42 CFR 480.131 - Access to medical records for the monitoring of QIOs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Disclosure of Confidential Information § 480.131 Access to medical records...

Air pollution due to traffic, air quality monitoring along three sections of National Highway N-5, Pakistan.

PubMed

Ali, Mahboob; Athar, Makshoof

2008-01-01

Transportation system has contributed significantly to the development of human civilization; on the other hand it has an enormous impact on the ambient air quality in several ways. In this paper the air and noise pollution at selected sites along three sections of National Highway was monitored. Pakistan National Highway Authority has started a Highway Improvement program for rehabilitations and maintenance of National highways to improve the traffic flows, and would ultimately improve the air quality along highways. The ambient air quality and noise level was monitored at nine different locations along these sections of highways to quantify the air pollution. The duration of monitoring at individual location was 72 h. The most of the sampling points were near the urban or village population, schools or hospitals, in order to quantify the air pollution at most affected locations along these roads. A database consisting of information regarding the source of emission, local metrology and air quality may be created to assess the profile of air quality in the area.

Quality assurance and the need to evaluate interventions and audit programme outcomes.

PubMed

Zhao, Min; Vaartjes, Ilonca; Klipstein-Grobusch, Kerstin; Kotseva, Kornelia; Jennings, Catriona; Grobbee, Diederick E; Graham, Ian

2017-06-01

Evidence-based clinical guidelines provide standards for the provision of healthcare. However, these guidelines have been poorly implemented in daily practice. Clinical audit is a quality improvement tool to promote quality of care in daily practice and to improve outcomes through the systematic review of care delivery and implementation of changes. A major priority in the management of subjects with cardiovascular disease (CVD) management is secondary prevention by controlling cardiovascular risk factors and providing appropriate medical treatment. Clinical audits can be applied to monitor modifiable risk factors and evaluate quality improvements of CVD management in daily practice. Existing clinical audits have provided an overview of the burden of risk factors in subjects with CVD and reflect real-world risk factor recording and management. However, consistent and representative data from clinic audits are still insufficient to fully monitor quality improvement of CVD management. Data are lacking in particular from low- and middle-income countries, limiting the evaluation of CVD management quality by clinical audit projects in many settings. To support the development of clinical standards, monitor daily practice performance, and improve quality of care in CVD management at national and international levels, more widespread clinical audits are warranted.

An Architecture for Continuous Data Quality Monitoring in Medical Centers.

PubMed

Endler, Gregor; Schwab, Peter K; Wahl, Andreas M; Tenschert, Johannes; Lenz, Richard

2015-01-01

In the medical domain, data quality is very important. Since requirements and data change frequently, continuous and sustainable monitoring and improvement of data quality is necessary. Working together with managers of medical centers, we developed an architecture for a data quality monitoring system. The architecture enables domain experts to adapt the system during runtime to match their specifications using a built-in rule system. It also allows arbitrarily complex analyses to be integrated into the monitoring cycle. We evaluate our architecture by matching its components to the well-known data quality methodology TDQM.

Quality of trauma care and trauma registries.

PubMed

Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F

2015-03-01

Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

An evaluation of the effectiveness of a risk-based monitoring approach implemented with clinical trials involving implantable cardiac medical devices.

PubMed

Diani, Christopher A; Rock, Angie; Moll, Phil

2017-12-01

Background Risk-based monitoring is a concept endorsed by the Food and Drug Administration to improve clinical trial data quality by focusing monitoring efforts on critical data elements and higher risk investigator sites. BIOTRONIK approached this by implementing a comprehensive strategy that assesses risk and data quality through a combination of operational controls and data surveillance. This publication demonstrates the effectiveness of a data-driven risk assessment methodology when used in conjunction with a tailored monitoring plan. Methods We developed a data-driven risk assessment system to rank 133 investigator sites comprising 3442 subjects and identify those sites that pose a potential risk to the integrity of data collected in implantable cardiac device clinical trials. This included identification of specific risk factors and a weighted scoring mechanism. We conducted trend analyses for risk assessment data collected over 1 year to assess the overall impact of our data surveillance process combined with other operational monitoring efforts. Results Trending analyses of key risk factors revealed an improvement in the quality of data collected during the observation period. The three risk factors follow-up compliance rate, unavailability of critical data, and noncompliance rate correspond closely with Food and Drug Administration's risk-based monitoring guidance document. Among these three risk factors, 100% (12/12) of quantiles analyzed showed an increase in data quality. Of these, 67% (8/12) of the improving trends in worst performing quantiles had p-values less than 0.05, and 17% (2/12) had p-values between 0.05 and 0.06. Among the poorest performing site quantiles, there was a statistically significant decrease in subject follow-up noncompliance rates, protocol noncompliance rates, and incidence of missing critical data. Conclusion One year after implementation of a comprehensive strategy for risk-based monitoring, including a data-driven risk assessment methodology to target on-site monitoring visits, statistically significant improvement was seen in a majority of measurable risk factors at the worst performing site quantiles. For the three risk factors which are most critical to the overall compliance of cardiac rhythm management medical device studies: follow-up compliance rate, unavailability of critical data, and noncompliance rate, we measured significant improvement in data quality. Although the worst performing site quantiles improved but not significantly in some risk factors such as subject attrition, the data-driven risk assessment highlighted key areas on which to continue focusing both on-site and centralized monitoring efforts. Data-driven surveillance of clinical trial performance provides actionable observations that can improve site performance. Clinical trials utilizing risk-based monitoring by leveraging a data-driven quality assessment combined with specific operational procedures may lead to an improvement in data quality and resource efficiencies.

Improving and monitoring air quality.

PubMed

DuPont, André

2018-05-01

Since the authorization of the Clean Air Act Amendments of 1990, the air quality in the USA has significantly improved because of strong public support. The lessons learned over the last 25 years are being shared with the policy analysts, technical professionals, and scientist who endeavor to improve air quality in their communities. This paper will review how the USA has achieved the "high" standard of air quality that was envisioned in the early 1990s. This document will describe SO 2 gas emission reduction technology and highlight operation of emission monitoring technology. This paper describes the basic process operation of an air pollution control scrubber. A technical review of measures required to operate and maintain a large-scale pollution control system will be described. Also, the author explains how quality assurance procedures in performance of continuous emission monitoring plays a significant role in reducing air pollution.

40 CFR 64.8 - Quality improvement plan (QIP) requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 16 2014-07-01 2014-07-01 false Quality improvement plan (QIP) requirements. 64.8 Section 64.8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.8 Quality improvement plan (QIP) requirements. (a...

40 CFR 64.8 - Quality improvement plan (QIP) requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Quality improvement plan (QIP) requirements. 64.8 Section 64.8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.8 Quality improvement plan (QIP) requirements. (a...

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

PubMed

Rowe, Alexander K

2009-06-01

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

Utilizing the Multidisciplinary Team for Planning and Monitoring Care and Quality Improvement

PubMed Central

Patel, A.; Franko, Edward R.; Fleshman, James W.

2015-01-01

Multidisciplinary team management of patients with rectal cancer requires a dedicated group of surgeons, medical and radiation oncologists, pathologists, radiologists, and mid-level providers who meet to discuss every patient with rectal cancer. The data from that meeting is collected prospectively, recommendations made for case, follow-up obtained, and quality issues monitored. Improved case is the result. PMID:25733969

Association of Implementation of Practice Standards for Electrocardiographic Monitoring With Nurses' Knowledge, Quality of Care, and Patient Outcomes: Findings From the Practical Use of the Latest Standards of Electrocardiography (PULSE) Trial.

PubMed

Funk, Marjorie; Fennie, Kristopher P; Stephens, Kimberly E; May, Jeanine L; Winkler, Catherine G; Drew, Barbara J

2017-02-01

Although continuous electrocardiographic (ECG) monitoring is ubiquitous in hospitals, monitoring practices are inconsistent. We evaluated implementation of American Heart Association practice standards for ECG monitoring on nurses' knowledge, quality of care, and patient outcomes. The PULSE (Practical Use of the Latest Standards of Electrocardiography) Trial was a 6-year multisite randomized clinical trial with crossover that took place in 65 cardiac units in 17 hospitals. We measured outcomes at baseline, time 2 after group 1 hospitals received the intervention, and time 3 after group 2 hospitals received the intervention. Measurement periods were 15 months apart. The 2-part intervention consisted of an online ECG monitoring education program and strategies to implement and sustain change in practice. Nurses' knowledge (N=3013 nurses) was measured by a validated 20-item online test, quality of care related to ECG monitoring (N=4587 patients) by on-site observation, and patient outcomes (mortality, in-hospital myocardial infarction, and not surviving a cardiac arrest; N=95 884 hospital admissions) by review of administrative, laboratory, and medical record data. Nurses' knowledge improved significantly immediately after the intervention in both groups but was not sustained 15 months later. For most measures of quality of care (accurate electrode placement, accurate rhythm interpretation, appropriate monitoring, and ST-segment monitoring when indicated), the intervention was associated with significant improvement, which was sustained 15 months later. Of the 3 patient outcomes, only in-hospital myocardial infarction declined significantly after the intervention and was sustained. Online ECG monitoring education and strategies to change practice can lead to improved nurses' knowledge, quality of care, and patient outcomes. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01269736. © 2017 American Heart Association, Inc.

Association of Implementation of Practice Standards for Electrocardiographic Monitoring with Nurses’ Knowledge, Quality of Care, and Patient Outcomes: Findings from the Practical Use of the Latest Standards of Electrocardiography (PULSE) Trial

PubMed Central

Funk, Marjorie; Fennie, Kristopher P.; Stephens, Kimberly E.; May, Jeanine L.; Winkler, Catherine G.; Drew, Barbara J.

2017-01-01

Background Although continuous electrocardiographic (ECG) monitoring is ubiquitous in hospitals, monitoring practices are inconsistent. We evaluated implementation of American Heart Association practice standards for ECG monitoring on nurses’ knowledge, quality of care, and patient outcomes. Methods and Results The PULSE Trial was a 6-year multi-site randomized clinical trial with crossover that took place in 65 cardiac units in 17 hospitals. We measured outcomes at baseline, Time 2 after Group 1 hospitals received the intervention, and Time 3 after Group 2 hospitals received the intervention. Measurement periods were 15 months apart. The 2-part intervention consisted of an online ECG monitoring education program and strategies to implement and sustain change in practice. Nurses’ knowledge (N=3,013 nurses) was measured by a validated 20-item online test, quality of care related to ECG monitoring (N=4,587 patients) by on-site observation, and patient outcomes (mortality, in-hospital myocardial infarction, and not surviving a cardiac arrest) (N=95,884 hospital admissions) by review of administrative, laboratory, and medical record data. Nurses’ knowledge improved significantly immediately following the intervention in both groups, but was not sustained 15 months later. For most measures of quality of care (accurate electrode placement, accurate rhythm interpretation, appropriate monitoring, and ST-segment monitoring when indicated), the intervention was associated with significant improvement, which was sustained 15 months later. Of the 3 patient outcomes, only in-hospital myocardial infarction declined significantly after the intervention, and was sustained. Conclusions Online ECG monitoring education and strategies to change practice can lead to improved nurses’ knowledge, quality of care, and patient outcomes. PMID:28174175

Gaining customer knowledge: obtaining and using customer judgments for hospitalwide quality improvement.

PubMed

Nelson, E C; Caldwell, C; Quinn, D; Rose, R

1991-03-01

Customer knowledge is an essential feature of hospitalwide quality improvement. All systems and processes have customers. The aim is to use customer knowledge and voice of the customer measurement to plan, design, improve, and monitor these systems and processes continuously. In this way, the hospital stands the best chance of meeting customers' needs and, hopefully, delivering services that are so outstanding that customers will be surprised and delighted. There are many methods, both soft and hard, that can be used to increase customer knowledge. One useful strategy is to use a family of quality measures that reflect the voice of the customer. These measures can generate practical and powerful customer knowledge information that is essential to performing strategic planning, deploying quality policy, designing new services, finding targets for improvements, and monitoring those continuous improvements based on customers' judgments.

Student satisfaction as an element of education quality monitoring in innovative higher education institution

NASA Astrophysics Data System (ADS)

Razinkina, Elena; Pankova, Ludmila; Trostinskaya, Irina; Pozdeeva, Elena; Evseeva, Lidiya; Tanova, Anna

2018-03-01

Topicality of the research is confirmed by increasing student involvement into the educational process, when not only the academic staff and administration participate in the improvement of higher education institution's activity, but also education customers - students. This adds a new dimension to the issue of monitoring education quality and student satisfaction with higher education. This issue echoes the ideas of M. Weber about the relationship between such components as cognitive motivation, personal development and student satisfaction with higher education. Besides, it is essential to focus on the approach of R. Barnet to defining the quality of education with the emphasis on a priority of development of an educational institution as the system that meets customers' needs. Monitoring student satisfaction with education quality has become an integral part of the educational process not only in a number of European universities, which have used this monitoring for decades, but also in Russian universities, which are interested in education quality improvement. Leading universities in Russia, including Peter the Great St. Petersburg Polytechnic University, are implementing policies targeted at increasing student satisfaction with higher education quality. Education quality monitoring as a key element in the system of providing feedback to students contributes greatly to this process.

Measuring, managing and maximizing refinery performance

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

Bascur, O.A.; Kennedy, J.P.

1996-01-01

Implementing continuous quality improvement is a confluence of total quality management, people empowerment, performance indicators and information engineering. Supporting information technologies allow a refiner to narrow the gap between management objectives and the process control level. Dynamic performance monitoring benefits come from production cost savings, improved communications and enhanced decision making. A refinery workgroup information flow model helps automate continuous improvement of processes, performance and the organization. The paper discusses the rethinking of refinery operations, dynamic performance monitoring, continuous process improvement, the knowledge coordinator and repository manager, an integrated plant operations workflow, and successful implementation.

42 CFR 418.58 - Condition of participation: Quality assessment and performance improvement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... collected to do the following: (i) Monitor the effectiveness and safety of services and quality of care. (ii..., patient safety, and quality of care. (2) Performance improvement activities must track adverse patient... care and patient safety, and that all improvement actions are evaluated for effectiveness. (3) That one...

Factors affecting mobile diabetes monitoring adoption among physicians: questionnaire study and path model.

PubMed

Okazaki, Shintaro; Castañeda, José Alberto; Sanz, Silvia; Henseler, Jörg

2012-12-21

Patients with type 1 and type 2 diabetes often find it difficult to control their blood glucose level on a daily basis because of distance or physical incapacity. With the increase in Internet-enabled smartphone use, this problem can be resolved by adopting a mobile diabetes monitoring system. Most existing studies have focused on patients' usability perceptions, whereas little attention has been paid to physicians' intentions to adopt this technology. The aim of the study was to evaluate the perceptions and user acceptance of mobile diabetes monitoring among Japanese physicians. A questionnaire survey of physicians was conducted in Japan. The structured questionnaire was prepared in a context of a mobile diabetes monitoring system that controls blood glucose, weight, physical activity, diet, insulin and medication, and blood pressure. Following a thorough description of mobile diabetes monitoring with a graphical image, questions were asked relating to system quality, information quality, service quality, health improvement, ubiquitous control, privacy and security concerns, perceived value, subjective norms, and intention to use mobile diabetes monitoring. The data were analyzed by partial least squares (PLS) path modeling. In total, 471 physicians participated from 47 prefectures across Japan, of whom 134 were specialized in internal and gastrointestinal medicine. Nine hypotheses were tested with both the total sample and the specialist subsample; results were similar for both samples in terms of statistical significance and the strength of path coefficients. We found that system quality, information quality, and service quality significantly affect overall quality. Overall quality determines the extent to which physicians perceive the value of mobile health monitoring. However, in contrast to our initial predictions, overall quality does not have a significant direct effect on the intention to use mobile diabetes monitoring. With regard to net benefits, both ubiquitous control and health improvement are significant predictors. Net benefits in turn significantly motivate physicians to use mobile health monitoring, and has a strong influence on perceived value. Perceived value and subjective norms are predictors of intention to use. In our sample, concerns over privacy and security risk have no significant effects on intention to use mobile diabetes monitoring. Among the 3 control variables, only age significantly affected intention to use mobile diabetes monitoring, whereas experience and gender were not significant predictors of intention. Physicians consider perceived value and net benefits as the most important motivators to use mobile diabetes monitoring. Overall quality assessment does affect their intention to use this technology, but only indirectly through perceived value. Net benefits seem to be a strong driver in both a direct and indirect manner, implying that physicians may perceive health improvement with ubiquitous control as a true utility by enhancing cost-effective monitoring, and simultaneously recognize it as a way to create value for their clinical practices.

SAMIRA - SAtellite based Monitoring Initiative for Regional Air quality

NASA Astrophysics Data System (ADS)

Schneider, Philipp; Stebel, Kerstin; Ajtai, Nicolae; Diamandi, Andrei; Horalek, Jan; Nicolae, Doina; Stachlewska, Iwona; Zehner, Claus

2016-04-01

Here, we present a new ESA-funded project entitled Satellite based Monitoring Initiative for Regional Air quality (SAMIRA), which aims at improving regional and local air quality monitoring through synergetic use of data from present and upcoming satellites, traditionally used in situ air quality monitoring networks and output from chemical transport models. Through collaborative efforts in four countries, namely Romania, Poland, the Czech Republic and Norway, all with existing air quality problems, SAMIRA intends to support the involved institutions and associated users in their national monitoring and reporting mandates as well as to generate novel research in this area. Despite considerable improvements in the past decades, Europe is still far from achieving levels of air quality that do not pose unacceptable hazards to humans and the environment. Main concerns in Europe are exceedances of particulate matter (PM), ground-level ozone, benzo(a)pyrene (BaP) and nitrogen dioxide (NO2). While overall sulfur dioxide (SO2) emissions have decreased in recent years, regional concentrations can still be high in some areas. The objectives of SAMIRA are to improve algorithms for the retrieval of hourly aerosol optical depth (AOD) maps from SEVIRI, and to develop robust methods for deriving column- and near-surface PM maps for the study area by combining satellite AOD with information from regional models. The benefit to existing monitoring networks (in situ, models, satellite) by combining these datasets using data fusion methods will be tested for satellite-based NO2, SO2, and PM/AOD. Furthermore, SAMIRA will test and apply techniques for downscaling air quality-related EO products to a spatial resolution that is more in line with what is generally required for studying urban and regional scale air quality. This will be demonstrated for a set of study sites that include the capitals of the four countries and the highly polluted areas along the border of Poland and the Czech Republic, and the Gorj County in Romania. All data products shall undergo a quality control, i.e. robust and independent validation. The SAMIRA consortium will further work towards a pre-operational system for improved PM10 forecasts using observational (in situ and satellite) data assimilation. SAMIRA aims to maximize project benefits by liaison with national and regional environmental protection agencies and health institutions, as well as related ESA and European initiatives such as the Copernicus Atmospheric Monitoring Services (CAMS).

Remote control improves quality of life in elderly pacemaker patients versus standard ambulatory-based follow-up.

PubMed

Comoretto, Rosanna Irene; Facchin, Domenico; Ghidina, Marco; Proclemer, Alessandro; Gregori, Dario

2017-08-01

Health-related quality of life (HRQoL) improves shortly after pacemaker (PM) implantation. No studies have investigated the HRQoL trend for elderly patients with a remote device monitoring follow-up system. Using EuroQol-5D Questionnaire and the PM-specific Assessment of Quality of Life and Related Events Questionnaire, HRQoL was measured at baseline and then repeatedly during the 6 months following PM implantation in a cohort of 42 consecutive patients. Twenty-five patients were followed-up with standard outpatient visits, while 17 used a remote monitoring system. Aquarel scores were significantly higher in patients with remote device monitoring system regarding chest discomfort and arrhythmia subscales the first month after PM implant and remained stable until 6 months. Remote monitoring affected the rate of HRQoL improvement in the first 3 months after pacemaker implantation more than ambulatory follow-up. Remote device monitoring has a significant impact on HRQoL in pacemaker patients, increasing its levels up to 6 months after implant. © 2017 John Wiley & Sons, Ltd.

Using a gradient boosting model to improve the performance of low-cost aerosol monitors in a dense, heterogeneous urban environment

NASA Astrophysics Data System (ADS)

Johnson, Nicholas E.; Bonczak, Bartosz; Kontokosta, Constantine E.

2018-07-01

The increased availability and improved quality of new sensing technologies have catalyzed a growing body of research to evaluate and leverage these tools in order to quantify and describe urban environments. Air quality, in particular, has received greater attention because of the well-established links to serious respiratory illnesses and the unprecedented levels of air pollution in developed and developing countries and cities around the world. Though numerous laboratory and field evaluation studies have begun to explore the use and potential of low-cost air quality monitoring devices, the performance and stability of these tools has not been adequately evaluated in complex urban environments, and further research is needed. In this study, we present the design of a low-cost air quality monitoring platform based on the Shinyei PPD42 aerosol monitor and examine the suitability of the sensor for deployment in a dense heterogeneous urban environment. We assess the sensor's performance during a field calibration campaign from February 7th to March 25th 2017 with a reference instrument in New York City, and present a novel calibration approach using a machine learning method that incorporates publicly available meteorological data in order to improve overall sensor performance. We find that while the PPD42 performs well in relation to the reference instrument using linear regression (R2 = 0.36-0.51), a gradient boosting regression tree model can significantly improve device calibration (R2 = 0.68-0.76). We discuss the sensor's performance and reliability when deployed in a dense, heterogeneous urban environment during a period of significant variation in weather conditions, and important considerations when using machine learning techniques to improve the performance of low-cost air quality monitors.

Critical loads and levels: Leveraging existing monitoring data

Treesearch

D. G. Fox; A. R. Riebau; R. Fisher

2006-01-01

A snapshot of current air quality in the National Parks and Wilderness areas of the US is presented based on data from the 165 site Interagency Monitoring of Protected Visual Environments, or IMPROVE program, and other relevant air quality monitoring programs. This snapshot is provided using the VIEWS web service, an on-line web-based data warehouse, analysis, and...

Improving the quality of physical health monitoring in CAMHS for children and adolescents prescribed medication for ADHD.

PubMed

Oxley, Cristal; Moghraby, Omer S; Samuel, Rani; Joyce, Dan W

2018-01-01

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterised by a persistent, pervasive pattern of inattention, impulsivity and hyperactivity. Stimulant medication such as methylphenidate has an established evidence base in the treatment of children and adolescents with ADHD. However, it is also associated with a risk of side effects which may include decreased appetite, increased blood pressure and possible reduced growth. Monitoring physical health in children and adolescents prescribed medication for ADHD is a key clinical responsibility and includes a number of parameters as outlined in the National Institute for Health and Care Excellence Guidelines. Ascertaining the centiles of physical observations is essential to put these into developmental context and accurately inform treatment decisions. This quality improvement project aimed to improve physical health monitoring in children and adolescents prescribed stimulant medication for ADHD within a large specialist urban inner-city Child and Adolescent Mental Health Service (CAMHS) in South London and Maudsley NHS Foundation Trust. Baseline data were obtained to establish the quality of physical monitoring including blood pressure, height, weight and centiles. Targeted interventions included the development of a novel web-based application designed to calculate and record centiles. We report an improvement in total proportion compliance with physical health monitoring from 24% to 75%. The frequency of recording baseline blood pressure centiles increased from 0% to 62%; recording baseline height centiles increased from 37% to 81% and recording baseline weight centiles increased from 37% to 81%. Improvement in the delivery of high-quality care was achieved and sustained through close collaboration with clinicians involved in the treatment pathway in order to elicit and respond effectively to feedback for improvement and codevelop interventions which were highly effective within the clinical system. We believe this model to be replicable in other CAMHS services and ADHD clinics to improve the delivery of high-quality clinical care.

Challenges in Hospital-Associated Infection Management: A Unit Perspective.

PubMed

Stacy, Kathleen M

2015-01-01

Maintaining a successful unit-based continuous quality improvement program for managing hospital-associated infections is a huge challenge and an overwhelming task. It requires strong organizational support and unit leadership, human and fiscal resources, time, and a dedicated and motivated nursing staff. A great deal of effort goes into implementing, monitoring, reporting, and evaluating quality improvement initiatives and can lead to significant frustration on the part of the leadership team and nursing staff when quality improvement efforts fail to produce the desired results. Each initiative presents its own unique set of challenges; however, common issues influence all initiatives. These common issues include organization and unit culture, current clinical practice guidelines being used to drive the initiatives, performance discrepancies on the part of nursing staff, availability of resources including equipment and supplies, monitoring of the data, and conflicting quality improvement priorities.

[Recommendations for the evaluation and follow-up of the continuous quality improvement].

PubMed

Maurellet-Evrard, S; Daunizeau, A

2013-06-01

Continual improvement of the quality in a medical laboratory is based on the implementation of tools for systematically evaluate the quality management system and its ability to meet the objectives defined. Monitoring through audit and management review, addressing complaints and nonconformities and performing client satisfaction survey are the key for the continual improvement.

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

PubMed

Tavakol, Mohsen; Dennick, Reg

2012-01-01

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

In Brief: Improving Mississippi River water quality

NASA Astrophysics Data System (ADS)

Showstack, Randy

2007-10-01

If water quality in the Mississippi River and the northern Gulf of Mexico is to improve, the U.S. Environmental Protection Agency (EPA) needs to take a stronger leadership role in implementing the federal Clean Water Act, according to a 16 October report from the U.S. National Research Council. The report notes that EPA has failed to use its authority to coordinate and oversee activities along the river. In addition, river states need to be more proactive and cooperative in efforts to monitor and improve water quality, and the river should be monitored and evaluated as a single system, the report indicates. Currently, the 10 states along the river conduct separate and widely varying water quality monitoring programs. ``The limited attention being given to monitoring and managing the Mississippi's water quality does not match the river's significant economic, ecological, and cultural importance,'' said committee chair David A. Dzombak, director of the Steinbrenner Institute for Environmental Education and Research at Carnegie Mellon University, Pittsburgh, Pa. The report notes that while measures taken under the Clean Water Act have successfully reduced much point source pollution, nutrient and sediment loads from nonpoint sources continue to be significant problems. For more information, visit the Web site: http://books.nap.edu/catalog.php?record_id=12051.

A novel quality assurance method in a university teaching paediatric radiology department.

PubMed

Gallet, J M; Reed, M H; Hlady, J

2000-08-01

Primary diagnostic equipment in a paediatric radiology department must perform at optimal levels at all times. The Children's Hospital Radiology Department in Winnipeg, Canada, has developed an impartial means of reporting radiographic image quality. The main objectives of this study programme were two-fold. First, to monitor diagnostic X-ray equipment performance, and second, to improve the resultant image quality as a means of implementing the fundamental concepts of continuous quality improvement. Reading radiologists completed a quality assurance (QA) card when they identified a radiographic image quality problem. The cards were subsequently collected by the clinical instructor who then informed, in confidence, the radiographers of the written comments or concerns. QA cards have been conspicuously installed in the paediatric radiology reading room since the middle of 1993. Since its inception, equipment malfunction has been monitored and indicators for improving image quality developed. This component of the QA programme has shown itself to be a successful means of communicating with radiographers in maintaining superior image quality.

Research monitoring by US medical institutions to protect human subjects: compliance or quality improvement?

PubMed

de Jong, Jean Philippe; van Zwieten, Myra C B; Willems, Dick L

2013-04-01

In recent years, to protect the rights and welfare of human subjects, institutions in the USA have begun to set up programmes to monitor ongoing medical research. These programmes provide routine, onsite oversight, and thus go beyond existing oversight such as investigating suspected misconduct or reviewing paperwork provided by investigators. However, because of a lack of guidelines and evidence, institutions have had little guidance in setting up their programmes. To help institutions make the right choices, we used interviews and document analysis to study how and why 11 US institutions have set up their monitoring programmes. Although these programmes varied considerably, we were able to distinguish two general types. 'Compliance' programmes on the one hand were part of the institutional review board office and set up to ensure compliance with regulations. Investigators' participation was mandatory. Monitors focused on documentation. Investigators could be disciplined, and could be obliged to take corrective actions. 'Quality-improvement' programmes on the other hand were part of a separate office. Investigators requested to be monitored. Monitors focused more on actual research conduct. Investigators and other parties received feedback on how to improve the research process. Although both types of programmes have their drawbacks and advantages, we argue that if institutions want to set up monitoring programmes, quality improvement is the better choice: it can help foster an atmosphere of trust between investigators and the institutional review board, and can help raise the standards for the protection of human subjects.

Enhancing the usability of CRT displays in test flight monitoring

NASA Astrophysics Data System (ADS)

Granaas, Michael M.; Sredinski, Victoria E.

1991-01-01

Enhancing the usability of Mission Control Center (MCC) CRT displays stands to improve the quality, productivity, and safety of flight-test research at the NASA Ames-Dryden Flight Research Facility. The results of this research suggests that much can be done to assist the user and improve the quality of flight research through the enhancement of current displays. This research has applications to a variety of flight data monitoring displays.

Shell Creek Summers

ERIC Educational Resources Information Center

Seier, Mark; Goedeken, Suzy

2005-01-01

In 2002 Shell Creek Watershed Improvement Group turned to the Newman Grove Public Schools' science department to help educate the public on water quality in the watershed and to establish a monitoring system that would be used to improve surface and groundwater quality in the creek's watershed. Nebraska Department of Environmental Quality provided…

Factors Affecting Mobile Diabetes Monitoring Adoption Among Physicians: Questionnaire Study and Path Model

PubMed Central

Castañeda, José Alberto; Sanz, Silvia; Henseler, Jörg

2012-01-01

Background Patients with type 1 and type 2 diabetes often find it difficult to control their blood glucose level on a daily basis because of distance or physical incapacity. With the increase in Internet-enabled smartphone use, this problem can be resolved by adopting a mobile diabetes monitoring system. Most existing studies have focused on patients’ usability perceptions, whereas little attention has been paid to physicians’ intentions to adopt this technology. Objective The aim of the study was to evaluate the perceptions and user acceptance of mobile diabetes monitoring among Japanese physicians. Methods A questionnaire survey of physicians was conducted in Japan. The structured questionnaire was prepared in a context of a mobile diabetes monitoring system that controls blood glucose, weight, physical activity, diet, insulin and medication, and blood pressure. Following a thorough description of mobile diabetes monitoring with a graphical image, questions were asked relating to system quality, information quality, service quality, health improvement, ubiquitous control, privacy and security concerns, perceived value, subjective norms, and intention to use mobile diabetes monitoring. The data were analyzed by partial least squares (PLS) path modeling. Results In total, 471 physicians participated from 47 prefectures across Japan, of whom 134 were specialized in internal and gastrointestinal medicine. Nine hypotheses were tested with both the total sample and the specialist subsample; results were similar for both samples in terms of statistical significance and the strength of path coefficients. We found that system quality, information quality, and service quality significantly affect overall quality. Overall quality determines the extent to which physicians perceive the value of mobile health monitoring. However, in contrast to our initial predictions, overall quality does not have a significant direct effect on the intention to use mobile diabetes monitoring. With regard to net benefits, both ubiquitous control and health improvement are significant predictors. Net benefits in turn significantly motivate physicians to use mobile health monitoring, and has a strong influence on perceived value. Perceived value and subjective norms are predictors of intention to use. In our sample, concerns over privacy and security risk have no significant effects on intention to use mobile diabetes monitoring. Among the 3 control variables, only age significantly affected intention to use mobile diabetes monitoring, whereas experience and gender were not significant predictors of intention. Conclusions Physicians consider perceived value and net benefits as the most important motivators to use mobile diabetes monitoring. Overall quality assessment does affect their intention to use this technology, but only indirectly through perceived value. Net benefits seem to be a strong driver in both a direct and indirect manner, implying that physicians may perceive health improvement with ubiquitous control as a true utility by enhancing cost-effective monitoring, and simultaneously recognize it as a way to create value for their clinical practices. PMID:23257115

Optimal Design of River Monitoring Network in Taizihe River by Matter Element Analysis

PubMed Central

Wang, Hui; Liu, Zhe; Sun, Lina; Luo, Qing

2015-01-01

The objective of this study is to optimize the river monitoring network in Taizihe River, Northeast China. The situation of the network and water characteristics were studied in this work. During this study, water samples were collected once a month during January 2009 - December 2010 from seventeen sites. Futhermore, the 16 monitoring indexes were analyzed in the field and laboratory. The pH value of surface water sample was found to be in the range of 6.83 to 9.31, and the average concentrations of NH4 +-N, chemical oxygen demand (COD), volatile phenol and total phosphorus (TP) were found decreasing significantly. The water quality of the river has been improved from 2009 to 2010. Through the calculation of the data availability and the correlation between adjacent sections, it was found that the present monitoring network was inefficient as well as the optimization was indispensable. In order to improve the situation, the matter element analysis and gravity distance were applied in the optimization of river monitoring network, which were proved to be a useful method to optimize river quality monitoring network. The amount of monitoring sections were cut from 17 to 13 for the monitoring network was more cost-effective after being optimized. The results of this study could be used in developing effective management strategies to improve the environmental quality of Taizihe River. Also, the results show that the proposed model can be effectively used for the optimal design of monitoring networks in river systems. PMID:26023785

Improving Reference Service: The Case for Using a Continuous Quality Improvement Method.

ERIC Educational Resources Information Center

Aluri, Rao

1993-01-01

Discusses the evaluation of library reference service; examines problems with past evaluations, including the lack of long-term planning and a systems perspective; and suggests a method for continuously monitoring and improving reference service using quality improvement tools such as checklists, cause and effect diagrams, Pareto charts, and…

Progress and lessons learned from water-quality monitoring networks

USGS Publications Warehouse

Myers, Donna N.; Ludtke, Amy S.

2017-01-01

Stream-quality monitoring networks in the United States were initiated and expanded after passage of successive federal water-pollution control laws from 1948 to 1972. The first networks addressed information gaps on the extent and severity of stream pollution and served as early warning systems for spills. From 1965 to 1972, monitoring networks expanded to evaluate compliance with stream standards, track emerging issues, and assess water-quality status and trends. After 1972, concerns arose regarding the ability of monitoring networks to determine if water quality was getting better or worse and why. As a result, monitoring networks adopted a hydrologic systems approach targeted to key water-quality issues, accounted for human and natural factors affecting water quality, innovated new statistical methods, and introduced geographic information systems and models that predict water quality at unmeasured locations. Despite improvements, national-scale monitoring networks have declined over time. Only about 1%, or 217, of more than 36,000 US Geological Survey monitoring sites sampled from 1975 to 2014 have been operated throughout the four decades since passage of the 1972 Clean Water Act. Efforts to sustain monitoring networks are important because these networks have collected information crucial to the description of water-quality trends over time and are providing information against which to evaluate future trends.

Spatial and temporal variation of fecal indicator organisms in two creeks in Beltsville, Maryland

USDA-ARS?s Scientific Manuscript database

Evaluation of microbial water quality is commonly achieved by monitoring populations of indicator bacteria such as E. coli and enterococci. Monitoring data are utilized by water managers to predict potential fecal contaminations as well as a decision tool to improve microbial water quality. Both te...

Comparison of exposure estimation methods for air pollutants: ambient monitoring data and regional air quality simulation.

PubMed

Bravo, Mercedes A; Fuentes, Montserrat; Zhang, Yang; Burr, Michael J; Bell, Michelle L

2012-07-01

Air quality modeling could potentially improve exposure estimates for use in epidemiological studies. We investigated this application of air quality modeling by estimating location-specific (point) and spatially-aggregated (county level) exposure concentrations of particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM(2.5)) and ozone (O(3)) for the eastern U.S. in 2002 using the Community Multi-scale Air Quality (CMAQ) modeling system and a traditional approach using ambient monitors. The monitoring approach produced estimates for 370 and 454 counties for PM(2.5) and O(3), respectively. Modeled estimates included 1861 counties, covering 50% more population. The population uncovered by monitors differed from those near monitors (e.g., urbanicity, race, education, age, unemployment, income, modeled pollutant levels). CMAQ overestimated O(3) (annual normalized mean bias=4.30%), while modeled PM(2.5) had an annual normalized mean bias of -2.09%, although bias varied seasonally, from 32% in November to -27% in July. Epidemiology may benefit from air quality modeling, with improved spatial and temporal resolution and the ability to study populations far from monitors that may differ from those near monitors. However, model performance varied by measure of performance, season, and location. Thus, the appropriateness of using such modeled exposures in health studies depends on the pollutant and metric of concern, acceptable level of uncertainty, population of interest, study design, and other factors. Copyright © 2012 Elsevier Inc. All rights reserved.

Can Technology Improve the Quality of Colonoscopy?

PubMed

Thirumurthi, Selvi; Ross, William A; Raju, Gottumukkala S

2016-07-01

In order for screening colonoscopy to be an effective tool in reducing colon cancer incidence, exams must be performed in a high-quality manner. Quality metrics have been presented by gastroenterology societies and now include higher adenoma detection rate targets than in the past. In many cases, the quality of colonoscopy can often be improved with simple low-cost interventions such as improved procedure technique, implementing split-dose bowel prep, and monitoring individuals' performances. Emerging technology has expanded our field of view and image quality during colonoscopy. We will critically review several technological advances in the context of quality metrics and discuss if technology can really improve the quality of colonoscopy.

Measuring, managing and maximizing performance of mineral processing plants

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

Bascur, O.A.; Kennedy, J.P.

1995-12-31

The implementation of continuous quality improvement is the confluence of Total Quality Management, People Empowerment, Performance Indicators and Information Engineering. The supporting information technologies allow a mineral processor to narrow the gap between management business objectives and the process control level. One of the most important contributors is the user friendliness and flexibility of the personal computer in a client/server environment. This synergistic combination when used for real time performance monitoring translates into production cost savings, improved communications and enhanced decision support. Other savings come from reduced time to collect data and perform tedious calculations, act quickly with fresh newmore » data, generate and validate data to be used by others. This paper presents an integrated view of plant management. The selection of the proper tools for continuous quality improvement are described. The process of selecting critical performance monitoring indices for improved plant performance are discussed. The importance of a well balanced technological improvement, personnel empowerment, total quality management and organizational assets are stressed.« less

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

PubMed

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

2012-07-01

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

42 CFR 418.58 - Condition of participation: Quality assessment and performance improvement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... collected to do the following: (i) Monitor the effectiveness and safety of services and quality of care. (ii... 42 Public Health 3 2010-10-01 2010-10-01 false Condition of participation: Quality assessment and performance improvement. 418.58 Section 418.58 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES...

42 CFR 495.316 - State monitoring and reporting regarding activities required to receive an incentive payment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... quality measures data; and (v) A description and quantitative data on how its incentive payment program... conditions to use for quality improvement, reduction of disparities, research or outreach. (B) Capability to... specific conditions to use for quality improvement, reduction of disparities, research, or outreach. (B...

42 CFR 495.316 - State monitoring and reporting regarding activities required to receive an incentive payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... quality measures data; and (v) A description and quantitative data on how its incentive payment program... conditions to use for quality improvement, reduction of disparities, research or outreach. (B) Capability to... specific conditions to use for quality improvement, reduction of disparities, research, or outreach. (B...

42 CFR 495.316 - State monitoring and reporting regarding activities required to receive an incentive payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... quality measures data; and (v) A description and quantitative data on how its incentive payment program... conditions to use for quality improvement, reduction of disparities, research or outreach. (B) Capability to... specific conditions to use for quality improvement, reduction of disparities, research, or outreach. (B...

The Satellite based Monitoring Initiative for Regional Air quality (SAMIRA): Project summary and first results

NASA Astrophysics Data System (ADS)

Schneider, Philipp; Stebel, Kerstin; Ajtai, Nicolae; Diamandi, Andrei; Horalek, Jan; Nemuc, Anca; Stachlewska, Iwona; Zehner, Claus

2017-04-01

We present a summary and some first results of a new ESA-funded project entitled Satellite based Monitoring Initiative for Regional Air quality (SAMIRA), which aims at improving regional and local air quality monitoring through synergetic use of data from present and upcoming satellite instruments, traditionally used in situ air quality monitoring networks and output from chemical transport models. Through collaborative efforts in four countries, namely Romania, Poland, the Czech Republic and Norway, all with existing air quality problems, SAMIRA intends to support the involved institutions and associated users in their national monitoring and reporting mandates as well as to generate novel research in this area. The primary goal of SAMIRA is to demonstrate the usefulness of existing and future satellite products of air quality for improving monitoring and mapping of air pollution at the regional scale. A total of six core activities are being carried out in order to achieve this goal: Firstly, the project is developing and optimizing algorithms for the retrieval of hourly aerosol optical depth (AOD) maps from the Spinning Enhanced Visible and InfraRed Imager (SEVIRI) onboard of Meteosat Second Generation. As a second activity, SAMIRA aims to derive particulate matter (PM2.5) estimates from AOD data by developing robust algorithms for AOD-to-PM conversion with the support from model- and Lidar data. In a third activity, we evaluate the added value of satellite products of atmospheric composition for operational European-scale air quality mapping using geostatistics and auxiliary datasets. The additional benefit of satellite-based monitoring over existing monitoring techniques (in situ, models) is tested by combining these datasets using geostatistical methods and demonstrated for nitrogen dioxide (NO2), sulphur dioxide (SO2), and aerosol optical depth/particulate matter. As a fourth activity, the project is developing novel algorithms for downscaling coarse-resolution satellite products of air quality with the help of high-resolution model information. This will add value to existing earth observation products of air quality by bringing them to spatial scales that are more in line with what is generally required for studying urban and regional scale air quality. In a fifth activity, we implement robust and independent validation schemes for evaluating the quality of the generated products. Finally, in a sixth activity the consortium is working towards a pre-operational system for improved PM forecasts using observational (in situ and satellite) data assimilation. SAMIRA aims to maximize project benefits by liaison with national and regional environmental protection agencies and health institutions, as well as related ESA and European initiatives such as the Copernicus Atmosphere Monitoring Service (CAMS).

Real-time video quality monitoring

NASA Astrophysics Data System (ADS)

Liu, Tao; Narvekar, Niranjan; Wang, Beibei; Ding, Ran; Zou, Dekun; Cash, Glenn; Bhagavathy, Sitaram; Bloom, Jeffrey

2011-12-01

The ITU-T Recommendation G.1070 is a standardized opinion model for video telephony applications that uses video bitrate, frame rate, and packet-loss rate to measure the video quality. However, this model was original designed as an offline quality planning tool. It cannot be directly used for quality monitoring since the above three input parameters are not readily available within a network or at the decoder. And there is a great room for the performance improvement of this quality metric. In this article, we present a real-time video quality monitoring solution based on this Recommendation. We first propose a scheme to efficiently estimate the three parameters from video bitstreams, so that it can be used as a real-time video quality monitoring tool. Furthermore, an enhanced algorithm based on the G.1070 model that provides more accurate quality prediction is proposed. Finally, to use this metric in real-world applications, we present an example emerging application of real-time quality measurement to the management of transmitted videos, especially those delivered to mobile devices.

Design and implementation air quality monitoring robot

NASA Astrophysics Data System (ADS)

Chen, Yuanhua; Li, Jie; Qi, Chunxue

2017-01-01

Robot applied in environmental protection can break through the limitations in working environment, scope and mode of the existing environmental monitoring and pollution abatement equipments, which undertake the innovation and improvement in the basin, atmosphere, emergency and pollution treatment facilities. Actually, the relevant technology is backward with limited research and investment. Though the device companies have achieved some results in the study on the water quality monitoring, pipeline monitoring and sewage disposal, this technological progress on the whole is still much slow, and the mature product has not been formed. As a result, the market urges a demand of a new type of device which is more suitable for environmental protection on the basis of robot successfully applied in other fields. This paper designs and realizes a tracked mobile robot of air quality monitoring, which can be used to monitor air quality for the pollution accident in industrial parks and regular management.

Active Ground Optical Remote Sensing for Improved Monitoring of Seedling Stress in Nurseries

USDA-ARS?s Scientific Manuscript database

Active ground optical remote sensing (AGORS) devices mounted on overhead irrigation booms could help to improve seedling quality by autonomously monitoring seedling stress. In contrast to traditionally used passive optical sensors, AGORS devices operate independently of ambient light conditions and ...

Robotic Spent Fuel Monitoring – It is time to improve old approaches and old techniques!

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

Tobin, Stephen Joseph; Dasari, Venkateswara Rao; Trellue, Holly Renee

This report describes various approaches and techniques associated with robotic spent fuel monitoring. The purpose of this description is to improve the quality of measured signatures, reduce the inspection burden on the IAEA, and to provide frequent verification.

Quality assurance guides health reform in Jordan.

PubMed

Abubaker, W; Abdulrahman, M

1996-01-01

In November 1995, a World Bank mission went to Jordan to conduct a study of the health sector. The study recommended three strategies to reform the health sector: decentralization of Ministry of Health (MOH) management; improvement of clinical practices, quality of care, and consumer satisfaction; and adoption of treatment protocols and standards. The MOH chose quality assurance (QA) methods and quality management (QM) techniques to accomplish these reforms. The Monitoring and QA Directorate oversees QA applications within MOH. It also institutes and develops the capacity of local QA units in the 12 governorates. The QA units implement and monitor day-to-day QA activities. The QM approach encompasses quality principles: establish objectives; use a systematic approach; teach lessons learned and applicable research; use QA training to teach quality care, quality improvement, and patient satisfaction; educate health personnel about QM approaches; use assessment tools and interviews; measure the needs and expectations of local health providers and patients; ensure feedback on QA improvement projects; ensure valid and reliable data; monitor quality improvement efforts; standardize systemic data collection and outcomes; and establish and disseminate QA standards and performance improvement efforts. The Jordan QA Project has helped with the successful institutionalization of a QA system at both the central and local levels. The bylaws of the QA councils and committees require team participation in the decision-making process. Over the last two years, the M&QA Project has adopted 21 standards for nursing, maternal and child health care centers, pharmacies, and medications. The Balqa pilot project has developed 44 such protocols. Quality improvement (COUGH) studies have examined hyper-allergy, analysis of patient flow rate, redistribution of nurses, vaccine waste, and anemic pregnant women. There are a considerable number of on-going clinical and non-clinical COUGH studies. Four epidemiological studies are examining maternal mortality, causes of death, morbidity, and perinatal mortality.

Evaluation of health benefit using BenMAP-CE with an integrated scheme of model and monitor data during Guangzhou Asian Games.

PubMed

Ding, Dian; Zhu, Yun; Jang, Carey; Lin, Che-Jen; Wang, Shuxiao; Fu, Joshua; Gao, Jian; Deng, Shuang; Xie, Junping; Qiu, Xuezhen

2016-04-01

Guangzhou is the capital and largest city (land area: 7287 km(2)) of Guangdong province in South China. The air quality in Guangzhou typically worsens in November due to unfavorable meteorological conditions for pollutant dispersion. During the Guangzhou Asian Games in November 2010, the Guangzhou government carried out a number of emission control measures that significantly improved the air quality. In this paper, we estimated the acute health outcome changes related to the air quality improvement during the 2010 Guangzhou Asian Games using a next-generation, fully-integrated assessment system for air quality and health benefits. This advanced system generates air quality data by fusing model and monitoring data instead of using monitoring data alone, which provides more reliable results. The air quality estimates retain the spatial distribution of model results while calibrating the value with observations. The results show that the mean PM2.5 concentration in November 2010 decreased by 3.5 μg/m(3) compared to that in 2009 due to the emission control measures. From the analysis, we estimate that the air quality improvement avoided 106 premature deaths, 1869 cases of hospital admission, and 20,026 cases of outpatient visits. The overall cost benefit of the improved air quality is estimated to be 165 million CNY, with the avoided premature death contributing 90% of this figure. The research demonstrates that BenMAP-CE is capable of assessing the health and cost benefits of air pollution control for sound policy making. Copyright © 2015. Published by Elsevier B.V.

Teaching Citizen Science Skills Online: Implications for Invasive Species Training Programs

ERIC Educational Resources Information Center

Newman, Greg; Crall, Alycia; Laituri, Melinda; Graham, Jim; Stohlgren, Tom; Moore, John C.; Kodrich, Kris; Holfelder, Kirstin A.

2010-01-01

Citizen science programs are emerging as an efficient way to increase data collection and help monitor invasive species. Effective invasive species monitoring requires rigid data quality assurances if expensive control efforts are to be guided by volunteer data. To achieve data quality, effective online training is needed to improve field skills…

Evaluation of Water Quality Trends in Goodwater Creek Experimental Watershed, Missouri: Implications for Monitoring Strategies and Objective Setting

USDA-ARS?s Scientific Manuscript database

Continued public support for U.S. tax-payer funded programs aimed at reducing agricultural non-point source pollutants depends on clear demonstrations of water quality improvements. Effectiveness of structural BMPs, as well as watershed monitoring networks is an important information need to make f...

[Indicators of healthcare quality in day surgery (2010-2012)].

PubMed

Martínez Rodenas, F; Codina Grifell, J; Deulofeu Quintana, P; Garrido Corchón, J; Blasco Casares, F; Gibanel Garanto, X; Cuixart Vilamajó, L; de Haro Licer, J; Vazquez Dorrego, X

2014-01-01

Monitoring quality indicators in Ambulatory Surgery centers is fundamental in order to identify problems, correct them and prevent them. Given their large number, it is essential to select the most valid ones. The objectives of the study are the continuous improvement in the quality of healthcare of day-case surgery in our center, by monitoring selective quality parameters, having periodic information on the results and taking corrective measures, as well as achieving a percentage of unplanned transfer and cancellations within quality standards. Prospective, observational and descriptive study of the day-case surgery carried out from January 2010 to December 2012. Unplanned hospital admissions and cancellations on the same day of the operation were selected and monitored, along with their reasons. Hospital admissions were classified as: inappropriate selection, medical-surgical complications, and others. The results were evaluated each year and statistically analysed using χ(2) tests. A total of 8,300 patients underwent day surgery during the 3 years studied. The day-case surgery and outpatient index increased by 5.4 and 6.4%, respectively (P<.01). Unexpected hospital admissions gradually decreased due to the lower number of complications (P<.01). Hospital admissions, due to an extended period of time in locoregional anaesthesia recovery, also decreased (P<.01). There was improved prevention of nausea and vomiting, and of poorly controlled pain. The proportion of afternoon admissions was significantly reduced (P<.01). The cancellations increased in 2011 (P<.01). The monitoring of quality parameters in day-case surgery has been a useful tool in our clinical and quality management. Globally, the unplanned transfer and cancellations have been within the quality standards and many of the indicators analysed have improved. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

State of the art of stream monitoring.

DOT National Transportation Integrated Search

1981-01-01

The study was conducted in an effort to identify methods of stream monitoring for use by the Environmental Quality Division in improving its monitoring programs. A literature search was undertaken to determine the present knowledge of the effects of ...

Quality Assurance Through Quality Improvement and Professional Development in the National Breast and Cervical Cancer Early Detection Program

PubMed Central

Siegl, Elvira J.; Miller, Jacqueline W.; Khan, Kris; Harris, Susan E.

2015-01-01

Quality assurance (QA) is the process of providing evidence that the outcome meets the established standards. Quality improvement (QI), by contrast, is the act of methodically developing ways to meet acceptable quality standards and evaluating current processes to improve overall performance. In the case of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the desired outcome is the delivery of quality health care services to program clients. The NBCCEDP provides professional development to ensure that participating providers have current knowledge of evidence-based clinical standards regarding breast and cervical cancer screening and diagnosis and are monitoring women with abnormal screening results for timely follow-up. To assess the quality of clinical care provided to NBCCEDP clients, performance data are collected by NBCCEDP grantees and compared against predetermined Centers for Disease Control and Prevention (CDC) benchmarks known as Data Quality Indicator Guides. In this article, the authors describe 1) the development and use of indicators for QI in the NBCCEDP and 2) the professional development activities implemented to improve clinical outcomes. QA identifies problems, whereas QI systematically corrects them. The quality of service delivery and improved patient outcomes among NBCCEDP grantees has enhanced significantly because of continuous monitoring of performance and professional development. By using QA, NBCCEDP grantees can maximize the quality of patient screening, diagnostic services, and follow-up. Examples of grantee activities to maintain quality of care are also described in this report. PMID:25099901

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

PubMed

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

2013-07-23

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

Updating the Synchrotron Radiation Monitor at TLS

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

Kuo, C. H.; Hsu, S. Y.; Wang, C. J.

2007-01-19

The synchrotron radiation monitor provides useful information to support routine operation and physics experiments using the beam. Precisely knowing the profile of the beam helps to improve machine performance. The synchrotron radiation monitor at the Taiwan Light Source (TLS) was recently upgraded. The optics and modeling were improved to increase the accuracy of measurement in the small beam size. A high-performance IEEE-1394 digital CCD camera was used to improve the quality of images and extend the dynamic range of measurement. The image analysis is also improved. This report summarizes status and results.

Improved head-controlled TV system produces high-quality remote image

NASA Technical Reports Server (NTRS)

Goertz, R.; Lindberg, J.; Mingesz, D.; Potts, C.

1967-01-01

Manipulator operator uses an improved resolution tv camera/monitor positioning system to view the remote handling and processing of reactive, flammable, explosive, or contaminated materials. The pan and tilt motions of the camera and monitor are slaved to follow the corresponding motions of the operators head.

A Novel and Intelligent Home Monitoring System for Care Support of Elders with Cognitive Impairment.

PubMed

Lazarou, Ioulietta; Karakostas, Anastasios; Stavropoulos, Thanos G; Tsompanidis, Theodoros; Meditskos, Georgios; Kompatsiaris, Ioannis; Tsolaki, Magda

2016-10-18

Assistive technology, in the form of a smart home environment, is employed to support people with dementia. To propose a system for continuous and objective remote monitoring of problematic daily living activity areas and design personalized interventions based on system feedback and clinical observations for improving cognitive function and health-related quality of life. The assistive technology of the proposed system, including wearable, sleep, object motion, presence, and utility usage sensors, was methodically deployed at four different home installations of people with cognitive impairment. Detection of sleep patterns, physical activity, and activities of daily living, based on the collected sensor data and analytics, was available at all times through comprehensive data visualization solutions. Combined with clinical observation, targeted psychosocial interventions were introduced to enhance the participants' quality of life and improve their cognitive functions and daily functionality. Meanwhile, participants and their caregivers were able to visualize a reduced set of information tailored to their needs. Overall, paired-sample t-test analysis of monitored qualities revealed improvement for all participants in neuropsychological assessment. Moreover, improvement was detected from the beginning to the end of the trial, in physical condition and in the domains of sleep. Detecting abnormalities via the system, for example in sleep quality, such as REM sleep, has proved to be critical to assess current status, drive interventions, and evaluate improvements in a reliable manner. It has been proved that the proposed system is suitable to support clinicians to reliably drive and evaluate clinical interventions toward quality of life improvement of people with cognitive impairment.

[A monitor for the emergency psychiatric service chain].

PubMed

Salden, M E F H; van Kemenade, J F L M; van Dam, A; Mulder, C L

2014-01-01

Many organisations are involved in the delivery of psychiatric emergency care to patients in crisis. We therefore refer to these organisations as the Psychiatric Emergency Chain (PEC). The quality of the PEC determines the quality of the psychiatric emergency care in a region. In order to measure the quality of this type of care a monitor has been developed in collaboration with the main stakeholders in the region Western North Brabant (WNB). To develop a monitor to measure the quality of a PEC in a region, identify weak spots in the chain and feed back the results to the chain. By searching the literature, studying the primary process in the chain and by having interviews with stakeholders we compiled a questionnaire for monitoring the pec. The monitor was tested in the WNB region and adjusted on the basis of experiences with the respondents. Then the monitor was generalised and tested in another region (Eindhoven and the Kempen) in order to find out whether this instrument might also be applicable to other pecs in the Netherlands. The monitor provided the PEC with a common language for evaluating the chain. The monitor was able to pinpoint particular weak spots and collaboration problems such as the response time required to reach the emergency, communication between and within organisations and domain discussions between different stakeholders. Chain partners used the results of the monitor to negotiate better collaborative agreements and to improve their care. The monitor is able to pinpoint problem areas in the PEC and subsequently to generate feedback to its stakeholders. This creates opportunities for improvement in the PEC. Therefore the monitor is a useful instrument for evaluating a local PEC periodically.

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

Water-quality control, monitoring and wastewater treatment in Lithuania 1950 to 1999.

PubMed

Cetkauskaite, A; Zarkov, D; Stoskus, L

2001-08-01

The Lithuanian water-management system developed on the basis of Soviet regulations in 1950-1990. Surface-water quality monitoring started in the 1950s, and the system was improved in the 1960s. Today, 48 rivers are being monitored using up to 70 parameters. Statutory monitoring of discharges started in 1962, wastewater standards were issued in 1957 and 1966, and then revised in 1996. Wastewater-treatment plants were built first in rural areas, in factories since the 1950s, and later in towns. Since 1991, large capacity municipal plants have been constructed with foreign assistance. Water quality has improved in some rivers since 1970, but Lithuania's main river, Nemunas, remains moderately polluted. The lower Nemunas is especially affected by discharges of municipal and industrial wastewater from Sovietsk and Neman (Russia), which account for half of the total loading. Hydrobiological data of 1994-1998 indicated the eutrophication of the Curonian Lagoon, and bacteriological pollution and blue-green algae blooms in the Baltic Sea north of Klaipeda.

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.

Staff education, regular sedation and analgesia quality feedback, and a sedation monitoring technology for improving sedation and analgesia quality for critically ill, mechanically ventilated patients: a cluster randomised trial.

PubMed

Walsh, Timothy S; Kydonaki, Kalliopi; Antonelli, Jean; Stephen, Jacqueline; Lee, Robert J; Everingham, Kirsty; Hanley, Janet; Phillips, Emma C; Uutela, Kimmo; Peltola, Petra; Cole, Stephen; Quasim, Tara; Ruddy, James; McDougall, Marcia; Davidson, Alan; Rutherford, John; Richards, Jonathan; Weir, Christopher J

2016-10-01

Optimal sedation of patients in intensive care units (ICUs) requires the avoidance of pain, agitation, and unnecessary deep sedation, but these outcomes are challenging to achieve. Excessive sedation can prolong ICU stay, whereas light sedation can increase pain and frightening memories, which are commonly recalled by ICU survivors. We aimed to assess the effectiveness of three interventions to improve sedation and analgesia quality: an online education programme; regular feedback of sedation-analgesia quality data; and use of a novel sedation-monitoring technology (the Responsiveness Index [RI]). We did a cluster randomised trial in eight ICUs, which were randomly allocated to receive education alone (two ICUs), education plus sedation-analgesia quality feedback (two ICUs), education plus RI monitoring technology (two ICUs), or all three interventions (two ICUs). Randomisation was done with computer-generated random permuted blocks, stratified according to recruitment start date. A 45 week baseline period was followed by a 45 week intervention period, separated by an 8 week implementation period in which the interventions were introduced. ICU and research staff were not masked to study group assignment during the intervention period. All mechanically ventilated patients were potentially eligible. We assessed patients' sedation-analgesia quality for each 12 h period of nursing care, and sedation-related adverse events daily. Our primary outcome was the proportion of care periods with optimal sedation-analgesia, defined as being free from excessive sedation, agitation, poor limb relaxation, and poor ventilator synchronisation. Analysis used multilevel generalised linear mixed modelling to explore intervention effects in a single model taking clustering and patient-level factors into account. A concurrent mixed-methods process evaluation was undertaken to help understand the trial findings. The trial is registered with ClinicalTrials.gov, number NCT01634451. Between June 1, 2012, and Dec 31, 2014, we included 881 patients (9187 care periods) during the baseline period and 591 patients (6947 care periods) during the intervention period. During the baseline period, optimal sedation-analgesia was present for 5150 (56%) care periods. We found a significant improvement in optimal sedation-analgesia with RI monitoring (odds ratio [OR] 1·44 [95% CI 1·07-1·95]; p=0·017), which was mainly due to increased periods free from excessive sedation (OR 1·59 [1·09-2·31]) and poor ventilator synchronisation (OR 1·55 [1·05-2·30]). However, more patients experienced sedation-related adverse events (OR 1·91 [1·02-3·58]). We found no improvement in overall optimal sedation-analgesia with education (OR 1·13 [95% CI 0·86-1·48]), but fewer patients experienced sedation-related adverse events (OR 0·56 [0·32-0·99]). The sedation-analgesia quality data feedback did not improve quality (OR 0·74 [95% CI 0·54-1·00]) or sedation-related adverse events (OR 1·15 [0·61-2·15]). The process evaluation suggested many clinicians found the RI monitoring useful, but it was often not used for decision making as intended. Education was valued and considered useful by staff. By contrast, sedation-analgesia quality feedback was poorly understood and thought to lack relevance to bedside nursing practice. Combination of RI monitoring and online education has the potential to improve sedation-analgesia quality and patient safety in mechanically ventilated ICU patients. The RI monitoring seemed to improve sedation-analgesia quality, but inconsistent adoption by bedside nurses limited its impact. The online education programme resulted in a clinically relevant improvement in patient safety and was valued by nurses, but any changes to behaviours did not seem to alter other measures of sedation-analgesia quality. Providing sedation-analgesia quality feedback to ICUs did not appear to improve any quality metrics, probably because staff did not think it relevant to bedside practice. Chief Scientist Office, Scotland; GE Healthcare. Copyright © 2016 Elsevier Ltd. All rights reserved.

Continuous water-quality monitoring to improve lake management at Lake Mattamuskeet National Wildlife Refuge

Treesearch

Michelle Moorman; Tom Augspurger

2016-01-01

The U.S. Fish and Wildlife Service has partnered with U.S. Geological Survey to establish 2 continuous water-quality monitoring stations at Lake Mattamuskeet. Stations on the east and west side of the lake measure water level, clarity, dissolved oxygen, pH, temperature, salinity, and conductivity.

Comprehensive Monitoring Program. Air Quality Data Assessment for 1989. Version 2.1. Volume 2

DTIC Science & Technology

1990-06-01

Hg collected on Hopcalite TH media. 4.4.3.2 Basin F Data. Table 4.4-5 shows average and maximum metals values for the Basin F Remedial Monitoring...PMRMA. "Chemical Quality Assurance Plan." Version 1.0, July, 1989. Rathje and Marcero. 1976. "Improved Hopcalite Procedure for the Determination of

Use of wetlands for water quality improvement under the USEPA Region V Clean Lakes Program

NASA Astrophysics Data System (ADS)

Landers, Judith C.; Knuth, Barbara A.

1991-03-01

The United States Environmental Protection Agency (USEPA) Region V Clean Lakes Program employs artificial and modified natural wetlands in an effort to improve the water quality of selected lakes. We examined use of wetlands at seven lake sites and evaluated the physical and institutional means by which wetland projects are implemented and managed, relative to USEPA program goals and expert recommendations on the use of wetlands for water quality improvement. Management practices recommended by wetlands experts addressed water level and retention, sheet flow, nutrient removal, chemical treatment, ecological and effectiveness monitoring, and resource enhancement. Institutional characteristics recommended included local monitoring, regulation, and enforcement and shared responsibilities among jurisdictions. Institutional and ecological objectives of the National Clean Lakes Program were met to some degree at every site. Social objectives were achieved to a lesser extent. Wetland protection mechanisms and appropriate institutional decentralization were present at all sites. Optimal management techniques were employed to varying degrees at each site, but most projects lack adequate monitoring to determine adverse ecological impacts and effectiveness of pollutant removal and do not extensively address needs for recreation and wildlife habitat. There is evidence that the wetland projects are contributing to improved lake water quality; however, more emphasis needs to be placed on wetland protection and long-term project evaluation.

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

PubMed

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

2015-05-01

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

Strategies for ensuring global consistency/comparability of water-quality data

USGS Publications Warehouse

Klein, J.M.

1999-01-01

In the past 20 years the water quality of the United States has improved remarkably-the waters are safer for drinking, swimming, and fishing. However, despite many accomplishments, it is still difficult to answer such basic questions as: 'How clean is the water?' and 'How is it changing over time?' These same questions exist on a global scale as well. In order to focus water-data issues in the United States, a national Intergovernmental Task Force on Monitoring Water Quality (ITFM) was initiated for public and private organizations, whereby key elements involved in data collection, analysis, storage, and management could be made consistent and comparable. The ITFM recommended and its members are implementing a nationwide strategy to improve water-quality monitoring, assessment, and reporting activities. The intent of this paper is to suggest that a voluntary effort be initiated to ensure the comparability and utility of hydrological data on a global basis. Consistent, long-term data sets that are comparable are necessary in order to formulate ideas regarding regional and global trends in water quantity and quality. The author recommends that a voluntary effort similar to the ITFM effort be utilized. The strategy proposed would involve voluntary representation from countries and international organizations (e.g. World Health Organization) involved in drinking-water assessments and/or ambient water-quality monitoring. Voluntary partnerships such as this will improve curability to reduce health risks and achieve a better return on public and private investments in monitoring, environmental protection, and natural resource management, and result in a collaborative process that will save millions of dollars.In this work it is suggested that a voluntary effort be initiated to ensure the comparability and utility of hydrological data on a global basis. The strategy proposed would involve voluntary representation from countries and international organizations involved in drinking-water assessments and/or ambient water-quality monitoring.

Optimization of Sample Points for Monitoring Arable Land Quality by Simulated Annealing while Considering Spatial Variations

PubMed Central

Wang, Junxiao; Wang, Xiaorui; Zhou, Shenglu; Wu, Shaohua; Zhu, Yan; Lu, Chunfeng

2016-01-01

With China’s rapid economic development, the reduction in arable land has emerged as one of the most prominent problems in the nation. The long-term dynamic monitoring of arable land quality is important for protecting arable land resources. An efficient practice is to select optimal sample points while obtaining accurate predictions. To this end, the selection of effective points from a dense set of soil sample points is an urgent problem. In this study, data were collected from Donghai County, Jiangsu Province, China. The number and layout of soil sample points are optimized by considering the spatial variations in soil properties and by using an improved simulated annealing (SA) algorithm. The conclusions are as follows: (1) Optimization results in the retention of more sample points in the moderate- and high-variation partitions of the study area; (2) The number of optimal sample points obtained with the improved SA algorithm is markedly reduced, while the accuracy of the predicted soil properties is improved by approximately 5% compared with the raw data; (3) With regard to the monitoring of arable land quality, a dense distribution of sample points is needed to monitor the granularity. PMID:27706051

Wastewater quality monitoring system using sensor fusion and machine learning techniques.

PubMed

Qin, Xusong; Gao, Furong; Chen, Guohua

2012-03-15

A multi-sensor water quality monitoring system incorporating an UV/Vis spectrometer and a turbidimeter was used to monitor the Chemical Oxygen Demand (COD), Total Suspended Solids (TSS) and Oil & Grease (O&G) concentrations of the effluents from the Chinese restaurant on campus and an electrocoagulation-electroflotation (EC-EF) pilot plant. In order to handle the noise and information unbalance in the fused UV/Vis spectra and turbidity measurements during the calibration model building, an improved boosting method, Boosting-Iterative Predictor Weighting-Partial Least Squares (Boosting-IPW-PLS), was developed in the present study. The Boosting-IPW-PLS method incorporates IPW into boosting scheme to suppress the quality-irrelevant variables by assigning small weights, and builds up the models for the wastewater quality predictions based on the weighted variables. The monitoring system was tested in the field with satisfactory results, underlying the potential of this technique for the online monitoring of water quality. Copyright © 2011 Elsevier Ltd. All rights reserved.

The network of Shanghai Stroke Service System (4S): A public health-care web-based database using automatic extraction of electronic medical records.

PubMed

Dong, Yi; Fang, Kun; Wang, Xin; Chen, Shengdi; Liu, Xueyuan; Zhao, Yuwu; Guan, Yangtai; Cai, Dingfang; Li, Gang; Liu, Jianmin; Liu, Jianren; Zhuang, Jianhua; Wang, Panshi; Chen, Xin; Shen, Haipeng; Wang, David Z; Xian, Ying; Feng, Wuwei; Campbell, Bruce Cv; Parsons, Mark; Dong, Qiang

2018-07-01

Background Several stroke outcome and quality control projects have demonstrated the success in stroke care quality improvement through structured process. However, Chinese health-care systems are challenged with its overwhelming numbers of patients, limited resources, and large regional disparities. Aim To improve quality of stroke care to address regional disparities through process improvement. Method and design The Shanghai Stroke Service System (4S) is established as a regional network for stroke care quality improvement in the Shanghai metropolitan area. The 4S registry uses a web-based database that automatically extracts data from structured electronic medical records. Site-specific education and training program will be designed and administrated according to their baseline characteristics. Both acute reperfusion therapies including thrombectomy and thrombolysis in the acute phase and subsequent care were measured and monitored with feedback. Primary outcome is to evaluate the differences in quality metrics between baseline characteristics (including rate of thrombolysis in acute stroke and key performance indicators in secondary prevention) and post-intervention. Conclusions The 4S system is a regional stroke network that monitors the ongoing stroke care quality in Shanghai. This project will provide the opportunity to evaluate the spectrum of acute stroke care and design quality improvement processes for better stroke care. A regional stroke network model for quality improvement will be explored and might be expanded to other large cities in China. Clinical Trial Registration-URL http://www.clinicaltrials.gov . Unique identifier: NCT02735226.

Integrated Analysis Tools for the NERRS System-Wide Monitoring Program Data

EPA Science Inventory

Standardized monitoring programs have vastly improved the quantity and quality of data that form the basis of environmental decision-making. One example is the NOAA-funded National Estuarine Research Reserve System (NERRS) System-wide Monitoring Program (SWMP) that was implement...

A Survey on Data Quality for Dependable Monitoring in Wireless Sensor Networks.

PubMed

Jesus, Gonçalo; Casimiro, António; Oliveira, Anabela

2017-09-02

Wireless sensor networks are being increasingly used in several application areas, particularly to collect data and monitor physical processes. Non-functional requirements, like reliability, security or availability, are often important and must be accounted for in the application development. For that purpose, there is a large body of knowledge on dependability techniques for distributed systems, which provide a good basis to understand how to satisfy these non-functional requirements of WSN-based monitoring applications. Given the data-centric nature of monitoring applications, it is of particular importance to ensure that data are reliable or, more generically, that they have the necessary quality. In this survey, we look into the problem of ensuring the desired quality of data for dependable monitoring using WSNs. We take a dependability-oriented perspective, reviewing the possible impairments to dependability and the prominent existing solutions to solve or mitigate these impairments. Despite the variety of components that may form a WSN-based monitoring system, we give particular attention to understanding which faults can affect sensors, how they can affect the quality of the information and how this quality can be improved and quantified.

The Improvement of Spatial-Temporal PM2.5 Resolution in Taiwan by Using Data Assimilation Method

NASA Astrophysics Data System (ADS)

Lin, Yong-Qing; Lin, Yuan-Chien

2017-04-01

Forecasting air pollution concentration, e.g., the concentration of PM2.5, is of great significance to protect human health and the environment. Accurate prediction of PM2.5 concentrations is limited in number and the data quality of air quality monitoring stations. The spatial and temporal variations of PM2.5 concentrations are measured by 76 National Air Quality Monitoring Stations (built by the TW-EPA) in Taiwan. The National Air Quality Monitoring Stations are costly and scarce because of the highly precise instrument and their size. Therefore, many places still out of the range of National Air Quality Monitoring Stations. Recently, there are an enormous number of portable air quality sensors called "AirBox" developed jointly by the Taiwan government and a private company. By virtue of its price and portative, the AirBox can provide higher resolution of space-time PM2.5 measurement. However, the spatiotemporal distribution and data quality are different between AirBox and National Air Quality Monitoring Stations. To integrate the heterogeneous PM2.5 data, the data assimilation method should be performed before further analysis. In this study, we propose a data assimilation method based on Ensemble Kalman Filter (EnKF), which is a variant of classic Kalman Filter, can be used to combine additional heterogeneous data from different source while modeling to improve the estimation of spatial-temporal PM2.5 concentration. The assimilation procedure uses the advantages of the two kinds of heterogeneous data and merges them to produce the final estimation. The results have shown that by combining AirBox PM2.5 data as additional information in our model based EnKF can bring the better estimation of spatial-temporal PM2.5 concentration and improve the it's space-time resolution. Under the approach proposed in this study, higher spatial-temporal resoultion could provide a very useful information for a better spatial-temporal data analysis and further environmental management, such as air pollution source localization and micro-scale air pollution analysis. Keywords: PM2.5, Data Assimilation, Ensemble Kalman Filter, Air Quality

A design of wireless sensor networks for a power quality monitoring system.

PubMed

Lim, Yujin; Kim, Hak-Man; Kang, Sanggil

2010-01-01

Power grids deal with the business of generation, transmission, and distribution of electric power. Recently, interest in power quality in electrical distribution systems has increased rapidly. In Korea, the communication network to deliver voltage, current, and temperature measurements gathered from pole transformers to remote monitoring centers employs cellular mobile technology. Due to high cost of the cellular mobile technology, power quality monitoring measurements are limited and data gathering intervals are large. This causes difficulties in providing the power quality monitoring service. To alleviate the problems, in this paper we present a communication infrastructure to provide low cost, reliable data delivery. The communication infrastructure consists of wired connections between substations and monitoring centers, and wireless connections between pole transformers and substations. For the wireless connection, we employ a wireless sensor network and design its corresponding data forwarding protocol to improve the quality of data delivery. For the design, we adopt a tree-based data forwarding protocol in order to customize the distribution pattern of the power quality information. We verify the performance of the proposed data forwarding protocol quantitatively using the NS-2 network simulator.

A ten-year history: the Cancer Quality Council of Ontario.

PubMed

Anas, Rebecca; Bell, Robert; Brown, Adalsteinn; Evans, William; Sawka, Carol

2012-01-01

One of the longest-established quality oversight organizations in Canadian healthcare, the Cancer Quality Council of Ontario (CQCO) is an advisory group formed in 2002 by the Ministry of Health and Long-Term Care. Although quasi-independent from Cancer Care Ontario (CCO), the council was established to provide advice to CCO and the ministry in their efforts to improve the quality of cancer care in the province. The council is composed of a multidisciplinary group of healthcare providers, cancer survivors and experts in the areas of oncology, health system policy and administration, governance, performance measurement and health services research. Its mandate is to monitor and report publicly on the performance of the Ontario cancer system and to motivate improvement through national and international benchmarking. Since its formation, the council has played an evolving role in improving the quality of care received by Ontario cancer patients. This article will briefly describe the origins and founding principles of the CQCO, its changing role in monitoring quality and its relationship with CCO. Copyright © 2012 Longwoods Publishing.

Development and Monitoring the Key Performance Indicators of the Quality of Care for Patients with Cleft Lips/Palates at Srinagarind Hospital.

PubMed

Mongkhonthawornchai, Siriporn; Pradubwong, Suteera; Augsornwan, Darawan; Pathumwiwatana, Pornpen; Sroyhin, Waranya; Pongpagatip, Sumalee; Wongkham, Jamras; Wachirapakorn, Jantira; Lao-unka, Kesorn; Mucnamporn, Tippawan; Chowchuen, Bowornsilp

2015-08-01

Congenital deformities, such as cleft lips and/or cleft palates (CLP), have high incidences in the Northeast of Thailand. These birth defects can affect patient's quality of life. CLP patients need crucial and long-term treatments by a multidisciplinary team starting from prenatal stage to late adulthood. Patients and their families should involve in their own care, and their care objectives should correspond with healthcare providers. Besides the clinical outcome of interdisciplinary team, key performance indicators (KPIs) need to be developed in the hospital service unit in order to improve quality of care and treatment outcomes. 1) to establish KPIs in hospital service units, and 2) to develop the information system to collect, analysis and improve the quality of CLP care. A nurse coordinator was appointed in the Tawanchai Center to coordinate care. The three periods were conducted for the nurse coordinator to work with nine service units in Srinagarind Hospital for consensus on both qualitative and quantitative data to be used as service unit quality measurement. Thirty one KPIs from nine service units were established, collected and analyzed during a four-month period in 2014. The 20 KPIs achieved the unit targets. Two PKIs of the rates of complication with anesthesia during/after surgery in the first 24 hours and the rates of patient/caregiver's satisfaction in acquiring information from the officer were improving. There were 11 KPIs that did not achieve the targets. The coordinator nurse of the Tawanchai Center discussed with the service unit for the cause and how to improve the outcome. The monitoring KPIs will lead to improvement of outcome for better patient quality as well as benchmarking with other hospitals of Cleft Center. The KPIs from hospital service units with the monitoring and analysis of information by the nurse coordinator will enhance and lead to improvement of the quality of the patients and family centered care process.

Cardiopulmonary resuscitation quality and beyond: the need to improve real-time feedback and physiologic monitoring.

PubMed

Lin, Steve; Scales, Damon C

2016-06-28

High-quality cardiopulmonary resuscitation (CPR) has been shown to improve survival outcomes after cardiac arrest. The current standard in studies evaluating CPR quality is to measure CPR process measures-for example, chest compression rate, depth, and fraction. Published studies evaluating CPR feedback devices have yielded mixed results. Newer approaches that seek to optimize CPR by measuring physiological endpoints during the resuscitation may lead to individualized patient care and improved patient outcomes.

Quality monitoring of salt produced in Indonesia through seawater evaporation on HDPE geomembrane lined ponds

NASA Astrophysics Data System (ADS)

Jumaeri; Sulistyaningsih, T.; Alighiri, D.

2018-03-01

Salt is one of the primary ingredients that humans always need for various purposes, both for consumption and industry. The need for high-quality salt continues to increase, as long as industry growth. It must improve product quality through the development of salt production process technology. In this research, the quality monitoring of salt produced in Indonesia by evaporation of seawater on ponds lined using high-density polyethylene (HDPE) geomembrane has been studied. The manufacturing of salt carried out through the gradual precipitation principle on prepared ponds. HDPE geomembrane is used to coat evaporation ponds with viscosity 12-22°Be and crystallization ponds with a viscosity of 23°Be. The monitoring of the product is carried out in the particular periods during the salt production period. The result of control shows that the quality of salt produced in HDPE geomembrane coated salt ponds has an average NaCl content of 95.75%, so it has fulfilled with Indonesia National Standard (SNI), that is NaCl> 94.70%. The production of salt with HDPE geomembrane can improve the quality of salt product from NaCl 85.4% (conventional system) to 95.75%.

Project officer's perspective: quality assurance as a management tool.

PubMed

Heiby, J

1993-06-01

Advances in the management of health programs in less developed countries (LDC) have not kept pace with the progress of the technology used. The US Agency for International Development mandated the Quality Assurance Project (QAP) to provide quality improvement technical assistance to primary health care systems in LDCs while developing appropriate quality assurance (QA) strategies. The quality of health care in recent years in the US and Europe focused on the introduction of management techniques developed for industry into health systems. The experience of the QAP and its predecessor, the PRICOR Project, shows that quality improvement techniques facilitate measurement of quality of care. A recently developed WHO model for the management of the sick child provides scientifically based standards for actual care. Since 1988, outside investigators measuring how LDC clinicians perform have revealed serious deficiencies in quality compared with the program's own standards. This prompted developed of new QA management initiatives: 1) communicating standards clearly to the program staff; 2) actively monitoring actual performance corresponds to these standards; and 3) taking action to improve performance. QA means that managers are expected to monitor service delivery, undertake problem solving, and set specific targets for quality improvement. Quality improvement methods strengthen supervision as supervisors can objectively assess health worker performance. QA strengthens the management functions that support service delivery, e.g., training, records management, finance, logistics, and supervision. Attention to quality can contribute to improved health worker motivation and effective incentive programs by recognition for a job well done and opportunities for learning new skills. These standards can also address patient satisfaction. QA challenges managers to aim for the optimal level of care attainable.

Renal function monitoring in patients prescribed dabigatran in the Compass Health Primary Health Organisation: a quality improvement audit.

PubMed

McBain, Lynn; Kyle, Anna

2018-03-09

To assess annual renal function monitoring and clinical indications for use in patients prescribed dabigatran. A quality improvement activity included all patients in the Compass Health Primary Health Organisation (PHO) prescribed dabigatran. Information recorded: demographics; indication for use; daily dose; height; weight; serum creatinine; and estimated glomerular filtration rate (eGFR). The first audit occurred during July 2013 - May 2014, the second during May 2014 - October 2016. Across the PHO, all patients prescribed dabigatran were reviewed: 941 patients and 1,564 respectively. At the time of the second pass audit, renal function monitoring improved from 88% to 90%, and 96% were prescribed dabigatran for an approved indication. Results showed a continuing high level of renal function monitoring across the PHO in 90% of patients prescribed dabigatran. Practitioners were reminded to use creatinine clearance as a marker of renal function. Dabigatran was prescribed for an approved indication in 96% of patients. Our results are in line with recommended best practice and clinical guidelines.

Effective Documentation Tools

NASA Technical Reports Server (NTRS)

Sleboda, Claire

1997-01-01

Quality assurance programs provide a very effective means to monitor and evaluate medical care. Quality assurance involves: (1) Identify a problem; (2) Determine the source and nature of the problem; (3) Develop policies and methods to effect improvement; (4) Implement those polices; (5) Monitor the methods applied; and (6) Evaluate their effectiveness. Because this definition of quality assurance so closely resembles the Nursing Process, the health unit staff was able to use their knowledge of the nursing process to develop many forms which improve the quality of patient care. These forms include the NASA DFRC Service Report, the occupational injury form (Incident Report), the patient survey (Pre-hospital Evaluation/Care Report), the Laboratory Log Sheet, the 911 Run Sheet, and the Patient Assessment Stamp. Examples and steps which are followed to generate these reports are described.

NASA JSC water monitor system: City of Houston field demonstration

NASA Technical Reports Server (NTRS)

Taylor, R. E.; Jeffers, E. L.; Fricks, D. H.

1979-01-01

A water quality monitoring system with on-line and real time operation similar to the function in a spacecraft was investigated. A system with the capability to determine conformance to future high effluent quality standards and to increase the potential for reclamation and reuse of water was designed. Although all system capabilities were not verified in the initial field trial, fully automated operation over a sustained period with only routine manual adjustments was accomplished. Two major points were demonstrated: (1) the water monitor system has great potential in water monitoring and/or process control applications; and (2) the water monitor system represents a vast improvement over conventional (grab sample) water monitoring techniques.

Clinical nursing leaders' perceptions of nutrition quality indicators in Swedish stroke wards: a national survey.

PubMed

Persenius, Mona; Hall-Lord, Marie-Louise; Wilde-Larsson, Bodil; Carlsson, Eva

2015-09-01

To describe nursing leaders' perceptions of nutrition quality in Swedish stroke wards. A high risk of undernutrition places great demand on nutritional care in stroke wards. Evidence-based guidelines exist, but healthcare professionals have reported low interest in nutritional care. The Donabedian framework of structure, process and outcome is recommended to monitor and improve nutrition quality. Using a descriptive cross-sectional design, a web-based questionnaire regarding nutritional care quality was delivered to eligible participants. Most clinical nursing leaders reported structure indicators, e.g. access to dieticians. Among process indicators, regular assessment of patients' swallowing was most frequently reported in comprehensive stroke wards compared with other stroke wards. Use of outcomes to monitor nutrition quality was not routine. Wards using standard care plans showed significantly better results. Using the structure, process and outcome framework to examine nutrition quality, quality-improvement needs became visible. To provide high-quality nutrition, all three structure, process and outcome components must be addressed. The use of care pathways, standard care plans, the Senior Alert registry, as well as systematic use of outcome measures could improve nutrition quality. To assist clinical nursing leaders in managing all aspects of quality, structure, process and outcome can be a valuable framework. © 2013 John Wiley & Sons Ltd.

The importance of continuing education for transplant coordination staff.

PubMed

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

2005-06-01

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

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.

How Much Will It Cost To Monitor Microbial Drinking Water Quality in Sub-Saharan Africa?

PubMed Central

2017-01-01

Microbial water quality monitoring is crucial for managing water resources and protecting public health. However, institutional testing activities in sub-Saharan Africa are currently limited. Because the economics of water quality testing are poorly understood, the extent to which cost may be a barrier to monitoring in different settings is unclear. This study used cost data from 18 African monitoring institutions (piped water suppliers and health surveillance agencies in six countries) and estimates of water supply type coverage from 15 countries to assess the annual financial requirements for microbial water testing at both national and regional levels, using World Health Organization recommendations for sampling frequency. We found that a microbial water quality test costs 21.0 ± 11.3 USD, on average, including consumables, equipment, labor, and logistics, which is higher than previously calculated. Our annual cost estimates for microbial monitoring of piped supplies and improved point sources ranged between 8 000 USD for Equatorial Guinea and 1.9 million USD for Ethiopia, depending primarily on the population served but also on the distribution of piped water system sizes. A comparison with current national water and sanitation budgets showed that the cost of implementing prescribed testing levels represents a relatively modest proportion of existing budgets (<2%). At the regional level, we estimated that monitoring the microbial quality of all improved water sources in sub-Saharan Africa would cost 16.0 million USD per year, which is minimal in comparison to the projected annual capital costs of achieving Sustainable Development Goal 6.1 of safe water for all (14.8 billion USD). PMID:28459563

How Much Will It Cost To Monitor Microbial Drinking Water Quality in Sub-Saharan Africa?

PubMed

Delaire, Caroline; Peletz, Rachel; Kumpel, Emily; Kisiangani, Joyce; Bain, Robert; Khush, Ranjiv

2017-06-06

Microbial water quality monitoring is crucial for managing water resources and protecting public health. However, institutional testing activities in sub-Saharan Africa are currently limited. Because the economics of water quality testing are poorly understood, the extent to which cost may be a barrier to monitoring in different settings is unclear. This study used cost data from 18 African monitoring institutions (piped water suppliers and health surveillance agencies in six countries) and estimates of water supply type coverage from 15 countries to assess the annual financial requirements for microbial water testing at both national and regional levels, using World Health Organization recommendations for sampling frequency. We found that a microbial water quality test costs 21.0 ± 11.3 USD, on average, including consumables, equipment, labor, and logistics, which is higher than previously calculated. Our annual cost estimates for microbial monitoring of piped supplies and improved point sources ranged between 8 000 USD for Equatorial Guinea and 1.9 million USD for Ethiopia, depending primarily on the population served but also on the distribution of piped water system sizes. A comparison with current national water and sanitation budgets showed that the cost of implementing prescribed testing levels represents a relatively modest proportion of existing budgets (<2%). At the regional level, we estimated that monitoring the microbial quality of all improved water sources in sub-Saharan Africa would cost 16.0 million USD per year, which is minimal in comparison to the projected annual capital costs of achieving Sustainable Development Goal 6.1 of safe water for all (14.8 billion USD).

Implementation of an Electronic Data Collection Tool to Monitor Nursing-Sensitive Indicators in a Large Academic Health Sciences Centre.

PubMed

Backman, Chantal; Vanderloo, Saskia; Momtahan, Kathy; d'Entremont, Barb; Freeman, Lisa; Kachuik, Lynn; Rossy, Dianne; Mille, Toba; Mojaverian, Naghmeh; Lemire-Rodger, Ginette; Forster, Alan

2015-09-01

Monitoring the quality of nursing care is essential to identify patients at risk, measure adherence to hospital policies and evaluate the effectiveness of best practice interventions. However, monitoring nursing-sensitive indicators (NSI) is a challenge. Prevalence surveys are one method used by some organizations to monitor NSI, which are patient outcomes that are directly affected by the quantity or quality of nursing care that the patient receives. The aim of this paper is to describe the development of an innovative electronic data collection tool to monitor NSI. In the preliminary development work, we designed a mobile computing application with pre-populated patient census information to collect the nursing quality data. In subsequent phases, we refined this process by designing an electronic trigger using The Ottawa Hospital's Patient Safety Learning System, which automatically generated a case report form for each inpatient based on the hospital's daily patient census on the day of the prevalence survey. Both of these electronic data collection tools were accessible on tablet computers, which substantially reduced data collection, analysis and reporting time compared to previous paper-based methods. The electronic trigger provided improved completeness of the data. This work leveraged the use of tablet computers combined with a web-based application for patient data collection at point of care. Overall, the electronic methods improved data completeness and timeliness compared to traditional paper-based methods. This initiative has resulted in the ability to collect and report on NSI organization-wide to advance decision-making support and identify quality improvement opportunities within the organization. Copyright © 2015 Longwoods Publishing.

Investigation of stormwater quality improvements utilizing permeable friction course (PFC).

DOT National Transportation Integrated Search

2010-09-01

This report describes research into the water quality and hydraulics of the Permeable Friction Course (PFC). : Water quality monitoring of 3 locations in the Austin area indicates up to a 90 percent reduction in pollutant : discharges from PFC compar...

ASSESSING THE COMPARABILITY OF AMMONIUM, NITRATE AND SULFATE CONCENTRATIONS MEASURED BY THREE AIR QUALITY MONITORING NETWORKS

EPA Science Inventory

Airborne fine particulate matter across the United States is monitored by different networks, the three prevalent ones presently being the Clean Air Status and Trend Network (CASTNet), the Interagency Monitoring of PROtected Visual Environment Network (IMPROVE) and the Speciati...

Relationships between environmental governance and water quality in growing metropolitan areas: a synthetic view through the coupled natural and human system lens

NASA Astrophysics Data System (ADS)

Chang, H.; Thiers, P.; Netusil, N. R.; Yeakley, J. A.; Rollwagen-Bollens, G.; Bollens, S. M.; Singh, S.

2013-06-01

We investigate relationships between environmental governance and water quality in two adjacent, growing metropolitan areas in the western US. While the Portland, Oregon and Vancouver, Washington metro areas share many biophysical characteristics, they have different land development histories and water governance structures, providing a unique opportunity for examining a coupled human and natural system (CHANS). We conceptualize feedback loops in which water quality influences governance directly, using monitoring efforts as a metric, and indirectly, using the metric of changes in the sale price of single-family residential properties. Governance then influences water quality directly through, for example, changes in the monitoring regime and riparian restoration and indirectly through land use policy. We investigate these hypotheses by presenting evidence of these linkages. Our results show that changes in monitoring regimes and land use differed in response to differences in governance systems. On the other hand, property sale prices increased in response to water quality improvement for both studied watersheds. Our results show that sales prices responded positively to improved water quality (i.e. DO) in both cities. Furthermore, riparian restoration efforts improved over time for both cities, indicating the positive effect of governance on this land-based resource that may result in improved water quality. However, as of yet, there were no substantial differences across study areas in changes in water temperature over time. While urban areas expanded more than 20% over 24 yr, water temperature did not change. The mechanisms by which water quality was maintained was similar in the sense that both cities benefited from riparian restoration, but different in the sense that Portland benefitted indirectly from land use policy. A combination of a long-term legacy effect of land development and a relatively short history of riparian restoration in both the Portland and Vancouver regions may have masked any subtle differences in both regions. An alternative explanation is that both cities exhibited combinations of positive indirect and direct water quality governance that resulted in maintenance of water quality in the face of increased urban growth. These findings suggest that a long-term water quality monitoring effort is needed to identify the effectiveness of alternative land development and water governance policies.

Integrating sentinel watershed-systems into the monitoring and assessment of Minnesota's (USA) waters quality.

PubMed

Magner, J A; Brooks, K N

2008-03-01

Section 303(d) of the Clean Water Act requires States and Tribes to list waters not meeting water quality standards. A total maximum daily load must be prepared for waters identified as impaired with respect to water quality standards. Historically, the management of pollution in Minnesota has been focused on point-source regulation. Regulatory effort in Minnesota has improved water quality over the last three decades. Non-point source pollution has become the largest driver of conventional 303(d) listings in the 21st century. Conventional pollutants, i.e., organic, sediment and nutrient imbalances can be identified with poor land use management practices. However, the cause and effect relationship can be elusive because of natural watershed-system influences that vary with scale. Elucidation is complex because the current water quality standards in Minnesota were designed to work best with water quality permits to control point sources of pollution. This paper presents a sentinel watershed-systems approach (SWSA) to the monitoring and assessment of Minnesota waterbodies. SWSA integrates physical, chemical, and biological data over space and time using advanced technologies at selected small watersheds across Minnesota to potentially improve understanding of natural and anthropogenic watershed processes and the management of point and non-point sources of pollution. Long-term, state-of-the-art monitoring and assessment is needed to advance and improve water quality standards. Advanced water quality or ecologically-based standards that integrate physical, chemical, and biological numeric criteria offer the potential to better understand, manage, protect, and restore Minnesota's waterbodies.

Recognition and management of depression in skilled-nursing and long-term care settings: evolving targets for quality improvement.

PubMed

Boyle, Vicki L; Roychoudhury, Canopy; Beniak, Renee; Cohn, Lisa; Bayer, Albert; Katz, Ira

2004-01-01

Depression is a common disorder associated with suffering, morbidity, and mortality in nursing home residents. It is treatable, and improving the quality of treatment can have a major impact. MPRO, Michigan's Quality Improvement Organization, initiated a quality-improvement project in 14 nursing facilities to improve the accuracy of assessments, targeting, and monitoring of care. Electronic Minimum Data Set (MDS) data and medical-record abstraction results were combined to form the analytic dataset. Findings from the baseline phase demonstrated that, according to medical and administrative records, 26% of newly admitted nursing home residents had symptoms of depression that were apparent at admission, and an additional 12% were recognized early in their stay. Eighty-one percent of residents with depression were receiving treatment on admission to the facility, and 79% of those with depression recognized by Day 14 were treated by then. These data demonstrate progress toward improving the initiation of treatment for depression in nursing homes; however, there are still opportunities for improving the quality of care and, especially, the quality of assessments. The authors recommend the addition of the Geriatric Depression Scale to the federally mandated MDS for cognitively intact patients. There could also be mechanisms to ensure that providers and facilities follow recommended practice guidelines. Initiating treatment with antidepressant medications should be followed with monitoring of residents to identify those who still have depressive symptoms and to modify or intensify their treatment.

Design, implementation, and initial results from a water-quality monitoring network for Atlanta, Georgia, USA

USGS Publications Warehouse

Horowitz, A.J.; Elrick, K.A.; Smith, J.J.

2005-01-01

In cooperation with the City of Atlanta, Georgia, the US Geological Survey has designed and implemented a water-quantity and quality monitoring network that measures a variety of biological and chemical constituents in water and suspended sediment. The network consists of 20 long-term monitoring sites and is intended to assess water-quality trends in response to planned infrastructural improvements. Initial results from the network indicate that nonpoint-source contributions may be more significant than point-source contributions for selected sediment associated trace elements and nutrients. There also are indications of short-term discontinuous point-source contributions of these same constituents during baseflow.

Quality in laboratory medicine: 50years on.

PubMed

Plebani, Mario

2017-02-01

The last 50years have seen substantial changes in the landscape of laboratory medicine: its role in modern medicine is in evolution and the quality of laboratory services is changing. The need to control and improve quality in clinical laboratories has grown hand in hand with the growth in technological developments leading to an impressive reduction of analytical errors over time. An essential cause of this impressive improvement has been the introduction and monitoring of quality indicators (QIs) such as the analytical performance specifications (in particular bias and imprecision) based on well-established goals. The evolving landscape of quality and errors in clinical laboratories moved first from analytical errors to all errors performed within the laboratory walls, subsequently to errors in laboratory medicine (including errors in test requesting and result interpretation), and finally, to a focus on errors more frequently associated with adverse events (laboratory-associated errors). After decades in which clinical laboratories have focused on monitoring and improving internal indicators of analytical quality, efficiency and productivity, it is time to shift toward indicators of total quality, clinical effectiveness and patient outcomes. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Quality control troubleshooting tools for the mill floor

Treesearch

John Dramm

2000-01-01

Statistical Process Control (SPC) provides effective tools for improving process quality in the forest products industry resulting in reduced costs and improved productivity. Implementing SPC helps identify and locate problems that occur in wood products manufacturing. SPC tools achieve their real value when applied on the mill floor for monitoring and troubleshooting...

Toward delisting of the water quality beneficial use impairment in the St. Louis River, MN: A monitoring approach

EPA Science Inventory

Water quality in the St. Louis River Estuary (SLRE), a great lakes area of concern (AOC), is improving. A significant leap forward followed the opening of the Western Lake Superior Sanitary District in 1978. However, desire for continued improvement throughout the estuary was the...

MEDNET: A Multi-State Policymaker/Researcher Collaboration to Improve Prescribing Practices

PubMed Central

Finnerty, Molly; Neese-Todd, Sheree; Bilder, Scott; Olfson, Mark; Crystal, Stephen

2015-01-01

States face new federal requirements to monitor psychotropic prescribing practices for children and adults in Medicaid. Effective use of quality measurement and quality improvement strategies hold the promise of improved outcomes for public mental health systems. The Medicaid/Mental Health Network for Evidence Based Treatment (MEDNET) is an AHRQ funded multi-state Medicaid quality collaborative with the Rutgers University Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes. We review the development, infrastructure, challenges, and early evidence of success of this public-academic partnership, the first multi-state Medicaid quality improvement collaborative to focus on psychotropic medications. PMID:25756882

Implantable cardiac devices: the utility of remote monitoring in a paediatric and CHD population.

PubMed

Olen, Melissa M; Dechert-Crooks, Brynn

2017-01-01

Remote monitoring in the modern era has improved outcomes for patients with cardiac implantable electronic devices. There are many advantages to remote monitoring, including improved quality of life for patients, decreased need for in-office interrogation, and secondary reduced costs. Patient safety and enhanced survival remain the most significant benefit. With most of the published literature on this topic being focussed on adults, paediatric outcomes continue to be defined. This is a review of the benefits of remote monitoring in paediatrics and in patients with CHD.

Quality in the molecular microbiology laboratory.

PubMed

Wallace, Paul S; MacKay, William G

2013-01-01

In the clinical microbiology laboratory advances in nucleic acid detection, quantification, and sequence analysis have led to considerable improvements in the diagnosis, management, and monitoring of infectious diseases. Molecular diagnostic methods are routinely used to make clinical decisions based on when and how to treat a patient as well as monitor the effectiveness of a therapeutic regime and identify any potential drug resistant strains that may impact on the long term patient treatment program. Therefore, confidence in the reliability of the result provided by the laboratory service to the clinician is essential for patient treatment. Hence, suitable quality assurance and quality control measures are important to ensure that the laboratory methods and service meet the necessary regulatory requirements both at the national and international level. In essence, the modern clinical microbiology laboratory ensures the appropriateness of its services through a quality management system that monitors all aspects of the laboratory service pre- and post-analytical-from patient sample receipt to reporting of results, from checking and upholding staff competency within the laboratory to identifying areas for quality improvements within the service offered. For most European based clinical microbiology laboratories this means following the common International Standard Organization (ISO9001) framework and ISO15189 which sets out the quality management requirements for the medical laboratory (BS EN ISO 15189 (2003) Medical laboratories-particular requirements for quality and competence. British Standards Institute, Bristol, UK). In the United States clinical laboratories performing human diagnostic tests are regulated by the Centers for Medicare and Medicaid Services (CMS) following the requirements within the Clinical Laboratory Improvement Amendments document 1988 (CLIA-88). This chapter focuses on the key quality assurance and quality control requirements within the modern microbiology laboratory providing molecular diagnostics.

Earth Observation Data Quality Monitoring and Control: A Case Study of STAR Central Data Repository

NASA Astrophysics Data System (ADS)

Han, W.; Jochum, M.

2017-12-01

Earth observation data quality is very important for researchers and decision makers involved in weather forecasting, severe weather warning, disaster and emergency response, environmental monitoring, etc. Monitoring and control earth observation data quality, especially accuracy, completeness, and timeliness, is very useful in data management and governance to optimize data flow, discover potential transmission issues, and better connect data providers and users. Taking a centralized near real-time satellite data repository, STAR (Center for Satellite Applications and Research of NOAA) Central Data Repository (SCDR), as an example, this paper describes how to develop new mechanism to verify data integrity, check data completeness, and monitor data latency in an operational data management system. Such quality monitoring and control of large volume satellite data help data providers and managers improve data transmission of near real-time satellite data, enhance its acquisition and management, and overcome performance and management issues to better serve research and development activities.

A Survey on Data Quality for Dependable Monitoring in Wireless Sensor Networks

PubMed Central

Oliveira, Anabela

2017-01-01

Wireless sensor networks are being increasingly used in several application areas, particularly to collect data and monitor physical processes. Non-functional requirements, like reliability, security or availability, are often important and must be accounted for in the application development. For that purpose, there is a large body of knowledge on dependability techniques for distributed systems, which provide a good basis to understand how to satisfy these non-functional requirements of WSN-based monitoring applications. Given the data-centric nature of monitoring applications, it is of particular importance to ensure that data are reliable or, more generically, that they have the necessary quality. In this survey, we look into the problem of ensuring the desired quality of data for dependable monitoring using WSNs. We take a dependability-oriented perspective, reviewing the possible impairments to dependability and the prominent existing solutions to solve or mitigate these impairments. Despite the variety of components that may form a WSN-based monitoring system, we give particular attention to understanding which faults can affect sensors, how they can affect the quality of the information and how this quality can be improved and quantified. PMID:28869505

Improve EPA's AIRNow Air Quality Index Maps with NASA/NOAA Satellite Data

NASA Astrophysics Data System (ADS)

Pasch, A.; Zahn, P. H.; DeWinter, J. L.; Haderman, M. D.; White, J. E.; Dickerson, P.; Dye, T. S.; Martin, R. V.

2011-12-01

The U.S. Environmental Protection Agency's (EPA) AIRNow program provides maps of real-time hourly Air Quality Index (AQI) conditions and daily AQI forecasts nationwide (http://www.airnow.gov). The public uses these maps to make decisions concerning their respiratory health. The usefulness of the AIRNow air quality maps depends on the accuracy and spatial coverage of air quality measurements. Currently, the maps use only ground-based measurements, which have significant gaps in coverage in some parts of the United States. As a result, contoured AQI levels have high uncertainty in regions far from monitors. To improve the usefulness of air quality maps, scientists at EPA and Sonoma Technology, Inc. are working in collaboration with the National Aeronautics and Space Administration (NASA), the National Oceanic and Atmospheric Administration (NOAA), and university researchers on a project to incorporate additional measurements into the maps via the AIRNow Satellite Data Processor (ASDP). These measurements include estimated surface PM

The immunization data quality audit: verifying the quality and consistency of immunization monitoring systems.

PubMed Central

Ronveaux, O.; Rickert, D.; Hadler, S.; Groom, H.; Lloyd, J.; Bchir, A.; Birmingham, M.

2005-01-01

OBJECTIVE: To evaluate the consistency and quality of immunization monitoring systems in 27 countries during 2002-03 using standardized data quality audits (DQAs) that had been launched within the framework of the Global Alliance for Vaccines and Immunization. METHODS: The consistency of reporting systems was estimated by determining the proportion of third doses of diphtheria-tetanuspertussis (DTP-3) vaccine reported as being administered that could be verified by written documentation at health facilities and districts. The quality of monitoring systems was measured using quality indices for different components of the monitoring systems. These indices were applied to each level of the health service (health unit, district and national). FINDINGS: The proportion of verified DTP-3 doses was lower than 85% in 16 countries. Difficulties in verifying the doses administered often arose at the peripheral level of the health service, usually as the result of discrepancies in information between health units and their corresponding districts or because completed recording forms were not available from health units. All countries had weaknesses in their monitoring systems; these included the inconsistent use of monitoring charts; inadequate monitoring of vaccine stocks, injection supplies and adverse events; unsafe computer practices; and poor monitoring of completeness and timeliness of reporting. CONCLUSION: Inconsistencies in immunization data occur in many countries, hampering their ability to manage their immunization programmes. Countries should use these findings to strengthen monitoring systems so that data can reliably guide programme activities. The DQA is an innovative tool that provides a way to independently assess the quality of immunization monitoring systems at all levels of a health service and serves as a point of entry to make improvements. It provides a useful example for other global health initiatives. PMID:16175824

A Novel Approach for Evaluation of Water Quality Trends in Gulf Coast Estuaries

EPA Science Inventory

Water quality data form the backbone of management programs aimed at protecting environmental resources. The increasing availability of long-term monitoring data for estuaries can improve detection of temporal and spatial changes in water quality. However, the relatively simple...

Why is Improving Water Quality in the Gulf of Mexico so Critical?

EPA Pesticide Factsheets

The EPA regional offices and the Gulf of Mexico Program work with Gulf States to continue to maximize the efficiency and utility of water quality monitoring efforts for local managers by coordinating and standardizing state and federal water quality data

Air Pollution Monitoring | Air Quality Planning & Standards ...

EPA Pesticide Factsheets

2016-06-08

The basic mission of the Office of Air Quality Planning and Standards is to preserve and improve the quality of our nation's air. To accomplish this, OAQPS must be able to evaluate the status of the atmosphere as compared to clean air standards and historical information.

A roadmap for improving healthcare service quality.

PubMed

Kennedy, Denise M; Caselli, Richard J; Berry, Leonard L

2011-01-01

A data-driven, comprehensive model for improving service and creating long-term value was developed and implemented at Mayo Clinic Arizona (MCA). Healthcare organizations can use this model to prepare for value-based purchasing, a payment system in which quality and patient experience measures will influence reimbursement. Surviving and thriving in such a system will require a comprehensive approach to sustaining excellent service performance from physicians and allied health staff (e.g., nurses, technicians, nonclinical staff). The seven prongs in MCA's service quality improvement model are (1) multiple data sources to drive improvement, (2) accountability for service quality, (3) service consultation and improvement tools, (4) service values and behaviors, (5) education and training, (6) ongoing monitoring and control, and (7) recognition and reward. The model was fully implemented and tested in five departments in which patient perception of provider-specific service attributes and/or overall quality of care were below the 90th percentile for patient satisfaction in the vendor's database. Extent of the implementation was at the discretion of department leadership. Perception data rating various service attributes were collected from randomly selected patients and monitored over a 24-month period. The largest increases in patient perception of excellence over the pilot period were realized when all seven prongs of the model were implemented as a comprehensive improvement approach. The results of this pilot may help other healthcare organizations prepare for value-based purchasing.

Assessment of the quality of hospital care for children in Indonesia.

PubMed

Sidik, Nurul A; Lazuardi, Lilliana; Agung, Fransisca H; Pritasari, Kirana; Roespandi, Hanny; Setiawan, Tini; Pawitro, Udjiani; Nurhamzah, Waldi; Weber, Martin W

2013-04-01

To obtain an overview of the quality of care for children in Indonesia, by assessing hospitals with a view to proceed to a quality improvement mechanism for child care. Stratified two-stage random sampling in six regions identified 18 hospitals (provinces Jambi, East Java, Central Kalimantan, South-East Sulawesi, East Nusa Tenggara, North Maluku). Three randomly selected hospitals in each province were visited by trained assessors who scored each assessed service (expressed as a percentage of achievement) and grouped into good (≥ 80%), requiring improvement (60-79%) and urgently requiring improvement (< 60%). The overall median result score across all areas was 43% (IQR 28%-53%). Case management for common childhood illnesses had a median score of 37% (IQR18-43%), neonatal care 46% (IQR 26-57%) and patient monitoring 40% (IQR 30-50%), all indicating an urgent need for improvement. Qualitative data showed as main problems inadequate use of standard treatment guidelines, irrational prescribing of antibiotics, poor progress monitoring and poor supportive care. We found serious shortcomings in the quality of hospital care for children. Finding and documenting those is the first step in a quality improvement process. Work is needed to start an improvement cycle for hospital care. © 2013 Blackwell Publishing Ltd. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Quality of the ophthalmological service to outpatients of the public and private healthcare systems.

PubMed

Hercos, Benigno Vicente Santos; Berezovsky, Adriana

2017-01-01

To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

Walnut creek watershed monitoring project, Iowa: Monitoring water quality in response to prairie restoration

USGS Publications Warehouse

Schilling, K.E.; Thompson, C.A.

2000-01-01

Land use and surface water data for nitrogen and pesticides (1995 to 1997) are reported for the Walnut Creek Watershed Monitoring Project, Jasper County Iowa. The Walnut Creek project was established in 1995 as a nonpoint source monitoring program in relation to watershed habitat restoration and agricultural management changes implemented at the Neal Smith National Wildlife Refuge by the U.S. Fish and Wildlife Service. The monitoring project utilizes a paired-watershed approach (Walnut and Squaw creeks) as well as upstream/downstream comparisons on Walnut for analysis and tracking of trends. From 1992 to 1997, 13.4 percent of the watershed was converted from row crop to native prairie in the Walnut Creek watershed. Including another 6 percent of watershed farmed on a cash-rent basis, land use changes have been implemented on 19.4 percent of the watershed by the USFWS. Nitrogen and pesticide applications were reduced an estimated 18 percent and 28 percent in the watershed from land use changes. Atrazine was detected most often in surface water with frequencies of detection ranging from 76-86 percent. No significant differences were noted in atrazine concentrations between Walnut and Squaw Creek. Nitrate-N concentrations measured in both watersheds were similar; both basins showed a similar pattern of detection and an overall reduction in nitrate-N concentrations from upstream to downstream monitoring sites. Water quality improvements are suggested by nitrate-N and chloride ratios less than one in the Walnut Creek watershed and low nitrate-N concentrations measured in the subbasin of Walnut Creek containing the greatest amount of land use changes. Atrazine and nitrate-N concentrations from the lower portion of the Walnut Creek watershed (including the prairie restoration area) may be decreasing in relation to the upstream untreated component of the watershed. The frequencies of pesticide detections and mean nitrate-N concentrations appear related to the percentage of row crop in the basins and subbasins. Although some results are encouraging, definitive water quality improvements have not been observed during the first three years of monitoring. Possible reasons include: (1) more time is needed to adequately detect changes; (2) the size of the watershed is too large to detect improvements; (3) land use changes are not located in the area of the watershed where they would have greatest effect; or (4) water quality improvements have occurred but have been missed by the project monitoring design. Longer-term monitoring will allow better evaluation of the impact of restoration activities on water quality.An overview is given on the Walnut Creek Watershed Monitoring Project established as a nonpoint source monitoring program in relation to watershed habitat restoration and agricultural management changes implemented at the Neal Smith National Wildlife Refuge by the U.S. Fish and Wildlife Services. Focus is on land use and surface water data for nitrogen and pesticides. Initial results obtained for the first three years of monitoring are discussed.

Design of Cycle 3 of the National Water-Quality Assessment Program, 2013-23: Part 2: Science plan for improved water-quality information and management

USGS Publications Warehouse

Rowe, Gary L.; Belitz, Kenneth; Demas, Charlie R.; Essaid, Hedeff I.; Gilliom, Robert J.; Hamilton, Pixie A.; Hoos, Anne B.; Lee, Casey J.; Munn, Mark D.; Wolock, David W.

2013-01-01

This report presents a science strategy for the third decade of the National Water-Quality Assessment (NAWQA) Program, which since 1991, has been responsible for providing nationally consistent information on the quality of the Nation's streams and groundwater; how water quality is changing over time; and the major natural and human factors that affect current water quality conditions and trends. The strategy is based on an extensive evaluation of the accomplishments of NAWQA over its first two decades, the current status of water-quality monitoring activities by USGS and its partners, and an updated analysis of stakeholder priorities. The plan is designed to address priority issues and national needs identified by NAWQA stakeholders and the National Research Council (2012) irrespective of budget constraints. This plan describes four major goals for the third decade (Cycle 3), the approaches for monitoring, modeling, and scientific studies, key partnerships required to achieve these goals, and products and outcomes that will result from planned assessment activities. The science plan for 2013–2023 is a comprehensive approach to meet stakeholder priorities for: (1) rebuilding NAWQA monitoring networks for streams, rivers, and groundwater, and (2) upgrading models used to extrapolate and forecast changes in water-quality and stream ecosystem condition in response to changing climate and land use. The Cycle 3 plan continues approaches that have been central to the Program’s long-term success, but adjusts monitoring intensities and study designs to address critical information needs and identified data gaps. Restoration of diminished monitoring networks and new directions in modeling and interpretative studies address growing and evolving public and stakeholder needs for water-quality information and improved management, particularly in the face of increasing challenges related to population growth, increasing demands for water, and changing land use and climate. However, a combination of funding growth and extensive collaboration with other USGS programs and other Federal, State, and local agencies, public interest groups, professional and trade associations, academia, and private industry will be needed to fully realize the monitoring and modeling goals laid out in this plan (USGS Fact Sheet 2013-3008).

Extra-analytical quality indicators and laboratory performances.

PubMed

Sciacovelli, Laura; Aita, Ada; Plebani, Mario

2017-07-01

In the last few years much progress has been made in raising the awareness of laboratory medicine professionals about the effectiveness of quality indicators (QIs) in monitoring, and improving upon, performances in the extra-analytical phases of the Total Testing Process (TTP). An effective system for management of QIs includes the implementation of an internal assessment system and participation in inter-laboratory comparison. A well-designed internal assessment system allows the identification of critical activities and their systematic monitoring. Active participation in inter-laboratory comparison provides information on the performance level of one laboratory with respect to that of other participating laboratories. In order to guarantee the use of appropriate QIs and facilitate their implementation, many laboratories have adopted the Model of Quality Indicators (MQI) proposed by Working Group "Laboratory Errors and Patient Safety" (WG-LEPS) of IFCC, since 2008, which is the result of international consensus and continuous experimentation, and updating to meet new, constantly emerging needs. Data from participating laboratories are collected monthly and reports describing the statistical results and evaluating laboratory data, utilizing the Six Sigma metric, issued regularly. Although the results demonstrate that the processes need to be improved upon, overall the comparison with data collected in 2014 shows a general stability of quality levels and that an improvement has been achieved over time for some activities. The continuous monitoring of QI data allows identification all possible improvements, thus highlighting the value of participation in the inter-laboratory program proposed by WG-LEPS. The active participation of numerous laboratories will guarantee an ever more significant State-of-the-Art, promote the reduction of errors and improve quality of the TTP, thus guaranteeing patient safety. Copyright © 2017. Published by Elsevier Inc.

Total Quality Management Simplified.

ERIC Educational Resources Information Center

Arias, Pam

1995-01-01

Maintains that Total Quality Management (TQM) is one method that helps to monitor and improve the quality of child care. Lists four steps for a child-care center to design and implement its own TQM program. Suggests that quality assurance in child-care settings is an ongoing process, and that TQM programs help in providing consistent, high-quality…

Water Technology Innovation: 10 Market Opportunities

EPA Pesticide Factsheets

The Water Technology Innovation Blueprint offers an overview of market opportunities that include conserving and recovering energy, recovering nutrients, improving water infrastructure, reducing costs for water monitoring, and improving water quality.

Effects on work ability, job strain and quality of life of monitoring depression using a self-assessment instrument in recurrent general practitioner consultations: A randomized controlled study.

PubMed

Petersson, E-L; Wikberg, C; Westman, J; Ariai, N; Nejati, S; Björkelund, C

2018-05-01

Depression reduces individuals' function and work ability and is associated with both frequent and long-term sickness absence. Investigate if monitoring of depression course using a self-assessment instrument in recurrent general practitioner (GP) consultations leads to improved work ability, decreased job strain, and quality of life among primary care patients. Primary care patients n = 183, who worked. In addition to regular treatment (control group), intervention patients received evaluation and monitoring and used the MADRS-S depression scale during GP visit at baseline and at visits 4, 8, and 12 weeks. Work ability, quality of life and job strain were outcome measures. Depression symptoms decreased in all patients. Significantly steeper increase of WAI at 3 months in the intervention group. Social support was perceived high in a significantly higher frequency in intervention group compared to control group. Monitoring of depression course using a self-assessment instrument in recurrent GP consultations seems to lead to improved self-assessed work ability and increased high social support, but not to reduced job strain or increased quality of life compared to TAU. Future studies concerning rehabilitative efforts that seek to influence work ability probably also should include more active interventions at the workplace.

To What Extent is Drinking Water Tested in Sub-Saharan Africa? A Comparative Analysis of Regulated Water Quality Monitoring.

PubMed

Peletz, Rachel; Kumpel, Emily; Bonham, Mateyo; Rahman, Zarah; Khush, Ranjiv

2016-03-02

Water quality information is important for guiding water safety management and preventing water-related diseases. To assess the current status of regulated water quality monitoring in sub-Saharan Africa, we evaluated testing programs for fecal contamination in 72 institutions (water suppliers and public health agencies) across 10 countries. Data were collected through written surveys, in-person interviews, and analysis of microbial water quality testing levels. Though most institutions did not achieve the testing levels specified by applicable standards or World Health Organization (WHO) Guidelines, 85% of institutions had conducted some microbial water testing in the previous year. Institutions were more likely to meet testing targets if they were suppliers (as compared to surveillance agencies), served larger populations, operated in urban settings, and had higher water quality budgets (all p < 0.05). Our results indicate that smaller water providers and rural public health offices will require greater attention and additional resources to achieve regulatory compliance for water quality monitoring in sub-Saharan Africa. The cost-effectiveness of water quality monitoring should be improved by the application of risk-based water management approaches. Efforts to strengthen monitoring capacity should pay greater attention to program sustainability and institutional commitment to water safety.

To What Extent is Drinking Water Tested in Sub-Saharan Africa? A Comparative Analysis of Regulated Water Quality Monitoring

PubMed Central

Peletz, Rachel; Kumpel, Emily; Bonham, Mateyo; Rahman, Zarah; Khush, Ranjiv

2016-01-01

Water quality information is important for guiding water safety management and preventing water-related diseases. To assess the current status of regulated water quality monitoring in sub-Saharan Africa, we evaluated testing programs for fecal contamination in 72 institutions (water suppliers and public health agencies) across 10 countries. Data were collected through written surveys, in-person interviews, and analysis of microbial water quality testing levels. Though most institutions did not achieve the testing levels specified by applicable standards or World Health Organization (WHO) Guidelines, 85% of institutions had conducted some microbial water testing in the previous year. Institutions were more likely to meet testing targets if they were suppliers (as compared to surveillance agencies), served larger populations, operated in urban settings, and had higher water quality budgets (all p < 0.05). Our results indicate that smaller water providers and rural public health offices will require greater attention and additional resources to achieve regulatory compliance for water quality monitoring in sub-Saharan Africa. The cost-effectiveness of water quality monitoring should be improved by the application of risk-based water management approaches. Efforts to strengthen monitoring capacity should pay greater attention to program sustainability and institutional commitment to water safety. PMID:26950135

Improving the Quantity and Quality of Attendance Data to Enhance Student Retention

ERIC Educational Resources Information Center

Bowen, Eleri; Price, Trevor; Lloyd, Steve; Thomas, Steve

2005-01-01

This article draws attention to local and global attendance monitoring in higher education. The paper outlines benefits of attendance monitoring for both the individual learner and university, and compares traditional paper-based attendance monitoring systems with an electronic system piloted in the Business School and School of Technology at the…

Microfluidics for food, agriculture and biosystems industries.

PubMed

Neethirajan, Suresh; Kobayashi, Isao; Nakajima, Mitsutoshi; Wu, Dan; Nandagopal, Saravanan; Lin, Francis

2011-05-07

Microfluidics, a rapidly emerging enabling technology has the potential to revolutionize food, agriculture and biosystems industries. Examples of potential applications of microfluidics in food industry include nano-particle encapsulation of fish oil, monitoring pathogens and toxins in food and water supplies, micro-nano-filtration for improving food quality, detection of antibiotics in dairy food products, and generation of novel food structures. In addition, microfluidics enables applications in agriculture and animal sciences such as nutrients monitoring and plant cells sorting for improving crop quality and production, effective delivery of biopesticides, simplified in vitro fertilization for animal breeding, animal health monitoring, vaccination and therapeutics. Lastly, microfluidics provides new approaches for bioenergy research. This paper synthesizes information of selected microfluidics-based applications for food, agriculture and biosystems industries. © The Royal Society of Chemistry 2011

Monitoring game-based motor rehabilitation of patients at home for better plans of care and quality of life.

PubMed

Ponte, S; Gabrielli, S; Jonsdottir, J; Morando, M; Dellepiane, S

2015-01-01

This paper describes the biomedical, remote monitoring infrastructure developed and currently tested in the EU REHAB@HOME project to support home rehabilitation of the upper extremity of persons post-stroke and in persons with other neurological disorders, such as Multiple Sclerosis patients, in order to track their progress over therapy and improve their Quality of Life. The paper will specifically focus on describing the initial testing of the tele-rehabilitation system's components for patients' biomedical monitoring over therapy, which support the delivery and monitoring of more personalized, engaging plans of care by rehabilitation centers and services.

7 CFR 2.61 - Chief, Natural Resources Conservation Service.

Code of Federal Regulations, 2010 CFR

2010-01-01

... water quality, and several surveying and monitoring activities related to environmental improvement. All are designed to assure: (i) Quality in the natural resource base for sustained use; (ii) Quality in... otherwise delegated to the Administrator, Agricultural Research Service in § 2.65(a)(80) and the...

7 CFR 2.61 - Chief, Natural Resources Conservation Service.

Code of Federal Regulations, 2011 CFR

2011-01-01

... water quality, and several surveying and monitoring activities related to environmental improvement. All are designed to assure: (i) Quality in the natural resource base for sustained use; (ii) Quality in... otherwise delegated to the Administrator, Agricultural Research Service in § 2.65(a)(80) and the...

Performance Evaluation of the Operational Air Quality Monitor for Water Testing Aboard the International Space Station

NASA Technical Reports Server (NTRS)

Wallace, William T.; Limero, Thomas F.; Gazda, Daniel B.; Macatangay, Ariel V.; Dwivedi, Prabha; Fernandez, Facundo M.

2014-01-01

In the history of manned spaceflight, environmental monitoring has relied heavily on archival sampling. For short missions, this type of sample collection was sufficient; returned samples provided a snapshot of the presence of chemical and biological contaminants in the spacecraft air and water. However, with the construction of the International Space Station (ISS) and the subsequent extension of mission durations, soon to be up to one year, the need for enhanced, real-time environmental monitoring became more pressing. The past several years have seen the implementation of several real-time monitors aboard the ISS, complemented with reduced archival sampling. The station air is currently monitored for volatile organic compounds (VOCs) using gas chromatography-differential mobility spectrometry (Air Quality Monitor [AQM]). The water on ISS is analyzed to measure total organic carbon and biocide concentrations using the Total Organic Carbon Analyzer (TOCA) and the Colorimetric Water Quality Monitoring Kit (CWQMK), respectively. The current air and water monitors provide important data, but the number and size of the different instruments makes them impractical for future exploration missions. It is apparent that there is still a need for improvements in environmental monitoring capabilities. One such improvement could be realized by modifying a single instrument to analyze both air and water. As the AQM currently provides quantitative, compound-specific information for target compounds present in air samples, and many of the compounds are also targets for water quality monitoring, this instrument provides a logical starting point to evaluate the feasibility of this approach. In this presentation, we will discuss our recent studies aimed at determining an appropriate method for introducing VOCs from water samples into the gas phase and our current work, in which an electro-thermal vaporization unit has been interfaced with the AQM to analyze target analytes at the relevant concentrations at which they are routinely detected in archival water samples from the ISS.

Spatial Analysis of Air Quality Monitor Data in China, Japan, and South Korea

NASA Astrophysics Data System (ADS)

Rohde, Robert

2016-04-01

In 2015, Berkeley Earth published a widely-reported study concluding that air pollution contributes to 1.6 million deaths per year in China. This presentation will provide an update on that work with additional data for China and new analysis for South Korea and Japan. In China, two years of data from more than 1500 monitoring stations allows local trends to be estimated. Preliminary review indicates a trend towards improving air quality across most of China with decreasing emissions at most major population centers. Such improvements are consistent with tightening emissions standards and the decreasing usage of coal. In addition, new spatial analysis has been applied to ~900 monitoring sites in Japan and ~120 sites in South Korea. This new analysis provides information on air quality, pollutant source distributions, and implied mortality in these countries. Finally, boundary crossing fluxes in South Korea and Japan have been used to estimate the fraction of air pollution in Japan and South Korea that has being imported from sources in China.

Efficacy of critical incident monitoring for evaluating disaster medical readiness and response during the Sydney 2000 Olympic Games.

PubMed

Flabouris, Arthas; Nocera, Antony; Garner, Alan

2004-01-01

Multiple casualty incidents (MCI) are infrequent events for medical systems. This renders audit and quality improvement of the medical responses difficult. Quality tools and use of such tools for improvement is necessary to ensure that the design of medical systems facilitates the best possible response to MCI. To describe the utility of incident reporting as a quality monitoring and improvement tool during the deployment of medical teams for mass gatherings and multiple casualty incidents. Voluntary and confidential reporting of incidents was provided by members of the disaster medical response teams during the period of disaster medical team deployment for the 2000 Sydney Olympic Games. Qualitative evaluations were conducted of reported incidents. The main outcome measures included the nature of incident and associated contributing factors, minimization factors, harm potential, and comparison with the post-deployment, cold debriefings. A total of 53 incidents were reported. Management-based decisions, poor or non-existent protocols, and equipment and communication-related issues were the principal contributing factors. Eighty nine percent of the incidents were considered preventable. A potential for harm to patients and/or team members was documented in 58% of reports, of which 76% were likely to cause at least significant harm. Of equipment incidents, personal protective equipment (33%), medical equipment (27%), provision of equipment (22%), and communication equipment (17%) predominated. Personal protective equipment (50%) was reported as the most frequent occupational health and safety incident followed by fatigue (25%). Pre-deployment planning was the most important factor for future incident impact minimization. Incident monitoring was efficacious as a quality tool in identifying incident contributing factors. Incident monitoring allowed for greater systems evaluation. Further evaluation of this quality tool within different disaster settings is required.

Loch Vale Watershed Long-Term Ecological Research and Monitoring Program: Quality Assurance Report, 2003-09

USGS Publications Warehouse

Richer, Eric E.; Baron, Jill S.

2011-01-01

The Loch Vale watershed project is a long-term research and monitoring program located in Rocky Mountain National Park that addresses watershed-scale ecosystem processes, particularly as they respond to atmospheric deposition and climate variability. Measurements of precipitation depth, precipitation chemistry, discharge, and surface-water quality are made within the watershed and elsewhere in Rocky Mountain National Park. As data collected for the program are used by resource managers, scientists, policy makers, and students, it is important that all data collected in Loch Vale watershed meet high standards of quality. In this report, data quality was evaluated for precipitation, discharge, and surface-water chemistry measurements collected during 2003-09. Equipment upgrades were made at the Loch Vale National Atmospheric Deposition Program monitoring site to improve precipitation measurements and evaluate variability in precipitation depth and chemistry. Additional solar panels and batteries have been installed to improve the power supply, and data completeness, at the NADP site. As a result of equipment malfunction, discharge data for the Loch Outlet were estimated from October 18, 2005, to August 17, 2006. Quality-assurance results indicate that more than 98 percent of all surface-water chemistry measurements were accurate and precise. Records that did not meet quality criteria were removed from the database. Measurements of precipitation depth, precipitation chemistry, discharge, and surface-water quality were all sufficiently complete and consistent to support project data needs.

Aerospace technology and hospital systems

NASA Technical Reports Server (NTRS)

1972-01-01

The use of aerospace medical techniques to improve the quality of earth health care systems is discussed. Data are focused on physiological measurements and monitoring, medical information management, clean room technology, and reliability and quality assurance for hospital equipment.

42 CFR 495.316 - State monitoring and reporting regarding activities required to receive an incentive payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... quality measures data; and (v) A description and quantitative data on how its incentive payment program... for quality improvement, reduction of disparities, research or outreach. (ii) Capability to submit...

42 CFR 495.316 - State monitoring and reporting regarding activities required to receive an incentive payment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... quality measures data; and (v) A description and quantitative data on how its incentive payment program... for quality improvement, reduction of disparities, research or outreach. (ii) Capability to submit...

Developing policy, standard orders, and quality-assurance monitoring for palliative sedation therapy.

PubMed

Ghafoor, Virginia L; Silus, Lauren S

2011-03-15

The development of a policy, evidence-based standard orders, and monitoring for palliative sedation therapy (PST) is described. Concerns regarding PST at the University of Minnesota Medical Center (UMMC) arose and needed to be addressed in a formal process. A multidisciplinary group consisting of palliative care physicians, nurse practitioners, clinical nurse specialists, and clinical pharmacy specialists reached consensus on the practice model and medications to be used for PST. Major elements of the plan included the development and implementation of an institutional policy for palliative sedation; standard orders for patient care, sedation, and monitoring; education for staff, patients, and patients' family members; and quality-assurance monitoring. A literature review was performed to identify research and guidelines defining the practice of PST. Policy content includes the use of a standard order set linking patient care, medication administration, the monitoring of sedation, and symptom management. Approval of the policy involved several UMMC committees. An evaluation matrix was used to determine critical areas for PST monitoring and to guide development of a form to monitor quality. A retrospective chart audit using the quality-assurance monitoring form assessed baseline sedation medication and patient outcomes. Assessment of compliance began in the fall of 2008, after the policy and standard orders were approved by the UMMC medical executive committee. In 2008, two cases of PST were monitored using the standardized form. PST cases will be continually monitored and analyzed. Development of policy, standard orders, and quality-assurance monitoring for PST required a formal multidisciplinary process. A process-improvement process is critical to defining institutional policy, educational goals, and outcome metrics for PST.

Thermoelectric converters for monitoring the temperature of salt baths

NASA Astrophysics Data System (ADS)

Spektor, Yu. A.

1985-02-01

It is recommended to use RTEC in lieu of a radiational pyrometer and an STEC to monitor and maintain the temperature automatically in high-temperature salt melts; this contributes to a marked improvement in the quality of heat-treated components.

7 CFR 2.61 - Chief, Natural Resources Conservation Service.

Code of Federal Regulations, 2014 CFR

2014-01-01

... water quality, and several surveying and monitoring activities related to environmental improvement. All are designed to assure: (i) Quality in the natural resource base for sustained use; (ii) Quality in... otherwise delegated to the Administrator, Agricultural Research Service in § 2.65(a)(80) and the Director...

7 CFR 2.61 - Chief, Natural Resources Conservation Service.

Code of Federal Regulations, 2012 CFR

2012-01-01

... water quality, and several surveying and monitoring activities related to environmental improvement. All are designed to assure: (i) Quality in the natural resource base for sustained use; (ii) Quality in... otherwise delegated to the Administrator, Agricultural Research Service in § 2.65(a)(80) and the Director...

7 CFR 2.61 - Chief, Natural Resources Conservation Service.

Code of Federal Regulations, 2013 CFR

2013-01-01

... water quality, and several surveying and monitoring activities related to environmental improvement. All are designed to assure: (i) Quality in the natural resource base for sustained use; (ii) Quality in... otherwise delegated to the Administrator, Agricultural Research Service in § 2.65(a)(80) and the Director...

Statistical analysis of the water-quality monitoring program, Upper Klamath Lake, Oregon, and optimization of the program for 2013 and beyond

USGS Publications Warehouse

Eldridge, Sara L. Caldwell; Wherry, Susan A.; Wood, Tamara M.

2014-01-01

Upper Klamath Lake in south-central Oregon has become increasingly eutrophic over the past century and now experiences seasonal cyanobacteria-dominated and potentially toxic phytoplankton blooms. Growth and decline of these blooms create poor water-quality conditions that can be detrimental to fish, including two resident endangered sucker species. Upper Klamath Lake is the primary water supply to agricultural areas within the upper Klamath Basin. Water from the lake is also used to generate power and to enhance and sustain downstream flows in the Klamath River. Water quality in Upper Klamath Lake has been monitored by the Klamath Tribes since the early 1990s and by the U.S. Geological Survey (USGS) since 2002. Management agencies and other stakeholders have determined that a re-evaluation of the goals for water-quality monitoring is warranted to assess whether current data-collection activities will continue to adequately provide data for researchers to address questions of interest and to facilitate future natural resource management decisions. The purpose of this study was to (1) compile an updated list of the goals and objectives for long-term water-quality monitoring in Upper Klamath Lake with input from upper Klamath Basin stakeholders, (2) assess the current water-quality monitoring programs in Upper Klamath Lake to determine whether existing data-collection strategies can fulfill the updated goals and objectives for monitoring, and (3) identify potential modifications to future monitoring plans in accordance with the updated monitoring objectives and improve stakeholder cooperation and data-collection efficiency. Data collected by the Klamath Tribes and the USGS were evaluated to determine whether consistent long-term trends in water-quality variables can be described by the dataset and whether the number and distribution of currently monitored sites captures the full range of environmental conditions and the multi-scale variability of water-quality parameters in the lake. Also, current monitoring strategies were scrutinized for unnecessary redundancy within the overall network.

Statistical monitoring of data quality and consistency in the Stomach Cancer Adjuvant Multi-institutional Trial Group Trial.

PubMed

Timmermans, Catherine; Doffagne, Erik; Venet, David; Desmet, Lieven; Legrand, Catherine; Burzykowski, Tomasz; Buyse, Marc

2016-01-01

Data quality may impact the outcome of clinical trials; hence, there is a need to implement quality control strategies for the data collected. Traditional approaches to quality control have primarily used source data verification during on-site monitoring visits, but these approaches are hugely expensive as well as ineffective. There is growing interest in central statistical monitoring (CSM) as an effective way to ensure data quality and consistency in multicenter clinical trials. CSM with SMART™ uses advanced statistical tools that help identify centers with atypical data patterns which might be the sign of an underlying quality issue. This approach was used to assess the quality and consistency of the data collected in the Stomach Cancer Adjuvant Multi-institutional Trial Group Trial, involving 1495 patients across 232 centers in Japan. In the Stomach Cancer Adjuvant Multi-institutional Trial Group Trial, very few atypical data patterns were found among the participating centers, and none of these patterns were deemed to be related to a quality issue that could significantly affect the outcome of the trial. CSM can be used to provide a check of the quality of the data from completed multicenter clinical trials before analysis, publication, and submission of the results to regulatory agencies. It can also form the basis of a risk-based monitoring strategy in ongoing multicenter trials. CSM aims at improving data quality in clinical trials while also reducing monitoring costs.

Expert Water Quality Panel Review of Responses to the NASA Request for Information for the International Space Station On-Board Environmental Monitoring System

NASA Technical Reports Server (NTRS)

Fishman, Julianna L.; Mudgett, Paul D.; Packham, Nigel J.; Schultz, John R.; Straub, John E., II

2005-01-01

On August 9, 2003, NASA, with the cooperative support of the Vehicle Office of the International Space Station Program, the Advanced Human Support Technology Program, and the Johnson Space Center Habitability and Environmental Factors Office released a Request for Information, or RFI, to identify next-generation environmental monitoring systems that have demonstrated ability or the potential to meet defined requirements for monitoring air and water quality onboard the International Space Station. This report summarizes the review and analysis of the proposed solutions submitted to meet the water quality monitoring requirements. Proposals were to improve upon the functionality of the existing Space Station Total Organic Carbon Analyzer (TOCA) and monitor additional contaminants in water samples. The TOCA is responsible for in-flight measurement of total organic carbon, total inorganic carbon, total carbon, pH, and conductivity in the Space Station potable water supplies. The current TOCA requires hazardous reagents to accomplish the carbon analyses. NASA is using the request for information process to investigate new technologies that may improve upon existing capabilities, as well as reduce or eliminate the need for hazardous reagents. Ideally, a replacement for the TOCA would be deployed in conjunction with the delivery of the Node 3 water recovery system currently scheduled for November 2007.

Practical Approaches to Quality Improvement for Radiologists.

PubMed

Kelly, Aine Marie; Cronin, Paul

2015-10-01

Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

Continuous quality improvement interventions to improve long-term outcomes of antiretroviral therapy in women who initiated therapy during pregnancy or breastfeeding in the Democratic Republic of Congo: design of an open-label, parallel, group randomized trial.

PubMed

Yotebieng, Marcel; Behets, Frieda; Kawende, Bienvenu; Ravelomanana, Noro Lantoniaina Rosa; Tabala, Martine; Okitolonda, Emile W

2017-04-26

Despite the rapid adoption of the World Health Organization's 2013 guidelines, children continue to be infected with HIV perinatally because of sub-optimal adherence to the continuum of HIV care in maternal and child health (MCH) clinics. To achieve the UNAIDS goal of eliminating mother-to-child HIV transmission, multiple, adaptive interventions need to be implemented to improve adherence to the HIV continuum. The aim of this open label, parallel, group randomized trial is to evaluate the effectiveness of Continuous Quality Improvement (CQI) interventions implemented at facility and health district levels to improve retention in care and virological suppression through 24 months postpartum among pregnant and breastfeeding women receiving ART in MCH clinics in Kinshasa, Democratic Republic of Congo. Prior to randomization, the current monitoring and evaluation system will be strengthened to enable collection of high quality individual patient-level data necessary for timely indicators production and program outcomes monitoring to inform CQI interventions. Following randomization, in health districts randomized to CQI, quality improvement (QI) teams will be established at the district level and at MCH clinics level. For 18 months, QI teams will be brought together quarterly to identify key bottlenecks in the care delivery system using data from the monitoring system, develop an action plan to address those bottlenecks, and implement the action plan at the level of their district or clinics. If proven to be effective, CQI as designed here, could be scaled up rapidly in resource-scarce settings to accelerate progress towards the goal of an AIDS free generation. The protocol was retrospectively registered on February 7, 2017. ClinicalTrials.gov Identifier: NCT03048669 .

High-frequency phosphorus and nitrate measurements for improved statutory water quality monitoring and management

NASA Astrophysics Data System (ADS)

Bieroza, Magdalena

2017-04-01

High-frequency nutrient (phosphorus and nitrogen) monitoring using wet-chemistry analysers and optical sensors has revolutionised the collection of biogeochemical data from streams, rivers and lakes. Matching the nutrient measurement time with timescales of hydrological responses has revealed biogeochemical patterns and nutrient hydrological responses not observed previously. Capturing a wider range of nutrient concentrations compared to traditional coarse resolution sampling enables more accurate estimation of mean concentrations and loads and thus improved water body classification. However, to date the scientific insights from the high-frequency nutrient monitoring studies have not been translated into policy and operational responses. The pertinent question is where and how often to measure nutrients to satisfy statutory monitoring requirements for the Water Framework Directive and the Nitrates Directive. Therefore this paper discusses how the reduced data uncertainty and improved process understanding obtained with the high-frequency measurements can improve statutory nutrient monitoring, using case studies from England and Sweden.

Quality assurance and quality improvement in U.S. clinical molecular genetic laboratories.

PubMed

Chen, Bin; Richards, C Sue; Wilson, Jean Amos; Lyon, Elaine

2011-04-01

A robust quality-assurance program is essential for laboratories that perform molecular genetic testing to maintain high-quality testing and be able to address challenges associated with performance or delivery of testing services as the use of molecular genetic tests continues to expand in clinical and public health practice. This unit discusses quality-assurance and quality-improvement considerations that are critical for molecular genetic testing performed for heritable diseases and conditions. Specific discussion is provided on applying regulatory standards and best practices in establishing/verifying test performance, ensuring quality of the total testing process, monitoring and maintaining personnel competency, and continuing quality improvement. The unit provides a practical reference for laboratory professionals to use in recognizing and addressing essential quality-assurance issues in human molecular genetic testing. It should also provide useful information for genetics researchers, trainees, and fellows in human genetics training programs, as well as others who are interested in quality assurance and quality improvement for molecular genetic testing. 2011 by John Wiley & Sons, Inc.

Heart failure patients utilizing an electric home monitor: What effects does heart failure have on their quality of life?

NASA Astrophysics Data System (ADS)

Simuel, Gloria J.

Heart Failure continues to be a major public health problem associated with high mortality and morbidity. Heart Failure is the leading cause of hospitalization for persons older than 65 years, has a poor prognosis and is associated with poor quality of life. More than 5.3 million American adults are living with heart failure. Despite maximum medical therapy and frequent hospitalizations to stabilize their condition, one in five heart failure patients die within the first year of diagnosis. Several disease-management programs have been proposed and tested to improve the quality of heart failure care. Studies have shown that hospital admissions and emergency room visits decrease with increased nursing interventions in the home and community setting. An alternative strategy for promoting self-management of heart failure is the use of electronic home monitoring. The purpose of this study was to examine what effects heart failure has on patient's quality of life that had been monitoring on an electronic home monitor longer than 2 months. Twenty-one questionnaires were given to patients utilizing an electronic home monitor by their home health agency nurse. Eleven patients completed the questionnaire. The findings showed that there is some deterioration in quality of life with more association with the physical aspects of life than with the emotional aspects of life, which probably was due to the small sample size. There was no significant difference in readmission rates in patients utilizing an electronic home monitor. Further research is needed with a larger population of patients with chronic heart failure and other chronic diseases which may provide more data, and address issues such as patient compliance with self-care, impact of heart failure on patient's quality of life, functional capacity, and heart failure patient's utilization of the emergency rooms and hospital. Telemonitoring holds promise for improving the self-care abilities of persons with HF.

Relationships between environmental governance and water quality in a growing metropolitan area of the Pacific Northwest, USA

NASA Astrophysics Data System (ADS)

Chang, H.; Thiers, P.; Netusil, N. R.; Yeakley, J. A.; Rollwagen-Bollens, G.; Bollens, S. M.; Singh, S.

2014-04-01

We investigate relationships between environmental governance and water quality in two adjacent growing metropolitan areas in the western US. While the Portland, Oregon and Vancouver, Washington metro areas share many common biophysical characteristics, they have different land development histories and water governance structures, providing a unique opportunity for examining how differences in governance might affect environmental quality. We conceptualize possible linkages in which water quality influences governance directly, using monitoring efforts as a metric, and indirectly by using the change in the sale price of single-family residential properties. Governance may then influence water quality directly through riparian restoration resulting from monitoring results and indirectly through land use policy. We investigate evidence to substantiate these linkages. Our results showed that changes in monitoring regimes and land development patterns differed in response to differences in growth management policy and environmental governance systems. Our results also showed similarities in environmental quality responses to varying governance systems. For example, we found that sales prices responded positively to improved water quality (e.g., increases in DO and reductions in bacteria counts) in both cities. Furthermore, riparian restoration efforts improved over time for both cities, indicating the positive effect of governance on this land-based resource that may result in improved water quality. However, as of yet, there were no substantial differences across study areas in water temperature over time, despite an expansion of these urban areas of more than 20 % over 24 years. The mechanisms by which water quality was maintained was similar in the sense that both cities benefited from riparian restoration, but different in the sense that Portland benefited indirectly from land use policy. A combination of long-term legacy effects of land development, and a relatively short history of riparian restoration in both the Portland and Vancouver regions, may have masked any subtle differences between study areas. An alternative explanation is that both cities exhibited combinations of positive indirect and direct water quality governance that resulted in maintenance of water quality in the face of increased urban growth. These findings suggest that a much longer-term water quality monitoring effort is needed to identify the effectiveness of alternative land development and water governance policies.

The use of patient feedback by hospital boards of directors: a qualitative study of two NHS hospitals in England

PubMed Central

Lee, Robert; Baeza, Juan I; Fulop, Naomi J

2018-01-01

Background Although previous research suggests that different kinds of patient feedback are used in different ways to help improve the quality of hospital care, there have been no studies of the ways in which hospital boards of directors use feedback for this purpose. Objectives To examine whether and how boards of directors of hospitals use feedback from patients to formulate strategy and to assure and improve the quality of care. Methods We undertook an in-depth qualitative study in two acute hospital National Health Service foundation trusts in England, purposively selected as contrasting examples of the collection of different kinds of patient feedback. We collected and analysed data from interviews with directors and other managers, from observation of board meetings, and from board papers and other documents. Results The two boards used in-depth qualitative feedback and quantitative feedback from surveys in different ways to help develop strategies, set targets for quality improvement and design specific quality improvement initiatives; but both boards made less subsequent use of any kinds of feedback to monitor their strategies or explicitly to assure the quality of services. Discussion and conclusions We have identified limitations in the uses of patient feedback by hospital boards that suggest that boards should review their current practice to ensure that they use the different kinds of patient feedback that are available to them more effectively to improve, monitor and assure the quality of care. PMID:28754814

Efficacy of monitoring and empirical predictive modeling at improving public health protection at Chicago beaches

USGS Publications Warehouse

Nevers, Meredith B.; Whitman, Richard L.

2011-01-01

Efforts to improve public health protection in recreational swimming waters have focused on obtaining real-time estimates of water quality. Current monitoring techniques rely on the time-intensive culturing of fecal indicator bacteria (FIB) from water samples, but rapidly changing FIB concentrations result in management errors that lead to the public being exposed to high FIB concentrations (type II error) or beaches being closed despite acceptable water quality (type I error). Empirical predictive models may provide a rapid solution, but their effectiveness at improving health protection has not been adequately assessed. We sought to determine if emerging monitoring approaches could effectively reduce risk of illness exposure by minimizing management errors. We examined four monitoring approaches (inactive, current protocol, a single predictive model for all beaches, and individual models for each beach) with increasing refinement at 14 Chicago beaches using historical monitoring and hydrometeorological data and compared management outcomes using different standards for decision-making. Predictability (R2) of FIB concentration improved with model refinement at all beaches but one. Predictive models did not always reduce the number of management errors and therefore the overall illness burden. Use of a Chicago-specific single-sample standard-rather than the default 235 E. coli CFU/100 ml widely used-together with predictive modeling resulted in the greatest number of open beach days without any increase in public health risk. These results emphasize that emerging monitoring approaches such as empirical models are not equally applicable at all beaches, and combining monitoring approaches may expand beach access.

Planning and Monitoring the Quality of Primary Education in Sub-Saharan Africa. AFTHR Technical Note No. 14.

ERIC Educational Resources Information Center

Heneveld, Ward

This report is based on the conviction that improvements in the quality of education must focus on the school as the unit of change. Through a review of the qualitative research literature on school improvement and the more quantitative literature on school effectiveness, a conceptual framework that identifies generic factors that determine school…

Twelve Months of Air Quality Monitoring at Ash Meadows National Wildlife Refuge, Southwestern Rural Nevada, U.S.A (EMSI April 2007)

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

Engelbrecht, Johann P; Shafer, David S; Campbell, Dave

The one year of air quality monitoring data collected at the Ash Meadows National Wildlife Refuge (NWR) was the final part of the air quality "Scoping Studies" for the Environmental Monitoring Systems Initiative (EMSI) in southern and central Nevada. The objective of monitoring at Ash Meadows was to examine aerosol and meteorological data, seasonal trends in aerosol and meteorological parameters as well as to examine evidence for long distance transport of some constituents. The 9,307 hectare refuge supports more than 50 springs and 24 endemic species, including the only population of the federally listed endangered Devil’s Hole pupfish (Cyprinodon diabolis)more » (U.S. Fish and Wildlife Service, 1990). Ash Meadows NWR is located in a Class II air quality area, and the aerosol measurements collected with this study are compared to those of Interagency Monitoring of Protected Visual Environments (IMPROVE) sites. Measurements taken at Ash Meadows NWR over a period of 12 months provide new baseline air quality and meteorological information for rural southwestern Nevada, specifically Nye County and the Amargosa Valley.« less

Large-scale monitoring of air pollution in remote and ecologically important areas

Treesearch

Andrzej Bytnerowicz; Witold Fraczek

2013-01-01

New advances in air quality monitoring techniques, such as passive samplers for nitrogenous (N) or sulphurous (S) pollutants and ozone (O3), have allowed for an improved understanding of concentrations of these pollutants in remote areas. Mountains create special problems with regard to the feasibility of establishing and maintaining air pollution monitoring networks,...

Efficacy of a Self-Monitoring Tool for Improving the Quality of the Language Environment in the Preschool Classroom

ERIC Educational Resources Information Center

Strasser, Katherine; Mendive, Susana; Vergara, Daniela; Darricades, Michelle

2018-01-01

Research Findings: This study evaluated the impact of a self-monitoring intervention on preschool teachers' use of language and on children's language growth. Nineteen classrooms from Santiago de Chile participated (10 intervention, 9 control). Twice a week, intervention teachers filled out a checklist to monitor the language stimulation they…

Improving the quality of healthcare for children: implementing the results of the AHSR research agenda conference.

PubMed Central

Halfon, N; Schuster, M; Valentine, W; McGlynn, E

1998-01-01

OBJECTIVE: To describe the rationale, development, content, and results of the AHSR-sponsored conference on developing a research agenda focused on improving the quality of care for children. DATA SOURCES AND METHODS: Planning documents, background papers, and conference proceedings. PRINCIPAL FINDINGS: The conference developed the research agenda focused on (1) monitoring the health of children; (2) evaluating the efficacy and effectiveness of health services for children; (3) assessing the quality of healthcare provided to children; (4) improving the quality of healthcare within health systems; (5) assessing the performance of community systems for children; (6) exploring the impact of different financial incentives on the provision of pediatric healthcare; and (7) developing and disseminating clinical practice guidelines and other information to physicians, families, and consumers. Specific issues and research questions in each area are also presented. Strategies for implementing the research agenda are presented and include: (1) expanding the child health services research workforce; (2) developing child healthcare quality improvement research centers; (3) conducting research in specific high-priority areas; (4) focusing research on improving the health of vulnerable populations; (5) improving child health data and collection systems at the national level; (6) developing better community health monitoring for children; (7) building and supporting research networks and a consortium of research users; and (8) developing a coordinated interagency federal effort to advance this agenda and to provide accountability for its completion. CONCLUSION: The proposed research agenda should be a national priority so that all Americans can be assured that children are receiving the best quality of care that the United States can provide. PMID:9776945

Practical Insight to Monitor Home NIV in COPD Patients.

PubMed

Arnal, Jean-Michel; Texereau, Joëlle; Garnero, Aude

2017-08-01

Home noninvasive ventilation (NIV) is used in COPD patients with concomitant chronic hypercapnic respiratory failure in order to correct nocturnal hypoventilation and improve sleep quality, quality of life, and survival. Monitoring of home NIV is needed to assess the effectiveness of ventilation and adherence to therapy, resolve potential adverse effects, reinforce patient knowledge, provide maintenance of the equipment, and readjust the ventilator settings according to the changing condition of the patient. Clinical monitoring is very informative. Anamnesis focuses on the improvement of nocturnal hypoventilation symptoms, sleep quality, and side effects of NIV. Side effects are major cause of intolerance. Screening side effects leads to modification of interface, gas humidification, or ventilator settings. Home care providers maintain ventilator and interface and educate patients for correct use. However, patient's education should be supervised by specialized clinicians. Blood gas measurement shows a significant decrease in PaCO 2 when NIV is efficient. Analysis of ventilator data is very useful to assess daily use, unintentional leaks, upper airway obstruction, and patient ventilator synchrony. Nocturnal oximetry and capnography are additional monitoring tools to assess the impact of NIV on gas exchanges. In the near future, telemonitoring will reinforce and change the organization of home NIV for COPD patients.

Metropolitan transportation management center : a case study : Milwaukee MONITOR : addressing congestion while improving safety and air quality

DOT National Transportation Integrated Search

1999-10-01

The following case study provides a snapshot of Milwaukee's MONITOR transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross Cutting Stu...

Assessing the Value of Enhancing AirNow Data with NASA Satellite Data

NASA Astrophysics Data System (ADS)

Pasch, A. N.; Burke, B.; Huang, S.; Dye, T.; Dawes, S. S.; DeWinter, J. L.; Zahn, P. H.; Haderman, M.; Szykman, J.; White, J. E.; Dickerson, P.; van Donkelaar, A.; Martin, R.

2013-12-01

We will describe the methodology and findings from a study that addressed how satellite-enhanced air quality information provided through the U.S. Environmental Protection Agency's (EPA) AirNow Satellite Data Processor (ASDP) program could contribute to greater socioeconomic benefits. This study was funded by the National Aeronautics and Space Administration (NASA) and conducted, in partnership with the EPA, by the Center for Technology in Government at the University at Albany (CTG) and Sonoma Technology, Inc. (STI). AirNow is the national repository of real-time air quality data and forecasts for the United States. While mainly a public outreach and awareness tool, AirNow relies on the same network of ground-based air quality monitors that is used by federal, state, local, and tribal governments throughout the United States. Extensive as the monitoring network is, considerable gaps exist in certain parts of the United States. Even areas with monitors considered adequate for regulatory purposes can lack information needed to resolve localized air quality issues or give forecasters sufficient confidence about the potential air quality impact of specific events. Monitors are expensive to deploy and maintain; thus, EPA is seeking other ways to improve coverage and detail. Satellite-estimated data can provide information for many places where ground monitors do not exist, and supplement ground monitors, providing additional information for use in analysis and forecasting. ASDP uses satellite-derived estimates for fine-particle pollution (PM2.5) and provides coverage for a small window of time during the day. As satellite capabilities improve in terms of different types of sensors and increased coverage throughout the day, the ASDP program is prepared to extend its scope to additional pollutants and provide greater enhancements to the ground-based networks. In this study, CTG assessed the socioeconomic benefits of air quality data at a community level through three case studies in the Denver, Atlanta, and Kansas City regions by interviewing people at EPA regional offices, state environmental and public health agencies, local public health authorities, regional planning and non-profit outreach organizations, and universities. The interviews focused on the existing uses of air quality information and the potential value of incorporating NASA satellite-enhanced AirNow data to support and enhance the missions of the organizations interviewed. STI analyzed the economic benefit of using satellite data to fill in gaps in the current air quality monitoring network used to provide information to the public. This presentation will discuss how the findings can be used to improve estimation of the socioeconomic benefits derived from Earth observation science in policy and management decisions.

Improving rates of cotrimoxazole prophylaxis in resource-limited settings: implementation of a quality improvement approach.

PubMed

Bardfield, J; Agins, B; Palumbo, M; Wei, A L; Morris, J; Marston, B

2014-12-01

To demonstrate the effectiveness of quality improvement methods to monitor and improve administration of cotrimoxazole (CTX) prophylaxis to improve health outcomes among adults living with HIV/AIDS in low resource countries. Program evaluation. HIV/AIDS health care facilities in Uganda, Mozambique, Namibia and Haiti. Performance measures based on national guidelines are developed in each country. These may include CD4 monitoring, ART adherence and uptake of CTX prophylaxis. CTX prophylaxis is routinely selected, because it has been shown to reduce HIV-related morbidity and mortality. Patient records are sampled using a standard statistical table to achieve a minimum confidence interval of 90% with a spread of ±8% in participating clinics. If an electronic medical record is available, all patients are reviewed. Routine review of performance measures, usually every 6 months, is conducted to identify gaps in care. Improvement interventions are developed and implemented at health facilities, informed by performance results, and local/national public health priorities. Median clinic rates of CTX prophylaxis. Median performance rates of CTX prophylaxis generally improved for adult HIV+ patients between 2006 and 2013 across countries, with median clinic rates higher than baseline at follow-up in 16 of 18 groups of clinics implementing CTX -focused improvement projects. Quality management offers a data-driven method to improve the quality of HIV care in low resource countries. Application of improvement principles has been shown to be effective to increase the rates of CTX prophylaxis in national HIV programs in multiple countries. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Data fraud in clinical trials

PubMed Central

George, Stephen L; Buyse, Marc

2015-01-01

Highly publicized cases of fabrication or falsification of data in clinical trials have occurred in recent years and it is likely that there are additional undetected or unreported cases. We review the available evidence on the incidence of data fraud in clinical trials, describe several prominent cases, present information on motivation and contributing factors and discuss cost-effective ways of early detection of data fraud as part of routine central statistical monitoring of data quality. Adoption of these clinical trial monitoring procedures can identify potential data fraud not detected by conventional on-site monitoring and can improve overall data quality. PMID:25729561

Preliminary assessment of a water-quality monitoring program for total maximum daily loads in Johnson County, Kansas, January 2015 through June 2016

USGS Publications Warehouse

Rasmussen, Teresa J.; Paxson, Chelsea R.

2017-08-25

Municipalities in Johnson County in northeastern Kansas are required to implement stormwater management programs to reduce pollutant discharges, protect water quality, and comply with applicable water-quality regulations in accordance with National Pollutant Discharge Elimination System permits for stormwater discharge. To this end, municipalities collect grab samples at streams entering and leaving their jurisdiction to determine levels of excessive nutrients, sediment, and fecal bacteria to characterize pollutants and understand the factors affecting them.In 2014, the U.S. Geological Survey and the Johnson County Stormwater Management Program, with input from the Kansas Department of Health and Environment, initiated a 5-year monitoring program to satisfy minimum sampling requirements for each municipality as described by new stormwater permits issued to Johnson County municipalities. The purpose of this report is to provide a preliminary assessment of the monitoring program. The monitoring program is described, a preliminary assessment of the monitoring program design is provided using water-quality data collected during the first 2 years of the program, and the ability of the current monitoring network and sampling plan to provide data sufficient to quantify improvements in water quality resulting from implemented and planned best management practices is evaluated. The information in this initial report may be used to evaluate changes in data collection methods while data collection is still ongoing that may lead to improved data utility.Discrete water-quality samples were collected at 27 sites and analyzed for nutrients, Escherichia coli (E. coli) bacteria, total suspended solids, and suspended-sediment concentration. In addition, continuous water-quality data (water temperature, pH, dissolved oxygen, specific conductance, turbidity, and nitrate plus nitrite) were collected at one site to characterize variability and provide a basis for comparison to discrete data. Base flow samples indicated that point sources are likely affecting nutrient concentrations and E. coli bacteria densities at several sites. Concentrations of all analytes in storm runoff samples were characterized by substantial variability among sites and samples. About one-half of the sites, representing different watersheds, had storm runoff samples with nitrogen concentrations greater than 10 milligrams per liter. About one-third of the sites, representing different watersheds, had storm runoff samples with total phosphorus concentrations greater than 3 milligrams per liter. Six sites had samples with E. coli densities greater than 100,000 colonies per 100 milliliters of water. Total suspended solids concentrations of about 12,000 milligrams per liter or greater occurred in samples from three sites.Data collected for this monitoring program may be useful for some general assessment purposes but may also be limited in potential to fully inform stormwater management activities. Valuable attributes of the monitoring program design included incorporating many sites across the county for comparisons among watersheds and municipalities, using fixed-stage samplers to collect multiple samples during single events, collection of base flow samples in addition to storm samples to isolate possible point sources from stormwater sources, and use of continuous monitors to characterize variability. Limiting attributes of the monitoring program design included location of monitoring sites along municipal boundaries to satisfy permit requirements rather than using watershed-based criteria such as locations of tributaries, potential pollutant sources, and implemented management practices. Additional limiting attributes include having a large number of widespread sampling locations, which presented logistical challenges for predicting localized rainfall and collecting and analyzing samples during short timeframes associated with storms, and collecting storm samples at fixed-stage elevations only during the rising limb of storms, which does not characterize conditions over the storm hydrograph. The small number of samples collected per site resulted in a sample size too small to be representative of site conditions, including seasonal and hydrologic variability, and insufficient for meaningful statistical analysis or site-specific modeling.Several measures could be taken to improve data utility and include redesigning the monitoring network according to watershed characteristics, incorporating a nested design in which data are collected at different scales (watershed, subwatershed, and best management practices), increasing sampling frequency, and combining different methods to allow for flexibility to focus on areas and conditions of particular interest. A monitoring design that would facilitate most of these improvements would be to focus efforts on a limited number of watersheds for several years, then cycle to the next set of watersheds for several years, eventually returning to previously monitored watersheds to document changes.Redesign of the water-quality monitoring program requires considerable effort and commitment from municipalities of Johnson County. However, the long-term benefit likely is a monitoring program that results in improved stream conditions and more effective management practices and efficient expenditure of resources.

Use of cancer performance measures in population health: a macro-level perspective.

PubMed

Clauser, Steven B

2004-01-01

The use of performance measurement to inform macro-level studies of cancer control and quality of care is receiving increasing interest at the state, national, and international level. This article describes the use of these measures to inform health policy and monitor cancer disparities and disease burden. Applications are discussed in clinical and provider-reported outcomes such as cancer incidence, mortality and survival, and outcome-linked processes of care, and patient-reported outcomes such as health-related quality of life and patient satisfaction/experience with care. The use of economic measures to monitor and evaluate the burden of illness is also discussed. The growing demand for surveillance capability coupled with the need to expand both the quality and breadth of available measure sets, suggests that there is a need to supplement traditional clinical and provider-reported process and outcomes measures with patient-reported outcomes measures such as health-related quality of life and patient satisfaction and experience with care. In addition, there is also a need to broaden and standardize outcome-linked process-of-care measures to improve the ability to measure and monitor incremental progress in improving cancer care. Finally, better measures of indirect costs of cancer care, such as loss productivity and caregiver burden among the aged, would improve national estimates of the cost of illness associated with cancer.

Developing an automated database for monitoring ultrasound- and computed tomography-guided procedure complications and diagnostic yield.

PubMed

Itri, Jason N; Jones, Lisa P; Kim, Woojin; Boonn, William W; Kolansky, Ana S; Hilton, Susan; Zafar, Hanna M

2014-04-01

Monitoring complications and diagnostic yield for image-guided procedures is an important component of maintaining high quality patient care promoted by professional societies in radiology and accreditation organizations such as the American College of Radiology (ACR) and Joint Commission. These outcome metrics can be used as part of a comprehensive quality assurance/quality improvement program to reduce variation in clinical practice, provide opportunities to engage in practice quality improvement, and contribute to developing national benchmarks and standards. The purpose of this article is to describe the development and successful implementation of an automated web-based software application to monitor procedural outcomes for US- and CT-guided procedures in an academic radiology department. The open source tools PHP: Hypertext Preprocessor (PHP) and MySQL were used to extract relevant procedural information from the Radiology Information System (RIS), auto-populate the procedure log database, and develop a user interface that generates real-time reports of complication rates and diagnostic yield by site and by operator. Utilizing structured radiology report templates resulted in significantly improved accuracy of information auto-populated from radiology reports, as well as greater compliance with manual data entry. An automated web-based procedure log database is an effective tool to reliably track complication rates and diagnostic yield for US- and CT-guided procedures performed in a radiology department.

Engaging staff to improve quality and safety in an austere medical environment: a case-control study in two Sierra Leonean hospitals.

PubMed

Rosen, Michael A; Chima, Adaora M; Sampson, John B; Jackson, Eric V; Koka, Rahul; Marx, Megan K; Kamara, Thaim B; Ogbuagu, Onyebuchi U; Lee, Benjamin H

2015-08-01

Inadequate observance of basic processes in patient care such as patient monitoring and documentation practices are potential impediments to the timely diagnoses and management of patients. These gaps exist in low resource settings such as Sierra Leone and can be attributed to a myriad of factors such as workforce and technology deficiencies. In the study site, only 12.4% of four critical vital signs were documented in the pre-intervention period. Implement a failure mode and effects analysis (FMEA) to improve documentation of four patient vital signs: temperature, blood pressure, pulse rate and respiratory rate. FMEA was implemented among a subpopulation of health workers who are involved in monitoring and documenting patient vital signs. Pre- and post-FMEA monitoring and documentation practice were compared with a control site. Participants identified a four-step process to monitoring and documenting vital signs, three categories of failure modes and four potential solutions. Based on 2100 patient days of documentation compliance data from 147 patients between July and November 2012, staff members at the study site were 1.79 times more likely to document all four patient vital signs in the post-implementation period (95% CI [1.35, 2.38]). FMEA is a feasible and effective strategy for improving quality and safety in an austere medical environment. Documentation compliance improved at the intervention facility. To evaluate the scalability and sustainability of this approach, programs targeting the development of these types of process improvement skills in local staff should be evaluated. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Deming, quality and the small medical group administrator.

PubMed

Noll, D C

1992-01-01

As administrators, writes Douglas Noll, we can coordinate and implement quality measures affecting our practices and which impact the patient's total medical experience. Unfortunately, many smaller groups cannot hire an outside consultant or single employee whose sole purpose would be to monitor quality. Noll offers several simple practices that administrators can use to improve the quality of service in their groups.

Using Learning Analytics to Enhance Student Learning in Online Courses Based on Quality Matters Standards

ERIC Educational Resources Information Center

Martin, Florence; Ndoye, Abdou; Wilkins, Patricia

2016-01-01

Quality Matters is recognized as a rigorous set of standards that guide the designer or instructor to design quality online courses. We explore how Quality Matters standards guide the identification and analysis of learning analytics data to monitor and improve online learning. Descriptive data were collected for frequency of use, time spent, and…

Quality Assurance and Accreditation in Higher Education: India vis-à-vis European Countries

ERIC Educational Resources Information Center

Dey, Niradhar

2011-01-01

Quality assurance (QA) and accreditation in higher education include the systematic management and assessment of procedures to monitor performance and to address areas of improvement. In the context of globalization, without assuring the quality of higher education programmes it is not possible to ensure credit transfer and student mobility, to…

Governing Healthcare through Performance Measurement in Massachusetts and the Netherlands

PubMed Central

Van der Wees, Philip J.; der Sanden, Maria W.G. Nijhuis-van; van Ginneken, Ewout; Ayanian, John Z.; Schneider, Eric C.; Westert, Gert P.

2016-01-01

Massachusetts and the Netherlands have implemented comprehensive health reforms, which have heightened the importance of performance measurement. The performance measures addressing access to health care and patient experience are similar in the two jurisdictions, but measures of processes and outcomes of care differ considerably. In both jurisdictions, the use of health outcomes to compare the quality of health care organizations is limited, and specific information about costs is lacking. New legislation in both jurisdictions led to the establishment of institutes to monitor the quality of care, similar mandates to make the performance of health care providers transparent, and to establish a shared responsibility of providers, consumers and insurers to improve the quality of health care. In Massachusetts a statewide mandatory quality measure set was established to monitor the quality of care. The Netherlands is stimulating development of performance measures by providers based on a mandatory framework for developing such measures. Both jurisdictions are expanding the use of patient-reported outcomes to support patient care, quality improvement, and performance comparisons with the aim of explicitly linking performance to new payment incentives. PMID:24138729

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.

Multi-scale monitoring for improved nutrient management

USDA-ARS?s Scientific Manuscript database

In many watersheds, monitoring at the outlet of small watersheds has not been able to demonstrate that conservation efforts have had any impact on stream water quality. Reasons are multiple including legacy issues, time for the conservation practices to have any benefit, temporal variability of weat...

Staff acceptance of video monitoring for coordination: a video system to support perioperative situation awareness.

PubMed

Kim, Young Ju; Xiao, Yan; Hu, Peter; Dutton, Richard

2009-08-01

To understand staff acceptance of a remote video monitoring system for operating room (OR) coordination. Improved real-time remote visual access to OR may enhance situational awareness but also raises privacy concerns for patients and staff. Survey. A system was implemented in a six-room surgical suite to display OR monitoring video at an access restricted control desk area. Image quality was manipulated to improve staff acceptance. Two months after installation, interviews and a survey were conducted on staff acceptance of video monitoring. About half of all OR personnel responded (n = 63). Overall levels of concerns were low, with 53% rated no concerns and 42% little concern. Top two reported uses of the video were to see if cases are finished and to see if a room is ready. Viewing the video monitoring system as useful did not reduce levels of concern. Staff in supervisory positions perceived less concern about the system's impact on privacy than did those supervised (p < 0.03). Concerns for patient privacy correlated with concerns for staff privacy and performance monitoring. Technical means such as manipulating image quality helped staff acceptance. Manipulation of image quality resulted overall acceptance of monitoring video, with residual levels of concerns. OR nurses may express staff privacy concern in the form of concerns over patient privacy. This study provided suggestions for technological and implementation strategies of video monitoring for coordination use in OR. Deployment of communication technology and integration of clinical information will likely raise concerns over staff privacy and performance monitoring. The potential gain of increased information access may be offset by negative impact of a sense of loss of autonomy.

Development of a bioanalytical test battery for water quality monitoring: Fingerprinting identified micropollutants and their contribution to effects in surface water.

PubMed

Neale, Peta A; Altenburger, Rolf; Aït-Aïssa, Selim; Brion, François; Busch, Wibke; de Aragão Umbuzeiro, Gisela; Denison, Michael S; Du Pasquier, David; Hilscherová, Klára; Hollert, Henner; Morales, Daniel A; Novák, Jiří; Schlichting, Rita; Seiler, Thomas-Benjamin; Serra, Helene; Shao, Ying; Tindall, Andrew J; Tollefsen, Knut Erik; Williams, Timothy D; Escher, Beate I

2017-10-15

Surface waters can contain a diverse range of organic pollutants, including pesticides, pharmaceuticals and industrial compounds. While bioassays have been used for water quality monitoring, there is limited knowledge regarding the effects of individual micropollutants and their relationship to the overall mixture effect in water samples. In this study, a battery of in vitro bioassays based on human and fish cell lines and whole organism assays using bacteria, algae, daphnids and fish embryos was assembled for use in water quality monitoring. The selection of bioassays was guided by the principles of adverse outcome pathways in order to cover relevant steps in toxicity pathways known to be triggered by environmental water samples. The effects of 34 water pollutants, which were selected based on hazard quotients, available environmental quality standards and mode of action information, were fingerprinted in the bioassay test battery. There was a relatively good agreement between the experimental results and available literature effect data. The majority of the chemicals were active in the assays indicative of apical effects, while fewer chemicals had a response in the specific reporter gene assays, but these effects were typically triggered at lower concentrations. The single chemical effect data were used to improve published mixture toxicity modeling of water samples from the Danube River. While there was a slight increase in the fraction of the bioanalytical equivalents explained for the Danube River samples, for some endpoints less than 1% of the observed effect could be explained by the studied chemicals. The new mixture models essentially confirmed previous findings from many studies monitoring water quality using both chemical analysis and bioanalytical tools. In short, our results indicate that many more chemicals contribute to the biological effect than those that are typically quantified by chemical monitoring programs or those regulated by environmental quality standards. This study not only demonstrates the utility of fingerprinting single chemicals for an improved understanding of the biological effect of pollutants, but also highlights the need to apply bioassays for water quality monitoring in order to prevent underestimation of the overall biological effect. Copyright © 2017 Elsevier Ltd. All rights reserved.

Medication errors: an analysis comparing PHICO's closed claims data and PHICO's Event Reporting Trending System (PERTS).

PubMed

Benjamin, David M; Pendrak, Robert F

2003-07-01

Clinical pharmacologists are all dedicated to improving the use of medications and decreasing medication errors and adverse drug reactions. However, quality improvement requires that some significant parameters of quality be categorized, measured, and tracked to provide benchmarks to which future data (performance) can be compared. One of the best ways to accumulate data on medication errors and adverse drug reactions is to look at medical malpractice data compiled by the insurance industry. Using data from PHICO insurance company, PHICO's Closed Claims Data, and PHICO's Event Reporting Trending System (PERTS), this article examines the significance and trends of the claims and events reported between 1996 and 1998. Those who misread history are doomed to repeat the mistakes of the past. From a quality improvement perspective, the categorization of the claims and events is useful for reengineering integrated medication delivery, particularly in a hospital setting, and for redesigning drug administration protocols on low therapeutic index medications and "high-risk" drugs. Demonstrable evidence of quality improvement is being required by state laws and by accreditation agencies. The state of Florida requires that quality improvement data be posted quarterly on the Web sites of the health care facilities. Other states have followed suit. The insurance industry is concerned with costs, and medication errors cost money. Even excluding costs of litigation, an adverse drug reaction may cost up to $2500 in hospital resources, and a preventable medication error may cost almost $4700. To monitor costs and assess risk, insurance companies want to know what errors are made and where the system has broken down, permitting the error to occur. Recording and evaluating reliable data on adverse drug events is the first step in improving the quality of pharmacotherapy and increasing patient safety. Cost savings and quality improvement evolve on parallel paths. The PHICO data provide an excellent opportunity to review information that typically would not be in the public domain. The events captured by PHICO are similar to the errors and "high-risk" drugs described in the literature, the U.S. Pharmacopeia's MedMARx Reporting System, and the Sentinel Event reporting system maintained by the Joint Commission for the Accreditation of Healthcare Organizations. The information in this report serves to alert clinicians to the possibility of adverse events when treating patients with the reported drugs, thus allowing for greater care in their use and closer monitoring. Moreover, when using high-risk drugs, patients should be well informed of known risks, dosage should be titrated slowly, and therapeutic drug monitoring and laboratory monitoring should be employed to optimize therapy and minimize adverse effects.

Using management information systems to enhance health care quality assurance.

PubMed

Rosser, L H; Kleiner, B H

1995-01-01

Examines how computers and quality assurance are being used to improve the quality of health care delivery. Traditional quality assurance methods have been limited in their ability to effectively manage the high volume of data generated by the health care process. Computers on the other hand are able to handle large volumes of data as well as monitor patient care activities in both the acute care and ambulatory care settings. Discusses the use of computers to collect and analyse patient data so that changes and problems can be identified. In addition, computer models for reminding physicians to order appropriate preventive health measures for their patients are presented. Concludes that the use of computers to augment quality improvement is essential if the quality of patient care and health promotion are to be improved.

Asan medical information system for healthcare quality improvement.

PubMed

Ryu, Hyeon Jeong; Kim, Woo Sung; Lee, Jae Ho; Min, Sung Woo; Kim, Sun Ja; Lee, Yong Su; Lee, Young Ha; Nam, Sang Woo; Eo, Gi Seung; Seo, Sook Gyoung; Nam, Mi Hyun

2010-09-01

This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. AMIS CONSISTED OF SEVERAL DISTINCTIVE SYSTEMS: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.

Tweets about hospital quality: a mixed methods study

PubMed Central

Greaves, Felix; Laverty, Antony A; Cano, Daniel Ramirez; Moilanen, Karo; Pulman, Stephen; Darzi, Ara; Millett, Christopher

2014-01-01

Background Twitter is increasingly being used by patients to comment on their experience of healthcare. This may provide information for understanding the quality of healthcare providers and improving services. Objective To examine whether tweets sent to hospitals in the English National Health Service contain information about quality of care. To compare sentiment on Twitter about hospitals with established survey measures of patient experience and standardised mortality rates. Design A mixed methods study including a quantitative analysis of all 198 499 tweets sent to English hospitals over a year and a qualitative directed content analysis of 1000 random tweets. Twitter sentiment and conventional quality metrics were compared using Spearman's rank correlation coefficient. Key results 11% of tweets to hospitals contained information about care quality, with the most frequent topic being patient experience (8%). Comments on effectiveness or safety of care were present, but less common (3%). 77% of tweets about care quality were positive in tone. Other topics mentioned in tweets included messages of support to patients, fundraising activity, self-promotion and dissemination of health information. No associations were observed between Twitter sentiment and conventional quality metrics. Conclusions Only a small proportion of tweets directed at hospitals discuss quality of care and there was no clear relationship between Twitter sentiment and other measures of quality, potentially limiting Twitter as a medium for quality monitoring. However, tweets did contain information useful to target quality improvement activity. Recent enthusiasm by policy makers to use social media as a quality monitoring and improvement tool needs to be carefully considered and subjected to formal evaluation. PMID:24748372

Global Monitoring of Water Supply and Sanitation: History, Methods and Future Challenges

PubMed Central

Bartram, Jamie; Brocklehurst, Clarissa; Fisher, Michael B.; Luyendijk, Rolf; Hossain, Rifat; Wardlaw, Tessa; Gordon, Bruce

2014-01-01

International monitoring of drinking water and sanitation shapes awareness of countries’ needs and informs policy, implementation and research efforts to extend and improve services. The Millennium Development Goals established global targets for drinking water and sanitation access; progress towards these targets, facilitated by international monitoring, has contributed to reducing the global disease burden and increasing quality of life. The experiences of the MDG period generated important lessons about the strengths and limitations of current approaches to defining and monitoring access to drinking water and sanitation. The methods by which the Joint Monitoring Programme (JMP) of WHO and UNICEF tracks access and progress are based on analysis of data from household surveys and linear regression modelling of these results over time. These methods provide nationally-representative and internationally-comparable insights into the drinking water and sanitation facilities used by populations worldwide, but also have substantial limitations: current methods do not address water quality, equity of access, or extra-household services. Improved statistical methods are needed to better model temporal trends. This article describes and critically reviews JMP methods in detail for the first time. It also explores the impact of, and future directions for, international monitoring of drinking water and sanitation. PMID:25116635

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

PubMed

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

2016-09-01

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

Ambient air monitoring plan for Ciudad Acuna and Piedra Negras, Coahuila, Mexico. Final report

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

Winberry, J.; Henning, L.; Crume, R.

1998-01-01

The Cities of Ciudad Acuna and Piedras Negras and the State of Coahuila in Mexico are interested in improving ambient air quality monitoring capabilities in the two cities through the establishment of a network of ambient air monitors. The purpose of the network is to characterize population exposure to potentially harmful air contaminants, possibly including sulfur dioxide (SO{sub 2}), nitrogen oxides (NO{sub x}), ozone (O{sub 3}), carbon monoxide (CO), total suspended particulate matter (TSP), particulate matter with aerodynamic diameter less than 100 micrometers PM-10, and lead. This report presents the results of an evaluation of existing air quality monitoring equipmentmore » and facilities in Ciudad Acuna and Piedras Negras. Additionally, the report presents recommendations for developing an air quality monitoring network for PM-10, SO{sub 2}, lead, and ozone in these cities, using a combination of both new and existing equipment. The human resources currently available and ultimately needed to operate and maintain the network are also discussed.« less

A Spectral Method for Spatial Downscaling

PubMed Central

Reich, Brian J.; Chang, Howard H.; Foley, Kristen M.

2014-01-01

Summary Complex computer models play a crucial role in air quality research. These models are used to evaluate potential regulatory impacts of emission control strategies and to estimate air quality in areas without monitoring data. For both of these purposes, it is important to calibrate model output with monitoring data to adjust for model biases and improve spatial prediction. In this article, we propose a new spectral method to study and exploit complex relationships between model output and monitoring data. Spectral methods allow us to estimate the relationship between model output and monitoring data separately at different spatial scales, and to use model output for prediction only at the appropriate scales. The proposed method is computationally efficient and can be implemented using standard software. We apply the method to compare Community Multiscale Air Quality (CMAQ) model output with ozone measurements in the United States in July 2005. We find that CMAQ captures large-scale spatial trends, but has low correlation with the monitoring data at small spatial scales. PMID:24965037

Drinking-water quality management: the Australian framework.

PubMed

Sinclair, Martha; Rizak, Samantha

The most effective means of assuring drinking-water quality and the protection of public health is through adoption of a preventive management approach that encompasses all steps in water production from catchment to consumer. However, the reliance of current regulatory structures on compliance monitoring of treated water tends to promote a reactive management style where corrective actions are initiated after monitoring reveals that prescribed levels have been exceeded, and generally after consumers have received the noncomplying water. Unfortunately, the important limitations of treated water monitoring are often not appreciated, and there is a widespread tendency to assume that intensification of compliance monitoring or lowering of compliance limits is an effective strategy to improving the protection of public health. To address these issues and emphasize the role of preventive system management, the Australian National Health and Medical Research Council in collaboration with the Co-operative Research Centre for Water Quality and Treatment has developed a comprehensive quality management approach for drinking water. This Framework for Management of Drinking Water Quality will assist water suppliers in providing a higher level of assurance for drinking water quality and safety. The framework integrates quality and risk management principles, and provides a comprehensive, flexible, and proactive means of optimizing, drinking-water quality and protecting public health. It does not eliminate the requirement for compliance monitoring but allows it to be viewed in the proper perspective as providing verification that preventive measures are effective, rather than as the primary means of protecting public health.

Quality Indicators for Continuous Monitoring to Improve Maternal and Infant Health in Maternity Departments: A Modified Delphi Survey of an International Multidisciplinary Panel

PubMed Central

Boulkedid, Rym; Sibony, Olivier; Goffinet, François; Fauconnier, Arnaud; Branger, Bernard; Alberti, Corinne

2013-01-01

Objective Measuring the quality of inpatient obstetrical care using quality indicators is becoming increasingly important for both patients and healthcare providers. However, there is no consensus about which measures are optimal. We describe a modified Delphi method to identify a set of indicators for continuously monitoring the quality of maternity care by healthcare professionals. Methodology and Main Findings An international French-speaking multidisciplinary panel comprising 22 obstetricians-gynaecologists, 12 midwives, and 1 paediatrician assessed potential indicators extracted from a medical literature search, using a two-round Delphi procedure followed by a physical meeting. Each panellist rated each indicator based on validity and feasibility. In the first round, 35 panellists from 5 countries and 20 maternity units evaluated 26 indicators including 15 related to the management of the overall population of pregnant women, 3 to the management of women followed from the first trimester of pregnancy, 2 to the management of low-risk pregnant women, and 6 to the management of neonates. 25 quality indicators were kept for next step. In the second round, 27 (27/35: 77%) panellists selected 17 indicators; the remaining 8 indicators were discussed during a physical meeting. The final set comprised 18 indicators. Conclusion A multidisciplinary panel selected indicators that reflect the quality of obstetrical care. This set of indicators could be used to assess and monitor obstetrical care, with the goal of improving the quality of care in maternity units. PMID:23577143

Monitoring And Modeling Environmental Water Quality To Support Environmental Water Purchase Decision-making

NASA Astrophysics Data System (ADS)

Null, S. E.; Elmore, L.; Mouzon, N. R.; Wood, J. R.

2016-12-01

More than 25 million cubic meters (20,000 acre feet) of water has been purchased from willing agricultural sellers for environmental flows in Nevada's Walker River to improve riverine habitat and connectivity with downstream Walker Lake. Reduced instream flows limit native fish populations, like Lahontan cutthroat trout, through warm daily stream temperatures and low dissolved oxygen concentrations. Environmental water purchases maintain instream flows, although effects on water quality are more varied. We use multi-year water quality monitoring and physically-based hydrodynamic and water quality modeling to estimate streamflow, water temperature, and dissolved oxygen concentrations with alternative environmental water purchases. We simulate water temperature and dissolved oxygen changes from increased streamflow to prioritize the time periods and locations that environmental water purchases most enhance trout habitat as a function of water quality. Monitoring results indicate stream temperature and dissolved oxygen limitations generally exist in the 115 kilometers upstream of Walker Lake (about 37% of the study area) from approximately May through September, and this reach acts as a water quality barrier for fish passage. Model results indicate that low streamflows generally coincide with critically warm stream temperatures, water quality refugia exist on a tributary of the Walker River, and environmental water purchases may improve stream temperature and dissolved oxygen conditions for some reaches and seasons, especially in dry years and prolonged droughts. This research supports environmental water purchase decision-making and allows water purchase decisions to be prioritized with other river restoration alternatives.

Quality of care in reproductive health programmes: education for quality improvement.

PubMed

Kwast, B E

1998-09-01

The provision of high quality maternity care will make the difference between life and death or lifelong maiming for millions of pregnant women. Barriers preventing access to affordable, appropriate, acceptable and effective services, and lack of facilities providing high quality obstetric care result in about 1600 maternal deaths every day. Education in its broadest sense is required at all levels and sectors of society to enhance policy formulation that will strengthen programme commitment, improve services with a culturally sensitive approach and ensure appropriate delegation of responsibility to health staff at peripheral levels. This paper is the second in series of three which addresses quality of care. The first (Kwast 1998) contains an overview of concepts, assessments, barriers and improvements of quality of care. The third article will describe selected aspects of monitoring and evaluation of quality of care.

Reliability and Utility of the Behaviour Support Plan Quality Evaluation Tool (BSP-QEII) for Auditing and Quality Development in Services for Adults with Intellectual Disability and Challenging Behaviour

ERIC Educational Resources Information Center

McVilly, K.; Webber, L.; Paris, M.; Sharp, G.

2013-01-01

Background: Having an objective means of evaluating the quality of behaviour support plans (BSPs) could assist service providers and statutory authorities to monitor and improve the quality of support provided to people with intellectual disability (ID) who exhibit challenging behaviour. The Behaviour Support Plan Quality Evaluation Guide II…

Water quality facility investigation report : final summary of project and evaluation of monitoring plan implementation.

DOT National Transportation Integrated Search

2005-07-05

The Oregon Department of Transportation (ODOT) has installed several stormwater : treatment facilities throughout the State to improve the quality of runoff discharged from : highways. These facilities include a variety of both above ground and below...

The future of monitoring in clinical research - a holistic approach: linking risk-based monitoring with quality management principles.

PubMed

Ansmann, Eva B; Hecht, Arthur; Henn, Doris K; Leptien, Sabine; Stelzer, Hans Günther

2013-01-01

Since several years risk-based monitoring is the new "magic bullet" for improvement in clinical research. Lots of authors in clinical research ranging from industry and academia to authorities are keen on demonstrating better monitoring-efficiency by reducing monitoring visits, monitoring time on site, monitoring costs and so on, always arguing with the use of risk-based monitoring principles. Mostly forgotten is the fact, that the use of risk-based monitoring is only adequate if all mandatory prerequisites at site and for the monitor and the sponsor are fulfilled.Based on the relevant chapter in ICH GCP (International Conference on Harmonisation of technical requirements for registration of pharmaceuticals for human use - Good Clinical Practice) this publication takes a holistic approach by identifying and describing the requirements for future monitoring and the use of risk-based monitoring. As the authors are operational managers as well as QA (Quality Assurance) experts, both aspects are represented to come up with efficient and qualitative ways of future monitoring according to ICH GCP.

Cost-effectiveness and Budget Impact of Routine Use of Fractional Exhaled Nitric Oxide Monitoring for the Management of Adult Asthma Patients in Spain.

PubMed

Sabatelli, L; Seppälä, U; Sastre, J; Crater, G

Fractional exhaled nitric oxide (FeNO) is a marker for type 2 airway inflammation. The objective of this study was to evaluate the cost-effectiveness and budget impact of FeNO monitoring for management of adult asthma in Spain. A cost-effectiveness analysis model was used to evaluate the effect on costs of adding FeNO monitoring to asthma management. Over a 1-year period, the model estimated the incremental cost per quality-adjusted life year and incremental number of exacerbations avoided when FeNO monitoring was added to standard guideline-driven asthma care compared with standard care alone. Univariate and multivariate sensitivity analyses were applied to explore uncertainty in the model. A budget impact model was used to examine the impact of FeNO monitoring on primary care costs across the Spanish health system. The results showed that adding FeNO to standard asthma care saved €62.53 per patient-year in the adult population and improved quality-adjusted life years by 0.026 per patient-year. The budget impact analysis revealed a potential net yearly saving of €129 million if FeNO monitoring had been used in primary care settings in Spain. The present economic model shows that adding FeNO to the treatment algorithm can considerably reduce costs and improve quality of life when used to manage asthma in combination with current treatment guidelines.

Fuzzy intelligent quality monitoring model for X-ray image processing.

PubMed

Khalatbari, Azadeh; Jenab, Kouroush

2009-01-01

Today's imaging diagnosis needs to adapt modern techniques of quality engineering to maintain and improve its accuracy and reliability in health care system. One of the main factors that influences diagnostic accuracy of plain film X-ray on detecting pathology is the level of film exposure. If the level of film exposure is not adequate, a normal body structure may be interpretated as pathology and vice versa. This not only influences the patient management but also has an impact on health care cost and patient's quality of life. Therefore, providing an accurate and high quality image is the first step toward an excellent patient management in any health care system. In this paper, we study these techniques and also present a fuzzy intelligent quality monitoring model, which can be used to keep variables from degrading the image quality. The variables derived from chemical activity, cleaning procedures, maintenance, and monitoring may not be sensed, measured, or calculated precisely due to uncertain situations. Therefore, the gamma-level fuzzy Bayesian model for quality monitoring of an image processing is proposed. In order to apply the Bayesian concept, the fuzzy quality characteristics are assumed as fuzzy random variables. Using the fuzzy quality characteristics, the newly developed model calculates the degradation risk for image processing. A numerical example is also presented to demonstrate the application of the model.

Improving the implementation of marine monitoring in the northeast Atlantic.

PubMed

Turrell, W R

2018-03-01

Marine monitoring in the northeast Atlantic is delivered within identifiable monitoring themes, established through time and defined by the geographical area and policy drivers they serve, the sampling methodologies they use, their assessment methodologies, their funding and governance structures and the people or organisations involved in their implementation. Within a monitoring theme, essential components for effective monitoring are governance, strategy and work plan, sampling protocols, quality assurance, and data and assessment structures. This simple framework is used to analyse two monitoring theme case studies; national ecosystem health monitoring, and regional fish stock monitoring. Such essential component analyses, within marine monitoring themes, can help improve monitoring implementation by identifying gaps and overlaps. Once monitoring themes are recognised, explicitly defined and streamlined, travel towards integrated monitoring may be made easier as the current lack of clarity in thematic marine monitoring implementation is one barrier to integration at both national and regional scales. Copyright © 2018 The Author. Published by Elsevier Ltd.. All rights reserved.

Local body cooling to improve sleep quality and thermal comfort in a hot environment.

PubMed

Lan, L; Qian, X L; Lian, Z W; Lin, Y B

2018-01-01

The effects of local body cooling on thermal comfort and sleep quality in a hot environment were investigated in an experiment with 16 male subjects. Sleep quality was evaluated subjectively, using questionnaires completed in the morning, and objectively, by analysis of electroencephalogram (EEG) signals that were continuously monitored during the sleeping period. Compared with no cooling, the largest improvement in thermal comfort and sleep quality was observed when the back and head (neck) were both cooled at a room temperature of 32°C. Back cooling alone also improved thermal comfort and sleep quality, although the effects were less than when cooling both back and head (neck). Mean sleep efficiency was improved from 84.6% in the no cooling condition to 95.3% and 92.8%, respectively, in these conditions, indicating good sleep quality. Head (neck) cooling alone slightly improved thermal comfort and subjective sleep quality and increased Stage N3 sleep, but did not otherwise improve sleep quality. The results show that local cooling applied to large body sections (back and head) could effectively maintain good sleep and improve thermal comfort in a hot environment. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Ambient air quality programmes for health impact assessment in the WHO European region.

PubMed

Mücke, H G

2000-06-01

An important aim of air quality assessment is to provide information about population exposure and health impact assessment. Numerous epidemiological studies have already shown that exposure to excessive levels of ambient air pollutants are associated with either acute or chronic health effects. Until recently, the adequacy of monitoring population exposure in relation to quantitative assessment of health effects of air pollution was rarely considered in ambient air monitoring strategies. This made the formulation of health-related recommendations to risk management difficult and weakens preventive and other measures to reduce adverse health effects of air pollution. To improve local and national capacities for health impact assessment, the European Centre for Environment and Health of the World Health Organization has prepared methodology guidelines concerning selected aspects of air monitoring. The WHO Collaborating Centre for Air Quality Management and Air Pollution Control support efforts in line with international programmes on quality assurance and control for Europe.

Medication and monitoring in palliative sedation therapy: a systematic review and quality assessment of published guidelines.

PubMed

Schildmann, Eva Katharina; Schildmann, Jan; Kiesewetter, Isabel

2015-04-01

Palliative sedation therapy (PST) is increasingly used in patients at the end of life. However, consensus about medications and monitoring is lacking. To assess published PST guidelines with regard to quality and recommendations on drugs and monitoring. We searched CINAHL, the Cochrane Library, Embase, PsycINFO, PubMed, and references of included articles until July 2014. Search terms included "palliative sedation" or "sedation" and "guideline" or "policy" or "framework." Guideline selection was based on English or German publications that included a PST guideline. Two investigators independently assessed the quality of the guidelines according to the Appraisal of Guidelines for Research and Evaluation II instrument (AGREE II) and extracted information on drug selection and monitoring. Nine guidelines were eligible. Eight guidelines received high quality scores for the domain "scope and purpose" (median 69%, range 28-83%), whereas in the other domains the guidelines' quality differed considerably. The majority of guidelines suggest midazolam as drug of first choice. Recommendations on dosage and alternatives vary. The guidelines' recommendations regarding monitoring of PST show wide variation in the number and details of outcome parameters and methods of assessment. The published guidelines on PST vary considerably regarding their quality and content on drugs and monitoring. Given the need for clear guidance regarding PST in patients at the end of life, this comparative analysis may serve as a starting point for further improvement. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The use of patient feedback by hospital boards of directors: a qualitative study of two NHS hospitals in England.

PubMed

Lee, Robert; Baeza, Juan I; Fulop, Naomi J

2018-02-01

Although previous research suggests that different kinds of patient feedback are used in different ways to help improve the quality of hospital care, there have been no studies of the ways in which hospital boards of directors use feedback for this purpose. To examine whether and how boards of directors of hospitals use feedback from patients to formulate strategy and to assure and improve the quality of care. We undertook an in-depth qualitative study in two acute hospital National Health Service foundation trusts in England, purposively selected as contrasting examples of the collection of different kinds of patient feedback. We collected and analysed data from interviews with directors and other managers, from observation of board meetings, and from board papers and other documents. The two boards used in-depth qualitative feedback and quantitative feedback from surveys in different ways to help develop strategies, set targets for quality improvement and design specific quality improvement initiatives; but both boards made less subsequent use of any kinds of feedback to monitor their strategies or explicitly to assure the quality of services. We have identified limitations in the uses of patient feedback by hospital boards that suggest that boards should review their current practice to ensure that they use the different kinds of patient feedback that are available to them more effectively to improve, monitor and assure the quality of care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The water-quality monitoring program for the Baltimore reservoir system, 1981-2007—Description, review and evaluation, and framework integration for enhanced monitoring

USGS Publications Warehouse

Koterba, Michael T.; Waldron, Marcus C.; Kraus, Tamara E.C.

2011-01-01

The City of Baltimore, Maryland, and parts of five surrounding counties obtain their water from Loch Raven and Liberty Reservoirs. A third reservoir, Prettyboy, is used to resupply Loch Raven Reservoir. Management of the watershed conditions for each reservoir is a shared responsibility by agreement among City, County, and State jurisdictions. The most recent (2005) Baltimore Reservoir Watershed Management Agreement (RWMA) called for continued and improved water-quality monitoring in the reservoirs and selected watershed tributaries. The U.S. Geological Survey (USGS) conducted a retrospective review of the effectiveness of monitoring data obtained and analyzed by the RWMA jurisdictions from 1981 through 2007 to help identify possible improvements in the monitoring program to address RWMA water-quality concerns. Long-term water-quality concerns include eutrophication and sedimentation in the reservoirs, and elevated concentrations of (a) nutrients (nitrogen and phosphorus) being transported from the major tributaries to the reservoirs, (b) iron and manganese released from reservoir bed sediments during periods of deep-water anoxia, (c) mercury in higher trophic order game fish in the reservoirs, and (d) bacteria in selected reservoir watershed tributaries. Emerging concerns include elevated concentrations of sodium, chloride, and disinfection by-products (DBPs) in the drinking water from both supply reservoirs. Climate change and variability also could be emerging concerns, affecting seasonal patterns, annual trends, and drought occurrence, which historically have led to declines in reservoir water quality. Monitoring data increasingly have been used to support the development of water-quality models. The most recent (2006) modeling helped establish an annual sediment Total Maximum Daily Load to Loch Raven Reservoir, and instantaneous and 30-day moving average water-quality endpoints for chlorophyll-a (chl-a) and dissolved oxygen (DO) in Loch Raven and Prettyboy Reservoirs. Modelers cited limitations in data, including too few years with sufficient stormflow data, and (or) a lack of (readily available) data, for selected tributary and reservoir hydrodynamic, water-quality, and biotic conditions. Reservoir monitoring also is too infrequent to adequately address the above water-quality endpoints. Monitoring data also have been effectively used to generally describe trophic states, changes in trophic state or conditions related to trophic state, and in selected cases, trends in water-quality or biotic parameters that reflect RWMA water-quality concerns. Limitations occur in the collection, aggregation, analyses, and (or) archival of monitoring data in relation to most RWMA water-quality concerns. Trophic, including eutrophic, conditions have been broadly described for each reservoir in terms of phytoplankton production, and variations in production related to typical seasonal patterns in the concentration of DO, and hypoxic to anoxic conditions, where the latter have led to elevated concentrations of iron and manganese in reservoir and supply waters. Trend analyses for the period 1981-2004 have shown apparent declines in production (algal counts and possibly chl-a). The low frequency of phytoplankton data collection (monthly or bimonthly, depending on the reservoir), however, limits the development of a model to quantitatively describe and relate temporal variations in phytoplankton production including seasonal succession to changes in trophic states or other reservoir water-quality or biotic conditions. Extensive monitoring for nutrients, which, in excessive amounts, cause eutrophic conditions, has been conducted in the watershed tributaries and reservoirs. Data analyses (1980-90s) have (a) identified seasonal patterns in concentrations, (b) characterized loads from (non)point sources, and (c) shown that different seasonal patterns and trends in nutrient concentrations occur between watershed tributaries and downstream reservoir

Quasi-experimental evaluation of a multifaceted intervention to improve quality of end-of-life care and quality of dying for patients with advanced dementia in long-term care institutions.

PubMed

Verreault, René; Arcand, Marcel; Misson, Lucie; Durand, Pierre J; Kroger, Edeltraut; Aubin, Michèle; Savoie, Maryse; Hadjistavropoulos, Thomas; Kaasalainen, Sharon; Bédard, Annick; Grégoire, Annie; Carmichael, Pierre-Hughes

2018-03-01

Improvement in the quality of end-of-life care for advanced dementia is increasingly recognized as a priority in palliative care. To evaluate the impact of a multidimensional intervention to improve quality of care and quality of dying in advanced dementia in long-term care facilities. Quasi-experimental study with the intervention taking place in two long-term care facilities versus usual care in two others over a 1-year period. The intervention had five components: (1) training program to physicians and nursing staff, (2) clinical monitoring of pain using an observational pain scale, (3) implementation of a regular mouth care routine, (4) early and systematic communication with families about end-of-life care issues with provision of an information booklet, and (5) involvement of a nurse facilitator to implement and monitor the intervention. Quality of care was assessed with the Family Perception of Care Scale. The Symptom Management for End-of-Life Care in Dementia and the Comfort Assessment in Dying scales were used to assess the quality of dying. A total of 193 residents with advanced dementia and their close family members were included (97 in the intervention group and 96 in the usual care group). The Family Perception of Care score was significantly higher in the intervention group than in the usual care group (157.3 vs 149.1; p = 0.04). The Comfort Assessment and Symptom Management scores were also significantly higher in the intervention group. Our multidimensional intervention in long-term care facilities for patients with terminal dementia resulted in improved quality of care and quality of dying when compared to usual care.

Quantifying a Total Non-Methane Hydrocarbon Signal using Low-Cost VOC Sensors in an Effort to Help Communities Learn More About their Air Quality

NASA Astrophysics Data System (ADS)

Collier, A. M.; Hannigan, M.; Piedrahita, R.; Casey, J. G.; Johnston, J.; Chiang, S.

2016-12-01

The growing accessibility of low-cost air quality monitoring technologies has led to their increased usage among community-based organizations, particularly for the monitoring of pollutants dangerous to human health (e.g., hazardous air pollutants or HAPS). However, often these low-cost sensors are `off-the-shelf' and are being utilized in a manner that differs from their intended purpose - necessitating high quality calibrations. For example, VOC sensors intended for the detection of high levels of a particular compound in an industrial setting may instead be used for ambient monitoring of a group of VOCs. Academic/community partnerships can be an ideal way to improve this type of sensor quantification while providing a community with not only the opportunity to use these technologies with additional support around data quality, but also the opportunity for education around the abilities and applications of low-cost sensors. In the spring of 2016, our lab at the University of Colorado, Boulder partnered with communities in Los Angeles and Kern County to deploy low-cost air quality monitors for the purpose of quantifying methane and non-methane hydrocarbon signals in an effort to learn more about potential impacts from local sources (e.g., nearby highways and oil & gas development). The monitoring platform was developed in our lab and is capable of logging multiple gas phase species as well as some environmental parameters. The monitors include two different metal oxide VOC sensors - each with slightly different sensing capabilities. Calibration was achieved using a pre- and post-deployment field normalization to reference monitoring equipment maintained by the South Coast Air Quality Management District. Monitors were then deployed at locations throughout the community. We will present results on our efforts to quantify a total non-methane hydrocarbon signal, observations from the field data, and recommendations for academic/community partnerships formed around air quality monitoring.

Variations in Chinese Parental Perceptions of Early Childhood Education Quality

ERIC Educational Resources Information Center

Hu, Bi Ying; Zhou, Yisu; Li, Kejian

2017-01-01

As consumers of Early Childhood Education and Care (ECEC), Chinese parents play a crucial role in the ongoing process of monitoring, evaluating, and improving the quality of ECEC in China. This study used questionnaires to solicit parental feedback on the importance of, and their quality ratings for, aspects of ECEC. The researchers used a random…

76 FR 57845 - Approval of Air Quality Implementation Plans; California; San Joaquin Valley; Attainment Plan for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-16

... evaluate monitored air quality data and is used to determine whether an area's air quality meets a NAAQS... documentation in their submittals explaining how the emissions data were calculated. 70 FR at 71664 and EI... inventories for the SJV. See Table 1 below. These revised inventories incorporate improved activity data and...

Relations of changes in wastewater-treatment practices to changes in stream-water quality during 1978-88 in the Chicago area, Illinois, and implications for regional and national water-quality assessments

USGS Publications Warehouse

Terrio, P.J.

1994-01-01

A study in the upper Illinois River Basin defined relations between changes in wastewater-treatment practices and changes in stream-water quality on the basis of available information. These relations were examined for five large wastewater-treatment plants in the Chicago area, Illinois. At the three largest treatment plants, two major changes in wastewater-treatment practices were identified--the cessation of chlorination and the implementation of Chicago's Tunnel and Reservoir Plan (TARP). Other changes, such as improved aeration and expansion of the facilities, also were made at some of the treatment plants. At the Calumet Water Reclamation Plant, median densities of fecal coliform bacteria in the effluent increased from 3,100 to 1,200,000 colonies per 100 milliliters after the cessation of chlorination. Median densities at the nearest downstream monitoring site increased from 9,500 to 250,000 colonies per 100 milliliters. Similar changes in bacteria densities were indicated for other treatment plants and stream-monitoring sites, but increases in densities of fecal coliform bacteria were not indicated at distances greater than 7 miles downstream. Substantial changes in effluent and stream-water quality, primarily improvements, were identified after the implemen- of TARP and improvements in aeration. Decreases in some of the largest concentrations of ammonia were particularly notable and were likely results of the cape and treatment of combined sewer overflows by TARP. Improvements in water quality were commonly related to climatic season, with greater changes taking place during warm periods. Substantial decreases in concentrations were identified for many constituents, including oxygen demand, ammonia, bacteria, and cyanide. The water-quality data available for this study were considered to be more accurate and were more comprehensive than data from most other monitoring programs. The results of this study, however, identified some needed enhancements to increase the usefulness of the data for additional purposes and analyses.

Closed-Loop Control of Humidification for Artifact Reduction in Capacitive ECG Measurements.

PubMed

Leicht, Lennart; Eilebrecht, Benjamin; Weyer, Soren; Leonhardt, Steffen; Teichmann, Daniel

2017-04-01

Recording biosignals without the need for direct skin contact offers new opportunities for ubiquitous health monitoring. Electrodes with capacitive coupling have been shown to be suitable for the monitoring of electrical potentials on the body surface, in particular ECG. However, due to triboelectric charge generation and motion artifacts, signal and thus diagnostic quality is inferior to galvanic coupling. Active closed-loop humidification of capacitive electrodes is proposed in this work as a new concept to improve signal quality. A capacitive ECG recording system integrated into a common car seat is presented. It can regulate the micro climate at the interface of electrode and patient by actively dispensing water vapour and monitoring humidity in a closed-loop approach. As a regenerative water reservoir, silica gel is used. The system was evaluated with respect to subjective and objective ECG signal quality. Active humidification was found to have a significant positive effect in case of previously poor quality. Also, it had no diminishing effect in case of already good signal quality.

Silicon Sheet Quality is Improved By Meniscus Control

NASA Technical Reports Server (NTRS)

Yates, D. A.; Hatch, A. E.; Goldsmith, J. M.

1983-01-01

Better quality silicon crystals for solar cells are possible with instrument that monitors position of meniscus as sheet of solid silicon is drawn from melt. Using information on meniscus height, instrument generates feedback signal to control melt temperature. Automatic control ensures more uniform silicon sheets.

Monitoring environmental quality at the landscape scale

Treesearch

Robert V. O' Neill; Carolyn T. Hunsaker; K. Bruce Jones; Kurt H. Riitters; James D. Wickham; Paul M. Schwartz; Iris A. Goodman; Barbara L. Jackson; William S. Baillargeon

1997-01-01

Over the past century, technological advances have greatly improved the standard of living in the United States. But these same advances have caused sweeping environmental changes, often unforeseen and potentially irreparable. Ethical stewardship of the environment requires that society monitor and assess environmental changes at the national scale with a view toward...

Evaluation of an electronic nose for improved biosolids alkaline-stabilization treatment and odor management

USDA-ARS?s Scientific Manuscript database

Electronic nose sensors are designed to detect differences in complex air sample matrices. For example, they have been used in the food industry to monitor process performance and quality control. However, no information is available on the application of sensor arrays to monitor process performanc...

Quality of chronic kidney disease management in primary care: a retrospective study.

PubMed

Van Gelder, Vincent A; Scherpbier-De Haan, Nynke D; De Grauw, Wim J C; Vervoort, Gerald M M; Van Weel, Chris; Biermans, Marion C J; Braspenning, Jozé C C; Wetzels, Jack F M

2016-01-01

Early detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality. To assess the quality of care (QoC) of CKD in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies. Retrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults). CKD management of patients under the care of their general practitioner (GP) was qualified using indicators derived from the Dutch interdisciplinary CKD guideline for primary care and nephrology and included (1) monitoring of renal function, albuminuria, blood pressure, and glucose, (2) monitoring of metabolic parameters, and alongside the guideline: (3) recognition of CKD. The outcome indicator was (4) achieving blood pressure targets. Multilevel logistic regression analysis was applied to identify associated patient and practice characteristics. Kidney function or albuminuria data were available for 59 728 adult patients; 9288 patients had CKD, of whom 8794 were under GP care. Monitoring of disease progression was complete in 42% of CKD patients, monitoring of metabolic parameters in 2%, and blood pressure target was reached in 43.1%. GPs documented CKD in 31.4% of CKD patients. High QoC was strongly associated with diabetes, and to a lesser extent with hypertension and male sex. Room for improvement was found in all aspects of CKD management. As QoC was higher in patients who received structured diabetes care, future CKD care may profit from more structured primary care management, e.g. according to the chronic care model. Quality of care for chronic kidney disease patients in primary care can be improved. In comparison with guideline advice, adequate monitoring of disease progression was observed in 42%, of metabolic parameters in 2%, correct recognition of impaired renal function in 31%, and reaching blood pressure targets in 43% of chronic kidney disease patients. Quality of care was higher in patients with diabetes. Chronic kidney disease management may be improved by developing strategies similar to diabetes care.

Risk management in air protection in the Republic of Croatia.

PubMed

Peternel, Renata; Toth, Ivan; Hercog, Predrag

2014-03-01

In the Republic of Croatia, according to the Air Protection Act, air pollution assessment is obligatory on the whole State territory. For individual regions and populated areas in the State a network has been established for permanent air quality monitoring. The State network consists of stations for measuring background pollution, regional and cross-border remote transfer and measurements as part of international government liabilities, then stations for measuring air quality in areas of cultural and natural heritage, and stations for measuring air pollution in towns and industrial zones. The exceeding of alert and information threshold levels of air pollutants are related to emissions from industrial plants, and accidents. Each excess represents a threat to human health in case of short-time exposure. Monitoring of alert and information threshold levels is carried out at stations from the state and local networks for permanent air quality monitoring according to the Air Quality Measurement Program in the State network for permanent monitoring of air quality and air quality measurement programs in local networks for permanent air quality monitoring. The State network for permanent air quality monitoring has a developed automatic system for reporting on alert and information threshold levels, whereas many local networks under the competence of regional and local self-governments still lack any fully installed systems of this type. In case of accidents, prompt action at all responsibility levels is necessary in order to prevent crisis and this requires developed and coordinated competent units of State Administration as well as self-government units. It is also necessary to be continuously active in improving the implementation of legislative regulations in the field of crises related to critical and alert levels of air pollutants, especially at local levels.

Monitoring and Assessment of Youshui River Water Quality in Youyang

NASA Astrophysics Data System (ADS)

Wang, Xue-qin; Wen, Juan; Chen, Ping-hua; Liu, Na-na

2018-02-01

By monitoring the water quality of Youshui River from January 2016 to December 2016, according to the indicator grading and the assessment standard of water quality, the formulas for 3 types water quality indexes are established. These 3 types water quality indexes, the single indicator index Ai, single moment index Ak and the comprehensive water quality index A, were used to quantitatively evaluate the quality of single indicator, the water quality and the change of water quality with time. The results show that, both total phosphorus and fecal coliform indicators exceeded the standard, while the other 16 indicators measured up to the standard. The water quality index of Youshui River is 0.93 and the grade of water quality comprehensive assessment is level 2, which indicated that the water quality of Youshui River is good, and there is room for further improvement. To this end, several protection measures for Youshui River environmental management and pollution treatment are proposed.

International health research monitoring: exploring a scientific and a cooperative approach using participatory action research

PubMed Central

Chantler, Tracey; Cheah, Phaik Yeong; Miiro, George; Hantrakum, Viriya; Nanvubya, Annet; Ayuo, Elizabeth; Kivaya, Esther; Kidola, Jeremiah; Kaleebu, Pontiano; Parker, Michael; Njuguna, Patricia; Ashley, Elizabeth; Guerin, Philippe J; Lang, Trudie

2014-01-01

Objectives To evaluate and determine the value of monitoring models developed by the Mahidol Oxford Tropical Research Unit and the East African Consortium for Clinical Research, consider how this can be measured and explore monitors’ and investigators’ experiences of and views about the nature, purpose and practice of monitoring. Research design A case study approach was used within the context of participatory action research because one of the aims was to guide and improve practice. 34 interviews, five focus groups and observations of monitoring practice were conducted. Setting and participants Fieldwork occurred in the places where the monitoring models are coordinated and applied in Thailand, Cambodia, Uganda and Kenya. Participants included those coordinating the monitoring schemes, monitors, senior investigators and research staff. Analysis Transcribed textual data from field notes, interviews and focus groups was imported into a qualitative data software program (NVIVO V. 10) and analysed inductively and thematically by a qualitative researcher. The initial coding framework was reviewed internally and two main categories emerged from the subsequent interrogation of the data. Results The categories that were identified related to the conceptual framing and nature of monitoring, and the practice of monitoring, including relational factors. Particular emphasis was given to the value of a scientific and cooperative style of monitoring as a means of enhancing data quality, trust and transparency. In terms of practice the primary purpose of monitoring was defined as improving the conduct of health research and increasing the capacity of researchers and trial sites. Conclusions The models studied utilise internal and network wide expertise to improve the ethics and quality of clinical research. They demonstrate how monitoring can be a scientific and constructive exercise rather than a threatening process. The value of cooperative relations needs to be given more emphasis in monitoring activities, which seek to ensure that research protects human rights and produces reliable data. PMID:24534257

Air Pollution Monitoring Changes to Accompany the Transition from a Control to a Systems Focus

EPA Science Inventory

During the 20th century, air pollution control technologies grew at an amazingly rapid rate. Air quality in much of the industrialized world greatly improved as the efficiencies of these technologies improved. This continued improvement in pollution control has more recently been...

Water monitor system: Phase 1 test report

NASA Technical Reports Server (NTRS)

Taylor, R. E.; Jeffers, E. L.

1976-01-01

Automatic water monitor system was tested with the objectives of assuring high-quality effluent standards and accelerating the practice of reclamation and reuse of water. The NASA water monitor system is described. Various components of the system, including the necessary sensors, the sample collection system, and the data acquisition and display system, are discussed. The test facility and the analysis methods are described. Test results are reviewed, and recommendations for water monitor system design improvement are presented.

Geostatistical Prediction of Microbial Water Quality Throughout a Stream Network Using Meteorology, Land Cover, and Spatiotemporal Autocorrelation.

PubMed

Holcomb, David A; Messier, Kyle P; Serre, Marc L; Rowny, Jakob G; Stewart, Jill R

2018-06-25

Predictive modeling is promising as an inexpensive tool to assess water quality. We developed geostatistical predictive models of microbial water quality that empirically modeled spatiotemporal autocorrelation in measured fecal coliform (FC) bacteria concentrations to improve prediction. We compared five geostatistical models featuring different autocorrelation structures, fit to 676 observations from 19 locations in North Carolina's Jordan Lake watershed using meteorological and land cover predictor variables. Though stream distance metrics (with and without flow-weighting) failed to improve prediction over the Euclidean distance metric, incorporating temporal autocorrelation substantially improved prediction over the space-only models. We predicted FC throughout the stream network daily for one year, designating locations "impaired", "unimpaired", or "unassessed" if the probability of exceeding the state standard was ≥90%, ≤10%, or >10% but <90%, respectively. We could assign impairment status to more of the stream network on days any FC were measured, suggesting frequent sample-based monitoring remains necessary, though implementing spatiotemporal predictive models may reduce the number of concurrent sampling locations required to adequately assess water quality. Together, these results suggest that prioritizing sampling at different times and conditions using geographically sparse monitoring networks is adequate to build robust and informative geostatistical models of water quality impairment.

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

PubMed

Nakhleh, Raouf E

2009-11-01

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

The 'Severe Hypertensive Illness in Pregnancy' (SHIP) audit: promoting quality care using a high risk monitoring chart and eclampsia treatment pack.

PubMed

Baldwin, K Joanne; Leighton, Nicola A; Kilby, M D; Wyldes, M; Churchill, D; Jones, P W; Johanson, R B

2002-07-01

We set out to measure the standards of care in a regional cohort of women with severe hypertensive illness of pregnancy and to subsequently improve the quality of care using a series of interventions. This was a multi centre cyclical criterion audit involving 21 maternity units in the West Midlands Region. Prospective data collection involved named co-ordinators in each unit using customised proformas. Intervention comprised feedback of baseline results to each hospital, a monitoring chart and eclampsia treatment pack. The first audit period (n = 183) was for a 4-month period between 1/9/96 and 31/12/96 and the second audit period (n = 111) was during the same 4-month period 1 year later. Although compliance with the audit standards set increased in all but one standard, there is clearly a need to make further improvements in the quality of care administered.

Quality tracing in meat supply chains

PubMed Central

Mack, Miriam; Dittmer, Patrick; Veigt, Marius; Kus, Mehmet; Nehmiz, Ulfert; Kreyenschmidt, Judith

2014-01-01

The aim of this study was the development of a quality tracing model for vacuum-packed lamb that is applicable in different meat supply chains. Based on the development of relevant sensory parameters, the predictive model was developed by combining a linear primary model and the Arrhenius model as the secondary model. Then a process analysis was conducted to define general requirements for the implementation of the temperature-based model into a meat supply chain. The required hardware and software for continuous temperature monitoring were developed in order to use the model under practical conditions. Further on a decision support tool was elaborated in order to use the model as an effective tool in combination with the temperature monitoring equipment for the improvement of quality and storage management within the meat logistics network. Over the long term, this overall procedure will support the reduction of food waste and will improve the resources efficiency of food production. PMID:24797136

Quality tracing in meat supply chains.

PubMed

Mack, Miriam; Dittmer, Patrick; Veigt, Marius; Kus, Mehmet; Nehmiz, Ulfert; Kreyenschmidt, Judith

2014-06-13

The aim of this study was the development of a quality tracing model for vacuum-packed lamb that is applicable in different meat supply chains. Based on the development of relevant sensory parameters, the predictive model was developed by combining a linear primary model and the Arrhenius model as the secondary model. Then a process analysis was conducted to define general requirements for the implementation of the temperature-based model into a meat supply chain. The required hardware and software for continuous temperature monitoring were developed in order to use the model under practical conditions. Further on a decision support tool was elaborated in order to use the model as an effective tool in combination with the temperature monitoring equipment for the improvement of quality and storage management within the meat logistics network. Over the long term, this overall procedure will support the reduction of food waste and will improve the resources efficiency of food production.

Improving Cardiometabolic Monitoring of Children on Antipsychotics.

PubMed

Cotes, Robert O; Fernandes, Nisha K; McLaren, Jennifer L; McHugo, Gregory J; Bartels, Stephen J; Brunette, Mary F

2017-12-01

This study evaluated changes in cardiometabolic monitoring for children and adolescents who were prescribed an antipsychotic medication in a state mental health system before and after a quality improvement intervention. The intervention included education for prescribers, auditing on metabolic monitoring, and feedback to mental health center leaders regarding their monitoring. Research staff extracted yearly data on cardiometabolic monitoring from randomly selected community mental health center records before and after the intervention. Pre- and postintervention changes in monitoring were assessed with chi-squared tests. Evidence of past year monitoring increased: for glucose 18.9%-42.1% (χ 2  = 6.75, p < 0.001), for triglycerides 13.5%-31.0% (χ 2  = 4.54, p = 0.033), for cholesterol 13.5%-33.1% (χ 2  = 5.48, p = 0.019), and for weight 67.6%-84.1% (χ 2  = 5.21, p = 0.022). Rates of monitoring for blood pressure and waist circumference increased but not significantly. In both years studied, weight was obtained most frequently and waist circumference was obtained least frequently. Monitoring rates significantly improved for four out of six parameters evaluated, but overall monitoring rates remained low at the end of the study period. Prescriber education with audit and feedback may improve cardiometabolic monitoring rates, but research is needed to evaluate barriers to monitoring in children.

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

Conducting remote bioanalytical data monitoring and review based on scientific quality objectives.

PubMed

He, Ling

2011-07-01

For bioanalytical laboratories that follow GLP regulations and generate data for new drug filing, ensuring quality standards set by regulatory guidance is a fundamental expectation. Numerous guidelines and White Papers have been published by regulatory agencies, professional working groups and field experts in the past two decades, and have significantly improved the standards of good practices for bioanalysis. From a sponsor's perspective, continuous quality monitoring of the data generated by CRO laboratories, identifying adverse trends and taking corrective and preventative actions against issues encountered, are critical aspects of effective bioanalytical outsourcing management. This is especially important for clinical bioanalysis, where one validated assay is applied for analyzing a large number of samples of diverse demographics and disease states. This perspective article presents thoughts toward remote data monitoring and its merits for scientific quality oversight, and introduces a novel Bioanalytical Data Review software that was custom-developed and platform-neural, to conduct remote data monitoring on raw or processed LC-MS/MS data from CROs. Flexible, adaptive and user-customizable queries are applied for conducting project-, batch- and sample-level data review based on scientific quality performance factors commonly assessed for good bioanalytical practice.

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on measurement to maintain and improve quality of enhanced recovery pathways for elective colorectal surgery.

PubMed

Moonesinghe, S Ramani; Grocott, Michael P W; Bennett-Guerrero, Elliott; Bergamaschi, Roberto; Gottumukkala, Vijaya; Hopkins, Thomas J; McCluskey, Stuart; Gan, Tong J; Mythen, Michael Monty G; Shaw, Andrew D; Miller, Timothy E

2017-01-01

This article sets out a framework for measurement of quality of care relevant to enhanced recovery pathways (ERPs) in elective colorectal surgery. The proposed framework is based on established measurement systems and/or theories, and provides an overview of the different approaches for improving clinical monitoring, and enhancing quality improvement or research in varied settings with different levels of available resources. Using a structure-process-outcome framework, we make recommendations for three hierarchical tiers of data collection. Core, Quality Improvement, and Best Practice datasets are proposed. The suggested datasets incorporate patient data to describe case-mix, process measures to describe delivery of enhanced recovery and clinical outcomes. The fundamental importance of routine collection of data for the initiation, maintenance, and enhancement of enhanced recovery pathways is emphasized.

[Dynamic monitoring and analysis of ecological environment in Weinan City, Northwest China based on RSEI model].

PubMed

Song, Hui Min; Xue, Liang

2016-12-01

Based on the data of remote sensing images from Landsat in 1995 and 2015, this paper used the principal component analysis (PCA) method to determine the weights of four ecological indexes (greenness, dryness, wetness and heat), and then selected a evaluation model of remote sensing based ecological index (RSEI) to monitor and analyze the ecological environment quality of Weinan City from 1995 to 2015. The results showed that the mean values of RSEI in Weinan City increased from 0.489 to 0.556 during 1995-2015, which indicated the ecological environment qua-lity had been improved. The improved area of ecological quality was mainly distributed in the central area of Weinan City and its proportion was 49.6%. While the proportion of ecological environment degradation was 15.4%, and such areas were mainly distributed in some mine areas of Hancheng City and the southern Weinan (Weinan Section in North Qinling Mountains). The quality of ecolo-gical environment was greatly influenced by the urban planning and construction in the study area. Generally, the ecological condition of Weinan City had been improved, which benefited from the attention and investment of government.

Quality measurement and improvement in liver transplantation.

PubMed

Mathur, Amit K; Talwalkar, Jayant

2018-06-01

There is growing interest in the quality of health care delivery in liver transplantation. Multiple stakeholders, including patients, transplant providers and their hospitals, payers, and regulatory bodies have an interest in measuring and monitoring quality in the liver transplant process, and understanding differences in quality across centres. This article aims to provide an overview of quality measurement and regulatory issues in liver transplantation performed within the United States. We review how broader definitions of health care quality should be applied to liver transplant care models. We outline the status quo including the current regulatory agencies, public reporting mechanisms, and requirements around quality assurance and performance improvement (QAPI) activities. Additionally, we further discuss unintended consequences and opportunities for growth in quality measurement. Quality measurement and the integration of quality improvement strategies into liver transplant programmes hold significant promise, but multiple challenges to successful implementation must be addressed to optimise value. Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

WATER QUALITY IMPROVEMENTS DURING RIVERBANK FILTRATION AT THREE SITES IN THE MIDWESTERN US

EPA Science Inventory

A 3-year project is underway to evaluate riverbank filtration systems along three major US rivers. A principal aspects of the study involved monitoring a suite or organic, inorganic, and microbiological water quality parameters, with emphasis on disinfection byproduct formation p...

Quality assurance in the surgical intensive care unit. Where it came from and where it's going.

PubMed

Osler, T; Horne, L

1991-08-01

The early history of QA is one of stunning achievements. Men and women led by a vision of what hospital health care should be brought about fundamental changes in the structure of hospitals and medical schools. These successes required lifetimes of work and enormous capital (Flexner's war chest would have amounted to billions of 1990 dollars). A second wave of reform included the creation of credentialing committees, tissue committees, and infection control efforts. Although less dramatic in their impact, these efforts have had measurable influence on the outcome of health care and, under the joint administration of local hospitals and the JCAHO, continue to guarantee excellence in health care. The most recent attempts at quality assurance, driven at least in part by a federal mandate to control costs, have been much more modest in their success. Committed groups working within a sound theoretical framework have had great difficulty monitoring and evaluating centrally a process as decentralized as health care. The regularity with which new fashions in QA have appeared underscores the frustration felt with this approach. If the quality of health care is to be monitored centrally, reliable measures of quality will be required. No one knows if such measures actually exist. The absence of objective evidence that quality has been improved by these efforts suggests that little has been accomplished, perhaps because all easily attainable improvements had already been implemented. The basic concept of a centrally monitored hospital structure within which provision is made for ongoing observation and innovation by those actually involved in the care of patients retains the advantages of central monitoring and local invention. It is a model that will be hard to improve on. We should persist in our efforts, but fundamental advances are unlikely. In the end, quality is only doing everything the best it can be done. The best quality assurance requires an excellent hospital in which a well-trained and committed staff has a central mandate and local purview to do the best possible job. Two thousand years after Hammurabi's minions busied themselves determining the appropriate punishment for various medical misadventures, the Greek Hippocrates advocated a less complex approach to the same problem. He suggested that the quality of health care could be best guaranteed by administering an oath to physicians, exhorting them simply to do what was best for their fellow men. This approach has seen us through two millennia and, however variable its results, may not be easily improved on.

Healthcare Reimbursement and Quality Improvement: Integration Using the Electronic Medical Record

PubMed Central

Britton, John R.

2015-01-01

Reimbursement for healthcare has utilized a variety of payment mechanisms with varying degrees of effectiveness. Whether these mechanisms are used singly or in combination, it is imperative that the resulting systems remunerate on the basis of the quantity, complexity, and quality of care provided. Expanding the role of the electronic medical record (EMR) to monitor provider practice, patient responsiveness, and functioning of the healthcare organization has the potential to not only enhance the accuracy and efficiency of reimbursement mechanisms but also to improve the quality of medical care. PMID:26340397

Quality management of Body Donation Program at the University of Padova.

PubMed

Porzionato, Andrea; Macchi, Veronica; Stecco, Carla; Mazzi, Anna; Rambaldo, Anna; Sarasin, Gloria; Parenti, Anna; Scipioni, Antonio; De Caro, Raffaele

2012-01-01

Quality management improvement has become a recent focus of attention in medical education. The program for the donation of bodies and body parts (Body Donation Program) at the University of Padova has recently been subjected to a global quality management standard, the ISO 9001:2008 certification. The aim of the present work is to show how the above standard is useful in enhancing the efficiency of body donation procedures and the quality and output of medical education. The program is managed by means of the following interlinked procedures: the collection of body donations, death certificates, data, and body parts from living donors; the transportation and identification of cadavers; the management of bodies, body parts, equipment, instruments, purchasing of necessary materials, and setting up anatomical training sessions; the management of preventive and corrective actions; the management of documents and registration; the management of internal and external quality audits; and the review of outcomes and improvement planning. Monitoring indicators are identified in the numbers of donors and of donated body parts per year, education sessions, and satisfaction of learners and donors, as evaluated by questionnaires. The process management approach, the integrated involvement of medical, technical, and administrative staff in defining procedures, and the application of monitoring indicators allow quality improvement in all aspects of the Body Donation Program. Copyright © 2012 American Association of Anatomists.

[Real-time feedback systems for improvement of resuscitation quality].

PubMed

Lukas, R P; Van Aken, H; Engel, P; Bohn, A

2011-07-01

The quality of chest compression is a determinant of survival after cardiac arrest. Therefore, the European Resuscitation Council (ERC) 2010 guidelines on resuscitation strongly focus on compression quality. Despite its impact on survival, observational studies have shown that chest compression quality is not reached by professional rescue teams. Real-time feedback devices for resuscitation are able to measure chest compression during an ongoing resuscitation attempt through a sternal sensor equipped with a motion and pressure detection system. In addition to the electrocardiograph (ECG) ventilation can be detected by transthoracic impedance monitoring. In cases of quality deviation, such as shallow chest compression depth or hyperventilation, feedback systems produce visual or acoustic alarms. Rescuers can thereby be supported and guided to the requested quality in chest compression and ventilation. Feedback technology is currently available both as a so-called stand-alone device and as an integrated feature in a monitor/defibrillator unit. Multiple studies have demonstrated sustainable enhancement in the education of resuscitation due to the use of real-time feedback technology. There is evidence that real-time feedback for resuscitation combined with training and debriefing strategies can improve both resuscitation quality and patient survival. Chest compression quality is an independent predictor for survival in resuscitation and should therefore be measured and documented in further clinical multicenter trials.

The National Water-Quality Assessment (NAWQA) Program planned monitoring and modeling activities for Texas, 2013–23

USGS Publications Warehouse

Ging, Patricia

2013-01-01

The U.S. Geological Survey’s (USGS) National Water-Quality Assessment (NAWQA) Program was established by Congress in 1992 to answer the following question: What is the status of the Nation’s water quality and is it getting better or worse? Since 1992, NAWQA has been a primary source of nationally consistent data and information on the quality of the Nation’s streams and groundwater. Data and information obtained from objective and nationally consistent water-quality monitoring and modeling activities provide answers to where, when, and why the Nation’s water quality is degraded and what can be done to improve and protect it for human and ecosystem needs. For NAWQA’s third decade (2013–23), a new strategic Science Plan has been developed that describes a strategy for building upon and enhancing the USGS’s ongoing assessment of the Nation’s freshwater quality and aquatic ecosystems.

Reliability in individual monitoring service.

PubMed

Mod Ali, N

2011-03-01

As a laboratory certified to ISO 9001:2008 and accredited to ISO/IEC 17025, the Secondary Standard Dosimetry Laboratory (SSDL)-Nuclear Malaysia has incorporated an overall comprehensive system for technical and quality management in promoting a reliable individual monitoring service (IMS). Faster identification and resolution of issues regarding dosemeter preparation and issuing of reports, personnel enhancement, improved customer satisfaction and overall efficiency of laboratory activities are all results of the implementation of an effective quality system. Review of these measures and responses to observed trends provide continuous improvement of the system. By having these mechanisms, reliability of the IMS can be assured in the promotion of safe behaviour at all levels of the workforce utilising ionising radiation facilities. Upgradation of in the reporting program through a web-based e-SSDL marks a major improvement in Nuclear Malaysia's IMS reliability on the whole. The system is a vital step in providing a user friendly and effective occupational exposure evaluation program in the country. It provides a higher level of confidence in the results generated for occupational dose monitoring of the IMS, thus, enhances the status of the radiation protection framework of the country.

Seasonal variation of fecal contamination in drinking water sources in developing countries: a systematic review.

PubMed

Kostyla, Caroline; Bain, Rob; Cronk, Ryan; Bartram, Jamie

2015-05-01

Accounting for fecal contamination of drinking water sources is an important step in improving monitoring of global access to safe drinking water. Fecal contamination varies with time while its monitoring is often infrequent. We sought to understand seasonal trends in fecal contamination to guide best practices to capture seasonal variation and ascertain the extent to which the results of a single sample may overestimate compliance with health guidelines. The findings from 22 studies from developing countries written in English and identified through a systematic review were analyzed. Fecal contamination in improved drinking water sources was shown to follow a statistically significant seasonal trend of greater contamination during the wet season (p<0.001). This trend was consistent across fecal indicator bacteria, five source types, twelve Köppen-Geiger climate zones, and across both rural and urban areas. Guidance on seasonally representative water quality monitoring by the World Health Organization and national water quality agencies could lead to improved assessments of access to safe drinking water. Copyright © 2015 Elsevier B.V. All rights reserved.

An Investigation of Techniques for Detecting Data Anomalies in Earned Value Management Data

DTIC Science & Technology

2011-12-01

Management Studio Harte Hanks Trillium Software Trillium Software System IBM Info Sphere Foundation Tools Informatica Data Explorer Informatica ...Analyst Informatica Developer Informatica Administrator Pitney Bowes Business Insight Spectrum SAP BusinessObjects Data Quality Management DataFlux...menting quality monitoring efforts and tracking data quality improvements Informatica http://www.informatica.com/products_services/Pages/index.aspx

Understanding the effectiveness of vegetated streamside management zones for protecting water quality (Chapter 5)

Treesearch

Philip Smethurst; Kevin Petrone; Daniel Neary

2012-01-01

We set out to improve understanding of the effectiveness of streamside management zones (SMZs) for protecting water quality in landscapes dominated by agriculture. We conducted a paired-catchment experiment that included water quality monitoring before and after the establishment of a forest plantation as an SMZ on cleared farmland that was used for extensive grazing....

Undertaking clinical audit, with reference to a Prescribing Observatory for Mental Health audit of lithium monitoring.

PubMed

Paton, Carol; Barnes, Thomas R E

2014-06-01

Audit is an important tool for quality improvement. The collection of data on clinical performance against evidence-based and clinically relevant standards, which are considered by clinicians to be realistic in routine practice, can usefully prompt reflective practice and the implementation of change. Evidence of participation in clinical audit is required to achieve intended learning outcomes for trainees in psychiatry and revalidation for those who are members of the Royal College of Psychiatrists. This article addresses some of the practical steps involved in conducting an audit project, and, to illustrate key points, draws on lessons learnt from a national, audit-based, quality improvement programme of lithium prescribing and monitoring conducted through the Prescribing Observatory for Mental Health.

Clinical application of a modern high-definition head-mounted display in sonography.

PubMed

Takeshita, Hideki; Kihara, Kazunori; Yoshida, Soichiro; Higuchi, Saori; Ito, Masaya; Nakanishi, Yasukazu; Kijima, Toshiki; Ishioka, Junichiro; Matsuoka, Yoh; Numao, Noboru; Saito, Kazutaka; Fujii, Yasuhisa

2014-08-01

Because of the remarkably improved image quality and wearability of modern head-mounted displays, a monitoring system using a head-mounted display rather than a fixed-site monitor for sonographic scanning has the potential to improve the diagnostic performance and lessen the examiner's physical burden during a sonographic examination. In a preclinical setting, 2 head-mounted displays, the HMZ-T2 (Sony Corporation, Tokyo, Japan) and the Wrap1200 (Vuzix Corporation, Rochester, NY), were found to be applicable to sonography. In a clinical setting, the feasibility of the HMZ-T2 was shown by its good image quality and acceptable wearability. This modern device is appropriate for clinical use in sonography. © 2014 by the American Institute of Ultrasound in Medicine.

From Computer-interpretable Guidelines to Computer-interpretable Quality Indicators: A Case for an Ontology.

PubMed

White, Pam; Roudsari, Abdul

2014-01-01

In the United Kingdom's National Health Service, quality indicators are generally measured electronically by using queries and data extraction, resulting in overlap and duplication of query components. Electronic measurement of health care quality indicators could be improved through an ontology intended to reduce duplication of effort during healthcare quality monitoring. While much research has been published on ontologies for computer-interpretable guidelines, quality indicators have lagged behind. We aimed to determine progress on the use of ontologies to facilitate computer-interpretable healthcare quality indicators. We assessed potential for improvements to computer-interpretable healthcare quality indicators in England. We concluded that an ontology for a large, diverse set of healthcare quality indicators could benefit the NHS and reduce workload, with potential lessons for other countries.

Accuracy and reliability of Chile's National Air Quality Information System for measuring particulate matter: Beta attenuation monitoring issue.

PubMed

Toro A, Richard; Campos, Claudia; Molina, Carolina; Morales S, Raul G E; Leiva-Guzmán, Manuel A

2015-09-01

A critical analysis of Chile's National Air Quality Information System (NAQIS) is presented, focusing on particulate matter (PM) measurement. This paper examines the complexity, availability and reliability of monitoring station information, the implementation of control systems, the quality assurance protocols of the monitoring station data and the reliability of the measurement systems in areas highly polluted by particulate matter. From information available on the NAQIS website, it is possible to confirm that the PM2.5 (PM10) data available on the site correspond to 30.8% (69.2%) of the total information available from the monitoring stations. There is a lack of information regarding the measurement systems used to quantify air pollutants, most of the available data registers contain gaps, almost all of the information is categorized as "preliminary information" and neither standard operating procedures (operational and validation) nor assurance audits or quality control of the measurements are reported. In contrast, events that cause saturation of the monitoring detectors located in northern and southern Chile have been observed using beta attenuation monitoring. In these cases, it can only be concluded that the PM content is equal to or greater than the saturation concentration registered by the monitors and that the air quality indexes obtained from these measurements are underestimated. This occurrence has been observed in 12 (20) public and private stations where PM2.5 (PM10) is measured. The shortcomings of the NAQIS data have important repercussions for the conclusions obtained from the data and for how the data are used. However, these issues represent opportunities for improving the system to widen its use, incorporate comparison protocols between equipment, install new stations and standardize the control system and quality assurance. Copyright © 2015 Elsevier Ltd. All rights reserved.

Monitoring and Evaluation of Cultivated Land Irrigation Guarantee Capability with Remote Sensing

NASA Astrophysics Data System (ADS)

Zhang, C., Sr.; Huang, J.; Li, L.; Wang, H.; Zhu, D.

2015-12-01

Abstract: Cultivated Land Quality Grade monitoring and evaluation is an important way to improve the land production capability and ensure the country food safety. Irrigation guarantee capability is one of important aspects in the cultivated land quality monitoring and evaluation. In the current cultivated land quality monitoring processing based on field survey, the irrigation rate need much human resources investment in long investigation process. This study choses Beijing-Tianjin-Hebei as study region, taking the 1 km × 1 km grid size of cultivated land unit with a winter wheat-summer maize double cropping system as study object. A new irrigation capacity evaluation index based on the ratio of the annual irrigation requirement retrieved from MODIS data and the actual quantity of irrigation was proposed. With the years of monitoring results the irrigation guarantee capability of study area was evaluated comprehensively. The change trend of the irrigation guarantee capability index (IGCI) with the agricultural drought disaster area in rural statistical yearbook of Beijing-Tianjin-Hebei area was generally consistent. The average of IGCI value, the probability of irrigation-guaranteed year and the weighted average which controlled by the irrigation demand index were used and compared in this paper. The experiment results indicate that the classification result from the present method was close to that from irrigation probability in the gradation on agriculture land quality in 2012, with overlap of 73% similar units. The method of monitoring and evaluation of cultivated land IGCI proposed in this paper has a potential in cultivated land quality level monitoring and evaluation in China. Key words: remote sensing, evapotranspiration, MODIS cultivated land quality, irrigation guarantee capability Authors: Chao Zhang, Jianxi Huang, Li Li, Hongshuo Wang, Dehai Zhu China Agricultural University zhangchaobj@gmail.com

ISO 9001 in a neonatal intensive care unit (NICU).

PubMed

Vitner, Gad; Nadir, Erez; Feldman, Michael; Yurman, Shmuel

2011-01-01

The aim of this paper is to present the process for approving and certifying a neonatal intensive care unit to ISO 9001 standards. The process started with the department head's decision to improve services quality before deciding to achieve ISO 9001 certification. Department processes were mapped and quality management mechanisms were developed. Process control and performance measurements were defined and implemented to monitor the daily work. A service satisfaction review was conducted to get feedback from families. In total, 28 processes and related work instructions were defined. Process yields showed service improvements. Family satisfaction improved. The paper is based on preparing only one neonatal intensive care unit to the ISO 9001 standard. The case study should act as an incentive for hospital managers aiming to improve service quality based on the ISO 9001 standard. ISO 9001 is becoming a recommended tool to improve clinical service quality.

National Forest Health Monitoring Program, Monitoring Urban Forests in Indiana: Pilot Study 2002, Part 2: Statewide Estimates Using the UFORE Model

Treesearch

David Nowak; Anne Buckelew Cumming; Daniel Twardus; Robert Hoehn; Manfred Mielke

2007-01-01

Trees in cities can improve environmental quality and human health. Unfortunately, little is known about the urban forest resource and what and how it contributes to local, regional, and national societies and economies. To better understand the urban forest resource and its value, the Forest Service, U.S. Department of Agriculture, Forest Health Monitoring Program...

Fiber Optic Raman Sensor to Monitor Concentration Ratio of Nitrogen and Oxygen in a Cryogenic Mixture

NASA Technical Reports Server (NTRS)

Tiwari, Vidhu S.; Kalluru, Rajamohan R.; Yueh, Fang-Yu; Singh, Jagdish P.; SaintCyr, William

2007-01-01

A spontaneous Raman scattering optical fiber sensor is developed for a specific need of NASA/SSC for long-term detection and monitoring of the quality of liquid oxygen (LOX) in the delivery line during ground testing of rocket engines. The sensor performance was tested in the laboratory and with different excitation light sources. To evaluate the sensor performance with different excitation light sources for the LOX quality application, we have used the various mixtures of liquid oxygen and liquid nitrogen as samples. The study of the sensor performance shows that this sensor offers a great deal of flexibility and provides a cost effective solution for the application. However, an improved system response time is needed for the real-time, quantitative monitoring of the quality of cryogenic fluids in harsh environment.

78 FR 12325 - Medicare and Medicaid Programs; Application From the Center for Improvement in Healthcare Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-22

... use in enforcement activities; monitoring procedures for provider entities found not in compliance... located at 42 CFR part 489 and those pertaining to activities relating to the survey and certification of... accredited facilities. ++ CIHQ's processes and procedures for monitoring a hospital that is out of compliance...

Exploring the Use of Participatory Information to Improve Monitoring, Mapping and Assessment of Aquatic Ecosystem Services at Landascape Scales

EPA Science Inventory

Traditionally, the EPA has monitored aquatic ecosystems using statistically rigorous sample designs and intensive field efforts which provide high quality datasets. But by their nature they leave many aquatic systems unsampled, follow a top down approach, have a long lag between ...

[Development of wireless monitoring system based on Zigbee technology in blood and bacterin cold chain].

PubMed

Zhao, Peng; Sun, Jian-Jun; Wu, Tai-Hu

2008-11-01

Real-time monitoring for temperature is required in cold chain for the medical products that are sensible with temperature, such as blood and bacterin, to guarantee the quality and reduce their wastage. This wireless monitoring system in cold chain is developed with Zigbee technology. Functions such as real-time monitoring, analyzing, alarming are realized. The system boasts such characteristics as low power consumption, low cost, big capacity and high reliability, and could improve the capability of real-time monitoring and management in cold chain effectively.

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative.

PubMed

Dückers, Michel La; Wagner, Cordula; Vos, Leti; Groenewegen, Peter P

2011-03-09

Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.

Engagement Insights: Survey Findings on the Quality of Undergraduate Education. Annual Results 2016

ERIC Educational Resources Information Center

National Survey of Student Engagement, 2016

2016-01-01

The National Survey of Student Engagement (NSSE) and its companion projects serve colleges and universities committed to monitoring and improving the quality of the undergraduate experience. While participating institutions receive detailed customized reports, the "Annual Results" series presents noteworthy aggregate findings from the…

77 FR 66470 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-05

... provided by grantees under the SCDTDP and monitor and drive improvement on quality measures; (2) collect... review by the Office of Management and Budget (OMB), in compliance with the Paperwork Reduction Act of... Act of 1995: Proposed Project: Sickle Cell Disease Treatment Demonstration Program-- Quality...

INFORMATION MANAGEMENT AND RELATED QUALITY ASSURANCE FOR A LARGE SCALE, MULTI-SITE RESEARCH PROJECT

EPA Science Inventory

During the summer of 2000, as part of a U.S. Environmental Protection Agency study designed to improve microbial water quality monitoring protocols at public beaches, over 11,000 water samples were collected at five selected beaches across the country. At each beach, samples wer...

Quality assessment of patients’ self-monitoring of blood glucose in community pharmacies

PubMed Central

Kjome, Reidun L. S.; Granas, Anne G.; Nerhus, Kari; Sandberg, Sverre

2009-01-01

Objective To evaluate diabetes patients’ self-monitoring of blood glucose using a community pharmacy-based quality assurance procedure, to investigate whether the procedure improved the quality of the patient performance of self monitoring of blood glucose, and to examine the opinions of the patients taking part in the study. Methods The results of patient blood glucose measurements were compared to the results obtained with HemoCue Glucose 201+ by pharmacy employees in 16 Norwegian community pharmacies. Patient performance was monitored using an eight item checklist. Patients whose blood glucose measurements differed from pharmacy measurements by more than 20% were instructed in the correct use of their glucometer. The patients then re-measured their blood glucose. If the results were still outside the set limits, the control procedure was repeated with a new lot of glucometer strips, and then with a new glucometer. The patients returned for a follow-up visit after three months. Results During the first visit, 5% of the 338 patients had measurements that deviated from pharmacy blood glucose values by more than 20% and user errors were observed for 50% of the patients. At the second visit, there was no significant change in the analytical quality of patient measurements, but the percentage of patients who made user errors had decreased to 29% (p < 0.001). Eighty-five percent of the patients reported that they used their blood glucose results to adjust medication, exercise or meals. Fifty-one percent of the patients reported a greater trust in their measurements after the second visit. Eighty percent of patients wished to have their measurements assessed yearly. Of these patients, 83% preferred to have the assessment done at the community pharmacy. Conclusion A community pharmacy-based quality assessment procedure of patients’ self monitoring of blood glucose significantly reduced the number of user errors. The analytical quality of the patients’ measurements was good and did not improve further during the study. The high analytical quality might be explained by a selection bias of participating patients. Patients also reported increased confidence in their blood glucose measurements after their measurements had been assessed at the pharmacy. PMID:25152795

A machine learning calibration model using random forests to improve sensor performance for lower-cost air quality monitoring

NASA Astrophysics Data System (ADS)

Zimmerman, Naomi; Presto, Albert A.; Kumar, Sriniwasa P. N.; Gu, Jason; Hauryliuk, Aliaksei; Robinson, Ellis S.; Robinson, Allen L.; Subramanian, R.

2018-01-01

Low-cost sensing strategies hold the promise of denser air quality monitoring networks, which could significantly improve our understanding of personal air pollution exposure. Additionally, low-cost air quality sensors could be deployed to areas where limited monitoring exists. However, low-cost sensors are frequently sensitive to environmental conditions and pollutant cross-sensitivities, which have historically been poorly addressed by laboratory calibrations, limiting their utility for monitoring. In this study, we investigated different calibration models for the Real-time Affordable Multi-Pollutant (RAMP) sensor package, which measures CO, NO2, O3, and CO2. We explored three methods: (1) laboratory univariate linear regression, (2) empirical multiple linear regression, and (3) machine-learning-based calibration models using random forests (RF). Calibration models were developed for 16-19 RAMP monitors (varied by pollutant) using training and testing windows spanning August 2016 through February 2017 in Pittsburgh, PA, US. The random forest models matched (CO) or significantly outperformed (NO2, CO2, O3) the other calibration models, and their accuracy and precision were robust over time for testing windows of up to 16 weeks. Following calibration, average mean absolute error on the testing data set from the random forest models was 38 ppb for CO (14 % relative error), 10 ppm for CO2 (2 % relative error), 3.5 ppb for NO2 (29 % relative error), and 3.4 ppb for O3 (15 % relative error), and Pearson r versus the reference monitors exceeded 0.8 for most units. Model performance is explored in detail, including a quantification of model variable importance, accuracy across different concentration ranges, and performance in a range of monitoring contexts including the National Ambient Air Quality Standards (NAAQS) and the US EPA Air Sensors Guidebook recommendations of minimum data quality for personal exposure measurement. A key strength of the RF approach is that it accounts for pollutant cross-sensitivities. This highlights the importance of developing multipollutant sensor packages (as opposed to single-pollutant monitors); we determined this is especially critical for NO2 and CO2. The evaluation reveals that only the RF-calibrated sensors meet the US EPA Air Sensors Guidebook recommendations of minimum data quality for personal exposure measurement. We also demonstrate that the RF-model-calibrated sensors could detect differences in NO2 concentrations between a near-road site and a suburban site less than 1.5 km away. From this study, we conclude that combining RF models with carefully controlled state-of-the-art multipollutant sensor packages as in the RAMP monitors appears to be a very promising approach to address the poor performance that has plagued low-cost air quality sensors.

Productivity in Pediatric Palliative Care: Measuring and Monitoring an Elusive Metric.

PubMed

Kaye, Erica C; Abramson, Zachary R; Snaman, Jennifer M; Friebert, Sarah E; Baker, Justin N

2017-05-01

Workforce productivity is poorly defined in health care. Particularly in the field of pediatric palliative care (PPC), the absence of consensus metrics impedes aggregation and analysis of data to track workforce efficiency and effectiveness. Lack of uniformly measured data also compromises the development of innovative strategies to improve productivity and hinders investigation of the link between productivity and quality of care, which are interrelated but not interchangeable. To review the literature regarding the definition and measurement of productivity in PPC; to identify barriers to productivity within traditional PPC models; and to recommend novel metrics to study productivity as a component of quality care in PPC. PubMed ® and Cochrane Database of Systematic Reviews searches for scholarly literature were performed using key words (pediatric palliative care, palliative care, team, workforce, workflow, productivity, algorithm, quality care, quality improvement, quality metric, inpatient, hospital, consultation, model) for articles published between 2000 and 2016. Organizational searches of Center to Advance Palliative Care, National Hospice and Palliative Care Organization, National Association for Home Care & Hospice, American Academy of Hospice and Palliative Medicine, Hospice and Palliative Nurses Association, National Quality Forum, and National Consensus Project for Quality Palliative Care were also performed. Additional semistructured interviews were conducted with directors from seven prominent PPC programs across the U.S. to review standard operating procedures for PPC team workflow and productivity. Little consensus exists in the PPC field regarding optimal ways to define, measure, and analyze provider and program productivity. Barriers to accurate monitoring of productivity include difficulties with identification, measurement, and interpretation of metrics applicable to an interdisciplinary care paradigm. In the context of inefficiencies inherent to traditional consultation models, novel productivity metrics are proposed. Further research is needed to determine optimal metrics for monitoring productivity within PPC teams. Innovative approaches should be studied with the goal of improving efficiency of care without compromising value. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

SU-E-T-776: Use of Quality Metrics for a New Hypo-Fractionated Pre-Surgical Mesothelioma Protocol

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

Richardson, S; Mehta, V

Purpose: The “SMART” (Surgery for Mesothelioma After Radiation Therapy) approach involves hypo-fractionated radiotherapy of the lung pleura to 25Gy over 5 days followed by surgical resection within 7. Early clinical results suggest that this approach is very promising, but also logistically challenging due to the multidisciplinary involvement. Due to the compressed schedule, high dose, and shortened planning time, the delivery of the planned doses were monitored for safety with quality metric software. Methods: Hypo-fractionated IMRT treatment plans were developed for all patients and exported to Quality Reports™ software. Plan quality metrics or PQMs™ were created to calculate an objective scoringmore » function for each plan. This allows for an objective assessment of the quality of the plan and a benchmark for plan improvement for subsequent patients. The priorities of various components were incorporated based on similar hypo-fractionated protocols such as lung SBRT treatments. Results: Five patients have been treated at our institution using this approach. The plans were developed, QA performed, and ready within 5 days of simulation. Plan Quality metrics utilized in scoring included doses to OAR and target coverage. All patients tolerated treatment well and proceeded to surgery as scheduled. Reported toxicity included grade 1 nausea (n=1), grade 1 esophagitis (n=1), grade 2 fatigue (n=3). One patient had recurrent fluid accumulation following surgery. No patients experienced any pulmonary toxicity prior to surgery. Conclusion: An accelerated course of pre-operative high dose radiation for mesothelioma is an innovative and promising new protocol. Without historical data, one must proceed cautiously and monitor the data carefully. The development of quality metrics and scoring functions for these treatments allows us to benchmark our plans and monitor improvement. If subsequent toxicities occur, these will be easy to investigate and incorporate into the metrics. This will improve the safe delivery of large doses for these patients.« less

High-frequency remote monitoring of large lakes with MODIS 500 m imagery

USGS Publications Warehouse

McCullough, Ian M.; Loftin, Cynthia S.; Sader, Steven A.

2012-01-01

Satellite-based remote monitoring programs of regional lake water quality largely have relied on Landsat Thematic Mapper (TM) owing to its long image archive, moderate spatial resolution (30 m), and wide sensitivity in the visible portion of the electromagnetic spectrum, despite some notable limitations such as temporal resolution (i.e., 16 days), data pre-processing requirements to improve data quality, and aging satellites. Moderate-Resolution Imaging Spectroradiometer (MODIS) sensors on Aqua/Terra platforms compensate for these shortcomings, although at the expense of spatial resolution. We developed and evaluated a remote monitoring protocol for water clarity of large lakes using MODIS 500 m data and compared MODIS utility to Landsat-based methods. MODIS images captured during May–September 2001, 2004 and 2010 were analyzed with linear regression to identify the relationship between lake water clarity and satellite-measured surface reflectance. Correlations were strong (R² = 0.72–0.94) throughout the study period; however, they were the most consistent in August, reflecting seasonally unstable lake conditions and inter-annual differences in algal productivity during the other months. The utility of MODIS data in remote water quality estimation lies in intra-annual monitoring of lake water clarity in inaccessible, large lakes, whereas Landsat is more appropriate for inter-annual, regional trend analyses of lakes ≥ 8 ha. Model accuracy is improved when ancillary variables are included to reflect seasonal lake dynamics and weather patterns that influence lake clarity. The identification of landscape-scale drivers of regional water quality is a useful way to supplement satellite-based remote monitoring programs relying on spectral data alone.

Applying PCI in Combination Swivel Head Wrench

NASA Astrophysics Data System (ADS)

Chen, Tsang-Chiang; Yang, Chun-Ming; Hsu, Chang-Hsien; Hung, Hsiang-Wen

2017-09-01

Taiwan’s traditional industries are subject to competition in the era of globalization and environmental change, the industry is facing economic pressure and shock, and now sustainable business can only continue to improve production efficiency and quality of technology, in order to stabilize the market, to obtain high occupancy. The use of process capability indices to monitor the quality of the ratchet wrench to find the key function of the dual-use ratchet wrench, the actual measurement data, The use of process capability Cpk index analysis, and draw Process Capability Analysis Chart model. Finally, this study explores the current situation of this case and proposes a lack of improvement and improvement methods to improve the overall quality and thereby enhance the overall industry.

Using a monitoring and evaluation framework to improve study efficiency and quality during a prospective cohort study in infants receiving rotavirus vaccination in El Alto, Bolivia: the Infant Nutrition, Inflammation, and Diarrheal Illness (NIDI) study.

PubMed

Aceituno, Anna M; Stanhope, Kaitlyn K; Rebolledo, Paulina A; Burke, Rachel M; Revollo, Rita; Iñiguez, Volga; Suchdev, Parminder S; Leon, Juan S

2017-11-28

Implementing rigorous epidemiologic studies in low-resource settings involves challenges in participant recruitment and follow-up (e.g., mobile populations, distrust), biological sample collection (e.g., cold-chain, laboratory equipment scarcity) and data collection (e.g., literacy, staff training, and infrastructure). This article describes the use of a monitoring and evaluation (M&E) framework to improve study efficiency and quality during participant engagement, and biological sample and data collection in a longitudinal cohort study of Bolivian infants. The study occurred between 2013 and 2015 in El Alto, Bolivia, a high-altitude, urban, low-resource community. The study's M&E framework included indicators for participant engagement (e.g., recruitment, retention, safety), biological sample (e.g., stool and blood), and data (e.g., anthropometry, questionnaires) collection and quality. Monitoring indicators were measured regularly throughout the study and used for course correction, communication, and staff retraining. Participant engagement indicators suggested that enrollment objectives were met (461 infants), but 15% loss-to-follow-up resulted in only 364 infants completing the study. Over the course of the study, there were four study-related adverse events (minor swelling and bruising related to a blood draw) and five severe adverse events (infant deaths) not related to study participation. Biological sample indicators demonstrated two blood samples collected from 95% (333 of 350 required) infants and stool collected for 61% of reported infant diarrhea episodes. Anthropometry data quality indicators were extremely high (median SDs for weight-for-length, length-for-age and weight-for-age z-scores 1.01, 0.98, and 1.03, respectively), likely due to extensive training, standardization, and monitoring efforts. Conducting human subjects research studies in low-resource settings often presents unique logistical difficulties, and collecting high-quality data is often a challenge. Investing in comprehensive M&E is important to improve participant recruitment, retention and safety, and sample and data quality. The M&E framework from this study can be applied to other longitudinal studies.

Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery.

PubMed

Gockel, Ines; Ahlbrand, Constantin Johannes; Arras, Michael; Schreiber, Elke Maria; Lang, Hauke

2015-12-01

Ranking systems and comparisons of quality and performance indicators will be of increasing relevance for complex "high-risk" procedures such as esophageal cancer surgery. The identification of evidence-based standards relevant for key performance indicators in esophageal surgery is essential for establishing monitoring systems and furthermore a requirement to enhance treatment quality. In the course of this review, we analyze the key performance indicators case volume, radicality of resection, and postoperative morbidity and mortality, leading to continuous quality improvement. Ranking systems established on this basis will gain increased relevance in highly complex procedures within the national and international comparison and furthermore improve the treatment of patients with esophageal carcinoma.

Long-term ecosystem monitoring and assessment of the Detroit River and Western Lake Erie.

PubMed

Hartig, J H; Zarull, M A; Ciborowski, J J H; Gannon, J E; Wilke, E; Norwood, G; Vincent, A N

2009-11-01

Over 35 years of US and Canadian pollution prevention and control efforts have led to substantial improvements in environmental quality of the Detroit River and western Lake Erie. However, the available information also shows that much remains to be done. Improvements in environmental quality have resulted in significant ecological recovery, including increasing populations of bald eagles (Haliaeetus leucocephalus), peregrine falcons (Falco columbarius), lake sturgeon (Acipenser fulvescens), lake whitefish (Coregonus clupeaformis), walleye (Sander vitreus), and burrowing mayflies (Hexagenia spp.). Although this recovery is remarkable, many challenges remain, including population growth, transportation expansion, and land use changes; nonpoint source pollution; toxic substances contamination; habitat loss and degradation; introduction of exotic species; and greenhouse gases and global warming. Research/monitoring must be sustained for effective management. Priority research and monitoring needs include: demonstrating and quantifying cause-effect relationships; establishing quantitative endpoints and desired future states; determining cumulative impacts and how indicators relate; improving modeling and prediction; prioritizing geographic areas for protection and restoration; and fostering long-term monitoring for adaptive management. Key management agencies, universities, and environmental and conservation organizations should pool resources and undertake comprehensive and integrative assessments of the health of the Detroit River and western Lake Erie at least every 5 years to practice adaptive management for long-term sustainability.

Comparison of bioimpedance analysis scan, hemoglobin and urea reduction ratio in hemodialysis patients following and not following monitoring program for improving quality of life

NASA Astrophysics Data System (ADS)

Muzasti, R. A.; Lubis, H. R.

2018-03-01

Hemodialysis (HD) is the renal replacement therapy in end-stage renal disease (ESRD), at least 2-3 times a week, impacting substantial changes in daily life. Therefore a monitoring program is needed to improve the quality of life (QoL) of HD patients. Indicators in monitoring QoL include phase angle (PhA), muscle and fat mass, and body fluid composition through Bio Scan impedance analysis (BIA) Scan, hemoglobin level, and urea reduction ratio (URR). An analytic study with the cross-sectional design was performed in 168 patients at Klinik Spesialis Ginjal Hipertensi (KSGH) Rasyida, Medan to compare BIA Scan profiles, hemoglobin levels, and URR in HD patients who follow and do not follow the monitoring program for improving QoL {Program Pemantauan Peningkatan Kualitas Hidup (P3KH)}. Each variable was analyzed by independent T-test, it is significant if p <0.05. This study showed that there were differences in BMI (p = 0.006), fat mass (p = 0.010), extracellular water / intracellular water (ECW / ICW) (p = 0.046), and haemoglobin p = 0.001). Although it was better in the program group, statistically there was no difference of PhA (p = 0.136), muscle mass (p = 0.842), and URR (p = 0.232).

The monitoring of eco-hydrological parameters within the LIFE Ljubljanica Connects project

NASA Astrophysics Data System (ADS)

Sapač, Klaudija; Šraj, Mojca; Zabret, Katarina; Brilly, Mitja; Vidmar, Andrej

2016-04-01

The main objectives of the Ljubljanica Connects project arising from the need to improve the living conditions in the Ljubljanica River for endangered fish species. The history of improving the conditions dates back more than 100 years ago with the construction of fish passages at the obstacles on the Ljubljanica River. As part of the project the fish passages were reconstructed and upgraded to improve river connectivity. But for the survival of fish and other aquatic organisms in the river also adequate living conditions are necessary which can be determined by measurements of individual parameters of water quality. Within the LIFE Ljubljanica Connects project we have established continuous eco-hydrological monitoring of water level and temperature at 17 measuring sites and concentration of dissolved oxygen at 3 measuring sites along the Ljubljanica River and its tributaries. Water level data are input data for the hydrological model of Ljubljanica River, while water temperature and concentration of dissolved oxygen are the basic indicators of the quality of the water. The purpose of this paper is to present the measuring equipment of eco-hydrological monitoring, the first feedback on the results of measured water temperature and the concentration of dissolved oxygen in the Ljubljanica River, and the advantages and importance of such monitoring.

Large Scale Application of Vibration Sensors for Fan Monitoring at Commercial Layer Hen Houses

PubMed Central

Chen, Yan; Ni, Ji-Qin; Diehl, Claude A.; Heber, Albert J.; Bogan, Bill W.; Chai, Li-Long

2010-01-01

Continuously monitoring the operation of each individual fan can significantly improve the measurement quality of aerial pollutant emissions from animal buildings that have a large number of fans. To monitor the fan operation by detecting the fan vibration is a relatively new technique. A low-cost electronic vibration sensor was developed and commercialized. However, its large scale application has not yet been evaluated. This paper presents long-term performance results of this vibration sensor at two large commercial layer houses. Vibration sensors were installed on 164 fans of 130 cm diameter to continuously monitor the fan on/off status for two years. The performance of the vibration sensors was compared with fan rotational speed (FRS) sensors. The vibration sensors exhibited quick response and high sensitivity to fan operations and therefore satisfied the general requirements of air quality research. The study proved that detecting fan vibration was an effective method to monitor the on/off status of a large number of single-speed fans. The vibration sensor itself was $2 more expensive than a magnetic proximity FRS sensor but the overall cost including installation and data acquisition hardware was $77 less expensive than the FRS sensor. A total of nine vibration sensors failed during the study and the failure rate was related to the batches of product. A few sensors also exhibited unsteady sensitivity. As a new product, the quality of the sensor should be improved to make it more reliable and acceptable. PMID:22163544

Web-based Comparative Patient-reported Outcome Feedback to Support Quality Improvement and Comparative Effectiveness Research in Total Joint Replacement.

PubMed

Zheng, Hua; Li, Wenjun; Harrold, Leslie; Ayers, David C; Franklin, Patricia D

2014-01-01

Patient-reported outcomes (PROs) are rarely included in quality monitoring systems, surgeon comparative feedback reports, or registries. We present the design and implementation of a secure website in a federally funded research program-Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR)-to return comparative PRO reports to participating surgeons, in addition to including traditional quality measures, in order to monitor and improve quality and health outcomes. The surgeon-specific comparative PRO reports were designed and structured based on user input for content, data elements, integration, and display. Three questions are addressed regarding the knee and hip joint symptom profiles of patients before TJR, as well as outcomes of surgery. The website is organized with a hierarchical structure to display data at national, practice, and individual surgeon levels, and provides a comprehensive site-level executive summary and surgeon-level data reports that can be downloaded. As of September 2014, over 22,000 patients were enrolled from more than 130 surgeons in 22 states. The reporting website was launched in September 2012 and has been updated quarterly for all surgeons to review their site- and individual-specific outcomes data compared to national benchmarks. In this novel system, quarterly comparative surgeon feedback extends beyond traditional measures of complication rates to include PROs of pain relief and functional gain. We anticipate that this enhanced data will facilitate patient-centered quality improvement (QI) and outcomes research from the registry. As the Centers for Medicare & Medicaid Services (CMS) and other insurers consider future implementation of PROs, surgeons will increasingly need comparative data by which to self-monitor their practice outcomes.

The principles of ultrasound and its application in freezing related processes of food materials: A review.

PubMed

Cheng, Xinfeng; Zhang, Min; Xu, Baoguo; Adhikari, Benu; Sun, Jincai

2015-11-01

Ultrasonic processing is a novel and promising technology in food industry. The propagation of ultrasound in a medium generates various physical and chemical effects and these effects have been harnessed to improve the efficiency of various food processing operations. Ultrasound has also been used in food quality control as diagnostic technology. This article provides an overview of recent developments related to the application of ultrasound in low temperature and closely related processes such as freezing, thawing, freeze concentration and freeze drying. The applications of high intensity ultrasound to improve the efficiency of freezing process, to control the size and size distribution of ice crystals and to improve the quality of frozen foods have been discussed in considerable detail. The use of low intensity ultrasound in monitoring the ice content and to monitor the progress of freezing process has also been highlighted. Copyright © 2015 Elsevier B.V. All rights reserved.

Development of a new Clinical Engineering Management Tool & Information System (CLE-MANTIS).

PubMed

Panousis, S G; Malataras, P; Patelodimou, C; Kolitsi, Z; Pallikarakis, N

1997-01-01

The evolution of the field of biomedical technology has led to the diffusion of an impressive number of medical devices into healthcare institutions. In this environment, Clinical Engineering Departments (CEDs) are expanding their role in healthcare technology management, by changing their structure and introducing quality systems in order to improve their services and monitor the outcomes. In the framework of the national project BIOTECHNET II, a software tool for the management of biomedical technology, named CLE-MANTIS, has been developed, with the aim to assist CEDs in their tasks. CLE-MANTIS functions include the upkeep of an inventory, the support and monitoring of scheduled maintenance, corrective maintenance, vigilance, equipment acquisition and replacement, service contract management and user training. The system offers clinical engineers the possibility to monitor and evaluate the quality and cost-effectiveness of their departments through the monitoring of quality and cost indicators. This paper presents the main features and functions of the system.

Real-time robot deliberation by compilation and monitoring of anytime algorithms

NASA Technical Reports Server (NTRS)

Zilberstein, Shlomo

1994-01-01

Anytime algorithms are algorithms whose quality of results improves gradually as computation time increases. Certainty, accuracy, and specificity are metrics useful in anytime algorighm construction. It is widely accepted that a successful robotic system must trade off between decision quality and the computational resources used to produce it. Anytime algorithms were designed to offer such a trade off. A model of compilation and monitoring mechanisms needed to build robots that can efficiently control their deliberation time is presented. This approach simplifies the design and implementation of complex intelligent robots, mechanizes the composition and monitoring processes, and provides independent real time robotic systems that automatically adjust resource allocation to yield optimum performance.

Enhancing wind erosion monitoring and assessment for U.S. rangelands

USGS Publications Warehouse

Webb, Nicholas P.; Van Zee, Justin W.; Karl, Jason W.; Herrick, Jeffrey E.; Courtright, Ericha M.; Billings, Benjamin J.; Boyd, Robert C.; Chappell, Adrian; Duniway, Michael C.; Derner, Justin D.; Hand, Jenny L.; Kachergis, Emily; McCord, Sarah E.; Newingham, Beth A.; Pierson, Frederick B.; Steiner, Jean L.; Tatarko, John; Tedela, Negussie H.; Toledo, David; Van Pelt, R. Scott

2017-01-01

On the GroundWind erosion is a major resource concern for rangeland managers because it can impact soil health, ecosystem structure and function, hydrologic processes, agricultural production, and air quality.Despite its significance, little is known about which landscapes are eroding, by how much, and when.The National Wind Erosion Research Network was established in 2014 to develop tools for monitoring and assessing wind erosion and dust emissions across the United States.The Network, currently consisting of 13 sites, creates opportunities to enhance existing rangeland soil, vegetation, and air quality monitoring programs.Decision-support tools developed by the Network will improve the prediction and management of wind erosion across rangeland ecosystems.

Environmental Assessment: 49th Materiel Maintenance Group BEAR Base Improvements Holloman Air Force Base, New Mexico

DTIC Science & Technology

2004-08-01

land clearing action will be an irreversible commitment of resources. 4.3.2 Water Quality Construction project impacts to storm water quality can...nearby monitored outfalls for the MSGP. High turbidity, suspended solids, and decreased cross section due to deposition can violate storm water quality benchmarks...and result in a Notice of Violation for storm water quality permits. Beside erosive impacts, construction period activities can cause

Should we have confidence if a physician is accredited? A Study of the Relative Impacts of Accreditation and Insurance Payments on Quality of Care in the Philippines

PubMed Central

Quimbo, Stella A; Shimkhada, Riti; Woo, Kimberley; Solon, Orville

2008-01-01

It is unclear whether health provider accreditation ensures or promotes quality of care. Using baseline data from the Quality Improvement Demonstration Study (QIDS) in the Philippines we measured the quality of pediatric care provided by private and public doctors working at the district hospital level in the country’s central region. We found that national level accreditation by a national insurance programme influences quality of care. However, our data also show that insurance payments have a similar, strong impact on quality of care. These results suggest that accreditation alone may not be sufficient to promote high quality of care. Further improvements may be achieved with properly monitored and well-designed payment or incentive schemes. PMID:18534734

Real time monitoring of powder blend bulk density for coupled feed-forward/feed-back control of a continuous direct compaction tablet manufacturing process.

PubMed

Singh, Ravendra; Román-Ospino, Andrés D; Romañach, Rodolfo J; Ierapetritou, Marianthi; Ramachandran, Rohit

2015-11-10

The pharmaceutical industry is strictly regulated, where precise and accurate control of the end product quality is necessary to ensure the effectiveness of the drug products. For such control, the process and raw materials variability ideally need to be fed-forward in real time into an automatic control system so that a proactive action can be taken before it can affect the end product quality. Variations in raw material properties (e.g., particle size), feeder hopper level, amount of lubrication, milling and blending action, applied shear in different processing stages can affect the blend density significantly and thereby tablet weight, hardness and dissolution. Therefore, real time monitoring of powder bulk density variability and its incorporation into the automatic control system so that its effect can be mitigated proactively and efficiently is highly desired. However, real time monitoring of powder bulk density is still a challenging task because of different level of complexities. In this work, powder bulk density which has a significant effect on the critical quality attributes (CQA's) has been monitored in real time in a pilot-plant facility, using a NIR sensor. The sensitivity of the powder bulk density on critical process parameters (CPP's) and CQA's has been analyzed and thereby feed-forward controller has been designed. The measured signal can be used for feed-forward control so that the corrective actions on the density variations can be taken before they can influence the product quality. The coupled feed-forward/feed-back control system demonstrates improved control performance and improvements in the final product quality in the presence of process and raw material variations. Copyright © 2015 Elsevier B.V. All rights reserved.

A systematic review of the cost of data collection for performance monitoring in hospitals.

PubMed

Jones, Cheryl; Gannon, Brenda; Wakai, Abel; O'Sullivan, Ronan

2015-04-01

Key performance indicators (KPIs) are used to identify where organisational performance is meeting desired standards and where performance requires improvement. Valid and reliable KPIs depend on the availability of high-quality data, specifically the relevant minimum data set ((MDS) the core data identified as the minimum required to measure performance for a KPI) elements. However, the feasibility of collecting the relevant MDS elements is always a limitation of performance monitoring using KPIs. Preferably, data should be integrated into service delivery, and, where additional data are required that are not currently collected as part of routine service delivery, there should be an economic evaluation to determine the cost of data collection. The aim of this systematic review was to synthesise the evidence base concerning the costs of data collection in hospitals for performance monitoring using KPI, and to identify hospital data collection systems that have proven to be cost minimising. We searched MEDLINE (1946 to May week 4 2014), Embase (1974 to May week 2 2014), and CINAHL (1937 to date). The database searches were supplemented by searching for grey literature through the OpenGrey database. Data was extracted, tabulated, and summarised as part of a narrative synthesis. The searches yielded a total of 1,135 publications. After assessing each identified study against specific inclusion exclusion criteria only eight studies were deemed as relevant for this review. The studies attempt to evaluate different types of data collection interventions including the installation of information communication technology (ICT), improvements to current ICT systems, and how different analysis techniques may be used to monitor performance. The evaluation methods used to measure the costs and benefits of data collection interventions are inconsistent across the identified literature. Overall, the results weakly indicate that collection of hospital data and improvements in data recording can be cost-saving. Given the limitations of this systematic review, it is difficult to conclude whether improvements in data collection systems can save money, increase quality of care, and assist performance monitoring of hospitals. With that said, the results are positive and suggest that data collection improvements may lead to cost savings and aid quality of care. PROSPERO CRD42014007450 .

Genetic Improvement of Switchgrass and Other Herbaceous Plants for Use as Biomass Fuel Feedstock

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

Vogel, K.P.

2001-01-11

It should be highly feasible to genetically modify the feedstock quality of switchgrass and other herbaceous plants using both conventional and molecular breeding techniques. Effectiveness of breeding to modify herbages of switchgrass and other perennial and annual herbaceous species has already been demonstrated. The use of molecular markers and transformation technology will greatly enhance the capability of breeders to modify the plant structure and cell walls of herbaceous plants. It will be necessary to monitor gene flow to remnant wild populations of plants and have strategies available to curtail gene flow if it becomes a potential problem. It also willmore » be necessary to monitor plant survival and long-term productivity as affected by genetic changes that improve forage quality. Information on the conversion processes that will be used and the biomass characteristics that affect conversion efficiency and rate is absolutely essential as well as information on the relative economic value of specific traits. Because most forage or biomass quality characteristics are highly affected by plant maturity, it is suggested that plant material of specific maturity stages be used in research to determining desirable feedstock quality characteristics. Plant material could be collected at various stages of development from an array of environments and storage conditions that could be used in conversion research. The same plant material could be used to develop NIRS calibrations that could be used by breeders in their selection programs and also to develop criteria for a feedstock quality assessment program. Breeding for improved feedstock quality will likely affect the rate of improvement of biomass production per acre. If the same level of resources are used, multi-trait breeding simply reduces the selection pressure and hence the breeding progress that can be made for a single trait unless all the traits are highly correlated. Since desirable feedstock traits are likely to be similar to IVDMD, it is likely that they will not be highly positively correlated with yield. Hence to achieve target yields and improve specific quality traits, it will likely be necessary to increase the resources available to plant breeders. Marker assisted selection will be extremely useful in breeding for quality traits, particularly for traits that can be affected by modifying a few genes. Genetic markers are going to be needed for monitoring gene flow to wild populations. Transformation will be a very useful tool for determining the affects of specific genes on biomass feedstock quality.« less

Evaluation of the AirNow Satellite Data Processor for 2010-2012

NASA Astrophysics Data System (ADS)

Pasch, A. N.; DeWinter, J. L.; Dye, T.; Haderman, M.; Zahn, P. H.; Szykman, J.; White, J. E.; Dickerson, P.; van Donkelaar, A.; Martin, R.

2013-12-01

The U.S. Environmental Protection Agency's (EPA) AirNow program provides the public with real-time and forecasted air quality conditions. Millions of people each day use information from AirNow to protect their health. The AirNow program (http://www.airnow.gov) reports ground-level ozone (O3) and fine particulate matter (PM2.5) with a standardized index called the Air Quality Index (AQI). AirNow aggregates information from over 130 state, local, and federal air quality agencies and provides tools for over 2,000 agency staff responsible for monitoring, forecasting, and communicating local air quality. Each hour, AirNow systems generate thousands of maps and products. The usefulness of the AirNow air quality maps depends on the accuracy and spatial coverage of air quality measurements. Currently, the maps use only ground-based measurements, which have significant gaps in coverage in some parts of the United States. As a result, contoured AQI levels have high uncertainty in regions far from monitors. To improve the usefulness of air quality maps, scientists at EPA, Dalhousie University, and Sonoma Technology, Inc., in collaboration with the National Aeronautics and Space Administration (NASA) and the National Oceanic and Atmospheric Administration (NOAA), have completed a project to incorporate satellite-estimated surface PM2.5 concentrations into the maps via the AirNow Satellite Data Processor (ASDP). These satellite estimates are derived using NASA/NOAA satellite aerosol optical depth (AOD) retrievals and GEOS-Chem modeled ratios of surface PM2.5 concentrations to AOD. GEOS-Chem is a three-dimensional chemical transport model for atmospheric composition driven by meteorological input from the Goddard Earth Observing System (GEOS). The ASDP can fuse multiple PM2.5 concentration data sets to generate AQI maps with improved spatial coverage. The goals of ASDP are to provide more detailed AQI information in monitor-sparse locations and to augment monitor-dense locations with more information. The ASDP system uses a weighted-average approach using uncertainty information about each data set. Recent improvements in the estimation of the uncertainty of interpolated ground-based monitor data have allowed for a more complete characterization of the uncertainty of the surface measurements. We will present a statistical analysis for 2010-2012 of the ASDP predictions of PM2.5 focusing on performance at validation sites. In addition, we will present several case studies evaluating the ASDP's performance for multiple regions and seasons, focusing specifically on days when large spatial gradients in AQI and wildfire smoke impacts were observed.

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

PubMed

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

2004-07-12

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

Improving the Quality of Low-Cost GPS Receiver Data for Monitoring Using Spatial Correlations

NASA Astrophysics Data System (ADS)

Zhang, Li; Schwieger, Volker

2016-06-01

The investigations on low-cost single frequency GPS receivers at the Institute of Engineering Geodesy (IIGS) show that u-blox LEA-6T GPS receivers combined with Trimble Bullet III GPS antennas containing self-constructed L1-optimized choke rings can already obtain an accuracy in the range of millimeters which meets the requirements of geodetic precise monitoring applications (see [27]). However, the quality (accuracy and reliability) of low-cost GPS receiver data, particularly in shadowing environment, should still be improved, since the multipath effects are the major error for the short baselines. For this purpose, several adjoined stations with low-cost GPS receivers and antennas were set up next to the metal wall on the roof of the IIGS building and measured statically for several days. The time series of three-dimensional coordinates of the GPS receivers were analyzed. Spatial correlations between the adjoined stations, possibly caused by multipath effect, will be taken into account. The coordinates of one station can be corrected using the spatial correlations of the adjoined stations, so that the quality of the GPS measurements is improved. The developed algorithms are based on the coordinates and the results will be delivered in near-real-time (in about 30 minutes), so that they are suitable for structural health monitoring applications.

Development of sleep monitoring system for observing the effect of the room ambient toward the quality of sleep

NASA Astrophysics Data System (ADS)

Saad, W. H. M.; Khoo, C. W.; Rahman, S. I. Ab; Ibrahim, M. M.; Saad, N. H. M.

2017-06-01

Getting enough sleep at the right times can help in improving quality of life and protect mental and physical health. This study proposes a portable sleep monitoring device to determine the relationship between the room ambient and quality of sleep. Body condition parameter such as heart rate, body temperature and body movement was used to determine quality of sleep and Audio/video-based monitoring system. The functionality test on all sensors is carried out to make sure that all sensors is working properly. The functionality of the overall system is designed for a better experience with a very minimal intervention to the user. The simple test on the body condition (body temperature and heart rate) while asleep with several different ambient parameters (humidity, brightness and temperature) are varied and the result shows that someone has a better sleep in a dark and colder ambient. This can prove by lower body temperature and lower heart rate.

Environmental Assessment And Finding of No Significant Impact for the Low Impact Development Retrofit At Pillar Point Air Force Station, California

DTIC Science & Technology

2012-01-09

utilize LID techniques to enable greater on-site infiltration of storm water to improve storm water quality and restore natural water quality conditions...systems and conveyed through above- and below-ground piping to concrete roadside ditches. Stonn Water Quality Storm water quality monitoring has been...process of being awarded and implemented. The results of all referenced storm water quality and septic inspection reports is available upon request to

Design and Deployment of Low-Cost Sensors for Monitoring the Water Quality and Fish Behavior in Aquaculture Tanks during the Feeding Process

PubMed Central

Parra, Lorena; García, Laura

2018-01-01

The monitoring of farming processes can optimize the use of resources and improve its sustainability and profitability. In fish farms, the water quality, tank environment, and fish behavior must be monitored. Wireless sensor networks (WSNs) are a promising option to perform this monitoring. Nevertheless, its high cost is slowing the expansion of its use. In this paper, we propose a set of sensors for monitoring the water quality and fish behavior in aquaculture tanks during the feeding process. The WSN is based on physical sensors, composed of simple electronic components. The system proposed can monitor water quality parameters, tank status, the feed falling and fish swimming depth and velocity. In addition, the system includes a smart algorithm to reduce the energy waste when sending the information from the node to the database. The system is composed of three nodes in each tank that send the information though the local area network to a database on the Internet and a smart algorithm that detects abnormal values and sends alarms when they happen. All the sensors are designed, calibrated, and deployed to ensure its suitability. The greatest efforts have been accomplished with the fish presence sensor. The total cost of the sensors and nodes for the proposed system is less than 90 €. PMID:29494560

Design and Deployment of Low-Cost Sensors for Monitoring the Water Quality and Fish Behavior in Aquaculture Tanks during the Feeding Process.

PubMed

Parra, Lorena; Sendra, Sandra; García, Laura; Lloret, Jaime

2018-03-01

The monitoring of farming processes can optimize the use of resources and improve its sustainability and profitability. In fish farms, the water quality, tank environment, and fish behavior must be monitored. Wireless sensor networks (WSNs) are a promising option to perform this monitoring. Nevertheless, its high cost is slowing the expansion of its use. In this paper, we propose a set of sensors for monitoring the water quality and fish behavior in aquaculture tanks during the feeding process. The WSN is based on physical sensors, composed of simple electronic components. The system proposed can monitor water quality parameters, tank status, the feed falling and fish swimming depth and velocity. In addition, the system includes a smart algorithm to reduce the energy waste when sending the information from the node to the database. The system is composed of three nodes in each tank that send the information though the local area network to a database on the Internet and a smart algorithm that detects abnormal values and sends alarms when they happen. All the sensors are designed, calibrated, and deployed to ensure its suitability. The greatest efforts have been accomplished with the fish presence sensor. The total cost of the sensors and nodes for the proposed system is less than 90 €.

Laser-induced breakdown spectroscopy application in environmental monitoring of water quality: a review.

PubMed

Yu, Xiaodong; Li, Yang; Gu, Xiaofeng; Bao, Jiming; Yang, Huizhong; Sun, Li

2014-12-01

Water quality monitoring is a critical part of environmental management and protection, and to be able to qualitatively and quantitatively determine contamination and impurity levels in water is especially important. Compared to the currently available water quality monitoring methods and techniques, laser-induced breakdown spectroscopy (LIBS) has several advantages, including no need for sample pre-preparation, fast and easy operation, and chemical free during the process. Therefore, it is of great importance to understand the fundamentals of aqueous LIBS analysis and effectively apply this technique to environmental monitoring. This article reviews the research conducted on LIBS analysis for liquid samples, and the article content includes LIBS theory, history and applications, quantitative analysis of metallic species in liquids, LIBS signal enhancement methods and data processing, characteristics of plasma generated by laser in water, and the factors affecting accuracy of analysis results. Although there have been many research works focusing on aqueous LIBS analysis, detection limit and stability of this technique still need to be improved to satisfy the requirements of environmental monitoring standard. In addition, determination of nonmetallic species in liquid by LIBS is equally important and needs immediate attention from the community. This comprehensive review will assist the readers to better understand the aqueous LIBS technique and help to identify current research needs for environmental monitoring of water quality.

Antimicrobial silver-montmorillonite nanoparticles to prolong the shelf life of fresh fruit salad.

PubMed

Costa, C; Conte, A; Buonocore, G G; Del Nobile, M A

2011-08-15

In this work, silver-montmorillonite (Ag-MMT) antimicrobial nanoparticles have been obtained by allowing silver ions from nitrate solutions to replace the Na(+) of natural montmorillonite and then to be reduced by a thermal treatment. Ag-MMT were used as active antimicrobial compounds to improve the shelf life of fresh fruit salad. In order to assess their influence on product shelf life, sensorial and microbiological quality has been monitored during the storage. The microbiological quality was determined by monitoring the principal spoilage microorganisms (mesophilic and psychrotrophic bacteria, coliforms, lactic acid bacteria, yeasts and molds). Additionally, the evolution of sensorial quality was assessed by monitoring color, odor, firmness and product overall quality. The Ag-MMT nanoparticles seemed to be effective in inhibiting microbial growth, above all at the highest tested concentration. Consequently, the sensorial quality of samples stored in the active packaging appeared to be better preserved. Thus, experimental results showed that a significant shelf life prolongation of fresh fruit salad can be obtained by a straightforward new packaging system. Copyright © 2011 Elsevier B.V. All rights reserved.

The Assessment of Instruments for Detecting Surface Water Spills Associated with Oil and Gas Operations

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

Harris, Aubrey E.; Hopkinson, Leslie; Soeder, Daniel

Surface water and groundwater risks associated with unconventional oil and gas development result from potential spills of the large volumes of chemicals stored on-site during drilling and hydraulic fracturing operations, and the return to the surface of significant quantities of saline water produced during oil or gas well production. To better identify and mitigate risks, watershed models and tools are needed to evaluate the dispersion of pollutants in possible spill scenarios. This information may be used to determine the placement of in-stream water-quality monitoring instruments and to develop early-warning systems and emergency plans. A chemical dispersion model has been usedmore » to estimate the contaminant signal for in-stream measurements. Spills associated with oil and gas operations were identified within the Susquehanna River Basin Commission’s Remote Water Quality Monitoring Network. The volume of some contaminants was found to be sufficient to affect the water quality of certain drainage areas. The most commonly spilled compounds and expected peak concentrations at monitoring stations were used in laboratory experiments to determine if a signal could be detected and positively identified using standard water-quality monitoring equipment. The results were compared to historical data and baseline observations of water quality parameters, and showed that the chemicals tested do commonly affect water quality parameters. This work is an effort to demonstrate that hydrologic and water quality models may be applied to improve the placement of in-stream water quality monitoring devices. This information may increase the capability of early-warning systems to alert community health and environmental agencies of surface water spills associated with unconventional oil and gas operations.« less

Assessment of Gas Potential in the Niobrara Formation, Rosebud Reservation, South Dakota

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

Harris, Aubrey E.; Hopkinson, Leslie; Soeder, Daniel

2016-01-23

Surface water and groundwater risks associated with unconventional oil and gas development result from potential spills of the large volumes of chemicals stored on-site during drilling and hydraulic fracturing operations, and the return to the surface of significant quantities of saline water produced during oil or gas well production. To better identify and mitigate risks, watershed models and tools are needed to evaluate the dispersion of pollutants in possible spill scenarios. This information may be used to determine the placement of in-stream water-quality monitoring instruments and to develop early-warning systems and emergency plans. A chemical dispersion model has been usedmore » to estimate the contaminant signal for in-stream measurements. Spills associated with oil and gas operations were identified within the Susquehanna River Basin Commission’s Remote Water Quality Monitoring Network. The volume of some contaminants was found to be sufficient to affect the water quality of certain drainage areas. The most commonly spilled compounds and expected peak concentrations at monitoring stations were used in laboratory experiments to determine if a signal could be detected and positively identified using standard water-quality monitoring equipment. The results were compared to historical data and baseline observations of water quality parameters, and showed that the chemicals tested do commonly affect water quality parameters. This work is an effort to demonstrate that hydrologic and water quality models may be applied to improve the placement of in-stream water quality monitoring devices. This information may increase the capability of early-warning systems to alert community health and environmental agencies of surface water spills associated with unconventional oil and gas operations.« less

[TEIS--a system for public health offices for assessing, presenting, evaluating and communicating data on the quality of drinking water].

PubMed

Henke, A; Overath, H; Heinzke, J

1999-05-01

Monitoring the quality of drinking water is a cardinal task of German Public Health Offices and of the relevant Ministries of Health of the German Federal states ("Länder"). Today this can be tackled on a large scale and economically only with computer assistance. A system has been developed in North Rhine Westphalia on behalf of the Ministry of Health, for data assessment and communication which is suitable for practical work and user friendly. It aims at supporting the Public Health Offices in their daily work and at improving and simplifying the monitoring of drinking water supply systems and of drinking water quality control.

Interpreting drinking water quality in the distribution system using Dempster-Shafer theory of evidence.

PubMed

Sadiq, Rehan; Rodriguez, Manuel J

2005-04-01

Interpreting water quality data routinely generated for control and monitoring purposes in water distribution systems is a complicated task for utility managers. In fact, data for diverse water quality indicators (physico-chemical and microbiological) are generated at different times and at different locations in the distribution system. To simplify and improve the understanding and the interpretation of water quality, methodologies for aggregation and fusion of data must be developed. In this paper, the Dempster-Shafer theory also called theory of evidence is introduced as a potential methodology for interpreting water quality data. The conceptual basis of this methodology and the process for its implementation are presented by two applications. The first application deals with the interpretation of spatial water quality data fusion, while the second application deals with the development of water quality index based on key monitored indicators. Based on the obtained results, the authors discuss the potential contribution of theory of evidence as a decision-making tool for water quality management.

The relationships of physician practice characteristics to quality of care and costs.

PubMed

Kralewski, John; Dowd, Bryan; Knutson, David; Tong, Junliang; Savage, Megan

2015-06-01

Medical group practices are central to many of the proposals for health care reform, but little is known about the relationship between practice-level characteristics and the quality and cost of care. Practice characteristics from a 2009 national survey of 211 group practices were linked to Medicare claims data for beneficiaries attributed to the practices. Multivariate regression was used to examine the relationship between practice characteristics and claims-computable measures of screening and monitoring, avoidable utilization, risk-adjusted per-beneficiary per-year (PBPY) costs, and the practice's net revenue. Several characteristics of group practices are predictive of screening and monitoring measures. Those measures, in turn, are predictive of lower values of avoidable utilization measures that contribute to higher PBPY costs. The effects of group practice characteristics on avoidable utilization, cost, and practice net revenue appear to work primarily through improved screening and monitoring. Practice characteristics influence costs indirectly through a set of statistically significant relationships among screening and monitoring measures and avoidable utilization. However, these relationships are not the only pathways connecting practice characteristics to cost and those additional pathways contain substantial "noise" adding uncertainty to the estimated direct effects. Some of the attributes thought to be important characteristics of accountable care organizations and medical homes appear to be associated with lower quality and no improvement in cost. © Health Research and Educational Trust.

Saltwater intrusion in the surficial aquifer system of the Big Cypress Basin, southwest Florida, and a proposed plan for improved salinity monitoring

USGS Publications Warehouse

Prinos, Scott T.

2013-01-01

The installation of drainage canals, poorly cased wells, and water-supply withdrawals have led to saltwater intrusion in the primary water-use aquifers in southwest Florida. Increasing population and water use have exacerbated this problem. Installation of water-control structures, well-plugging projects, and regulation of water use have slowed saltwater intrusion, but the chloride concentration of samples from some of the monitoring wells in this area indicates that saltwater intrusion continues to occur. In addition, rising sea level could increase the rate and extent of saltwater intrusion. The existing saltwater intrusion monitoring network was examined and found to lack the necessary organization, spatial distribution, and design to properly evaluate saltwater intrusion. The most recent hydrogeologic framework of southwest Florida indicates that some wells may be open to multiple aquifers or have an incorrect aquifer designation. Some of the sampling methods being used could result in poor-quality data. Some older wells are badly corroded, obstructed, or damaged and may not yield useable samples. Saltwater in some of the canals is in close proximity to coastal well fields. In some instances, saltwater occasionally occurs upstream from coastal salinity control structures. These factors lead to an incomplete understanding of the extent and threat of saltwater intrusion in southwest Florida. A proposed plan to improve the saltwater intrusion monitoring network in the South Florida Water Management District’s Big Cypress Basin describes improvements in (1) network management, (2) quality assurance, (3) documentation, (4) training, and (5) data accessibility. The plan describes improvements to hydrostratigraphic and geospatial network coverage that can be accomplished using additional monitoring, surface geophysical surveys, and borehole geophysical logging. Sampling methods and improvements to monitoring well design are described in detail. Geochemical analyses that provide insights concerning the sources of saltwater in the aquifers are described. The requirement to abandon inactive wells is discussed.

High Frequency monitoring of cyanoHABs and cyanotoxin production to characterize periods of greatest risk on an inland reservoir

EPA Science Inventory

A monitoring approach combining wet chemistry and high frequency (HF) water quality sensors has been employed to improve our understanding of the ecology of an inland reservoir with a history of cyanoHAB events. Lake Harsha is a multi-use reservoir managed by the USACE in southwe...

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.

Implementation Science Supports Core Clinical Competencies: An Overview and Clinical Example.

PubMed

Kirchner, JoAnn E; Woodward, Eva N; Smith, Jeffrey L; Curran, Geoffrey M; Kilbourne, Amy M; Owen, Richard R; Bauer, Mark S

2016-12-08

Instead of asking clinicians to work faster or longer to improve quality of care, implementation science provides another option. Implementation science is an emerging interdisciplinary field dedicated to studying how evidence-based practice can be adopted into routine clinical care. This article summarizes principles and methods of implementation science, illustrates how they can be applied in a routine clinical setting, and highlights their importance to practicing clinicians as well as clinical trainees. A hypothetical clinical case scenario is presented that explains how implementation science improves clinical practice. The case scenario is also embedded within a real-world implementation study to improve metabolic monitoring for individuals prescribed antipsychotics. Context, recipient, and innovation (ie, the evidence-based practice) factors affected improvement of metabolic monitoring. To address these factors, an external facilitator and a local quality improvement team developed an implementation plan involving a multicomponent implementation strategy that included education, performance reports, and clinician follow-up. The clinic remained compliant with recommended metabolic monitoring at 1-year follow up. Implementation science improves clinical practice by addressing context, recipient, and innovation factors and uses this information to develop and utilize specific strategies that improve clinical practice. It also enriches clinical training, aligning with core competencies by the Accreditation Council for Graduate Medical Education and American Boards of Medical Specialties. By learning how to change clinical practice through implementation strategies, clinicians are more able to adapt in complex systems of practice. © Copyright 2016 Physicians Postgraduate Press, Inc.

[Research and design for optimal position of electrocardio-electrodes in monitoring clothing for men].

PubMed

Liang, Lijun; Hu, Yao; Liu, Hao; Li, Xiaojiu; Li, Jin; He, Yin

2017-04-01

In order to reduce the mortality rate of cardiovascular disease patients effectively, improve the electrocardiogram (ECG) accuracy of signal acquisition, and reduce the influence of motion artifacts caused by the electrodes in inappropriate location in the clothing for ECG measurement, we in this article present a research on the optimum place of ECG electrodes in male clothing using three-lead monitoring methods. In the 3-lead ECG monitoring clothing for men we selected test points. Comparing the ECG and power spectrum analysis of the acquired ECG signal quality of each group of points, we determined the best location of ECG electrodes in the male monitoring clothing. The electrode motion artifacts caused by improper location had been significantly improved when electrodes were put in the best position of the clothing for men. The position of electrodes is crucial for ECG monitoring clothing. The stability of the acquired ECG signal could be improved significantly when electrodes are put at optimal locations.

Gerontechnologies for Older Patients with Heart Failure: What is the Role of Smartphones, Tablets, and Remote Monitoring Devices in Improving Symptom Monitoring and Self-Care Management?

PubMed

Masterson Creber, Ruth M; Hickey, Kathleen T; Maurer, Mathew S

2016-10-01

Older adults with heart failure have multiple chronic conditions and a large number and range of symptoms. A fundamental component of heart failure self-care management is regular symptom monitoring. Symptom monitoring can be facilitated by cost-effective, easily accessible technologies that are integrated into patients' lives. Technologies that are tailored to older adults by incorporating gerontological design principles are called gerontechnologies. Gerontechnology is an interdisciplinary academic and professional field that combines gerontology and technology with the goals of improving prevention, care, and enhancing the quality of life for older adults. The purpose of this article is to discuss the role of gerontechnologies, specifically the use of mobile applications available on smartphones and tablets as well as remote monitoring systems, for outpatient disease management among older adults with heart failure. While largely unproven, these rapidly developing technologies have great potential to improve outcomes among older persons.

Sigma Metrics Across the Total Testing Process.

PubMed

Charuruks, Navapun

2017-03-01

Laboratory quality control has been developed for several decades to ensure patients' safety, from a statistical quality control focus on the analytical phase to total laboratory processes. The sigma concept provides a convenient way to quantify the number of errors in extra-analytical and analytical phases through the defect per million and sigma metric equation. Participation in a sigma verification program can be a convenient way to monitor analytical performance continuous quality improvement. Improvement of sigma-scale performance has been shown from our data. New tools and techniques for integration are needed. Copyright © 2016 Elsevier Inc. All rights reserved.

Communication of the monitoring and evaluation process through the use of storyboards and story notebooks.

PubMed

Lewis, L C; Honea, S H; Kanter, D F; Haney, P E

1993-10-01

In preparation for the 1993 Joint Commission on Accreditation of Health Care Organizations (JCAHO) survey, Audie L. Murphy Memorial Veterans Hospital Nursing Service was faced with determining the best approach to presenting their Total Quality Improvement/Total Quality Management (TQI/TQM) process. Nursing Service management and staff, Quality Improvement Clinicians, and medical staff used the Storyboard concept and the accompanying Story Notebooks to organize and to communicate their TQI/TQM process and findings. This concept was extremely beneficial, enabling staff to successfully present the multidisciplinary TQI/TQM data to the JCAHO surveyors.

Application of RFID in the area of agricultural products quality traceability and tracking and the anti-collision algorithm

NASA Astrophysics Data System (ADS)

Wang, Zu-liang; Zhang, Ting; Xie, Shi-yang

2017-01-01

In order to improve the agricultural tracing efficiency and reduce tracking and monitoring cost, agricultural products quality tracking and tracing based on Radio-Frequency Identification(RFID) technology is studied, then tracing and tracking model is set up. Three-layer structure model is established to realize the high quality of agricultural products traceability and tracking. To solve the collision problems between multiple RFID tags and improve the identification efficiency a new reservation slot allocation mechanism is proposed. And then we analyze and optimize the parameter by numerical simulation method.

Adaptation of a Weighted Regression Approach to Evaluate Water Quality Trends in Tampa Bay, Florida

EPA Science Inventory

The increasing availability of long-term monitoring data can improve resolution of temporal and spatial changes in water quality. In many cases, the fact that changes have occurred is no longer a matter of debate. However, the relatively simple methods that have been used to ev...

Guide to Improving Parenting Education in Even Start Family Literacy Programs.

ERIC Educational Resources Information Center

Powell, Douglas R.; D'Angelo, Diane

This guide provides a framework and suggestions for strengthening the quality and impact of parenting education services in Even Start. It is aimed at Even Start state coordinators and local program administrators responsible for supporting and monitoring the quality of parenting education services in Even Start, and at local program staff…

A Longitudinal Sociological Monitoring of Customers' Satisfaction with the Quality of Educational Services

ERIC Educational Resources Information Center

Gaidukova, G. N.

2014-01-01

Research data on levels of satisfaction with educational services in a Russian university show room for improvement in such areas as vocational guidance work; range of opportunities in the choice of specialization and optional disciplines; availability of academic and methodological literature; the quality of food services; and amount of practical…

Capacity Building for School Development: Current Problems and Future Challenges

ERIC Educational Resources Information Center

Ho, Dora; Lee, Moosung

2016-01-01

This article offers a theoretical discussion on the current problems and future challenges of school capacity building in early childhood education (ECE), aiming to highlight some key areas for future research. In recent years, there has been a notable policy shift from monitoring quality through inspection to improving quality through school…

Medicaid.gov

MedlinePlus

... Monitoring Review Plans Program Integrity National Correct Coding Initiative Affordable Care Act Program Integrity Provisions Cost Sharing ... to Care Living Well Quality of Care Improvement Initiatives Medicaid Managed Care Performance Measurement Releases & Announcements Enrollment ...

Medicaid Benefits

MedlinePlus

... Monitoring Review Plans Program Integrity National Correct Coding Initiative Affordable Care Act Program Integrity Provisions Cost Sharing ... to Care Living Well Quality of Care Improvement Initiatives Medicaid Managed Care Performance Measurement Releases & Announcements Enrollment ...

[Implementation of performance indicators in the Czech Breast Cancer Screening Programme -  results of the regular monitoring].

PubMed

Májek, O; Bartoňková, H; Daneš, J; Skovajsová, M; Dušek, L

2014-01-01

The Czech organised breast cancer screening programme was initiated in 2002. Collection of data on screening mammography examinations, subsequent diagnostic procedures, and final dia-gnosis is an indispensable part of the programme. Data collection is obligatory for all accredited centres, in accordance with regulations issued by the Czech Ministry of Health. This contribution aims to demonstrate the recent results of quality monitoring of the accredited centres. Quality indicators, whose definition complies with international standards, involve the women's participation, the volume of performed examinations, the accuracy of screening mammography, the use of preoperative diagnostics, and the proportion of early detected tumours. Our evaluation documents a continuous improvement in quality of the Czech mammography screening programme, which is thereby in full agreement with international recommendations on quality assurance.

Feasibility study of imaging spectroscopy to monitor the quality of online welding.

PubMed

Mirapeix, Jesús; García-Allende, P Beatriz; Cobo, Adolfo; Conde, Olga M; López-Higuera, José M

2009-08-20

An online welding quality system based on the use of imaging spectroscopy is proposed and discussed. Plasma optical spectroscopy has already been successfully applied in this context by establishing a direct correlation between some spectroscopic parameters, e.g., the plasma electronic temperature and the resulting seam quality. Given that the use of the so-called hyperspectral devices provides both spatial and spectral information, we propose their use for the particular case of arc welding quality monitoring in an attempt to determine whether this technique would be suitable for this industrial situation. Experimental welding tests are presented, and the ability of the proposed solution to identify simulated defects is proved. Detailed spatial analyses suggest that this additional dimension can be used to improve the performance of the entire system.

A knowledge-based patient assessment system: conceptual and technical design.

PubMed Central

Reilly, C. A.; Zielstorff, R. D.; Fox, R. L.; O'Connell, E. M.; Carroll, D. L.; Conley, K. A.; Fitzgerald, P.; Eng, T. K.; Martin, A.; Zidik, C. M.; Segal, M.

2000-01-01

This paper describes the design of an inpatient patient assessment application that captures nursing assessment data using a wireless laptop computer. The primary aim of this system is to capture structured information for facilitating decision support and quality monitoring. The system also aims to improve efficiency of recording patient assessments, reduce costs, and improve discharge planning and early identification of patient learning needs. Object-oriented methods were used to elicit functional requirements and to model the proposed system. A tools-based development approach is being used to facilitate rapid development and easy modification of assessment items and rules for decision support. Criteria for evaluation include perceived utility by clinician users, validity of decision support rules, time spent recording assessments, and perceived utility of aggregate reports for quality monitoring. PMID:11079970

A knowledge-based patient assessment system: conceptual and technical design.

PubMed

Reilly, C A; Zielstorff, R D; Fox, R L; O'Connell, E M; Carroll, D L; Conley, K A; Fitzgerald, P; Eng, T K; Martin, A; Zidik, C M; Segal, M

2000-01-01

This paper describes the design of an inpatient patient assessment application that captures nursing assessment data using a wireless laptop computer. The primary aim of this system is to capture structured information for facilitating decision support and quality monitoring. The system also aims to improve efficiency of recording patient assessments, reduce costs, and improve discharge planning and early identification of patient learning needs. Object-oriented methods were used to elicit functional requirements and to model the proposed system. A tools-based development approach is being used to facilitate rapid development and easy modification of assessment items and rules for decision support. Criteria for evaluation include perceived utility by clinician users, validity of decision support rules, time spent recording assessments, and perceived utility of aggregate reports for quality monitoring.

Review of air pollution and health impacts in Malaysia.

PubMed

Afroz, Rafia; Hassan, Mohd Nasir; Ibrahim, Noor Akma

2003-06-01

In the early days of abundant resources and minimal development pressures, little attention was paid to growing environmental concerns in Malaysia. The haze episodes in Southeast Asia in 1983, 1984, 1991, 1994, and 1997 imposed threats to the environmental management of Malaysia and increased awareness of the environment. As a consequence, the government established Malaysian Air Quality Guidelines, the Air Pollution Index, and the Haze Action Plan to improve air quality. Air quality monitoring is part of the initial strategy in the pollution prevention program in Malaysia. Review of air pollution in Malaysia is based on the reports of the air quality monitoring in several large cities in Malaysia, which cover air pollutants such as Carbon monoxide (CO), Sulphur Dioxide (SO2), Nitrogen Dioxide (NO2), Ozone (O3), and Suspended Particulate Matter (SPM). The results of the monitoring indicate that Suspended Particulate Matter (SPM) and Nitrogen Dioxide (NO2) are the predominant pollutants. Other pollutants such as CO, O(x), SO2, and Pb are also observed in several big cities in Malaysia. The air pollution comes mainly from land transportation, industrial emissions, and open burning sources. Among them, land transportation contributes the most to air pollution. This paper reviews the results of the ambient air quality monitoring and studies related to air pollution and health impacts.

Air Quality Applications Based on Space Observations: The Role of the 11 Years OMI Data Record and the Potentials for TROPOMI

NASA Astrophysics Data System (ADS)

Levelt, P.; Veefkind, J. P.; Kleipool, Q.; Eskes, H.; A, R. V. D.; Mijling, B.; Tamminen, J.; Joiner, J.; Bhartia, P. K.

2015-12-01

In the last three decades the capabilities of measuring the atmospheric composition from space did grow tremendously with ESA's ENVISAT and NASA's Eos-Aura satellite programmes. The potential to operationally monitor the atmospheric composition, like the meteorological community is doing for the physical parameters, is now within reach. At the same time, the importance for society of operational environmental monitoring, related to the ozone layer, air quality and climate change, became apparent. The Ozone Monitoring Instrument (OMI), launched on board of NASA's EOS-Aura spacecraft in on July 15, 2004, provides unique contributions to air quality monitoring from Space. The combination of urban scale resolution (13 x 24 km2 in nadir) and daily global coverage proved to be key features for the air quality community. The OMI data is currently used for improving the air quality forecasts, for inverting high-resolution emission maps, for UV forecast and for volcanic plume warning systems for aviation. Due to its 11 year continuous operation OMI now provides the longest NO2 record from space, which is essential to understand the changes in emissions globally. In 2016 Tropospheric Monitoring Instrument (TROPOMI), will be launched on board ESA's Sentinel 5 Precursor satellite. TROPOMI will have a spatial resolution of 7x7 km2 in nadir; a more than 6 times improvement over OMI. The high spatial resolution serves two goals: (1) emissions sources can be detected with even better accuracy and (2) the number of cloud-free ground pixels will increase substantially. TROPOMI also adds additional spectral bands that allow for better cloud corrections, as well as the retrieval of carbon monoxide and methane. TROPOMI will be an important satellite mission for the Copernicus atmosphere service. TROPOMI will play a key role in the Air Quality Constellation, being the polar instruments that can link the 3 GEO UVN instruments, Sentinel 4, TEMPO and GEMS. Thus, TROPOMI can serve as a travelling standard that allows intercomparison of the calibration of the geostationary instruments. An overview of air quality applications, emission inversions and trend analyses will be presented, based on the 11 years of OMI data. An outlook will be presented on the potentials of TROPOMI, including its role in the Air Quality Constellation.

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

NASA Astrophysics Data System (ADS)

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

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

Spectral Band Characterization for Hyperspectral Monitoring of Water Quality

NASA Technical Reports Server (NTRS)

Vermillion, Stephanie C.; Raqueno, Rolando; Simmons, Rulon

2001-01-01

A method for selecting the set of spectral characteristics that provides the smallest increase in prediction error is of interest to those using hyperspectral imaging (HSI) to monitor water quality. The spectral characteristics of interest to these applications are spectral bandwidth and location. Three water quality constituents of interest that are detectable via remote sensing are chlorophyll (CHL), total suspended solids (TSS), and colored dissolved organic matter (CDOM). Hyperspectral data provides a rich source of information regarding the content and composition of these materials, but often provides more data than an analyst can manage. This study addresses the spectral characteristics need for water quality monitoring for two reasons. First, determination of the greatest contribution of these spectral characteristics would greatly improve computational ease and efficiency. Second, understanding the spectral capabilities of different spectral resolutions and specific regions is an essential part of future system development and characterization. As new systems are developed and tested, water quality managers will be asked to determine sensor specifications that provide the most accurate and efficient water quality measurements. We address these issues using data from the Airborne Visible/Infrared Imaging Spectrometer (AVIRIS) and a set of models to predict constituent concentrations.

Spatial prediction of water quality variables along a main river channel, in presence of pollution hotspots.

PubMed

Rizo-Decelis, L D; Pardo-Igúzquiza, E; Andreo, B

2017-12-15

In order to treat and evaluate the available data of water quality and fully exploit monitoring results (e.g. characterize regional patterns, optimize monitoring networks, infer conditions at unmonitored locations, etc.), it is crucial to develop improved and efficient methodologies. Accordingly, estimation of water quality along fluvial ecosystems is a frequent task in environment studies. In this work, a particular case of this problem is examined, namely, the estimation of water quality along a main stem of a large basin (where most anthropic activity takes place), from observational data measured along this river channel. We adapted topological kriging to this case, where each watershed contains all the watersheds of the upstream observed data ("nested support effect"). Data analysis was additionally extended by taking into account the upstream distance to the closest contamination hotspot as an external drift. We propose choosing the best estimation method by cross-validation. The methodological approach in spatial variability modeling may be used for optimizing the water quality monitoring of a given watercourse. The methodology presented is applied to 28 water quality variables measured along the Santiago River in Western Mexico. Copyright © 2017 Elsevier B.V. All rights reserved.

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

PubMed

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

2014-03-01

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

An Energy Efficient Adaptive Sampling Algorithm in a Sensor Network for Automated Water Quality Monitoring.

PubMed

Shu, Tongxin; Xia, Min; Chen, Jiahong; Silva, Clarence de

2017-11-05

Power management is crucial in the monitoring of a remote environment, especially when long-term monitoring is needed. Renewable energy sources such as solar and wind may be harvested to sustain a monitoring system. However, without proper power management, equipment within the monitoring system may become nonfunctional and, as a consequence, the data or events captured during the monitoring process will become inaccurate as well. This paper develops and applies a novel adaptive sampling algorithm for power management in the automated monitoring of the quality of water in an extensive and remote aquatic environment. Based on the data collected on line using sensor nodes, a data-driven adaptive sampling algorithm (DDASA) is developed for improving the power efficiency while ensuring the accuracy of sampled data. The developed algorithm is evaluated using two distinct key parameters, which are dissolved oxygen (DO) and turbidity. It is found that by dynamically changing the sampling frequency, the battery lifetime can be effectively prolonged while maintaining a required level of sampling accuracy. According to the simulation results, compared to a fixed sampling rate, approximately 30.66% of the battery energy can be saved for three months of continuous water quality monitoring. Using the same dataset to compare with a traditional adaptive sampling algorithm (ASA), while achieving around the same Normalized Mean Error (NME), DDASA is superior in saving 5.31% more battery energy.

An Energy Efficient Adaptive Sampling Algorithm in a Sensor Network for Automated Water Quality Monitoring

PubMed Central

Shu, Tongxin; Xia, Min; Chen, Jiahong; de Silva, Clarence

2017-01-01

Power management is crucial in the monitoring of a remote environment, especially when long-term monitoring is needed. Renewable energy sources such as solar and wind may be harvested to sustain a monitoring system. However, without proper power management, equipment within the monitoring system may become nonfunctional and, as a consequence, the data or events captured during the monitoring process will become inaccurate as well. This paper develops and applies a novel adaptive sampling algorithm for power management in the automated monitoring of the quality of water in an extensive and remote aquatic environment. Based on the data collected on line using sensor nodes, a data-driven adaptive sampling algorithm (DDASA) is developed for improving the power efficiency while ensuring the accuracy of sampled data. The developed algorithm is evaluated using two distinct key parameters, which are dissolved oxygen (DO) and turbidity. It is found that by dynamically changing the sampling frequency, the battery lifetime can be effectively prolonged while maintaining a required level of sampling accuracy. According to the simulation results, compared to a fixed sampling rate, approximately 30.66% of the battery energy can be saved for three months of continuous water quality monitoring. Using the same dataset to compare with a traditional adaptive sampling algorithm (ASA), while achieving around the same Normalized Mean Error (NME), DDASA is superior in saving 5.31% more battery energy. PMID:29113087

Integration of Satellite, Modeled, and Ground Based Aerosol Data for use in Air Quality and Public Health Applications

NASA Astrophysics Data System (ADS)

Garcia, V.; Kondragunta, S.; Holland, D.; Dimmick, F.; Boothe, V.; Szykman, J.; Chu, A.; Kittaka, C.; Al-Saadi, J.; Engel-Cox, J.; Hoff, R.; Wayland, R.; Rao, S.; Remer, L.

2006-05-01

Advancements in remote sensing over the past decade have been recognized by governments around the world and led to the development of the international Global Earth Observation System of Systems 10-Year Implementation Plan. The plan for the U.S. contribution to GEOSS has been put forth in The Strategic Plan for the U.S. Integrated Earth Observation System (IEOS) developed under IWGEO-CENR. The approach for the development of the U.S. IEOS is to focus on specific societal benefits that can be achieved by integrating the nation's Earth observation capabilities. One such challenge is our ability to understand the impact of poor air quality on human health and well being. Historically, the air monitoring networks put in place for the Nations air quality programs provided the only aerosol air quality data on an ongoing and systematic basis at national levels. However, scientific advances in the remote sensing of aerosols from space have improved dramatically. The MODIS sensor and GOES Imager aboard NASA and NOAA satellites, respectively, provide synoptic-scale measurements of aerosol optical depth (AOD) which have been demonstrated to correlate with high levels of PM10 and PM2.5 at the surface. The MODIS sensor has been shown to be capable of a 1 km x 1 km (at nadir) AOD product, while the GOES Imager can provide AOD at 4 km x 4 km every 30 minutes. Within the next several years NOAA and EPA will begin to issue PM2.5 air quality forecasts over the entire domain of the eastern United States, eventually extending to national coverage. These forecasts will provide continuous estimated values of PM2.5 on a daily basis. A multi-agency collaborative project among government and academia is underway to improve the spatial prediction of fine particulate matter through the integration of multi-sensor and multi-platform aerosol observations (MODIS and GOES), numerical model output, and air monitoring data. By giving more weight to monitoring data in monitored areas and relying on adjusted model output and satellite data in non-monitored areas, a Bayesian hierarchical space-time model will be used to improve the accuracy of prediction and associated prediction errors. The improved spatial predictions will be tested as estimates of exposure for input to modeling relationships between air quality and asthma/other respiratory diseases through CDC under the Environmental Public Health Tracking Network. We will also focus on the use of the predictive spatial maps within the EPA AIRNow program which provides near real-time spatial maps of daily average PM2.5 concentrations across the US. We will present the overall project plan and preliminary results with emphasis on how GEOSS framework is facilitating this effort.

Development and implementation of a remote-sensing and in situ data-assimilating version of CMAQ for operational PM2.5 forecasting. Part 1: MODIS aerosol optical depth (AOD) data-assimilation design and testing.

PubMed

McHenry, John N; Vukovich, Jeffery M; Hsu, N Christina

2015-12-01

This two-part paper reports on the development, implementation, and improvement of a version of the Community Multi-Scale Air Quality (CMAQ) model that assimilates real-time remotely-sensed aerosol optical depth (AOD) information and ground-based PM2.5 monitor data in routine prognostic application. The model is being used by operational air quality forecasters to help guide their daily issuance of state or local-agency-based air quality alerts (e.g. action days, health advisories). Part 1 describes the development and testing of the initial assimilation capability, which was implemented offline in partnership with NASA and the Visibility Improvement State and Tribal Association of the Southeast (VISTAS) Regional Planning Organization (RPO). In the initial effort, MODIS-derived aerosol optical depth (AOD) data are input into a variational data-assimilation scheme using both the traditional Dark Target and relatively new "Deep Blue" retrieval methods. Evaluation of the developmental offline version, reported in Part 1 here, showed sufficient promise to implement the capability within the online, prognostic operational model described in Part 2. In Part 2, the addition of real-time surface PM2.5 monitoring data to improve the assimilation and an initial evaluation of the prognostic modeling system across the continental United States (CONUS) is presented. Air quality forecasts are now routinely used to understand when air pollution may reach unhealthy levels. For the first time, an operational air quality forecast model that includes the assimilation of remotely-sensed aerosol optical depth and ground based PM2.5 observations is being used. The assimilation enables quantifiable improvements in model forecast skill, which improves confidence in the accuracy of the officially-issued forecasts. This helps air quality stakeholders be more effective in taking mitigating actions (reducing power consumption, ride-sharing, etc.) and avoiding exposures that could otherwise result in more serious air quality episodes or more deleterious health effects.

WE-D-9A-06: Open Source Monitor Calibration and Quality Control Software for Enterprise Display Management

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

Bevins, N; Vanderhoek, M; Lang, S

2014-06-15

Purpose: Medical display monitor calibration and quality control present challenges to medical physicists. The purpose of this work is to demonstrate and share experiences with an open source package that allows for both initial monitor setup and routine performance evaluation. Methods: A software package, pacsDisplay, has been developed over the last decade to aid in the calibration of all monitors within the radiology group in our health system. The software is used to calibrate monitors to follow the DICOM Grayscale Standard Display Function (GSDF) via lookup tables installed on the workstation. Additional functionality facilitates periodic evaluations of both primary andmore » secondary medical monitors to ensure satisfactory performance. This software is installed on all radiology workstations, and can also be run as a stand-alone tool from a USB disk. Recently, a database has been developed to store and centralize the monitor performance data and to provide long-term trends for compliance with internal standards and various accrediting organizations. Results: Implementation and utilization of pacsDisplay has resulted in improved monitor performance across the health system. Monitor testing is now performed at regular intervals and the software is being used across multiple imaging modalities. Monitor performance characteristics such as maximum and minimum luminance, ambient luminance and illuminance, color tracking, and GSDF conformity are loaded into a centralized database for system performance comparisons. Compliance reports for organizations such as MQSA, ACR, and TJC are generated automatically and stored in the same database. Conclusion: An open source software solution has simplified and improved the standardization of displays within our health system. This work serves as an example method for calibrating and testing monitors within an enterprise health system.« less

Implementation of clinical governance in hospitals: challenges and the keys for success.

PubMed

Mousavi, Seyed Mohammad Hadi; Agharahimi, Zahra; Daryabeigi, Maede; Rezaei, Nima

2014-01-01

There is a number of models and strategies for improving the quality of care such as total quality management, continuous quality improvement and clinical governance. The policy of clinical governance is part of the governments overall strategy for monitoring, assuring and improving in the national health services organization. Clinical governance has been introduced as a bridge between managerial and clinical approaches to quality. For successful implementing of clinical governance, it is necessary to pay attention to firm foundations of the structure, including equipment, staffing arrangement, supporting specialties, and staff training. Therefore, as clinical governance improves safety and quality in health care services, the current situation in hospitals should be evaluated before any intervention while barriers and blocks on structure and process should be determined to select a method for changing them. Considering these points could guarantee success in implementation of clinical governance; otherwise there would be a little chance to achieve the desired results despite consumption of plenty of time and huge paper works.

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative

PubMed Central

2011-01-01

Background Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. Methods The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. Results MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. Conclusions It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects. PMID:21385467

Decoding Student Satisfaction: How to Manage and Improve the Laboratory Experience

ERIC Educational Resources Information Center

Nikolic, Sasha; Ritz, Christian; Vial, Peter James; Ros, Montserrat; Stirling, David

2015-01-01

The laboratory plays an important role in teaching engineering skills. An Electrical Engineering department at an Australian University implemented a reform to monitor and improve student satisfaction with the teaching laboratories. A Laboratory Manager was employed to oversee the quality of 27 courses containing instructional laboratories.…

Improving city forests through assessment, modelling and monitoring

Treesearch

D.J. Nowak

2018-01-01

Urban and peri-urban forests produce numerous benefits for society. These include moderating the climate; reducing energy use in buildings; sequestering atmospheric carbon dioxide; improving air and water quality; mitigating rainfall run-off and flooding; providing an aesthetic environment and recreational opportunities; enhancing human health and social well-being;...

Report: EPA Is Taking Steps to Improve State Drinking Water Program Reviews and Public Water Systems Compliance Data

EPA Pesticide Factsheets

Report #17-P-0326, July 18, 2017. The EPA is taking action to improve oversight tools used to determine whether public water systems are monitoring and reporting drinking water quality in accordance with the Safe Drinking Water Act.

Business Administration Scale for Family Child Care, BAS

ERIC Educational Resources Information Center

Talan, Teri N.; Bloom, Paula Jorde

2009-01-01

The "BAS for Family Child Care" is the first valid and reliable tool for measuring and improving the overall quality of business and professional practices in family child care settings. It is applicable for multiple uses, including program self-improvement, technical assistance and monitoring, training, research and evaluation, and public…

Business Administration Scale for Family Child Care (BAS). Second Edition

ERIC Educational Resources Information Center

Talan, Teri N.; Bloom, Paula Jorde

2018-01-01

The "Business Administration Scale for Family Child Care" (BAS) is the first valid and reliable tool for measuring and improving the overall quality of business and professional practices in family child care settings. It is applicable for multiple uses, including program self-improvement, technical assistance and monitoring, training,…

Using wilderness character to improve wilderness stewardship

Treesearch

Peter Landres; Wade M. Vagias; Suzy Stutzman

2012-01-01

This article describes how understanding wilderness character leads to improved communication among staff and with the public, helping park staff make more informed decisions about park planning, management, and monitoring in wilderness. Wilderness character is defined in terms of five qualities: natural, solitude or primitive and unconfined recreation, undeveloped,...

Low-Dose Naltrexone Treatment of Familial Benign Pemphigus (Hailey-Hailey Disease).

PubMed

Ibrahim, Omer; Hogan, Sara R; Vij, Alok; Fernandez, Anthony P

2017-10-01

Familial benign pemphigus, or Hailey-Hailey disease (HHD), is a rare and debilitating genetic dermatosis characterized by chronic, recurrent vesicles, erosions, and maceration in flexural areas. Despite the reported therapeutic modalities, such as topical and systemic corticosteroids, systemic immunomodulators, topical and systemic retinoids, and laser, HHD can still be markedly difficult to control. To assess low-dose naltrexone hydrochloride in the treatment of recalcitrant HHD. In this case series, 3 patients with biopsy-proven recalcitrant HHD were evaluated in the outpatient dermatology clinic at the Cleveland Clinic. Each patient was treated with low-dose naltrexone hydrochloride at a dosage of 1.5 to 3.0 mg per day. No laboratory monitoring was necessary. Clinical response (healing of erosions, improvement in erythema, and alleviation of pain), adverse effects, and subjective quality of life were monitored throughout the treatment. The study dates were January 2016 to January 2017. Objective clinical response as assessed by the treating dermatologist, subjective quality of life as reported by the patient, and recorded adverse effects were monitored throughout the treatment at intervals of 2 to 3 months. The 3 patients included a woman in her 40s and 2 men in their 60s. Each patient exhibited at least an 80% improvement in extent of disease, with one patient demonstrating 90% clearance. All 3 patients had substantial improvement in quality of life, with one patient reporting improvement in his depression. No adverse effects were recorded. Low-dose naltrexone may represent a low-cost and low-risk alternative or adjunct in the treatment of HHD.

Quality management, a directive approach to patient safety.

PubMed

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

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

Tool path strategy and cutting process monitoring in intelligent machining

NASA Astrophysics Data System (ADS)

Chen, Ming; Wang, Chengdong; An, Qinglong; Ming, Weiwei

2018-06-01

Intelligent machining is a current focus in advanced manufacturing technology, and is characterized by high accuracy and efficiency. A central technology of intelligent machining—the cutting process online monitoring and optimization—is urgently needed for mass production. In this research, the cutting process online monitoring and optimization in jet engine impeller machining, cranio-maxillofacial surgery, and hydraulic servo valve deburring are introduced as examples of intelligent machining. Results show that intelligent tool path optimization and cutting process online monitoring are efficient techniques for improving the efficiency, quality, and reliability of machining.

Improved implementation of the risk-adjusted Bernoulli CUSUM chart to monitor surgical outcome quality.

PubMed

Keefe, Matthew J; Loda, Justin B; Elhabashy, Ahmad E; Woodall, William H

2017-06-01

The traditional implementation of the risk-adjusted Bernoulli cumulative sum (CUSUM) chart for monitoring surgical outcome quality requires waiting a pre-specified period of time after surgery before incorporating patient outcome information. We propose a simple but powerful implementation of the risk-adjusted Bernoulli CUSUM chart that incorporates outcome information as soon as it is available, rather than waiting a pre-specified period of time after surgery. A simulation study is presented that compares the performance of the traditional implementation of the risk-adjusted Bernoulli CUSUM chart to our improved implementation. We show that incorporating patient outcome information as soon as it is available leads to quicker detection of process deterioration. Deterioration of surgical performance could be detected much sooner using our proposed implementation, which could lead to the earlier identification of problems. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Development of the Veterans Healthcare Administration (VHA) Ophthalmic Surgical Outcome Database (OSOD) project and the role of ophthalmic nurse reviewers.

PubMed

Lara-Smalling, Agueda; Cakiner-Egilmez, Tulay; Miller, Dawn; Redshirt, Ella; Williams, Dale

2011-01-01

Currently, ophthalmic surgical cases are not included in the Veterans Administration Surgical Quality Improvement Project data collection. Furthermore, there is no comprehensive protocol in the health system for prospectively measuring outcomes for eye surgery in terms of safety and quality. There are 400,000 operative cases in the system per year. Of those, 48,000 (12%) are ophthalmic surgical cases, with 85% (41,000) of those being cataract cases. The Ophthalmic Surgical Outcome Database Pilot Project was developed to incorporate ophthalmology into VASQIP, thus evaluating risk factors and improving cataract surgical outcomes. Nurse reviewers facilitate the monitoring and measuring of these outcomes. Since its inception in 1778, the Veterans Administration (VA) Health System has provided comprehensive healthcare to millions of deserving veterans throughout the U.S. and its territories. Historically, the quality of healthcare provided by the VA has been the main focus of discussion because it did not meet a standard of care comparable to that of the private sector. Information regarding quality of healthcare services and outcomes data had been unavailable until 1986, when Congress mandated the VA to compare its surgical outcomes to those of the private sector (PL-99-166). 1 Risk adjustment of VA surgical outcomes began in 1987 with the Continuous Improvement in Cardiac Surgery Program (CICSP) in which cardiac surgical outcomes were reported and evaluated. 2 Between 1991 and 1993, the National VA Surgical Risk Study (NVASRS) initiated a validated risk-adjustment model for predicting surgical outcomes and comparative assessment of the quality of surgical care in 44 VA medical centers. 3 The success of NVASRS encouraged the VA to establish an ongoing program for monitoring and improving the quality of surgical care, thus developing the National Surgical Quality Improvement Program (NSQIP) in 1994. 4 According to a prospective study conducted between 1991-1997 in 123 VA medical centers by Khuri et al., the 30-day mortality and morbidity rates for major surgeries had decreased by 9% and 30%, respectively. 5 Recently renamed the VA Surgical Quality Improvement Program (VASQIP) in 2010, the quality of surgical outcomes has continued to improve among all documented surgical specialties. Ophthalmic surgery is presumed to have a very low mortality rate and therefore has not been included in the VASQIP database.

Applications of aerospace technology in the public interest: Pollution measurement

NASA Technical Reports Server (NTRS)

Heins, C. F.; Johnson, F. D.

1974-01-01

This study of selected NASA contributions to the improvement of pollution measurement examines the pervasiveness and complexity of the economic, political, and social issues in the environmental field; provides a perspective on the relationship between the conduct of aerospace R and D and specific improvements in on site air pollution monitoring equipment now in use; describes the basic relationship between the development of satellite-based monitoring systems and their influence on long-term progress in improving environmental quality; and comments on how both instrumentation and satellite remote sensing are contributing to an improved environment. Examples of specific gains that have been made in applying aerospace R and D to environmental problem-solving are included.

CDC Vital Signs: Child Injury

MedlinePlus

... first aid training). Health care systems can Use technology, such as electronic medical records, to improve the speed and quality of care for injured children, and to monitor the number and severity of ...

How can the research potential of the clinical quality databases be maximized? The Danish experience.

PubMed

Nørgaard, M; Johnsen, S P

2016-02-01

In Denmark, the need for monitoring of clinical quality and patient safety with feedback to the clinical, administrative and political systems has resulted in the establishment of a network of more than 60 publicly financed nationwide clinical quality databases. Although primarily devoted to monitoring and improving quality of care, the potential of these databases as data sources in clinical research is increasingly being recognized. In this review, we describe these databases focusing on their use as data sources for clinical research, including their strengths and weaknesses as well as future concerns and opportunities. The research potential of the clinical quality databases is substantial but has so far only been explored to a limited extent. Efforts related to technical, legal and financial challenges are needed in order to take full advantage of this potential. © 2016 The Association for the Publication of the Journal of Internal Medicine.

End-user perspective of low-cost sensors for outdoor air pollution monitoring.

PubMed

Rai, Aakash C; Kumar, Prashant; Pilla, Francesco; Skouloudis, Andreas N; Di Sabatino, Silvana; Ratti, Carlo; Yasar, Ansar; Rickerby, David

2017-12-31

Low-cost sensor technology can potentially revolutionise the area of air pollution monitoring by providing high-density spatiotemporal pollution data. Such data can be utilised for supplementing traditional pollution monitoring, improving exposure estimates, and raising community awareness about air pollution. However, data quality remains a major concern that hinders the widespread adoption of low-cost sensor technology. Unreliable data may mislead unsuspecting users and potentially lead to alarming consequences such as reporting acceptable air pollutant levels when they are above the limits deemed safe for human health. This article provides scientific guidance to the end-users for effectively deploying low-cost sensors for monitoring air pollution and people's exposure, while ensuring reasonable data quality. We review the performance characteristics of several low-cost particle and gas monitoring sensors and provide recommendations to end-users for making proper sensor selection by summarizing the capabilities and limitations of such sensors. The challenges, best practices, and future outlook for effectively deploying low-cost sensors, and maintaining data quality are also discussed. For data quality assurance, a two-stage sensor calibration process is recommended, which includes laboratory calibration under controlled conditions by the manufacturer supplemented with routine calibration checks performed by the end-user under final deployment conditions. For large sensor networks where routine calibration checks are impractical, statistical techniques for data quality assurance should be utilised. Further advancements and adoption of sophisticated mathematical and statistical techniques for sensor calibration, fault detection, and data quality assurance can indeed help to realise the promised benefits of a low-cost air pollution sensor network. Copyright © 2017 Elsevier B.V. All rights reserved.

Setting standards and monitoring quality in the NHS 1999-2013: a classic case of goal conflict.

PubMed

Littlejohns, Peter; Knight, Alec; Littlejohns, Anna; Poole, Tara-Lynn; Kieslich, Katharina

2017-04-01

2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high-quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross-sectional, in-depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio-political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman-Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

Setting standards and monitoring quality in the NHS 1999–2013: a classic case of goal conflict

PubMed Central

Knight, Alec; Littlejohns, Anna; Poole, Tara‐Lynn; Kieslich, Katharina

2016-01-01

Abstract 2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high‐quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross‐sectional, in‐depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio‐political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman–Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. PMID:27435020

A method of monitoring contact (pointed) welding

NASA Astrophysics Data System (ADS)

Bessonov, V. B.; Staroverov, N. E.; Larionov, I. A.; Guk, K. K.; Obodovskiy, A. V.

2018-02-01

The technology of welding parts of different thicknesses from various materials is improved, which is why the range of applied types and methods of welding is constantly expanding. In this regard, the issue of monitoring welded joints is particularly acute. The goal was: to develop a method of non-destructive radiographic inspection of point welds with a high accuracy rating of its quality.

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

PubMed

Stivelman, John C

2012-10-01

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

Harmonization activities of Noklus - a quality improvement organization for point-of-care laboratory examinations.

PubMed

Stavelin, Anne; Sandberg, Sverre

2018-05-16

Noklus is a non-profit quality improvement organization that focuses to improve all elements in the total testing process. The aim is to ensure that all medical laboratory examinations are ordered, performed and interpreted correctly and in accordance with the patients' needs for investigation, treatment and follow-up. For 25 years, Noklus has focused on point-of-care (POC) testing in primary healthcare laboratories and has more than 3100 voluntary participants. The Noklus quality system uses different tools to obtain harmonization and improvement: (1) external quality assessment for the pre-examination, examination and postexamination phase to monitor the harmonization process and to identify areas that need improvement and harmonization, (2) manufacturer-independent evaluations of the analytical quality and user-friendliness of POC instruments and (3) close interactions and follow-up of the participants through site visits, courses, training and guidance. Noklus also recommends which tests that should be performed in the different facilities like general practitioner offices, nursing homes, home care, etc. About 400 courses with more than 6000 delegates are organized annually. In 2017, more than 21,000 e-learning programs were completed.

Developing a Deep Brain Stimulation Neuromodulation Network for Parkinson Disease, Essential Tremor, and Dystonia: Report of a Quality Improvement Project

PubMed Central

O’Suilleabhain, Padraig E.; Sanghera, Manjit; Patel, Neepa; Khemani, Pravin; Lacritz, Laura H.; Chitnis, Shilpa; Whitworth, Louis A.; Dewey, Richard B.

2016-01-01

Objective To develop a process to improve patient outcomes from deep brain stimulation (DBS) surgery for Parkinson disease (PD), essential tremor (ET), and dystonia. Methods We employed standard quality improvement methodology using the Plan-Do-Study-Act process to improve patient selection, surgical DBS lead implantation, postoperative programming, and ongoing assessment of patient outcomes. Results The result of this quality improvement process was the development of a neuromodulation network. The key aspect of this program is rigorous patient assessment of both motor and non-motor outcomes tracked longitudinally using a REDCap database. We describe how this information is used to identify problems and to initiate Plan-Do-Study-Act cycles to address them. Preliminary outcomes data is presented for the cohort of PD and ET patients who have received surgery since the creation of the neuromodulation network. Conclusions Careful outcomes tracking is essential to ensure quality in a complex therapeutic endeavor like DBS surgery for movement disorders. The REDCap database system is well suited to store outcomes data for the purpose of ongoing quality assurance monitoring. PMID:27711133

Developing a Deep Brain Stimulation Neuromodulation Network for Parkinson Disease, Essential Tremor, and Dystonia: Report of a Quality Improvement Project.

PubMed

Dewey, Richard B; O'Suilleabhain, Padraig E; Sanghera, Manjit; Patel, Neepa; Khemani, Pravin; Lacritz, Laura H; Chitnis, Shilpa; Whitworth, Louis A; Dewey, Richard B

2016-01-01

To develop a process to improve patient outcomes from deep brain stimulation (DBS) surgery for Parkinson disease (PD), essential tremor (ET), and dystonia. We employed standard quality improvement methodology using the Plan-Do-Study-Act process to improve patient selection, surgical DBS lead implantation, postoperative programming, and ongoing assessment of patient outcomes. The result of this quality improvement process was the development of a neuromodulation network. The key aspect of this program is rigorous patient assessment of both motor and non-motor outcomes tracked longitudinally using a REDCap database. We describe how this information is used to identify problems and to initiate Plan-Do-Study-Act cycles to address them. Preliminary outcomes data is presented for the cohort of PD and ET patients who have received surgery since the creation of the neuromodulation network. Careful outcomes tracking is essential to ensure quality in a complex therapeutic endeavor like DBS surgery for movement disorders. The REDCap database system is well suited to store outcomes data for the purpose of ongoing quality assurance monitoring.

Evolution of a residue laboratory network and the management tools for monitoring its performance.

PubMed

Lins, E S; Conceição, E S; Mauricio, A De Q

2012-01-01

Since 2005 the National Residue & Contaminants Control Plan (NRCCP) in Brazil has been considerably enhanced, increasing the number of samples, substances and species monitored, and also the analytical detection capability. The Brazilian laboratory network was forced to improve its quality standards in order to comply with the NRCP's own evolution. Many aspects such as the limits of quantification (LOQs), the quality management systems within the laboratories and appropriate method validation are in continuous improvement, generating new scenarios and demands. Thus, efficient management mechanisms for monitoring network performance and its adherence to the established goals and guidelines are required. Performance indicators associated to computerised information systems arise as a powerful tool to monitor the laboratories' activity, making use of different parameters to describe this activity on a day-to-day basis. One of these parameters is related to turnaround times, and this factor is highly affected by the way each laboratory organises its management system, as well as the regulatory requirements. In this paper a global view is presented of the turnaround times related to the type of analysis, laboratory, number of samples per year, type of matrix, country region and period of the year, all these data being collected from a computerised system called SISRES. This information gives a solid background to management measures aiming at the improvement of the service offered by the laboratory network.

Use of a consumer market activity monitoring and feedback device improves exercise capacity and activity levels in COPD.

PubMed

Caulfield, Brian; Kaljo, Indira; Donnelly, Seamas

2014-01-01

COPD is associated with a gradual decline in physical activity, which itself contributes to a worsening of the underlying condition. Strategies that improve physical activity levels are critical to halt this cycle. Wearable sensor based activity monitoring and persuasive feedback might offer a potential solution. However it is not clear just how much intervention might be needed in this regard - i.e. whether programmes need to be tailored specifically for the target clinical population or whether more simple activity monitoring and feedback solutions, such as that offered in consumer market devices, might be sufficient. This research was carried out to investigate the impact of 4 weeks of using an off the shelf consumer market activity monitoring and feedback application on measures of physical activity, exercise capacity, and health related quality of life in a population of 10 Stage I and II COPD patients. Results demonstrate a significant and positive effect on exercise capacity (measured using a 6-minute walk test) and activity levels (measured in terms of average number of steps per hour) yet no impact on health related quality of life (St Georges Respiratory Disease Questionnaire).

Five-year performance monitoring of a high-density polyethylene (HDPE) cover system at a reclaimed mine waste rock pile in the Sydney Coalfield (Nova Scotia, Canada).

PubMed

Power, Christopher; Ramasamy, Murugan; MacAskill, Devin; Shea, Joseph; MacPhee, Joseph; Mayich, David; Baechler, Fred; Mkandawire, Martin

2017-12-01

Cover systems are commonly placed over waste rock piles (WRPs) to limit atmospheric water and oxygen ingress and control the generation and release of acid mine drainage (AMD) to the receiving environment. Although covers containing geomembranes such as high-density polyethylene (HDPE) exhibit the attributes to be highly effective, there are few, if any, published studies monitoring their performance at full-scale WRPs. In 2011, a HDPE cover was installed over the Scotchtown Summit WRP in Nova Scotia, Canada, and extensive field performance monitoring was conducted over the next five years. A range of parameters within the atmosphere, cover, waste rock, groundwater and surface water, were monitored and integrated into a comprehensive hydrogeochemical conceptual model to assess (i) atmospheric ingress to the waste rock, (ii) waste rock acidity and depletion and (iii) evolution of groundwater and surface water quality. Results demonstrate that the cover is effective and meeting site closure objectives. Depletion in oxygen influx resulted in slower sulphide oxidation and AMD generation, while a significant reduction in water influx (i.e. 512 to 50 mm/year) resulted in diminished AMD release. Consistent improvements in groundwater quality (decrease in sulphate and metals; increase in pH) beneath and downgradient of the WRP were observed. Protection and/or significant improvement in surface water quality was evident in all surrounding watercourses due to the improved groundwater plume and elimination of contaminated runoff over previously exposed waste rock. A variably saturated flow and contaminant transport model is currently being developed to predict long-term cover system performance.

Downscaler Model for predicting daily air pollution

EPA Pesticide Factsheets

This model combines daily ozone and particulate matter monitoring and modeling data from across the U.S. to provide improved fine-scale estimates of air quality in communities and other specific locales.

Monitoring the effects of manure policy in the Peat region, Netherlands

NASA Astrophysics Data System (ADS)

Hooijboer, Arno; Buis, Eke; Fraters, Dico; Boumans, Leo; Lukacs, Saskia; Vrijhoef, Astrid

2014-05-01

Total N concentrations in farm ditches in the Peat region of the Netherlands are on the average twice as high as the Good Ecological Potential value of the Water Framework Directive. Since ditches are connected to regional surface water, they may contribute to eutrophication. The minerals policy aims to improve the water quality. In the Netherlands, the effectiveness of the minerals policy on water quality is evaluated with data from the National Minerals Policy Monitoring Programme (LMM). This regards farm data on the quality of water leaching from the root zone and on farm practices. The soil balance nitrogen surpluses decreased between 1996 and 2003 on dairy farms in the Peat region. However, no effect on root zone leaching was found. This study aims to show how monitoring in the Peat region can be improved in order to link water quality to agricultural practice. Contrary to the other Dutch regions, nitrate concentrations in root zone leaching on farms in the Peat region are often very low (90% of the farms below 25 mg/l) due to the reduction of nitrate (denitrification). The main nitrogen (N) components in the peat region waters are ammonium and organic N. Total N is therefore a better measure for N concentrations in the Peat region. The ammonium concentration in groundwater in Dutch peat soils increases with depth. It is assumed that the deeper ammonia-rich water is older and relates to anaerobic peat decomposition instead of agricultural practice. Recent infiltrated low-ammonium water, lies like a thin freshwater lens on the older water. In the Peat region, root zone leaching is monitored by taking samples from the upper meter of groundwater. Unintended, often both lens water and older water are sampled and this distorts the relation between agricultural practice and water quality. In the Peat region, the N surplus is transported with the precipitation surplus to ditches. The relation between the N surplus and the total N in ditch water is therefore better than between N surplus and total N in root zone leaching. The precipitation surplus flows to ditches directly or via open field drains. However, the ditches may be fed partly with older water (seepage of groundwater). In the open field drain only recent water will occur. We expect that monitoring the water quality of the open field drains may even better reflect changes in agricultural practices. These data may also improve the understanding of contribution of agricultural nitrogen and natural nitrogen, necessary to develop measures to decrease the total-N concentration in ditch water.

Optimization of a Coastal Environmental Monitoring Network Based on the Kriging Method: A Case Study of Quanzhou Bay, China

PubMed Central

Chen, Kai; Ni, Minjie; Wang, Jun; Huang, Dongren; Chen, Huorong; Wang, Xiao; Liu, Mengyang

2016-01-01

Environmental monitoring is fundamental in assessing environmental quality and to fulfill protection and management measures with permit conditions. However, coastal environmental monitoring work faces many problems and challenges, including the fact that monitoring information cannot be linked up with evaluation, monitoring data cannot well reflect the current coastal environmental condition, and monitoring activities are limited by cost constraints. For these reasons, protection and management measures cannot be developed and implemented well by policy makers who intend to solve this issue. In this paper, Quanzhou Bay in southeastern China was selected as a case study; and the Kriging method and a geographic information system were employed to evaluate and optimize the existing monitoring network in a semienclosed bay. This study used coastal environmental monitoring data from 15 sites (including COD, DIN, and PO4-P) to adequately analyze the water quality from 2009 to 2012 by applying the Trophic State Index. The monitoring network in Quanzhou Bay was evaluated and optimized, with the number of sites increased from 15 to 24, and the monitoring precision improved by 32.9%. The results demonstrated that the proposed advanced monitoring network optimization was appropriate for environmental monitoring in Quanzhou Bay. It might provide technical support for coastal management and pollutant reduction in similar areas. PMID:27777951

Optimization of a Coastal Environmental Monitoring Network Based on the Kriging Method: A Case Study of Quanzhou Bay, China.

PubMed

Chen, Kai; Ni, Minjie; Cai, Minggang; Wang, Jun; Huang, Dongren; Chen, Huorong; Wang, Xiao; Liu, Mengyang

2016-01-01

Environmental monitoring is fundamental in assessing environmental quality and to fulfill protection and management measures with permit conditions. However, coastal environmental monitoring work faces many problems and challenges, including the fact that monitoring information cannot be linked up with evaluation, monitoring data cannot well reflect the current coastal environmental condition, and monitoring activities are limited by cost constraints. For these reasons, protection and management measures cannot be developed and implemented well by policy makers who intend to solve this issue. In this paper, Quanzhou Bay in southeastern China was selected as a case study; and the Kriging method and a geographic information system were employed to evaluate and optimize the existing monitoring network in a semienclosed bay. This study used coastal environmental monitoring data from 15 sites (including COD, DIN, and PO 4 -P) to adequately analyze the water quality from 2009 to 2012 by applying the Trophic State Index. The monitoring network in Quanzhou Bay was evaluated and optimized, with the number of sites increased from 15 to 24, and the monitoring precision improved by 32.9%. The results demonstrated that the proposed advanced monitoring network optimization was appropriate for environmental monitoring in Quanzhou Bay. It might provide technical support for coastal management and pollutant reduction in similar areas.

A DMAIC approach for process capability improvement an engine crankshaft manufacturing process

NASA Astrophysics Data System (ADS)

Sharma, G. V. S. S.; Rao, P. Srinivasa

2014-05-01

The define-measure-analyze-improve-control (DMAIC) approach is a five-strata approach, namely DMAIC. This approach is the scientific approach for reducing the deviations and improving the capability levels of the manufacturing processes. The present work elaborates on DMAIC approach applied in reducing the process variations of the stub-end-hole boring operation of the manufacture of crankshaft. This statistical process control study starts with selection of the critical-to-quality (CTQ) characteristic in the define stratum. The next stratum constitutes the collection of dimensional measurement data of the CTQ characteristic identified. This is followed by the analysis and improvement strata where the various quality control tools like Ishikawa diagram, physical mechanism analysis, failure modes effects analysis and analysis of variance are applied. Finally, the process monitoring charts are deployed at the workplace for regular monitoring and control of the concerned CTQ characteristic. By adopting DMAIC approach, standard deviation is reduced from 0.003 to 0.002. The process potential capability index ( C P) values improved from 1.29 to 2.02 and the process performance capability index ( C PK) values improved from 0.32 to 1.45, respectively.

Current Applications of OMI Tropospheric NO2 Data for Air Quality and a Look to the Future

NASA Technical Reports Server (NTRS)

Pickering, Kenneth E.; Bucsela, E.; Allen, D.; Prados, A.; Gleason, J.; Kondragunta, S.

2010-01-01

Ozone Monitoring Instrument (OMI) Tropospheric NO2 products are being used to enhance the ability to monitor changes in NO2 air quality, update emission inventories, and evaluate regional air quality models. Trends in tropospheric column NO2 have been examined over the eastern United States in relation to emissions changes mandated by regulatory actions. Decreases of 20 to 40 percent over the period 2005 to 2008 were noted, largely in response to major emission reductions at power plants. The OMI data have been used to identify regions in which the opposite trend has been found. We have also used OMI NO2 in efforts to improve emission inventories for NOx emissions from soil. Lightning NOx emissions have been added to CMAQ, the US Environmental Protection Agency's regional air quality model. Evaluation of the resulting NO2 columns in the model is being conducted using the OMI NO2 observations. Community Multiscale Air Quality (CMAQ) together with the OMI NO2 data comprise a valuable tool for monitoring and predicting air quality. Looking to the future, we expect that the combination of Global Ozone Monitoring Experiment-2 (GOME-2) (morning) and OMI (afternoon) data sets obtained through use of the same retrieval algorithms will substantially increase the possibility of successful integration of satellite information into regional air quality forecast models. Farther down the road, we anticipate the Geostationary Coastal and Air Pollution Events (GEO-CAPE) platform to supply data possibly on an hourly basis, allowing much more comprehensive analysis of air quality from space.

Developing students' worksheets applying soft skill-based scientific approach for improving building engineering students' competencies in vocational high schools

NASA Astrophysics Data System (ADS)

Suparno, Sudomo, Rahardjo, Boedi

2017-09-01

Experts and practitioners agree that the quality of vocational high schools needs to be greatly improved. Many construction services have voiced their dissatisfaction with today's low-quality vocational high school graduates. The low quality of graduates is closely related to the quality of the teaching and learning process, particularly teaching materials. In their efforts to improve the quality of vocational high school education, the government have implemented Curriculum 2013 (K13) and supplied teaching materials. However, the results of monitoring and evaluation done by the Directorate of Vocational High School, Directorate General of Secondary Education (2014), the provision of tasks for students in the teaching materials was totally inadequate. Therefore, to enhance the quality and the result of the instructional process, there should be provided students' worksheets that can stimulate and improve students' problem-solving skills and soft skills. In order to develop worksheets that can meet the academic requirements, the development needs to be in accordance with an innovative learning approach, which is the soft skill-based scientific approach.

Study of Water Pollution Early Warning Framework Based on Internet of Things

NASA Astrophysics Data System (ADS)

Chengfang, H.; Xiao, X.; Dingtao, S.; Bo, C.; Xiongfei, W.

2016-06-01

In recent years, with the increasing world environmental pollution happening, sudden water pollution incident has become more and more frequently in China. It has posed a serious threat to water safety of the people living in the water source area. Conventional water pollution monitoring method is manual periodic testing, it maybe miss the best time to find that pollution incident. This paper proposes a water pollution warning framework to change this state. On the basis of the Internet of things, we uses automatic water quality monitoring technology to realize monitoring. We calculate the monitoring data with water pollution model to judge whether the water pollution incident is happen or not. Water pollution warning framework is divided into three layers: terminal as the sensing layer, it with the deployment of the automatic water quality pollution monitoring sensor. The middle layer is the transfer network layer, data information implementation is based on GPRS wireless network transmission. The upper one is the application layer. With these application systems, early warning information of water pollution will realize the high-speed transmission between grassroots units and superior units. The paper finally gives an example that applying this pollution warning framework to water quality monitoring of Beijing, China, it greatly improves the speed of the pollution warning responding of Beijing.

Predictive monitoring and diagnosis of periodic air pollution in a subway station.

PubMed

Kim, YongSu; Kim, MinJung; Lim, JungJin; Kim, Jeong Tai; Yoo, ChangKyoo

2010-11-15

The purpose of this study was to develop a predictive monitoring and diagnosis system for the air pollutants in a subway system using a lifting technique with a multiway principal component analysis (MPCA) which monitors the periodic patterns of the air pollutants and diagnoses the sources of the contamination. The basic purpose of this lifting technique was to capture the multivariate and periodic characteristics of all of the indoor air samples collected during each day. These characteristics could then be used to improve the handling of strong periodic fluctuations in the air quality environment in subway systems and will allow important changes in the indoor air quality to be quickly detected. The predictive monitoring approach was applied to a real indoor air quality dataset collected by telemonitoring systems (TMS) that indicated some periodic variations in the air pollutants and multivariate relationships between the measured variables. Two monitoring models--global and seasonal--were developed to study climate change in Korea. The proposed predictive monitoring method using the lifted model resulted in fewer false alarms and missed faults due to non-stationary behavior than that were experienced with the conventional methods. This method could be used to identify the contributions of various pollution sources. Copyright © 2010 Elsevier B.V. All rights reserved.

College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference on good laboratory practices in gynecologic cytology: background, rationale, and organization.

PubMed

Tworek, Joseph A; Henry, Michael R; Blond, Barbara; Jones, Bruce Allen

2013-02-01

Gynecologic cytopathology is a heavily regulated field, with Clinical Laboratory Improvement Amendments of 1988 mandating the collection of many quality metrics. There is a lack of consensus regarding methods to collect, monitor, and benchmark these data and how these data should be used in a quality assurance program. Furthermore, the introduction of human papilloma virus testing and proficiency testing has provided more data to monitor. To determine good laboratory practices in quality assurance of gynecologic cytopathology. Data were collected through a written survey consisting of 98 questions submitted to 1245 Clinical Laboratory Improvement Amendments-licensed or Department of Defense laboratories. There were 541 usable responses. Additional input was sought through a Web posting of results and questions on the College of American Pathologists Web site. Four senior authors who authored the survey and 28 cytopathologists and cytotechnologists were assigned to 5 working groups to analyze data and present statements on good laboratory practices in gynecologic cytopathology at the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference. Ninety-eight attendees at the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference discussed and voted on good laboratory practice statements to obtain consensus. This paper describes the rationale, background, process, and strengths and limitations of a series of papers that summarize good laboratory practice statements in quality assurance in gynecologic cytopathology.

Application of indices Cp and Cpk to improve quality control capability in clinical biochemistry laboratories.

PubMed

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

2014-04-30

The traditional criteria for acceptability of analytic quality may not be objective in clinical laboratories. To establish quality control procedures intended to enhance Westgard multi-rules for improving the quality of clinical biochemistry tests, we applied the Cp and Cpk quality-control indices to monitor tolerance fitting and systematic variation of clinical biochemistry test results. Daily quality-control data of a large Taiwanese hospital in 2009 were analyzed. The test items were selected based on an Olympus biochemistry machine and included serum albumin, aspartate aminotransferase, cholesterol, glucose and potassium levels. Cp and Cpk values were calculated for normal and abnormal levels, respectively. The tolerance range was estimated with data from 50 laboratories using the same instruments and reagents. The results showed a monthly trend of variation for the five items under investigation. The index values of glucose were lower than those of the other items, and their values were usually <2. In contrast to the Cp value for cholesterol, Cpk of cholesterol was lower than 2, indicating a systematic error that should be further investigated. This finding suggests a degree of variation or failure to meet specifications that should be corrected. The study indicated that Cp and Cpk could be applied not only for monitoring variations in quality control, but also for revealing inter-laboratory qualitycontrol capability differences.

Total quality management and nursing: a shared vision.

PubMed

Morey, W

1996-09-01

The application of the Total Quality Management (TQM) philosophy within the health care sector would enhance the development of nursing power, leadership and knowledge. TQM challenges conventional management techniques as it requires a participative management style in order to be effective. There are many potential benefits for nurses, when quality assurance monitoring within a hierarchical management structure, is replaced with a focus on continuous quality improvement by every member of staff. These benefits are described within the context of both organisational and personal commitment to Total Quality Management.

Standardized quality-assessment system to evaluate pressure ulcer care in the nursing home.

PubMed

Bates-Jensen, Barbara M; Cadogan, Mary; Jorge, Jennifer; Schnelle, John F

2003-09-01

To demonstrate reliability and feasibility of a standardized protocol to assess and score quality indicators relevant to pressure ulcer (PU) care processes in nursing homes (NHs). Descriptive. Eight NHs. One hundred ninety-one NH residents for whom the PU Resident Assessment Protocol of the Minimum Data Set was initiated. Nine quality indicators (two related to screening and prevention of PU, two focused on assessment, and five addressing management) were scored using medical record data, direct human observation, and wireless thigh monitor observation data. Feasibility and reliability of medical record, observation, and thigh monitor protocols were determined. The percentage of participants who passed each of the indicators, indicating care consistent with practice guidelines, ranged from 0% to 98% across all indicators. In general, participants in NHs passed fewer indicators and had more problems with medical record accuracy before a PU was detected (screening/prevention indicators) than they did once an ulcer was documented (assessment and management indicators). Reliability of the medical record protocol showed kappa statistics ranging from 0.689 to 1.00 and percentage agreement from 80% to 100%. Direct observation protocols yielded kappa statistics of 0.979 and 0.928. Thigh monitor protocols showed kappa statistics ranging from 0.609 to 0.842. Training was variable, with the observation protocol requiring 1 to 2 hours, medical records requiring joint review of 20 charts with average time to complete the review of 20 minutes, and the thigh monitor data requiring 1 week for training in data preparation and interpretation. The standardized quality assessment system generated scores for nine PU quality indicators with good reliability and provided explicit scoring rules that permit reproducible conclusions about PU care. The focus of the indicators on care processes that are under the control of NH staff made the protocol useful for external survey and internal quality improvement purposes, and the thigh monitor observational technology provided a method for monitoring repositioning care processes that were otherwise difficult to monitor and manage.

[Quality of health care, accreditation, and health technology assessment in Croatia: role of agency for quality and accreditation in health].

PubMed

Mittermayer, Renato; Huić, Mirjana; Mestrović, Josipa

2010-12-01

Avedis Donabedian defined the quality of care as the kind of care, which is expected to maximize an inclusive measure of patient welfare, after taking into account the balance of expected gains and losses associated with the process of care in all its segments. According to the World Medical Assembly, physicians and health care institutions have an ethical and professional obligation to strive for continuous quality improvement of services and patient safety with the ultimate goal to improve both individual patient outcomes as well as population health. Health technology assessment (HTA) is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner, with the aim to formulate safe and effective health policies that are patient focused and seek to achieve the highest value. The Agency for Quality and Accreditation in Health was established in 2007 as a legal, public, independent, nonprofit institution under the Act on Quality of Health Care. The Agency has three departments: Department of Quality and Education, Department of Accreditation, and Department of Development, Research, and Health Technology Assessment. According to the Act, the Agency should provide the procedure of granting, renewal and cancellation of accreditation of healthcare providers; proposing to the Minister, in cooperation with professional associations, the plan and program for healthcare quality assurance, improvement, promotion and monitoring; proposing the healthcare quality standards as well as the accreditation standards to the Minister; keeping a register of accreditations and providing a database related to accreditation, healthcare quality improvement, and education; providing education in the field of healthcare quality assurance, improvement and promotion; providing the HTA procedure and HTA database, supervising the healthcare insurance standards, and providing other services in the field of healthcare quality assurance, improvement, promotion and monitoring, according to the Act. Formal activities of the Agency in the field of HTA actually began in summer 2009. In the field of quality and accreditation, the plan and program of healthcare quality assurance, improvement, promotion and monitoring was finished and published in October 2010; preparation of the healthcare quality standards as well as the accreditation standards is still in process, with the aim to start accreditation process at 10 hospitals in 2011. Education in the field of healthcare quality assurance, improvement and promotion has been established as a continuous process from the beginning. The Agency is member of the International Society for Quality in Health Care (ISQua) and participates in the work of the European Accreditation Network (EAN). In the field of HTA, the Agency has established international collaboration and support, which resulted in its appointment and participation in the European network for Health Technology Assessment (EUnetHTA) Joint Action Project as a EUnetHTA Partner, as well as its membership in the international society, HTAi. TAIEX project has been approved as a two-day workshop in December 2010. The Croatian HTA Guidelines have been issued with the aim to start the HTA process and reports that should serve as recommendations, as a support to policy-makers at the national level, in particular the Croatian Ministry of Health and Social Welfare, and Croatian Institute of Health Insurance, in making evidence-informed decisions on the strategic planning, investment, management and implementation of technologies in health care, on funding (reimbursement) and coverage of health technologies, and at hospital level on the request from hospital directors and policy teams. In conclusion, establishment of all these measures in Croatia is by no means an easy and quick process, however, we do believe that it is feasible through continuous and close collaboration of all those involved.

Spatiotemporal classification of environmental monitoring data in the Yeongsan River basin, Korea, using self-organizing maps.

PubMed

Jin, Y-H; Kawamura, A; Park, S-C; Nakagawa, N; Amaguchi, H; Olsson, J

2011-10-01

Environmental monitoring data for planning, implementing and evaluating the Total Maximum Daily Loads (TMDL) management system have been measured at about 8-day intervals in a number of rivers in Korea since 2004. In the present study, water quality parameters such as Suspended Solids (SS), Biochemical Oxygen Demand (BOD), Dissolved Oxygen (DO), Total Nitrogen (TN), and Total Phosphorus (TP) and the corresponding runoff were collected from six stations in the Yeongsan River basin for six years and transformed into monthly mean values. With the primary objective to understand spatiotemporal characteristics of the data, a methodologically systematic application of a Self-Organizing Map (SOM) was made. The SOM application classified the environmental monitoring data into nine clusters showing exclusively distinguishable patterns. Data frequency at each station on a monthly basis identified the spatiotemporal distribution for the first time in the study area. Consequently, the SOM application provided useful information that the sub-basin containing a metropolitan city is associated with deteriorating water quality and should be monitored and managed carefully during spring and summer for water quality improvement in the river basin.

Optimal redistribution of an urban air quality monitoring network using atmospheric dispersion model and genetic algorithm

NASA Astrophysics Data System (ADS)

Hao, Yufang; Xie, Shaodong

2018-03-01

Air quality monitoring networks play a significant role in identifying the spatiotemporal patterns of air pollution, and they need to be deployed efficiently, with a minimum number of sites. The revision and optimal adjustment of existing monitoring networks is crucial for cities that have undergone rapid urban expansion and experience temporal variations in pollution patterns. The approach based on the Weather Research and Forecasting-California PUFF (WRF-CALPUFF) model and genetic algorithm (GA) was developed to design an optimal monitoring network. The maximization of coverage with minimum overlap and the ability to detect violations of standards were developed as the design objectives for redistributed networks. The non-dominated sorting genetic algorithm was applied to optimize the network size and site locations simultaneously for Shijiazhuang city, one of the most polluted cities in China. The assessment on the current network identified the insufficient spatial coverage of SO2 and NO2 monitoring for the expanding city. The optimization results showed that significant improvements were achieved in multiple objectives by redistributing the original network. Efficient coverage of the resulting designs improved to 60.99% and 76.06% of the urban area for SO2 and NO2, respectively. The redistributing design for multi-pollutant including 8 sites was also proposed, with the spatial representation covered 52.30% of the urban area and the overlapped areas decreased by 85.87% compared with the original network. The abilities to detect violations of standards were not improved as much as the other two objectives due to the conflicting nature between the multiple objectives. Additionally, the results demonstrated that the algorithm was slightly sensitive to the parameter settings, with the number of generations presented the most significant effect. Overall, our study presents an effective and feasible procedure for air quality network optimization at a city scale.

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.

Health Monitoring and Management for Manufacturing Workers in Adverse Working Conditions.

PubMed

Xu, Xiaoya; Zhong, Miao; Wan, Jiafu; Yi, Minglun; Gao, Tiancheng

2016-10-01

In adverse working conditions, environmental parameters such as metallic dust, noise, and environmental temperature, directly affect the health condition of manufacturing workers. It is therefore important to implement health monitoring and management based on important physiological parameters (e.g., heart rate, blood pressure, and body temperature). In recent years, new technologies, such as body area networks, cloud computing, and smart clothing, have allowed the improvement of the quality of services. In this article, we first give five-layer architecture for health monitoring and management of manufacturing workers. Then, we analyze the system implementation process, including environmental data processing, physical condition monitoring and system services and management, and present the corresponding algorithms. Finally, we carry out an evaluation and analysis from the perspective of insurance and compensation for manufacturing workers in adverse working conditions. The proposed scheme will contribute to the improvement of workplace conditions, realize health monitoring and management, and protect the interests of manufacturing workers.

BMP Effectiveness/Efficiency Monitoring Annotated Bibliography

DOT National Transportation Integrated Search

2002-05-17

The Oregon Department of Transportation (ODOT) has installed several stormwater treatment facilities to : improve the quality of runoff discharged from the States highway network. These facilities include a : variety of both above ground and below...

Is My Small School Really Just a Business.

ERIC Educational Resources Information Center

Ross, Lee A.; Chance, W. G.

1984-01-01

Discusses steps necessary to running small schools on a more business-like basis, including quality control, product (student) evaluation, production process monitoring, establishment of standards, improved recruitment, market research, and sales promotion. (MH)

Health claims data as a strategy and tool in disease management.

PubMed

Solz, H; Gilbert, K

2001-04-01

A comprehensive definition of disease management provides an opportunity to track a population of patients across the entire continuum of a condition, from wellness through disease and disability, so that improvements in health status and quality of life and efficiencies in the application of health care resources can be demonstrated. The need is great for information systems that can computerize clinical encounter, summarize, and apply the information to help identify opportunities for improvement in the performance of quality and cost control, monitor processes of care, and report outcomes that are meaningful to the organization. By tracking health care charges as a proxy for the application of health care resources, health claim data analyses can identify conditions for disease management, facilitate provider buy-in, develop the disease management program, monitor interventions, and report outcomes.

Introducing care pathway commissioning to primary dental care: measuring performance.

PubMed

Harris, R; Bridgman, C; Ahmad, M; Bowes, L; Haley, R; Saleem, S; Singh, R; Taylor, S

2011-12-09

Care pathways have been used in a variety of ways: firstly to support quality improvement through standardising clinical processes, but also for secondary purposes, by purchasers of healthcare, to monitor activity and health outcomes and to commission services. This paper focuses on reporting a secondary use of care pathways: to commission and monitor performance of primary dental care services. Findings of a project involving three dental practices implementing a system based on rating patients according to their risk of disease and need for care are outlined. Data from surgery-based clinical databases and interviews from commissioners and providers are reported. The use of both process and outcome key performance indicators in this context is discussed, as well as issues which arise such as attributability of outcome measures and strategic approaches to improving quality of care.

Atmospheric pollutants in peri-urban forests of Quercus ilex: evidence of pollution abatement and threats for vegetation.

PubMed

García-Gómez, Héctor; Aguillaume, Laura; Izquieta-Rojano, Sheila; Valiño, Fernando; Àvila, Anna; Elustondo, David; Santamaría, Jesús M; Alastuey, Andrés; Calvete-Sogo, Héctor; González-Fernández, Ignacio; Alonso, Rocío

2016-04-01

Peri-urban vegetation is generally accepted as a significant remover of atmospheric pollutants, but it could also be threatened by these compounds, with origin in both urban and non-urban areas. To characterize the seasonal and geographical variation of pollutant concentrations and to improve the empirical understanding of the influence of Mediterranean broadleaf evergreen forests on air quality, four forests of Quercus ilex (three peri-urban and one remote) were monitored in different areas in Spain. Concentrations of nitrogen dioxide (NO2), ammonia (NH3), nitric acid (HNO3) and ozone (O3) were measured during 2 years in open areas and inside the forests and aerosols (PM10) were monitored in open areas during 1 year. Ozone was the only air pollutant expected to have direct phytotoxic effects on vegetation according to current thresholds for the protection of vegetation. The concentrations of N compounds were not high enough to directly affect vegetation but could be contributing through atmospheric N deposition to the eutrophization of these ecosystems. Peri-urban forests of Q. ilex showed a significant below-canopy reduction of gaseous concentrations (particularly NH3, with a mean reduction of 29-38%), which indicated the feasibility of these forests to provide an ecosystem service of air quality improvement. Well-designed monitoring programs are needed to further investigate air quality improvement by peri-urban ecosystems while assessing the threat that air pollution can pose to vegetation.

CONTINUOUS GLUCOSE MONITORING: A CONSENSUS CONFERENCE OF THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY.

PubMed

Fonseca, Vivian A; Grunberger, George; Anhalt, Henry; Bailey, Timothy S; Blevins, Thomas; Garg, Satish K; Handelsman, Yehuda; Hirsch, Irl B; Orzeck, Eric A; Roberts, Victor Lawrence; Tamborlane, William

2016-08-01

Barriers to continuous glucose monitoring (CGM) use continue to hamper adoption of this valuable technology for the management of diabetes. The American Association of Clinical Endocrinologists and the American College of Endocrinology convened a public consensus conference February 20, 2016, to review available CGM data and propose strategies for expanding CGM access. Conference participants agreed that evidence supports the benefits of CGM in type 1 diabetes and that these benefits are likely to apply whenever intensive insulin therapy is used, regardless of diabetes type. CGM is likely to reduce healthcare resource utilization for acute and chronic complications, although real-world analyses are needed to confirm potential cost savings and quality of life improvements. Ongoing technological advances have improved CGM accuracy and usability, but more innovations in human factors, data delivery, reporting, and interpretation are needed to foster expanded use. The development of a standardized data report using similar metrics across all devices would facilitate clinician and patient understanding and utilization of CGM. Expanded CGM coverage by government and private payers is an urgent need. CGM improves glycemic control, reduces hypoglycemia, and may reduce overall costs of diabetes management. Expanding CGM coverage and utilization is likely to improve the health outcomes of people with diabetes. A1C = glycated hemoglobin AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology ASPIRE = Automation to Simulate Pancreatic Insulin Response CGM = continuous glucose monitoring HRQOL = health-related quality of life ICER = incremental cost-effectiveness ratio JDRF = Juvenile Diabetes Research Foundation MARD = mean absolute relative difference MDI = multiple daily injections QALY = quality-adjusted life years RCT = randomized, controlled trial SAP = sensor-augmented pump SMBG = self-monitoring of blood glucose STAR = Sensor-Augmented Pump Therapy for A1C Reduction T1D = type 1 diabetes T2D = type 2 diabetes.

Monitoring outcomes with relational databases: does it improve quality of care?

PubMed

Clemmer, Terry P

2004-12-01

There are 3 key ingredients in improving quality of medial care: 1) using a scientific process of improvement, 2) executing the process at the lowest possible level in the organization, and 3) measuring the results of any change reliably. Relational databases when used within these guidelines are of great value in these efforts if they contain reliable information that is pertinent to the project and used in a scientific process of quality improvement by a front line team. Unfortunately, the data are frequently unreliable and/or not pertinent to the local process and is used by persons at very high levels in the organization without a scientific process and without reliable measurement of the outcome. Under these circumstances the effectiveness of relational databases in improving care is marginal at best, frequently wasteful and has the potential to be harmful. This article explores examples of these concepts.

Implementation science for ambulatory care safety: a novel method to develop context-sensitive interventions to reduce quality gaps in monitoring high-risk patients.

PubMed

McDonald, Kathryn M; Su, George; Lisker, Sarah; Patterson, Emily S; Sarkar, Urmimala

2017-06-24

Missed evidence-based monitoring in high-risk conditions (e.g., cancer) leads to delayed diagnosis. Current technological solutions fail to close this safety gap. In response, we aim to demonstrate a novel method to identify common vulnerabilities across clinics and generate attributes for context-flexible population-level monitoring solutions for widespread implementation to improve quality. Based on interviews with staff in otolaryngology, pulmonary, urology, breast, and gastroenterology clinics at a large urban publicly funded health system, we applied journey mapping to co-develop a visual representation of how patients are monitored for high-risk conditions. Using a National Academies framework and context-sensitivity theory, we identified common systems vulnerabilities and developed preliminary concepts for improving the robustness for monitoring patients with high-risk conditions ("design seeds" for potential solutions). Finally, we conducted a face validity and prioritization assessment of the design seeds with the original interviewees. We identified five high-risk situations for potentially consequential diagnostic delays arising from suboptimal patient monitoring. All situations related to detection of cancer (head and neck, lung, prostate, breast, and colorectal). With clinic participants we created 5 journey maps, each representing specialty clinic workflow directed at evidence-based monitoring. System vulnerabilities common to the different clinics included challenges with: data systems, communications handoffs, population-level tracking, and patient activities. Clinic staff ranked 13 design seeds (e.g., keep patient list up to date, use triggered notifications) addressing these vulnerabilities. Each design seed has unique evaluation criteria for the usefulness of potential solutions developed from the seed. We identified and ranked 13 design seeds that characterize situations that clinicians described 'wake them up at night', and thus could reduce their anxiety, save time, and improve monitoring of high-risk patients. We anticipate that the design seed approach promotes robust and context-sensitive solutions to safety and quality problems because it provides a human-centered link between the experienced problem and various solutions that can be tested for viability. The study also demonstrates a novel integration of industrial and human factors methods (journey mapping, process tracing and design seeds) linked to implementation theory for use in designing interventions that anticipate and reduce implementation challenges.

Results from the Big Spring basin water quality monitoring and demonstration projects, Iowa, USA

USGS Publications Warehouse

Rowden, R.D.; Liu, H.; Libra, R.D.

2001-01-01

Agricultural practices, hydrology, and water quality of the 267-km2 Big Spring groundwater drainage basin in Clayton County, Iowa, have been monitored since 1981. Land use is agricultural; nitrate-nitrogen (-N) and herbicides are the resulting contaminants in groundwater and surface water. Ordovician Galena Group carbonate rocks comprise the main aquifer in the basin. Recharge to this karstic aquifer is by infiltration, augmented by sinkhole-captured runoff. Groundwater is discharged at Big Spring, where quantity and quality of the discharge are monitored. Monitoring has shown a threefold increase in groundwater nitrate-N concentrations from the 1960s to the early 1980s. The nitrate-N discharged from the basin typically is equivalent to over one-third of the nitrogen fertilizer applied, with larger losses during wetter years. Atrazine is present in groundwater all year; however, contaminant concentrations in the groundwater respond directly to recharge events, and unique chemical signatures of infiltration versus runoff recharge are detectable in the discharge from Big Spring. Education and demonstration efforts have reduced nitrogen fertilizer application rates by one-third since 1981. Relating declines in nitrate and pesticide concentrations to inputs of nitrogen fertilizer and pesticides at Big Spring is problematic. Annual recharge has varied five-fold during monitoring, overshadowing any water-quality improvements resulting from incrementally decreased inputs. ?? Springer-Verlag 2001.

A spectral method for spatial downscaling | Science Inventory ...

EPA Pesticide Factsheets

Complex computer models play a crucial role in air quality research. These models are used to evaluate potential regulatory impacts of emission control strategies and to estimate air quality in areas without monitoring data. For both of these purposes, it is important to calibrate model output with monitoring data to adjust for model biases and improve spatial prediction. In this paper, we propose a new spectral method to study and exploit complex relationships between model output and monitoring data. Spectral methods allow us to estimate the relationship between model output and monitoring data separately at different spatial scales, and to use model output for prediction only at the appropriate scales. The proposed method is computationally efficient and can be implemented using standard software. We apply the method to compare Community Multiscale Air Quality (CMAQ) model output with ozone measurements in the United States in July, 2005. We find that CMAQ captures large-scale spatial trends, but has low correlation with the monitoring data at small spatial scales. The National Exposure Research Laboratory′s (NERL′s)Atmospheric Modeling Division (AMAD) conducts research in support of EPA′s mission to protect human health and the environment. AMAD′s research program is engaged in developing and evaluating predictive atmospheric models on all spatial and temporal scales for forecasting the Nation′s air quality and for assessing ch

Register-Recall Systems: Tools for Chronic Disease Management in General Practice.

PubMed

Georgiou, Andrew; Burns, Joan; Penn, Danielle; Infante, Fernando; Harris, Mark

2004-09-01

The Divisions Diabetes and Cardiovascular Disease Quality Improvement Project (DDCQIP) is a national project that aims to promote quality improvement initiatives among Divisions of General Practice. DDCQIP has investigated the growth of Division-based diabetes and cardiovascular disease register-recall systems and the role they play in promoting evidence-based structured care within general practice. In the period 2000-2002, an increase in the number of GPs using register-recall systems and the rise in the number of active registered patients have made it possible to monitor quality of care and health outcome indicators, and contributed to the growth of a Division-based population health program.

Analysis and detection of functional outliers in water quality parameters from different automated monitoring stations in the Nalón river basin (Northern Spain).

PubMed

Piñeiro Di Blasi, J I; Martínez Torres, J; García Nieto, P J; Alonso Fernández, J R; Díaz Muñiz, C; Taboada, J

2015-01-01

The purposes and intent of the authorities in establishing water quality standards are to provide enhancement of water quality and prevention of pollution to protect the public health or welfare in accordance with the public interest for drinking water supplies, conservation of fish, wildlife and other beneficial aquatic life, and agricultural, industrial, recreational, and other reasonable and necessary uses as well as to maintain and improve the biological integrity of the waters. In this way, water quality controls involve a large number of variables and observations, often subject to some outliers. An outlier is an observation that is numerically distant from the rest of the data or that appears to deviate markedly from other members of the sample in which it occurs. An interesting analysis is to find those observations that produce measurements that are different from the pattern established in the sample. Therefore, identification of atypical observations is an important concern in water quality monitoring and a difficult task because of the multivariate nature of water quality data. Our study provides a new method for detecting outliers in water quality monitoring parameters, using turbidity, conductivity and ammonium ion as indicator variables. Until now, methods were based on considering the different parameters as a vector whose components were their concentration values. This innovative approach lies in considering water quality monitoring over time as continuous curves instead of discrete points, that is to say, the dataset of the problem are considered as a time-dependent function and not as a set of discrete values in different time instants. This new methodology, which is based on the concept of functional depth, was applied to the detection of outliers in water quality monitoring samples in the Nalón river basin with success. Results of this study were discussed here in terms of origin, causes, etc. Finally, the conclusions as well as advantages of the functional method are exposed.

Role of Large Clinical Datasets From Physiologic Monitors in Improving the Safety of Clinical Alarm Systems and Methodological Considerations: A Case From Philips Monitors.

PubMed

Sowan, Azizeh Khaled; Reed, Charles Calhoun; Staggers, Nancy

2016-09-30

Large datasets of the audit log of modern physiologic monitoring devices have rarely been used for predictive modeling, capturing unsafe practices, or guiding initiatives on alarm systems safety. This paper (1) describes a large clinical dataset using the audit log of the physiologic monitors, (2) discusses benefits and challenges of using the audit log in identifying the most important alarm signals and improving the safety of clinical alarm systems, and (3) provides suggestions for presenting alarm data and improving the audit log of the physiologic monitors. At a 20-bed transplant cardiac intensive care unit, alarm data recorded via the audit log of bedside monitors were retrieved from the server of the central station monitor. Benefits of the audit log are many. They include easily retrievable data at no cost, complete alarm records, easy capture of inconsistent and unsafe practices, and easy identification of bedside monitors missed from a unit change of alarm settings adjustments. Challenges in analyzing the audit log are related to the time-consuming processes of data cleaning and analysis, and limited storage and retrieval capabilities of the monitors. The audit log is a function of current capabilities of the physiologic monitoring systems, monitor's configuration, and alarm management practices by clinicians. Despite current challenges in data retrieval and analysis, large digitalized clinical datasets hold great promise in performance, safety, and quality improvement. Vendors, clinicians, researchers, and professional organizations should work closely to identify the most useful format and type of clinical data to expand medical devices' log capacity.

Quality of clinical trials: A moving target

PubMed Central

Bhatt, Arun

2011-01-01

Quality of clinical trials depends on data integrity and subject protection. Globalization, outsourcing and increasing complexicity of clinical trials have made the target of achieving global quality challenging. The quality, as judged by regulatory inspections of the investigator sites, sponsors/contract research organizations and Institutional Review Board, has been of concern to the US Food and Drug Administration, as there has been hardly any change in frequency and nature of common deficiencies. To meet the regulatory expectations, the sponsors need to improve quality by developing systems with specific standards for each clinical trial process. The quality systems include: personnel roles and responsibilities, training, policies and procedures, quality assurance and auditing, document management, record retention, and reporting and corrective and preventive action. With an objective to improve quality, the FDA has planned new inspection approaches such as risk-based inspections, surveillance inspections, real-time oversight, and audit of sponsor quality systems. The FDA has partnered with Duke University for Clinical Trials Transformation Initiative, which will conduct research projects on design principles, data quality and quantity including monitoring, study start-up, and adverse event reporting. These recent initiatives will go a long way in improving quality of clinical trials. PMID:22145122

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

Temporalization of Electric Generation Emissions for Improved Representation of Peak Air Quality Episodes

NASA Astrophysics Data System (ADS)

Farkas, C. M.; Moeller, M.; Carlton, A. G.

2013-12-01

Photochemical transport models routinely under predict peak air quality events. This deficiency may be due, in part, to inadequate temporalization of emissions from the electric generating sector. The National Emissions Inventory (NEI) reports emissions from Electric Generating Units (EGUs) by either Continuous Emission Monitors (CEMs) that report hourly values or as an annual total. The Sparse Matrix Operator Kernel Emissions preprocessor (SMOKE), used to prepare emissions data for modeling with the CMAQ air quality model, allocates annual emission totals throughout the year using specific monthly, weekly, and hourly weights according to standard classification code (SCC) and location. This approach represents average diurnal and seasonal patterns of electricity generation but does not capture spikes in emissions due to episodic use as with peaking units or due to extreme weather events. In this project we use a combination of state air quality permits, CEM data, and EPA emission factors to more accurately temporalize emissions of NOx, SO2 and particulate matter (PM) during the extensive heat wave of July and August 2006. Two CMAQ simulations are conducted; the first with the base NEI emissions and the second with improved temporalization, more representative of actual emissions during the heat wave. Predictions from both simulations are evaluated with O3 and PM measurement data from EPA's National Air Monitoring Stations (NAMS) and State and Local Air Monitoring Stations (SLAMS) during the heat wave, for which ambient concentrations of criteria pollutants were often above NAAQS. During periods of increased photochemistry and high pollutant concentrations, it is critical that emissions are most accurately represented in air quality models.

Monitoring Quality Across Home Visiting Models: A Field Test of Michigan's Home Visiting Quality Assurance System.

PubMed

Heany, Julia; Torres, Jennifer; Zagar, Cynthia; Kostelec, Tiffany

2018-06-05

Introduction In order to achieve the positive outcomes with parents and children demonstrated by many home visiting models, home visiting services must be well implemented. The Michigan Home Visiting Initiative developed a tool and procedure for monitoring implementation quality across models referred to as Michigan's Home Visiting Quality Assurance System (MHVQAS). This study field tested the MHVQAS. This article focuses on one of the study's evaluation questions: Can the MHVQAS be applied across models? Methods Eight local implementing agencies (LIAs) from four home visiting models (Healthy Families America, Early Head Start-Home Based, Parents as Teachers, Maternal Infant Health Program) and five reviewers participated in the study by completing site visits, tracking their time and costs, and completing surveys about the process. LIAs also submitted their most recent review by their model developer. The researchers conducted participant observation of the review process. Results Ratings on the MHVQAS were not significantly different between models. There were some differences in interrater reliability and perceived reliability between models. There were no significant differences between models in perceived validity, satisfaction with the review process, or cost to participate. Observational data suggested that cross-model applicability could be improved by assisting sites in relating the requirements of the tool to the specifics of their model. Discussion The MHVQAS shows promise as a tool and process to monitor implementation quality of home visiting services across models. The results of the study will be used to make improvements before the MHVQAS is used in practice.

Developing and Implementing a Quality Assurance Strategy for Electroconvulsive Therapy.

PubMed

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

2018-04-17

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

Can the Mentoring and Socialization of Pre-Service Teachers Improve Teacher Education?

ERIC Educational Resources Information Center

Vumilia, Philbert L.; Semali, Ladislaus M.

2016-01-01

The goal of this study was to determine whether the processes of mentoring and socialization that take place during block teaching practice (BTP) in Tanzania can improve the quality of teacher education. In this essay, "mentoring" refers to all activities geared toward guiding, counseling, monitoring, supervising, and supporting teacher…

New and Improved Methods for Monitoring Air Quality and the Terrestrial Environment

DTIC Science & Technology

1999-06-01

SECTION 6 3 of 5 Working Copy: New and Improved Methods for Biomonitoring, 1998 Annual Report Propolis . The material used by bees to seal cracks...in the hive, reinforce comb walls, and create a smooth coating over interior surfaces. Propolis is made up of plant resins collected by bees. Pupae

Racial/Ethnic Disparity in NICU Quality of Care Delivery.

PubMed

Profit, Jochen; Gould, Jeffrey B; Bennett, Mihoko; Goldstein, Benjamin A; Draper, David; Phibbs, Ciaran S; Lee, Henry C

2017-09-01

Differences in NICU quality of care provided to very low birth weight (<1500 g) infants may contribute to the persistence of racial and/or ethnic disparity. An examination of such disparities in a population-based sample across multiple dimensions of care and outcomes is lacking. Prospective observational analysis of 18 616 very low birth weight infants in 134 California NICUs between January 1, 2010, and December 31, 2014. We assessed quality of care via the Baby-MONITOR, a composite indicator consisting of 9 process and outcome measures of quality. For each NICU, we calculated a risk-adjusted composite and individual component quality score for each race and/or ethnicity. We standardized each score to the overall population to compare quality of care between and within NICUs. We found clinically and statistically significant racial and/or ethnic variation in quality of care between NICUs as well as within NICUs. Composite quality scores ranged by 5.26 standard units (range: -2.30 to 2.96). Adjustment of Baby-MONITOR scores by race and/or ethnicity had only minimal effect on comparative assessments of NICU performance. Among subcomponents of the Baby-MONITOR, non-Hispanic white infants scored higher on measures of process compared with African Americans and Hispanics. Compared with whites, African Americans scored higher on measures of outcome; Hispanics scored lower on 7 of the 9 Baby-MONITOR subcomponents. Significant racial and/or ethnic variation in quality of care exists between and within NICUs. Providing feedback of disparity scores to NICUs could serve as an important starting point for promoting improvement and reducing disparities. Copyright © 2017 by the American Academy of Pediatrics.

WHO Better Outcomes in Labour Difficulty (BOLD) project: innovating to improve quality of care around the time of childbirth.

PubMed

Oladapo, Olufemi T; Souza, João Paulo; Bohren, Meghan A; Tunçalp, Özge; Vogel, Joshua P; Fawole, Bukola; Mugerwa, Kidza; Gülmezoglu, A Metin

2015-05-26

As most pregnancy-related deaths and morbidities are clustered around the time of childbirth, quality of care during this period is critical to the survival of pregnant women and their babies. Despite the wide acceptance of partograph as the central tool to optimize labour outcomes for over 40 years, its use has not successfully improved outcomes in many settings for several reasons. There are also increasing questions about the validity and applicability of its central feature - "the alert line" - to all women regardless of their labour characteristics. Apart from the known deficiencies in labour care, attempts to improve quality of care in low resource settings have also failed to address and integrate women's birth experience into quality improvement processes. It was against this background that the World Health Organization (WHO) embarked on the Better Outcomes in Labour Difficulty (BOLD) project to improve the quality of intrapartum care in low- and middle-income countries. The main goal of the BOLD project is to reduce intrapartum-related stillbirths, maternal and newborn mortalities and morbidities by addressing the critical barriers to the process of good quality intrapartum care and enhancing the connection between health systems and communities. The project seeks to achieve this goal by (1) developing an evidence-based, easy to use, labour monitoring-to-action decision-support tool (currently termed Simplified, Effective, Labour Monitoring-to-Action - SELMA); and (2) by developing innovative service prototypes/tools, co-designed with users of health services (women, their families and communities) and health providers, to promote access to respectful, dignified and emotionally supportive care for pregnant women and their companions at the time of birth ("Passport to Safer Birth"). This two-pronged approach is expected to positively impact on important domains of quality of care relating to both provision and experience of care. In this paper, we briefly describe the rationale for innovative thinking in relation to improving quality of care around the time of childbirth and introduce WHO current plans to improve care through research, design and implementation of innovative tools and services in the post-2015 era.Please see related articles ' http://dx.doi.org/10.1186/s12978-015-0029-4 ' and ' http://dx.doi.org/10.1186/s12978-015-0028-5 '.

Costs associated with data collection and reporting for diabetes quality improvement in primary care practices: a report from SNOCAP-USA.

PubMed

West, David R; Radcliff, Tiffany A; Brown, Tiffany; Cote, Murray J; Smith, Peter C; Dickinson, W Perry

2012-01-01

Information about the costs and experiences of collecting and reporting quality measure data are vital for practices deciding whether to adopt new quality improvement initiatives or monitor existing initiatives. Six primary care practices from Colorado's Improving Performance in Practice program participated. We conducted structured key informant interviews with Improving Performance in Practice coaches and practice managers, clinicians, and staff and directly observed practices. Practices had 3 to 7 clinicians and 75 to 300 patients with diabetes, half had electronic health records, and half were members of an independent practice association. The estimated per-practice cost of implementation for the data collection and reporting for the diabetes quality improvement program was approximately $15,552 per practice (about $6.23 per diabetic patient per month). The first-year maintenance cost for this effort was approximately $9,553 per practice ($3.83 per diabetic patient per month). The cost of implementing and maintaining a diabetes quality improvement effort that incorporates formal data collection, data management, and reporting is significant and quantifiable. Policymakers must become aware of the financial and cultural impact on primary care practices when considering value-based purchasing initiatives.

Designing and implementing a trust-wide quality assurance programme.

PubMed

Coope, Sally-Ann

2018-04-02

Derbyshire Community Health Services (DCHS) NHS Foundation Trust provides a wide range of community-based health services. After the Care Quality Commission (CQC) found gaps in the trust's assurance process, its board decided to develop a method of continuous quality improvements that could be used as a basis for the trust's quality assurance system. The trust adapted and built on an acute model so it was suitable for community services. The final assurance system, Quality Always, has four elements: the clinical assessment and accreditation scheme; leadership development; 'champions' within clinical teams to support and promote the scheme; and dashboards to record and monitor progress. A system to recognise and reward achievement was essential for success. Quality Always has resulted in better care quality, an improved CQC rating, a sense of achievement among staff, the development of support networks, learning (especially among support staff) and good practice being shared.

Introducing a quality improvement programme to primary healthcare teams

PubMed Central

Hearnshaw, H.; Reddish, S.; Carlyle, D.; Baker, R.; Robertson, N.

1998-01-01

OBJECTIVES: To evaluate a programme in which quality improvement was facilitated, based on principles of total quality management, in primary healthcare teams, and to determine its feasibility, acceptability, effectiveness, and the duration of its effect. METHOD: Primary healthcare teams in Leicestershire (n = 147) were invited to take part in the facilitated programme. The programme comprised seven team meetings, led by a researcher, plus up to two facilitated meetings of quality improvement subgroups, appointed by each team to consider specific quality issues. OUTCOME MEASURES: To assess the effect and feasibility of the programme on improving the quality of care provided, the individual quality improvement projects undertaken by the teams were documented and opportunities for improvement were noted at each session by the facilitator. The programme's acceptability was assessed with questionnaires issued in the final session to each participant. To assess the long term impact on teams, interviews with team members were conducted 3 years after the programme ended. RESULTS: 10 of the 27 teams that initially expressed interest in the programme agreed to take part, and six started the programme. Of these, five completed their quality improvement projects and used several different quality tools, and three completed all seven sessions of the programme. The programme was assessed as appropriate and acceptable by the participants. Three years later, the changes made during the programme were still in place in three of the six teams. Four teams had decided to undertake the local quality monitoring programme, resourced and supported by the Health Authority. CONCLUSIONS: The facilitated programme was feasible, acceptable, and effective for a few primary healthcare teams. The outcomes of the programme can be sustained. Research is needed on the characteristics of teams likely to be successful in the introduction and maintenance of quality improvement programmes. PMID:10339022

ANMCO/AIIC/SIT Consensus Information Document: definition, precision, and suitability of electrocardiographic signals of electrocardiographs, ergometry, Holter electrocardiogram, telemetry, and bedside monitoring systems.

PubMed

Gulizia, Michele Massimo; Casolo, Giancarlo; Zuin, Guerrino; Morichelli, Loredana; Calcagnini, Giovanni; Ventimiglia, Vincenzo; Censi, Federica; Caldarola, Pasquale; Russo, Giancarmine; Leogrande, Lorenzo; Franco Gensini, Gian

2017-05-01

The electrocardiogram (ECG) signal can be derived from different sources. These include systems for surface ECG, Holter monitoring, ergometric stress tests, and telemetry systems and bedside monitoring of vital parameters, which are useful for rhythm and ST-segment analysis and ECG screening of electrical sudden cardiac death predictors. A precise ECG diagnosis is based upon correct recording, elaboration, and presentation of the signal. Several sources of artefacts and potential external causes may influence the quality of the original ECG waveforms. Other factors that may affect the quality of the information presented depend upon the technical solutions employed to improve the signal. The choice of the instrumentations and solutions used to offer a high-quality ECG signal are, therefore, of paramount importance. Some requirements are reported in detail in scientific statements and recommendations. The aim of this consensus document is to give scientific reference for the choice of systems able to offer high quality ECG signal acquisition, processing, and presentation suitable for clinical use.

ANMCO/AIIC/SIT Consensus Information Document: definition, precision, and suitability of electrocardiographic signals of electrocardiographs, ergometry, Holter electrocardiogram, telemetry, and bedside monitoring systems

PubMed Central

Casolo, Giancarlo; Zuin, Guerrino; Morichelli, Loredana; Calcagnini, Giovanni; Ventimiglia, Vincenzo; Censi, Federica; Caldarola, Pasquale; Russo, Giancarmine; Leogrande, Lorenzo; Franco Gensini, Gian

2017-01-01

Abstract The electrocardiogram (ECG) signal can be derived from different sources. These include systems for surface ECG, Holter monitoring, ergometric stress tests, and telemetry systems and bedside monitoring of vital parameters, which are useful for rhythm and ST-segment analysis and ECG screening of electrical sudden cardiac death predictors. A precise ECG diagnosis is based upon correct recording, elaboration, and presentation of the signal. Several sources of artefacts and potential external causes may influence the quality of the original ECG waveforms. Other factors that may affect the quality of the information presented depend upon the technical solutions employed to improve the signal. The choice of the instrumentations and solutions used to offer a high-quality ECG signal are, therefore, of paramount importance. Some requirements are reported in detail in scientific statements and recommendations. The aim of this consensus document is to give scientific reference for the choice of systems able to offer high quality ECG signal acquisition, processing, and presentation suitable for clinical use. PMID:28751842

An urban observatory for quantifying phosphorus and suspended solid loads in combined natural and stormwater conveyances.

PubMed

Melcher, Anthony A; Horsburgh, Jeffery S

2017-06-01

Water quality in urban streams and stormwater systems is highly dynamic, both spatially and temporally, and can change drastically during storm events. Infrequent grab samples commonly collected for estimating pollutant loadings are insufficient to characterize water quality in many urban water systems. In situ water quality measurements are being used as surrogates for continuous pollutant load estimates; however, relatively few studies have tested the validity of surrogate indicators in urban stormwater conveyances. In this paper, we describe an observatory aimed at demonstrating the infrastructure required for surrogate monitoring in urban water systems and for capturing the dynamic behavior of stormwater-driven pollutant loads. We describe the instrumentation of multiple, autonomous water quality and quantity monitoring sites within an urban observatory. We also describe smart and adaptive sampling procedures implemented to improve data collection for developing surrogate relationships and for capturing the temporal and spatial variability of pollutant loading events in urban watersheds. Results show that the observatory is able to capture short-duration storm events within multiple catchments and, through inter-site communication, sampling efforts can be synchronized across multiple monitoring sites.

A quality management systems approach for CD4 testing in resource-poor settings.

PubMed

Westerman, Larry E; Kohatsu, Luciana; Ortiz, Astrid; McClain, Bernice; Kaplan, Jonathan; Spira, Thomas; Marston, Barbara; Jani, Ilesh V; Nkengasong, John; Parsons, Linda M

2010-10-01

Quality assurance (QA) is a systematic process to monitor and improve clinical laboratory practices. The fundamental components of a laboratory QA program include providing a functional and safe laboratory environment, trained and competent personnel, maintained equipment, adequate supplies and reagents, testing of appropriate specimens, internal monitoring of quality, accurate reporting, and external quality assessments. These components are necessary to provide accurate and precise CD4 T-cell counts, an essential test to evaluate start of and monitor effectiveness of antiretroviral therapy for HIV-infected patients. In recent years, CD4 testing has expanded dramatically in resource-limited settings. Information on a CD4 QA program as described in this article will provide guidelines not only for clinical laboratory staff but also for managers of programs responsible for supporting CD4 testing. All agencies involved in implementing CD4 testing must understand the needs of the laboratory and provide advocacy, guidance, and financial support to established CD4 testing sites and programs. This article describes and explains the procedures that must be put in place to provide reliable CD4 determinations in a variety of settings.

Quality of surface water in Missouri, water year 2009

USGS Publications Warehouse

Barr, Miya N.

2010-01-01

The U.S. Geological Survey, in cooperation with the Missouri Department of Natural Resources, designs and operates a series of monitoring stations on streams throughout Missouri known as the Ambient Water-Quality Monitoring Network. During the 2009 water year (October 1, 2008, through September 30, 2009), data were collected at 75 stations-69 Ambient Water-Quality Monitoring Network stations, 2 U.S. Geological Survey National Stream Quality Accounting Network stations, 1 spring sampled in cooperation with the U.S. Forest Service, and 3 stations sampled in cooperation with the Elk River Watershed Improvement Association. Dissolved oxygen, specific conductance, water temperature, suspended solids, suspended sediment, fecal coliform bacteria, Escherichia coli bacteria, dissolved nitrate plus nitrite, total phosphorus, dissolved and total recoverable lead and zinc, and select pesticide compound summaries are presented for 72 of these stations. The stations primarily have been classified into groups corresponding to the physiography of the State, primary land use, or unique station types. In addition, a summary of hydrologic conditions in the State including peak discharges, monthly mean discharges, and seven-day low flow is presented.

Developing and Transitioning Numerical Air Quality Models to Improve Air Quality and Public Health Decision-Making in El Salvador and Costa Rica As Part of the Servir Applied Sciences Team

NASA Astrophysics Data System (ADS)

Thomas, A.; Huff, A. K.; Gomori, S. G.; Sadoff, N.

2014-12-01

In order to enhance the capacity for air quality modeling and improve air quality monitoring and management in the SERVIR Mesoamerica region, members of SERVIR's Applied Sciences Team (AST) are developing national numerical air quality models for El Salvador and Costa Rica. We are working with stakeholders from the El Salvador Ministry of the Environment and Natural Resources (MARN); National University of Costa Rica (UNA); the Costa Rica Ministry of the Environment, Energy, and Telecommunications (MINAET); and Costa Rica National Meteorological Institute (IMN), who are leaders in air quality monitoring and management in the Mesoamerica region. Focusing initially on these institutions will build sustainability in regional modeling activities by developing air quality modeling capability that can be shared with other countries in Mesoamerica. The air quality models are based on the Community Multi-scale Air Quality (CMAQ) model and incorporate meteorological inputs from the Weather Research and Forecasting (WRF) model, as well as national emissions inventories from El Salvador and Costa Rica. The models are being optimized for urban air quality, which is a priority of decision-makers in Mesoamerica. Once experimental versions of the modeling systems are complete, they will be transitioned to servers run by stakeholders in El Salvador and Costa Rica. The numerical air quality models will provide decision support for stakeholders to identify 1) high-priority areas for expanding national ambient air monitoring networks, 2) needed revisions to national air quality regulations, and 3) gaps in national emissions inventories. This project illustrates SERVIR's goal of the transition of science to support decision-making through capacity building in Mesoamerica, and it aligns with the Group on Earth Observations' health societal benefit theme. This presentation will describe technical aspects of the development of the models and outline key steps in our successful collaboration with the Mesoamerican stakeholders, including the processes of identifying and engaging decision-makers, understanding their requirements and limitations, communicating status updates on a regular basis, and providing sufficient training for end users to be able to utilize the models in a decision-making context.

A New Era of Air Quality Monitoring from Space in East Asia: Korea's Geostationary Environmental Monitoring Spectrometer (GEMS) and an Integrated Korea-US Air Quality (KORUS-AQ) Study

NASA Astrophysics Data System (ADS)

Hong, J.; Hong, Y.; Song, C. K.; Kim, S. K.; Chang, L. S.; Lim, J.; Ahn, J.; Park, J. H.; Kim, J. Y.; Han, Y. J.; Kim, J.; Park, R.; Lee, G.; Lefer, B. L.; Al-Saadi, J. A.; Crawford, J. H.

2015-12-01

Due to remarkable economic growth over the last two decades, East Asia has become a region experiencing some of the poorest air quality in the world. In addition to local sources of pollution, the Korea peninsula is downwind of the largest emission sources in East Asia, complicating the understanding of air quality over Korea. Thus, knowing the factors controlling changes in air pollution across urban-rural and marine-continental interfaces, in addition to the contributions from local emissions and transboundary transport, is important for building effective management strategies and improving air quality in East Asia. GEMS (Geostationary Environmental Monitoring Spectrometer) is a satellite instrument planned for launch in 2019 by the Republic of Korea. The instrument will observe East Asia and the western Pacific region, providing real-time monitoring of air quality (e.g. O3, NO2, SO2, HCHO, AOD, etc.) and enabling better scientific understanding of the transboundary transport of air pollutants. The KORUS-AQ (the Korea and U.S. Air Quality) field campaign will take place in May - June 2016 and will employ an integrated observing strategy including multiplatform observations (i.e. ground stations, aircraft, ships, and satellites) and chemical transport models. This mission aims to not only strengthen our knowledge of atmospheric chemistry but also provide important data sets for validating GEMS retrieval algorithms. In preparation for KORUS-AQ, a pre-campaign has been successfully conducted in Korea during early summer 2015 with observations from multiple ground sites and a small aircraft. A brief summary of pre-field campaign results will be presented. Moving forward, the GEMS mission and KORUS-AQ study will lead to a new era of air quality monitoring in East Asia. GEMS will also make critical contributions to the global air quality perspective working in concert with geostationary missions launched by the U.S. (TEMPO: Tropospheric Emissions: Monitoring of Pollution) and Europe (Sentinel-4) and low-Earth orbit missions including the European Sentinel-5 Precursor.

Quality improvement project in cervical cancer screening: practical measures for monitoring laboratory performance.

PubMed

Tarkkanen, Jussi; Geagea, Antoine; Nieminen, Pekka; Anttila, Ahti

2003-01-01

We conducted a quality improvement project in a cervical cancer screening programme in Helsinki in order to see if detection of precancerous lesions could be influenced by external (participation rate) and internal (laboratory praxis) quality measures. In order to increase the participation rate, a second personal invitation to Pap-test was mailed to nonparticipants of the first call. In order to improve the quality of screening, the cytotechnicians monitored their performance longitudinally by recording the number of slides reviewed per day, the pick-up rate of abnormal smears, the report of the consulting cytopathologist, and the number of histologically verified lesions detected from the cases that they had screened. Regular sessions were held to compare the histological findings with the cytological findings of all cases referred for colposcopy. No pressure was applied on the cytotechnicians to ensure that they felt comfortable with their daily workload. A total of 110 000 smears were screened for cervical cancer at the Helsinki City Hospital during 1996-99. Initially, the overall participation rate increased from 62% to 71%. The number of histologically confirmed precancerous lesions (CIN 1-3) more than doubled and their detection rate increased from 0.32% to 0.72%. Continuous education and feedback from daily work performance were important, yet rather inexpensive means in increasing laboratory performance. Additional measures are needed to further increase the participation rate. Impact of the quality measures on cancer incidence needs to be assessed later on.

Team-based efforts to improve quality of care, the fundamental role of ethics, and the responsibility of health managers: monitoring and management strategies to enhance teamwork.

PubMed

Kossaify, A; Hleihel, W; Lahoud, J-C

2017-12-01

Highlight the importance of teamwork in health care institutions by performing a review and discussion of the relevant literature. Review paper. A MEDLINE/Pubmed search was performed starting from 1990, and the terms 'team, teamwork, managers, healthcare, and cooperation' were searched in titles, abstracts, keywords, and conclusions; other terms 'patient safety, ethics, audits and quality of care' were specifically searched in abstracts and were used as additional filters criteria to select relevant articles. Thirty-three papers were found relevant; factors affecting the quality of care in health care institutions are multiple and varied, including issues related to individual profile, to administrative structure and to team-based effort. Issues affecting teamwork include mainly self-awareness, work environment, leadership, ethics, cooperation, communication, and competition. Moreover, quality improvement plans aiming to enhance and expand teams are essential in this context. Team monitoring and management are vital to achieve efficient teamwork with all the required qualities for a safer health system. In all cases, health managers' responsibility plays a fundamental role in creating and sustaining a teamwork atmosphere. Teamwork is known to improve outcomes in medicine, whether at the clinical, organizational, or scientific level. Teamwork in health care institutions must increasingly be encouraged, given that individual effort is often insufficient for optimal clinical outcome. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

[Ophthalmological service quality offered to outpatients of the Public Healthcare System].

PubMed

Santos Hercos, Benigno Vicente; Berezovsky, Adriana

2006-01-01

To identify the perception of the ophthalmic service quality provided for outpatients of the public healthcare system as well as to detect which actions should be considered necessary and priority in order to improve its quality. A quantitative descriptive study was carried out on 100 outpatients of the public healthcare system which were submitted to ophthalmic tests at Fundação Hilton Rocha--Belo Horizonte-MG, from July 1st-July 30th 2004. Individual interviews were carried out by giving the interviewees two structured questionnaires adapted from the modified SERVQUAL. This scale is in agreement with the reality of the studied institute. The adapted SERVQUAL scale was submitted to statistical validation and it showed a suitable internal consistency index. In general terms, a slight general dissatisfaction was detected regarding ophthalmological service quality. The interviewees cared more about safety and reliability. A higher degree of dissatisfaction was detected mainly concerning fulfillment of procedures at scheduled appointments related to the execution of services within due time-limits. The institute is supposed to plan as well as carry out actions which lead to a general improvement in the patient's satisfaction regarding service quality and mainly reliability. Service quality monitoring through periodic use of the SERVQUAL scale will not only make it possible to plan highly precise and effective intervention strategies in these and in other healthcare services but it will also allow monitoring the responses to these actions. All these actions will contribute to the improvement of the service in the system as a whole.

Shortcomings of low-cost imaging systems for viewing computed radiographs.

PubMed

Ricke, J; Hänninen, E L; Zielinski, C; Amthauer, H; Stroszczynski, C; Liebig, T; Wolf, M; Hosten, N

2000-01-01

To assess potential advantages of a new PC-based viewing tool featuring image post-processing for viewing computed radiographs on low-cost hardware (PC) with a common display card and color monitor, and to evaluate the effect of using color versus monochrome monitors. Computed radiographs of a statistical phantom were viewed on a PC, with and without post-processing (spatial frequency and contrast processing), employing a monochrome or a color monitor. Findings were compared with the viewing on a radiological Workstation and evaluated with ROC analysis. Image post-processing improved the perception of low-contrast details significantly irrespective of the monitor used. No significant difference in perception was observed between monochrome and color monitors. The review at the radiological Workstation was superior to the review done using the PC with image processing. Lower quality hardware (graphic card and monitor) used in low cost PCs negatively affects perception of low-contrast details in computed radiographs. In this situation, it is highly recommended to use spatial frequency and contrast processing. No significant quality gain has been observed for the high-end monochrome monitor compared to the color display. However, the color monitor was affected stronger by high ambient illumination.

A new approach to power quality and electricity reliability monitoring-case study illustrations of the capabilities of the I-GridTM system

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

Divan, Deepak; Brumsickle, William; Eto, Joseph

2003-04-01

This report describes a new approach for collecting information on power quality and reliability and making it available in the public domain. Making this information readily available in a form that is meaningful to electricity consumers is necessary for enabling more informed private and public decisions regarding electricity reliability. The system dramatically reduces the cost (and expertise) needed for customers to obtain information on the most significant power quality events, called voltage sags and interruptions. The system also offers widespread access to information on power quality collected from multiple sites and the potential for capturing information on the impacts ofmore » power quality problems, together enabling a wide variety of analysis and benchmarking to improve system reliability. Six case studies demonstrate selected functionality and capabilities of the system, including: Linking measured power quality events to process interruption and downtime; Demonstrating the ability to correlate events recorded by multiple monitors to narrow and confirm the causes of power quality events; and Benchmarking power quality and reliability on a firm and regional basis.« less

[Electronic fetal monitoring and management of adverse outcomes: how to perform and improve a training program for clinicians?].

PubMed

Secourgeon, J-F

2012-10-01

Electronic fetal monitoring during labor is the most commonly used method to evaluate the fetal status, but it remains exposed to some criticism. By comparison with intermittent auscultation and in the light of the results of the great studies in the last 30 years, it may be accused its failure to improve the neonatal outcome and its responsibility in the increase on operative deliveries. Actually, the electronic fetal monitoring is a tool whose effectiveness is linked to the accuracy of the analysis developed by the clinician. Studies on assessment of the tracing interpretation indicate that there is always a lack of quality, which may be improved through training programs. It also reveals the benefit of the fetal blood sampling to reduce operative deliveries and the generalization of this method, in addition to electronic fetal monitoring, is recommended by referral agencies. More generally, the continuous monitoring is only a part of the patient safety strategy in the labour ward and we are currently observing, in some European countries and in the United States, the development of training programs concerning the management of the adverse outcomes in obstetrics. The good performances related to the quality of care are demonstrated by the findings of the studies performed in the centers that have implemented an active training policy. In France, the professionals directly involved in the field of the perinatology should benefit from such educational programs that could be organized within the care networks under the authority of referral agencies. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

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

PubMed

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

2018-06-20

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

Control of a metalorganic chemical vapor deposition process for improved composition and thickness precision in compound semiconductors

NASA Astrophysics Data System (ADS)

Gaffney, Monique Suzanne

1998-11-01

Metalorganic chemical vapor deposition (MOCVD) is a process used to manufacture electronic and optoelectronic devices that has traditionally lacked real-time growth monitoring and control. Controlling the growth rate and composition using the existing sensors, as well as advanced monitoring systems developed in-house, is shown to improve device quality. Specific MOCVD growth objectives are transformed into controller performance goals. Group III bubbler concentration variations, which perturb both growth rate and composition precision, are identified to be the primary disturbances. First a feed forward control system was investigated, which used an ultrasonic concentration monitor, located upstream in the process. This control strategy resulted in improved regulation of the gallium delivery rate by cancelling the sensed gallium bubbler concentration disturbances via the injection mass flow controller. The controller performance is investigated by growing GaInAs/InP superlattices. Results of growths performed under normal operating conditions and also under large perturbations include X-ray diffraction from the samples as well as real-time sensor signal data. High quality superlattices that display up to eight orders of satellite peaks are obtained under the feed forward compensation scheme, demonstrating improved layer-to-layer reproducibility of thickness and composition. The success of the feed forward control demonstration led to the development of a more complex downstream feedback control system. An ultraviolet absorption monitor was fabricated and retrofitted as a feedback control signal. A control-oriented model of the downstream process was developed for the feedback controller synthesis. Although challenged with both the photolysis and multi-gas detection issues common to UV absorption monitors, closed loop control with the UV sensor was performed and proved to be an effective method of disturbance rejection. An InP/GaInAs test structure was grown under both open and closed loop conditions. During the growth of a bulk GaInAs layer, an indium concentration disturbance was injected by way of the bubbler pressure control valve. The controller goal was to reject this concentration disturbance. The UV absorption real-time data, as well as both X-ray diffraction and photoluminescence post-growth sample measurements were used to evaluate the controller performance. All results indicate that the closed loop control system greatly improved the quality of the perturbed growth.

Wildland Fire Research: Tools and Technology Development

EPA Pesticide Factsheets

Scientific tools are needed to better quantify and predict the impact of smoke from wildlfires on public health. EPA research is supporting the development of new air quality monitors, advancing modeling and improving emissions inventories.

Improving the safety and quality of nursing care through standardized operating procedures in Bosnia and Herzegovina.

PubMed

Ausserhofer, Dietmar; Rakic, Severin; Novo, Ahmed; Dropic, Emira; Fisekovic, Eldin; Sredic, Ana; Van Malderen, Greet

2016-06-01

We explored how selected 'positive deviant' healthcare facilities in Bosnia and Herzegovina approach the continuous development, adaptation, implementation, monitoring and evaluation of nursing-related standard operating procedures. Standardized nursing care is internationally recognized as a critical element of safe, high-quality health care; yet very little research has examined one of its key instruments: nursing-related standard operating procedures. Despite variability in Bosnia and Herzegovina's healthcare and nursing care quality, we assumed that some healthcare facilities would have developed effective strategies to elevate nursing quality and safety through the use of standard operating procedures. Guided by the 'positive deviance' approach, we used a multiple-case study design to examine a criterion sample of four facilities (two primary healthcare centres and two hospitals), collecting data via focus groups and individual interviews. In each studied facility, certification/accreditation processes were crucial to the initiation of continuous development, adaptation, implementation, monitoring and evaluation of nursing-related SOPs. In one hospital and one primary healthcare centre, nurses working in advanced roles (i.e. quality coordinators) were responsible for developing and implementing nursing-related standard operating procedures. Across the four studied institutions, we identified a consistent approach to standard operating procedures-related processes. The certification/accreditation process is enabling necessary changes in institutions' organizational cultures, empowering nurses to take on advanced roles in improving the safety and quality of nursing care. Standardizing nursing procedures is key to improve the safety and quality of nursing care. Nursing and Health Policy are needed in Bosnia and Herzegovina to establish a functioning institutional framework, including regulatory bodies, educational systems for developing nurses' capacities or the inclusion of nursing-related standard operating procedures in certification/accreditation standards. © 2016 International Council of Nurses.

Integrated monitoring technologies for the management of a Soil-Aquifer-Treatment (SAT) system.

NASA Astrophysics Data System (ADS)

Papadopoulos, Alexandros; Kallioras, Andreas; Kofakis, Petros; Bumberger, Jan; Schmidt, Felix; Athanasiou, Georgios; Uzunoglou, Nikolaos; Amditis, Angelos; Dietrich, Peter

2016-04-01

Artificial recharge of groundwater has an important role to play in water reuse as treated wastewater effluent can be infiltrated into the ground for aquifer recharge. As the effluent moves through the soil and the aquifer, it undergoes significant quality improvements through physical, chemical, and biological processes in the underground environment. Collectively, these processes and the water quality improvement obtained are called soil-aquifer-treatment (SAT) or geopurification. The pilot site of Lavrion Technological & Cultural Park (LTCP) of the National Technical University of Athens (NTUA), involves the employment of plot infiltration basins at experimental scale, which will be using waters of impaired quality as a recharge source, and hence acting as a Soil-Aquifer-Treatment, SAT, system. Τhe LTCP site will be employed as a pilot SAT system complemented by new technological developments, which will be providing continuous monitoring of the quantitative and qualitative characteristics of infiltrating groundwater through all hydrologic zones (i.e. surface, unsaturated and saturated zone). This will be achieved by the development and installation of an integrated system of prototype sensing technologies, installed on-site, and offering a continuous evaluation of the performance of the SAT system. An integrated approach of the performance evaluation of any operating SAT system should aim at parallel monitoring of all hydrologic zones, proving the sustainability of all involved water quality treatment processes within unsaturated and saturated zone. Hence a prototype system of Time and Frequency Domain Reflectometry (TDR & FDR) sensors is developed and will be installed, in order to achieve continuous quantitative monitoring of the unsaturated zone through the entire soil column down to significant depths below the SAT basin. Additionally, the system contains two different radar-based sensing systems that will be offering (i) identification of preferential flow effects of the TDR/FDR sensors and (ii) monitoring of the water table within the shallow karst aquifer layer. The above technique will offer continuous monitoring of infiltration rates and identify possible mechanical or biological clogging effects. The monitoring system will be connected to an ad-hoc wireless network for continuous data transfer within the SAT facilities. It is envisaged that the development and combined application of all the above technologies will provide an integrated monitoring platform for the evaluation of SAT system performance.

The Empower project - a new way of assessing and monitoring test comparability and stability.

PubMed

De Grande, Linde A C; Goossens, Kenneth; Van Uytfanghe, Katleen; Stöckl, Dietmar; Thienpont, Linda M

2015-07-01

Manufacturers and laboratories might benefit from using a modern integrated tool for quality management/assurance. The tool should not be confounded by commutability issues and focus on the intrinsic analytical quality and comparability of assays as performed in routine laboratories. In addition, it should enable monitoring of long-term stability of performance, with the possibility to quasi "real-time" remedial action. Therefore, we developed the "Empower" project. The project comprises four pillars: (i) master comparisons with panels of frozen single-donation samples, (ii) monitoring of patient percentiles and (iii) internal quality control data, and (iv) conceptual and statistical education about analytical quality. In the pillars described here (i and ii), state-of-the-art as well as biologically derived specifications are used. In the 2014 master comparisons survey, 125 laboratories forming 8 peer groups participated. It showed not only good intrinsic analytical quality of assays but also assay biases/non-comparability. Although laboratory performance was mostly satisfactory, sometimes huge between-laboratory differences were observed. In patient percentile monitoring, currently, 100 laboratories participate with 182 devices. Particularly, laboratories with a high daily throughput and low patient population variation show a stable moving median in time with good between-instrument concordance. Shifts/drifts due to lot changes are sometimes revealed. There is evidence that outpatient medians mirror the calibration set-points shown in the master comparisons. The Empower project gives manufacturers and laboratories a realistic view on assay quality/comparability as well as stability of performance and/or the reasons for increased variation. Therefore, it is a modern tool for quality management/assurance toward improved patient care.

Educational Evaluation and Assessment in the United States. Position Paper and Recommendations for Action.

ERIC Educational Resources Information Center

Council of Chief State School Officers, Washington, DC.

The lack of high quality data to describe and monitor U.S. educational systems hampers reform decisions and will impair reform evaluation. This paper sets forth the Council of Chief State School Officers' (CCSSO) recommendations for the Council and federal, state, and local education agencies to help improve the quality of educational indicators.…

Fuels planning: science synthesis and integration; social issues fact sheet 13: Strategies for managing fuels and visual quality

Treesearch

Christine Esposito

2006-01-01

The public's acceptance of forest management practices, including fuels reduction, is heavily based on how forests look. Fuels managers can improve their chances of success by considering aesthetics when making management decisions. This fact sheet reviews a three-part general strategy for managing fuels and visual quality: planning, implementation, and monitoring...

DCERP Annual Technical Report II

DTIC Science & Technology

2009-05-01

information among the various DCERP partners . Research and monitoring activities during Phase II of DCERP are currently planned for 4 years (until...this information to improve scheduling of amphibious maneuvers in the NRE. Preliminary analysis of MCBCL air quality data indicated an increasing...2008 at the three MCBCL sites exceeded current National Ambient Air Quality Standards. Experimental results show that salt marshes bordering the

Transforming Data into Practical Information: Using Consumer Input to Improve Home-Care Services

ERIC Educational Resources Information Center

Applebaum, Robert; Kunkel, Suzanne; Wilson, Ken

2007-01-01

Purpose: As funds have increased for the provision of in-home care, so too have concerns about the quality of services. In response, care management agencies and home-care providers have developed an array of monitoring activities designed to ensure the quality of services. In this article, we show how an area agency on aging both collected and…

Developing effective feedback on quality of anaesthetic care: what are its most valuable characteristics from a clinical perspective?

PubMed

D'Lima, Danielle M; Moore, Joanna; Bottle, Alex; Brett, Stephen J; Arnold, Glenn M; Benn, Jonathan

2015-01-01

Research suggests that better feedback from quality and safety indicators leads to enhanced capability of clinicians and departments to improve care and change behaviour. The aim of the current study was to investigate the characteristics of feedback perceived by clinicians to be of most value. Data were collected using a survey designed as part of a wider evaluation of a data feedback initiative in anaesthesia. Eighty-nine consultant anaesthetists from two English NHS acute Trusts completed the survey. Multiple linear regression with hierarchical variable entry was used to investigate which characteristics of feedback predict its perceived usefulness for monitoring variation and improving care. The final model demonstrated that the relevance of the quality indicators to the specific service area (β=0.64, p=0.01) and the credibility of the data as coming from a trustworthy, unbiased source (β=0.55, p=0.01) were the significant predictors, having controlled for all other covariates. For clinicians to engage with effective quality monitoring and feedback, the perceived local relevance of indicators and trust in the credibility of the resulting data are paramount. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Evolving approaches to management of quality in clinical microbiology.

PubMed Central

Bartlett, R C; Mazens-Sullivan, M; Tetreault, J Z; Lobel, S; Nivard, J

1994-01-01

Quality management in clinical microbiology began in the 1960s. Both government and professional societies introduced programs for proficiency testing and laboratory inspection and accreditation. Many laboratory scientists and pathologists were independently active and creative in expanding efforts to monitor and improve practices. The initial emphasis was placed on intralaboratory process. Later, attention was shifted to physician ordering, specimen collection, reporting, and use of information. Quality management in the laboratory depends in large part on the monitoring of indicators that provide some evidence of how laboratory resources are being used and how the information benefits patient care. Continuous quality improvement should be introduced. This consists of a more thorough assessment of doing the right things versus the wrong things in terms of customer demand and satisfaction and studying the cumulative effect of error when responsibility is passed from one person to another. Prevention of error is accomplished more through effective training and continuing education than through surveillance. Also, this system will force more conscious attention to meeting the expectations of the many customers that must be satisfied by laboratory services, including patients, physicians, third-party payers, and managed-care organizations. PMID:8118791

Gas House Autonomous System Monitoring

NASA Technical Reports Server (NTRS)

Miller, Luke; Edsall, Ashley

2015-01-01

Gas House Autonomous System Monitoring (GHASM) will employ Integrated System Health Monitoring (ISHM) of cryogenic fluids in the High Pressure Gas Facility at Stennis Space Center. The preliminary focus of development incorporates the passive monitoring and eventual commanding of the Nitrogen System. ISHM offers generic system awareness, adept at using concepts rather than specific error cases. As an enabler for autonomy, ISHM provides capabilities inclusive of anomaly detection, diagnosis, and abnormality prediction. Advancing ISHM and Autonomous Operation functional capabilities enhances quality of data, optimizes safety, improves cost effectiveness, and has direct benefits to a wide spectrum of aerospace applications.

Legislation should support optimal breastfeeding practices and access to low-cost, high-quality complementary foods: Indonesia provides a case study.

PubMed

Soekarjo, Damayanti; Zehner, Elizabeth

2011-10-01

It is important to support women to exclusively breastfeed for 6 months and continue breastfeeding for 24 months and beyond. It is also necessary to provide the poor with access to affordable ways to improve the quality of complementary foods. Currently, many countries do not have the legal and policy environment necessary to support exclusive and continued breastfeeding. Legislative and policy changes are also necessary for introducing complementary food supplements, allowing them to be marketed to those who need them, and ensuring that marketing remains appropriate and in full compliance with the International Code of Marketing of Breastmilk Substitutes. This paper aims to illustrate the above with examples from Indonesia and to identify legislative requirements for supporting breastfeeding and enabling appropriate access to high-quality complementary food supplements for children 6-24 months of age. Requirements include improved information, training, monitoring and enforcement systems for the International Code of Marketing of Breastmilk Substitutes; implementation and monitoring of the Baby-Friendly Hospital Initiative; establishment of a registration category for complementary food supplements to enhance availability of high-quality, low-cost fortified products to help improve young child feeding; clear identification and marketing of these products as complementary food supplements for 6-24-month-olds so as to promote proper use and not interfere with breastfeeding. © 2011 Blackwell Publishing Ltd.

High resolution pollutant measurements in complex urban ...

EPA Pesticide Factsheets

Measuring air pollution in real-time using an instrumented vehicle platform has been an emerging strategy to resolve air pollution trends at a very fine spatial scale (10s of meters). Achieving second-by-second data representative of urban air quality trends requires advanced instrumentation, such as a quantum cascade laser utilized to resolve carbon monoxide and real-time optical detection of black carbon. An equally challenging area of development is processing and visualization of complex geospatial air monitoring data to decipher key trends of interest. EPA’s Office of Research and Development staff have applied air monitoring to evaluate community air quality in a variety of environments, including assessing air quality surrounding rail yards, evaluating noise wall or tree stand effects on roadside and on-road air quality, and surveying of traffic-related exposure zones for comparison with land-use regression estimates. ORD has ongoing efforts to improve mobile monitoring data collection and interpretation, including instrumentation testing, evaluating the effect of post-processing algorithms on derived trends, and developing a web-based tool called Real-Time Geospatial Data Viewer (RETIGO) allowing for a simple plug-and-play of mobile monitoring data. Example findings from mobile data sets include an estimated 50% in roadside ultrafine particle levels when immediately downwind of a noise barrier, increases in neighborhood-wide black carbon levels (3

Cost-effective handling of digital medical images in the telemedicine environment.

PubMed

Choong, Miew Keen; Logeswaran, Rajasvaran; Bister, Michel

2007-09-01

This paper concentrates on strategies for less costly handling of medical images. Aspects of digitization using conventional digital cameras, lossy compression with good diagnostic quality, and visualization through less costly monitors are discussed. For digitization of film-based media, subjective evaluation of the suitability of digital cameras as an alternative to the digitizer was undertaken. To save on storage, bandwidth and transmission time, the acceptable degree of compression with diagnostically no loss of important data was studied through randomized double-blind tests of the subjective image quality when compression noise was kept lower than the inherent noise. A diagnostic experiment was undertaken to evaluate normal low cost computer monitors as viable viewing displays for clinicians. The results show that conventional digital camera images of X-ray images were diagnostically similar to the expensive digitizer. Lossy compression, when used moderately with the imaging noise to compression noise ratio (ICR) greater than four, can bring about image improvement with better diagnostic quality than the original image. Statistical analysis shows that there is no diagnostic difference between expensive high quality monitors and conventional computer monitors. The results presented show good potential in implementing the proposed strategies to promote widespread cost-effective telemedicine and digital medical environments. 2006 Elsevier Ireland Ltd

Evaluating barnyard Best Management Practices in Wisconsin using upstream-downstream monitoring

USGS Publications Warehouse

Stuntebeck, Todd D.

1995-01-01

The Nonpoint Source Water Pollution Abatement Program was created in 1978 by the Wisconsin Legislature. The goal of the program is to improve and protect the water quality of lakes, streams, wetlands, and ground water within selected priority watersheds by controlling sources of nonpoint pollution. For each selected watershed, the Wisconsin Department of Natural Resources drafts a management plan that guides the implementation of pollution-control strategies known as Best Management Practices (BMP's). This plan summarizes resource and land-use inventories, describes the results of pollution-source modeling, and suggests pollution reduction goals. The U.S. Geological Survey, through a cooperative effort with the Wisconsin Department of Natural Resources, is monitoring water-quality improvements that result from the implementation of BMP's. The data collected are then compared to the watershed plans to assess progress and determine whether goals are being realized. This fact sheet describes the data-collection efforts, preliminary results, and planned data-analysis techniques of monitoring projects for pre-BMP conditions at two barnyards, one each on Otter Creek and Halfway Prairie Creek.

Web-based video monitoring of CT and MRI procedures

NASA Astrophysics Data System (ADS)

Ratib, Osman M.; Dahlbom, Magdalena; Kho, Hwa T.; Valentino, Daniel J.; McCoy, J. Michael

2000-05-01

A web-based video transmission of images from CT and MRI consoles was implemented in an Intranet environment for real- time monitoring of ongoing procedures. Images captured from the consoles are compressed to video resolution and broadcasted through a web server. When called upon, the attending radiologists can view these live images on any computer within the secured Intranet network. With adequate compression, these images can be displayed simultaneously in different locations at a rate of 2 to 5 images/sec through standard LAN. The quality of the images being insufficient for diagnostic purposes, our users survey showed that they were suitable for supervising a procedure, positioning the imaging slices and for routine quality checking before completion of a study. The system was implemented at UCLA to monitor 9 CTs and 6 MRIs distributed in 4 buildings. This system significantly improved the radiologists productivity by saving precious time spent in trips between reading rooms and examination rooms. It also improved patient throughput by reducing the waiting time for the radiologists to come to check a study before moving the patient from the scanner.

COST Action ES1206: Advanced GNSS Tropospheric Products for Monitoring Severe Weather Events and Climate (GNSS4SWEC)

NASA Astrophysics Data System (ADS)

Jones, Jonathan; Guerova, Guergana; Dousa, Jan; Dick, Galina; de Haan, Siebren; Pottiaux, Eric; Bock, Olivier; Pacione, Rosa

2017-04-01

GNSS is a well established atmospheric observing technique which can accurately sense atmospheric water vapour, the most abundant greenhouse gas, accounting for up to 70% of atmospheric warming. Water vapour is typically under-sampled in modern operational meteorological observing systems and obtaining and exploiting additional high-quality humidity observations is essential to improve weather forecasting and climate monitoring. COST Action ES1206 is a 4-year project, running from 2013 to 2017, which is coordinating the research activities and improved capabilities from concurrent developments in the GNSS, meteorological and climate communities. For the first time, the synergy of multi-GNSS constellations is used to develop new, more advanced tropospheric products, exploiting the full potential of multi-GNSS on a wide range of temporal and spatial scales - from real-time products monitoring and forecasting severe weather, to the highest quality post-processed products suitable for climate research. The Action also promotes the use of meteorological data as an input to real-time GNSS services and is stimulating the transfer of knowledge and data throughout Europe and beyond.

Trend analysis of a tropical urban river water quality in Malaysia.

PubMed

Othman, Faridah; M E, Alaa Eldin; Mohamed, Ibrahim

2012-12-01

Rivers play a significant role in providing water resources for human and ecosystem survival and health. Hence, river water quality is an important parameter that must be preserved and monitored. As the state of Selangor and the city of Kuala Lumpur, Malaysia, are undergoing tremendous development, the river is subjected to pollution from point and non-point sources. The water quality of the Klang River basin, one of the most densely populated areas within the region, is significantly degraded due to human activities as well as urbanization. Evaluation of the overall river water quality status is normally represented by a water quality index (WQI), which consists of six parameters, namely dissolved oxygen, biochemical oxygen demand, chemical oxygen demand, suspended solids, ammoniacal nitrogen and pH. The objectives of this study are to assess the water quality status for this tropical, urban river and to establish the WQI trend. Using monthly WQI data from 1997 to 2007, time series were plotted and trend analysis was performed by employing the first-order autocorrelated trend model on the moving average values for every station. The initial and final values of either the moving average or the trend model were used as the estimates of the initial and final WQI at the stations. It was found that Klang River water quality has shown some improvement between 1997 and 2007. Water quality remains good in the upper stream area, which provides vital water sources for water treatment plants in the Klang valley. Meanwhile, the water quality has also improved in other stations. Results of the current study suggest that the present policy on managing river quality in the Klang River has produced encouraging results; the policy should, however, be further improved alongside more vigorous monitoring of pollution discharge from various point sources such as industrial wastewater, municipal sewers, wet markets, sand mining and landfills, as well as non-point sources such as agricultural or urban runoff and commercial activity.

Factors controlling stream water nitrate and phosphor loads during precipitation events

NASA Astrophysics Data System (ADS)

Rozemeijer, J.; van der Velde, Y.; van Geer, F.; de Rooij, G. H.; Broers, H.; Bierkens, M. F.

2009-12-01

Pollution of surface waters in densely populated areas with intensive land use is a serious threat to their ecological, industrial and recreational utilization. European and national manure policies and several regional and local pilot projects aim at reducing pollution loads to surface waters. For the evaluation of measures, water authorities and environmental research institutes are putting a lot of effort into monitoring surface water quality. Within regional surface water quality monitoring networks, the measurement locations are usually situated in the downstream part of the catchment to represent a larger area. The monitoring frequency is usually low (e.g. monthly), due to the high costs for sampling and analysis. As a consequence, human induced trends in nutrient loads and concentrations in these monitoring data are often concealed by the large variability of surface water quality caused by meteorological variations. Because this natural variability in surface water quality is poorly understood, large uncertainties occur in the estimates of (trends in) nutrient loads or average concentrations. This study aims at uncertainty reduction in the estimates of mean concentrations and loads of N and P from regional monitoring data. For this purpose, we related continuous records of stream water N and P concentrations to easier and cheaper to collect quantitative data on precipitation, discharge, groundwater level and tube drain discharge. A specially designed multi scale experimental setup was installed in an agricultural lowland catchment in The Netherlands. At the catchment outlet, continuous measurements of water quality and discharge were performed from July 2007-January 2009. At an experimental field within the catchment we collected continuous measurements of precipitation, groundwater levels and tube drain discharges. 20 significant rainfall events with a variety of antecedent conditions, durations and intensities were selected for analysis. Singular and multiple regression analysis were used to identify relations between the N and P response to the rainfall events and the quantitative event characteristics. We successfully used these relations to predict the N and P responses to events and to improve the interpolation between low frequency grab sample measurements. Incorporating the predicted concentration changes during high discharge events dramatically improved the precision of our load estimations.

Going beyond the vertical: leveraging a national HIV quality improvement programme to address other health priorities in Haiti.

PubMed

Joseph, Jean Paul; Jerome, Gregory; Lambert, Wesler; Almazor, Patrick; Cupidon, Colette Eugene; Hirschhorn, Lisa R

2015-07-01

Although the central role of quality to achieve targeted population health goals is widely recognized, how to spread the capacity to measure and improve quality across programmes has not been widely studied. We describe the successful leveraging of expertise and framework of a national HIV quality improvement programme to spread capacity and improve quality across a network of clinics in HIV and other targeted areas of healthcare delivery in rural Haiti.The work was led by Zamni LaSante, a Haitian nongovernment organization and its sister organization, Partners In Health working in partnership with the Haitian Ministry of Health in the Plateau Central and Lower Artibonite regions in 12 public sector facilities.Data included routinely collected organizational assessments of facility quality improvement capacity, national HIV performance measures and Zamni LaSante programme records.We found that facility quality improvement capacity increased with spread from HIV to other areas of inpatient and outpatient care, including tuberculosis (TB), maternal health and inpatient services in all 12 supported healthcare facilities. A significant increase in the quality of HIV care was also seen in most areas, including CD4 monitoring, TB screening, HIV treatment (all P < 0.01) and nutritional assessment and prevention of mother-to-child transmission (both P < .05), with an increase in average facility performance from 39 to 72% (P < .01).In conclusion, using a diagonal approach to leverage a national vertical programme for wider benefit resulted in accelerated change in professional culture and increased capacity to spread quality improvement activities across facilities and areas of healthcare delivery. This led to improvement within and beyond HIV care and contributed to the goal of quality of care for all.

Environmental Assessment for the Improvements and Repair to Forty-Niner Avenue Holloman Air Force Base, New Mexico

DTIC Science & Technology

2005-06-01

impacts to storm water quality can range from minor to severe. For this project, impacts are anticipated to be moderate ifBMPs are adequately applied...monitored outfalls. High turbidity, suspended solids, and decreased cross section due to deposition may violate storm water quality benchmarks and...result in a Notice of Violation (NOV) for storm water quality permits. Besides erosive impacts, construction period activities can cause much more

Continuous quality improvement for the clinical decision unit.

PubMed

Mace, Sharon E

2004-01-01

Clinical decision units (CDUs) are a relatively new and growing area of medicine in which patients undergo rapid evaluation and treatment. Continuous quality improvement (CQI) is important for the establishment and functioning of CDUs. CQI in CDUs has many advantages: better CDU functioning, fulfillment of Joint Commission on Accreditation of Healthcare Organizations mandates, greater efficiency/productivity, increased job satisfaction, better performance improvement, data availability, and benchmarking. Key elements include a database with volume indicators, operational policies, clinical practice protocols (diagnosis specific/condition specific), monitors, benchmarks, and clinical pathways. Examples of these important parameters are given. The CQI process should be individualized for each CDU and hospital.

SUPERFUND INNOVATIVE TECHNOLOGIES EVALUATION ...

EPA Pesticide Factsheets

This task seeks to identify high priority needs of the Regions and Program Offices for innovative field sampling, characterization, monitoring, and measurement technologies. When an appropriate solution to a specific problem is identified, a field demonstration is conducted to document the performance and cost of the proposed technologies. The use of field analysis almost always provides a savings in time and cost over the usual sample and ship to a conventional laboratory for analysis approach to site characterization and monitoring. With improvements in technology and appropriate quality assurance/quality control, field analysis has been shown to provide high quality data, useful for most environmental monitoring or characterization projects. An emphasis of the program is to seek out innovative solutions to existing problems and to provide the cost and performance data a user would require to make an informed decision regarding the adequacy of a technology to address a specific environmental problem. The objective of this program is to promote the acceptance and use of innovative field technologies by providing well-documented performance and cost data obtained from field demonstrations.

The Ozone Monitoring Instrument (OMI): towards a 14 Year Data Record and Applications in the Air Quality and Climate Domain

NASA Astrophysics Data System (ADS)

Levelt, P.; Joiner, J.; Tamminen, J.; Veefkind, P.; Bhartia, P. K.; Court, A. J.; Vlemmix, T.

2017-12-01

Keywords: emission monitoring, air quality, climate, atmospheric composition The Ozone Monitoring Instrument (OMI), launched on board of NASA's EOS-Aura spacecraft on July 15, 2004, provides unique contributions to the monitoring of the ozone layer, air quality and climate from space. With a data record of 13 years, OMI provides the longest NO2 and SO2 record from space, which is essential to understand the changes to emissions globally. The combination of urban scale resolution (13 x 24 km2 in nadir) and daily global coverage proved to be key features for the air quality community. Due to the operational Very Fast Delivery (VFD / direct readout) and Near Real Time (NRT) availability of the data, OMI also plays an important role in the early developments of operational services in the atmospheric chemistry domain. For example, OMI data is currently used operationally for improving air quality forecasts, for inverting high-resolution emission maps, the UV forecast and for volcanic plume warning systems for aviation. An overview of air quality applications, emission inventory inversions and trend analyses based on the OMI data record will be presented. An outlook will be given on the potentials of augmenting this record with the high resolution air quality measurements of TROPOMI (3,5 x 7 km2) and new satellite instrumentation entering the imaging domain, such as the TROPOLITE instrument ( 1 x 1 km2). Potential of imaging type of NO2 measurements in the the climate and air quality domain will be given, most notably on the use of high resolution NO2 measurements for pin-pointing anthropogenic CO2 emissions.

Improved but unsustainable: accounting for sachet water in post-2015 goals for global safe water.

PubMed

Stoler, Justin

2012-12-01

The advent and rapid spread of sachet drinking water in West Africa presents a new challenge for providing sustainable access to global safe water. Sachet water has expanded drinking water access and is often of sufficient quality to serve as an improved water source for Millennium Development Goals (MDG) monitoring purposes, yet sachets are an unsustainable water delivery vehicle due to their overwhelming plastic waste burden. Monitoring of primary drinking water sources in West Africa generally ignores sachet water, despite its growing ubiquity. Sub-Saharan Africa as a region is unlikely to meet the MDG Target for drinking water provision, and post-2015 monitoring activities may depend upon rapid adaptability to local drinking water trends. © 2012 Blackwell Publishing Ltd.

Health authority commissioning for quality in contraception services

PubMed Central

Newman, M.; Bardsley, M.; Morgan, D.; Jacobson, B.

1998-01-01

OBJECTIVE: To compare the commissioning of contraception services by London health authorities with accepted models of good practice. DESIGN: Combined interview and postal surveys of all health authorities and National Health Service (NHS) trusts responsible for running family planning clinics in the Greater London area. MAIN OUTCOME MEASURES: Health authority commissioning was assessed on the presence of four key elements of good practice--strategies, coordination, service specifications, and quality standards in contracts--by monitoring activity and quality. RESULTS: Less than half the health authorities surveyed had written strategies or service specifications for contraception services. Arrangements for coordination of services were limited and monitoring was underdeveloped. CONCLUSION: The process of commissioning services for contraception seems to be relatively underdeveloped despite the importance of health problems associated with unplanned pregnancy in London. These findings raise questions about the capacity of health authorities to improve the quality of these services through the commissioning process. PMID:10185140

Quality improvement project to reduce infiltration and extravasation events in a pediatric hospital.

PubMed

Tofani, Barbara F; Rineair, Sylvia A; Gosdin, Craig H; Pilcher, Patricia M; McGee, Susan; Varadarajan, Kartik R; Schoettker, Pamela J

2012-12-01

A safety event response team at Cincinnati Children's Hospital Medical Center developed and tested improvement strategies to reduce peripheral intravenous (PIV) infiltration and extravasation injuries. Improvement activities included development of the touch-look-compare method for hourly PIV site assessment, staff education and mandatory demonstration of PIV site assessment, and performance monitoring and sharing of compliance results. We observed a significant reduction in the injury rate immediately following implementation of the interventions that corresponded with monitoring compliance in performing hourly assessments on patients with a PIV, but this was not sustained. The team is currently examining other strategies to reduce PIV injuries. Copyright © 2012 Elsevier Inc. All rights reserved.

SPARROW MODELING - Enhancing Understanding of the Nation's Water Quality

USGS Publications Warehouse

Preston, Stephen D.; Alexander, Richard B.; Woodside, Michael D.; Hamilton, Pixie A.

2009-01-01

The information provided here is intended to assist water-resources managers with interpretation of the U.S. Geological Survey (USGS) SPARROW model and its products. SPARROW models can be used to explain spatial patterns in monitored stream-water quality in relation to human activities and natural processes as defined by detailed geospatial information. Previous SPARROW applications have identified the sources and transport of nutrients in the Mississippi River basin, Chesapeake Bay watershed, and other major drainages of the United States. New SPARROW models with improved accuracy and interpretability are now being developed by the USGS National Water Quality Assessment (NAWQA) Program for six major regions of the conterminous United States. These new SPARROW models are based on updated geospatial data and stream-monitoring records from local, State, and other federal agencies.

The role of quality improvement in disease management: a statewide tuberculosis control success story.

PubMed

Fos, Peter J; Lee, Jae Eun; Sung, Jung Hye; Zuniga, Miguel A; Amy, Brian W

2005-01-01

This study describes Mississippi's statewide latent tuberculosis infection (LTBI) control management efforts to improve treatment outcomes using scientific quality improvement tools. LTBI medication completion rates were observed by month and by nine administrative health districts for a 12-month period. Analysis of variance (ANOVA) was conducted to see if there was any significant change between preintervention and postintervention in medication completion rates. Regression analysis was performed to test the linearity of change across the monthly rates. A change from a rate of 79.7 percent to 90.5 percent completion of the LTBI medication regimen was observed after the quality improvement intervention was instituted. During the quality improvement intervention, the mean reached 96.5 percent completion, followed by a slight decline at the end of the intervention to 90.5 percent. The analysis revealed that the mean LTBI medication completion rate across the nine administrative health districts was significantly increased and variability was decreased across all administrative health districts, with minor exceptions. A quality improvement team approach was shown to be effective in disease management by increasing LTBI medication completion. New baseline expectations can be established when quality improvement initiatives are implemented. This success can be linked, in part, to the use of scientific methods, precise and valid data, persuasive and clear goal setting, appropriate feedback, and ongoing monitoring.

When Are Mobile Phones Useful for Water Quality Data Collection? An Analysis of Data Flows and ICT Applications among Regulated Monitoring Institutions in Sub-Saharan Africa

PubMed Central

Kumpel, Emily; Peletz, Rachel; Bonham, Mateyo; Fay, Annette; Cock-Esteb, Alicea; Khush, Ranjiv

2015-01-01

Water quality monitoring is important for identifying public health risks and ensuring water safety. However, even when water sources are tested, many institutions struggle to access data for immediate action or long-term decision-making. We analyzed water testing structures among 26 regulated water suppliers and public health surveillance agencies across six African countries and identified four water quality data management typologies. Within each typology, we then analyzed the potential for information and communication technology (ICT) tools to facilitate water quality information flows. A consistent feature of all four typologies was that testing activities occurred in laboratories or offices, not at water sources; therefore, mobile phone-based data management may be most beneficial for institutions that collect data from multiple remote laboratories. We implemented a mobile phone application to facilitate water quality data collection within the national public health agency in Senegal, Service National de l’Hygiène. Our results indicate that using the phones to transmit more than just water quality data will likely improve the effectiveness and sustainability of this type of intervention. We conclude that an assessment of program structure, particularly its data flows, provides a sound starting point for understanding the extent to which ICTs might strengthen water quality monitoring efforts. PMID:26404343

When Are Mobile Phones Useful for Water Quality Data Collection? An Analysis of Data Flows and ICT Applications among Regulated Monitoring Institutions in Sub-Saharan Africa.

PubMed

Kumpel, Emily; Peletz, Rachel; Bonham, Mateyo; Fay, Annette; Cock-Esteb, Alicea; Khush, Ranjiv

2015-09-02

Water quality monitoring is important for identifying public health risks and ensuring water safety. However, even when water sources are tested, many institutions struggle to access data for immediate action or long-term decision-making. We analyzed water testing structures among 26 regulated water suppliers and public health surveillance agencies across six African countries and identified four water quality data management typologies. Within each typology, we then analyzed the potential for information and communication technology (ICT) tools to facilitate water quality information flows. A consistent feature of all four typologies was that testing activities occurred in laboratories or offices, not at water sources; therefore, mobile phone-based data management may be most beneficial for institutions that collect data from multiple remote laboratories. We implemented a mobile phone application to facilitate water quality data collection within the national public health agency in Senegal, Service National de l'Hygiène. Our results indicate that using the phones to transmit more than just water quality data will likely improve the effectiveness and sustainability of this type of intervention. We conclude that an assessment of program structure, particularly its data flows, provides a sound starting point for understanding the extent to which ICTs might strengthen water quality monitoring efforts.

Health benefits from improved outdoor air quality and intervention in China.

PubMed

Li, Shanshan; Williams, Gail; Guo, Yuming

2016-07-01

China is at its most critical stage of outdoor air quality management. In order to prevent further deterioration of air quality and to protect human health, the Chinese government has made a series of attempts to reduce ambient air pollution. Unlike previous literature reviews on the widespread hazards of air pollution on health, this review article firstly summarized the existing evidence of human health benefits from intermittently improved outdoor air quality and intervention in China. Contents of this paper provide concrete and direct clue that improvement in outdoor air quality generates various health benefits in China, and confirm from a new perspective that it is worthwhile for China to shift its development strategy from economic growth to environmental economic sustainability. Greater emphasis on sustainable environment design, consistently strict regulatory enforcement, and specific monitoring actions should be regarded in China to decrease the health risks and to avoid long-term environmental threats. Copyright © 2016 Elsevier Ltd. All rights reserved.

Bacteria and emerging chemical contaminants in the St. Clair River/Lake St. Clair Basin, Michigan

USGS Publications Warehouse

Fogarty, Lisa R.

2007-01-01

Introduction Since the enactment of the Clean Water Act in 1972, awareness of the quality of the Nation's water has continued to improve. Despite improvements to wastewater-treatment systems and increased regulation on waste discharge, bacterial and chemical contamination is still a problem for many rivers and lakes throughout the United States. Pathogenic microorganism and newly recognized chemical contaminants have been found in waters that are used for drinking water and recreation (Rose and Grimes, 2001; Kolpin and others, 2002). This summary of bacteria and emerging-chemical-contaminant monitoring in the St. Clair River/Lake St. Clair Basin (fig. 1) was initiated by the Lake St. Clair Regional Monitoring Project (LSCRMP) in 2003, in cooperation with the Michigan Department of Environmental Quality (MDEQ), the Counties of Macomb, Oakland, St. Clair, and Wayne, and the U.S. Geological Survey (USGS).

Evaluation Model of Plate Waste to Monitor Food Consumption in Two Different Catering Settings

PubMed Central

Scognamiglio, Umberto; Moroni, Catia; Marani, Alessandra; Calcaterra, Veronica; Amendola, Mariano; Civitelli, Giulia; Cattaruzza, Maria Sofia; Ermenegildi, Arianna; Morena, Valeria

2014-01-01

An increasing number of people regularly eats lunch away from home, using catering services. In this context, therefore, it is extremely important to improve the meals’ quality, remaining faithful to the principles of hygiene, nutritional and organoleptic quality and proper food handling. At the same time, it is necessary to promote food choices, nutritionally correct, by evaluations of appropriateness of menus. The study of food waste allows an evaluation of the nutritional habits of consumers and an important economic consideration of the costs incurred for the implementation of the service. This becomes even more important in some particularly sensitive groups, such as children and elderly. The purpose of this work is to test a model of semi-quantitative evaluation of waste to monitor food consumption in two different catering contexts (educational and business), in order to improve the service for school students and other consumers. PMID:27800337

Evaluation Model of Plate Waste to Monitor Food Consumption in Two Different Catering Settings.

PubMed

Saccares, Stefano; Scognamiglio, Umberto; Moroni, Catia; Marani, Alessandra; Calcaterra, Veronica; Amendola, Mariano; Civitelli, Giulia; Cattaruzza, Maria Sofia; Ermenegildi, Arianna; Morena, Valeria

2014-04-17

An increasing number of people regularly eats lunch away from home, using catering services. In this context, therefore, it is extremely important to improve the meals' quality, remaining faithful to the principles of hygiene, nutritional and organoleptic quality and proper food handling. At the same time, it is necessary to promote food choices, nutritionally correct, by evaluations of appropriateness of menus. The study of food waste allows an evaluation of the nutritional habits of consumers and an important economic consideration of the costs incurred for the implementation of the service. This becomes even more important in some particularly sensitive groups, such as children and elderly. The purpose of this work is to test a model of semi-quantitative evaluation of waste to monitor food consumption in two different catering contexts (educational and business), in order to improve the service for school students and other consumers.

40 CFR 63.175 - Quality improvement program for valves.

Code of Federal Regulations, 2010 CFR

2010-07-01

... improvement program for valves. (a) In Phase III, an owner or operator may elect to comply with one of the... use one of these alternative provisions to comply with the requirements of § 63.168(d)(1)(ii) of this... exceeds 2 percent leaking valves, and in such case, monthly monitoring will be required. (d) The following...

40 CFR 63.175 - Quality improvement program for valves.

Code of Federal Regulations, 2014 CFR

2014-07-01

... improvement program for valves. (a) In Phase III, an owner or operator may elect to comply with one of the... use one of these alternative provisions to comply with the requirements of § 63.168(d)(1)(ii) of this... exceeds 2 percent leaking valves, and in such case, monthly monitoring will be required. (d) The following...

Neural manufacturing: a novel concept for processing modeling, monitoring, and control

NASA Astrophysics Data System (ADS)

Fu, Chi Y.; Petrich, Loren; Law, Benjamin

1995-09-01

Semiconductor fabrication lines have become extremely costly, and achieving a good return from such a high capital investment requires efficient utilization of these expensive facilities. It is highly desirable to shorten processing development time, increase fabrication yield, enhance flexibility, improve quality, and minimize downtime. We propose that these ends can be achieved by applying recent advances in the areas of artificial neural networks, fuzzy logic, machine learning, and genetic algorithms. We use the term neural manufacturing to describe such applications. This paper describes our use of artificial neural networks to improve the monitoring and control of semiconductor process.

Construction and Application of Enhanced Remote Sensing Ecological Index

NASA Astrophysics Data System (ADS)

Wang, X.; Liu, C.; Fu, Q.; Yin, B.

2018-04-01

In order to monitor the change of regional ecological environment quality, this paper use MODIS and DMSP / OLS remote sensing data, from the production capacity, external disturbance changes and human socio-economic development of the three main factors affecting the quality of ecosystems, select the net primary productivity, vegetation index and light index, using the principal component analysis method to automatically determine the weight coefficient, construction of the formation of enhanced remote sensing ecological index, and the ecological environment quality of Hainan Island from 2001 to 2013 was monitored and analyzed. The enhanced remote sensing ecological index combines the effects of the natural environment and human activities on ecosystems, and according to the contribution of each principal component automatically determine the weight coefficient, avoid the design of the weight of the parameters caused by the calculation of the human error, which provides a new method for the operational operation of regional macro ecological environment quality monitoring. During the period from 2001 to 2013, the ecological environment quality of Hainan Island showed the characteristics of decend first and then rise, the ecological environment in 2005 was affected by severe natural disasters, and the quality of ecological environment dropped sharply. Compared with 2001, in 2013 about 20000 square kilometers regional ecological environmental quality has improved, about 8760 square kilometers regional ecological environment quality is relatively stable, about 5272 square kilometers regional ecological environment quality has decreased. On the whole, the quality of ecological environment in the study area is good, the frequent occurrence of natural disasters, on the quality of the ecological environment to a certain extent.

Pilot evaluation of electricity-reliability and power-quality monitoring in California's Silicon Valley with the I-Grid(R) system

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

Eto, Joseph; Divan, Deepak; Brumsickle, William

2004-02-01

Power-quality events are of increasing concern for the economy because today's equipment, particularly computers and automated manufacturing devices, is susceptible to these imperceptible voltage changes. A small variation in voltage can cause this equipment to shut down for long periods, resulting in significant business losses. Tiny variations in power quality are difficult to detect except with expensive monitoring equipment used by trained technicians, so many electricity customers are unaware of the role of power-quality events in equipment malfunctioning. This report describes the findings from a pilot study coordinated through the Silicon Valley Manufacturers Group in California to explore the capabilitiesmore » of I-Grid(R), a new power-quality monitoring system. This system is designed to improve the accessibility of power-quality in formation and to increase understanding of the growing importance of electricity reliability and power quality to the economy. The study used data collected by I-Grid sensors at seven Silicon Valley firms to investigate the impacts of power quality on individual study participants as well as to explore the capabilities of the I-Grid system to detect events on the larger electricity grid by means of correlation of data from the sensors at the different sites. In addition, study participants were interviewed about the value they place on power quality, and their efforts to address electricity-reliability and power-quality problems. Issues were identified that should be taken into consideration in developing a larger, potentially nationwide, network of power-quality sensors.« less

Evaluating fundamentals of care: The development of a unit-level quality measurement and improvement programme.

PubMed

Parr, Jenny M; Bell, Jeanette; Koziol-McLain, Jane

2018-06-01

The project aimed to develop a unit-level quality measurement and improvement programme using evidence-based fundamentals of care. Feedback from patients, families, whānau, staff and audit data in 2014 indicated variability in the delivery of fundamental aspects of care such as monitoring, nutrition, pain management and environmental cleanliness at a New Zealand District Health Board. A general inductive approach was used to explore the fundamentals of care and design a measurement and improvement programme, the Patient and Whānau Centred Care Standards (PWCCS), focused on fundamental care. Five phases were used to explore the evidence, and design and test a measurement and improvement framework. Nine identified fundamental elements of care were used to define expected standards of care and develop and test a measurement and improvement framework. Four six-monthly peer reviews have been undertaken since June 2015. Charge Nurse Managers used results to identify quality improvements. Significant improvement was demonstrated overall, in six of the 27 units, in seven of the nine standards and three of the four measures. In all, 89% (n = 24) of units improved their overall result. The PWCCS measurement and improvement framework make visible nursing fundamentals of care in line with continuous quality improvement to increase quality of care. Delivering fundamentals of care is described by nurses as getting ?back to basics'. Patient and family feedback supports the centrality of fundamentals of care to their hospital experience. Implementing a unit-level fundamentals of care quality measurement and improvement programme clarifies expected standards of care, highlights the contribution of fundamentals of care to quality and provides a mechanism for ongoing improvements. © 2018 John Wiley & Sons Ltd.

Industrial yogurt manufacture: monitoring of fermentation process and improvement of final product quality.

PubMed

Soukoulis, C; Panagiotidis, P; Koureli, R; Tzia, C

2007-06-01

Lactic acid fermentation during the production of skim milk and whole fat set-style yogurt was continuously monitored by measuring pH. The modified Gompertz model was successfully applied to describe the pH decline and viscosity development during the fermentation process. The viscosity and incubation time data were also fitted to linear models against ln(pH). The investigation of the yogurt quality improvement practices included 2 different heat treatments (80 degrees C for 30 min and 95 degrees C for 10 min), 3 milk protein fortifying agents (skim milk powder, whey powder, and milk protein concentrate) added at 2.0%, and 4 hydrocolloids (kappa-carrageenan, xanthan, guar gum, and pectin) added at 0.01% to whole fat and skim yogurts. Heat treatment significantly affected viscosity and acetaldehyde development without influencing incubation time and acidity. The addition of whey powder shortened the incubation time but had a detrimental effect on consistency, firmness, and overall acceptance of yogurts. On the other hand, addition of skim milk powder improved the textural quality and decreased the vulnerability of yogurts to syneresis. Anionic stabilizers (kappa-carrageenan and pectin) had a poor effect on the texture and palatability of yogurts. However, neutral gums (xanthan and guar gum) improved texture and prevented the wheying-off defect. Skim milk yogurts exhibited longer incubation times and higher viscosities, whereas they were rated higher during sensory evaluation than whole fat yogurts.

The use of process mapping in healthcare quality improvement projects.

PubMed

Antonacci, Grazia; Reed, Julie E; Lennox, Laura; Barlow, James

2018-05-01

Introduction Process mapping provides insight into systems and processes in which improvement interventions are introduced and is seen as useful in healthcare quality improvement projects. There is little empirical evidence on the use of process mapping in healthcare practice. This study advances understanding of the benefits and success factors of process mapping within quality improvement projects. Methods Eight quality improvement projects were purposively selected from different healthcare settings within the UK's National Health Service. Data were gathered from multiple data-sources, including interviews exploring participants' experience of using process mapping in their projects and perceptions of benefits and challenges related to its use. These were analysed using inductive analysis. Results Eight key benefits related to process mapping use were reported by participants (gathering a shared understanding of the reality; identifying improvement opportunities; engaging stakeholders in the project; defining project's objectives; monitoring project progress; learning; increased empathy; simplicity of the method) and five factors related to successful process mapping exercises (simple and appropriate visual representation, information gathered from multiple stakeholders, facilitator's experience and soft skills, basic training, iterative use of process mapping throughout the project). Conclusions Findings highlight benefits and versatility of process mapping and provide practical suggestions to improve its use in practice.

Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study.

PubMed

Lim, Paul Chun Yih; Lee, Audry Shan Yin; Chua, Kelvin Chi Ming; Lim, Eric Tien Siang; Chong, Daniel Thuan Tee; Tan, Boon Yew; Ho, Kah Leng; Teo, Wee Siong; Ching, Chi Keong

2016-07-01

Remote monitoring of cardiac implantable electronic devices (CIED) has been shown to improve patient safety and reduce in-office visits. We report our experience with remote monitoring via the Medtronic CareLink(®) network. Patients were followed up for six months with scheduled monthly remote monitoring transmissions in addition to routine in-office checks. The efficacy of remote monitoring was evaluated by recording compliance to transmissions, number of device alerts requiring intervention and time from transmission to review. Questionnaires were administered to evaluate the experiences of patients, physicians and medical technicians. A total of 57 patients were enrolled; 16 (28.1%) had permanent pacemakers, 34 (59.6%) had implantable cardioverter defibrillators and 7 (12.3%) had cardiac resynchronisation therapy defibrillators. Overall, of 334 remote transmissions scheduled, 73.7% were on time, 14.5% were overdue and 11.8% were missed. 84.6% of wireless transmissions were on time, compared to 53.8% of non-wireless transmissions. Among all transmissions, 4.4% contained alerts for which physicians were informed and only 1.8% required intervention. 98.6% of remote transmissions were reviewed by the second working day. 73.2% of patients preferred remote monitoring. Physicians agreed that remote transmissions provided information equivalent to in-office checks 97.1% of the time. 77.8% of medical technicians felt that remote monitoring would help the hospital improve patient management. No adverse events were reported. Remote monitoring of CIED is safe and feasible. It has possible benefits to patient safety through earlier detection of arrhythmias or device malfunction, permitting earlier intervention. Wireless remote monitoring, in particular, may improve compliance to device monitoring. Patients may prefer remote monitoring due to possible improvements in quality of life. Copyright: © Singapore Medical Association.

Remote monitoring of patients with cardiac implantable electronic devices: a Southeast Asian, single-centre pilot study

PubMed Central

Lim, Paul Chun Yih; Lee, Audry Shan Yin; Chua, Kelvin Chi Ming; Lim, Eric Tien Siang; Chong, Daniel Thuan Tee; Tan, Boon Yew; Ho, Kah Leng; Teo, Wee Siong; Ching, Chi Keong

2016-01-01

INTRODUCTION Remote monitoring of cardiac implantable electronic devices (CIED) has been shown to improve patient safety and reduce in-office visits. We report our experience with remote monitoring via the Medtronic CareLink® network. METHODS Patients were followed up for six months with scheduled monthly remote monitoring transmissions in addition to routine in-office checks. The efficacy of remote monitoring was evaluated by recording compliance to transmissions, number of device alerts requiring intervention and time from transmission to review. Questionnaires were administered to evaluate the experiences of patients, physicians and medical technicians. RESULTS A total of 57 patients were enrolled; 16 (28.1%) had permanent pacemakers, 34 (59.6%) had implantable cardioverter defibrillators and 7 (12.3%) had cardiac resynchronisation therapy defibrillators. Overall, of 334 remote transmissions scheduled, 73.7% were on time, 14.5% were overdue and 11.8% were missed. 84.6% of wireless transmissions were on time, compared to 53.8% of non-wireless transmissions. Among all transmissions, 4.4% contained alerts for which physicians were informed and only 1.8% required intervention. 98.6% of remote transmissions were reviewed by the second working day. 73.2% of patients preferred remote monitoring. Physicians agreed that remote transmissions provided information equivalent to in-office checks 97.1% of the time. 77.8% of medical technicians felt that remote monitoring would help the hospital improve patient management. No adverse events were reported. CONCLUSION Remote monitoring of CIED is safe and feasible. It has possible benefits to patient safety through earlier detection of arrhythmias or device malfunction, permitting earlier intervention. Wireless remote monitoring, in particular, may improve compliance to device monitoring. Patients may prefer remote monitoring due to possible improvements in quality of life. PMID:27439396

An integrated sampling and analysis approach for improved biodiversity monitoring

USGS Publications Warehouse

DeWan, Amielle A.; Zipkin, Elise

2010-01-01

Successful biodiversity conservation requires high quality monitoring data and analyses to ensure scientifically defensible policy, legislation, and management. Although monitoring is a critical component in assessing population status and trends, many governmental and non-governmental organizations struggle to develop and implement effective sampling protocols and statistical analyses because of the magnitude and diversity of species in conservation concern. In this article we describe a practical and sophisticated data collection and analysis framework for developing a comprehensive wildlife monitoring program that includes multi-species inventory techniques and community-level hierarchical modeling. Compared to monitoring many species individually, the multi-species approach allows for improved estimates of individual species occurrences, including rare species, and an increased understanding of the aggregated response of a community to landscape and habitat heterogeneity. We demonstrate the benefits and practicality of this approach to address challenges associated with monitoring in the context of US state agencies that are legislatively required to monitor and protect species in greatest conservation need. We believe this approach will be useful to regional, national, and international organizations interested in assessing the status of both common and rare species.

A tentative discussion on the monitoring of water resources in China

NASA Astrophysics Data System (ADS)

Yang, Jianqing; Dai, Ning; Wu, Mengying; Wang, Guangsheng

2016-10-01

With the rapid economy development and social civilization progress, the Chinese Government also is improving ecological environmental conditions. More efforts have been made to solve water problems through the implementation of stringent water resources management, as a key government policy on water. Thus, monitoring of water resources has been strengthened, being a main component of the hydrological work in recent years. Compared with routine hydrological monitoring, water resources monitoring pays more attention to the quantity and quality variations of regional waters, to reflect the status of water in river basins and administrative regions. In this paper, the overall layout of the hydrometric network in China is presented, monitoring efforts of the natural water cycle and water consumptions are analyzed, methodologies of water resources monitoring, which are commonly applied in the country, are summed up. Taking the hydrometric network planning on interprovincial boundary waterbodies as example, a summary of the planning at interprovincial boundary river sections is presented. The planning can meet the need of water resources management of administrative divisions. It can also improve the overall water resources monitoring for the country.

Assessment of Reactive Catch Basin Larvicide Treatments Toward Improved Water Quality Using FourStar(®) Briquets and CocoBear™ Larvicide Oil.

PubMed

Harbison, Justin E; Zazra, Dave; Henry, Marlon; Xamplas, Christopher; Kafensztok, Ruth

2015-09-01

Because it is often logistically impossible to monitor all catch basins within an operational area, local mosquito control programs will preemptively treat catch basins with larvicides each season. However, these larvicides can, ostensibly, be considered water quality pollutants. To experimentally reduce the use of larvicides toward improving water quality, 30 basins within a small 0.7-km(2) residential area were monitored weekly for the presence of larvae and pupae for 14 wk in the summer of 2013. Once a basin was found to reach a threshold of 12 mosquitoes per dip sample, it received a FourStar® Briquet (a 180-day briquet formulation of 6% Bacillus sphaericus and 1% B. thuringiensis israelensis). Each week a FourStar-treated basin surpassed this threshold, it was treated with an application of CocoBear™ oil (10% mineral oil). By the end of trials, all but one basin received a briquet and 13 required at least 4 treatments of CocoBear, suggesting that preemptive treatment is appropriate for the study area.

Development and implementation of a comprehensive quality assurance program at a community endoscopy facility.

PubMed

Hilsden, Robert Jay; Rostom, Alaa; Dubé, Catherine; Pontifex, Darlene; McGregor, S Elizabeth; Bridges, Ronald J

2011-10-01

Quality assurance (QA) is a process that includes the systematic evaluation of a service, institution of improvements and ongoing evaluation to ensure that effective changes were made. QA is a fundamental component of any organized colorectal cancer screening program. However, it should play an equally important role in opportunistic screening. Establishing the processes and procedures for a comprehensive QA program can be a daunting proposition for an endoscopy unit. The present article describes the steps taken to establish a QA program at the Forzani & MacPhail Colon Cancer Screening Centre (Calgary, Alberta) - a colorectal cancer screening centre and nonhospital endoscopy unit that is dedicated to providing colorectal cancer screening-related colonoscopies. Lessons drawn from the authors' experience may help others develop their own initiatives. The Global Rating Scale, a quality assessment and improvement tool developed for the gastrointestinal endoscopy services of the United Kingdom's National Health Service, was used as the framework to develop the QA program. QA activities include monitoring the patient experience through surveys, creating endoscopist report cards on colonoscopy performance, tracking and evaluating adverse events and monitoring wait times.

Cycle chemistry monitoring system as means of improving the reliability of the equipment at the power plants

NASA Astrophysics Data System (ADS)

Yegoshina, O. V.; Voronov, V. N.; Yarovoy, V. O.; Bolshakova, N. A.

2017-11-01

There are many problems in domestic energy at the present that require urgent solutions in the near future. One of these problems - the aging of the main and auxiliary equipment. Wear of equipment is the cause of decrease reliability and efficiency of power plants. Reliability of the equipment are associated with the introduction of cycle chemistry monitoring system. The most damageable equipment’s are boilers (52.2 %), turbines (12.6 %) and heating systems (12.3 %) according to the review of failure rate on the power plants. The most part of the damageability of the boiler is heated surfaces (73.2 %). According to the Russian technical requirements, the monitoring systems are responsible to reduce damageability the boiler heating surfaces and to increase the reliability of the equipment. All power units capacity of over 50 MW are equipped with cycle chemistry monitoring systems in order to maintain water chemistry within operating limits. The main idea of cycle chemistry monitoring systems is to improve water chemistry at power plants. According to the guidelines, cycle chemistry monitoring systems of a single unit depends on its type (drum or once-through boiler) and consists of: 20…50 parameters of on-line chemical analyzers; 20…30 «grab» sample analyses (daily) and about 15…20 on-line monitored operating parameters. The operator of modern power plant uses with many data at different points of steam/water cycle. Operators do not can estimate quality of the cycle chemistry due to the large volume of daily and every shift information and dispersion of data, lack of systematization. In this paper, an algorithm for calculating the quality index developed for improving control the water chemistry of the condensate, feed water and prevent scaling and corrosion in the steam/water cycle.

Quality-based purchasing in health care.

PubMed

Waters, Hugh R; Morlock, Laura L; Hatt, Laurel

2004-01-01

Quality-based purchasing is a growing trend that seeks to improve healthcare quality through the purchaser-provider relationship. This article provides a unifying conceptual framework, presents examples of the purchaser-provider relationship in countries at different income levels, and identifies important supporting mechanisms for quality-based purchasing. As countries become wealthier, a higher proportion of healthcare spending is channeled through pooled arrangements, allowing for greater involvement of purchasers in promoting the quality of service provision. Global and line item budgets are the most common type of provider payment system in low and middle-income countries. In these countries, improving public hospital performance through contracting and incentives is a key issue. In middle and high-income countries, there are several documented examples of governments contracting to private or non-governmental health care providers, resulting in higher perceived quality of care and lower delivery costs. Encouraging quality through employer purchasing arrangements has been promoted in several countries, particularly the United States. Community-based financing schemes are an increasingly common form of health financing in parts of sub-Saharan Africa and Asia, but these schemes still cover less than 10% of national populations in countries in which they are active. To date, there is little evidence of their impact on healthcare quality. The availability of information--concerning healthcare service provision and outcomes--determines the options for establishing and monitoring contract provisions and promoting quality. Regardless of the context, quality-based purchasing depends critically on informa-tion--reporting, monitoring, and providing useful information to healthcare consumers. In many low and middle-income countries, the lack of availability of information is the principal constraint on measuring performance, a critical component of quality-based purchasing.

Application of Biomedical Sensor and Transducer in the Elderly

NASA Astrophysics Data System (ADS)

Tamura, Toshiyo

In the elderly society, the sensor and transducers are applied to improve quality of life. Sensors are attached to the furniture or inside a room instead of attached to the human.The non-invasive and unconstrained monitoring are performed in the home and less constrained monitoring using portable-small sensor are used. In this paper, recent development of sensor and transducer in the Gerontechnology field is reviewed.

A patient self-assessment tool for cardiac rehabilitation.

PubMed

Phelan, C; Finnell, M D; Mottla, K A

1989-01-01

A patient self-assessment tool was designed, tested, and implemented to promote cardiac-specific data collection, based on Gordon's Functional Health Patterns, to maximize patient/family involvement in determining a plan of care, and to streamline primary nurses' documentation requirements. Retrospective and concurrent chart reviews provided data for quality assurance monitoring. The results of the monitoring demonstrated that the self-assessment tool markedly improved the patient-specific data base.

Healthcare Reimbursement and Quality Improvement: Integration Using the Electronic Medical Record Comment on "Fee-for-Service Payment--an Evil Practice That Must Be Stamped Out?".

PubMed

Britton, John R

2015-05-08

Reimbursement for healthcare has utilized a variety of payment mechanisms with varying degrees of effectiveness. Whether these mechanisms are used singly or in combination, it is imperative that the resulting systems remunerate on the basis of the quantity, complexity, and quality of care provided. Expanding the role of the electronic medical record (EMR) to monitor provider practice, patient responsiveness, and functioning of the healthcare organization has the potential to not only enhance the accuracy and efficiency of reimbursement mechanisms but also to improve the quality of medical care. © 2015 by Kerman University of Medical Sciences.

Maximizing the spatial representativeness of NO2 monitoring data using a combination of local wind-based sectoral division and seasonal and diurnal correction factors.

PubMed

Donnelly, Aoife; Naughton, Owen; Misstear, Bruce; Broderick, Brian

2016-10-14

This article describes a new methodology for increasing the spatial representativeness of individual monitoring sites. Air pollution levels at a given point are influenced by emission sources in the immediate vicinity. Since emission sources are rarely uniformly distributed around a site, concentration levels will inevitably be most affected by the sources in the prevailing upwind direction. The methodology provides a means of capturing this effect and providing additional information regarding source/pollution relationships. The methodology allows for the division of the air quality data from a given monitoring site into a number of sectors or wedges based on wind direction and estimation of annual mean values for each sector, thus optimising the information that can be obtained from a single monitoring station. The method corrects for short-term data, diurnal and seasonal variations in concentrations (which can produce uneven weighting of data within each sector) and uneven frequency of wind directions. Significant improvements in correlations between the air quality data and the spatial air quality indicators were obtained after application of the correction factors. This suggests the application of these techniques would be of significant benefit in land-use regression modelling studies. Furthermore, the method was found to be very useful for estimating long-term mean values and wind direction sector values using only short-term monitoring data. The methods presented in this article can result in cost savings through minimising the number of monitoring sites required for air quality studies while also capturing a greater degree of variability in spatial characteristics. In this way, more reliable, but also more expensive monitoring techniques can be used in preference to a higher number of low-cost but less reliable techniques. The methods described in this article have applications in local air quality management, source receptor analysis, land-use regression mapping and modelling and population exposure studies.

A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center

PubMed Central

Sindhwani, Geetika; Gupta, Monica; Arora, Sweta; Mishra, Arpita; Bhatt, Jayesh; Arora, Manali; Gehani, Anisha

2017-01-01

Introduction An organization’s transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. Aim To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. Materials and Methods To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP’s), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis. Results A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. Conclusion Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety. PMID:28969238

The CCLM contribution to improvements in quality and patient safety.

PubMed

Plebani, Mario

2013-01-01

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

Real-time geomagnetic monitoring for space weather-related applications: Opportunities and challenges

USGS Publications Warehouse

Love, Jeffrey J.; Finn, Carol

2017-01-01

An examination is made of opportunities and challenges for enhancing global, real-time geomagnetic monitoring that would be beneficial for a variety of operational projects. This enhancement in geomagnetic monitoring can be attained by expanding the geographic distribution of magnetometer stations, improving the quality of magnetometer data, increasing acquisition sampling rates, increasing the promptness of data transmission, and facilitating access to and use of the data. Progress will benefit from new partnerships to leverage existing capacities and harness multisector, cross-disciplinary, and international interests.

Cost-effective water quality assessment through the integration of monitoring data and modeling results

NASA Astrophysics Data System (ADS)

Lobuglio, Joseph N.; Characklis, Gregory W.; Serre, Marc L.

2007-03-01

Sparse monitoring data and error inherent in water quality models make the identification of waters not meeting regulatory standards uncertain. Additional monitoring can be implemented to reduce this uncertainty, but it is often expensive. These costs are currently a major concern, since developing total maximum daily loads, as mandated by the Clean Water Act, will require assessing tens of thousands of water bodies across the United States. This work uses the Bayesian maximum entropy (BME) method of modern geostatistics to integrate water quality monitoring data together with model predictions to provide improved estimates of water quality in a cost-effective manner. This information includes estimates of uncertainty and can be used to aid probabilistic-based decisions concerning the status of a water (i.e., impaired or not impaired) and the level of monitoring needed to characterize the water for regulatory purposes. This approach is applied to the Catawba River reservoir system in western North Carolina as a means of estimating seasonal chlorophyll a concentration. Mean concentration and confidence intervals for chlorophyll a are estimated for 66 reservoir segments over an 11-year period (726 values) based on 219 measured seasonal averages and 54 model predictions. Although the model predictions had a high degree of uncertainty, integration of modeling results via BME methods reduced the uncertainty associated with chlorophyll estimates compared with estimates made solely with information from monitoring efforts. Probabilistic predictions of future chlorophyll levels on one reservoir are used to illustrate the cost savings that can be achieved by less extensive and rigorous monitoring methods within the BME framework. While BME methods have been applied in several environmental contexts, employing these methods as a means of integrating monitoring and modeling results, as well as application of this approach to the assessment of surface water monitoring networks, represent unexplored areas of research.

Passive Sampling in Regulatory Chemical Monitoring of Nonpolar Organic Compounds in the Aquatic Environment.

PubMed

Booij, Kees; Robinson, Craig D; Burgess, Robert M; Mayer, Philipp; Roberts, Cindy A; Ahrens, Lutz; Allan, Ian J; Brant, Jan; Jones, Lisa; Kraus, Uta R; Larsen, Martin M; Lepom, Peter; Petersen, Jördis; Pröfrock, Daniel; Roose, Patrick; Schäfer, Sabine; Smedes, Foppe; Tixier, Céline; Vorkamp, Katrin; Whitehouse, Paul

2016-01-05

We reviewed compliance monitoring requirements in the European Union, the United States, and the Oslo-Paris Convention for the protection of the marine environment of the North-East Atlantic, and evaluated if these are met by passive sampling methods for nonpolar compounds. The strengths and shortcomings of passive sampling are assessed for water, sediments, and biota. Passive water sampling is a suitable technique for measuring concentrations of freely dissolved compounds. This method yields results that are incompatible with the EU's quality standard definition in terms of total concentrations in water, but this definition has little scientific basis. Insufficient quality control is a present weakness of passive sampling in water. Laboratory performance studies and the development of standardized methods are needed to improve data quality and to encourage the use of passive sampling by commercial laboratories and monitoring agencies. Successful prediction of bioaccumulation based on passive sampling is well documented for organisms at the lower trophic levels, but requires more research for higher levels. Despite the existence of several knowledge gaps, passive sampling presently is the best available technology for chemical monitoring of nonpolar organic compounds. Key issues to be addressed by scientists and environmental managers are outlined.

The role of NASA's Water Resources applications area in improving access to water quality-related information and water resources management

NASA Astrophysics Data System (ADS)

Lee, C. M.

2016-02-01

The NASA Applied Sciences Program plays a unique role in facilitating access to remote sensing-based water information derived from US federal assets towards the goal of improving science and evidence-based decision-making in water resources management. The Water Resources Application Area within NASA Applied Sciences works specifically to develop and improve water data products to support improved management of water resources, with partners who are faced with real-world constraints and conditions including cost and regulatory standards. This poster will highlight the efforts and collaborations enabled by this program that have resulted in integration of remote sensing-based information for water quality modeling and monitoring within an operational context.

The role of NASA's Water Resources applications area in improving access to water quality-related information and water resources management

NASA Astrophysics Data System (ADS)

Lee, C. M.

2016-12-01

The NASA Applied Sciences Program plays a unique role in facilitating access to remote sensing-based water information derived from US federal assets towards the goal of improving science and evidence-based decision-making in water resources management. The Water Resources Application Area within NASA Applied Sciences works specifically to develop and improve water data products to support improved management of water resources, with partners who are faced with real-world constraints and conditions including cost and regulatory standards. This poster will highlight the efforts and collaborations enabled by this program that have resulted in integration of remote sensing-based information for water quality modeling and monitoring within an operational context.

Defining and Assessing Quality Improvement Outcomes: A Framework for Public Health

PubMed Central

Nawaz, Saira; Thomas, Craig; Young, Andrea

2015-01-01

We describe an evidence-based framework to define and assess the impact of quality improvement (QI) in public health. Developed to address programmatic and research-identified needs for articulating the value of public health QI in aggregate, this framework proposes a standardized set of measures to monitor and improve the efficiency and effectiveness of public health programs and operations. We reviewed the scientific literature and analyzed QI initiatives implemented through the Centers for Disease Control and Prevention’s National Public Health Improvement Initiative to inform the selection of 5 efficiency and 8 effectiveness measures. This framework provides a model for identifying the types of improvement outcomes targeted by public health QI efforts and a means to understand QI’s impact on the practice of public health. PMID:25689185

Personalised telehealth intervention for chronic disease management: A pilot randomised controlled trial.

PubMed

Bohingamu Mudiyanselage, Shalika; Stevens, Jo; Watts, Jennifer J; Toscano, Julian; Kotowicz, Mark A; Steinfort, Christopher L; Bell, Jennifer; Byrnes, Janette; Bruce, Stephanie; Carter, Sarah; Hunter, Claire; Barrand, Chris; Hayles, Robyn

2018-01-01

Introduction The aim of this study was to assess the impact of home-based telehealth monitoring on health outcomes, quality of life and costs over 12 months for patients with diabetes and/or chronic obstructive pulmonary disease (COPD) who were identified as being at high risk of readmission to hospital. Methods This pilot study was a randomised controlled trial combined with an economic analysis to examine the outcomes of standard care versus home-based telehealth for people with diabetes and/or COPD who were at risk of hospital readmission within one year. The primary outcomes were (i) hospital admission and length of stay (LOS); and (ii) health-related quality of life (HRQOL); and the secondary outcomes were (i) health-related clinical outcomes; (ii) anxiety and depression scores; and (iii) health literacy. The costs of the intervention and hospitalisations were included. Results A total of 86 and 85 participants were randomised to the intervention and control groups respectively. The difference between groups in hospital LOS was -3.89 (95% confidence interval (CI): -9.40, 1.62) days, and for HRQOL, 0.09 (95% CI: 0.05, 0.14) in favour of the telehealth monitoring group. There was a saving of AUD$6553 (95% CI: -12145, -961) in the cost of hospitalisation over 12 months, which offset the increased cost of tele-monitoring. The intervention group showed an improvement in anxiety, depression and health literacy at 12 months, and in the diabetes group, a reduction in microalbuminuria. Discussion The telehealth monitoring intervention improved patient's health outcomes and quality of life at no additional cost.

Scandinavian systems monitoring the oral health in children and adolescents; an evaluation of their quality and utility in the light of modern perspectives of caries management.

PubMed

Skeie, Marit S; Klock, Kristin S

2014-04-30

Recording reliable oral health data is a challenge. The aims were a) to outline different Scandinavian systems of oral health monitoring, b) to evaluate the quality and utility of the collected data in the light of modern concepts of disease management and to suggest improvements. The information for in this study was related to (a) children and adolescents, (b) oral health data and (c) routines for monitoring such data. This meant information available in the official web sites of the "KOSTRA-data" (Municipality-State-Report) in Norway, the Swedish National Board of Health and Welfare ("Socialstyrelsen") and Oral Health Register (the SCOR system, National Board of Health) in Denmark. A potential for increasing the reliability and validity of the data existed. Routines for monitoring other oral diseases than caries were limited. Compared with the other Scandinavian countries, the data collection system in Denmark appeared more functional and had adopted more modern concepts of disease management than other systems. In the light of modern concepts of caries management, data collected elsewhere had limited utility. The Scandinavian systems of health reporting had much in common, but some essential differences existed. If the quality of epidemiological data were enhanced, it would be possible to use the data for planning oral health care. Routines and procedures should be improved and updated in accordance with the modern ideas about caries prevention and therapy. For appropriate oral health planning in an organised dental service, reporting of enamel caries is essential.

Future water quality monitoring--adapting tools to deal with mixtures of pollutants in water resource management.

PubMed

Altenburger, Rolf; Ait-Aissa, Selim; Antczak, Philipp; Backhaus, Thomas; Barceló, Damià; Seiler, Thomas-Benjamin; Brion, Francois; Busch, Wibke; Chipman, Kevin; de Alda, Miren López; de Aragão Umbuzeiro, Gisela; Escher, Beate I; Falciani, Francesco; Faust, Michael; Focks, Andreas; Hilscherova, Klara; Hollender, Juliane; Hollert, Henner; Jäger, Felix; Jahnke, Annika; Kortenkamp, Andreas; Krauss, Martin; Lemkine, Gregory F; Munthe, John; Neumann, Steffen; Schymanski, Emma L; Scrimshaw, Mark; Segner, Helmut; Slobodnik, Jaroslav; Smedes, Foppe; Kughathas, Subramaniam; Teodorovic, Ivana; Tindall, Andrew J; Tollefsen, Knut Erik; Walz, Karl-Heinz; Williams, Tim D; Van den Brink, Paul J; van Gils, Jos; Vrana, Branislav; Zhang, Xiaowei; Brack, Werner

2015-04-15

Environmental quality monitoring of water resources is challenged with providing the basis for safeguarding the environment against adverse biological effects of anthropogenic chemical contamination from diffuse and point sources. While current regulatory efforts focus on monitoring and assessing a few legacy chemicals, many more anthropogenic chemicals can be detected simultaneously in our aquatic resources. However, exposure to chemical mixtures does not necessarily translate into adverse biological effects nor clearly shows whether mitigation measures are needed. Thus, the question which mixtures are present and which have associated combined effects becomes central for defining adequate monitoring and assessment strategies. Here we describe the vision of the international, EU-funded project SOLUTIONS, where three routes are explored to link the occurrence of chemical mixtures at specific sites to the assessment of adverse biological combination effects. First of all, multi-residue target and non-target screening techniques covering a broader range of anticipated chemicals co-occurring in the environment are being developed. By improving sensitivity and detection limits for known bioactive compounds of concern, new analytical chemistry data for multiple components can be obtained and used to characterise priority mixtures. This information on chemical occurrence will be used to predict mixture toxicity and to derive combined effect estimates suitable for advancing environmental quality standards. Secondly, bioanalytical tools will be explored to provide aggregate bioactivity measures integrating all components that produce common (adverse) outcomes even for mixtures of varying compositions. The ambition is to provide comprehensive arrays of effect-based tools and trait-based field observations that link multiple chemical exposures to various environmental protection goals more directly and to provide improved in situ observations for impact assessment of mixtures. Thirdly, effect-directed analysis (EDA) will be applied to identify major drivers of mixture toxicity. Refinements of EDA include the use of statistical approaches with monitoring information for guidance of experimental EDA studies. These three approaches will be explored using case studies at the Danube and Rhine river basins as well as rivers of the Iberian Peninsula. The synthesis of findings will be organised to provide guidance for future solution-oriented environmental monitoring and explore more systematic ways to assess mixture exposures and combination effects in future water quality monitoring. Copyright © 2015 Elsevier B.V. All rights reserved.

Estimation of contribution ratios of pollutant sources to a specific section based on an enhanced water quality model.

PubMed

Cao, Bibo; Li, Chuan; Liu, Yan; Zhao, Yue; Sha, Jian; Wang, Yuqiu

2015-05-01

Because water quality monitoring sections or sites could reflect the water quality status of rivers, surface water quality management based on water quality monitoring sections or sites would be effective. For the purpose of improving water quality of rivers, quantifying the contribution ratios of pollutant resources to a specific section is necessary. Because physical and chemical processes of nutrient pollutants are complex in water bodies, it is difficult to quantitatively compute the contribution ratios. However, water quality models have proved to be effective tools to estimate surface water quality. In this project, an enhanced QUAL2Kw model with an added module was applied to the Xin'anjiang Watershed, to obtain water quality information along the river and to assess the contribution ratios of each pollutant source to a certain section (the Jiekou state-controlled section). Model validation indicated that the results were reliable. Then, contribution ratios were analyzed through the added module. Results show that among the pollutant sources, the Lianjiang tributary contributes the largest part of total nitrogen (50.43%), total phosphorus (45.60%), ammonia nitrogen (32.90%), nitrate (nitrite + nitrate) nitrogen (47.73%), and organic nitrogen (37.87%). Furthermore, contribution ratios in different reaches varied along the river. Compared with pollutant loads ratios of different sources in the watershed, an analysis of contribution ratios of pollutant sources for each specific section, which takes the localized chemical and physical processes into consideration, was more suitable for local-regional water quality management. In summary, this method of analyzing the contribution ratios of pollutant sources to a specific section based on the QUAL2Kw model was found to support the improvement of the local environment.

Effectiveness of UK provider financial incentives on quality of care: a systematic review.

PubMed

Mandavia, Rishi; Mehta, Nishchay; Schilder, Anne; Mossialos, Elias

2017-11-01

Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency. To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care. Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as 'positive', those that were 'intermediate' showed improvement in some measures, and those classified as 'negative' showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist. Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points. The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives - if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK. © British Journal of General Practice 2017.

Using Six Sigma to improve once daily gentamicin dosing and therapeutic drug monitoring performance.

PubMed

Egan, Sean; Murphy, Philip G; Fennell, Jerome P; Kelly, Sinead; Hickey, Mary; McLean, Carolyn; Pate, Muriel; Kirke, Ciara; Whiriskey, Annette; Wall, Niall; McCullagh, Eddie; Murphy, Joan; Delaney, Tim

2012-12-01

Safe, effective therapy with the antimicrobial gentamicin requires good practice in dose selection and monitoring of serum levels. Suboptimal therapy occurs with breakdown in the process of drug dosing, serum blood sampling, laboratory processing and level interpretation. Unintentional underdosing may result. This improvement effort aimed to optimise this process in an academic teaching hospital using Six Sigma process improvement methodology. A multidisciplinary project team was formed. Process measures considered critical to quality were defined, and baseline practice was examined through process mapping and audit. Root cause analysis informed improvement measures. These included a new dosing and monitoring schedule, and standardised assay sampling and drug administration timing which maximised local capabilities. Three iterations of the improvement cycle were conducted over a 24-month period. The attainment of serum level sampling in the required time window improved by 85% (p≤0.0001). A 66% improvement in accuracy of dosing was observed (p≤0.0001). Unnecessary dose omission while awaiting level results and inadvertent disruption to therapy due to dosing and monitoring process breakdown were eliminated. Average daily dose administered increased from 3.39 mg/kg to 4.78 mg/kg/day. Using Six Sigma methodology enhanced gentamicin usage process performance. Local process related factors may adversely affect adherence to practice guidelines for gentamicin, a drug which is complex to use. It is vital to adapt dosing guidance and monitoring requirements so that they are capable of being implemented in the clinical environment as a matter of routine. Improvement may be achieved through a structured localised approach with multidisciplinary stakeholder involvement.

Long Term Trend Analysis and Assessment of Water Quality in the Penchala River, Malaysia

NASA Astrophysics Data System (ADS)

Chow, M. F.; Haris, H. B.; Mohd Sidek, L. B.

2014-12-01

Rapid urban expansion produces negative impacts on the natural environment, especially river water quality. Studies assessing long term changes of water quality have been recognized as a key tool for understanding ongoing processes in watersheds and for providing an essential background for evaluation of rapid changes within industrialized and populated urban areas. Unfortunately, only limited studies are available for developing countries such as Malaysia. Thus, a long term study was conducted to evaluate water quality trends at Pencala river basin that has undergone extensive land use changes related to industrial, agricultural and urban activities. Fifteen physical and chemical variables were analysed in river water samples collected every month over a period of 13 years, between 1997 and 2009. The trend study was performed using the Mann-Kendall Seasonal test and the Sen's Slope estimator. Results revealed that most water quality parameters showed a downward trend for yearly average concentration. The water quality index (WQI) for Pencala River was improved from Class V to Class IV, according to National Water Quality Standards for Malaysia. BOD, COD, NH3-N and SS show trends toward decreasing concentrations over time. The improvements seen in water quality appear to be the result of improved wastewater treatment and other water quality improvement efforts achieved through government initiative. Continued long-term and high frequency monitoring is necessary to establish plans and policies for effective water resources management.

Influence of the water quality improvement on fish population in the Seine River (Paris, France) over the 1990-2013 period.

PubMed

Azimi, Sam; Rocher, Vincent

2016-01-15

Over the past 20 years, rules concerning wastewater treatment and quality of water discharged into the environment have changed considerably. Huge investments have been made in Paris conurbation to improve waste water treatment processes in accordance with the European Water Framework Directive. The interdepartmental association for sewage disposal in Paris conurbation (SIAAP) carried out a monitoring of both fish assemblages and water quality in the Seine River around the Paris conurbation (France) since the early 90's. The main goal of this study was to estimate the influence of the water quality improvement on fish. On one hand, the study confirmed the improvement of the water quality (dissolved oxygen, ammonia nitrogen, organic matter) in the Seine River, mostly focused downstream of Paris conurbation. On the other hand, an increase of the number of species occurred from 1990 (14) to 2013 (21). Moreover, changes in the river Seine assemblages happened over that 23-year period with emergence of sensitive species (ruffe, scalpin and pike-perch). The improvement of the water quality was also reported with respect to the Index of Biotic Integrity (IBI). However, no variation of pollutant concentrations in roach, eel and chub muscles has been observed. An exceedance of the environmental quality standards have even been reported all over this period as regards mercury and organochlorine.

[Evaluating comprehensive quality of sediment in Dianchi Lake using adjusted AHP method and 137Cs dating].

PubMed

Zhang, Yan; Deng, Xi-Hai; Peng, Bu-Zhuo

2006-08-01

It is difficult to evaluate comprehensive quality of sediment and to understand development trend of pollution because of absence of monitoring data, especially history data. Combining the method of 137Cs dating with the ways of general sampling and measurement can easily resolve the problem of absence of data and also provide the possibility for calculating weighted environmental quality comprehensive index using the adjusted analytical hierarchy process (AHP) method. In order to overcome the willfulness the judgment matrix is formed objectively based on calculating monitoring data. Based on the monitoring data of sediment pollution and the weights of various factors gained by adjusted AHP method the comprehensive quality of sediment in each zone of Dianchi Lake was evaluated and the results indicated that the pollution of sediments in each zone at the present be serious more than that in the history. The condition may be related to the industrial development and distribution of industries in Dianchi Lake basin. Therefore, in order to improve the comprehensive quality of sediment in Dianchi Lake and to prevent the secondary pollution of heavy metals in sediment from happening, it is necessary to control the pollutants discharge and to remove the pollutants with various ways.

Microbiological monitoring for the US Geological Survey National Water-Quality Assessment Program

USGS Publications Warehouse

Francy, Donna S.; Myers, Donna N.; Helsel, Dennis R.

2000-01-01

Data to characterize the microbiological quality of the Nation?s fresh, marine, and estuarine waters are usually collected for local purposes, most often to judge compliance with standards for protection of public health in swimmable or drinkable waters. Methods and procedures vary with the objectives and practices of the parties collecting data and are continuously being developed or modified. Therefore, it is difficult to provide a nationally consistent picture of the microbial quality of the Nation?s waters. Study objectives and guidelines for a national microbiological monitoring program are outlined in this report, using the framework of the U.S. Geological Survey (USGS) National Water-Quality Assessment (NAWQA) program. A national program is designed to provide long-term data on the presence of microbiological pathogens and indicators in ground water and surface water to support effective water policy and management. Three major groups of waterborne pathogens affect the public health acceptability of waters in the United States?bacteria, protozoa, and viruses. Microbiological monitoring in NAWQA would be designed to assess the occurrence, distribution, and trends of pathogenic organisms and indicators in surface waters and ground waters; relate the patterns discerned to factors that help explain them; and improve our understanding of the processes that control microbiological water quality.

Assessment of the Indoor Odour Impact in a Naturally Ventilated Room

PubMed Central

Eusebio, Lidia; Derudi, Marco; Capelli, Laura; Nano, Giuseppe; Sironi, Selena

2017-01-01

Indoor air quality influences people’s lives, potentially affecting their health and comfort. Nowadays, ventilation is the only technique commonly used for regulating indoor air quality. CO2 is the reference species considered in order to calculate the air exchange rates of indoor environments. Indeed, regarding air quality, the presence of pleasant or unpleasant odours can strongly influence the environmental comfort. In this paper, a case study of indoor air quality monitoring is reported. The indoor field tests were conducted measuring both CO2 concentration, using a photoacoustic multi-gas analyzer, and odour trends, using an electronic nose, in order to analyze and compare the information acquired. The indoor air monitoring campaign was run for a period of 20 working days into a university room. The work was focused on the determination of both CO2 and odour emission factors (OEF) emitted by the human activity and on the evaluation of the odour impact in a naturally ventilated room. The results highlighted that an air monitoring and recycling system based only on CO2 concentration and temperature measurements might be insufficient to ensure a good indoor air quality, whereas its performances could be improved by integrating the existing systems with an electronic nose for odour detection. PMID:28379190

FTIR Monitoring Of Curing Of Composites

NASA Technical Reports Server (NTRS)

Druy, Mark A.; Stevenson, William A.; Young, Philip R.

1990-01-01

Infrared-sensing optical fiber system developed to monitor principal infrared absorption bands resulting from vibrations of atoms and molecules as chemical bonds form when resin cured. System monitors resin chemistry more directly. Used to obtain Fourier transform infrared (FTIR) spectrum from graphite fiber/polyimide matrix resin prepreg. Embedded fiber optic FTIR sensor used to indicate state of cure of thermosetting composite material. Developed primarily to improve quality of advanced composites, many additional potential applications exist because principal of operation applicable to all organic materials and most inorganic gases. Includes monitoring integrities of composite materials in service, remote sensing of hazardous materials, and examination of processes in industrial reactors and furnaces.

Preventing falls in assisted living: Results of a quality improvement pilot study.

PubMed

Zimmerman, Sheryl; Greene, Angela; Sloane, Philip D; Mitchell, Madeline; Giuliani, Carol; Nyrop, Kirsten; Walsh, Edith

Residents of assisted living (AL) communities are at high risk for falls, which result in negative outcomes and high health care costs. Adapting effective falls prevention programs for AL quality improvement (QI) has the potential to reduce falls, improve resident quality of life, and reduce costs. This project tested the feasibility and outcomes of an evidence-based multi-component QI program, the Assisted Living Falls Prevention and Monitoring Program (AL-FPMP). Resident posture and gait improved, likely due to exercise and/or physical therapy. Effective falls prevention QI programs can be implemented in AL, and are advised to (1) establish and maintain a falls team to create a culture focused on the reduction of falls risk; (2) teach staff to assess residents using the Morse Falls Scale to increase their awareness of residents' falls risk and improvement; and (3) modify existing exercise programs to address balance and lower body strength. Copyright © 2016 Elsevier Inc. All rights reserved.

[Hygienic evaluation of the effectiveness of the concept of improvement the water supply in the south-eastern region of the Republic of Tatarstan].

PubMed

Ivanov, A V; Tafeeva, E A; Davletova, N Kh

2014-01-01

In the paper there is presented the hygienic assessment of the effectiveness of the implementation of a program aimed at improving conditions of the water supply in the oil producing regions of the Republic of Tatarstan. As a result of realization of measures it was able to improve the quality of drinking water in terms of chemical safety and to reduce the risk to public health. For the present time the following factors: water quality of the water source, the mismatch of sanitary protective zone to requirements of sanitary laws and failure to comply with security measures on its territory, deterioration of water quality during transport and imperfection of laboratory control monitoring were shown to make the highest contribution to the disadvantage of centralized drinking water systems.

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

PubMed

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

2015-01-01

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

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

PubMed Central

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

2015-01-01

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

Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises.

PubMed

Schlein, Karen; De La Cruz, Anna York; Gopalakrishnan, Tisha; Montagu, Dominic

2013-01-03

Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs. The study included three data sources and levels of investigation: 1) Self-reported program data; 2) Scoping telephone interviews; and 3) In-depth field interviews and clinic visits. Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback. These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance becomes a part of the organizational culture, and the components of a quality assurance system that are most correlated with improved quality of clinical care for patients.

Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises

PubMed Central

2013-01-01

Background Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs. Methods The study included three data sources and levels of investigation: 1) Self-reported program data; 2) Scoping telephone interviews; and 3) In-depth field interviews and clinic visits. Results Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback. Conclusions These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance becomes a part of the organizational culture, and the components of a quality assurance system that are most correlated with improved quality of clinical care for patients. PMID:23286899

Streamflow and water-quality conditions, Wilsons Creek and James River, Springfield area, Missouri

USGS Publications Warehouse

Berkas, Wayne R.

1982-01-01

A network of water-quality-monitoring stations was established upstream and downstream from the Southwest Wastewater-Treatment Plant on Wilsons Creek to monitor the effects of sewage effluent on water quality. Data indicate that 82 percent of the time the flow in Wilsons Creek upstream from the wastewater-treatment plant is less than the effluent discharged from the plant. On October 15, 1977, an advanced wastewater-treatment facility was put into operation. Of the four water-quality indicators measured at the monitoring stations (specific conductance, dissolved oxygen, pH, and water temperature), only dissolved oxygen showed improvement downstream from the plant. During urban runoff, the specific conductance momentarily increased and dissolved-oxygen concentration momentarily decreased in Wilsons Creek upstream from the plant. Urban runoff was found to have no long-term effects on specific conductance and dissolved oxygen downstream from the plant before or after the addition of the advanced wastewater-treatment facility. Data collected monthly from the James River showed that the dissolved-oxygen concentrations and the total nitrite plus nitrate nitrogen concentrations increased, whereas the dissolved-manganese concentrations decreased after the advanced wastewater-treatment facility became operational.

Key Performance Indicators in Radiology: You Can't Manage What You Can't Measure.

PubMed

Harvey, H Benjamin; Hassanzadeh, Elmira; Aran, Shima; Rosenthal, Daniel I; Thrall, James H; Abujudeh, Hani H

2016-01-01

Quality assurance (QA) is a fundamental component of every successful radiology operation. A radiology QA program must be able to efficiently and effectively monitor and respond to quality problems. However, as radiology QA has expanded into the depths of radiology operations, the task of defining and measuring quality has become more difficult. Key performance indicators (KPIs) are highly valuable data points and measurement tools that can be used to monitor and evaluate the quality of services provided by a radiology operation. As such, KPIs empower a radiology QA program to bridge normative understandings of health care quality with on-the-ground quality management. This review introduces the importance of KPIs in health care QA, a framework for structuring KPIs, a method to identify and tailor KPIs, and strategies to analyze and communicate KPI data that would drive process improvement. Adopting a KPI-driven QA program is both good for patient care and allows a radiology operation to demonstrate measurable value to other health care stakeholders. Copyright © 2015 Mosby, Inc. All rights reserved.

A continuous quality improvement approach to improving clinical practice in the areas of sedation, analgesia, and neuromuscular blockade.

PubMed

Arbour, Richard

2003-01-01

Practice concerns associated with the medical prescription and nurses' administration and monitoring of sedatives, analgesics, and neuromuscular blocking agents were identified by the clinical nurse specialist within a surgical intensive care unit of a large, tertiary-care referral center. These concerns were identified using a variety of needs assessment strategies. Results of the needs assessment were used to develop a program of care, including a teaching initiative, specific to these practice areas. The teaching initiative incorporated principles of andragogy, the theory of adult learning. Educational techniques included inservice education, bedside instruction using "teaching moments," competency-based education modules, and integration of instruction into critical care orientation. Content and approach were based on the background and level of experience of participants. Educational program outcomes included increased consistency in monitoring neuromuscular blockade by clinical assessment and peripheral nerve stimulation. A second outcome was more accurate patient assessment leading to the provision of drug therapy specific to the patients' clinical states, including anxiety or pain. The continuous quality improvement approach offers a model for improving patient care using individualized needs assessment, focused educational interventions, and program evaluation strategies.