Science.gov

Sample records for improving operator quality

  1. (abstract) Mission Operations and Control Assurance: Flight Operations Quality Improvements

    NASA Technical Reports Server (NTRS)

    Welz, Linda L.; Bruno, Kristin J.; Kazz, Sheri L.; Witkowski, Mona M.

    1993-01-01

    Mission Operations and Command Assurance (MO&CA), a recent addition to flight operations teams at JPL. provides a system level function to instill quality in mission operations. MO&CA's primary goal at JPL is to help improve the operational reliability for projects during flight. MO&CA tasks include early detection and correction of process design and procedural deficiencies within projects. Early detection and correction are essential during development of operational procedures and training of operational teams. MO&CA's effort focuses directly on reducing the probability of radiating incorrect commands to a spacecraft. Over the last seven years at JPL, MO&CA has become a valuable asset to JPL flight projects. JPL flight projects have benefited significantly from MO&CA's efforts to contain risk and prevent rather than rework errors. MO&CA's ability to provide direct transfer of knowledge allows new projects to benefit directly from previous and ongoing experience. Since MO&CA, like Total Quality Management (TQM), focuses on continuous improvement of processes and elimination of rework, we recommend that this effort be continued on NASA flight projects.

  2. Mission operations and command assurance: Flight operations quality improvements

    NASA Technical Reports Server (NTRS)

    Welz, Linda L.; Bruno, Kristin J.; Kazz, Sheri L.; Potts, Sherrill S.; Witkowski, Mona M.

    1994-01-01

    Mission Operations and Command Assurance (MO&CA) is a Total Quality Management (TQM) task on JPL projects to instill quality in flight mission operations. From a system engineering view, MO&CA facilitates communication and problem-solving among flight teams and provides continuous solving among flight teams and provides continuous process improvement to reduce risk in mission operations by addressing human factors. The MO&CA task has evolved from participating as a member of the spacecraft team, to an independent team reporting directly to flight project management and providing system level assurance. JPL flight projects have benefited significantly from MO&CA's effort to contain risk and prevent rather than rework errors. MO&CA's ability to provide direct transfer of knowledge allows new projects to benefit from previous and ongoing flight experience.

  3. Quality of inguinal hernia operative reports: room for improvement

    PubMed Central

    Ma, Grace W.; Pooni, Amandeep; Forbes, Shawn S.; Eskicioglu, Cagla; Pearsall, Emily; Brenneman, Fred D.; McLeod, Robin S.

    2013-01-01

    Background Operative reports (ORs) serve as the official documentation of surgical procedures. They are essential for optimal patient care, physician accountability and billing, and direction for clinical research and auditing. Nonstandardized narrative reports are often of poor quality and lacking in detail. We sought to audit the completeness of narrative inguinal hernia ORs. Methods A standardized checklist for inguinal hernia repair (IHR) comprising 33 variables was developed by consensus of 4 surgeons. Five high-volume IHR surgeons categorized items as essential, preferable or nonessential. We audited ORs for open IHR at 6 academic hospitals. Results We audited 213 ORs, and we excluded 7 femoral hernia ORs. Tension-free repairs were the most common (82.5%), and the plug-and-patch technique was the most frequent (52.9%). Residents dictated 59% of ORs. Of 33 variables, 15 were considered essential and, on average, 10.8 ± 1.3 were included. Poorly reported elements included first occurrence versus recurrent repair (8.3%), small bowel viability in incarcerated hernias (10.7%) and occurrence of intraoperative complications (32.5%). Of 18 nonessential elements, deep vein thrombosis prophylaxis, preoperative antibiotics and urgency were reported in 1.9%, 11.7% and 24.3% of ORs, respectively. Repair-specific details were reported in 0 to 97.1% of ORs, including patch sutured to tubercle (55.1%) and location of plug (67.0%). Conclusion Completeness of IHR ORs varied with regards to essential and nonessential items but were generally incomplete, suggesting there is opportunity for improvement, including implementation of a standardized synoptic OR. PMID:24284146

  4. Improving environmental quality in an operating room: clinical outcomes and economic implications.

    PubMed

    Sartini, M; Spagnolo, A M; Panatto, D; Perdelli, F; Cristina, M L

    2013-06-01

    An experimental study was conducted in a hospital in Liguria (northern Italy) on two groups of patients with the same disease severity who were undergoing the same type of surgery (primary hemiarthroplasty). Our aim was to assessing the results of a quality-improvement scheme implemented in the operating room. The quality-improvement protocol involved analyzing a set of parameters concerning the operating team's behavior and environmental conditions that could be attributed to the operating team itself A program of training and sanitary education was carried to rectify any improper behavior of the operating staff Two hundred and six hip-joint replacement operations (primary hip hemiarthroplasty--ICD9-CM 81.51) all conducted in the same operating room were studied: 103 patients, i.e. operations performed before the quality-improvement scheme and 103 patients, i.e. operations performed after the quality improvement scheme; all were comparable in terms of type of surgery and severity. The scheme resulted in an improvement in both behavioral and environmental parameters and an 80% reduction in the level of microbial air contamination (p < 0.001). Patient outcomes improved in terms of average postoperative hospitalization time, the occurrence and duration of fever (> 37.5 degrees C) and microbiological contamination of surgical wounds. From an economic point of view, facility efficiency increased by 28.57%, average hospitalization time decreased (p < 0.001) and a theoretical increase of Euro 1,441,373.58 a year in revenues was achieved.

  5. Improving the quality of procedure-specific operation reports in orthopaedic surgery

    PubMed Central

    Barritt, Andrew W; Clark, Laura; Cohen, Adam MM; Hosangadi-Jayedev, Naveen; Gibb, Paul A

    2010-01-01

    INTRODUCTION The objectives of this study were to: (i) assess whether handwritten operation reports for hip hemi-arthroplasties adhere to The Royal College of Surgeons of England (RCSE) guidelines on surgical documentation; (ii) improve adherence to these guidelines with procedure-specific computerised operation reports; and (iii) improve the quality of documentation in surgery. PATIENTS AND METHODS Thirty-three parameters based on RCSE guidelines were used to score hip hemi-arthroplasty operation reports. The first audit cycle was performed retrospectively to assess 50 handwritten operation reports, and the second cycle prospectively to assess 30 new computerised procedure-specific operation reports produced for hip hemi-arthroplasties. Eighty patients undergoing hip hemi-arthroplasty in a department of orthopaedic surgery within a UK hospital between September 2007 and August 2008 formed the study cohort. RESULTS The main outcome measure was the average scores attained by handwritten versus computerised operation reports. Handwritten reports scored an average of 58.7%, rising significantly (P < 0.01) to 92.8% following the introduction of detailed, computerised proformas for the operation note. Adherence to each RCSE parameter was improved. CONCLUSIONS Computerised proformas reduce variability between different operation reports for the same procedure and increase their content in line with RCSE recommendations. The proformas also constitute a more robust means of operative documentation. PMID:19995491

  6. Application of Lean Methodology for Improved Quality and Efficiency in Operating Room Instrument Availability.

    PubMed

    Farrokhi, Farrokh R; Gunther, Maria; Williams, Barbara; Blackmore, Christopher Craig

    2015-01-01

    Advances in surgical instrumentation allow surgeons to treat patients with less morbidity and shorter recovery time. However, the increasing complexity also adds to surgical risk, and to operating room supply chain burden. To improve the quality and efficiency of operating room instrument availability, we developed and validated a Lean 5S approach consisting of sort (determining instrument usage and waste), simplify (removing unnecessary instruments), sweep (confirm availability of needed instruments), standardize (all trays the same for a given procedure), and self-discipline (monitor success). The primary outcome was reduction in unnecessary instruments delivered to the operating room. As a secondary analysis, we evaluated the effect of the Lean instrument intervention on surgery times. We reduced the number of instruments for minimally invasive spine surgery by 70% (from 197 to 58), and setup time decreased 37% (13.1-8.2 min, p = .0015). We also report subsequent validation of the approach on deep brain stimulator cases. We conclude that complex surgical procedures offer opportunities for substantial waste reduction, simplification, and quality improvement, with potential institutional annual cost savings of $2.8 million. We demonstrate that Lean methodology can improve quality at lower cost.

  7. Institutionalizing pain management: the Post-Operative Pain Management Quality Improvement Project.

    PubMed

    Dahl, June L; Gordon, Deb; Ward, Sandra; Skemp, Marty; Wochos, Sarah; Schurr, Michael

    2003-09-01

    Clinical practice and quality improvement (QI) guidelines for acute postoperative pain management have been developed to address the well-documented problem of undertreatment of postoperative pain. The Post-Operative Pain Management Quality Improvement Project (the POP Project) was initiated to determine whether an intervention designed to support hospitals in the development of QI efforts would lead to improvements in structures, processes, and outcomes consistent with recommended guidelines. A nationwide sample of 233 hospitals joined the project. The intervention consisted of written resource materials accompanied by support services that included an e-mail list server, a resource Web page, and assistance from POP Project staff via telephone. Data regarding critical structures, processes (practice patterns), and patient outcomes were collected at baseline before the intervention began and at follow-up 12 to 18 months later. Results showed a statistically significant increase from baseline (45%) to follow-up (72%) in the presence of structural elements that are critical to improving pain management. There were statistically significant improvements in practices including documented use of pain rating scales, decreased use of intramuscular opioids, and increased use of nonpharmacologic strategies. Patient survey data showed no change in pain outcomes. Evaluation data showed that 70% of hospitals were very or extremely satisfied with their participation in the POP Project and 90% of them planned to continue efforts to improve pain management after the POP Project ended. Further research is needed to determine how to translate the excellent results obtained for structure and process into meaningful outcomes for patients.

  8. NASA Symposium on Productivity and Quality: Strategies for Improving Operations in Government and Industry

    NASA Technical Reports Server (NTRS)

    1984-01-01

    The purpose of the Symposium is to increase the awareness of productivity and quality issues in the United States, and to foster national initiatives through government and industry executive leadership. The Symposium will provide a forum for discussion of white-collar productivity issues by experienced executives from successful organizations and an opportunity to share information learned through Productivity initiatives in govemment, industry and academic organizations. It will focus on white-collar organizational issues that are common to large companies and technology oriented organizations. The Symposium program will include strategies for improving operations in government and industry and will be responsive to the management issues viewed necessary to increase our nation's productivity growth rate.

  9. Introducing Change (Science into the Operating Room): Quality Improvement versus Experimentation

    PubMed Central

    Poullis, Mike

    2009-01-01

    Abstract: Introducing change is sometimes vital on an individual, departmental, and institutional level to improve the quality of care of patients undergoing cardiopulmonary bypass. This review discussed the following areas: cost of poor quality, variation, knowledge, Deming’s red bead experiments and his conclusions, how do you try to improve, measurement, statistics, and quality improvement verses research. Successes and failures with regard to the introduction of change, and strategies to introduce change without creating conflict are discussed with reference to the hospital in which the author works. PMID:20092081

  10. Quality and productivity drive innovation and improvement at United Technologies Aerospace Operations, Inc.

    NASA Technical Reports Server (NTRS)

    Jamar, L. G.

    1986-01-01

    Quality and innovation are the hallmarks of the national space program. In programs that preceded the Shuttle Program the emphasis was on meeting the risks and technical challenges of space with safety, quality, reliability, and success. At United Technologies Aerospace Operations, Inc. (UTAO), the battle has developed along four primary fronts. These fronts include programs to motivate and reward people, development and construction of optimized processes and facilities, implementation of specifically tailored management systems, and the application of appropriate measurement and control systems. Each of these initiatives is described. However, to put this quality and productivity program in perspective, UTAO and its role in the Shuttle Program are described first.

  11. The Biological Stain Commission's Quality Control Laboratory operations and improved traceability of certified stains.

    PubMed

    Fagan, C L

    2012-01-01

    The Biological Stain Commission (BSC) is a quality control laboratory that certifies biological dyes for staining cells and tissues. Originally, a single lot of a certified dye was sold to histologists. Today, companies frequently change their lot numbers as part of regulatory efforts. When a certified dye undergoes a lot number change, the BSC must re-certify this dye to verify that it is identical to the one certified earlier. The BSC has improved how these lot changes are monitored using a redesigned BSC certification label. Certification labels always have been issued by the BSC and are attached to every bottle of "BSC certified dye" that is sold. The new BSC certification label has added security features and currently bears both the BSC certification number and the manufacturer batch lot number. The result is improved security and traceability of certified dyes.

  12. FOCUS: the Society of Cardiovascular Anesthesiologists' initiative to improve quality and safety in the cardiovascular operating room.

    PubMed

    Barbeito, Atilio; Lau, William Travis; Weitzel, Nathaen; Abernathy, James H; Wahr, Joyce; Mark, Jonathan B

    2014-10-01

    The Society of Cardiovascular Anesthesiologists (SCA) introduced the FOCUS initiative (Flawless Operative Cardiovascular Unified Systems) in 2005 in response to the need for a rigorous scientific approach to improve quality and safety in the cardiovascular operating room (CVOR). The goal of the project, which is supported by the SCA Foundation, is to identify hazards and develop evidence-based protocols to improve cardiac surgery safety. A hazard is anything that has the potential to cause a preventable adverse event. Specifically, the strategic plan of FOCUS includes 3 goals: (1) identifying hazards in the CVOR, (2) prioritizing hazards and developing risk-reduction interventions, and (3) disseminating these interventions. Collectively, the FOCUS initiative, through the work of several groups composed of members from different disciplines such as clinical medicine, human factors engineering, industrial psychology, and organizational sociology, has identified and documented significant hazards occurring daily in our CVORs. Some examples of frequent occurrences that contribute to reduce the safety and quality of care provided to cardiac surgery patients include deficiencies in teamwork, poor OR design, incompatible technologies, and failure to adhere to best practices. Several projects are currently under way that are aimed at better understanding these hazards and developing interventions to mitigate them. The SCA, through the FOCUS initiative, has begun this journey of science-driven improvement in quality and safety. There is a long and arduous road ahead, but one we need to continue to travel.

  13. Reducing the carbon footprint of the operating theatre: a multicentre quality improvement report.

    PubMed

    Southorn, T; Norrish, A R; Gardner, K; Baxandall, R

    2013-06-01

    Currently, there are very few provisions for recycling in theatres. We measured the weight of clinical waste for several orthopaedic operations. This waste was then examined and sorted into domestic waste and clinical waste. With staff education it is possible to reduce the amount of clinical waste generated by the operating theatre by roughly 50%. A greater awareness of disposal options leads to a reduction in waste disposed of by incineration.

  14. Teaching quality improvement.

    PubMed

    Murray, Marry Ellen; Douglas, Stephen; Girdley, Diana; Jarzemsky, Paula

    2010-08-01

    Practicing nurses are required to engage in quality improvement work as a part of their clinical practice, but few undergraduate nursing education programs offer course work and applied experience in this area. This article presents a description of class content and teaching strategies, assignments, and evaluation strategies designed to achieve the Quality and Safety Education in Nursing competencies related to quality improvement and interdisciplinary teams. Students demonstrate their application of the quality improvement process by designing and implementing a small-scale quality improvement project that they report in storyboard format on a virtual conference Web site.

  15. A Case Study of Factors Affecting Continuous Improvement in DoD activities Operating Under Total Quality Management

    DTIC Science & Technology

    1993-09-01

    basis of price tag. 5 . Improve constantly and forever the system of production and service, to improve quality and productivity, and thus decrease...that exists. Continuous improvement is a call to management to make quality the basis for doing business. Juran believes in a systematic approach to...review were the writings of: Deming; Juran; Crosby; Ishikawa; Feigenbaum ; Garvin ; Mondon; Leonard and Sasser; Adam, Herschauer and Ruch; and eleven

  16. Improving Indoor Air Quality

    EPA Pesticide Factsheets

    Usually the most effective way to improve indoor air quality is to eliminate individual sources of pollution or to reduce their emissions. Some sources, like those that contain asbestos, can be sealed or enclosed.

  17. Quality Function Deployment in Launch Operations

    DTIC Science & Technology

    1990-11-23

    tool in translating these requirements throughout the whole process of design, development, manufacture, and operations. This report explores the...Command operational requirements. 4 2. QUALITY FUNCTION DEPLOYMENT OVERVIEW Quality Function Deployment (QFD) is a planning tool to improve the process...Finish Process Control Production Control Insulation Welding Forming Machining Trimming Composites Fabrication Environmental Control 0 33 In order to

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

    PubMed

    Ni, Ji-Qin

    2015-05-01

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

  19. Quality and performance improvement in respiratory care.

    PubMed

    Malinowski, Thomas P

    2004-06-01

    An essential responsibility of the modern respiratory care manager is to establish and monitor a particular level of quality and service being provided by a department. Focusing on quality and performance improvement fosters an environment that empowers and encourages all employees to be innovative and resolve roadblocks that limit organizational performance. This article discusses the issues regarding quality and performance improvement that arise in the daily operations of a respiratory care department.

  20. White-collar productivity and quality issues; Proceedings of the Symposium on Productivity and Quality: Strategies for Improving Operations in Government and Industry, Washington, DC, September 25, 26, 1984

    NASA Technical Reports Server (NTRS)

    Gerard, M. (Editor); Edwards, P. W. (Editor)

    1985-01-01

    Techniques for improving the productivity of white-collar workers while maintaining high product quality are examined in reviews and reports. The emphasis is on the application of strategies developed in the private sector to government-agency and aerospace-industry operations. Topics discussed include international competition, organizational attitudes and orientation, management practices, education and training, renewing large organizations, encouraging innovation, national initiatives, employee involvement, management involvement, and applications of new technology.

  1. Improvement of operational activities efficiency

    NASA Astrophysics Data System (ADS)

    Sitruk, Fabien

    This paper presents the methods used by the Toulouse Space Center (CNES) to minimize the risk of deterioration in service during flight mission operations. It also presents planned improvements following recent analyses.

  2. Improving productivity, efficiency, product quality and environmental sustainability of aquaculture operations through systemic integration of information and knowledge

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Experts on selective breeding, physiology, genomics and bioinformatics will present and discuss state of the art information and relevant examples from fish and other animal systems. Identify strategies that will foster continuous improvements in experimental design and data gathering, analysis, be...

  3. Data quality improvements for FAA

    SciTech Connect

    Perry, R.; Marlman, K.; Olson, D.; Werner, P.

    1997-09-01

    Effective communication among air safety professionals is only as good as the information being communicated. Data sharing cannot be effective unless the data are relevant to aviation safety problems, and decisions based on faulty data are likely to be invalid. The validity of aviation safety data depends on satisfying two primary characteristics. Data must accurately represent or conform to the real world (conformance), and it must be relevant or useful to addressing the problems at hand (utility). The FAA, in efforts to implement the Safety Performance Analysis System (SPAS), identified significant problems in the quality of the data which SPAS and FAA air safety professionals would use in defining the state of aviation safety in the US. These finding were reinforced by Department of Transportation Inspector General and General Accounting Office investigations into FAA surveillance of air transport operations. Many recent efforts to improve data quality have been centered on technological solutions to the problems. They concentrate on reducing errors in the data (conformance), but they cannot adequately address the relationship of data to need (utility). Sandia National Laboratories, working with the FAA`s Airport and Aircraft Safety Research and Development Division and the Flight Standards Service, has been involved in four programs to assist FAA in addressing their data quality problems. The Sandia approach has been data-driven rather than technology-driven. In other words, the focus has been on first establishing the data requirements by analyzing the FAA`s surveillance and decision-making processes. This process analysis looked at both the data requirements and the methods used to gather the data in order to address both the conformance and utility problems inherent in existing FAA data systems. This paper discusses Sandia`s data quality programs and their potential improvements to the safety analysis processes and surveillance programs of the FAA.

  4. Environmental control: operating room air quality.

    PubMed

    Bartley, J M

    1993-01-01

    1. OR staff members should familiarize themselves with basic air handling system terminology to better manage their own environment (eg, HVAC, air changes, air balancing, HEPA filtration). A working relationship with building engineers is an important skill for the OR nurse. 2. Knowledge of the standards on which air quality in the OR is based should assist in the process of planning for improved design--as well as in monitoring existing air quality. 3. Current standards balance energy savings with air changes and high levels of filtration to achieve optimum outcomes. Recommendations from design and engineering authorities (even for implant surgery) are based on average air changes and HEPA filtration, not laminar air flow. 4. The daily, operational role of the OR staff in maintaining high air quality includes managing traffic, using low-lint barrier materials, monitoring air quality indicators, and investigating unusual variances with the engineering staff for appropriate follow-up (eg, filter changes).

  5. Improving Army Operational Contract Support

    DTIC Science & Technology

    2013-04-01

    8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) Dr. Richard M. Meinhart U.S. Army War...Austin Project Adviser Dr. Richard M. Meinhart U.S. Army War College Faculty Mentor This manuscript is submitted in partial...Improving Army Operational Contract Support by Colonel Daryl P. Harger United States Army United

  6. Mission operations and command assurance: Instilling quality into flight operations

    NASA Technical Reports Server (NTRS)

    Welz, Linda L.; Witkowski, Mona M.; Bruno, Kristin J.; Potts, Sherrill S.

    1993-01-01

    Mission Operations and Command Assurance (MO&CA) is a Total Quality Management (TQM) task on JPL projects to instill quality in flight mission operations. From a system engineering view, MO&CA facilitates communication and problem-solving among flight teams and provides continuous process improvement to reduce the probability of radiating incorrect commands to a spacecraft. The MO&CA task has evolved from participating as a member of the spacecraft team to an independent team reporting directly to flight project management and providing system level assurance. JPL flight projects have benefited significantly from MO&CA's effort to contain risk and prevent rather than rework errors. MO&CA's ability to provide direct transfer of knowledge allows new projects to benefit from previous and ongoing flight experience.

  7. Shared Decision Making in Neonatal Quality Improvement.

    PubMed

    Warren, Jamie B; Wiggins, Nikki

    2016-01-01

    Since the Institute of Medicine published Crossing the Quality Chasm in 2001, healthcare systems have become more focused on improving the quality of healthcare delivery. At Oregon Health & Science University and Doernbecher Children's Hospital, we recognize the need to take an interprofessional, team-based approach to improving the care we provide to our current and future patients. We describe here an ongoing quality improvement project in the Doernbecher Neonatal Intensive Care Unit (NICU), with specific attention to the factors we believe have contributed to the implementation and early success of the project. These factors include the history of quality improvement work in our NICU and in the field of neonatology, the "dyad leadership" structure under which we operate in our NICU, and our developing understanding of the concept of "team intelligence." These elements have led to the formation of a team that can practice shared decision making and work as one to realize a shared goal.

  8. Improving a Dental School's Clinic Operations Using Lean Process Improvement.

    PubMed

    Robinson, Fonda G; Cunningham, Larry L; Turner, Sharon P; Lindroth, John; Ray, Deborah; Khan, Talib; Yates, Audrey

    2016-10-01

    The term "lean production," also known as "Lean," describes a process of operations management pioneered at the Toyota Motor Company that contributed significantly to the success of the company. Although developed by Toyota, the Lean process has been implemented at many other organizations, including those in health care, and should be considered by dental schools in evaluating their clinical operations. Lean combines engineering principles with operations management and improvement tools to optimize business and operating processes. One of the core concepts is relentless elimination of waste (non-value-added components of a process). Another key concept is utilization of individuals closest to the actual work to analyze and improve the process. When the medical center of the University of Kentucky adopted the Lean process for improving clinical operations, members of the College of Dentistry trained in the process applied the techniques to improve inefficient operations at the Walk-In Dental Clinic. The purpose of this project was to reduce patients' average in-the-door-to-out-the-door time from over four hours to three hours within 90 days. Achievement of this goal was realized by streamlining patient flow and strategically relocating key phases of the process. This initiative resulted in patient benefits such as shortening average in-the-door-to-out-the-door time by over an hour, improving satisfaction by 21%, and reducing negative comments by 24%, as well as providing opportunity to implement the electronic health record, improving teamwork, and enhancing educational experiences for students. These benefits were achieved while maintaining high-quality patient care with zero adverse outcomes during and two years following the process improvement project.

  9. Safety and efficacy of botox injection in alleviating post-operative pain and improving quality of life in lower extremity limb lengthening and deformity correction

    PubMed Central

    Hamdy, Reggie C; Montpetit, Kathleen; Ruck-Gibis, Joanne; Thorstad, Kelly; Raney, Ellen; Aiona, Michael; Platt, Robert; Finley, Allen; Mackenzie, William; McCarthy, James; Narayanan, Unni

    2007-01-01

    Background Distraction osteogenesis is the standard treatment for the management of lower limb length discrepancy of more than 3 cm and bone loss secondary to congenital anomalies, trauma or infection. This technique consists of an osteotomy of the bone to be lengthened, application of an external fixator, followed by gradual and controlled distraction of the bone ends. Although limb lengthening using the Ilizarov distraction osteogenesis principle yields excellent results in most cases, the technique has numerous problems and is not well tolerated by many children. The objective of the current study is to determine if Botulinum Toxin A (BTX-A), which is known to possess both analgesic and paralytic actions, can be used to alleviate post-operative pain and improve the functional outcome of children undergoing distraction osteogenesis. Methods/Design The study design consists of a multi centre, randomized, double-blinded, placebo-controlled trial. Patients between ages 5–21 years requiring limb lengthening or deformity correction using distraction will be recruited from 6 different sites (Shriners Hospital for Children in Montreal, Honolulu, Philadelphia and Portland as well as DuPont Hospital for Children in Wilmington, Delaware and Hospital for Sick Children in Toronto, Ont). Approximately 150 subjects will be recruited over 2 years and will be randomized to either receive 10 units per Kg of BTX-A or normal saline (control group) intraoperatively following the surgery. Functional outcome effects will be assessed using pain scores, medication dosages, range of motion, flexibility, strength, mobility function and quality of life of the patient. IRB approval was obtained from all sites and adverse reactions will be monitored vigorously and reported to IRB, FDA and Health Canada. Discussion BTX-A injection has been widely used world wide with no major side effects reported. However, to the best of our knowledge, this is the first time BTX-A is being used under the

  10. Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care

    PubMed Central

    Olofsson, Pia; Fredrikson, Mats; Sjoberg, Folke

    2017-01-01

    Total duration of stay adjusted for percentage of the total body surface area burned (TBSA%) is a commonly used outcome measure in burn care. However, it has been criticised as it is affected by many factors, some of which are not strictly part of burn care. A division into operative stay and postoperative stay may improve this measure. The aim was to evaluate if operative stay can serve as a more standardised measure by: comparing the variation in operative stay/TBSA% with the variation in total stay/TBSA%, and to study different factors associated with operative stay and postoperative stay. Patients and methods Surgically managed burn patients admitted between 2010–14 were included. Operative stay was defined as the time from admission until the last operation, postoperative stay as the time from the last operation until discharge. The difference in variation was analysed with F-test. A retrospective review of medical records was done to explore reasons for extended postoperative stay. Multivariable regression was used to assess factors associated with operative stay and postoperative stay. Results Operative stay/TBSA% showed less variation than total duration/TBSA% (F test = 2.38, p<0.01). The size of the burn, and the number of operations, were the independent factors that influenced operative stay (R2 0.65). Except for the size of the burn other factors were associated with duration of postoperative stay: wound related, psychological and other medical causes, advanced medical support, and accommodation arrangements before discharge, of which the two last were the most important with an increase of (mean) 12 and 17 days (p<0.001, R2 0.51). Conclusion Adjusted operative stay showed less variation than total hospital stay and thus can be considered a more accurate outcome measure for surgically managed burns. The size of burn and number of operations are the factors affecting this outcome measure. PMID:28362844

  11. [Multidimensional Qualities to Improve Education.

    ERIC Educational Resources Information Center

    United Nations Educational, Scientific, and Cultural Organization, Santiago (Chile). Regional Office for Education in Latin America and the Caribbean.

    This bulletin contains five essays on the theme of expanding the challenge of improving the quality of education to encompass the curricular, administrative, institutional, and teaching levels. The articles include: (1) "Educational Assessment Systems in Latin America: A Review of Issues and Recent Experience" (Robin Horn; Laurence Wolf;…

  12. Quality improvement tools and processes.

    PubMed

    Lau, Catherine Y

    2015-04-01

    The Model for Improvement and the Plan-Do-Study-Act cycle is a popular quality improvement (QI) tool for health care providers to successfully lead QI projects and redesign care processes. This tool has several distinct components that must be addressed in sequence to organize and critically evaluate improvement activities. Unlike other health sciences clinical research, QI projects and research are based on dynamic hypotheses that develop into observable, serial tests of change with continuous collection and feedback of performance data to stakeholders.

  13. The Science of Quality Improvement.

    PubMed

    Itri, Jason N; Bakow, Eric; Probyn, Linda; Kadom, Nadja; Duong, Phuong-Anh T; Gettle, Lori Mankowski; Mendiratta-Lala, Mishal; Scali, Elena P; Winokur, Ronald S; Zygmont, Matthew E; Kung, Justin W; Rosenkrantz, Andrew B

    2017-03-01

    Scientific rigor should be consistently applied to quality improvement (QI) research to ensure that healthcare interventions improve quality and patient safety before widespread implementation. This article provides an overview of the various study designs that can be used for QI research depending on the stage of investigation, scope of the QI intervention, constraints on the researchers and intervention being studied, and evidence needed to support widespread implementation. The most commonly used designs in QI studies are quasi-experimental designs. Randomized controlled trials and cluster randomized trials are typically reserved for large-scale research projects evaluating the effectiveness of QI interventions that may be implemented broadly, have more than a minimal impact on patients, or are costly. Systematic reviews of QI studies will play an important role in providing overviews of evidence supporting particular QI interventions or methods of achieving change. We also review the general requirements for developing quality measures for reimbursement, public reporting, and pay-for-performance initiatives. A critical part of the testing process for quality measures includes assessment of feasibility, reliability, validity, and unintended consequences. Finally, publication and critical appraisal of QI work is discussed as an essential component to generating evidence supporting QI initiatives in radiology.

  14. Thermoelectric Integrated Membrane Evaporation Subsystem operational improvements

    NASA Technical Reports Server (NTRS)

    Dehner, G. F.; Winkler, H. E.; Reysa, R. P.

    1984-01-01

    A three-man preprototype Thermoelectric Integrated Membrane Evaporation Subsystem (TIMES) has been developed to provide high quality water recovery from waste fluids on extended duration space flights. In the most recent effort, a number of improvements have been made to simplify subsystem operation and increase performance. These modifications include changes to the hollow fiber membrane evaporator, the condensing section of the thermoelectric heat pump, and the electronic controller logic and display. This paper describes the results of the test program that was conducted to evaluate the implemented improvements. In addition, an advanced design concept is discussed that will provide lower electrical power consumption, greater water production capacity, lower weight, and a smaller package than the present subsystem configuration.

  15. Improved process control alarm operation.

    PubMed

    Bristol, E H

    2001-01-01

    Alarms are the main connection from the automation to the operator, when addressing process operation outside of its normal function. They are often as much a source of operator overload and consternation as help. Better engineering of the relative role of the operator and automation would materially help overcome the difficulties. Expert systems have been proposed as a solution. But Expert systems are really another form of automation. There remains that aspect of the alarms, which must address our inability to cover and understand a possibly larger domain of the operation not appropriate to traditional controls or present-day automation. Appropriate tools for this domain must support operator discretion and initiative. The paper suggests a set of such general, computer science based, tools requiring only the most basic configuration. They are viewed as implemented on top of those properly detailed alarm displays and interlocks, which reflect the more formal plant operating policies. They include: (a) Various forms of alarm logging and trending; (b) Short, automatically generated, word summaries of alarm activity, which allow low level data to propagate to the highest levels, including: one word and priority summaries; (c) Causal alarm pattern analyses that help the operator to predict or diagnose alarm behavior; (d) Automatic adaptation of alarms and alarm limits to varying process situations; (e) Uniform use of alarm policies to simplify alarm configuration.

  16. Analyses to improve operational flexibility

    SciTech Connect

    Trikouros, N.G.

    1986-01-01

    Operational flexibility is greatly enhanced if the technical bases for plant limits and design margins are fully understood, and the analyses necessary to evaluate the effect of plant modifications or changes in operating modes on these parameters can be performed as required. If a condition should arise that might jeopardize a plant limit or reduce operational flexibility, it would be necessary to understand the basis for the limit or the specific condition limiting operational flexibility and be capable of performing a reanalysis to either demonstrate that the limit will not be violated or to change the limit. This paper provides examples of GPU Nuclear efforts in this regard. Examples of Oyster Creek and Three Mile Island operating experiences are discussed.

  17. Factors associated with sleep quality among operating engineers.

    PubMed

    Choi, Seung Hee; Terrell, Jeffrey E; Pohl, Joanne M; Redman, Richard W; Duffy, Sonia A

    2013-06-01

    Blue collar workers generally report high job stress and are exposed to loud noises at work and engage in many of risky health behavioral factors, all of which have been associated with poor sleep quality. However, sleep quality of blue collar workers has not been studied extensively, and no studies have focused Operating Engineers (heavy equipment operators) among whom daytime fatigue would place them at high risk for accidents. Therefore, the purpose of this study was to determine variables associated with sleep quality among Operating Engineers. This was a cross-sectional survey design with a dependent variable of sleep quality and independent variables of personal and related health behavioral factors. A convenience sample of 498 Operating Engineers was recruited from approximately 16,000 Operating Engineers from entire State of Michigan in 2008. Linear regression was used to determine personal and related health behavior factors associated with sleep quality. Multivariate analyses showed that personal factors related to poor sleep quality were younger age, female sex, higher pain, more medical comorbidities and depressive symptoms and behavioral factors related to poor sleep quality were nicotine dependence. While sleep scores were similar to population norms, approximately 34 % (n = 143) showed interest in health services for sleep problems. While many personal factors are not changeable, interventions to improve sleep hygiene as well as interventions to treat pain, depression and smoking may improve sleep quality resulting in less absenteeism, fatal work accidents, use of sick leave, work disability, medical comorbidities, as well as subsequent mortality.

  18. Quality improvement and quality management: Complementary or contradictory

    SciTech Connect

    Calhoun, M.B. )

    1993-09-01

    Quality improvement processes (QIP's) and quality management systems (QMS's) are becoming part of manufacturing and service company language. In some cases, there are perceived differences between the concepts of continuous improvement and documented systems to ensure quality. The author has seen examples of QIP's and QMS's working in a complementary fashion to improve existing manufacturing and administrative processes. These examples show that quality improvement activities are compatible with and can enhance the effectiveness of QMS's if the two are integrated properly.

  19. The process of managerial control in quality improvement initiatives.

    PubMed

    Slovensky, D J; Fottler, M D

    1994-11-01

    The fundamental intent of strategic management is to position an organization with in its market to exploit organizational competencies and strengths to gain competitive advantage. Competitive advantage may be achieved through such strategies as low cost, high quality, or unique services or products. For health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations, continually improving both processes and outcomes of organizational performance--quality improvement--in all operational areas of the organization is a mandated strategy. Defining and measuring quality and controlling the quality improvement strategy remain problematic. The article discusses the nature and processes of managerial control, some potential measures of quality, and related information needs.

  20. Handling Qualities Implications for Crewed Spacecraft Operations

    NASA Technical Reports Server (NTRS)

    Bailey, Randall E.; Jackson, E. Bruce; Arthur, J. J.

    2012-01-01

    Abstract Handling qualities embody those qualities or characteristics of an aircraft that govern the ease and precision with which a pilot is able to perform the tasks required in support of an aircraft role. These same qualities are as critical, if not more so, in the operation of spacecraft. A research, development, test, and evaluation process was put into effect to identify, understand, and interpret the engineering and human factors principles which govern the pilot-vehicle dynamic system as they pertain to space exploration missions and tasks. Toward this objective, piloted simulations were conducted at the NASA Langley Research Center and Ames Research Center for earth-orbit proximity operations and docking and lunar landing. These works provide broad guidelines for the design of spacecraft to exhibit excellent handling characteristics. In particular, this work demonstrates how handling qualities include much more than just stability and control characteristics of a spacecraft or aircraft. Handling qualities are affected by all aspects of the pilot-vehicle dynamic system, including the motion, visual and aural cues of the vehicle response as the pilot performs the required operation or task. A holistic approach to spacecraft design, including the use of manual control, automatic control, and pilot intervention/supervision is described. The handling qualities implications of design decisions are demonstrated using these pilot-in-the-loop evaluations of docking operations and lunar landings.

  1. Improving data quality in neuronal population recordings

    PubMed Central

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

    2017-01-01

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

  2. Quality improvement practices: enhancing quality of life during mealtimes.

    PubMed

    Evans, B C; Crogan, N L

    2001-01-01

    This article describes ten dining room problems, identified in a nursing home study, that needed quality improvement, as well as six quality practices suggested for implementation. These six quality practices provide the basis for an excellent eating experience characterized by a home-like atmosphere, high levels of staff-resident interaction, and increased attention to safety and ethical issues. The six practices also could serve as the foundation for a facility-wide, cost-effective, quality improvement program.

  3. Better Cleaning with Continuous Quality Improvement.

    ERIC Educational Resources Information Center

    Griffin, William R.

    1999-01-01

    Examines ways of improving school cleaning costs and quality by adhering to 15 specific principles. Principles discussed include the use of employee training, accountability, quality equipment and supplies, assignment scheduling, written self audits, computerized management, and industry involvement. (GR)

  4. SF Bay Water Quality Improvement Fund

    EPA Pesticide Factsheets

    EPAs grant program to protect and restore San Francisco Bay. The San Francisco Bay Water Quality Improvement Fund (SFBWQIF) has invested in 58 projects along with 70 partners contributing to restore wetlands, water quality, and reduce polluted runoff.,

  5. Surface Operations Systems Improve Airport Efficiency

    NASA Technical Reports Server (NTRS)

    2009-01-01

    With Small Business Innovation Research (SBIR) contracts from Ames Research Center, Mosaic ATM of Leesburg, Virginia created software to analyze surface operations at airports. Surface surveillance systems, which report locations every second for thousands of air and ground vehicles, generate massive amounts of data, making gathering and analyzing this information difficult. Mosaic?s Surface Operations Data Analysis and Adaptation (SODAA) tool is an off-line support tool that can analyze how well the airport surface operation is working and can help redesign procedures to improve operations. SODAA helps researchers pinpoint trends and correlations in vast amounts of recorded airport operations data.

  6. Improving Health and Quality of Life

    MedlinePlus

    ... Supplements Managing Activities and Exercise Improving Health and Quality of Life Pediatric Definition and Diagnosis Management and Treatment Factsheets Healthcare Professionals Parents Education Professionals ...

  7. Economic and quality scheduling for effective utilization of operating rooms.

    PubMed

    Jeang, Angus; Chiang, An-Jen

    2012-06-01

    Under the constraints of limited medical resources and severe competition among hospitals, administrators have begun to pay attention to the opportunities of cost reduction and quality improvement in hospital management, in order to find methods to increase hospital revenue and improve service quality. The operating room should be one of the most important sources of hospital income, yet it is both costly to run and constrictive to inpatient flow. Successful hospital management necessitates the construction of cost-effective and quality operating room scheduling. This paper attempts to model the scheduling problem in the form of mathematical programming with the objective being to minimize the deviation between the total operation time and the total available time in operating rooms. Urgent revisions to the model in consideration of such factors as doctor's availability, outpatient consulting hours and unfavorable surgery hours can be achieved in a timely manner. With the present approach, surgical procedures can start punctually, inpatient waiting time for surgery and length of stay can be reduced, and staff morale can be enhanced. These improvements will result in cost reduction, and increased hospital revenue without sacrificing the quality of medical care.

  8. Water quality improvement plan for Greater Vancouver

    SciTech Connect

    Foellmi, S.N. . Environmental Div.); Neden, D.G. ); Dawson, R.N. )

    1993-10-01

    The Greater Vancouver Regional District commissioned an 18-month planning and predesign study to define the components in a comprehensive water and predesign study to define the components in a comprehensive water quality improvement plan for its 2,500-ML/d (660-mgd) system. The study included three primary tasks: (1) predesign of disinfection and corrosion control facilities, (2) a 12-month pilot testing program using parallel pilot plants at the Seymour and Capilano water supply reservoirs, and (3) planning for future filtration plants. The results of the study identified chlorine, ammonia, sulfur dioxide, soda ash, and carbon dioxide in a two-stage treatment approach as the recommended disinfection and corrosion control scheme for the low-pH, low-alkalinity water supplies. The pilot-plant studies confirmed that direct filtration using deep-bed monomedium filters operating at a loading rate of 22.5 m/h provided excellent treatment performance and productivity over a wide range of raw-water quality. Ozonation was studied extensively and found not to be beneficial in the overall treatment performance. The phased improvement plan for the disinfection, corrosion control, and filtration facilities has an estimated capital cost of about Can$459 million.

  9. Rethinking Quality and Improvement in Higher Education

    ERIC Educational Resources Information Center

    Houston, Don

    2008-01-01

    Purpose: The purpose of this paper is to critically review dominant conceptions of and approaches to quality in higher education. It suggests an alternative approach with potential to shift the focus of quality activities from accountability and control to improvement. Design/methodology/approach: The applicability and limits of quality concepts…

  10. Improve Quality: Use Tool Kits.

    ERIC Educational Resources Information Center

    Gartner, Sue

    2001-01-01

    Addresses issues of defining quality in both business and community service. Describes the use of a regulatory tool kit containing rules and regulations a child care center must follow to ensure children's health, safety, and well-being. Specific tool kit types described include regulatory, government funded, rating scale, and NAEYC. (SD)

  11. Essentialism: Common Sense Quality Improvement.

    ERIC Educational Resources Information Center

    Wallin, Desna L.; Ryan, John R.

    Essentialism is a trimmed down, action-oriented, user-friendly approach to Total Quality Management (TQM) in education. This book explores the concept of essentialism to describe strategies for implementing TQM in community colleges. Chapter 1 examines the history of the TQM movement and reviews experiences of community college practitioners…

  12. Quality Improvement of Liver Ultrasound Images Using Fuzzy Techniques

    PubMed Central

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

    2016-01-01

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

  13. Narrative methods in quality improvement research

    PubMed Central

    Greenhalgh, T; Russell, J; Swinglehurst, D

    2005-01-01

    

 This paper reviews and critiques the different approaches to the use of narrative in quality improvement research. The defining characteristics of narrative are chronology (unfolding over time); emplotment (the literary juxtaposing of actions and events in an implicitly causal sequence); trouble (that is, harm or the risk of harm); and embeddedness (the personal story nests within a particular social, historical and organisational context). Stories are about purposeful action unfolding in the face of trouble and, as such, have much to offer quality improvement researchers. But the quality improvement report (a story about efforts to implement change), which is common, must be distinguished carefully from narrative based quality improvement research (focused systematic enquiry that uses narrative methods to generate new knowledge), which is currently none. We distinguish four approaches to the use of narrative in quality improvement research—narrative interview; naturalistic story gathering; organisational case study; and collective sense-making—and offer a rationale, describe how data can be collected and analysed, and discuss the strengths and limitations of each using examples from the quality improvement literature. Narrative research raises epistemological questions about the nature of narrative truth (characterised by sense-making and emotional impact rather than scientific objectivity), which has implications for how rigour should be defined (and how it might be achieved) in this type of research. We offer some provisional guidance for distinguishing high quality narrative research in a quality improvement setting from other forms of narrative account such as report, anecdote, and journalism. PMID:16326792

  14. A Count for Quality: Child Care Center Directors on Rating and Improvement Systems

    ERIC Educational Resources Information Center

    Schulman, Karen; Matthews, Hannah; Blank, Helen; Ewen, Danielle

    2012-01-01

    Quality Rating and Improvement Systems (QRIS)--a strategy to improve families' access to high-quality child care--assess the quality of child care programs, offer incentives and assistance to programs to improve their ratings, and give information to parents about the quality of child care. These systems are operating in a growing number of…

  15. The role of regulation in quality improvement.

    PubMed

    Brennan, T A

    1998-01-01

    Many new methods for measuring the quality of health care have been devised since 1970. For the past ten years, the health care field has been struggling to integrate industrial models into its quality improvement systems. In order to judge whether regulation has evolved in tandem with these developments, three critical questions are examined: Is regulation improving the quality of health care? Are regulators integrating the tools of quality research into their oversight activities? Is there a way to combine continuous quality improvement (CQI) and modern methods of quality measurement into a new regulatory format? An exploration of these questions produces relatively little evidence that regulation has moved in the recommended direction, although there are some encouraging signs that regulators are becoming more responsive to the issues.

  16. Stone volume is best predictor of operative time required in retrograde intrarenal surgery for renal calculi: implications for surgical planning and quality improvement.

    PubMed

    Sorokin, Igor; Cardona-Grau, Diana K; Rehfuss, Alexandra; Birney, Alan; Stavrakis, Costas; Leinwand, Gabriel; Herr, Allen; Feustel, Paul J; White, Mark D

    2016-11-01

    Retrograde intrarenal surgery (RIRS) is highly successful at eliminating renal stones of various sizes and compositions. As urologists are taking on more complex procedures using RIRS, this has led to an increase in operative (OR) times. Our objective was to determine the best predictor of OR time in patients undergoing RIRS. We retrospectively reviewed the records of patients undergoing unilateral RIRS for solitary stones over a 10 year time span. Stones were fragmented and actively extracted using a basket. Variables potentially affecting OR time such as patient age, sex, BMI, lower pole stone location, volume, Hounsfield units (HU), composition, ureteral access sheath (UAS) use, and pre-operative stenting were collected. Multivariable linear and stepwise regression was used to evaluate the predictors of OR time. There were 118 patients that met inclusion criteria. The median stone volume was 282.6 mm(3) (IQR 150.7-644.7) and the mean OR time was 50 min (±25.9 SD). On univariate linear regression, stone volume had a moderate correlation with OR time (y = 0.022x + 38.2, r (2) = 0.363, p < 0.01). On multivariable stepwise regression, stone volume had the strongest impact on OR time, increasing time by 2.0 min for each 100 mm(3) increase in stone volume (p < 0.001). UAS added 13.5 (SE 3.9, p = 0.001) minutes and renal lower pole location added 9 min (SE 4.3, p = 0.03) in each case they were used. Pre-operative stenting, HU, calcium oxalate stone composition, sex, and age had no significant effect on OR time. Amongst the main stone factors in RIRS, stone volume has the strongest impact on operative time. This can be used to predict the length of the procedure by roughly adding 2 min per 100 mm(3) increase in stone volume.

  17. Human Performance Improvement: Lessons To Be Learned from Quality Improvement.

    ERIC Educational Resources Information Center

    Hummel, Paul A.

    2003-01-01

    Discusses quality improvement (QI) and how it can help human performance improvement (HPI). Compares QI and HPI and discusses focusing on products and services; focusing on the customer; using data more effectively; continuous improvement; benchmarking; establishing standards; specialization; and involving the clients. (LRW)

  18. Improving Service Management in Campus IT Operations

    ERIC Educational Resources Information Center

    Wan, Stewart H. C.; Chan, Yuk-Hee

    2008-01-01

    Purpose: This paper aims at presenting the benefits from implementing IT service management (ITSM) in an organization for managing campus-wide IT operations. In order to improve the fault correlation from business perspectives, we proposed a framework to automate network and system alerts with respect to its business service impact for proactive…

  19. Do English NHS Microbiology laboratories offer adequate services for the diagnosis of UTI in children? Healthcare Quality Improvement Partnership (HQIP) Audit of Standard Operational Procedures.

    PubMed

    McNulty, Cliodna A M; Verlander, Neville Q; Moore, Philippa C L; Larcombe, James; Dudley, Jan; Banerjee, Jaydip; Jadresic, Lyda

    2015-09-01

    The National Institute of Care Excellence (NICE) 2007 guidance CG54, on urinary tract infection (UTI) in children, states that clinicians should use urgent microscopy and culture as the preferred method for diagnosing UTI in the hospital setting for severe illness in children under 3 years old and from the GP setting in children under 3 years old with intermediate risk of severe illness. NICE also recommends that all 'infants and children with atypical UTI (including non-Escherichia coli infections) should have renal imaging after a first infection'. We surveyed all microbiology laboratories in England with Clinical Pathology Accreditation to determine standard operating procedures (SOPs) for urgent microscopy, culture and reporting of children's urine and to ascertain whether the SOPs facilitate compliance with NICE guidance. We undertook a computer search in six microbiology laboratories in south-west England to determine urine submissions and urine reports in children under 3 years. Seventy-three per cent of laboratories (110/150) participated. Enterobacteriaceae that were not E. coli were reported only as coliforms (rather than non-E. coli coliforms) by 61% (67/110) of laboratories. Eighty-eight per cent of laboratories (97/110) provided urgent microscopy for hospital and 54% for general practice (GP) paediatric urines; 61% of laboratories (confidence interval 52-70%) cultured 1 μl volume of urine, which equates to one colony if the bacterial load is 106 c.f.u. l(-1). Only 22% (24/110) of laboratories reported non-E. coli coliforms and provided urgent microscopy for both hospital and GP childhood urines; only three laboratories also cultured a 5 μl volume of urine. Only one of six laboratories in our submission audit had a significant increase in urine submissions and urines reported from children less than 3 years old between the predicted pre-2007 level in the absence of guidance and the 2008 level following publication of the NICE guidance. Less than a

  20. How to Sustain Change and Support Continuous Quality Improvement.

    PubMed

    Silver, Samuel A; McQuillan, Rory; Harel, Ziv; Weizman, Adam V; Thomas, Alison; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T; Chertow, Glenn M

    2016-05-06

    To achieve sustainable change, quality improvement initiatives must become the new way of working rather than something added on to routine clinical care. However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement. Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles. Process control and performance boards are methods to communicate improvement results to staff and leadership. Standard work is a written or visual outline of current best practices for a task and provides a framework to ensure that changes that have improved patient care are consistently and reliably applied to every patient encounter. Improvement huddles are short, regular meetings among staff to anticipate problems, review performance, and support a culture of improvement. Many of these tools rely on principles of visual management, which are systems transparent and simple so that every staff member can rapidly distinguish normal from abnormal working conditions. Even when quality improvement methods are properly applied, the success of a project still depends on contextual factors. Context refers to aspects of the local setting in which the project operates. Context affects resources, leadership support, data infrastructure, team motivation, and team performance. For these reasons, the same project may thrive in a supportive context and fail in a different context. To demonstrate the practical applications of these quality improvement principles, these principles are

  1. Reformer operation improved by feed sulfur removal

    SciTech Connect

    Mc Clung, R.G. )

    1990-10-08

    This paper reports how reduction of sulfur in catalytic reforming feeds below that typically obtainable with naphtha hydrotreating improves the reformer operation significantly. In evaluations of pilot-plant and commercial operations, high-rhenium content reforming catalysts have been used with low-sulfur naphtha feeds and have been shown to dramatically affect catalyst cycle length, gasoline yield, and stability. The consequences of insufficient removal of sulfur include shorter cycle length, more rapid reactor temperature rise to maintain octane, and as a result of that increase, more rapid catalyst deactivation.

  2. Using Human Dynamics to Improve Operator Performance

    NASA Astrophysics Data System (ADS)

    Antunes, Rui; Coito, Fernando V.; Duarte-Ramos, Hermínio

    Traditionally Man-Machine Interfaces (MMI) are concerned with the ergonomic aspects of the operation, often disregarding other aspects on how humans learn and use machines. The explicit use of the operator dynamics characterization for the definition of the Human-in-the-Loop control system may allow an improved performance for manual control systems. The proposed human model depends on the activity to be performed and the mechanical Man-Machine Interface. As a first approach for model development, a number of 1-D manual tracking experiments were evaluated, using an analog Joystick. A simple linear human model was obtained and used to design an improved closed-loop control structure. This paper describes practical aspects of an ongoing PhD work on cognitive control in Human-Machine systems.

  3. Nursing informatics, outcomes, and quality improvement.

    PubMed

    Charters, Kathleen G

    2003-08-01

    Nursing informatics actively supports nursing by providing standard language systems, databases, decision support, readily accessible research results, and technology assessments. Through normalized datasets spanning an entire enterprise or other large demographic, nursing informatics tools support improvement of healthcare by answering questions about patient outcomes and quality improvement on an enterprise scale, and by providing documentation for business process definition, business process engineering, and strategic planning. Nursing informatics tools provide a way for advanced practice nurses to examine their practice and the effect of their actions on patient outcomes. Analysis of patient outcomes may lead to initiatives for quality improvement. Supported by nursing informatics tools, successful advance practice nurses leverage their quality improvement initiatives against the enterprise strategic plan to gain leadership support and resources.

  4. Improving Organisational Effectiveness of Coalition Operations

    DTIC Science & Technology

    2010-04-01

    organisational effectiveness of coalition HQs conducting Non-article 5 crisis response operations. The paper will present intermediate results of the work of...PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Swiss Military Academy at ETH Zurich...their organisational effectiveness. It is the result of the work of NATO Research and Technology Organisation (RTO) Task Group HFM-163 “Improving

  5. Recommendations for Improving FBI Joint Counterterrorism Operations

    DTIC Science & Technology

    2012-03-13

    Development includes specific activities designed to expand mindsets, in addition to the behaviors , skills, and experience of the individual.48 As described...operations with the military, the FBI enhances its ability to conduct investigative activity in defense of the U.S. Without improvements to the...FBI’s existing system of assigning leaders to match the needs of the organization, the ability to fulfill these responsibilities, as set forth in the 9

  6. Afghanistan's national strategy for improving quality in health care

    PubMed Central

    Rahimzai, Mirwais; Amiri, Mirwais; Burhani, Nadera Hayat; Leatherman, Sheila; Hiltebeitel, Simon; Rahmanzai, Ahmed Javed

    2013-01-01

    Quality problem or issue When the Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan began reconstructing the health system in 2003, it faced serious challenges. Decades of war had severely damaged the health infrastructure and the country's ability to deliver health services. Initial assessment A national health resources assessment in 2002 revealed huge structural and resource disparities fundamental to improving health care. For example, only 9% of the population was able to access basic health services, and about 40% of health facilities had no female health providers, severely constraining access of women to health care. Multiple donor programs and the MoPH had some success in improving quality, but questions about sustainability, as well as fragmentation and poor coordination, existed. Plan of action In 2009, MoPH resolved to align and accelerate quality improvement efforts as well as build structural and skill capacity. Implementation The MoPH established a new quality unit within the ministry and undertook a year-long consultative process that drew on international evidence and inputs from all levels of the health system to developed a National Strategy for Improving Quality in Health Care consisting of a strategy implementation framework and a five-year operational plan. Lessons Learned Even in resource-restrained countries, under the most adverse circumstances, quality of health care can be improved at the front-lines and a consensual and coherent national quality strategy developed and implemented. PMID:23485422

  7. Quality assurance: Importance of systems and standard operating procedures.

    PubMed

    Manghani, Kishu

    2011-01-01

    It is mandatory for sponsors of clinical trials and contract research organizations alike to establish, manage and monitor their quality control and quality assurance systems and their integral standard operating procedures and other quality documents to provide high-quality products and services to fully satisfy customer needs and expectations. Quality control and quality assurance systems together constitute the key quality systems. Quality control and quality assurance are parts of quality management. Quality control is focused on fulfilling quality requirements, whereas quality assurance is focused on providing confidence that quality requirements are fulfilled. The quality systems must be commensurate with the Company business objectives and business model. Top management commitment and its active involvement are critical in order to ensure at all times the adequacy, suitability, effectiveness and efficiency of the quality systems. Effective and efficient quality systems can promote timely registration of drugs by eliminating waste and the need for rework with overall financial and social benefits to the Company.

  8. Quality assurance: Importance of systems and standard operating procedures

    PubMed Central

    Manghani, Kishu

    2011-01-01

    It is mandatory for sponsors of clinical trials and contract research organizations alike to establish, manage and monitor their quality control and quality assurance systems and their integral standard operating procedures and other quality documents to provide high-quality products and services to fully satisfy customer needs and expectations. Quality control and quality assurance systems together constitute the key quality systems. Quality control and quality assurance are parts of quality management. Quality control is focused on fulfilling quality requirements, whereas quality assurance is focused on providing confidence that quality requirements are fulfilled. The quality systems must be commensurate with the Company business objectives and business model. Top management commitment and its active involvement are critical in order to ensure at all times the adequacy, suitability, effectiveness and efficiency of the quality systems. Effective and efficient quality systems can promote timely registration of drugs by eliminating waste and the need for rework with overall financial and social benefits to the Company. PMID:21584180

  9. Improving the quality of mass produced maps

    USGS Publications Warehouse

    Simley, J.

    2001-01-01

    Quality is critical in cartography because key decisions are often made based on the information the map communicates. The mass production of digital cartographic information to support geographic information science has now added a new dimension to the problem of cartographic quality, as problems once limited to small volumes can now proliferate in mass production programs. These problems can also affect the economics of map production by diverting a sizeable portion of production cost to pay for rework on maps with poor quality. Such problems are common to general industry-in response, the quality engineering profession has developed a number of successful methods to overcome these problems. Two important methods are the reduction of error through statistical analysis and addressing the quality environment in which people work. Once initial and obvious quality problems have been solved, outside influences periodically appear that cause adverse variations in quality and consequently increase production costs. Such errors can be difficult to detect before the customer is affected. However, a number of statistical techniques can be employed to detect variation so that the problem is eliminated before significant damage is caused. Additionally, the environment in which the workforce operates must be conductive to quality. Managers have a powerful responsibility to create this environment. Two sets of guidelines, known as Deming's Fourteen Points and ISO-9000, provide models for this environment.

  10. Engaging with quality improvement in anticoagulation management.

    PubMed

    Barnes, Geoffrey D; Kline-Rogers, Eva

    2015-04-01

    Anticoagulants are highly effective at preventing thrombosis across a variety of clinical indications. However, their use can also lead to devastating effects, including major bleeding and death. Anticoagulation providers strive to balance the benefits of anticoagulant therapy with the risks of major bleeding. A measure of quality care can be used to assess the strengths and potential weaknesses in any system of coordinated care delivery. Quality measures in anticoagulation include patient-centered outcomes (e.g. major bleeding, time in the therapeutic range) and provider- or process-focused outcomes (e.g. compliance with guideline recommendations and response times to out-of-range laboratory values). Engaging in quality improvement activities allows anticoagulation providers to assess their own performance and identify areas for targeted interventions. This review summarizes the justification for engaging in quality improvement for anticoagulation management and describes a number of example programs. Interventions benefiting the management of both warfarin and the direct oral anticoagulants are included. The review also details potential quality measures and resources for any anticoagulation provider looking to begin a quality improvement process.

  11. Engaging with quality improvement in anticoagulation management

    PubMed Central

    Barnes, Geoffrey D.; Kline-Rogers, Eva

    2016-01-01

    Anticoagulants are highly effective at preventing thrombosis across a variety of clinical indications. However, their use can also lead to devastating effects, including major bleeding and death. Anticoagulation providers strive to balance the benefits of anticoagulant therapy with the risks of major bleeding. A measure of quality care can be used to assess the strengths and potential weaknesses in any system of coordinated care delivery. Quality measures in anticoagulation include patient-centered outcomes (e.g. major bleeding, time in the therapeutic range) and provider- or process-focused outcomes (e.g. compliance with guideline recommendations and response times to out-of-range laboratory values). Engaging in quality improvement activities allows anticoagulation providers to assess their own performance and identify areas for targeted interventions. This review summarizes the justification for engaging in quality improvement for anticoagulation management and describes a number of example programs. Interventions benefiting the management of both warfarin and the direct oral anticoagulants are included. The review also details potential quality measures and resources for any anticoagulation provider looking to begin a quality improvement process. PMID:25772116

  12. Improving the Usefulness of Operational Radiosonde Data.

    NASA Astrophysics Data System (ADS)

    Durre, Imke; Reale, Tony; Carlson, David; Christy, John; Uddstrom, Michael; Gelman, Melvyn; Thorne, Peter

    2005-03-01

    and Contributions from 23 additional Workshop participantsThe Workshop to Improve the Usefulness of Operational Radiosonde Data was held at the NOAA National Climatic Data Center (NCDC) in Asheville, North Carolina, from 11 through 13 March 2003. It brought together users of global radiosonde data in numerical weather prediction, climate, and satellite data applications, along with a number of experts concerned with radiosonde instrument development, validation, and operational programs. This report provides a set of findings and recommendations produced by the group. The recommendations address issues in the areas of accuracy, calibration, and corrections of radiosonde measurements, sampling strategies, and the exchange of and response to information on data integrity, metadata, and data processing strategies.

  13. MODIS Instrument Operation and Calibration Improvements

    NASA Technical Reports Server (NTRS)

    Xiong, X.; Angal, A.; Madhavan, S.; Link, D.; Geng, X.; Wenny, B.; Wu, A.; Chen, H.; Salomonson, V.

    2014-01-01

    Terra and Aqua MODIS have successfully operated for over 14 and 12 years since their respective launches in 1999 and 2002. The MODIS on-orbit calibration is performed using a set of on-board calibrators, which include a solar diffuser for calibrating the reflective solar bands (RSB) and a blackbody for the thermal emissive bands (TEB). On-orbit changes in the sensor responses as well as key performance parameters are monitored using the measurements of these on-board calibrators. This paper provides an overview of MODIS on-orbit operation and calibration activities, and instrument long-term performance. It presents a brief summary of the calibration enhancements made in the latest MODIS data collection 6 (C6). Future improvements in the MODIS calibration and their potential applications to the S-NPP VIIRS are also discussed.

  14. Improved high operating temperature MCT MWIR modules

    NASA Astrophysics Data System (ADS)

    Lutz, H.; Breiter, R.; Figgemeier, H.; Schallenberg, T.; Schirmacher, W.; Wollrab, R.

    2014-06-01

    High operating temperature (HOT) IR-detectors are a key factor to size, weight and power (SWaP) reduced IR-systems. Such systems are essential to provide infantrymen with low-weight handheld systems with increased battery lifetimes or most compact clip-on weapon sights in combination with high electro-optical performance offered by cooled IR-technology. AIM's MCT standard n-on-p technology with vacancy doping has been optimized over many years resulting in MWIR-detectors with excellent electro-optical performance up to operating temperatures of ~120K. In the last years the effort has been intensified to improve this standard technology by introducing extrinsic doping with Gold as an acceptor. As a consequence the dark current could considerably be suppressed and allows for operation at ~140K with good e/o performance. More detailed investigations showed that limitation for HOT > 140K is explained by consequences from rising dark current rather than from defective pixel level. Recently, several crucial parameters were identified showing great promise for further optimization of HOT-performance. Among those, p-type concentration could successfully be reduced from the mid 1016 / cm3 to the lower 1015/ cm3 range. Since AIM is one of the leading manufacturers of split linear cryocoolers, an increase in operating temperature will directly lead to IR-modules with improved SWaP characteristics by making use of the miniature members of its SX cooler family with single piston and balancer technology. The paper will present recent progress in the development of HOT MWIR-detector arrays at AIM and show electro-optical performance data in comparison to focal plane arrays produced in the standard technology.

  15. Improving the Quality of Think-Alouds

    ERIC Educational Resources Information Center

    Ness, Molly; Kenny, MaryBeth

    2016-01-01

    An essential element in teaching children to effectively comprehend text is the use of teacher-led think alouds. This article presents a three-step model to improve the quality and quantity of think alouds in K-6 classrooms. The article follows elementary teachers who planned, implemented, transcribed, and reflected upon think aloud lessons to…

  16. National Quality Improvement Center on Early Childhood

    ERIC Educational Resources Information Center

    Browne, Charlyn Harper

    2014-01-01

    The national Quality Improvement Center on early Childhood (QIC-eC) funded four research and demonstration projects that tested child maltreatment prevention approaches. The projects were guided by several key perspectives: the importance of increasing protective factors in addition to decreasing risk factors in child maltreatment prevention…

  17. Quality Improvements in Curricula for Global Studies

    ERIC Educational Resources Information Center

    Bader, Lena; Bereuther, Tabea; Deutsch, Elisabeth; Edlinger, Julia; Fureder, Silvia; Kaspar, Emanuel; Kottstorfer, Marlene; Mautner, Claudia; Rossegger, Christine; Samonig, Alina; Samonig, Stefan; Schuster, Christoph; Witz, Gerhard; Zotter, Victoria; Ahamer, Gilbert

    2013-01-01

    Purpose: Based on an in-depth comparison of 20 multicultural university curricula, this article aims to provide practical and implementable suggestions about how to improve such curricula in order to ensure highest and globally compatible academic quality. The recently founded developmental Master's curriculum "Global Studies" (GS) at…

  18. Fostering Quality Improvement in EHDI Programs

    ERIC Educational Resources Information Center

    Bradham, Tamala S.; Hoffman, Jeff; Houston, K. Todd; Guignard, Gayla Hutsell

    2011-01-01

    State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that consisted of 12 evaluative areas of EHDI programs. For the quality improvement area, a total of 218 items were listed by 47 EHDI coordinators, and themes were identified in each…

  19. AQIP and Accreditation: Improving Quality and Performance

    ERIC Educational Resources Information Center

    Spangehl, Stephen D.

    2012-01-01

    For the past 12 years, the Academic Quality Improvement Program (AQIP) has offered an innovative means for colleges and universities to maintain regional accreditation with the Higher Learning Commission (HLC), the only regional U.S. accrediting commission currently providing alternative pathways for maintaining accreditation. Although all HLC…

  20. Quality Improvement in University Counseling Centers

    ERIC Educational Resources Information Center

    Maffini, Cara S.; Toth, Paul L.

    2017-01-01

    University Counseling Centers (UCCs) experience high clinical demands and severe client presentations leaving counselors with limited time and resources to evaluate delivery of services. In this article, we present clinician-friendly quality improvement (QI) strategies used at a large Midwestern university and provide recommendations for…

  1. Operational Environmental Monitoring Program Quality Assurance Project Plan

    SciTech Connect

    Perkins, C.J.

    1994-08-01

    This Quality Assurance Project Plan addresses the quality assurance requirements for the activities associated with the preoperational and operational environmental monitoring performed by Westinghouse Hanford Company as it implements the Operational Environmental Monitoring program. This plan applies to all sampling and monitoring activities performed by Westinghouse Hanford Company in implementing the Operational Environmental Monitoring program at the Hanford Site.

  2. Advanced kick detection systems improve HPHT operations

    SciTech Connect

    Harris, T.W.R.; Hendriks, P.; Surewaard, J.H.G.

    1995-09-01

    Many high-pressure, high-temperature (HPHT) wells are often characterized by the small margins that can exist between pore pressure and formation strength. Therefore, it is not surprising that kicks are far more likely to occur in HPHT wells and that a greater risk of internal blowout exists. The development and application of advanced kick detection systems for HPHT wells can help manage risks and improve drilling efficiency. Such systems enable earlier well shut-in, minimizing both the influx volume and the subsequent well bore pressures. This in turn lowers the risk, time and cost required for well control operations. Carefully considered application of these systems can also justify favorable economic benefits by optimization of the HPHT preliminary casing design. Minimizing kick volume can be important for the critical HPHT hole sections, where a reduced operating margin between pore pressure and fracture gradient exists, defining small design kick tolerance limits to permit safe drilling ahead to reach specified objectives. Kick detection for HPHT wells equivalent to less than 5 bbl of gas influx are often necessary to adequately minimize the risk of internal blowout and obtain the same levels of safety which are applied to conventional wells. This paper reviews these systems for both on-shore and off-shore operations.

  3. Engaging Clinical Nurses in Quality Improvement Projects.

    PubMed

    Moore, Susan; Stichler, Jaynelle F

    2015-10-01

    Clinical nurses have the knowledge and expertise required to provide efficient and proficient patient care. Time and knowledge deficits can prevent nurses from developing and implementing quality improvement or evidence-based practice projects. This article reviews a process for professional development of clinical nurses that helped them to define, implement, and analyze quality improvement or evidence-based practice projects. The purpose of this project was to educate advanced clinical nurses to manage a change project from inception to completion, using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) Change Acceleration Process as a framework. One-to-one mentoring and didactic in-services advanced the knowledge, appreciation, and practice of advanced practice clinicians who completed multiple change projects. The projects facilitated clinical practice changes, with improved patient outcomes; a unit cultural shift, with appreciation of quality improvement and evidence-based projects; and engagement with colleagues. Project outcomes were displayed in poster presentations at a hospital exposition for knowledge dissemination.

  4. Improving service quality in primary care.

    PubMed

    Kennedy, Denise M; Nordrum, Jon T; Edwards, Frederick D; Caselli, Richard J; Berry, Leonard L

    2015-01-01

    A framework for improving health care service quality was implemented at a 12-provider family medicine practice in 2010. A national patient satisfaction research vendor conducted weekly telephone surveys of 840 patients served by that practice: 280 patients served in 2009, and 560 served during 2010 and 2011. After the framework was implemented, the proportion of "excellent" ratings of provider service (the highest rating on a 5-point scale) increased by 5% to 9%, most notably thoroughness (P = .04), listening (P = .04), and explaining (P = .04). Other improvements included prompt test result notification and telephone staff courtesy (each by 10%, P = .02), as well as teamwork (by 8%, P = .04). Overall quality increased by 10% (P = .01), moving the practice from the 68th to the 91st percentile of medical practices in the research vendor's database. Improvements in patient satisfaction suggest that this framework may be useful in value-based payment models.

  5. 78 FR 7816 - Quality Assurance Program Requirements (Operations)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-04

    ... COMMISSION Quality Assurance Program Requirements (Operations) AGENCY: Nuclear Regulatory Commission. ACTION... issuing for public comment draft regulatory guide (DG), DG-1300, ``Quality Assurance Program Requirements...'s Agencywide Documents Access and Management System (ADAMS): You may access...

  6. Creating Quality Improvement Culture in Public Health Agencies

    PubMed Central

    Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

    2014-01-01

    Objectives. We conducted case studies of 10 agencies that participated in early quality improvement efforts. Methods. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007–2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Results. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Conclusions. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies’ ability to create and sustain a quality improvement culture. PMID:24228680

  7. Putting continuous quality improvement into accreditation: improving approaches to quality assessment.

    PubMed Central

    Scrivens, E

    1997-01-01

    The accreditation systems of the United States, Canada, and Australia have been restructured to reflect the adoption by health services of the industrial model of continuous quality improvement. The industrial model of quality makes assumptions about management structures and the relation of process to outcome which are not readily transferable to the assessment of quality in health care. The accreditation systems have therefore had to adapt the principles of continuous quality improvement to reflect the complex nature of health service organisations and the often untested assumptions about the relation between process and outcome. PMID:10177038

  8. Wind turbine generator with improved operating subassemblies

    DOEpatents

    Cheney, Jr., Marvin C.

    1985-01-01

    A wind turbine includes a yaw spring return assembly to return the nacelle from a position to which it has been rotated by yawing forces, thus preventing excessive twisting of the power cables and control cables. It also includes negative coning restrainers to limit the bending of the flexible arms of the rotor towards the tower, and stop means on the rotor shaft to orient the blades in a vertical position during periods when the unit is upwind when the wind commences. A pendulum pitch control mechanism is improved by orienting the pivot axis for the pendulum arm at an angle to the longitudinal axis of its support arm, and excessive creep is of the synthetic resin flexible beam support for the blades is prevented by a restraining cable which limits the extent of pivoting of the pendulum during normal operation but which will permit further pivoting under abnormal conditions to cause the rotor to stall.

  9. Improved operation of the nonambipolar electron source.

    PubMed

    Longmier, Ben; Hershkowitz, Noah

    2008-09-01

    Significant improvements have been made to the nonambipolar electron source (NES), a radio frequency (rf) plasma-based electron source that does not rely on electron emission at a cathode surface [B. Longmier, S. Baalrud, and N. Hershkowitz, Rev. Sci. Instrum. 77, 113504 (2006)]. A prototype NES has produced 30 A of continuous electron current, using 2 SCCM (SCCM denotes cubic centimeter per minute at STP) Xe, 1300 W rf power at 13.56 MHz, yielding a 180 times gas utilization factor. A helicon mode transition has also been identified during NES operation with an argon propellant, using 15 SCCM Ar, 1000 W rf, and 100 G magnetic field. This NES technology has the ability to replace hollow cathode electron sources and to enable high power electric propulsion missions, eliminating one of the lifetime restrictions that many ion thrusters have previously been faced with.

  10. 2.2 Continuous quality improvement.

    PubMed

    Rohlin, Madeleine; Schaub, Rob M H; Holbrook, Peter; Leibur, Edvitar; Lévy, Gérard; Roubalikova, Lenka; Nilner, Maria; Roger-Leroi, Valerie; Danner, Gunter; Iseri, Haluk; Feldman, Cecile

    2002-01-01

    Continuous quality improvement (CQI) can be envisaged as a circular process of goal-setting, followed by external and internal evaluations resulting in improvements that can serve as goals for a next cycle. The need for CQI is apparent, because of public accountability, maintaining European standards and the improvement of dental education. Many examples are known where recommendations from both external and internal evaluation are used for the improvement of dental education. Unfortunately, the implementation of the recommendations is inconsistent, rarely systematic and usually not transparent. This section agreed that it is essential to apply CQI in a structured, systematic and transparent way if we are to improve and maintain the quality of dental education. A model is proposed which includes three aspects: a) the process of CQI; b) the subjects to which CQI should be applied; and c) the management tools to govern CQI. It is stressed, that CQI is a process that can be applied in any dental school irrespective of curriculum or educational approach within the relevant context of the country or the region. The approach needs to recognize the complexity and the need to balance a quality improvement with accountability. A CQI system is also constrained in any organization by the attitudes and values of the staff. Inevitably there has to be a wide range in the application of CQI. Nevertheless, an agreed model on CQI might enhance convergence towards higher standards of dental education. The process of CQI can be supported by developments in information and communication technology (ICT): collection of data, identifying the steps in CQI, formats of reports, etc. The section was set, as one of its tasks, to advise on the development of a network based on a number of case studies on the application of CQI in dental education.

  11. 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.

  12. 42 CFR 423.162 - Quality improvement organization activities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Quality improvement organization activities. 423... Cost Control and Quality Improvement Requirements § 423.162 Quality improvement organization activities. (a) General rule. Quality improvement organizations (QIOs) are required to offer...

  13. Melatonin improves sleep quality in hemodialysis patients

    PubMed Central

    Edalat-Nejad, M.; Haqhverdi, F.; Hossein-Tabar, T.; Ahmadian, M.

    2013-01-01

    Disturbed sleep is common in end-stage renal disease (ESRD). Exogenous melatonin has somniferous properties in normal subjects and can improve sleep quality (SQ) in several clinical conditions. Recent studies have shown that melatonin may play a role in improving sleep in patients undergoing dialysis. The goal of the present study was to assess the effect of exogenous melatonin administration on SQ improvement in daytime hemodialysis patients. Lipid profile and the required dose of erythropoietin (EPO) are also reported as secondary outcomes. In a 6-week randomized, double-blind cross-over clinical trial, 3 mg melatonin or placebo was administered to 68 patients at bedtime. A 72-h washout preceded the switch from melatonin to placebo, or vice versa. SQ was assessed by the Pittsburgh sleep quality index (PSQI). Sixty-eight patients completed the study protocol and were included in the final analysis. Melatonin treatment significantly improved the global PSQI scores (P < 0.001), particularly subjective SQ (P < 0.001), sleep efficiency (P = 0.005) and sleep duration (P < 0.001). No differences in sleep latency and daytime sleepiness were observed. Melatonin also increased the high-density lipoprotein (HDL) cholesterol (P = 0.003). The need for EPO prescription decreased after melatonin treatment (P < 0.001). We conclude that melatonin can improve sleep in ESRD. The modest increase in HDL cholesterol and decrease in the EPO requirement are other benefits associated with this treatment PMID:23960341

  14. Multichannel DBS halftoning for improved texture quality

    NASA Astrophysics Data System (ADS)

    Slavuj, Radovan; Pedersen, Marius

    2015-01-01

    The paper aims to develop a method for multichannel halftoning based on the Direct Binary Search (DBS) algorithm. We integrate specifics and benefits of multichannel printing into the halftoning method in order to further improve texture quality of DBS and to create halftoning that would suit for multichannel printing. Originally, multichannel printing is developed for an extended color gamut, at the same time additional channels can help to improve individual and combined texture of color halftoning. It does so in a similar manner to the introduction of the light colors (diluted inks) in printing. Namely, if one observes Red, Green and Blue inks as the light version of the M+Y, C+Y, C+M combinations, the visibility of the unwanted halftoning textures can be reduced. Analogy can be extent to any number of ink combinations, or Neugebauer Primaries (NPs) as the alternative building blocks. The extended variability of printing spatially distributed NPs could provide many practical solution and improvements in color accuracy, image quality, and could enable spectral printing. This could be done by selection of NPs per dot area location based on the constraint of the desired reproduction. Replacement with brighter NP at the location could induce a color difference where a tradeoff between image quality and color accuracy is created. With multichannel enabled DBS haftoning, we are able to reduce visibility of the textures, to provide better rendering of transitions, especially in mid and dark tones.

  15. The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration

    PubMed Central

    Ogrinc, G; Mooney, S E; Estrada, C; Foster, T; Goldmann, D; Hall, L W; Huizinga, M M; Liu, S K; Mills, P; Neily, J; Nelson, W; Pronovost, P J; Provost, L; Rubenstein, L V; Speroff, T; Splaine, M; Thomson, R; Tomolo, A M; Watts, B

    2008-01-01

    As the science of quality improvement in health care advances, the importance of sharing its accomplishments through the published literature increases. Current reporting of improvement work in health care varies widely in both content and quality. It is against this backdrop that a group of stakeholders from a variety of disciplines has created the Standards for QUality Improvement Reporting Excellence, which we refer to as the SQUIRE publication guidelines or SQUIRE statement. The SQUIRE statement consists of a checklist of 19 items that authors need to consider when writing articles that describe formal studies of quality improvement. Most of the items in the checklist are common to all scientific reporting, but virtually all of them have been modified to reflect the unique nature of medical improvement work. This “Explanation and Elaboration” document (E & E) is a companion to the SQUIRE statement. For each item in the SQUIRE guidelines the E & E document provides one or two examples from the published improvement literature, followed by an analysis of the ways in which the example expresses the intent of the guideline item. As with the E & E documents created to accompany other biomedical publication guidelines, the purpose of the SQUIRE E & E document is to assist authors along the path from completion of a quality improvement project to its publication. The SQUIRE statement itself, this E & E document, and additional information about reporting improvement work can be found at http://www.squire-statement.org. PMID:18836062

  16. Quality management science in clinical chemistry: a dynamic framework for continuous improvement of quality.

    PubMed

    Westgard, J O; Burnett, R W; Bowers, G N

    1990-10-01

    Current quality assurance approaches will not be adequate to satisfy the needs for quality in the next decade. Quality management science (QMS), as evolving in industry today, provides the dynamic framework necessary to provide continuous improvement of quality. QMS emphasizes the importance of defining quality goals based on the needs and expectations (implied needs) of customers. The laboratory can develop customer-friendly goals and measures of quality by recognizing that customers' experiences are represented by a totality of results. Quality goals and measures are best communicated as "total performance" by specifying a limit and percentile of the distribution, rather than a mean and standard deviation. Application of quality goals within the laboratory will usually require partitioning the total performance goal into components and translating those components into specifications to guide the operation and management of production processes. QMS also extends beyond technical processes to people processes and provides guidance for improving the quality of worklife and caring for the laboratory's most essential resource--our people.

  17. Improving quality at many levels. Profamilia's experience in Colombia.

    PubMed

    Trias, M; Plata, M I

    1994-01-01

    Profamilia, the Colombian family planning association and the country's largest family planning provider, began diversifying its services in 1982 to offer prenatal care services as well as general medical consultations. The organization has since attempted to integrate quality assurance at all levels of operation. Specifically, Profamilia is aiming to provide care which is of sustainably high quality to satisfy present clients and attract new ones without overtaxing available organization resources, thereby prompting the eventual financial collapse of the programs and the failure to increase coverage especially among the middle and lower classes of the country. Drawing from the credo of modern corporate enterprise, "the client is always right," Profamilia listens and responds to clients' needs with the goal of making their satisfaction the ultimate objective. Moreover, organization staff receive regular training to motivate their receptiveness to client needs, while the pursuit of quality exists as a major goal at the managerial level. Profamilia regards quality maintenance and improvement as indispensable in program sustainability.

  18. Improving system quality through software evaluation.

    PubMed

    McDaniel, James G

    2002-05-01

    The role of evaluation is examined with respect to quality of software in healthcare. Of particular note is the failure of the Therac-25 radiation therapy machine. This example provides evidence of several types of defect which could have been detected and corrected using appropriate evaluation procedures. The field of software engineering has developed metrics and guidelines to assist in software evaluation but this example indicates that software evaluation must be extended beyond the formally defined interfaces of the software to its real-life operating context.

  19. Commentary: quality improvement projects: how do we protect patients' rights?

    PubMed

    Diamond, Louis H; Kliger, Alan S; Goldman, Richard S; Palevsky, Paul M

    2004-01-01

    A recent ruling by the Office of Human Research Protection (OHRP) has renewed an ongoing debate over whether Institutional Review Boards (IRBs) should have oversight not only over clinical research but also over quality improvement projects (QIPs). The authors discussed the similarities and differences among clinical practice, QIPs, and clinical research, pointing out issues to consider when identifying the most appropriate method for QIP oversight and accountability. They note that potential solutions must address ethical issues (eg, patient safety, privacy, and self-determination) and weigh the effect of the underlying QIP goal (administrative versus clinical improvement) on an individual patient and patient populations. They conclude that because QIPs are an extension of clinical practice and have elements of clinical research, it too should have an oversight system. Institutional or regional quality improvement boards, operating parallel to current IRBs, are suggested as 1 means of ensuring that QIP participants are offered the same protections as those who take part in clinical research.

  20. Quality improvement in basic histotechnology: the lean approach.

    PubMed

    Clark, David

    2016-01-01

    Lean is a comprehensive system of management based on the Toyota production system (TPS), encompassing all the activities of an organization. It focuses management activity on creating value for the end-user by continuously improving operational effectiveness and removing waste. Lean management creates a culture of continuous quality improvement with a strong emphasis on developing the problem-solving capability of staff using the scientific method (Deming's Plan, Do, Check, Act cycle). Lean management systems have been adopted by a number of histopathology departments throughout the world to simultaneously improve quality (reducing errors and shortening turnround times) and lower costs (by increasing efficiency). This article describes the key concepts that make up a lean management system, and how these concepts have been adapted from manufacturing industry and applied to histopathology using a case study of lean implementation and evidence from the literature. It discusses the benefits, limitations, and pitfalls encountered when implementing lean management systems.

  1. The Quality Assurance Project: introducing quality improvement to primary health care in less developed countries.

    PubMed

    Nicholas, D D; Heiby, J R; Hatzell, T A

    1991-01-01

    Persistently excessive morbidity and mortality rates in less developed countries (LDCs) served by primary health care systems suggest that the quality of services is inadequate. The PRICOR project, sponsored by the United States Agency for International Development, has designed and implemented methods for quality assessment and problem solving in LDC health systems. After developing comprehensive lists of essential activities and tasks, similar to practice parameters, for seven child survival interventions, PRICOR supported comprehensive quality assessment studies in twelve LDC countries. The studies, yielding over 6000 observations of health worker-client encounters, indicated highly prevalent, serious program deficiencies in areas including diagnosis, treatment, patient education and supervision. To facilitate corrective action, PRICOR assisted managers in conducting operations research to resolve priority problems revealed by the assessments. The recently initiated Quality Assurance Project is building on PRICOR techniques in designing and implementing sustainable continuous quality improvement programs for LDC health systems.

  2. Operational excellence (six sigma) philosophy: Application to software quality assurance

    SciTech Connect

    Lackner, M.

    1997-11-01

    This report contains viewgraphs on operational excellence philosophy of six sigma applied to software quality assurance. This report outlines the following: goal of six sigma; six sigma tools; manufacturing vs administrative processes; Software quality assurance document inspections; map software quality assurance requirements document; failure mode effects analysis for requirements document; measuring the right response variables; and questions.

  3. Health care quality improvement publication trends.

    PubMed

    Sun, Gordon H; MacEachern, Mark P; Perla, Rocco J; Gaines, Jean M; Davis, Matthew M; Shrank, William H

    2014-01-01

    To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991.

  4. Improving Air Quality Forecasts with AURA Observations

    NASA Technical Reports Server (NTRS)

    Newchurch, M. J.; Biazer, A.; Khan, M.; Koshak, W. J.; Nair, U.; Fuller, K.; Wang, L.; Parker, Y.; Williams, R.; Liu, X.

    2008-01-01

    Past studies have identified model initial and boundary conditions as sources of reducible errors in air-quality simulations. In particular, improving the initial condition improves the accuracy of short-term forecasts as it allows for the impact of local emissions to be realized by the model and improving boundary conditions improves long range transport through the model domain, especially in recirculating anticyclones. During the August 2006 period, we use AURA/OMI ozone measurements along with MODIS and CALIPSO aerosol observations to improve the initial and boundary conditions of ozone and Particulate Matter. Assessment of the model by comparison of the control run and satellite assimilation run to the IONS06 network of ozonesonde observations, which comprise the densest ozone sounding campaign ever conducted in North America, to AURA/TES ozone profile measurements, and to the EPA ground network of ozone and PM measurements will show significant improvement in the CMAQ calculations that use AURA initial and boundary conditions. Further analyses of lightning occurrences from ground and satellite observations and AURA/OMI NO2 column abundances will identify the lightning NOx signal evident in OMI measurements and suggest pathways for incorporating the lightning and NO2 data into the CMAQ simulations.

  5. Project Hanford management contract quality improvement project management plan

    SciTech Connect

    ADAMS, D.E.

    1999-03-25

    On July 13, 1998, the U.S. Department of Energy, Richland Operations Office (DOE-RL) Manager transmitted a letter to Fluor Daniel Hanford, Inc. (FDH) describing several DOE-RL identified failed opportunities for FDH to improve the Quality Assurance (QA) Program and its implementation. In addition, DOE-RL identified specific Quality Program performance deficiencies. FDH was requested to establish a periodic reporting mechanism for the corrective action program. In a July 17, 1998 response to DOE-RL, FDH agreed with the DOE concerns and committed to perform a comprehensive review of the Project Hanford Management Contract (PHMC) QA Program during July and August, 1998. As a result, the Project Hanford Management Contract Quality Improvement Plan (QIP) (FDH-3508) was issued on October 21, 1998. The plan identified corrective actions based upon the results of an in-depth Quality Program Assessment. Immediately following the scheduled October 22, 1998, DOE Office of Enforcement and Investigation (EH-10) Enforcement Conference, FDH initiated efforts to effectively implement the QIP corrective actions. A Quality Improvement Project (QI Project) leadership team was assembled to prepare a Project Management Plan for this project. The management plan was specifically designed to engage a core team and the support of representatives from FDH and the major subcontractors (MSCs) to implement the QIP initiatives; identify, correct, and provide feedback as to the root cause for deficiency; and close out the corrective actions. The QI Project will manage and communicate progress of the process.

  6. Improving Data Quality in Mass-Gatherings Health Research.

    PubMed

    Guy, Andrew; Prager, Ross; Turris, Sheila; Lund, Adam

    2017-03-09

    Mass gatherings attract large crowds and can strain the planning and health resources of the community, city, or nation hosting an event. Mass-Gatherings Health (MGH) is an evolving niche of prehospital care rooted in emergency medicine, emergency management, public health, and disaster medicine. To explore front-line issues related to data quality in the context of mass gatherings, the authors draw on five years of management experience with an online, mass-gathering event and patient registry, as well as clinical and operational experience amassed over several decades. Here the authors propose underlying human, environmental, and logistical factors that may contribute to poor data quality at mass gatherings, and make specific recommendations for improvement through pre-event planning, on-site actions, and post-event follow-up. The advancement of MGH research will rely on addressing factors that influence data quality and developing strategies to mitigate or enhance those factors. This is an exciting time for MGH research as higher order questions are beginning to be addressed; however, quality research must start from the ground up to ensure optimal primary data capture and quality. Guy A , Prager R , Turris S , Lund A . Improving data quality in mass-gatherings health research. Prehosp Disaster Med. 2017;32(3):1-4.

  7. Quality Rating and Improvement System State Evaluations and Research

    ERIC Educational Resources Information Center

    Ferguson, Daniel

    2016-01-01

    A quality rating and improvement system (QRIS) is a method used by states and local jurisdictions to assess the level of quality of child care and early education programs, improve quality, and convey quality ratings to parents and other consumers. A typical QRIS incorporates the following components: quality standards for participating providers;…

  8. Revitalizing Space Operations through Total Quality Management

    NASA Technical Reports Server (NTRS)

    Baylis, William T.

    1995-01-01

    The purpose of this paper is to show the reader what total quality management (TQM) is and how to apply TQM in the space systems and management arena. TQM is easily understood, can be implemented in any type of business organization, and works.

  9. Using genomics to improve fruit quality.

    PubMed

    Meneses, Claudio; Orellana, Ariel

    2013-01-01

    New fruit varieties are needed to satisfy consumers, and the industry is facing new challenges in order to respond to these demands. The emergence of genomic tools is releasing information on polymorphisms that can be utilized to expedite breeding processes in species that are difficult to breed, given the long periods of time required to get new varieties. The present review describes the current stages of the ongoing efforts that are being taken to apply these technologies to obtain varieties with improved fruit quality in species of the family Rosaceae.

  10. U. S. gas pipelines improve operations

    SciTech Connect

    True, W.R.

    1990-11-26

    This paper discusses how operations for regulated U.S. interstate natural-gas pipeline companies showed increased efficiency last year as incomes leaped despite flat revenues. Net incomes for these companies gained more than $900 million in 1989, while operating revenues declined a negligible 1.2%. Common-carrier oil pipelines, on the other hand, continued to operate in the doldrums with incomes declining for the third straight year and revenues dropping for the sixth year in a row.

  11. Ensemble Streamflow Forecast Improvements in NYC's Operations Support Tool

    NASA Astrophysics Data System (ADS)

    Wang, L.; Weiss, W. J.; Porter, J.; Schaake, J. C.; Day, G. N.; Sheer, D. P.

    2013-12-01

    end of high flow periods. These improvements allowed DEP to more effectively manage water quality control and spill mitigation operations immediately after storm events. Later on, post-processed hydrologic forecasts from the National Weather Service (NWS) including the Advanced Hydrologic Prediction Service (AHPS) and the Hydrologic Ensemble Forecast Service (HEFS) were implemented into OST. These forecasts further increased the predictive skill over the initial statistical models as current basin conditions (e.g. soil moisture, snowpack) and meteorological forecasts (with HEFS) are now explicitly represented. With the post-processed HEFS forecasts, DEP may now truly quantify impacts associated with wet weather events on the horizon, rather than relying on statistical representations of current hydrologic trends. This presentation will highlight the benefits of the improved forecasts using examples from actual system operations.

  12. Biospecimen reporting for improved study quality (BRISQ).

    PubMed

    Moore, Helen M; Kelly, Andrea B; Jewell, Scott D; McShane, Lisa M; Clark, Douglas P; Greenspan, Renata; Hayes, Daniel F; Hainaut, Pierre; Kim, Paula; Mansfield, Elizabeth A; Potapova, Olga; Riegman, Peter; Rubinstein, Yaffa; Seijo, Edward; Somiari, Stella; Watson, Peter; Weier, Heinz-Ulrich; Zhu, Claire; Vaught, Jim

    2011-04-25

    Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

  13. Biospecimen Reporting for Improved Study Quality (BRISQ)

    SciTech Connect

    National Cancer Institute; Jewell, Ph.D., Scott D.; Seijo, M.S., Edward; Kelly, Ph.D., Andrea; Somiari, Ph.D., Stella; B.Chir., M.B.; McShane, Ph.D., Lisa M.; Clark, M.D., Douglas; Greenspan, M.D., Renata; Hayes, M.D., Daniel F.; Hainaut, Ph.D., M.S., Pierre; Kim, Paula; Mansfield, Ph.D., Elizabeth; Potapova, Ph.D., Olga; Riegman, Ph.D., Peter; Rubinstein, Ph.D., Yaffa; Weier, Ph.D., Heinz-Ulrich; Zhu, Ph.D., Claire; Moore, Ph.D., Helen M.; Vaught, Ph.D., Jim; Watson, Peter

    2010-09-02

    Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

  14. Biospecimen Reporting for Improved Study Quality (BRISQ)

    SciTech Connect

    Moore, Ph.D., Helen M.; Kelly Ph.D., Andrea; Jewell Ph.D., Scott D.; McShane Ph.D., Lisa M.; Clark M.D., Douglas P.; Greenspan M.D., Renata; Hayes M.D., Daniel F.; Hainaut Ph.D.,, Pierre; Kim, Paula; Mansfield Ph.D., Elizabeth; Potapova Ph.D., Olga; Riegman Ph.D., Peter; Rubinstein Ph.D., Yaffa; Seijo M.S., Edward; Somiari Ph.D., Stella; Watson M.B., Peter; Weier Ph.D., Heinz-Ulrich; Zhu Ph.D., Claire; Vaught Ph.D., Jim

    2011-04-26

    Human biospecimens are subject to a number of different collection, processing, and storage factors that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research utilizing human tissues it is critical that information regarding the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications around biospecimen-related research and help reassure patient contributors and the advocacy community that the contributions are valued and respected.

  15. Biospecimen Reporting for Improved Study Quality

    SciTech Connect

    Moore, Ph.D., Helen M.; Kelly, Ph.D., Andrea B.; Jewell, Ph.D., Scott D.; McShane, Ph.D., Lisa M.; Clark, M.D., Douglas P.; Greenspan, M.D., Renata; Hayes, M.D., Daniel F.; Hainaut, Ph.D., Pierre; Kim, Paula; Mansfield, Ph.D., Elizabeth A.; Potapova, Ph.D., Olga; Riegman, Ph.D., Peter; Rubinstein, Ph.D., Yaffa; Seijo, M.S., Edward; Somiari, Ph.D., Stella; Chir., B; Weier, Ph.D., Heinz-Ulrich; Zhu, Ph.D., Claire; Vaught, Ph.D., Jim; Watson,M.B., Peter

    2010-12-27

    Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

  16. A Value Management Approach to Improving Quality (ICP/JOU-05-00825)

    SciTech Connect

    James R. Wixson; Howard Stromberg

    2005-07-01

    In October 2001, the Department of Energy’s, Office of Price-Anderson Enforcement determined that the continuous improvement aspect of the INEEL Quality Assurance Program was inadequate. At the request of the INEEL Senior Management, a Quality Assurance Operations (QAO) Task Team was identified and requested to review the INEEL practices to determine whether the INEEL was performing the activities that are required for Quality Implementation. The team consisted of INEEL managers from Operations, Quality Assurance, Document and Records Management, Construction Services, Radiological Control, and Engineering. FAST modeling combined with other analytical techniques were used to identify areas for improvement and resolve the issues related to inadequate continuous improvement efforts.

  17. Improving Influence Operations by Defining Influence and Influence Operations

    DTIC Science & Technology

    2013-12-10

    time and again,” neglected to consider fully the physical, cultural and social systems that exist within the overall human environment.8 Yet, as the...marketing. The underlying assumption is that all consumers will eventually purchase something. Thus, attitudinal messaging seeks to shape what... consumers ultimately purchase . (These principles form the basis of current Information Operations Officer training.) He argues that there is no linkage

  18. Automation Improves Schedule Quality and Increases Scheduling Efficiency for Residents

    PubMed Central

    Perelstein, Elizabeth; Rose, Ariella; Hong, Young-Chae; Cohn, Amy; Long, Micah T.

    2016-01-01

    Background Medical resident scheduling is difficult due to multiple rules, competing educational goals, and ever-evolving graduate medical education requirements. Despite this, schedules are typically created manually, consuming hours of work, producing schedules of varying quality, and yielding negative consequences for resident morale and learning. Objective To determine whether computerized decision support can improve the construction of residency schedules, saving time and improving schedule quality. Methods The Optimized Residency Scheduling Assistant was designed by a team from the University of Michigan Department of Industrial and Operations Engineering. It was implemented in the C.S. Mott Children's Hospital Pediatric Emergency Department in the 2012–2013 academic year. The 4 metrics of schedule quality that were compared between the 2010–2011 and 2012–2013 academic years were the incidence of challenging shift transitions, the incidence of shifts following continuity clinics, the total shift inequity, and the night shift inequity. Results All scheduling rules were successfully incorporated. Average schedule creation time fell from 22 to 28 hours to 4 to 6 hours per month, and 3 of 4 metrics of schedule quality significantly improved. For the implementation year, the incidence of challenging shift transitions decreased from 83 to 14 (P < .01); the incidence of postclinic shifts decreased from 72 to 32 (P < .01); and the SD of night shifts dropped by 55.6% (P < .01). Conclusions This automated shift scheduling system improves the current manual scheduling process, reducing time spent and improving schedule quality. Embracing such automated tools can benefit residency programs with shift-based scheduling needs. PMID:26913102

  19. How can we recognize continuous quality improvement?

    PubMed Central

    Rubenstein, Lisa; Khodyakov, Dmitry; Hempel, Susanne; Danz, Margie; Salem-Schatz, Susanne; Foy, Robbie; O'Neill, Sean; Dalal, Siddhartha; Shekelle, Paul

    2014-01-01

    Objective Continuous quality improvement (CQI) methods are foundational approaches to improving healthcare delivery. Publications using the term CQI, however, are methodologically heterogeneous, and labels other than CQI are used to signify relevant approaches. Standards for identifying the use of CQI based on its key methodological features could enable more effective learning across quality improvement (QI) efforts. The objective was to identify essential methodological features for recognizing CQI. Design Previous work with a 12-member international expert panel identified reliably abstracted CQI methodological features. We tested which features met rigorous a priori standards as essential features of CQI using a three-phase online modified-Delphi process. Setting Primarily United States and Canada. Participants 119 QI experts randomly assigned into four on-line panels. Intervention(s) Participants rated CQI features and discussed their answers using online, anonymous and asynchronous discussion boards. We analyzed ratings quantitatively and discussion threads qualitatively. Main outcome measure(s) Panel consensus on definitional CQI features. Results Seventy-nine (66%) panelists completed the process. Thirty-three completers self-identified as QI researchers, 18 as QI practitioners and 28 as both equally. The features ‘systematic data guided activities,’ ‘designing with local conditions in mind’ and ‘iterative development and testing’ met a priori standards as essential CQI features. Qualitative analyses showed cross-cutting themes focused on differences between QI and CQI. Conclusions We found consensus among a broad group of CQI researchers and practitioners on three features as essential for identifying QI work more specifically as ‘CQI.’ All three features are needed as a minimum standard for recognizing CQI methods. PMID:24311732

  20. Quality-control standard operating procedures-an essential tool for developing quality preparations.

    PubMed

    Ashworth, Lisa D

    2007-01-01

    Maintaining quality in compounded preparations must be a top priority of top management, and it must involve all pharmacy employees. Pharmacy compounding requires the development and maintenance of standard operating procedures to ensure quality and minimize compounding errors. Standard operating procedures are detailed instructions initiated by the pharmacist-in-charge or the quality control officer for the purpose of assuring the reliable, consistent performance of routine tasks involved in formulation development, purchasing, compounding, testing, maintenance, materials handling, quality assurance, and dispensing. Maintaining written standard operation procedures is an important step in assuring that a phamacy has developed a quality compounding practice that meets and/or exceeds United States Pharmacopeial standards.

  1. Improve operations and enhance refinery sulfur recovery

    SciTech Connect

    Bourdon, J.C.

    1997-04-01

    Sulfur is a common contaminant in fossil fuels, released when these fuels are combusted. It causes acid rain and other environmental problems. Sulfur emissions have gained worldwide attention, resulting in tighter requirements for sulfur recovery facilities. New technologies and enhancements to existing technologies have emerged as a result. This overview presents many technologies used for sulfur recovery. It is organized around the unit operations of gas and liquid sweetening, sour water stripping, sulfur recovery, sulfur degassing and solidification, tail gas treating, and incineration. New technical and equipment innovations have resulted in sulfur recovery facilities that are more reliable, recover more sulfur, are easier to operate, and reduce capital and operating costs.

  2. Quality improvement in neurology: dementia management quality measures.

    PubMed

    Odenheimer, Germaine; Borson, Soo; Sanders, Amy E; Swain-Eng, Rebecca J; Kyomen, Helen H; Tierney, Samantha; Gitlin, Laura; Forciea, Mary Ann; Absher, John; Shega, Joseph; Johnson, Jerry

    2014-03-01

    Professional and advocacy organizations have long urged that dementia should be recognized and properly diagnosed. With the passage of the National Alzheimer's Project Act in 2011, an Advisory Council for Alzheimer's Research, Care, and Services was convened to advise the Department of Health and Human Services. In May 2012, the Council produced the first National Plan to address Alzheimer's disease, and prominent in its recommendations is a call for quality measures suitable for evaluating and tracking dementia care in clinical settings. Although other efforts have been made to set dementia care quality standards, such as those pioneered by RAND in its series Assessing Care of Vulnerable Elders (ACOVE), practitioners, healthcare systems, and insurers have not widely embraced implementation. This executive summary (full manuscript available at www.neurology.org) reports on a new measurement set for dementia management developed by an interdisciplinary Dementia Measures Work Group (DWG) representing the major national organizations and advocacy organizations concerned with the care of individuals with dementia. The American Academy of Neurology (AAN), the American Geriatrics Society, the American Medical Directors Association, the American Psychiatric Association, and the American Medical Association-convened Physician Consortium for Performance Improvement led this effort. The ACOVE measures and the measurement set described here apply to individuals whose dementia has already been identified and properly diagnosed. Although similar in concept to ACOVE, the DWG measurement set differs in several important ways; it includes all stages of dementia in a single measure set, calls for the use of functional staging in planning care, prompts the use of validated instruments in patient and caregiver assessment and intervention, highlights the relevance of using palliative care concepts to guide care before the advanced stages of illness, and provides evidence-based support

  3. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities.

    PubMed

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high-quality

  4. SF Bay Water Quality Improvement Fund: Projects and Accomplishments

    EPA Pesticide Factsheets

    San Francisco Bay Water Quality Improvement Fund (SFBWQIF) projects listed here are part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

  5. Foliage Plants for Improving Indoor Air Quality

    NASA Technical Reports Server (NTRS)

    Wolverton, B. C.

    1988-01-01

    NASA's research with foliage houseplants during the past 10 years has produced a new concept in indoor air quality improvement. This new and exciting technology is quite simple. Both plant leaves and roots are utilized in removing trace levels of toxic vapors from inside tightly sealed buildings. Low levels of chemicals such as carbon monoxide and formaldehyde can be removed from indoor environments by plant leaves alone, while higher concentrations of numerous toxic chemicals can be removed by filtering indoor air through the plant roots surrounded by activated carbon. The activated carbon absorbs large quantities of the toxic chemicals and retains them until the plant roots and associated microorganisms degrade and assimilate these chemicals.

  6. Criteria for the Evaluation of Quality Improvement Programs and the Use of Quality Improvement Data

    ERIC Educational Resources Information Center

    American Psychologist, 2009

    2009-01-01

    This document provides a set of criteria to be used by psychologists in evaluating quality improvement programs (QIPs) that have been promulgated by health care organizations, government agencies, professional associations, or other entities. These criteria also address the privacy and confidentiality issues evoked by the intended use of patient…

  7. Quality Improvement: A Strategy for Planned Organizational Change.

    ERIC Educational Resources Information Center

    Kovel-Jarboe, Patricia

    1996-01-01

    Considers strategies for the implementation of quality improvement in libraries. Highlights include structured quality improvement, especially Total Quality Management; organizational change; customer focus; continuous improvement; data-based decision making; systems thinking; employee involvement in decision making; diffusion of innovation;…

  8. Thoughts about conceptual models, theories, and quality improvement projects.

    PubMed

    Fawcett, Jacqueline

    2014-10-01

    This essay focuses on how a conceptual model of nursing can be the basis for identification of the phenomenon of interest for a quality improvement project and how a theory of quality improvement or a theory of change is the methodological guide for the project. An explanation and examples of conceptual-theoretical-empirical structures for quality improvement projects are given.

  9. The impact of flying qualities on helicopter operational agility

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

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

  10. Operating Systems. Curriculum Improvement Project. Region II.

    ERIC Educational Resources Information Center

    Wagstaff, Charlene

    This course curriculum is intended for community college instructors and administrators to use in implementing an operating systems course. A student's course syllabus provides this information: credit hours, catalog description, prerequisites, required texts, instructional process, objectives, student evaluation, and class schedule. A student…

  11. Improving mental health outcomes: achieving equity through quality improvement

    PubMed Central

    Poots, Alan J.; Green, Stuart A.; Honeybourne, Emmi; Green, John; Woodcock, Thomas; Barnes, Ruth; Bell, Derek

    2014-01-01

    Objective To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative. Design Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control. Setting A psychological therapy service in Westminster, London, UK. Participants People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012. Intervention(s) Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks. Main Outcome Measure(s) (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator. Results Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), compared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low, medium and high deprivation areas attained similar changes in depression score (ΔPHQ9: M = −6.60, SD = 6.41). Similar proportions of patients achieved the key performance indicator across initiative phase and deprivation categories. Conclusions QI methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome. PMID:24521701

  12. Sustaining Operational Resiliency: A Process Improvement Approach to Security Management

    DTIC Science & Technology

    2006-04-01

    5 2 Operational Resiliency Defined....................................................................6 2.1 What is Resiliency...30 4.3.5 Increasing levels of competency............................................... 30 5 A Process Improvement Framework for...mission.................................. 19 Figure 5 : Foundation for operational resiliency ..................................................... 21

  13. Improvements needed in EPA's Inspector General operations

    SciTech Connect

    Bowsher, C.A.

    1983-10-21

    At the request of the Subcommittee on Natural Resources, Agriculture Research and Environment and the Subcommittee on Civil Service, House of Representatives, GAO reviewed the operations of the Office of Inspector General, Environmental Protection Agency, under the leadership of former Inspector General Matthew Novick. GAO found that although most investigations appear to have been handled properly, in some cases all relevant matters were not followed up and consistently addressed. GAO also noted the need to use investigative resources more effectively and to provide more balanced audit coverage. Acting Inspector General Charles Dempsey recognized and made a concerted effort to correct many problems during his tenure. GAO recommends further actions to strengthen inspector general operations at EPA.

  14. Improving Robotic Operator Performance Using Augmented Reality

    NASA Technical Reports Server (NTRS)

    Maida, James C.; Bowen, Charles K.; Pace, John W.

    2007-01-01

    The Special Purpose Dexterous Manipulator (SPDM) is a two-armed robot that functions as an extension to the end effector of the Space Station Robotics Manipulator System (SSRMS), currently in use on the International Space Station (ISS). Crew training for the SPDM is accomplished using a robotic hardware simulator, which performs most of SPDM functions under normal static Earth gravitational forces. Both the simulator and SPDM are controlled from a standard robotic workstation using a laptop for the user interface and three monitors for camera views. Most operations anticipated for the SPDM involve the manipulation, insertion, and removal of any of several types of Orbital Replaceable Unit (ORU), modules which control various ISS functions. Alignment tolerances for insertion of the ORU into its receptacle are 0.25 inch and 0.5 degree from nominal values. The pre-insertion alignment task must be performed within these tolerances by using available video camera views of the intrinsic features of the ORU and receptacle, without special registration markings. Since optimum camera views may not be available, and dynamic orbital lighting conditions may limit periods of viewing, a successful ORU insertion operation may require an extended period of time. This study explored the feasibility of using augmented reality (AR) to assist SPDM operations. Geometric graphical symbols were overlaid on one of the workstation monitors to afford cues to assist the operator in attaining adequate pre-insertion ORU alignment. Twelve skilled subjects performed eight ORU insertion tasks using the simulator with and without the AR symbols in a repeated measures experimental design. Results indicated that using the AR symbols reduced pre-insertion alignment error for all subjects and reduced the time to complete pre-insertion alignment for most subjects.

  15. Improving medical handover at the weekend: a quality improvement project

    PubMed Central

    Michael, Emma; Patel, Chandni

    2015-01-01

    revealed a high degree of satisfaction with the new weekend handover system. In conclusion we found that a structured, well organised weekend handover meeting together with an effective electronic handover system improves the quality of medical weekend handover. PMID:26734385

  16. Nutrition interventions need improved operational capacity

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Lancet's Child Survival Series was a galvanising manifesto: it focused action plans to improve the well-being of children worldwide. However, the authors did not address in detail the importance of nutrition in child survival, and thus the current Undernutrition Series was born. This welcome n...

  17. Team Learning for Healthcare Quality Improvement.

    PubMed

    Manukyan, Narine; Eppstein, Margaret J; Horbar, Jeffrey D

    2013-08-28

    In organized healthcare quality improvement collaboratives (QICs), teams of practitioners from different hospitals exchange information on clinical practices with the aim of improving health outcomes at their own institutions. However, what works in one hospital may not work in others with different local contexts because of nonlinear interactions among various demographics, treatments, and practices. In previous studies of collaborations where the goal is a collective problem solving, teams of diverse individuals have been shown to outperform teams of similar individuals. However, when the purpose of collaboration is knowledge diffusion in complex environments, it is not clear whether team diversity will help or hinder effective learning. In this paper, we first use an agent-based model of QICs to show that teams comprising similar individuals outperform those with more diverse individuals under nearly all conditions, and that this advantage increases with the complexity of the landscape and level of noise in assessing performance. Examination of data from a network of real hospitals provides encouraging evidence of a high degree of similarity in clinical practices, especially within teams of hospitals engaging in QIC teams. However, our model also suggests that groups of similar hospitals could benefit from larger teams and more open sharing of details on clinical outcomes than is currently the norm. To facilitate this, we propose a secure virtual collaboration system that would allow hospitals to efficiently identify potentially better practices in use at other institutions similar to theirs without any institutions having to sacrifice the privacy of their own data. Our results may also have implications for other types of data-driven diffusive learning such as in personalized medicine and evolutionary search in noisy, complex combinatorial optimization problems.

  18. Improving Water Quality With Conservation Buffers

    NASA Astrophysics Data System (ADS)

    Lowrance, R.; Dabney, S.; Schultz, R.

    2003-12-01

    Conservation buffer technologies are new approaches that need wider application. In-field buffer practices work best when used in combination with other buffer types and other conservation practices. Vegetative barriers may be used in combination with edge-of-field buffers to protect and improve their function and longevity by dispersing runoff and encouraging sediment deposition upslope of the buffer. It's important to understand how buffers can be managed to help reduce nutrient transport potential for high loading of nutrients from manure land application sites, A restored riparian wetland buffer retained or removed at least 59 percent of the nitrogen and 66 percent of the phosphorus that entered from an adjacent manure land application site. The Bear Creek National Restoration Demonstration Watershed project in Iowa has been the site of riparian forest buffers and filter strips creation; constructed wetlands to capture tile flow; stream-bank bioengineering; in-stream structures; and controlling livestock grazing. We need field studies that test various widths of buffers of different plant community compositions for their efficacy in trapping surface runoff, reducing nonpoint source pollutants in subsurface waters, and enhancing the aquatic ecosystem. Research is needed to evaluate the impact of different riparian grazing strategies on channel morphology, water quality, and the fate of livestock-associated pathogens and antibiotics. Integrating riparian buffers and other conservation buffers into these models is a key objective in future model development.

  19. Optical parametric osicllators with improved beam quality

    DOEpatents

    Smith, Arlee V.; Alford, William J.

    2003-11-11

    An optical parametric oscillator (OPO) having an optical pump, which generates a pump beam at a pump frequency greater than a desired signal frequency, a nonlinear optical medium oriented so that a signal wave at the desired signal frequency and a corresponding idler wave are produced when the pump beam (wave) propagates through the nonlinear optical medium, resulting in beam walk off of the signal and idler waves, and an optical cavity which directs the signal wave to repeatedly pass through the nonlinear optical medium, said optical cavity comprising an equivalently even number of non-planar mirrors that produce image rotation on each pass through the nonlinear optical medium. Utilizing beam walk off where the signal wave and said idler wave have nonparallel Poynting vectors in the nonlinear medium and image rotation, a correlation zone of distance equal to approximately .rho.L.sub.crystal is created which, through multiple passes through the nonlinear medium, improves the beam quality of the OPO output.

  20. Timing control improves seabed survey data quality

    SciTech Connect

    Green, R.

    1996-04-01

    Seateam has completed development of and field-proven the Dolphin data acquisition and timing system for high-density surveys offshore. The Dolphin project was initiated to improve quality control of survey sensor data and ensure time synchronization, thus leading to faster turnaround of seabed terrain information. Data received from survey sensors is asynchronous, so the system must provide for data correlation. This includes establishment of data latency, i.e., the time difference between data creation and timing of the message at first-byte arrival at the recording system. Until recently, asynchronous data from multiple sensors was collected by a single computer, regardless of whether it had additional intelligent or non-intelligent serial cards. This computer was fully responsible for time stamping all incoming data, plus associated storage and distribution. Though this initially sufficed and is still applicable to low-density data, increasingly larger data volumes required an associated boost in the capability to time stamp data prior to eventual correction.

  1. Improved Operating Performance of Mining Machine Picks

    NASA Astrophysics Data System (ADS)

    Prokopenko, S.; Li, A.; Kurzina, I.; Sushko, A.

    2016-08-01

    The reasons of low performance of mining machine picks are stated herein. In order to improve the wear resistance and the cutting ability of picks a new design of a cutting carbide tip insert to be fixed on a removable and rotating pick head is developed. Owing to the new design, the tool ensures a twofold increase in the cutting force maintained longer, a twofold reduction in the specific power consumption of the breaking process, and extended service life of picks and the possibility of their multiple use.

  2. Achieving the Health Care Financing Administration limits by quality improvement and quality control. A real-world example.

    PubMed

    Engebretson, M J; Cembrowski, G S

    1992-07-01

    With the enactment of the Clinical Laboratory Improvement Amendments of 1988 (CLIA 88), the federal government is now using proficiency testing as the primary indicator of laboratory quality. Laboratories with proficiency test failures are now at risk of a variety of harsh penalties including large monetary fines and suspension of operations. To minimize the risk of failed proficiency testing, we initiated a continuous quality improvement program in our general chemistry laboratory in conjunction with the use of a new survey-validated quality control product. This article describes the quality improvement program and our success in reducing the long-term random error in general chemistry. Despite our improvement program, significant analytical errors (greater than 30% of the CLIA limits) still exist in analytes measured by our chemistry analyzer. These errors are present in nearly the same analytes measured by other common chemistry analyzers indicating the need for improvement in their design and manufacture.

  3. Improvements in sparse matrix operations of NASTRAN

    NASA Technical Reports Server (NTRS)

    Harano, S.

    1980-01-01

    A "nontransmit" packing routine was added to NASTRAN to allow matrix data to be refered to directly from the input/output buffer. Use of the packing routine permits various routines for matrix handling to perform a direct reference to the input/output buffer if data addresses have once been received. The packing routine offers a buffer by buffer backspace feature for efficient backspacing in sequential access. Unlike a conventional backspacing that needs twice back record for a single read of one record (one column), this feature omits overlapping of READ operation and back record. It eliminates the necessity of writing, in decomposition of a symmetric matrix, of a portion of the matrix to its upper triangular matrix from the last to the first columns of the symmetric matrix, thus saving time for generating the upper triangular matrix. Only a lower triangular matrix must be written onto the secondary storage device, bringing 10 to 30% reduction in use of the disk space of the storage device.

  4. New thermal packer improves steamflood operations

    SciTech Connect

    Doherty, B.J.; Captain, K.M.; Hutchison, S.O.

    1982-10-01

    The sealing ability of a packer for high temperature use has been improved by the addition of a 3-metal, composite seal ring that replaces conventional elastomer material. Lab tests are being confirmed by prolonged use in the field. Field experience confirms that in deep, hot, steam-injection wells and geothermal wells, packer reliability is poor. The problem usually is caused by degradation of the packer seal while other parts of the packer (slips, etc.) seem to work well. Seal failure generally occurs because conventional seal materials degrade at high temperature and thus deform and distort under pressure. Such failure is hastened by transient loading (thermal cycling) that occurs, for instance, due to periodic interruptions in the steam supply.

  5. Quality improvement in public health institutions.

    PubMed

    Sanadia, Bharti N

    2005-02-01

    Quality issues are integral to providing primary health care. The delivery of health care is a complex process that involves a number of factors such as interpersonal skill, culture, technology and available resources. In general, quality is defined as customer satisfaction at competitive cost. As per John Guaspari, "Quality should not be positioned as the absence of problems as defined by us. It should be positioned as the presence of Value and satisfaction as defined by the customers/clients."

  6. 21 CFR 111.127 - What quality control operations are required for packaging and labeling operations?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false What quality control operations are required for packaging and labeling operations? 111.127 Section 111.127 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION CURRENT GOOD...

  7. Informatics: essential infrastructure for quality assessment and improvement in nursing.

    PubMed Central

    Henry, S B

    1995-01-01

    In recent decades there have been major advances in the creation and implementation of information technologies and in the development of measures of health care quality. The premise of this article is that informatics provides essential infrastructure for quality assessment and improvement in nursing. In this context, the term quality assessment and improvement comprises both short-term processes such as continuous quality improvement (CQI) and long-term outcomes management. This premise is supported by 1) presentation of a historical perspective on quality assessment and improvement; 2) delineation of the types of data required for quality assessment and improvement; and 3) description of the current and potential uses of information technology in the acquisition, storage, transformation, and presentation of quality data, information, and knowledge. PMID:7614118

  8. Improving Quality Higher Education in Nigeria: The Roles of Stakeholders

    ERIC Educational Resources Information Center

    Asiyai, Romina Ifeoma

    2015-01-01

    This paper discusses the roles of stakeholders in improving quality of university education in Nigeria. Internal and external stakeholders are identified and the various roles they could play in improving the quality of university education are discussed. The paper contends that continuous and holistic improvement in university education system…

  9. EPA Pushing Improved Air Quality in Schools.

    ERIC Educational Resources Information Center

    Sack, Joetta L.

    2002-01-01

    Discusses how, in response to the growing problem of poor air quality in schools, the Environmental Protection Agency (EPA) has set new voluntary air-quality guidelines for schools. Addresses common air-related irritants; successful efforts at Guerrero Elementary School in Mesa, Arizona; preventive maintenance; and a sample of the EPA's…

  10. Improving the Quality of Teaching in Australia

    ERIC Educational Resources Information Center

    Dinham, Stephen

    2011-01-01

    Australia needs to more effectively attract, train, support, retain, recognize, and reward quality teachers throughout their careers. After a slow start and decades of debate, the pieces of the quality teaching puzzle are now coming together. Increased federal government intervention and financial support, along with state and territorial support…

  11. Handling Qualities Influences on Civil Tiltrotor Terminal Operating Procedure Development

    NASA Technical Reports Server (NTRS)

    Decker, William A.; Simmons, Rickey C.; Tucker, George E.; Aiken, Edwin W. (Technical Monitor)

    1994-01-01

    The potential for tiltrotor aircraft as civil transports has been well recognized. Realization of that potential requires development of operating procedures tailored to take advantage of the tiltrotor's capabilities, including thrust vectoring independent of body pitch attitude and good low-speed control. While the tiltrotor shares flight characteristics with both fixed wing airplanes and helicopters, it must convert between those flight modes, typically within the context of precise terminal operations. A series of piloted simulation experiments has been conducted on the NASA Ames Research Center Vertical Motion Simulator (VMS) to investigate the influence of tiltrotor cockpit design features on developing certification and operating criteria for civil tiltrotor transports. Handling qualities evaluations have shaped cockpit design guidelines and operating procedure development for a civil tiltrotor. In particular, four topics demonstrate the interplay of handling qualities and operations profile in the development of terminal operating procedures and cockpit or control equipment for a civil tiltrotor: conversion (airplane to helicopter mode), final approach path angle, operating profile speeds and speed changes (particularly under instrument conditions), and one engine inoperative operational considerations.

  12. Guidelines for appraisal and publication of PDSA quality improvement.

    PubMed

    Speroff, Theodore; James, Brent C; Nelson, Eugene C; Headrick, Linda A; Brommels, Mats

    2004-01-01

    Plan-do-study-act (PDSA) quality improvement is the application of the scientific method to implement and test the effects of change ideas on the performance of the health care system. Users of quality improvement could benefit with markers to gauge the "best" science. Four core questions can determine the value of a quality improvement study: Is the quality improvement study pertinent and relevant? Are the results valid? Are appropriate criteria used to interpret the results? Will the study help you with your practice or organization of care? A set of guidelines is provided to help answer these questions. Similar guidelines exist for randomized clinical trials and clinical-epidemiologic observational studies. Analogous to these existing research guidelines, the PDSA quality improvement guidelines will provide researchers and reviewers with succinct standards of methodological rigor to assist in critical appraisal of quality improvement protocols and publications.

  13. Operational air quality forecast guidance for the United States

    NASA Astrophysics Data System (ADS)

    Stajner, Ivanka; Lee, Pius; Tong, Daniel; Pan, Li; McQueen, Jeff; Huang, Jinaping; Djalalova, Irina; Wilczak, James; Huang, Ho-Chun; Wang, Jun; Stein, Ariel; Upadhayay, Sikchya

    2016-04-01

    NOAA provides operational air quality predictions for ozone and wildfire smoke over the United States (U.S.) and predictions of airborne dust over the contiguous 48 states at http://airquality.weather.gov. These predictions are produced using U.S. Environmental Protection Agency (EPA) Community Model for Air Quality (CMAQ) and NOAA's HYSPLIT model (Stein et al., 2015) with meteorological inputs from the North American Mesoscale Forecast System (NAM). The current efforts focus on improving test predictions of fine particulate matter (PM2.5) from CMAQ. Emission inputs for ozone and PM2.5 predictions include inventory information from the U.S. EPA and recently added contributions of particulate matter from intermittent wildfires and windblown dust that rely on near real-time information. Current testing includes refinement of the vertical grid structure in CMAQ and inclusion of contributions of dust transport from global sources into the U.S. domain using the NEMS Global Aerosol Capability (NGAC). The addition of wildfire smoke and dust contributions in CMAQ reduced model underestimation of PM2.5 in summertime. Wintertime overestimation of PM2.5 was reduced by suppressing emissions of soil particles when the terrain is covered by snow or ice. Nevertheless, seasonal biases and biases in the diurnal cycle of PM2.5 are still substantial. Therefore, a new bias correction procedure based on an analog ensemble approach was introduced (Djalalova et al., 2015). It virtually eliminates biases in monthly means or in the diurnal cycle, but it also reduces day-to-day variability in PM2.5 predictions. Refinements to the bias correction procedure are being developed. Upgrades for the representation of wildfire smoke emissions within the domain and from global sources are in testing. Another area of active development includes approaches to scale emission inventories for nitrogen oxides in order to reproduce recent changes observed by the AirNow surface monitoring network and by

  14. Mining Program Source Code for Improving Software Quality

    DTIC Science & Technology

    2013-01-01

    REPORT Mining Program Source Code for Improving Software Quality 14. ABSTRACT 16. SECURITY CLASSIFICATION OF: While the last decade has witnessed great...Z39.18 - 7-Sep-2012 Mining Program Source Code for Improving Software Quality Report Title ABSTRACT While the last decade has witnessed great...businesses, governments, and societies, improving software productivity and quality is an important goal of software engineering. Mining software

  15. Improving Hospital Quality and Patient Safety an Examination of Organizational Culture and Information Systems

    ERIC Educational Resources Information Center

    Gardner, John Wallace

    2012-01-01

    This dissertation examines the effects of safety culture, including operational climate and practices, as well as the adoption and use of information systems for delivering high quality healthcare and improved patient experience. Chapter 2 studies the influence of both general and outcome-specific hospital climate and quality practices on process…

  16. Quality assurance of radiotherapy in cancer treatment: toward improvement of patient safety and quality of care.

    PubMed

    Ishikura, Satoshi

    2008-11-01

    The process of radiotherapy (RT) is complex and involves understanding of the principles of medical physics, radiobiology, radiation safety, dosimetry, radiation treatment planning, simulation and interaction of radiation with other treatment modalities. Each step in the integrated process of RT needs quality control and quality assurance (QA) to prevent errors and to give high confidence that patients will receive the prescribed treatment correctly. Recent advances in RT, including intensity-modulated and image-guided RT, focus on the need for a systematic RTQA program that balances patient safety and quality with available resources. It is necessary to develop more formal error mitigation and process analysis methods, such as failure mode and effect analysis, to focus available QA resources optimally on process components. External audit programs are also effective. The International Atomic Energy Agency has operated both an on-site and off-site postal dosimetry audit to improve practice and to assure the dose from RT equipment. Several countries have adopted a similar approach for national clinical auditing. In addition, clinical trial QA has a significant role in enhancing the quality of care. The Advanced Technology Consortium has pioneered the development of an infrastructure and QA method for advanced technology clinical trials, including credentialing and individual case review. These activities have an impact not only on the treatment received by patients enrolled in clinical trials, but also on the quality of treatment administered to all patients treated in each institution, and have been adopted globally; by the USA, Europe and Japan also.

  17. Air Quality Operating Permits Programs Which Apply to Tribal Lands

    EPA Pesticide Factsheets

    This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Policy and Guidance Database available at www2.epa.gov/title-v-operating-permits/title-v-operating-permit-policy-and-guidance-document-index. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

  18. Auditing and assessing air quality in concentrated feeding operations

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The potential adverse effects of concentrated animal feeding operations (CAFO) on the environment are a growing concern. The air quality issues of most concerns to CAFO vary, but generally include ammonia, hydrogen sulfide, particulate matter (PM), volatile organic compounds (VOC), green house gase...

  19. Lake Tahoe Water Quality Improvement Programs

    EPA Pesticide Factsheets

    Information on the Lake Tahoe watershed, EPA's protection efforts, water quality issues, effects of climate, change, Lake Tahoe Total Maximum Daily Load TMDL), EPA-sponsored projects, list of partner agencies.

  20. [Critical reflexion on quality improvement and networking].

    PubMed

    Adler, R

    2012-06-06

    Qualitiy-control and networking are two issues of debate in modern medicine. The origin of these terms is not to be found in medicine, but rather in industry. However their naive transfer to the field of medicine causes damage. It is relatively easy to test industrial products for their quality. Dealing with meaningful medical problems is far too complex. Simple data such as blood pressure, HbA1c, etc. may be assessed. The only means of quality-control of complex medical situations and actions are ward rounds by attending physicians, case presentations at staff meetings, etc. Issues of clinical quality-control are discussed on the basis of the history of an aged couple. Furthermore a personal clinical experience illustrates how doctors create a useful network with other physicians and how they eliminate "useless" colleagues from their network. Economists should have no influence or impact whatsoever on the quality-control and networking of physicians.

  1. The role of academic medicine in improving health care quality.

    PubMed

    Brindis, Ralph G; Spertus, John

    2006-09-01

    Academic medicine, often entrenched in biomedical and clinical research, has largely ignored the development and application of quality metrics to ensure the delivery of high-quality health care. Nevertheless, academic medicine has substantial opportunities to lead the charge in building a quality infrastructure with the goal of delivering high-quality and cost-efficient health care to all Americans. The American College of Cardiology (ACC) and American Heart Association (AHA) have worked jointly to measure and improve the quality of cardiovascular care. This effort has led to the development of clinical practice guidelines, performance measures, data standards, national registries, and appropriateness criteria for cardiovascular care. Academic medicine should actively embrace and promote the type of quality metrics and criteria developed by ACC and AHA and apply this model across the entire academic medicine community. Academic medicine, with its many resources, could lead the way in the expanding field of quality science by supporting fundamental research in quality improvement, supporting academicians to improve quality at their own institutions, developing educational models for quality assessment and improvement, creating and implementing data registries, and serving as a conduit for developing the emerging science of quality assessment. In this and many other ways, academic medicine must offer the health care community leadership for improving our nation's health care quality with the same fervor presently exhibited for the advancement of basic science, the development of specialized and experimental therapy, and as centers for tertiary and quaternary patient care.

  2. Orion Handling Qualities During ISS Proximity Operations and Docking

    NASA Technical Reports Server (NTRS)

    Stephens, John-Paul; Vos, Gordon A.; Bilimoria, Karl D.; Mueller, Eric R.; Brazzel, Jack; Spehar, Pete

    2011-01-01

    NASA's Orion spacecraft is designed to autonomously rendezvous and dock with many vehicles including the International Space Station. However, the crew is able to assume manual control of the vehicle s attitude and flight path. In these instances, Orion must meet handling qualities requirements established by NASA. Two handling qualities assessments were conducted at the Johnson Space Center to evaluate preliminary designs of the vehicle using a six degree of freedom, high-fidelity guidance, navigation, and control simulation. The first assessed Orion s handling qualities during the last 20 ft before docking, and included both steady and oscillatory motions of the docking target. The second focused on manual acquisition of the docking axis during the proximity operations phase and subsequent station-keeping. Cooper-Harper handling qualities ratings, workload ratings and comments were provided by 10 evaluation pilots for the docking study and 5 evaluation pilots for the proximity operations study. For the docking task, both cases received 90% Level 1 (satisfactory) handling qualities ratings, exceeding NASA s requirement. All ratings for the ProxOps task were Level 1. These evaluations indicate that Orion is on course to meet NASA's handling quality requirements for ProxOps and docking.

  3. Improving UK Air Quality Modelling Through Exploitation of Satellite Observations

    NASA Astrophysics Data System (ADS)

    Pope, R.; Chipperfield, M.; Savage, N.

    2012-12-01

    The Met Office's operational regional Air Quality Unified Model (AQUM) contains a description of atmospheric chemistry/aerosols which allows for the short-term forecast of chemical weather (e.g. high concentrations of ozone or nitrogen dioxide, which can trigger warnings of poor air quality). AQUM's performance has so far only been tested against a network of surface monitoring stations. Therefore, with recent improvements in the quality and quantity of satellite measurements, data products (e.g. tropospheric columns, vertical profiles) from several satellite instruments will be used to test the performance of the model. First comparisons between an AQUM simulation for the UK heatwave event of July 2006 and data from OMI, TES (both on AURA) and MODIS (on AQUA) have identified multiple model-satellite biases. The chemical/aerosol species investigated for this simulation include nitrogen dioxide (NO2), ozone (O3), formaldehyde (HCHO), carbon monoxide (CO) and aerosol optical depth (AOD) at 0.55 microns wavelength. NO2 spatial positive mean biases (AQUM-OMI July 2006 monthly mean tropospheric columns) over north- east England suggest model overestimation in the area's urban regions. Currently, sensitivity tests of the NOx emission datasets are investigating these biases and the model's represent of urban pollution. In the UK O3 monthly mean vertical profile comparisons (AQUM-TES), strong positive mean biases are detected in the upper troposphere/lower stratosphere. Since the AQUM does not use a stratospheric chemistry scheme, the satellite climatological vertical boundary conditions will be investigated (e.g. test the model with new boundary conditions using multiple satellite instruments or perturb existing climatologies). Comparisons of HCHO (AQUM-OMI monthly mean tropospheric columns) biases highlight strong negative biases over continental Europe and sporadic positive biases in the south-east lateral boundary conditions. Therefore, evaluation and development of

  4. Quality control and data flow operations of SPHERE

    NASA Astrophysics Data System (ADS)

    Hummel, Wolfgang; Girard, Julien H. V.; Milli, Julien; Wahhaj, Zahed; Lundin, Lars; Vigan, Arthur

    2016-07-01

    ESO operates since April 2015 the new planet finder instrument SPHERE1 with three arms supported by a common path coronograph with extreme AO. Observing modes include dual band imaging, long slit spectroscopy, IFS and high contrast polarimetry. We report on the implementation of the SPHERE data flow and quality control system and on operational highlights in the first year of operations: This includes some unconventional parts of the SPHERE calibration plan like special rules for the selection of filters and the measures for an optimized calibration of the two polarimetric channels of the ZIMPOL arm. Finally we report on the significance of the SPHERE quality control system, its relation to the data reduction pipeline and which previously undocumented instrumental features have been revealed so far.

  5. Update on the Improving Teacher Quality Program. Report 09-05

    ERIC Educational Resources Information Center

    Humphrey, Karen

    2009-01-01

    The Improving Teacher Quality (ITQ) State Grants Program is currently operating professional development grants for California teachers at 40 sites statewide. This is as large a cadre of projects as the California Postsecondary Education Commission has operated since the ITQ Program began with the passage of the No Child Left Behind Act of 2001.…

  6. Using Quality Tools and Methodologies to Improve a Hospital's Quality Position.

    PubMed

    Branco, Daniel; Wicks, Angela M; Visich, John K

    2017-01-01

    The authors identify the quality tools and methodologies most frequently used by quality-positioned hospitals versus nonquality hospitals. Northeastern U.S. hospitals in both groups received a brief, 12-question survey. The authors found that 93.75% of the quality hospitals and 81.25% of the nonquality hospitals used some form of process improvement methodologies. However, there were significant differences between the groups regarding the impact of quality improvement initiatives on patients. The findings indicate that in quality hospitals the use of quality improvement initiatives had a significantly greater positive impact on patient satisfaction and patient outcomes when compared to nonquality hospitals.

  7. Technological developments and approaches to improving service quality.

    PubMed

    Blumberg, M R

    1999-01-01

    In summary, major paradigm shifts in the health care industry are altering the way technology is maintained and supported. Service organizations are now responsible for maintaining a broader base of technology within the health care delivery network and must to this on an extremely rapid, efficient, and productive basis. A number of new technologies are coming on-line, which can allow a health care technology service organization to experience significant improvements in profitability, efficiency, and productivity. To realize maximum benefit from these technologies, service organizations may find themselves re-engineering their service processes. The author believes that this is a requirement for many service organizations, regardless of whether new technology is implemented. The traditional approaches to service delivery are ineffective in managing the new structural realities and service requirements of today's health care environment. New strategies and tactics are required for ensuring that these requirements are met. These approaches will no doubt improve the overall quality, productivity, and efficiency of service and are based on best practices utilized by leading OEMs and ISOs in the medical electronics and other high technology service industry such as information technology and telecommunications, where the service organization is responsible for supporting a broad array of the technology over a large geography with a densely populated installed base, not unlike the typical health care delivery service environment. Once operational improvements are made, a service organization can take advantage of the productivity and efficiency gains brought on by new technology. Organizations interested in doing so are urged to thoroughly research the current state-of-the-art and best practices, because there are numerous systems currently available off-the-shelf. The author believes that new technology will be a basic requirement for competing in the health care

  8. The Efficacy of Quality Improvement Programs in Education.

    ERIC Educational Resources Information Center

    Curley, John R.

    Total Quality Management (TQM) is being adopted by many governmental entities, including public school districts. A basic tenet of quality improvement is that the customer, not the organization, defines quality. Other tenets are that the organization must satisfy the customer in order to best the competition; and that the organization must change…

  9. Quality Improvement in Virtual Higher Education: A Grounded Theory Approach

    ERIC Educational Resources Information Center

    Mahdiuon, Rouhollah; Masoumi, Davoud; Farasatkhah, Maghsoud

    2017-01-01

    The article aims to explore the attributes of quality and quality improvement including the process and specific actions associated with these attributes--that contribute enhancing quality in Iranian Virtual Higher Education (VHE) institutions. A total of 16 interviews were conducted with experts and key actors in Iranian virtual higher education.…

  10. Improving Quality in Education: Dynamic Approaches to School Improvement

    ERIC Educational Resources Information Center

    Creemers, Bert P. M.; Kyriakides, Leonidas

    2011-01-01

    This book explores an approach to school improvement that merges the traditions of educational effectiveness research and school improvement efforts. It displays how the dynamic model, which is theoretical and empirically validated, can be used in both traditions. Each chapter integrates evidence from international and national studies, showing…

  11. Improving the Quality and Scope of EIA Data

    EIA Publications

    2011-01-01

    Section 805(a) of the Energy Independence and Security Act of 2007 (EISA), Public Law 110-1401 requires the U.S. Energy Information Administration (EIA) to establish a five-year plan to enhance the quality and scope of its data collection necessary to ensure that the scope, accuracy, and timeliness of the information needed for efficient functioning of energy markets and related financial operations. This report is in response to section 805(b) of EISA which calls on EIA to submit to Congress the plan established under subsection (a), including a description of any improvements needed to enhance the ability of the Administrator to collect and process energy information in a manner consistent with the needs of energy markets.

  12. Compost improves urban soil and water quality

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Construction in urban zones compacts the soil, which hinders root growth and infiltration and may increase erosion, which may degrade water quality. The purpose of our study was to determine the whether planting prairie grasses and adding compost to urban soils can mitigate these concerns. We simula...

  13. A Total Quality Leadership Process Improvement Model

    DTIC Science & Technology

    1993-12-01

    air- craft, then it is unlikely that a major quality concern would be processing travel orders for personnel. However, if the business is a travel ... agency , it may be entirely appropriate to optimize travel processing procedures. Whenever possible, it is best to establish goals that will provide a STOP

  14. Does Automated Feedback Improve Writing Quality?

    ERIC Educational Resources Information Center

    Wilson, Joshua; Olinghouse, Natalie G.; Andrada, Gilbert N.

    2014-01-01

    The current study examines data from students in grades 4-8 who participated in a statewide computer-based benchmark writing assessment that featured automated essay scoring and automated feedback. We examined whether the use of automated feedback was associated with gains in writing quality across revisions to an essay, and with transfer effects…

  15. The Benefits of Improving Indoor Environmental Quality

    ERIC Educational Resources Information Center

    Lamping, Jerry

    2012-01-01

    As school funding levels nationwide continue to plummet amid public demands for increased student performance, an expanding body of research in the field of indoor environmental quality (IEQ) is providing greater statistical validity about the relationship between environmental conditions in school facilities and student achievement. Since the…

  16. Improving forage quality using seedhead management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Controlling seedhead emergence in perennial grass pastures can extend vegetative growth and high leaf:stem ratios to avoid declines in forage quality during the reproductive development of grasses. There are various management tools for controlling the emergence of seedheads. Pastures can be mowed...

  17. Sleep Quality Improvement During Cognitive Behavioral Therapy for Anxiety Disorders.

    PubMed

    Ramsawh, Holly J; Bomyea, Jessica; Stein, Murray B; Cissell, Shadha H; Lang, Ariel J

    2016-01-01

    Despite the ubiquity of sleep complaints among individuals with anxiety disorders, few prior studies have examined whether sleep quality improves during anxiety treatment. The current study examined pre- to posttreatment sleep quality improvement during cognitive behavioral therapy (CBT) for panic disorder (PD; n = 26) or generalized anxiety disorder (GAD; n = 24). Among sleep quality indices, only global sleep quality and sleep latency improved significantly (but modestly) during CBT. Sleep quality improvement was greater for treatment responders, but did not vary by diagnosis. Additionally, poor baseline sleep quality was independently associated with worse anxiety treatment outcome, as measured by higher intolerance of uncertainty. Additional intervention targeting sleep prior to or during CBT for anxiety may be beneficial for poor sleepers.

  18. The Role of Staff in Quality Improvement in Early Childhood

    ERIC Educational Resources Information Center

    Sims, Margaret; Waniganayake, Manjula

    2015-01-01

    There is international recognition of the importance of high quality services for young children with a consensus that three pillars contribute to quality improvement: adult: child ratios, staff qualifications and group size. In Australia over the past 5 years, early childhood policy has attempted to drive improvements in early childhood service…

  19. Developing High-Quality Teachers: Teacher Evaluation for Improvement

    ERIC Educational Resources Information Center

    Looney, Janet

    2011-01-01

    As countries aim to ensure high achievement for all students, improving and sustaining the quality of the teacher workforce is a vital policy priority. Several studies have found that well-designed teacher evaluation systems, aligned with professional learning and development, can contribute to improvements in the quality of teaching and raise…

  20. 40 CFR 64.8 - Quality improvement plan (QIP) requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Quality improvement plan (QIP... PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.8 Quality improvement plan (QIP) requirements. (a... higher or lower percent or may rely on other criteria for purposes of indicating whether a...

  1. 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....

  2. 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....

  3. Does the EUA Institutional Evaluation Programme Contribute to Quality Improvement?

    ERIC Educational Resources Information Center

    Tavares, Diana Amado; Rosa, Maria Joao; Amaral, Alberto

    2010-01-01

    Purpose: This paper aims to reflect on the relevance of the Institutional Evaluation Programme (IEP) of the European University Association (EUA) to universities' quality improvement. It aims to analyse IEP follow-up reports to determine whether the programme contributes to the development of a quality improvement culture.…

  4. International Accreditations as Drivers of Business School Quality Improvement

    ERIC Educational Resources Information Center

    Bryant, Michael

    2013-01-01

    Business schools are under pressure to implement continuous improvement and quality assurance processes to remain competitive in a globalized higher education market. Drivers for quality improvement include external, environmental pressures, regulatory bodies such as governments, and, increasingly, voluntary accreditation agencies such as AACSB…

  5. Quality Improvement Strategies and Best Practices in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Casey, Michelle M.; Moscovice, Ira

    2004-01-01

    Critical access hospitals (CAHs) face many challenges in implementing quality improvement (QI) initiatives, which include limited resources, low volume of patients, small staffs, and inadequate information technology. A primary goal of the Medicare Rural Hospital Flexibility Program is to improve the quality of care provided by CAHs. This article…

  6. The Role of Accreditation in Directly Improving Educational Quality.

    ERIC Educational Resources Information Center

    Jung, Steven M.

    This study illustrates how the concept of "direct involvement" on the part of the accrediting agency can improve the quality of higher education. "Direct involvement" is defined as action by a representative of an educational agency that resulted in some observable improvement in educational quality. Categories and examples of direct assistance…

  7. 40 CFR 64.8 - Quality improvement plan (QIP) requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 16 2013-07-01 2013-07-01 false Quality improvement plan (QIP... PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.8 Quality improvement plan (QIP) requirements. (a... evaluating the control performance problems and, based on the results of the evaluation procedures, the...

  8. Effectiveness of the stormwater quality devices to improve water quality at Putrajaya

    NASA Astrophysics Data System (ADS)

    Sidek, L. M.; Basri, H.; Noh, M. N. Md; Ainan, A.; Mohd Puad, A. H.

    2013-06-01

    Development of Putrajaya has changed the character of the natural landform by covering the land with impervious surfaces. Houses, office buildings, commercial place and shopping centres have provided places to live and work. The route between buildings is facilitated and encouraged by a complex network of roads and car parks. However, this change from natural landforms and vegetative cover to impervious surfaces has major effect on stormwater which are water quality (non-point source pollution). This paper describes the effectiveness of the stormwater quality devices to improve water quality at selected Putrajaya for demonstration in order to evaluate low cost storm inlet type devices in the Putrajaya Catchment. Five stormwater quality devices were installed and monitored during the study. The devices include Ultra Drain Guard Recycle model, Ultra Curb Guard Plus, Ultra Grate Guard, Absorbent Tarp and Ultra Passive Skimmer. This paper will provide information on the benefits and costs of these devices, including operations and maintenance requirements. Applicability of these devices in gas stations, small convenience stores, residential and small parking lots in the catchment are possible due to their low cost.

  9. Quality improvement in depression care in the Netherlands: the Depression Breakthrough Collaborative. A quality improvement report

    PubMed Central

    Franx, Gerdien; Meeuwissen, Jolanda A.C; Sinnema, Henny; Spijker, Jan; Huyser, Jochanan; Wensing, Michel; de Lange, Jacomine

    2009-01-01

    Background Improving the healthcare for patients with depression is a priority health policy across the world. Roughly, two major problems can be identified in daily practice: (1) the content of care is often not completely consistent with recommendations in guidelines and (2) the organization of care is not always integrated and delivered by multidisciplinary teams. Aim To describe the content and preliminary results of a quality improvement project in primary care, aiming at improving the uptake of clinical depression guidelines in daily practice as well as the collaboration between different mental health professionals. Method A Depression Breakthrough Collaborative was initiated from December 2006 until March 2008. The activities included the development and implementation of a stepped care depression model, a care pathway with two levels of treatment intensity: a first step treatment level for patients with non-severe depression (brief or mild depressive symptoms) and a second step level for patients with severe depression. Twelve months data were measured by the teams in terms of one outcome and several process indicators. Qualitative data were gathered by the national project team with a semi-structured questionnaire amongst the local team coordinators. Results Thirteen multidisciplinary teams participated in the project. In total 101 health professionals were involved, and 536 patients were diagnosed. Overall 356 patients (66%) were considered non-severely depressed and 180 (34%) patients showed severe symptoms. The mean percentage of non-severe patients treated according to the stepped care model was 78%, and 57% for the severely depressed patient group. The proportion of non-severely depressed patients receiving a first step treatment according to the stepped care model, improved during the project, this was not the case for the severely depressed patients. The teams were able to monitor depression symptoms to a reasonable extent during a period of 6

  10. Improving quality in paediatric respiratory disease management.

    PubMed

    Harrop, Michele; Amegavie, Laweh

    2003-11-01

    Throughout the development, implementation and dissemination of the Paediatric Respiratory Newsletter, effective channels of communication between healthcare professionals have been established, highlighting the importance of collaboration. Promoting education, training, audit and research, the newsletter has nurtured both professional and practice development. The work begun during this project, and the outcomes it has achieved, have been developed into an ethos that recognises effective clinical practice and organisational development as central to the delivery of a quality service. This work informs and is informed by strategic developments, in particular, research and development, clinical audit, quality, practice development and clinical risk, all of which are observed to be the key elements of clinical governance. On a personal level, the project has provided me with an opportunity to consolidate information, forge links with the multidisciplinary team and establish a framework for the development of paediatric respiratory services. We hope it will continue to respond to, and be influenced by, changing health and social care demands.

  11. Can disease management reduce health care costs by improving quality?

    PubMed

    Fireman, Bruce; Bartlett, Joan; Selby, Joe

    2004-01-01

    Disease management (DM) promises to achieve cost savings by improving the quality of care for chronic diseases. During the past decade the Permanente Medical Group in Northern California has implemented extensive DM programs. Examining quality indicators, utilization, and costs for 1996-2002 for adults with four conditions, we find evidence of substantial quality improvement but not cost savings. The causal pathway--from improved care to reduced morbidity to cost savings--has not produced sufficient savings to offset the rising costs of improved care. We conclude that the rationale for DM programs, like the rationale for any medical treatments, should rest on their effectiveness and value.

  12. Casting Process Developments for Improving Quality

    NASA Astrophysics Data System (ADS)

    El-Mahallawy, Nahed A.; Taha, Mohamed A.

    1985-09-01

    This paper presents a short synopsis of the important developments in casting/solidification processes, as well as the important advances in the conventional methods. These developments are discussed related to quality aspects. The position of each process with respect to practice, as well as expected gains in cost, are examined. The paper briefly features the author's work on innovative processes (directional solidification, rheocasting, squeeze-casting and rapid solidification) as well as work of other investigators on developments in conventional methods.

  13. 21 CFR 111.110 - What quality control operations are required for laboratory operations associated with the...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... laboratory operations associated with the production and process control system? 111.110 Section 111.110 Food... OPERATIONS FOR DIETARY SUPPLEMENTS Production and Process Control System: Requirements for Quality Control... production and process control system? Quality control operations for laboratory operations associated...

  14. Reducing mortality from hip fractures: a systematic quality improvement programme.

    PubMed

    Lisk, Radcliffe; Yeong, Keefai

    2014-01-01

    Hip fracture is one of the most serious consequences of falls in the elderly, with a mortality of 10% at one month and 30% at one year. Elderly patients with hip fractures have complex medical, surgical, and rehabilitation needs, and a well-coordinated multidisciplinary team approach is essential for the best outcome. The model of best practice for hip fracture care is set out in the Orthopaedic Blue Book and is incentivised by the best practice tariff. In 2009 to 2010, only 39.6% of our patients were being operated on within 36 hours, 19% achieved best practice tariff [1], and mortality was 7.8%. We were ranked as one of the worst hospitals to achieve best practice tariff [1] and our mortality was average. The orthogeriatrics team at Ashford & St Peter's NHS Trust (SPH) was implemented in 2010. Through a system redesign, regular governance meetings, audits and quality improvement projects, we have managed to improve care for our patients and reduce mortality. Over the last three years we have successfully achieved best care for our hip fracture patients, demonstrating a steady improvement in our attainment of the best practice tariff and a reduction in mortality to 5.3% in 2013, which ranks us amongst the best trusts nationally.

  15. Quality improvement in pediatric inflammatory bowel disease: moving forward to improve outcomes.

    PubMed

    Quach, Pauline; Nguyen, Geoffrey C; Benchimol, Eric I

    2013-10-14

    In recent years, pediatric health care has embraced the concept of quality improvement to improve patient outcomes. As quality improvement efforts are implemented, network collaboration (where multiple centers and practices implement standardized programs) is a popular option. In a collaborative network, improvement in the conduct of structural, process and outcome quality measures can lead to improvements in overall health, and benchmarks can be used to assess and compare progress. In this review article, we provided an overview of the quality improvement movement and the role of quality indicators in this movement. We reviewed current quality improvement efforts in pediatric inflammatory bowel disease (IBD), as well as other pediatric chronic illnesses. We discussed the need to standardize the development of quality indicators used in quality improvement networks to assess medical care, and the validation techniques which can be used to ensure that process indicators result in improved outcomes of clinical significance. We aimed to assess current quality improvement efforts in pediatric IBD and other diseases, such as childhood asthma, childhood arthritis, and neonatal health. By doing so, we hope to learn from their successes and failures and to move the field forward for future improvements in the care provided to children with IBD.

  16. Quality properties of fruits as affected by drying operation.

    PubMed

    Omolola, Adewale O; Jideani, Afam I O; Kapila, Patrick F

    2017-01-02

    The increasing consumption of dried fruits requires further attention on the quality parameters. Drying has become necessary because most fruits are highly perishable owing to their high moisture content and the need to make them available all year round and at locations where they are not produced. In addition to preservation, the reduced weight and bulk of dehydrated products decreases packaging, handling and transportation costs. Quality changes associated with drying of fruit products include physical, sensory, nutritional, and microbiological. Drying gives rise to low or moderate glycemic index (GI) products with high calorie, vitamin and mineral contents. This review examines the nutritional benefits of dried fruits, protective compounds present in dried fruits, GI, overview of some fruit drying methods and effects of drying operations on the quality properties such as shrinkage, porosity, texture, color, rehydration, effective moisture diffusivity, nutritional, sensory, microbiological and shelf stability of fruits.

  17. Improving Air Quality with Economic Incentive Programs

    EPA Pesticide Factsheets

    This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

  18. Rotorcraft flying qualities improvement using advanced control

    NASA Technical Reports Server (NTRS)

    Walker, D.; Postlethwaite, I.; Howitt, J.; Foster, N.

    1993-01-01

    We report on recent experience gained when a multivariable helicopter flight control law was tested on the Large Motion Simulator (LMS) at DRA Bedford. This was part of a study into the application of multivariable control theory to the design of full-authority flight control systems for high-performance helicopters. In this paper, we present some of the results that were obtained during the piloted simulation trial and from subsequent off-line simulation and analysis. The performance provided by the control law led to level 1 handling quality ratings for almost all of the mission task elements assessed, both during the real-time and off-line analysis.

  19. Continuous quality improvement: an effective strategy for improvement of program outcomes in a higher education setting.

    PubMed

    Brown, Jennifer Field; Marshall, Bennie L

    2008-01-01

    The nursing department at a historically black university has implemented a continuous quality improvement approach to improve its program outcomes. A quality enhancement plan was designed with three major goals: to increase NCLEX-RN pass rates, to improve student advisement processes, and to increase student satisfaction. The strategies implemented to meet these outcomes are described and evaluated.

  20. NASA's Productivity Improvement and Quality Enhancement Initiatives

    NASA Technical Reports Server (NTRS)

    1984-01-01

    The National Aeronautics and Space Administration celebrated its 25th Anniversary in 1983 at the Air and Space Museum in Washington, DC, with President Reagan in attendance. We look back on the accomplishments of these twenty-five years with pride in our missions and our people. NASA captured the world's imagination during the days of the Apollo mission. So much so, that we now talk about the Apollo era. In the l970s, we moved into the Space Transportation business and in the 199Os, we look forward to having a manned Space Station. Each succeeding mission has presented its own challenge in terms of technology and resources. This is especially true today, when we are being asked to do more with less. To ensure that NASA continues to be a productive and quality conscious agency, one of our highest Agency goals is leadership in the development and application of practices which contribute to high productivity and quality. greatest competitive strength, and this country has a solid scientific and engineering foundation. Traditionally we have spent more money on research and development than Japan and Europe combined, and we are the source of most of this century significant innovations. We should build on this solid base and use it more effectively.

  1. It Pays to Improve School Quality

    ERIC Educational Resources Information Center

    Hanushek, Eric A.; Ruhose, Jens; Woessmann, Ludger

    2016-01-01

    Congress passed the Every Student Succeeds Act, supplanting No Child Left Behind and placing responsibility for public school improvement squarely upon each of the 50 states. With the federal government's role in school accountability sharply diminished, it now falls to state and local governments to take decisive action. Even though most…

  2. The Importance of Improving the Quality of Emergency Surgery for a Regional Quality Collaborative

    PubMed Central

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

    2013-01-01

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

  3. Rendezvous, proximity operations and capture quality function deployment report

    NASA Astrophysics Data System (ADS)

    Lamkin, Stephen L.

    1991-12-01

    Rendezvous, Proximity Operations, and Capture (RPOC) is a missions operations area which is extremely important to present and future space initiatives and must be well planned and coordinated. To support this, a study team was formed to identify a specific plan of action using the Quality Function Deployment (QFD) process. This team was composed of members from a wide spectrum of engineering and operations organizations which are involved in the RPOC technology area. The key to this study's success is an understanding of the needs of potential programmatic customers and the technology base available for system implementation. To this end, the study team conducted interviews with a variety of near term and future programmatic customers and technology development sponsors. The QFD activity led to a thorough understanding of the needs of these customers in the RPOC area, as well as the relative importance of these needs.

  4. Environmental Quality Information Analysis Center (EQIAC) operating procedures handbook

    SciTech Connect

    Walsh, T.E. ); Das, S. )

    1992-08-01

    The Operating Procedures Handbook of the Environmental Quality Information Analysis Center (EQIAC) is intended to be kept current as EQIAC develops and evolves. Its purpose is to provide a comprehensive guide to the mission, infrastructure, functions, and operational procedures of EQIAC. The handbook is a training tool for new personnel and a reference manual for existing personnel. The handbook will be distributed throughout EQIAC and maintained in binders containing current dated editions of the individual sections. The handbook will be revised at least annually to reflect the current structure and operational procedures of EQIAC. The EQIAC provides information on environmental issues such as compliance, restoration, and environmental monitoring do the Air Force and DOD contractors.

  5. Rendezvous, proximity operations and capture quality function deployment report

    NASA Technical Reports Server (NTRS)

    Lamkin, Stephen L. (Editor)

    1991-01-01

    Rendezvous, Proximity Operations, and Capture (RPOC) is a missions operations area which is extremely important to present and future space initiatives and must be well planned and coordinated. To support this, a study team was formed to identify a specific plan of action using the Quality Function Deployment (QFD) process. This team was composed of members from a wide spectrum of engineering and operations organizations which are involved in the RPOC technology area. The key to this study's success is an understanding of the needs of potential programmatic customers and the technology base available for system implementation. To this end, the study team conducted interviews with a variety of near term and future programmatic customers and technology development sponsors. The QFD activity led to a thorough understanding of the needs of these customers in the RPOC area, as well as the relative importance of these needs.

  6. Improving communication between phlebotomists and doctors: a quality improvement project

    PubMed Central

    Saunsbury, Emma; Howarth, Gabrielle

    2016-01-01

    Blood tests are a seemingly basic investigation, but are often a vital part of directing patient management. Despite the importance of this everyday process, we indentified the potential for improvement of the current phlebotomy service in our hospital, as both junior doctors and phlebotomists reported a lack of communication and standardised practice across the wards. Resulting delays in obtaining blood test results can impact detrimentally on patient safety and management. We designed a survey which highlighted inefficient handovers and discrepancies between wards as driving factors behind this. We therefore aimed to improve communication between phlebotomists and doctors, as well as the overall organisation of the service. This took the form of the “Phlebotomy Box,” a box file system offering a set location for blood stickers to be situated. The box concept was optimised on a series of medical and surgical wards, incorporating multidisciplinary feedback from relevant teams. We measured how many untaken bloods were handed over to medical staff continuously, both pre- and post implementation of the phlebotomy box. Our baseline ward demonstrated poor handover rates of untaken bloods, ranging from 0% to 40%. This increased to a consistent 100% following introduction of the Phlebotomy Box and ongoing staff education. Once optimised, the box was trialled on a further two medical wards and one surgical ward, achieving 100% handover from an initial 0% to 67%. Quantitative improvement was also reflected qualitatively in widespread staff surveys, with overwhelmingly positive support and acceptance. In summary, the Phlebotomy Box innovation has led to 100% of untaken bloods being effectively handed over. We have demonstrated a significant improvement in communication and efficiency within the phlebotomy service, with tangible benefits to patient care, as minimising time lags can prevent delays in clinical decisions. The phlebotomy box represents a simplistic

  7. Quality of Instruction Improved by Evaluation and Consultation of Instructors

    ERIC Educational Resources Information Center

    Rindermann, Heiner; Kohler, Jurgen; Meisenberg, Gerhard

    2007-01-01

    One aim of student evaluation of instruction is the improvement of teaching quality, but there is little evidence that student assessment of instruction alone improves teaching. This study tried to improve the effects of evaluation by combining evaluation with individual counselling in an institutional development approach. Evaluation was…

  8. Improvement of image quality in holographic microscopy.

    PubMed

    Budhiraja, C J; Som, S C

    1981-05-15

    A novel technique of noise reduction in holographic microscopy has been experimentally studied. It has been shown that significant improvement in the holomicroscopic images of actual low-contrast continuous tone biological objects can be achieved without trade off in image resolution. The technique makes use of holographically produced multidirectional phase gratings used as diffusers and the continuous addition of subchannel holograms. It has been shown that the self-imaging property of this type of diffuser makes the use of these diffusers ideal for microscopic objects. Experimental results have also been presented to demonstrate real-time image processing capability of this technique.

  9. Improving Information Operations with a Military Cultural Analyst

    DTIC Science & Technology

    2007-11-02

    marketing – marketing is a holistic process that coordinates the functions of multiple activities, commonly referred to as the marketing mix .39 In reality...information operations. In fact, analysis of the elements of the marketing process – the target market and the marketing mix – provides the IO planner with...two distinct tools by which to improve the planning and execution of information operations. First, the study of the marketing mix , the four

  10. Quality Improvement in Critical Care: Selection and Development of Quality Indicators

    PubMed Central

    Martin, Claudio M.; Project, The Quality Improvement in Critical Care

    2016-01-01

    Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts. PMID:27493476

  11. Reconstruction algorithm for improved ultrasound image quality.

    PubMed

    Madore, Bruno; Meral, F Can

    2012-02-01

    A new algorithm is proposed for reconstructing raw RF data into ultrasound images. Previous delay-and-sum beamforming reconstruction algorithms are essentially one-dimensional, because a sum is performed across all receiving elements. In contrast, the present approach is two-dimensional, potentially allowing any time point from any receiving element to contribute to any pixel location. Computer-intensive matrix inversions are performed once, in advance, to create a reconstruction matrix that can be reused indefinitely for a given probe and imaging geometry. Individual images are generated through a single matrix multiplication with the raw RF data, without any need for separate envelope detection or gridding steps. Raw RF data sets were acquired using a commercially available digital ultrasound engine for three imaging geometries: a 64-element array with a rectangular field-of- view (FOV), the same probe with a sector-shaped FOV, and a 128-element array with rectangular FOV. The acquired data were reconstructed using our proposed method and a delay- and-sum beamforming algorithm for comparison purposes. Point spread function (PSF) measurements from metal wires in a water bath showed that the proposed method was able to reduce the size of the PSF and its spatial integral by about 20 to 38%. Images from a commercially available quality-assurance phantom had greater spatial resolution and contrast when reconstructed with the proposed approach.

  12. Patients' complaints as a management tool for continuous quality improvement.

    PubMed

    Javetz, R; Stern, Z

    1996-01-01

    Continuous quality improvement focuses on the customer and, therefore, requires attention to customers' feedback as a vital input. Customers' feedback in general hospitals includes utilization statistics of various services, patient satisfaction surveys and patients' complaints. The role of complaint data as a management tool, and particularly as applied to quality improvement, has received little attention in the literature. As a quality control tool, complaints are investigated on the individual, unit and organizational levels. Repeated complaints about the same units, procedures or individuals, are especially important for quality review. The role of the hospital administration is to draw on the human, technological and procedural resources at its disposal, along a solution time interval (immediate, short and long term), in designing its policy for quality improvement. Presents three examples of policy changes. The aggregate of complaint data serves, in addition, for follow-up of the effect of changes introduced by policy decisions.

  13. A Quality Improvement Course Review of Advanced Pharmacy Practice Experiences

    PubMed Central

    Hornsby, Lori B.; Phillippe, Haley M.; Kelley, Kristi; McDonough, Sharon

    2011-01-01

    Objectives. To determine strengths of and quality improvements needed in advanced pharmacy practice experiences (APPE) through a systematic course review process. Design. Following the “developing a curriculum” (DACUM) format, course materials and assessments were reviewed by the curricular subcommittee responsible for experiential education and by key stakeholders. Course sequence overview and data were presented and discussed. A course review worksheet was completed, outlining strengths and areas for improvement. Assessment. Student feedback was positive. Strengths and areas for improvement were identified. The committee found reviewing the sequence of 8 APPE courses to be challenging. Conclusions. Course reviews are a necessary process in curricular quality improvement but can be difficult to accomplish. We found overall feedback about APPEs was positive and student performance was high. Areas identified as needing improvement will be the focus of continuous quality improvement of the APPE sequence. PMID:21931454

  14. Process safety improvement--quality and target zero.

    PubMed

    Van Scyoc, Karl

    2008-11-15

    Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The "plan, do, check, act" improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

  15. Issues in Measuring and Improving Health Care Quality

    PubMed Central

    Friedman, Maria A.

    1995-01-01

    This issue of the Health Care Financing Review focuses on issues and advances in measuring and improving the quality of care, particularly for Medicare and Medicaid beneficiaries. Discussions of quality-related topics are especially timely, given the growing and widespread interest in improving quality in the organization, financing, and delivery of health care services. This article has several purposes. The first is to provide a brief description of some of the causes underlying the growth of the health care quality movement; the second is to provide a contextual framework for discussion of some of the overarching themes that emerge in this issue. These themes include examining conceptual issues, developing quality measures for specific sites and populations, and creating or adapting data sets for quality-measurement purposes. PMID:10151882

  16. Geometrically tuned wettability of dynamic micromechanical sensors for an improved in-liquid operation

    NASA Astrophysics Data System (ADS)

    Peiker, P.; Oesterschulze, E.

    2015-09-01

    Partial wetting is a vital tool to improve the quality factor of dynamic micromechanical sensors operated in liquids owing to the reduced viscous damping. This technique employs meniscus formation which so far could only be stabilized for a hydrophobic sensory surface excluding biosensing applications. Here, we report on the geometrically tuned wettability of particular hybrid bridge resonators (HBR) with an integrated overhang structure. This allows low-loss operation irrespective of the sensory surface material. The impact of the overhang structure on wetting is explained in a simplified model. Experimental evidence is adduced operating the HBR coated with hydrophilic thin films in water. With an in-liquid quality factor Q of 91 and a small mass m ≈ 5 ng of the HBR, the m/Q-ratio, which is proportional to the limit of detection for mass sensing, was significantly improved in comparison to immersed resonators presented so far.

  17. A Post-operative Feeding Protocol to Improve Outcomes for Neonates With Critical Congenital Heart Disease.

    PubMed

    Newcombe, Jennifer; Fry-Bowers, Eileen

    2017-01-04

    Neonates with critical congenital heart disease (CCHD) are vulnerable to malnutrition during the post-operative period due to hypermetabolism and hypercatabolism. To improve nutritional outcomes during hospitalization, a nurse led post-operative enteral feeding protocol was implemented at a large U.S. children's hospital. During an eight-month implementation period, twenty-one neonates met protocol inclusion criteria. Days for neonates to achieve goal caloric feedings (120kcal/kg/day) were decreased. A one-way repeated measures analysis of variance showed serum albumin levels and serial anthropometric measurements improved significantly throughout hospitalization (p<0.005). Results from this quality improvement project show standardizing nutritional care for neonates with CCHD during the post-operative period is an effective way to improve nutritional outcomes and shorten length of hospital stay.

  18. Examining Pre-School Classroom Quality in a Statewide Quality Rating and Improvement System

    ERIC Educational Resources Information Center

    Jeon, Lieny; Buettner, Cynthia K.; Hur, Eunhye

    2014-01-01

    Background: Research has documented the importance of high-quality early childhood experiences in preparing children for school. Quality rating and improvement systems (QRIS) have recently emerged in many states as a way to build quality of child care and to promote better child outcomes. Objective: The goal of this study was to determine if…

  19. RETRAN analyses for improving plant procedures and operator training

    SciTech Connect

    Broughton, T.G.; Trikouros, N.G.

    1983-05-01

    The technical quality of procedures governing integrated nuclear power plant operation is influenced by knowledge of system, component, and operator interactions. This knowledge includes, in part, operating plant data and realistic simulations of plant operation. This same information can be used to develop training materials for teaching plant dynamic response to plant operators and engineering staffs. Realistic simulations of plant performance have been used to supplement existing plant data or to provide data where none existed. The simulations may cover events with durations in hours and may be required to consider unique plant conditions including actual core physics conditions, valve leakage, and auxiliary steam loads. In addition, it should be possible for the simulation to account for operator interaction and to provide the information operators would have available through plant instrumentation. Simulations using the RETRAN computer code have been used in the development of procedures and training materials. Procedure applications have included development and validation of general control philosophy and establishment of specific test conditions and setpoints. Training applications include development of materials for teaching general plant response, specific plant response during tests, and analysis of plant performance.

  20. Controller Design of Power Quality-Improving Appliances

    SciTech Connect

    Hammerstrom, Donald J.; Zhou, Ning; Lu, Ning

    2007-05-01

    This paper presents an innovative solution to power quality problems using power quality-improving (PQI) appliances. PQI appliances conduct currents that supplement and correct the sum of the other load currents within a premise. From the utility side, the premise housing a PQI appliance thus becomes an improved, if not ideal, utility customer. The PQI appliance improves both harmonic power quality and power factor while performing its normal function, such as heating water. In this paper, the water heater PQI appliance is used as an example to demonstrate the control circuit design and function. Both computer simulation results and laboratory experiment results are presented to demonstrate the effectiveness of the approach. The estimated costs of the PQI controller and of harmonic compensating filters are compared to show that the PQI appliance may be an economic way to provide power quality improvement at the building level.

  1. Improvement of Flow Quality in NAL Chofu Mach 10 Nozzle

    NASA Technical Reports Server (NTRS)

    Lacey, John; Inoue, Yasutoshi; Higashida, Akio; Inoue, Manabu; Ishizaka, Kouichi; Korte, John J.

    2002-01-01

    As a result of CFD analysis and remachining of the nozzle, the flow quality of the Mach 10 Hypersonic Wind Tunnel at NAL Chofu, Japan was improved. The subsequent test results validated the CFD analytical predictions by NASA and MHL.

  2. Improving Indoor Air Quality in St. Cloud Schools.

    ERIC Educational Resources Information Center

    Forer, Mike; Haus, El

    2000-01-01

    Describes how the St. Cloud Area School District (Minnesota), using Tools for Schools provided by the U.S. Environmental Protection Agency, managed the improvement of their school building indoor air quality (IAQ). The district goals of the IAQ Management Committee and the policy elements used to maintain high classroom air quality are…

  3. 42 CFR 422.152 - Quality improvement program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CMS based on a review of current quality performance; (2) Conduct quality improvement projects that... written policies and procedures that reflect current standards of medical practice. (2) Have in effect..., using the measurement tools required by CMS, and report its performance to CMS. The standard...

  4. Using Deming To Improve Quality in Colleges and Universities.

    ERIC Educational Resources Information Center

    Cornesky, Robert A.; And Others

    Of all the people known for stressing quality in industry, W. Edwards Deming is the pioneer. He stresses statistical process control (SPC) and a 14-point process for managers to improve quality and productivity. His approach is humanistic and treats people as intelligent human beings who want to do a good job. Twelve administrators in a university…

  5. The Application of Fishbone Diagram Analysis to Improve School Quality

    ERIC Educational Resources Information Center

    Slameto

    2016-01-01

    With the enactment of the National Education Standards (NES), the measurement of the school quality was clear; NES became a reference for school development program to improve the school quality. However, the form of the program that exist still in problematic, so that a good proposal need to be prepared. In the real condition, the school shows,…

  6. Using information systems to measure and improve quality.

    PubMed

    Bates, D W; Pappius, E; Kuperman, G J; Sittig, D; Burstin, H; Fairchild, D; Brennan, T A; Teich, J M

    1999-01-01

    Information systems (IS) are increasingly important for measuring and improving quality. In this paper, we describe our integrated delivery system's plan for and experiences with measuring and improving quality using IS. Our belief is that for quality measurement to be practical, it must be integrated with the routine provision of care and whenever possible should be done using IS. Thus, at one hospital, we now perform almost all quality measurement using IS. We are also building a clinical data warehouse, which will serve as a repository for quality information across the network. However, IS are not only useful for measuring care, but also represent powerful tools for improving care using decision support. Specific areas in which we have already seen significant benefit include reducing the unnecessary use of laboratory testing, reporting important abnormalities to key providers rapidly, prevention and detection of adverse drug events, initiatives to change prescribing patterns to reduce drug costs and making critical pathways available to providers. Our next major effort will be introduce computerized guidelines on a more widespread basis, which will be challenging. However, the advent of managed care in the US has produced strong incentives to provide high quality care at low cost and our perspective is that only with better IS than exist today will this be possible without compromising quality. Such systems make feasible implementation of quality measurement, care improvement and cost reduction initiatives on a scale which could not previously be considered.

  7. Quality Rating and Improvement Systems and Children's Cognitive Development

    ERIC Educational Resources Information Center

    Jeon, Lieny; Buettner, Cynthia K.

    2015-01-01

    Background: Providing enriched learning environments is important to stimulating children's development in early childhood. Early child-care policymakers in many states in the US have adopted Quality Rating and Improvement Systems (QRIS) as a way to verify quality of child care and to support children's school readiness. Objective: The purpose of…

  8. Total Quality Improvement Guide for Institutions of Higher Education.

    ERIC Educational Resources Information Center

    Cornesky, Robert A.; McCool, Samuel A.

    This book describes the steps and tools of Total Quality Management (TQM) and their use in the academic units of colleges and universities for Total Quality Improvement (TQI), illustrated by a case study from the School of Arts & Sciences at a state university. Section 1 explains how to: (1) identify problems contributing to non-value-added…

  9. Quality Emphasis on Career Development and Continuous Self-Improvement.

    ERIC Educational Resources Information Center

    Green, Joe A.; Foley, Phyllis A.

    1997-01-01

    Describes quality models that community colleges have adopted to improve program effectiveness and customer service, focusing on the use of these models in career development. Discusses exemplary college programs that focus on quality, teamwork and participatory management, and service to students as their prime customers. (AJL)

  10. Effects of Quality Improvement System for Child Care Centers

    ERIC Educational Resources Information Center

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace

    2011-01-01

    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

  11. Towards Improving the Quality of Work Life in Education.

    ERIC Educational Resources Information Center

    Wood, J. M.

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

  12. The business case for health-care quality improvement.

    PubMed

    Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M

    2013-03-01

    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance.

  13. Improved actions, redundant operators and scaling in lattice SU(3)

    NASA Astrophysics Data System (ADS)

    Patel, Apoorva; Gupta, Rajan

    1987-01-01

    Schwinger-Dyson equations are used to systematically calculate redundant operators in lattice QCD and their role in perturbatively improved actions is analyzed. The criteria for improved actions in Monte Carlo simulations are discussed and their usefulness also. In particular the renormalized trajectory is estimated for the b = sqrt(3) renormalization group transformation in a four-parameter space and its scaling behavior is studied for future use in spectrum calculations. J. Robert Oppenheimer Fellow.

  14. Water quantity and quality optimization modeling of dams operation based on SWAT in Wenyu River Catchment, China.

    PubMed

    Zhang, Yongyong; Xia, Jun; Chen, Junfeng; Zhang, Minghua

    2011-02-01

    Water quantity and quality joint operation is a new mode in the present dams' operation research. It has become a hot topic in governmental efforts toward integrated basin improvement. This paper coupled a water quantity and quality joint operation model (QCmode) and genetic algorithm with Soil and Water Assessment Tool (SWAT). Together, these tools were used to explore a reasonable operation of dams and floodgates at the basin scale. Wenyu River Catchment, a key area in Beijing, was selected as the case study. Results showed that the coupled water quantity and quality model of Wenyu River Catchment more realistically simulates the process of water quantity and quality control by dams and floodgates. This integrated model provides the foundation for research of water quantity and quality optimization on dam operation in Wenyu River Catchment. The results of this modeling also suggest that current water quality of Wenyu River will improve following the implementation of the optimized operation of the main dams and floodgates. By pollution control and water quantity and quality joint operation of dams and floodgates, water quality of Wenyu river will change significantly, and the available water resources will increase by 134%, 32%, 17%, and 82% at the downstream sites of Sha River Reservoir, Lutong Floodgate, Xinpu Floodgate, and Weigou Floodgate, respectively. The water quantity and quality joint operation of dams will play an active role in improving water quality and water use efficiency in Wenyu River Basin. The research will provide the technical support for water pollution control and ecological restoration in Wenyu River Catchment and could be applied to other basins with large number of dams. Its application to the Wenyu River Catchment has a great significance for the sustainable economic development of Beijing City.

  15. [Standard operating procedures and operating room management: Improvement of patient safety and the efficiency of processes].

    PubMed

    Bleyl, Jörg U; Heller, Axel R

    2008-01-01

    Financial pressures have led the way more efficiency in health care management. To decrease hospital costs a more proficient use of personal resources is required. The drive to increase efficiency with the concomitant increase in workload can cause a reduction in quality of patient care and of patient security. A professional operating room (OR) management and the introduction of standard operating procedures (SOP) have helped to optimise workflow in and around the OR. OR management can control an efficient workflow and generate data concerning performance, costs and quality. SOPs lead to a standardisation of workflow in the OR and in patient treatment modalities. This guaranties a high quality in patient care and more safety despite an increase in work-load.

  16. Expression Marker-Based Strategy to Improve Beef Quality

    PubMed Central

    Cassar-Malek, Isabelle; Picard, Brigitte

    2016-01-01

    For beef cattle research, a main objective is to control concomitantly the development of muscles and the qualities of beef cuts. Beef quality is a complex phenotype that is only detectable after slaughter and is highly variable. The beef industry is in need of tools to estimate beef quality of live cattle or online in abattoirs, with specific attention towards sensory attributes (tenderness, juiciness, flavour, and colour). Identification of relevant genetic and genomic markers is ongoing, especially for tenderness—a top priority quality attribute. In this paper, we describe the steps of an expression marker-based strategy to improve beef sensory quality, from the discovery of biomarkers that identify consistent beef and the biological functions governing beef tenderness to the integration of the knowledge into detection tests for desirable animals. These tools should soon be available for the management of sensory quality in the beef production chain for meeting market's demands and assuring good quality standards. PMID:27066527

  17. A comprehensive method for GNSS data quality determination to improve ionospheric data analysis.

    PubMed

    Kim, Minchan; Seo, Jiwon; Lee, Jiyun

    2014-08-14

    Global Navigation Satellite Systems (GNSS) are now recognized as cost-effective tools for ionospheric studies by providing the global coverage through worldwide networks of GNSS stations. While GNSS networks continue to expand to improve the observability of the ionosphere, the amount of poor quality GNSS observation data is also increasing and the use of poor-quality GNSS data degrades the accuracy of ionospheric measurements. This paper develops a comprehensive method to determine the quality of GNSS observations for the purpose of ionospheric studies. The algorithms are designed especially to compute key GNSS data quality parameters which affect the quality of ionospheric product. The quality of data collected from the Continuously Operating Reference Stations (CORS) network in the conterminous United States (CONUS) is analyzed. The resulting quality varies widely, depending on each station and the data quality of individual stations persists for an extended time period. When compared to conventional methods, the quality parameters obtained from the proposed method have a stronger correlation with the quality of ionospheric data. The results suggest that a set of data quality parameters when used in combination can effectively select stations with high-quality GNSS data and improve the performance of ionospheric data analysis.

  18. A Comprehensive Method for GNSS Data Quality Determination to Improve Ionospheric Data Analysis

    PubMed Central

    Kim, Minchan; Seo, Jiwon; Lee, Jiyun

    2014-01-01

    Global Navigation Satellite Systems (GNSS) are now recognized as cost-effective tools for ionospheric studies by providing the global coverage through worldwide networks of GNSS stations. While GNSS networks continue to expand to improve the observability of the ionosphere, the amount of poor quality GNSS observation data is also increasing and the use of poor-quality GNSS data degrades the accuracy of ionospheric measurements. This paper develops a comprehensive method to determine the quality of GNSS observations for the purpose of ionospheric studies. The algorithms are designed especially to compute key GNSS data quality parameters which affect the quality of ionospheric product. The quality of data collected from the Continuously Operating Reference Stations (CORS) network in the conterminous United States (CONUS) is analyzed. The resulting quality varies widely, depending on each station and the data quality of individual stations persists for an extended time period. When compared to conventional methods, the quality parameters obtained from the proposed method have a stronger correlation with the quality of ionospheric data. The results suggest that a set of data quality parameters when used in combination can effectively select stations with high-quality GNSS data and improve the performance of ionospheric data analysis. PMID:25196005

  19. Improving patient flow in pre-operative assessment

    PubMed Central

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  20. Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety?

    PubMed Central

    2011-01-01

    Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement

  1. [Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

    PubMed

    Godény, Sándor

    2012-02-05

    The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

  2. Operation Breakthrough for Continuous Self-Systems Improvement.

    ERIC Educational Resources Information Center

    Given, Barbara K.

    1994-01-01

    Operation Breakthrough, in which graduate student interns teach life skills to adolescents with learning disabilities, provided an impetus for identifying a profile of learning and work habits necessary for production of an agile workforce. Agile learning for self-systems improvement calls for self-empowered learning, collaborative learning,…

  3. Maintenance & Operations Solutions: Meeting the Challenge of Improving School Facilities.

    ERIC Educational Resources Information Center

    Association of School Business Officials International, Reston, VA.

    This paper examines the impact current maintenance and operations (M&O) practices have on U.S. school performance and offers possible opportunities for improvement through the judicious use of technology and methodology. The paper also presents a regional comparative analysis of M&O costs across the country. A list of equipment and their…

  4. Can Quality Improvement System Improve Childcare Site Performance in School Readiness?

    ERIC Educational Resources Information Center

    Ma, Xin; Shen, Jianping; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Watson, Grace

    2013-01-01

    The authors evaluated the effectiveness of the Quality Improvement System (QIS) developed and implemented by Children's Services Council of Palm Beach County (Florida) as a voluntary initiative to improve the quality of childcare and education. They adopted a growth model approach to investigate whether childcare sites that participated in QIS…

  5. Four Pillars for Improving the Quality of Safety-Critical Software-Reliant Systems

    DTIC Science & Technology

    2013-04-01

    the use of ISO 9001 /CMMI®,1 the suite of ISO -IEC SC 7 process standards, and standards and practices specific to the certification of safety...Four Pillars for Improving the Quality of Safety-Critical Software- Reliant Systems Studies of safety-critical software-reliant systems...many system level related to operational quality attributes, and 80% of these defects are discovered late in the development life cycle [Redman

  6. Health insurers' financial performance and quality improvement expenditures in the Affordable Care Act's second year.

    PubMed

    McCue, Michael J; Hall, Mark

    2015-02-01

    The Affordable Care Act requires health insurers to rebate any amounts less than 80%-85% of their premiums that they fail to spend on medical claims or quality improvement. This study uses the new comprehensive reporting under this law to examine changes in insurers' financial performance and differences in their quality improvement expenditures. In the ACA's second year (2012), insurers' median medical loss ratios continued to increase and their median administrative cost ratios dropped, producing moderate operating margins in the group markets but a small operating loss in the individual market, at the median. For-profit insurers showed larger changes, in general, than did nonprofits. For quality improvement, insurers reported spending a significantly greater amount per member in their government plans than they did on their self-insured members, with spending on commercial insurance being in between these two extremes. The magnitude and source of these differences varied by corporate ownership.

  7. Institutions for the elderly operating without a license: quality of care and the surveillance process.

    PubMed

    Fleishman, R; Holzer, I; Walk, D; Mandelson, J; Mizrahi, G; Bar-Giora, M; Yuz, F

    1999-01-01

    In 1992, Israel's Services for the Aged identified private institutions for the elderly operating illegally, which are notorious for poor quality. This article presents the findings of screening visits in 97 "pirate" institutions, as part of a plan to improve surveillance, and evaluates the outcomes as a measure of the effectiveness of intervention. Although a high proportion of deficiencies was found, some institutions showed a significant ability to correct them.

  8. Survey of methods for improving operator acceptance of computerized aids

    SciTech Connect

    Frey, P. R.; Kisner, R. A.

    1982-04-01

    The success of current attempts to improve the operational performance and safety of nuclear power plants by installing computerized operational aids in the control rooms is dependent, in part, on the operator's attitude toward the aid. Utility experience with process computer systems indicates that problems may already exist with operator acceptance of computerized aids. The growth of the role that computers have in nuclear power plants makes user acceptance of computer technology an important issue for the nuclear industry. The purpose of this report is to draw from the literature factors related to user acceptance of computerized equipment that may also be applicable to the acceptance of computerized aids used in the nuclear power plant control room.

  9. Hospital value-based purchasing (VBP) program: measurement of quality and enforcement of quality improvement.

    PubMed

    Szablowski, Katarzyna M

    2014-01-01

    VBP program is a novel medicare payment estimatin tool used to encourage clinical care quality improvement as well as improvement of patient experience as a customer of a health care system. The program utilizes well established tools of measuring clinical care quality and patient satisfaction such as the hospital IQR program and HCAHPS survey to estimate Medicare payments and encourage hospitals to continuosly improve the level of care they provide.

  10. Applying GRA and QFD to Improve Library Service Quality

    ERIC Educational Resources Information Center

    Chen, Yen-Ting; Chou, Tsung-Yu

    2011-01-01

    This paper applied Grey Relational Analysis (GRA) to Quality Function Deployment (QFD) to identify service improvement techniques for an academic library. First, reader needs and their importance, and satisfaction degrees were examined via questionnaires. Second, the service improvement techniques for satisfying the reader needs were developed by…

  11. Lean management systems: creating a culture of continuous quality improvement.

    PubMed

    Clark, David M; Silvester, Kate; Knowles, Simon

    2013-08-01

    This is the first in a series of articles describing the application of Lean management systems to Laboratory Medicine. Lean is the term used to describe a principle-based continuous quality improvement (CQI) management system based on the Toyota production system (TPS) that has been evolving for over 70 years. Its origins go back much further and are heavily influenced by the work of W Edwards Deming and the scientific method that forms the basis of most quality management systems. Lean has two fundamental elements--a systematic approach to process improvement by removing waste in order to maximise value for the end-user of the service and a commitment to respect, challenge and develop the people who work within the service to create a culture of continuous improvement. Lean principles have been applied to a growing number of Healthcare systems throughout the world to improve the quality and cost-effectiveness of services for patients and a number of laboratories from all the pathology disciplines have used Lean to shorten turnaround times, improve quality (reduce errors) and improve productivity. Increasingly, models used to plan and implement large scale change in healthcare systems, including the National Health Service (NHS) change model, have evidence-based improvement methodologies (such as Lean CQI) as a core component. Consequently, a working knowledge of improvement methodology will be a core skill for Pathologists involved in leadership and management.

  12. Workbook for Taguchi Methods for Product Quality Improvement.

    ERIC Educational Resources Information Center

    Zarghami, Ali; Benbow, Don

    Taguchi methods are methods of product quality improvement that analyze major contributions and how they can be controlled to reduce variability of poor performance. In this approach, knowledge is used to shorten testing. Taguchi methods are concerned with process improvement rather than with process measurement. This manual is designed to be used…

  13. Applying a Continuous Quality Improvement Model To Assess Institutional Effectiveness.

    ERIC Educational Resources Information Center

    Roberts, Keith

    This handbook outlines techniques and processes for improving institutional effectiveness and ensuring continuous quality improvement, based on strategic planning activities at Wisconsin's Milwaukee Area Technical College (MATC). First, institutional effectiveness is defined and 17 core indicators of effectiveness developed by the Wisconsin…

  14. Model for improvement - Part Two: Measurement and feedback for quality improvement efforts.

    PubMed

    Randolph, Greg; Esporas, Megan; Provost, Lloyd; Massie, Sara; Bundy, David G

    2009-08-01

    Measurement and feedback are fundamental to quality improvement. There is a knowledge gap among health care professionals in knowing how to measure the impact of their quality improvement projects and how to use these data to improve care. This article presents a pragmatic approach to measurement and feedback for quality improvement efforts in local health care settings, such as hospitals or clinical practices. The authors include evidence-based strategies from health care and other industries, augmented with practical examples from the authors' collective years of experience designing measurement and feedback strategies.

  15. Improving outcomes for ESRD patients: shifting the quality paradigm.

    PubMed

    Nissenson, Allen R

    2014-02-01

    The availability of life-saving dialysis therapy has been one of the great successes of medicine in the past four decades. Over this time period, despite treatment of hundreds of thousands of patients, the overall quality of life for patients with ESRD has not substantially improved. A narrow focus by clinicians and regulators on basic indicators of care, like dialysis adequacy and anemia, has consumed time and resources but not resulted in significantly improved survival; also, frequent hospitalizations and dissatisfaction with the care experience continue to be seen. A new quality paradigm is needed to help guide clinicians, providers, and regulators to ensure that patients' lives are improved by the technically complex and costly therapy that they are receiving. This paradigm can be envisioned as a quality pyramid: the foundation is the basic indicators (outstanding performance on these indicators is necessary but not sufficient to drive the primary outcomes). Overall, these basics are being well managed currently, but there remains an excessive focus on them, largely because of publically reported data and regulatory requirements. With a strong foundation, it is now time to focus on the more complex intermediate clinical outcomes-fluid management, infection control, diabetes management, medication management, and end-of-life care among others. Successfully addressing these intermediate outcomes will drive improvements in the primary outcomes, better survival, fewer hospitalizations, better patient experience with the treatment, and ultimately, improved quality of life. By articulating this view of quality in the ESRD program (pushing up the quality pyramid), the discussion about quality is reframed, and also, clinicians can better target their facilities in the direction of regulatory oversight and requirements about quality. Clinicians owe it to their patients, as the ESRD program celebrates its 40th anniversary, to rekindle the aspirations of the creators of

  16. Operational, quality, and risk management in the transfusion service: lessons learned.

    PubMed

    Goodnough, Lawrence Tim

    2012-07-01

    For general health care, the difference between quality and safety has been unclear for measurable patient outcomes. In contrast, in the transfusion service (TS), the relationship between quality and safety has been direct and demonstrable. Case studies are summarized to illustrate the relationship between operations, quality management, and risk management in the TS. In blood availability for elective surgery over 3 audited intervals, the incidence of patients undergoing elective surgery without available crossmatched blood that had been requested was 1:333, 1:328, and 1:225 for pre-quality improvement, post-quality improvement, and subsequent postintervention audit assessment, respectively. In event discovery reports (EDRs) over 2 years, incidence of biologic product deviation reports (Food and Drug Administration reportable) was successfully reduced from 60 biologic product deviation reports (12%) of 507 EDRs in 2009 to 42 (12%) of 336 EDRs in 2010. In wrong blood in tube, 102 specimens were identified (by a change in patient's ABO/Rh) from 176,711 type and screen/cross-match specimens received over a 5-year interval, detected either by previous patient record of ABO/Rh or by a second specimen for blood type confirmation implemented in our TS for the last 3 years. No known cases of "mismatched" red blood cell transfusion have occurred during this interval. There is an inverse relationship between resources/time expended on quality and risk management relative to volumes of operations in the TS. Laboratory-based initiatives that improve patient safety and clinical outcomes need to have resources aligned with the personnel and time required for quality management and risk management.

  17. Improving intensive care unit quality using collaborative networks.

    PubMed

    Watson, Sam R; Scales, Damon C

    2013-01-01

    Collaborative networks of intensive care units can help promote a quality-improvement agenda across an entire system or region. Proposed advantages include targeting a greater number of patients, sharing of resources, and common measurement systems for audit and feedback or benchmarking. This review focuses on elements that are essential for the success and sustainability of these collaborative networks, using as examples networks in Michigan and Ontario. More research is needed to understand the mechanisms through which collaborative networks lead to improved care delivery and to demonstrate their cost-effectiveness in comparison with other approaches to system-level quality improvement.

  18. On Improving Higher Vocational College Education Quality Assessment

    NASA Astrophysics Data System (ADS)

    Wu, Xiang; Chen, Yan; Zhang, Jie; Wang, Yi

    Teaching quality assessment is a judgment process by using the theory and technology of education evaluation system to test whether the process and result of teaching have got to a certain quality level. Many vocational schools have established teaching quality assessment systems of their own characteristics as the basic means to do self-examination and teaching behavior adjustment. Combined with the characteristics and requirements of the vocational education and by analyzing the problems exist in contemporary vocational school, form the perspective of the content, assessment criteria and feedback system of the teaching quality assessment to optimize the system, to complete the teaching quality information net and offer suggestions for feedback channels, to make the institutionalization, standardization of the vocational schools and indeed to make contribution for the overall improvement of the quality of vocational schools.

  19. Use of electronic documentation for quality improvement in hospice.

    PubMed

    Cagle, John G; Rokoske, Franziska S; Durham, Danielle; Schenck, Anna P; Spence, Carol; Hanson, Laura C

    2012-01-01

    Little evidence exists about the use of electronic documentation (ED) in hospice and its relationship to quality improvement (QI) practices. The purposes of this study were to (1) estimate the prevalence of ED use in hospice, (2) identify organizational characteristics associated with use of ED, and (3) determine whether quality measurement practices differed based on documentation format (electronic vs nonelectronic). Surveys concerning the use of ED for QI practices and the monitoring of quality-related care and outcomes were collected from 653 hospices. Users of ED were able to monitor a wider range of quality-related data than users of non-ED. Quality components such as advanced care planning, cultural needs, experience during care of the actively dying, and the number/types of care being delivered were more likely to be documented by users of ED. Use of ED may help hospices monitor quality and compliance.

  20. Ten tips for incorporating scientific quality improvement into everyday work.

    PubMed

    Goldmann, Don

    2011-04-01

    Healthcare personnel often find it challenging to incorporate disciplined quality improvement into their daily work. Planning, managing and completing improvement projects with sufficient rigour to generate credible evidence and potentially publishable knowledge are even more difficult. Nonetheless, careful set-up and agile leveraging of existing resources and expertise can lead to surprisingly robust results. Project designs that integrate data collection with the work itself are especially helpful. Although the general perception is that top-flight journals are loath to publish the results of quality improvement work, accumulating experience suggests that this hurdle can be overcome. The Standards for Quality Improvement Reporting Excellence guidelines provide a promising framework for crafting publications that can meet the exacting standards of peer-reviewed journals.

  1. Improving Teacher Quality Program: Current Grants and Upcoming Activities. Commission Report 08-26

    ERIC Educational Resources Information Center

    California Postsecondary Education Commission, 2008

    2008-01-01

    Several hundred teachers and thousands of students are benefiting from professional development projects that operate all over California under the auspices of the California Postsecondary Education Commission. The Improving Teacher Quality State Grants Program provides federal funds from the No Child Left Behind Act of 2001 to universities that…

  2. High-pressure jet cutters improve capping operations

    SciTech Connect

    Abel, L.W.; Campbell, P.J.; Bowden, J.R. Sr.

    1995-05-08

    Advances in abrasive cutting technology have improved the methods for removing damaged equipment and preparing wellheads for capping. This technology, much of which was refined during well control operations in Kuwait in 1991, can improve the safety and efficiency of capping jobs by cutting wellheads or casing quickly and cleanly. The majority of well control jobs involve one of three types of capping operations: capping to a flange, capping by installing a wellhead, or capping to a casing stub. Capping operations are often the first major step in regaining control of the well during blowout intervention. Proper planning of a capping operation must take into account the mass flow rate, combustible nature of the flow, well bore geometry, and operations in the post-capping phase of the project. The paper discusses capping vehicles, tree removal, jet cutters, capping to a flange, capping to a stub, swallowing the stub, spin-on technique, capping on fire, stinging, offshore blowouts, firefighting, pollution control, intervention equipment, and rig removal.

  3. Pediatric collaborative networks for quality improvement and research.

    PubMed

    Lannon, Carole M; Peterson, Laura E

    2013-01-01

    Despite efforts of individual clinicians, pediatric practices, and institutions to remedy continuing deficiencies in pediatric safety and health care quality, multiple gaps and disparities exist. Most pediatric diseases are rare; thus, few practices or centers care for sufficient numbers of children, particularly in subspecialties, to achieve large and representative sample sizes, and substantial between-site variation in care and outcomes persists. Pediatric collaborative improvement networks are multi-site clinical networks that allow practice-based teams to learn from one another, test changes to improve quality, and use their collective experience and data to understand, implement, and spread what works in practice. The model was initially developed in 2002 by an American Board of Pediatrics Workgroup to accelerate the translation of evidence into practice, improve care and outcomes for children, and to serve as the gold standard for the performance in practice component of Maintenance of Certification requirements. Many features of an improvement network derive from the Institute for Healthcare Improvement's collaborative improvement model Breakthrough Series, including focus on a high-impact condition or topic; providing support from clinical content and quality improvement experts; using the Model for Improvement to set aims, use data for feedback, and test changes iteratively; providing infrastructure support for data collection, analysis and reporting, and quality improvement coaching; activities to enhance collaboration; and participation of multidisciplinary teams from multiple sites. In addition, they typically include a population registry of the children receiving care for the improvement topic of interest. These registries provide large and representative study samples with high-quality data that can be used to generate information and evidence, as well as to inform clinical decision making. In addition to quality improvement, networks serve as large

  4. Using Operational Analysis to Improve Access to Pulmonary Function Testing

    PubMed Central

    Ip, Ada; Asamoah-Barnieh, Raymond; Bischak, Diane P.; Davidson, Warren J.; Flemons, W. Ward; Pendharkar, Sachin R.

    2016-01-01

    Background. Timely pulmonary function testing is crucial to improving diagnosis and treatment of pulmonary diseases. Perceptions of poor access at an academic pulmonary function laboratory prompted analysis of system demand and capacity to identify factors contributing to poor access. Methods. Surveys and interviews identified stakeholder perspectives on operational processes and access challenges. Retrospective data on testing demand and resource capacity was analyzed to understand utilization of testing resources. Results. Qualitative analysis demonstrated that stakeholder groups had discrepant views on access and capacity in the laboratory. Mean daily resource utilization was 0.64 (SD 0.15), with monthly average utilization consistently less than 0.75. Reserved testing slots for subspecialty clinics were poorly utilized, leaving many testing slots unfilled. When subspecialty demand exceeded number of reserved slots, there was sufficient capacity in the pulmonary function schedule to accommodate added demand. Findings were shared with stakeholders and influenced scheduling process improvements. Conclusion. This study highlights the importance of operational data to identify causes of poor access, guide system decision-making, and determine effects of improvement initiatives in a variety of healthcare settings. Importantly, simple operational analysis can help to improve efficiency of health systems with little or no added financial investment. PMID:27445545

  5. Benchmarking: a method for continuous quality improvement in health.

    PubMed

    Ettorchi-Tardy, Amina; Levif, Marie; Michel, Philippe

    2012-05-01

    Benchmarking, a management approach for implementing best practices at best cost, is a recent concept in the healthcare system. The objectives of this paper are to better understand the concept and its evolution in the healthcare sector, to propose an operational definition, and to describe some French and international experiences of benchmarking in the healthcare sector. To this end, we reviewed the literature on this approach's emergence in the industrial sector, its evolution, its fields of application and examples of how it has been used in the healthcare sector. Benchmarking is often thought to consist simply of comparing indicators and is not perceived in its entirety, that is, as a tool based on voluntary and active collaboration among several organizations to create a spirit of competition and to apply best practices. The key feature of benchmarking is its integration within a comprehensive and participatory policy of continuous quality improvement (CQI). Conditions for successful benchmarking focus essentially on careful preparation of the process, monitoring of the relevant indicators, staff involvement and inter-organizational visits. Compared to methods previously implemented in France (CQI and collaborative projects), benchmarking has specific features that set it apart as a healthcare innovation. This is especially true for healthcare or medical-social organizations, as the principle of inter-organizational visiting is not part of their culture. Thus, this approach will need to be assessed for feasibility and acceptability before it is more widely promoted.

  6. Benchmarking: A Method for Continuous Quality Improvement in Health

    PubMed Central

    Ettorchi-Tardy, Amina; Levif, Marie; Michel, Philippe

    2012-01-01

    Benchmarking, a management approach for implementing best practices at best cost, is a recent concept in the healthcare system. The objectives of this paper are to better understand the concept and its evolution in the healthcare sector, to propose an operational definition, and to describe some French and international experiences of benchmarking in the healthcare sector. To this end, we reviewed the literature on this approach's emergence in the industrial sector, its evolution, its fields of application and examples of how it has been used in the healthcare sector. Benchmarking is often thought to consist simply of comparing indicators and is not perceived in its entirety, that is, as a tool based on voluntary and active collaboration among several organizations to create a spirit of competition and to apply best practices. The key feature of benchmarking is its integration within a comprehensive and participatory policy of continuous quality improvement (CQI). Conditions for successful benchmarking focus essentially on careful preparation of the process, monitoring of the relevant indicators, staff involvement and inter-organizational visits. Compared to methods previously implemented in France (CQI and collaborative projects), benchmarking has specific features that set it apart as a healthcare innovation. This is especially true for healthcare or medical–social organizations, as the principle of inter-organizational visiting is not part of their culture. Thus, this approach will need to be assessed for feasibility and acceptability before it is more widely promoted. PMID:23634166

  7. Life in the Atacama: Science autonomy for improving data quality

    NASA Astrophysics Data System (ADS)

    Smith, Trey; Thompson, David R.; Wettergreen, David S.; Cabrol, Nathalie A.; Warren-Rhodes, Kimberley A.; Weinstein, Shmuel J.

    2007-12-01

    ``Science autonomy'' refers to exploration robotics technologies involving onboard science analysis of collected data. These techniques enable a rover to make adaptive decisions about which measurements to collect and transmit. Science autonomy can compensate for limited communications bandwidth by ensuring that planetary scientists receive those images and spectra that best meet mission goals. Here, we present the results of autonomous science experiments performed in the Atacama Desert of Chile during the Life in the Atacama (LITA) rover field campaign. We aim to provide an overview of autonomous science principles and examine their integration into the LITA operations strategy. We present experiments in four specific autonomous science domains: (1) autonomously responding to evidence of life with more detailed measurements; (2) rock detection for site profiling and selective data return; (3) tactical replanning to efficiently map the distribution of life; (4) detecting novel images and geologic unit boundaries in image sequences. In each of these domains we demonstrate improvements in the quality of returned data through autonomous analysis of imagery.

  8. Application of improved extension evaluation method to water quality evaluation

    NASA Astrophysics Data System (ADS)

    Wong, Heung; Hu, Bao Qing

    2014-02-01

    The extension evaluation method (EEM) has been developed and applied to evaluate water quality. There are, however, negative values in the correlative degree (water quality grades from EEM) after the calculation. This is not natural as the correlative degree is essentially an index based on grades (rankings) of water quality by different methods, which are positive. To overcome this negativity issue, the interval clustering approach (ICA) was introduced, which is based on the grey clustering approach (GCA) and interval-valued fuzzy sets. However, the computing process and formulas of ICA are rather complex. This paper provides a novel method, i.e., improved extension evaluation method, so as to avoid negative values in the correlative degree. To demonstrate our proposed approach, the improved EEM is applied to evaluate the water quality of three different cross-sections of the Fen River, the second major branch river of the Yellow River in China and the Han Jiang River, one of the major branch rivers of the Yangtse River in China. The results of the improved evaluation method are basically the same as the official water quality. The proposed method possesses also the same merit as the EEM and ICA method, which can be applied to assess water quality when the levels of attributes are defined in terms of intervals in the water quality criteria. Existing methods are mostly applicable to data in the form of single numeric values.

  9. Improved Wide Operating Temperature Range of Li-Ion Cells

    NASA Technical Reports Server (NTRS)

    Smart, Marshall C.; Bugga, Ratnakumar V.

    2013-01-01

    Future NASA missions aimed at exploring the Moon, Mars, and the outer planets require rechargeable batteries that can operate over a wide temperature range (-60 to +60 C) to satisfy the requirements of various applications including landers, rovers, penetrators, CEV, CLV, etc. This work addresses the need for robust rechargeable batteries that can operate well over a wide temperature range. The Department of Energy (DoE) has identified a number of technical barriers associated with the development of Liion rechargeable batteries for PHEVs. For this reason, DoE has interest in the development of advanced electrolytes that will improve performance over a wide range of temperatures, and lead to long life characteristics (5,000 cycles over a 10-year life span). There is also interest in improving the high-voltage stability of these candidate electrolyte systems to enable the operation of up to 5 V with high specific energy cathode materials. Currently, the state-of-the-art lithium-ion system has been demonstrated to operate over a wide range of temperatures (-40 to +40 C); however, the rate capability at the lower temperatures is very poor. In addition, the low-temperature performance typically deteriorates rapidly upon being exposed to high temperatures. A number of electrolyte formulations were developed that incorporate the use of electrolyte additives to improve the high-temperature resilience, low-temperature power capability, and life characteristics of methyl propionate (MP)-based electrolyte solutions. These electrolyte additives include mono-fluoroethylene carbonate (FEC), lithium oxalate, vinylene carbonate (VC), and lithium bis(oxalate borate) (LiBOB), which have previously been shown to result in improved high-temperature resilience of all carbonate-based electrolytes. These MP-based electrolytes with additives have been shown to have improved performance in experiments with MCMB-LiNiCoAlO2 cells.

  10. Improving operating room turnover time: a systems based approach.

    PubMed

    Bhatt, Ankeet S; Carlson, Grant W; Deckers, Peter J

    2014-12-01

    Operating room (OR) turnover time (TT) has a broad and significant impact on hospital administrators, providers, staff and patients. Our objective was to identify current problems in TT management and implement a consistent, reproducible process to reduce average TT and process variability. Initial observations of TT were made to document the existing process at a 511 bed, 24 OR, academic medical center. Three control groups, including one consisting of Orthopedic and Vascular Surgery, were used to limit potential confounders such as case acuity/duration and equipment needs. A redesigned process based on observed issues, focusing on a horizontally structured, systems-based approach has three major interventions: developing consistent criteria for OR readiness, utilizing parallel processing for patient and room readiness, and enhancing perioperative communication. Process redesign was implemented in Orthopedics and Vascular Surgery. Comparisons of mean and standard deviation of TT were made using an independent 2-tailed t-test. Using all surgical specialties as controls (n = 237), mean TT (hh:mm:ss) was reduced by 0:20:48 min (95 % CI, 0:10:46-0:30:50), from 0:44:23 to 0:23:25, a 46.9 % reduction. Standard deviation of TT was reduced by 0:10:32 min, from 0:16:24 to 0:05:52 and frequency of TT≥30 min was reduced from 72.5to 11.7 %. P < 0.001 for each. Using Vascular and Orthopedic surgical specialties as controls (n = 13), mean TT was reduced by 0:15:16 min (95 % CI, 0:07:18-0:23:14), from 0:38:51 to 0:23:35, a 39.4 % reduction. Standard deviation of TT reduced by 0:08:47, from 0:14:39 to 0:05:52 and frequency of TT≥30 min reduced from 69.2 to 11.7 %. P < 0.001 for each. Reductions in mean TT present major efficiency, quality improvement, and cost-reduction opportunities. An OR redesign process focusing on parallel processing and enhanced communication resulted in greater than 35 % reduction in TT. A systems-based focus should drive OR TT design.

  11. Theory and implementation of summarization: Improving sensor interpretation for spacecraft operations

    NASA Astrophysics Data System (ADS)

    Swartwout, Michael Alden

    New paradigms in space missions require radical changes in spacecraft operations. In the past, operations were insulated from competitive pressures of cost, quality and time by system infrastructures, technological limitations and historical precedent. However, modern demands now require that operations meet competitive performance goals. One target for improvement is the telemetry downlink, where significant resources are invested to acquire thousands of measurements for human interpretation. This cost-intensive method is used because conventional operations are not based on formal methodologies but on experiential reasoning and incrementally adapted procedures. Therefore, to improve the telemetry downlink it is first necessary to invent a rational framework for discussing operations. This research explores operations as a feedback control problem, develops the conceptual basis for the use of spacecraft telemetry, and presents a method to improve performance. The method is called summarization, a process to make vehicle data more useful to operators. Summarization enables rational trades for telemetry downlink by defining and quantitatively ranking these elements: all operational decisions, the knowledge needed to inform each decision, and all possible sensor mappings to acquire that knowledge. Summarization methods were implemented for the Sapphire microsatellite; conceptual health management and system models were developed and a degree-of-observability metric was defined. An automated tool was created to generate summarization methods from these models. Methods generated using a Sapphire model were compared against the conventional operations plan. Summarization was shown to identify the key decisions and isolate the most appropriate sensors. Secondly, a form of summarization called beacon monitoring was experimentally verified. Beacon monitoring automates the anomaly detection and notification tasks and migrates these responsibilities to the space segment. A

  12. Assessment of foodservice quality and identification of improvement strategies using hospital foodservice quality model

    PubMed Central

    Kim, Kyungjoo; Kim, Minyoung

    2010-01-01

    The purposes of this study were to assess hospital foodservice quality and to identify causes of quality problems and improvement strategies. Based on the review of literature, hospital foodservice quality was defined and the Hospital Foodservice Quality model was presented. The study was conducted in two steps. In Step 1, nutritional standards specified on diet manuals and nutrients of planned menus, served meals, and consumed meals for regular, diabetic, and low-sodium diets were assessed in three general hospitals. Quality problems were found in all three hospitals since patients consumed less than their nutritional requirements. Considering the effects of four gaps in the Hospital Foodservice Quality model, Gaps 3 and 4 were selected as critical control points (CCPs) for hospital foodservice quality management. In Step 2, the causes of the gaps and improvement strategies at CCPs were labeled as "quality hazards" and "corrective actions", respectively and were identified using a case study. At Gap 3, inaccurate forecasting and a lack of control during production were identified as quality hazards and corrective actions proposed were establishing an accurate forecasting system, improving standardized recipes, emphasizing the use of standardized recipes, and conducting employee training. At Gap 4, quality hazards were menus of low preferences, inconsistency of menu quality, a lack of menu variety, improper food temperatures, and patients' lack of understanding of their nutritional requirements. To reduce Gap 4, the dietary departments should conduct patient surveys on menu preferences on a regular basis, develop new menus, especially for therapeutic diets, maintain food temperatures during distribution, provide more choices, conduct meal rounds, and provide nutrition education and counseling. The Hospital Foodservice Quality Model was a useful tool for identifying causes of the foodservice quality problems and improvement strategies from a holistic point of view

  13. Improving the Standard of Orthopaedic Operation Documentation Using Typed Proforma Operation Notes: A Completed Audit Loop

    PubMed Central

    Ellanti, Prasad; Moriarty, Andrew; McAuley, Nuala; Hogan, Niall

    2017-01-01

    Introduction The Royal College of Surgeons (RCS) published Good Surgical Practice guidelines in 2008 and revised them in 2014. They outline the basic standard that all surgical operation notes should meet. Objectives To retrospectively audit 57 typed orthopaedic operation notes from St. James’s Hospital in Dublin (from August to November 2015) against the RCS Good Surgical Practice guidelines published in 2014. They were then compared with the department’s previous audit of handwritten notes to complete the audit loop. Materials and methods A total of 57 orthopaedic operation notes were audited by a single reviewer. They were prospectively collected between August and November 2015. All notes were typed on the standard St. James’s Hospital operation note proforma. Results Of the surgeries, 89.5% were emergencies with 77.2% of them being performed by trainees. All of the operation notes were typed and signed by trainees. The procedure name, incision and closure details, tourniquet time (when relevant), and postoperative instructions were documented in 100% of the notes. In total, 80.7% had an operative diagnosis included while only 26.9% of the documentation had prosthesis serial numbers. All of the typed notes were deemed to be legible. Conclusion The use of printed operation notes allows for improved legibility when compared to typed notes. Documentation standards remained very high in the same areas as the handwritten notes and a marked improvement was seen in areas that had been poorly documented.

  14. 40 CFR 63.1035 - Quality improvement program for pumps.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... determine the services, operating or maintenance practices, and pump or pump seal designs or technologies... and implement a pump quality assurance program that details purchasing specifications and maintenance... facility, or by a designated representative; and (D) Detail off-line pump maintenance and repair...

  15. 40 CFR 63.1035 - Quality improvement program for pumps.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... determine the services, operating or maintenance practices, and pump or pump seal designs or technologies... and implement a pump quality assurance program that details purchasing specifications and maintenance... facility, or by a designated representative; and (D) Detail off-line pump maintenance and repair...

  16. 40 CFR 63.1035 - Quality improvement program for pumps.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... determine the services, operating or maintenance practices, and pump or pump seal designs or technologies... and implement a pump quality assurance program that details purchasing specifications and maintenance... facility, or by a designated representative; and (D) Detail off-line pump maintenance and repair...

  17. 40 CFR 63.1035 - Quality improvement program for pumps.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... determine the services, operating or maintenance practices, and pump or pump seal designs or technologies... and implement a pump quality assurance program that details purchasing specifications and maintenance... facility, or by a designated representative; and (D) Detail off-line pump maintenance and repair...

  18. 40 CFR 63.1035 - Quality improvement program for pumps.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... determine the services, operating or maintenance practices, and pump or pump seal designs or technologies... and implement a pump quality assurance program that details purchasing specifications and maintenance... facility, or by a designated representative; and (D) Detail off-line pump maintenance and repair...

  19. Quality improvement of paediatric care in the Netherlands

    PubMed Central

    Schulpen, Tom W J; Lombarts, Kiki M J

    2007-01-01

    The development of the quality improvement programme of the Paediatric Association of the Netherlands is described within the setting of the national programme of the Dutch government. The programme is based on four pillars: site visits by peers (visitatie), continuous medical and professional education, development of clinical (evidence based) guidelines and patient safety with complication registration. The site visits by peers play a central role in assessing the quality improvement activities in hospital based paediatric care. The self assessment approach and the confidential character of the visits are well received by the surveyed specialists. Recent inclusion of quality criteria in the legally required 5 yearly medical specialist recertification process has boosted the care for quality, which could serve as example for other countries. PMID:17588977

  20. Interventions to improve water quality for preventing diarrhoea

    PubMed Central

    Clasen, Thomas F; Alexander, Kelly T; Sinclair, David; Boisson, Sophie; Peletz, Rachel; Chang, Howard H; Majorin, Fiona; Cairncross, Sandy

    2015-01-01

    Background Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces. In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home. Objectives To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014. Selection criteria Randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach. Main results Forty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with

  1. Mud management, special slurries improve deepwater cementing operations

    SciTech Connect

    Griffith, J.; Faul, R.

    1997-10-20

    Successful deepwater cementing requires improved mud-management techniques to reduce fluid loss, shorten slurry transition times, and make mud and cement slurry weights compatible with formation pore pressure and fracture gradients. If any one of these conditions is not met, the cementing job is less likely to be successful. Previous attempts to drill in deep water have had a low success rate, and failures have cost operators an average $2 million/well. By using new mud-management techniques and specially designed cement mixtures, operators in the Gulf of Mexico (GOM) are effectively setting conductor casing in deepwater conditions and are greatly improving the success rate in cementing deepwater wells. Recent case histories in the GOM describe these new techniques and the advantages of using a specially formulated, lightweight, foamed cement slurry to avoid cement-sheath damage caused by shallow-water flow.

  2. Ergonomic intervention for improving work postures during notebook computer operation.

    PubMed

    Jamjumrus, Nuchrawee; Nanthavanij, Suebsak

    2008-06-01

    This paper discusses the application of analytical algorithms to determine necessary adjustments for operating notebook computers (NBCs) and workstations so that NBC users can assume correct work postures during NBC operation. Twenty-two NBC users (eleven males and eleven females) were asked to operate their NBCs according to their normal work practice. Photographs of their work postures were taken and analyzed using the Rapid Upper Limb Assessment (RULA) technique. The algorithms were then employed to determine recommended adjustments for their NBCs and workstations. After implementing the necessary adjustments, the NBC users were then re-seated at their workstations, and photographs of their work postures were re-taken, to perform the posture analysis. The results show that the NBC users' work postures are improved when their NBCs and workstations are adjusted according to the recommendations. The effectiveness of ergonomic intervention is verified both visually and objectively.

  3. E-MSD: improving data deposition and structure quality

    PubMed Central

    Tagari, M.; Tate, J.; Swaminathan, G. J.; Newman, R.; Naim, A.; Vranken, W.; Kapopoulou, A.; Hussain, A.; Fillon, J.; Henrick, K.; Velankar, S.

    2006-01-01

    The Macromolecular Structure Database (MSD) () [H. Boutselakis, D. Dimitropoulos, J. Fillon, A. Golovin, K. Henrick, A. Hussain, J. Ionides, M. John, P. A. Keller, E. Krissinel et al. (2003) E-MSD: the European Bioinformatics Institute Macromolecular Structure Database. Nucleic Acids Res., 31, 458–462.] group is one of the three partners in the worldwide Protein DataBank (wwPDB), the consortium entrusted with the collation, maintenance and distribution of the global repository of macromolecular structure data [H. Berman, K. Henrick and H. Nakamura (2003) Announcing the worldwide Protein Data Bank. Nature Struct. Biol., 10, 980.]. Since its inception, the MSD group has worked with partners around the world to improve the quality of PDB data, through a clean up programme that addresses inconsistencies and inaccuracies in the legacy archive. The improvements in data quality in the legacy archive have been achieved largely through the creation of a unified data archive, in the form of a relational database that stores all of the data in the wwPDB. The three partners are working towards improving the tools and methods for the deposition of new data by the community at large. The implementation of the MSD database, together with the parallel development of improved tools and methodologies for data harvesting, validation and archival, has lead to significant improvements in the quality of data that enters the archive. Through this and related projects in the NMR and EM realms the MSD continues to improve the quality of publicly available structural data. PMID:16381867

  4. An integrated model for continuous quality improvement and productivity improvement in health services organizations.

    PubMed

    Rakich, J S; Darr, K; Longest, B B

    1993-01-01

    The health services paradigm with respect to quality has shifted to that of conformance to requirements (the absence of defects) and fitness for use (meeting customer expectations and needs). This article presents an integrated model of continuous quality improvement (CQI) (often referred to as total quality management) and productivity improvement for health services organizations. It incorporates input-output theory and focuses on the CQI challenge--"How can we be certain that we do the right things right the first time, every time?" The twin pillars of CQI are presented. Achievement of both will result in productivity improvement and enhancement of the health services organization's competitive position.

  5. Improving Quality of Emergency Care Through Integration of Mental Health.

    PubMed

    Okafor, Martha; Wrenn, Glenda; Ede, Victor; Wilson, Nana; Custer, William; Risby, Emile; Claeys, Michael; Shelp, Frank E; Atallah, Hany; Mattox, Gail; Satcher, David

    2016-04-01

    The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput.

  6. Relationships of physician characteristics to performance quality and improvement.

    PubMed Central

    Payne, B C; Lyons, T F; Neuhaus, E

    1984-01-01

    The quality of ambulatory medical care provided by 1,135 physicians in five separate practice settings in the Midwest was measured using predetermined process criteria. Specialists performed better in their own areas of specialized training than did family/general practitioners or specialists performing outside their specialty areas. Physicians with fewer years of practice performed somewhat better than physicians with more years since medical school graduation. Board certification was not consistently related to performance. Performances of the physicians improved following quality assurance interventions in these sites. Differences in the rates of change in performance quality were not consistently related to any of the physician characteristics studied. PMID:6746295

  7. A Quality Teacher in Every Classroom: Improving Teacher Quality and Enhancing the Profession.

    ERIC Educational Resources Information Center

    Executive Office of the President, Washington, DC.

    Through the No Child Left Behind Act and various budget proposals, President Bush is addressing the challenges of teacher quality and teacher training byassisting states and districts as they strive to improve teacher quality, taking specific steps to enhance the teaching profession and work environment, and providing new tools for teachers in…

  8. Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

    PubMed Central

    Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

    2015-01-01

    Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: ‘infrastructure’, ‘information’, ‘finance’, and ‘quality and safety’ to examine changes over time. Results Significant improvements were found in three of four domains: ‘quality and safety’ (F=22.81, p<0.01), ‘information’ (F=27.901, p<0.01) and ‘finance’ (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). Conclusions The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. PMID:25900466

  9. Rapid core measure improvement through a "business case for quality".

    PubMed

    Perlin, Jonathan B; Horner, Stephen J; Englebright, Jane D; Bracken, Richard M

    2014-01-01

    Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement. Improvement was measured by comparing systemwide rates of adherence to national quality measures for heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and surgical care (SCIP) to rates from all facilities reporting to the Centers for Medicare and Medicaid Services (CMS). As of the second quarter of 2011, 70% of HCA total measure set composite scores were at or above the 90th percentile of CMS scores. A test of differences in regression coefficients between the CMS national average and the HCA average revealed significant differences for AMI (p = .001), HF (p = .012), PN (p < .001), and SCIP (p = .015). This program demonstrated that presentation of the financial implications of quality, transparency in performance data, and clearly defined goals could cultivate the desire to use improvement tools and resources to raise performance.

  10. 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.

  11. Lower- Versus Higher-Income Populations In The Alternative Quality Contract: Improved Quality And Similar Spending.

    PubMed

    Song, Zirui; Rose, Sherri; Chernew, Michael E; Safran, Dana Gelb

    2017-01-01

    As population-based payment models become increasingly common, it is crucial to understand how such payment models affect health disparities. We evaluated health care quality and spending among enrollees in areas with lower versus higher socioeconomic status in Massachusetts before and after providers entered into the Alternative Quality Contract, a two-sided population-based payment model with substantial incentives tied to quality. We compared changes in process measures, outcome measures, and spending between enrollees in areas with lower and higher socioeconomic status from 2006 to 2012 (outcome measures were measured after the intervention only). Quality improved for all enrollees in the Alternative Quality Contract after their provider organizations entered the contract. Process measures improved 1.2 percentage points per year more among enrollees in areas with lower socioeconomic status than among those in areas with higher socioeconomic status. Outcome measure improvement was no different between the subgroups; neither were changes in spending. Larger or comparable improvements in quality among enrollees in areas with lower socioeconomic status suggest a potential narrowing of disparities. Strong pay-for-performance incentives within a population-based payment model could encourage providers to focus on improving quality for more disadvantaged populations.

  12. Use of ozone generating devices to improve indoor air quality.

    PubMed

    Boeniger, M F

    1995-06-01

    Room ozonization has been in widespread use to "freshen" indoor air for more than 100 years. This use is sometimes promoted with the claim that ozone can oxidize airborne gases, and even particulates, to simple carbon dioxide and water vapor. Aside from whether ozone can improve indoor air quality, the potentially deleterious consequences to public health of overexposure to ozone are of concern. The literature on both allegations is reviewed. It indicates that ozone is not a practical and effective means of improving indoor air quality, especially in light of its potentially serious risk to health.

  13. Operational water quality forecasting with EnKF data assimilation in the Yeongsan river basin, Korea

    NASA Astrophysics Data System (ADS)

    Shin, Changmin; Kim, Kyunghyun; Min, Joong-Hyuk; Na, Eunhye; Park, Suyoung; Song, Hyunoh

    2016-04-01

    National institute of environmental research(NIER) have been operating the water quality forecasting to prevent water quality deterioration for the major rivers in South Korea through WQFS-NIER(Water Quality Forecasting System) which developed based on Delft-FEWS system by the international joint research with NIER and Deltares from 2011 to 2013 The coupled the Hydrologic Simulation Program Fortran(HSPF) and the Environmental Fluid Dynamic Code(EFDC) models are being used to quantitatively predict the water quality. HSPF watershed model are used to generate the flows and water quality loads of the major tributaries which are used as the boundary conditions for EFDC model. The uncertainties in water quality forecasting are contributed by various factors such as input uncertainty, model structure uncertainty, parametric uncertainty, initial conditions uncertainty, of which to reduce uncertainty on the initial conditions is relatively effective in improving accuracy of short term water quality forecast. To reduce initial conditions uncertainties, ensemble Kalman filter(EnKF) data assimilation(DA) techniques are applied to the EFDC models. DA is to condition the model state on the observations to get a better estimate of state. Model error is assumed to come from uncertainties of the boundary conditions of EFDC model. The case study for Yeongsan river demonstrate that EnKF is successful in bringing the algae concentrations closer to the observations.

  14. Framework for continuous quality improvement in the provision of pharmaceutical care.

    PubMed

    Gitlow, H S; Melby, M J

    1991-09-01

    Implementation of the continuous quality improvement (CQI) process by health-care organizations is described. CQI involves a chain of events: Improvement in quality leads to decreased costs because of less rework, fewer mistakes, fewer delays, and better use of people and materials; productivity improves; better quality and lower price facilitate capturing the market, staying in business, and providing more jobs. The implementation of CQI within an organization involves the development, standardization, and deployment of standard methods and the use of daily management, cross-functional management, policy management, departmental management, and quality control circles to maintain, improve, or innovate standard methods. An organization's standard methods, key indicators (indicators for measuring performance of the organization's key functions), and standards emanate from its vision and mission statements and midterm and short-term strategic plans. In a quality control audit, an agreed-upon method, as monitored through a key indicator, is used to measure a result against an established standard; when a problem is detected, a quality control diagnosis is conducted and the method is changed if necessary. Use of this process requires the creation of standard methods for all important aspects of the organization's services, including operations, clinical services, and training of personnel. Health-care managers can use the principles of CQI in assessing the quality of care provided.

  15. Improving pharmacy supply-chain management in the operating room.

    PubMed

    Thomas, J A; Martin, V; Frank, S

    2000-12-01

    Anesthesia services can account for a significant portion of a healthcare organization's costs. Deaconess Hospital of Evansville, Indiana, used a collaborative, multidisciplinary effort to implement process improvements that yielded significant cost savings while improving patient care. Shifting responsibility for drug distribution from the operating room (OR) nurses to a pharmacist, the hospital established a satellite pharmacy service for the OR. As a result, the hospital was able to improve control of drug distribution and record-keeping, reduce turnaround time for medication preparation, lower its medication charge error rate, and increase the percentage of surgeries that start on time. The success of the OR satellite pharmacy led the hospital to expand satellite pharmacy services to labor and delivery, the cardiac cath laboratory, and the intensive care units.

  16. Improving machine operation management efficiency via improving the vehicle park structure and using the production operation information database

    NASA Astrophysics Data System (ADS)

    Koptev, V. Yu

    2017-02-01

    The work represents the results of studying basic interconnected criteria of separate equipment units of the transport network machines fleet, depending on production and mining factors to improve the transport systems management. Justifying the selection of a control system necessitates employing new methodologies and models, augmented with stability and transport flow criteria, accounting for mining work development dynamics on mining sites. A necessary condition is the accounting of technical and operating parameters related to vehicle operation. Modern open pit mining dispatching systems must include such kinds of the information database. An algorithm forming a machine fleet is presented based on multi-variation task solution in connection with defining reasonable operating features of a machine working as a part of a complex. Proposals cited in the work may apply to mining machines (drilling equipment, excavators) and construction equipment (bulldozers, cranes, pile-drivers), city transport and other types of production activities using machine fleet.

  17. Telephone - delivered quality of life after 365 male stress urinary incontinence (SUI) operations

    PubMed Central

    Bretterbauer, Katharina Maria; Huber, Erik Randall; Remzi, Mesut; Huebner, Wilhelm

    2016-01-01

    ABSTRACT Objectives: To assess patient satisfaction and quality of life and factors that may be related to these outcomes. Materials and Methods: Between 2000 and 2008 a retrospective chart review and telephone survey of all surgeries for male SUI was performed. Average age at times of operation was 69.4 ± 7.4 (median 69). As part of the survey 270 of 365 patients were available (response rate: 74%). The average follow up time (from operation to telephone survey) was 34.8 ± 22.8 months (median 32). Results: Pad use per day improved significantly after operation from 6.23±5.3 to 1.61±2.92 pads/day (p=0.001). 74.7% (n=198) declared to be continent with one safety pad and 87.7% (n=236) confirmed the postoperative improvement of incontinence. 189 (70.5%) patients were “very satisfied” and “satisfied”. In 81% (n=218) the expectation in operation could be met, therefore 84.3% (n=226) would undergo it again and 90.3% (n=243) would recommend it to others. Lower age (rs=0.211), few postoperative pads per day (rs=0.58), high reduction of pads (rs=-0.35) and physical activity level (rs=0.2) correlate significantly with better satisfaction. Conclusions: Eighty-seven pint seven percent (87.7%) of our incontinence operations (n=236) lead to an improvement, which is independent from the number of prior incontinence operations and preoperative pad count. The postoperative quality of life remains constant over the observed follow up time. Certain subgroups of patients (younger age, high physical activity level, large reduction of pads) demonstrated superior satisfaction rates. PMID:27532111

  18. An Improved Artificial Bee Colony Algorithm for Solving Hybrid Flexible Flowshop With Dynamic Operation Skipping.

    PubMed

    Li, Jun-Qing; Pan, Quan-Ke; Duan, Pei-Yong

    2016-06-01

    In this paper, we propose an improved discrete artificial bee colony (DABC) algorithm to solve the hybrid flexible flowshop scheduling problem with dynamic operation skipping features in molten iron systems. First, each solution is represented by a two-vector-based solution representation, and a dynamic encoding mechanism is developed. Second, a flexible decoding strategy is designed. Next, a right-shift strategy considering the problem characteristics is developed, which can clearly improve the solution quality. In addition, several skipping and scheduling neighborhood structures are presented to balance the exploration and exploitation ability. Finally, an enhanced local search is embedded in the proposed algorithm to further improve the exploitation ability. The proposed algorithm is tested on sets of the instances that are generated based on the realistic production. Through comprehensive computational comparisons and statistical analysis, the highly effective performance of the proposed DABC algorithm is favorably compared against several presented algorithms, both in solution quality and efficiency.

  19. CONSTRUCTED WETLAND TREATMENT SYSTEMS FOR WATER QUALITY IMPROVEMENT

    SciTech Connect

    Nelson, E.

    2010-07-19

    The Savannah River National Laboratory implemented a constructed wetland treatment system (CWTS) in 2000 to treat industrial discharge and stormwater from the Laboratory area. The industrial discharge volume is 3,030 m{sup 3} per day with elevated toxicity and metals (copper, zinc and mercury). The CWTS was identified as the best treatment option based on performance, capital and continuing cost, and schedule. A key factor for this natural system approach was the long-term binding capacity of heavy metals (especially copper, lead, and zinc) in the organic matter and sediments. The design required that the wetland treat the average daily discharge volume and be able to handle 83,280 m{sup 3} of stormwater runoff in a 24 hour period. The design allowed all water flow within the system to be driven entirely by gravity. The CWTS for A-01 outfall is composed of eight one-acre wetland cells connected in pairs and planted with giant bulrush to provide continuous organic matter input to the system. The retention basin was designed to hold stormwater flow and to allow controlled discharge to the wetland. The system became operational in October of 2000 and is the first wetland treatment system permitted by South Carolina DHEC for removal of metals. Because of the exceptional performance of the A-01 CWTS, the same strategy was used to improve water quality of the H-02 outfall that receives discharge and stormwater from the Tritium Area of SRS. The primary contaminants in this outfall were also copper and zinc. The design for this second system required that the wetland treat the average discharge volume of 415 m{sup 3} per day, and be able to handle 9,690 m{sup 3} of stormwater runoff in a 24 hour period. This allowed the building of a system much smaller than the A-01 CWTS. The system became operational in July 2007. Metal removal has been excellent since water flow through the treatment systems began, and performance improved with the maturation of the vegetation during

  20. Using mobile technology to improve healthcare service quality.

    PubMed

    Chao, Chia Chen; Jen, Wen Yuan; Li, Yu-Chuan; Chi, Y P; Chen, Chang-I; Feng, Chen Chjeh

    2005-01-01

    Improving healthcare service quality for illness of treatment, illness prevention and patient service is difficult for most hospitals because the hospitals are lack adequate resources and labor. In order to provide better healthcare service quality for patients, mobile technology can be used to manage healthcare in a way that provides the optimal healthcare service for patients. Pursuing utilization of mobile technology for better patient service, Taipei Medical University Municipal W. F. Teaching Hospital has implemented a mobile healthcare service (m-HS) system to increase healthcare service quality. The m-HS system improves the quality of medical care as well as healthcare service. The m-HS is a multi-functional healthcare management agent, meets the mobile tendency of the present society. This study seeks to discuss the m-HS architecture and workflow processes. We believe the m-HS does have the potential to improve healthcare service quality. Finally, the conclusions and suggestions for the m-HS are given.

  1. Benchmarking and audit of breast units improves quality of care

    PubMed Central

    van Dam, P.A.; Verkinderen, L.; Hauspy, J.; Vermeulen, P.; Dirix, L.; Huizing, M.; Altintas, S.; Papadimitriou, K.; Peeters, M.; Tjalma, W.

    2013-01-01

    Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. Assessment quality of care can be performed on different levels: national, regional, on a hospital basis or on an individual basis. It can be a mandatory or voluntary system. In all cases development of an adequate database for data extraction, and feedback of the findings is of paramount importance. In the present paper we performed a Medline search on “QIs and breast cancer” and “benchmarking and breast cancer care”, and we have added some data from personal experience. The current data clearly show that the use of QIs for breast cancer care, regular internal and external audit of performance of breast units, and benchmarking are effective to improve quality of care. Adherence to guidelines improves markedly (particularly regarding adjuvant treatment) and there are data emerging showing that this results in a better outcome. As quality assurance benefits patients, it will be a challenge for the medical and hospital community to develop affordable quality control systems, which are not leading to excessive workload. PMID:24753926

  2. A Framework for Improving the Quality of Research in the Biological Sciences

    PubMed Central

    Ellis, Lee M.; Davies, Erika W.; McFall-Ngai, Margaret; Fang, Ferric C.

    2016-01-01

    ABSTRACT The American Academy of Microbiology convened a colloquium to discuss problems in the biological sciences, with emphasis on identifying mechanisms to improve the quality of research. Participants from various disciplines made six recommendations: (i) design rigorous and comprehensive evaluation criteria to recognize and reward high-quality scientific research; (ii) require universal training in good scientific practices, appropriate statistical usage, and responsible research practices for scientists at all levels, with training content regularly updated and presented by qualified scientists; (iii) establish open data at the timing of publication as the standard operating procedure throughout the scientific enterprise; (iv) encourage scientific journals to publish negative data that meet methodologic standards of quality; (v) agree upon common criteria among scientific journals for retraction of published papers, to provide consistency and transparency; and (vi) strengthen research integrity oversight and training. These recommendations constitute an actionable framework that, in combination, could improve the quality of biological research. PMID:27578756

  3. Improving the quality of care for children in health systems.

    PubMed Central

    Homer, C J; Kleinman, L C; Goldman, D A

    1998-01-01

    OBJECTIVE: To summarize the state of the art in quality improvement, review its application to care for children, and define the information that will be needed so that care for children can be further improved. PRINCIPAL FINDINGS: Health services for children exhibit numerous deficiencies in quality of care. The deficiencies cross all major domains of pediatric care--preventive services, acute care, and chronic care--and provide the opportunity for creative application of improvement strategies with a potential to benefit the health and well-being of children. Approaches to quality improvement have changed over the past two decades from those emphasizing the inspection of structural aspects of care and the imposition of sanctions to more dynamic strategies that emphasize measurement and comparison to motivate change; the use of evidence to specify aims for improvement; and the adoption of a variety of management strategies adapted from business and the social sciences to achieve these aims. These modern approaches to quality improvement have rarely been subjected to rigorous testing of their effectiveness. Moreover, their application in pediatrics has been less widespread than in adult healthcare. For children, several aspects about health services, such as the relative rarity of chronic illness, the important effects of social factors on health, and the limited cost, make some of these approaches even more challenging and may require new approaches or meaningful modifications. RECOMMENDATIONS: Research to understand better the general process of improvement will benefit improvement efforts for children. Research that builds the base of knowledge about best practices for children--effectiveness research--will also result in an enhanced capacity for improvement of those systems that care for children's health. Quality of care for children would be enhanced by targeted research examining ways both to foster improvement across segments of society, and to make

  4. “Putting It All Together” to Improve Resuscitation Quality

    PubMed Central

    Sutton, Robert M.; Nadkarni, Vinay; Abella, Benjamin S.

    2013-01-01

    Cardiac arrest is a major public health problem affecting thousands of individuals each year in both the before hospital and in-hospital settings. However, although the scope of the problem is large, the quality of care provided during resuscitation attempts frequently does not meet quality of care standards, despite evidence-based cardiopulmonary resuscitation (CPR) guidelines, extensive provider training, and provider credentialing in resuscitation medicine. Although this fact may be disappointing, it should not be surprising. Resuscitation of the cardiac arrest victim is a highly complex task requiring coordination between various levels and disciplines of care providers during a stressful and relatively infrequent clinical situation. Moreover, it requires a targeted, high-quality response to improve clinical outcomes of patients. Therefore, solutions to improve care provided during resuscitation attempts must be multifaceted and targeted to the diverse number of care providers to be successful. PMID:22107978

  5. Improved electrode gives high-quality biological recordings

    NASA Technical Reports Server (NTRS)

    Day, J. L.; Lippitt, M. W.

    1964-01-01

    To obtain high quality waveforms from a subject engaged in physical activity, an improved electrode assembly has been devised. This consists of a cup containing an electrically conductive paste and a silver electrode. The paste maintains contact between the skin and the plate.

  6. San Francisco Bay Water Quality Improvement Fund RFP Webinar Registration

    EPA Pesticide Factsheets

    EPA Region 9 is hosting a free webinar to provide a detailed review of the FY 2017 San Francisco Bay Water Quality Improvement Fund RFP and help answer your proposal submittal questions.Date: Thursday, April 20, 2017Time: 2 PM – 3:30 PM Pacific

  7. IMPROVING NATIONAL AIR QUALITY FORECASTS WITH SATELLITE AEROSOL OBSERVATIONS

    EPA Science Inventory

    Air quality forecasts for major US metropolitan areas have been provided to the public through a partnership between the US Environmental Protection Agency and state and local air agencies since 1997. Recent years have witnessed improvement in forecast skill and expansion of fore...

  8. Continuous Quality Improvement: Making the Transition to Education.

    ERIC Educational Resources Information Center

    Hubbard, Dean L., Ed.

    This book is a collection of case studies by 27 educational and industrial leaders describing the implementation of specific Total Quality Management techniques which have demonstrated their value. Essays and their authors are as follows: "Process Improvements Using Team Environments" (Scot M. Faulkner); "Team Effectiveness" (Robert S. Winter);…

  9. Improving NAVFAC's total quality management of construction drawings with CLIPS

    NASA Technical Reports Server (NTRS)

    Antelman, Albert

    1991-01-01

    A diagnostic expert system to improve the quality of Naval Facilities Engineering Command (NAVFAC) construction drawings and specification is described. C Language Integrated Production System (CLIPS) and computer aided design layering standards are used in an expert system to check and coordinate construction drawings and specifications to eliminate errors and omissions.

  10. EPA Grant Will Help Central States Improve Air Quality

    EPA Pesticide Factsheets

    DALLAS - (April 12, 2016) The U.S. Environmental Protection Agency (EPA) has awarded $561,507 to the Central States Air Resource Agencies Association to help states collaborate on improving air quality. This group of nine states in the central U.S.

  11. Dramatic Improvements in Beach Water Quality Following Gull Removal

    EPA Science Inventory

    Gulls are often cited as important contributors of fecal contamination to surface waters, and some recreational beaches have used gull control measures to improve microbial water quality. In this study, gulls were chased from a Lake Michigan beach using specially trained dogs, a...

  12. 42 CFR 422.152 - Quality improvement program.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... means an MA plan that— (i) Has a network of providers that have agreed to a contractually specified... improvement program. (a) General rule. Each MA organization that offers one or more MA plans must have, for... section for the service it furnishes to its MA enrollees. As part of its ongoing quality...

  13. Software quality and process improvement in scientific simulation codes

    SciTech Connect

    Ambrosiano, J.; Webster, R.

    1997-11-01

    This report contains viewgraphs on the quest to develope better simulation code quality through process modeling and improvement. This study is based on the experience of the authors and interviews with ten subjects chosen from simulation code development teams at LANL. This study is descriptive rather than scientific.

  14. Developing a Quality Improvement Process to Optimize Faculty Success

    ERIC Educational Resources Information Center

    Merillat, Linda; Scheibmeir, Monica

    2016-01-01

    As part of a major shift to embed quality improvement processes within a School of Nursing at a medium-sized Midwestern university, a faculty enrichment program using a Plan-Do-Act-Study design was implemented. A central focus for the program was the development and maintenance of an online faculty resource center identified as "My Faculty…

  15. Student Evaluations of Teaching: Improving Teaching Quality in Higher Education

    ERIC Educational Resources Information Center

    Hammonds, Frank; Mariano, Gina J.; Ammons, Gracie; Chambers, Sheridan

    2017-01-01

    Student evaluations of teaching (SET) are widely used in both North America and the UK as a means of documenting and improving teaching quality. This article discusses current research on SET administration and interpretation in both regions. Sections of the article are dedicated to various problems associated with SETs and how these may be…

  16. Approaches for vegetable and fruit quality trait improvement

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Improving food quality traits has become a major goal of fruit and vegetable breeding due to the increasing public awareness of nutraceutical compounds to human nutrition and health. During domestication and breeding of modern varieties, many traits were left behind in the wild and in the primitive ...

  17. Guiding and Modelling Quality Improvement in Higher Education Institutions

    ERIC Educational Resources Information Center

    Little, Daniel

    2015-01-01

    The article considers the process of creating quality improvement in higher education institutions from the point of view of current organisational theory and social-science modelling techniques. The author considers the higher education institution as a functioning complex of rules, norms and other organisational features and reviews the social…

  18. Making Departments Distinctive: The Continuous Quality Improvement (CQI) Mindset.

    ERIC Educational Resources Information Center

    Chambliss, Catherine

    The Continuous Quality Improvement (CQI) approach has provided many corporations with a tool for adapting to ongoing shifts in demands and resources, and it can offer academic settings similar assistance. CQI offers a mechanism for building a collaborative process that can help departments define their unique strengths and cultivate a distinctive…

  19. Improving Lecture Quality through Training in Public Speaking

    ERIC Educational Resources Information Center

    Mowbray, Robert; Perry, Laura B.

    2015-01-01

    Lecturing is a common instructional format but poor lecturing skills can detract from students' learning experiences and outcomes. As lecturing is essentially a form of public communication, training in public speaking may improve lecture quality. Twelve university lecturers in Malaysia participated in a six-week public speaking skills training…

  20. Improving the Quality of Instruction through a Service Teaching Framework

    ERIC Educational Resources Information Center

    Husband, Terry

    2013-01-01

    Many professors lack sufficient pedagogical training needed to teach their courses effectively. In an effort to aid professors in improving the quality of instruction in their courses, this article distills the principles embedded within a service teaching framework for instruction. The principles discussed throughout this article pertain to:…

  1. Quality improvement in the biomedical communications audio visual unit.

    PubMed

    Stein, D

    1994-01-01

    The audio visual unit is a highly visible and most frequently requested service provided by a biomedical communications department. To continuously improve service, delivery, and operation of an audio visual communications function is a challenge. This article presents a field-tested audit tool for describing audio visual unit strengths and limitations. The tool suggests four assessment areas: the service plan, the client communication network, training and managing staff, and standard operating policy and procedures.

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

    PubMed Central

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

    2013-01-01

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

  3. Improving the Context Supporting Quality Improvement in a Neonatal Intensive Care Unit Quality Collaborative: An Exploratory Field Study.

    PubMed

    Grooms, Heather R; Froehle, Craig M; Provost, Lloyd P; Handyside, James; Kaplan, Heather C

    2016-04-26

    Successful quality improvement (QI) requires a supportive context. The goal was to determine whether a structured curriculum could help QI teams improve the context supporting their QI work. An exploratory field study was conducted of 43 teams participating in a neonatal intensive care unit QI collaborative. Using a curriculum based on the Model for Understanding Success in Quality, teams identified gaps in their context and tested interventions to modify context. Surveys and self-reflective journals were analyzed to understand how teams developed changes to modify context. More than half (55%) targeted contextual improvements within the microsystem, focusing on motivation and culture. "Information sharing" interventions to communicate information about the project as a strategy to engage more staff were the most common interventions tested. Further study is needed to determine if efforts to modify context consistently lead to greater outcome improvements.

  4. The Mark III IR FEL: Improvements in performance and operation

    SciTech Connect

    Barnett, G.A.; Madey, J.M.J.; Straub, K.D.

    1995-12-31

    The Mark III IR FEL has been upgraded by the installation of a new thermionic microwave gun. The new gun yields a reduced emittance and allows operation at a higher repetition rate and an increased electron macropulse length. The RF system of the Mark III has also been phase-locked to the RF systemof the adjacent storage ring driver for the laboratory`s short-wavelength FEL sources, making possible two-color UV-IR pump probe experiments. In this paper, the design and performance of the new gun are presented and the implications of the improvements investigated.

  5. Counseling in Primary Care Improves Depression and Quality of Life

    PubMed Central

    Carta, MG; Petretto, D; Adamo, S; Bhat, KM; Lecca, ME; Mura, G; Carta, V; Angermeyer, M; Moro, MF

    2012-01-01

    Introduction: To measure the effectiveness on Quality of Life of adjunctive cognitive behavioral counseling in the setting of General Practitioners (GPs) along with the treatment as usual (TAU;) for the treatment of depression. Methods: Six month-controlled trial of patients who were referred to randomly assigned GPs (four for experimental group of patients and ten for the control) was done. Experimental sample had 34 patients with DSM-IV diagnosis of Depression (Depressed Episode, Dysthymia, or Adjustment Disorder with Depressed Mood) receiving the TAU supplemented with counseling. Control group had 30 patients with diagnosis of Depression receiving only the TAU. Results: The Beck Depression Inventory (BDI) score improved in both groups. Patients in the experimental group showed greater improvement compared to the control group at T2. The World Health Organization Quality OF Life Questionnaire (WHOQOL) score also improved in the experimental group but not in the control group. The improvement in the experimental group was statistically significant in terms of both BDI and WHOQOL scores. Conclusions: Adding counseling to TAU in general medical practice settings is more effective in controlling the symptoms of depression and improving the quality of life as measured over a period of six months, than TAU alone. These results while encouraging, also calls for a larger study involving a largersample size and a longer period of time. PMID:23173011

  6. Improving the quality of patient handover on a surgical ward.

    PubMed

    Bradley, Alison

    2014-01-01

    The European Working Time Directive means safe patient hand over is imperative. It is the responsibility of every doctor and an issue of patient safety and clinical governance [1]. The aims of this project were to improve the quality of patient handover between combined assessment unit (CAU) and surgical ward FY1 doctors. The Royal College of Surgeons England (RCSEng) guidelines on surgical patient handover [1] were used as the standard. Data was collected throughout November 2013. A handover tool was then introduced and attached to the front of patient notes when a patient was transferred from CAU to the surgical ward. The doctor handing over the patient and the ward doctor receiving the handover signed this document. Policy was also changed so that handover should take place once the patient had received senior review on the CAU and was deemed appropriate for transfer to the surgical ward. Data from the handover tool was collated and checked against the list of surgical admission for February 2014. The number of patients handed over improved from 15 % to 45%. The quality of patient handover also improved. 0 patient handovers in November 2013 included all of the information recommended by the RCSEng guidelines. 100% of the patient handovers in February 2014 contained all the recommended information. Introduction of a handover tool and formalisation of timing of patient handover helped to improve quality and number of patients being handed over. Further work needs to be done to improve safe handover of surgical patients, particularly out of hours.

  7. Continuous quality improvement: educating towards a culture of clinical governance

    PubMed Central

    Heard, S; Schiller, G; Aitken, M; Fergie, C; Hall, L

    2001-01-01

    The National Health Service in England and Wales has recently adopted a policy aimed at embedding continuous quality improvement (CQI) at all levels and across all services. The key goal is to achieve changes in practice which improve patient outcomes. This paper describes the use of a training course for multiprofessional groups of participants tailored to offer them relevant knowledge, management and team working skills, and approaches to personal and career development. These were intended to assist them in changing their practice for the benefit of patients. The participants rated the course highly in fulfilling its objectives. One cohort followed up for 6 months named changes in practice which related specifically to learning from the course. This paper shows the important contribution of multiprofessional learning to CQI and presents a useful method of evaluating links between learning and performance. Key Words: continuous quality improvement; clinical governance; multiprofessional learning; performance PMID:11700383

  8. Remote Sensing and Modeling for Improving Operational Aquatic Plant Management

    NASA Technical Reports Server (NTRS)

    Bubenheim, Dave

    2016-01-01

    The California Sacramento-San Joaquin River Delta is the hub for California’s water supply, conveying water from Northern to Southern California agriculture and communities while supporting important ecosystem services, agriculture, and communities in the Delta. Changes in climate, long-term drought, water quality changes, and expansion of invasive aquatic plants threatens ecosystems, impedes ecosystem restoration, and is economically, environmentally, and sociologically detrimental to the San Francisco Bay/California Delta complex. NASA Ames Research Center and the USDA-ARS partnered with the State of California and local governments to develop science-based, adaptive-management strategies for the Sacramento-San Joaquin Delta. The project combines science, operations, and economics related to integrated management scenarios for aquatic weeds to help land and waterway managers make science-informed decisions regarding management and outcomes. The team provides a comprehensive understanding of agricultural and urban land use in the Delta and the major water sheds (San Joaquin/Sacramento) supplying the Delta and interaction with drought and climate impacts on the environment, water quality, and weed growth. The team recommends conservation and modified land-use practices and aids local Delta stakeholders in developing management strategies. New remote sensing tools have been developed to enhance ability to assess conditions, inform decision support tools, and monitor management practices. Science gaps in understanding how native and invasive plants respond to altered environmental conditions are being filled and provide critical biological response parameters for Delta-SWAT simulation modeling. Operational agencies such as the California Department of Boating and Waterways provide testing and act as initial adopter of decision support tools. Methods developed by the project can become routine land and water management tools in complex river delta systems.

  9. The 'Alternative Quality Contract,' based on a global budget, lowered medical spending and improved quality.

    PubMed

    Song, Zirui; Safran, Dana Gelb; Landon, Bruce E; Landrum, Mary Beth; He, Yulei; Mechanic, Robert E; Day, Matthew P; Chernew, Michael E

    2012-08-01

    Seven provider organizations in Massachusetts entered the Blue Cross Blue Shield Alternative Quality Contract in 2009, followed by four more organizations in 2010. This contract, based on a global budget and pay-for-performance for achieving certain quality benchmarks, places providers at risk for excessive spending and rewards them for quality, similar to the new Pioneer Accountable Care Organizations in Medicare. We analyzed changes in spending and quality associated with the Alternative Quality Contract and found that the rate of increase in spending slowed compared to control groups, more so in the second year than in the first. Overall, participation in the contract over two years led to savings of 2.8 percent (1.9 percent in year 1 and 3.3 percent in year 2) compared to spending in nonparticipating groups. Savings were accounted for by lower prices achieved through shifting procedures, imaging, and tests to facilities with lower fees, as well as reduced utilization among some groups. Quality of care also improved compared to control organizations, with chronic care management, adult preventive care, and pediatric care within the contracting groups improving more in year 2 than in year 1. These results suggest that global budgets with pay-for-performance can begin to slow underlying growth in medical spending while improving quality of care.

  10. Control methods to improve non-linear HVAC system operations

    NASA Astrophysics Data System (ADS)

    Phalak, Kaustubh Pradeep

    The change of weather conditions and occupancy schedules makes heating ventilating and air-conditioning (HVAC) systems heavily dynamic. The mass and thermal inertia, nonlinear characteristics and interactions in HVAC systems make the control more complicated. As a result, some conventional control methods often cannot provide desired control performance under variable operating conditions. The purpose of this study is to develop control methods to improve the control performance of HVAC systems. This study focuses on optimizing the airflow-pressure control method of air side economizers, identifying robust building pressurization controls, developing a control method to control outdoor air and building pressure in absence of flow and pressure sensors, stabilizing the cooling coil valve operation and, return fan speed control. The improvements can be achieved by identifying and selecting a method with relatively linear performance characteristics out of the available options, applying fans rather than dampers to control building pressure, and improving the controller's stability range using cascade control method. A steady state nonlinear network model, for an air handling unit (AHU), air distribution system and conditioned space, is applied to analyze the system control performance of air-side economizers and building pressurization. The study shows that traditional controls with completely interlinked outdoor air, recirculated air, relief air dampers have the best control performance. The decoupled relief damper control may result in negative building static pressure at lower outdoor airflow ratio and excessively positive building static pressure at higher outdoor airflow ratio. On the other hand, return fan speed control has a better controllability on building pressurization. In absence of flow and pressure sensors fixed interlinked damper and linear return fan speed tracking control can maintain constant outside air ratio and positive building pressure. The

  11. Bee pollination improves crop quality, shelf life and commercial value.

    PubMed

    Klatt, Björn K; Holzschuh, Andrea; Westphal, Catrin; Clough, Yann; Smit, Inga; Pawelzik, Elke; Tscharntke, Teja

    2014-01-22

    Pollination improves the yield of most crop species and contributes to one-third of global crop production, but comprehensive benefits including crop quality are still unknown. Hence, pollination is underestimated by international policies, which is particularly alarming in times of agricultural intensification and diminishing pollination services. In this study, exclusion experiments with strawberries showed bee pollination to improve fruit quality, quantity and market value compared with wind and self-pollination. Bee-pollinated fruits were heavier, had less malformations and reached higher commercial grades. They had increased redness and reduced sugar-acid-ratios and were firmer, thus improving the commercially important shelf life. Longer shelf life reduced fruit loss by at least 11%. This is accounting for 0.32 billion US$ of the 1.44 billion US$ provided by bee pollination to the total value of 2.90 billion US$ made with strawberry selling in the European Union 2009. The fruit quality and yield effects are driven by the pollination-mediated production of hormonal growth regulators, which occur in several pollination-dependent crops. Thus, our comprehensive findings should be transferable to a wide range of crops and demonstrate bee pollination to be a hitherto underestimated but vital and economically important determinant of fruit quality.

  12. Improving the quality of health care: what's taking so long?

    PubMed

    Chassin, Mark R

    2013-10-01

    Nearly fourteen years ago the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, triggered a national movement to improve patient safety. Despite the substantial and concentrated efforts that followed, quality and safety problems in health care continue to routinely result in harm to patients. Desired progress will not be achieved unless substantial changes are made to the way in which quality improvement is conducted. Alongside important efforts to eliminate preventable complications of care, there must also be an effort to seriously address the widespread overuse of health services. That overuse, which places patients at risk of harm and wastes resources at the same time, has been almost entirely left out of recent quality improvement endeavors. Newer and much more effective strategies and tools are needed to address the complex quality challenges confronting health care. Tools such as Lean, Six Sigma, and change management are proving highly effective in tackling problems as difficult as hand-off communication failures and patient falls. Finally, the organizational culture of most American hospitals and other health care organizations must change. To create a culture of safety, leaders must eliminate intimidating behaviors that suppress the reporting of errors and unsafe conditions. Leaders must also hold everyone accountable for adherence to safe practices.

  13. Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes.

    PubMed

    Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

    2015-10-01

    While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement.

  14. Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes

    PubMed Central

    Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

    2015-01-01

    While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. PMID:26178332

  15. Quality and productivity improvement program (PPKP) from alumni perspective

    NASA Astrophysics Data System (ADS)

    Ruza, Nadiah; Mustafa, Zainol

    2013-04-01

    Defining the quality of the university education system is not easy. Institutions of higher education, through curriculum are hoped to provide the knowledge, wisdom and personality of students. It is questionable of how far Quality and Productivity Improvement Program (PPKP) are capable to ensure the courses offered relevant and effective in preparing the students for job market. The effectiveness of a university to undertake responsibilities and the impact given to students even after they graduate can be a measure of education quality at university. So, the quality of education can be enhanced and improved from time to time. In general, this study is aims to determine the effectiveness of PPKP's education system from the perspective of their alumni as well as their satisfaction and the importance level based on how PPKP be able to meet their needs. In overall, summary of open-ended questions from the questionnaire, Importance-Performance analysis and correlation analysis were conducted for this study. Based on result, it appears that there are still some deficiencies that can be improve, particularly in terms of teaching skills and PPKP's relationships with external organizations to enable knowledge be channel effectively. Importance-Performance analysis highlights some topics or courses that should be offered by PPKP based on their importance in industrial practice. Summary of the results of correlation analysis was found that women are more positive and not too demanding compared to men. In addition, it is found that the responsibilities and workload of the older generations, higher income and a high level of experience demands them to use and practice what they have learned during their studies at PPKP. Results of this study are hoped could be used to improve the quality of education system at PPKP.

  16. Potential for luminosity improvement for low-energy RHIC operation

    SciTech Connect

    Fedotov A. V.

    2012-05-20

    At the Brookhaven National Laboratory, a physics program, motivated by the search of the QCD phase transition critical point, requires operation of the Relativistic Heavy Ion Collider (RHIC) with heavy ions at very low beam energies corresponding to 2.5-20 GeV/n. Several physics runs were already successfully performed at these low energies. However, the luminosity is very low at lowest energies of interest (< 10 GeV/n) limited by the intra-beam scattering and space-charge, as well as by machine nonlinearities. At these low energies, electron cooling could be very effective in counteracting luminosity degradation due to the IBS, while it is less effective against other limitations. Overall potential luminosity improvement for low-energy RHIC operation from cooling is summarized for various energies, taking into account all these limitations as well as beam lifetime measured during the low-energy RHIC runs. We also explore a possibility of further luminosity improvement under the space-charge limitation.

  17. Improving Data Quality in the Enlisted Master File

    DTIC Science & Technology

    1990-03-01

    NAVAL POSTGRADUATE SCHOOL Monterey, California 0CON in THSI IMPROVING DATA QUALITY IN THE ENLISTED MASTER FILE by Susan R. Sablan March 1990 Thesis ...Thes;is 1:r cm To March 1990 l0- o Spicnrr~ N~ra~anThe viewvs expressed in this thesis are those of the author and do not reflect th, oftficial polic>o...completeness, and accuracy of the actual data values. This thesis will survey the current state of data quality control for the NES and provide recommendations

  18. Quality: performance improvement, teamwork, information technology and protocols.

    PubMed

    Coleman, Nana E; Pon, Steven

    2013-04-01

    Using the Institute of Medicine framework that outlines the domains of quality, this article considers four key aspects of health care delivery which have the potential to significantly affect the quality of health care within the pediatric intensive care unit. The discussion covers: performance improvement and how existing methods for reporting, review, and analysis of medical error relate to patient care; team composition and workflow; and the impact of information technologies on clinical practice. Also considered is how protocol-driven and standardized practice affects both patients and the fiscal interests of the health care system.

  19. Method and apparatus for operating an improved thermocline storage unit

    DOEpatents

    Copeland, R.J.

    1982-09-30

    A method and apparatus for operating a thermocline storage unit in which an insulated barrier member is provided substantially at the interface region between the hot and cold liquids in the storage tank. The barrier member physically and thermally separates the hot and cold liquids substantially preventing any diffusing or mixing between them and substantially preventing any heat transfer there between. The barrier member follows the rise and fall of the interface region between the liquids as the tank is charged and discharged. Two methods of maintaining it in the interface region are disclosed. With the structure and operation of the present invention and in particular the significant reduction in diffusing or mixing between the hot and cold liquids as well as the significant reduction in the thermal heat transfer between them, the performance of the storage tank is improved. More specifically, the stability of the interface region or thermocline is enhanced and the thickness of the thermocline is reduced producing a corresponding increase in the steepness of the temperature gradient across the thermocline and a more efficiently operating thermocline storage unit.

  20. Application of the Toyota Production System improves core laboratory operations.

    PubMed

    Rutledge, Joe; Xu, Min; Simpson, Joanne

    2010-01-01

    To meet the increased clinical demands of our hospital expansion, improve quality, and reduce costs, our tertiary care, pediatric core laboratory used the Toyota Production System lean processing to reorganize our 24-hour, 7 d/wk core laboratory. A 4-month, consultant-driven process removed waste, led to a physical reset of the space to match the work flow, and developed a work cell for our random access analyzers. In addition, visual controls, single piece flow, standard work, and "5S" were instituted. The new design met our goals as reflected by achieving and maintaining improved turnaround time (TAT; mean for creatinine reduced from 54 to 23 minutes) with increased testing volume (20%), monetary savings (4 full-time equivalents), decreased variability in TAT, and better space utilization (25% gain). The project had the unanticipated consequence of eliminating STAT testing because our in-laboratory TAT for routine testing was less than our prior STAT turnaround goal. The viability of this approach is demonstrated by sustained gains and further PDCA (Plan, Do, Check, Act) improvements during the 4 years after completion of the project.

  1. The maturing of the quality improvement paradigm in the SEL

    NASA Technical Reports Server (NTRS)

    Basili, Victor R.

    1993-01-01

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

  2. An Effect of the Co-Operative Network Model for Students' Quality in Thai Primary Schools

    ERIC Educational Resources Information Center

    Khanthaphum, Udomsin; Tesaputa, Kowat; Weangsamoot, Visoot

    2016-01-01

    This research aimed: 1) to study the current and desirable states of the co-operative network in developing the learners' quality in Thai primary schools, 2) to develop a model of the co-operative network in developing the learners' quality, and 3) to examine the results of implementation of the co-operative network model in the primary school.…

  3. Effectiveness of a quality-improvement program in improving management of primary care practices

    PubMed Central

    Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

    2011-01-01

    Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the

  4. Highlights of contractor initiatives in quality enhancement and productivity improvement

    NASA Technical Reports Server (NTRS)

    1986-01-01

    The NASA/Contractor Team efforts are presented as part of NASA's continuing effort to facilitate the sharing of quality and productivity improvement ideas among its contractors. This complilation is not meant to be a comprehensive review of contractor initiative nor does it necessarily express NASA's views. The submissions represent samples from a general survey, and were not edited by NASA. The efforts are examples of quality and productivity programs in private industry, and as such, highlight company efforts in individual areas. Topics range from modernization of equipment, hardware, and technology to management of human resources. Of particular interest are contractor initiatives which deal with measurement and evaluation data pertaining to quality and productivity performance.

  5. Improving the Quality of Protein Crystals Using Stirring Crystallization

    NASA Astrophysics Data System (ADS)

    Adachi, Hiroaki; Matsumura, Hiroyoshi; Niino, Ai; Takano, Kazufumi; Kinoshita, Takayoshi; Warizaya, Masaichi; Inoue, Tsuyoshi; Mori, Yusuke; Sasaki, Takatomo

    2004-04-01

    Recent reports state that a high magnetic field improves the crystal quality of bovine adenosine deaminase (ADA) with an inhibitor [Kinoshita et al.: Acta Cryst. D59 (2003) 1333]. In this paper, we examine the effect of stirring solution on ADA crystallization using a vapor-diffusion technique with rotary and figure-eight motion shakers. The probability of obtaining high-quality crystals is increased with stirring in a figure-eight pattern. Furthermore, rotary stirring greatly increased the probability of obtaining high-quality crystals, however, nucleation time was also increased. The crystal structure with the inhibitor was determined at a high resolution using a crystal obtained from a stirred solution. These results indicate that stirring with simple equipment is as useful as the high magnetic field technique for protein crystallization.

  6. Investment in quality improvement: how to maximize the return.

    PubMed

    Gandjour, Afschin

    2010-01-01

    Today, one of the most pressing concerns of health-care policymakers in industrialized countries are deficits in the quality of health care. This paper presents a decision program that addresses the question in which disease areas and at what intensity to invest in quality improvement (QI) in order to maximize population health. The decision program considers both a budget constraint as well as time constraints of educators and health professionals to participate in educational activities. The calculations of the model are based on a single assumption which is that more intense quality efforts lead to larger QIs, but with diminishing returns. This assumption has been validated by previous studies. All other relationships described by the model are deduced from this assumption. The model uses data from QI trials published in the literature. Thus, it is able to assess how the vast number of published QI strategies compare in terms of their value.

  7. Image quality improvement of polygon computer generated holography.

    PubMed

    Pang, Xiao-Ning; Chen, Ding-Chen; Ding, Yi-Cong; Chen, Yi-Gui; Jiang, Shao-Ji; Dong, Jian-Wen

    2015-07-27

    Quality of holographic reconstruction image is seriously affected by undesirable messy fringes in polygon-based computer generated holography. Here, several methods have been proposed to improve the image quality, including a modified encoding method based on spatial-domain Fraunhofer diffraction and a specific LED light source. Fast Fourier transform is applied to the basic element of polygon and fringe-invisible reconstruction is achieved after introducing initial random phase. Furthermore, we find that the image with satisfactory fidelity and sharp edge can be reconstructed by either a LED with moderate coherence level or a modulator with small pixel pitch. Satisfactory image quality without obvious speckle noise is observed under the illumination of bandpass-filter-aided LED. The experimental results are consistent well with the correlation analysis on the acceptable viewing angle and the coherence length of the light source.

  8. Processes for quality improvements in radiation oncology clinical trials.

    PubMed

    FitzGerald, T J; Urie, Marcia; Ulin, Kenneth; Laurie, Fran; Yorty, Jeffrey; Hanusik, Richard; Kessel, Sandy; Jodoin, Maryann Bishop; Osagie, Gani; Cicchetti, M Giulia; Pieters, Richard; McCarten, Kathleen; Rosen, Nancy

    2008-01-01

    Quality assurance in radiotherapy (RT) has been an integral aspect of cooperative group clinical trials since 1970. In early clinical trials, data acquisition was nonuniform and inconsistent and computational models for radiation dose calculation varied significantly. Process improvements developed for data acquisition, credentialing, and data management have provided the necessary infrastructure for uniform data. With continued improvement in the technology and delivery of RT, evaluation processes for target definition, RT planning, and execution undergo constant review. As we move to multimodality image-based definitions of target volumes for protocols, future clinical trials will require near real-time image analysis and feedback to field investigators. The ability of quality assurance centers to meet these real-time challenges with robust electronic interaction platforms for imaging acquisition, review, archiving, and quantitative review of volumetric RT plans will be the primary challenge for future successful clinical trials.

  9. Teaching quality improvement: a collaboration project between medicine and engineering.

    PubMed

    Varkey, Prathibha; Karlapudi, Sudhakar P; Bennet, Kevin E

    2008-01-01

    Systems failures and their impact on quality and cost have fueled the need for a paradigm shift in medical education. Despite a growing interest in health care quality improvement (QI), few physician educators possess the necessary expertise in either systems engineering or QI. In this article, we describe a novel teaching partnership between engineers and physicians in implementing a 3-week elective QI training curriculum on health care QI. Nine learners, 2 preventive medicine and 7 endocrinology fellows, participated in this rotation. Key concepts taught by the 4 engineering faculty include stake-holder analysis, root cause analysis, process mapping, failure mode and effects analysis, resource management, negotiation, and leadership. Learner scores on the QI knowledge application tool improved significantly (P < .004) from 7.33 prerotation to 11.89 postrotation. Further research is necessary to study the effectiveness, efficacy, and scope of using engineering expertise in QI education initiatives.

  10. IMPROVING (SOFTWARE) PATENT QUALITY THROUGH THE ADMINISTRATIVE PROCESS.

    PubMed

    Rai, Arti K

    2013-11-24

    The available evidence indicates that patent quality, particularly in the area of software, needs improvement. This Article argues that even an agency as institutionally constrained as the U.S. Patent and Trademark Office ("PTO") could implement a portfolio of pragmatic, cost-effective quality improvement strategies. The argument in favor of these strategies draws upon not only legal theory and doctrine but also new data from a PTO software examination unit with relatively strict practices. Strategies that resolve around Section 112 of the patent statute could usefully be deployed at the initial examination stage. Other strategies could be deployed within the new post-issuance procedures available to the agency under the America Invents Act. Notably, although the strategies the Article discusses have the virtue of being neutral as to technology, they are likely to have a very significant practical impact in the area of software.

  11. The epistemology of quality improvement: it's all Greek.

    PubMed

    Perla, Rocco J; Parry, Gareth J

    2011-04-01

    In Plato's Theaetetus, knowledge is defined as the intersection of truth and belief, where knowledge cannot be claimed if something is true but not believed or believed but not true. Using an example from neonatal intensive care, this paper adapts Plato's definition of the concept 'knowledge' and applies it to the field of quality improvement in order to explore and understand where current tensions may lie for both practitioners and decision makers. To increase the uptake of effective interventions, not only does there need to be scientific evidence, there also needs to be an understanding of how people's beliefs are changed in order to increase adoption more rapidly. Understanding how best to maximise the overlap between actual and best practice is where quality improvement needs to employ educational and social sciences' methodologies and techniques.

  12. IMPROVING (SOFTWARE) PATENT QUALITY THROUGH THE ADMINISTRATIVE PROCESS

    PubMed Central

    Rai, Arti K.

    2014-01-01

    The available evidence indicates that patent quality, particularly in the area of software, needs improvement. This Article argues that even an agency as institutionally constrained as the U.S. Patent and Trademark Office (“PTO”) could implement a portfolio of pragmatic, cost-effective quality improvement strategies. The argument in favor of these strategies draws upon not only legal theory and doctrine but also new data from a PTO software examination unit with relatively strict practices. Strategies that resolve around Section 112 of the patent statute could usefully be deployed at the initial examination stage. Other strategies could be deployed within the new post-issuance procedures available to the agency under the America Invents Act. Notably, although the strategies the Article discusses have the virtue of being neutral as to technology, they are likely to have a very significant practical impact in the area of software. PMID:25221346

  13. The epistemology of quality improvement: it's all Greek

    PubMed Central

    Perla, Rocco J

    2011-01-01

    In Plato's Theaetetus, knowledge is defined as the intersection of truth and belief, where knowledge cannot be claimed if something is true but not believed or believed but not true. Using an example from neonatal intensive care, this paper adapts Plato's definition of the concept ‘knowledge’ and applies it to the field of quality improvement in order to explore and understand where current tensions may lie for both practitioners and decision makers. To increase the uptake of effective interventions, not only does there need to be scientific evidence, there also needs to be an understanding of how people's beliefs are changed in order to increase adoption more rapidly. Understanding how best to maximise the overlap between actual and best practice is where quality improvement needs to employ educational and social sciences' methodologies and techniques. PMID:21450765

  14. Improving diabetic foot screening at a primary care clinic: A quality improvement project

    PubMed Central

    Allen, Michelle L.; Gunst, Colette

    2016-01-01

    Background Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected. Aim This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices. Setting A primary health care clinic in the Western Cape province of South Africa Methods A quality improvement project was conducted. HCWs’ needs were assessed using a questionnaire. This was followed by focus group discussions with the HCWs, which were recorded, transcribed and assessed using a general inductive approach. An intervention was designed based on common themes. Staff members were trained on foot screening and patient information pamphlets and screening tools were made available to all clinic staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 with that in 2014 after initiation of the quality improvement cycle. Results HCWs’ confidence in conducting foot screening using the diabetic foot assessment questionnaire improved markedly after training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first quality improvement cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles. Conclusion The findings showed a significant improvement in the number of diabetic patients screened. Using strategic planning with appreciative intent based on SOAR, proved to be motivational and can be used in the planning of the next cycle. PMID:27608673

  15. 78 FR 67442 - Congestion Mitigation and Air Quality Improvement Program Interim Guidance

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-12

    ... Federal Highway Administration Congestion Mitigation and Air Quality Improvement Program Interim Guidance... Mitigation and Air Quality Improvement (CMAQ) Program (Interim Guidance). The Interim Guidance revises CMAQ....gov/environment/air_quality/cmaq/policy_and_guidance/2008_guidance/ guidance/. DATES: This...

  16. AN OPERATIONAL EVALUATION OF THE ETA-CMAQ AIR QUALITY FORECAST MODEL

    EPA Science Inventory

    The National Oceanic and Atmospheric Administration (NOAA), in collaboration with the Environmental Protection Agency (EPA), are developing an Air Quality Forecasting Program that will eventually result in an operational Nationwide Air Quality Forecasting System. The initial pha...

  17. Improving Quality of Seal Leak Test Product using Six Sigma

    NASA Astrophysics Data System (ADS)

    Luthfi Malik, Abdullah; Akbar, Muhammad; Irianto, Dradjad

    2016-02-01

    Seal leak test part is a polyurethane material-based product. Based on past data, defect level of this product was 8%, higher than the target of 5%. Quality improvement effort was done using six sigma method that included phases of define, measure, analyse, improve, and control. In the design phase, a Delphi method was used to identify factors that were critical to quality. In the measure phase, stability and process capability was measured. Fault tree analysis (FTA) and failure mode and effect analysis (FMEA) were used in the next phase to analize the root cause and to determine the priority issues. Improve phase was done by compiling, selecting, and designing alternative repair. Some improvement efforts were identified, i.e. (i) making a checklist for maintenance schedules, (ii) making written reminder form, (iii) modifying the SOP more detail, and (iv) performing a major service to the vacuum machine. To ensure the continuity of improvement efforts, some control activities were executed, i.e. (i) controlling, monitoring, documenting, and setting target frequently, (ii) implementing reward and punishment system, (iii) adding cleaning tool, and (iv) building six sigma organizational structure.

  18. Quality improvement initiatives in a case management service: case study.

    PubMed

    Davies, Deborah J

    2015-01-01

    This article explores the importance of quality practices in underpinning the person-centred approach at a Community Options Program (COP) case management service in northern NSW. The NSW community care sector does not have a statutory excellence body to identify, promote and support improved practices and quality and safety across community services, and therefore the COP provider decided to establish a dedicated role to focus on the quality improvement of its service. The subsequent quality improvement initiatives have included mapping the clients' journey through the service, identifying areas to standardise practice, and creating service pathways. The clients' journey was used as the framework to identify where standardised practice was required, and a robust process was implemented to develop over 25 good practice guidelines and tools that addressed the variations in practice and enabled the service pathways to be developed. Prior to trialling the guidelines and tools, staff received education sessions on the anticipated changes to practice, and the practicality and applicability of the guidelines were evaluated at the end of the trials. This information was reviewed and the guidelines were amended accordingly before being rolled out. The guidelines have been in use for over 12 months and have provided the benchmark against which to audit practice, and have resulted in key performance improvements such as an increase in client review rates and a rise in the feedback response rate from clients, with a noticeable shift in the comments about the brokered support worker to acknowledging the role of their case manager. Formalising informal supports for those clients that lived alone also increased, which means these people are less reliant on services and there is a reduced risk of social isolation.

  19. Patient safety and quality improvement in rehabilitation medicine.

    PubMed

    Cristian, Adrian; Green, Jonah

    2012-05-01

    Patient safety in medical settings has become a major concern. As more and more individuals seek rehabilitative care for their medical conditions or are referred to rehabilitation specialists with increasingly complex medical conditions, the issue of patient safety in the rehabilitation setting takes on added importance. This article introduces the concepts of patient safety, cognitive biases, systems thinking, and quality improvement as they apply to the rehabilitation medicine.

  20. Smart homes to improve the quality of life for all.

    PubMed

    Aiello, Marco; Aloise, Fabio; Baldoni, Roberto; Cincotti, Febo; Guger, Christoph; Lazovik, Alexander; Mecella, Massimo; Pucci, Paolo; Rinsma, Johanna; Santucci, Giuseppe; Taglieri, Massimiliano

    2011-01-01

    A home is smart when, being aware of its own state and that of its users, is capable of controlling itself in order to support the user wishes and thus improving their quality of life. This holds both for users with special needs and for those with ordinary domestic needs. In this paper, we overview the Smart Homes for All project which represents the current state of the art with respect to software control and user interfaces in the smart homes arena.

  1. Using Vision System Technologies to Enable Operational Improvements for Low Visibility Approach and Landing Operations

    NASA Technical Reports Server (NTRS)

    Kramer, Lynda J.; Ellis, Kyle K. E.; Bailey, Randall E.; Williams, Steven P.; Severance, Kurt; Le Vie, Lisa R.; Comstock, James R.

    2014-01-01

    Flight deck-based vision systems, such as Synthetic and Enhanced Vision System (SEVS) technologies, have the potential to provide additional margins of safety for aircrew performance and enable the implementation of operational improvements for low visibility surface, arrival, and departure operations in the terminal environment with equivalent efficiency to visual operations. To achieve this potential, research is required for effective technology development and implementation based upon human factors design and regulatory guidance. This research supports the introduction and use of Synthetic Vision Systems and Enhanced Flight Vision Systems (SVS/EFVS) as advanced cockpit vision technologies in Next Generation Air Transportation System (NextGen) operations. Twelve air transport-rated crews participated in a motion-base simulation experiment to evaluate the use of SVS/EFVS in NextGen low visibility approach and landing operations. Three monochromatic, collimated head-up display (HUD) concepts (conventional HUD, SVS HUD, and EFVS HUD) and two color head-down primary flight display (PFD) concepts (conventional PFD, SVS PFD) were evaluated in a simulated NextGen Chicago O'Hare terminal environment. Additionally, the instrument approach type (no offset, 3 degree offset, 15 degree offset) was experimentally varied to test the efficacy of the HUD concepts for offset approach operations. The data showed that touchdown landing performance were excellent regardless of SEVS concept or type of offset instrument approach being flown. Subjective assessments of mental workload and situation awareness indicated that making offset approaches in low visibility conditions with an EFVS HUD or SVS HUD may be feasible.

  2. Partnering health disparities research with quality improvement science in pediatrics.

    PubMed

    Lion, K Casey; Raphael, Jean L

    2015-02-01

    Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction.

  3. Partnering Health Disparities Research With Quality Improvement Science in Pediatrics

    PubMed Central

    Lion, K. Casey

    2015-01-01

    Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction. PMID:25560436

  4. Method and apparatus for improving the quality and efficiency of ultrashort-pulse laser machining

    DOEpatents

    Stuart, Brent C.; Nguyen, Hoang T.; Perry, Michael D.

    2001-01-01

    A method and apparatus for improving the quality and efficiency of machining of materials with laser pulse durations shorter than 100 picoseconds by orienting and maintaining the polarization of the laser light such that the electric field vector is perpendicular relative to the edges of the material being processed. Its use is any machining operation requiring remote delivery and/or high precision with minimal collateral dames.

  5. Total area strain mapping improves total quality of stampings

    NASA Astrophysics Data System (ADS)

    Schmidt, Timothy; Tyson, John; Galanulis, Konstantin

    2004-02-01

    Sheet metal manufacturers are under constant and increasing pressure to improve and document quality, while reducing cost. Furthermore, OEMs are shifting responsibility for quality inspections to suppliers, adding extra burdens. Exciting, shapely product designs are placing greater demands on both quality assurance and development departments. Deep drawing and other new advanced forming methods push materials to their limits. There is a new stamping quality control tool available for easy, effective and reliable determination of shape, strains and thinning. Full-field optical vision systems, based on the well-known principles of circle grid analysis and photogrammetry, provide automated analysis and quantitative color maps for every square inch of complex parts. Quality results are displayed on a 3D computer model, using the actual measured dimensions of the real part, allowing it to be viewed from any angle. One of the key features of this system is a dynamic link between the forming limit diagram and the strain/thinning color map. When a point is clicked on either display, a second crosshair automatically highlights that same point on the other display, and a detail box presents all measured and calculated quantities. Critical points can be identified at a glance so that corrective action can be taken. Examples shown include before and after die optimization, and analysis of a 1.2 meter long B-pillar stamping.

  6. Smart garments for safety improvement of emergency/disaster operators.

    PubMed

    Curone, Davide; Dudnik, Gabriela; Loriga, Giannicola; Luprano, Jean; Magenes, Giovanni; Paradiso, Rita; Tognetti, Alessandro; Bonfiglio, Annalisa

    2007-01-01

    The main purpose of the European project ProeTEX is to develop equipment to improve safety, coordination and efficiency of emergency disaster intervention personnel like fire-fighters or civil protection rescuers. The equipment consists of a new generation of "smart" garments, integrating wearable sensors which will allow monitoring physiological parameters, position and activity of the user, as like as environmental variables of the operating field in which rescuers are working: both commercial and newly developed textile and fibre based sensors will be included. The garments will also contain an electronic box to process data collected by the sensors and a communication system enabling the transmission of data to the other rescuers and to a monitoring station. Also a "smart" victim patch will be developed: a wearable garment which will allow monitoring physiological parameters of injured civilians involved in disasters, with the aim of optimizing their survival management.

  7. Automatisms in EMIR instrument to improve operation, safety and maintenance

    NASA Astrophysics Data System (ADS)

    Fernández Izquierdo, Patricia; Núñez Cagigal, Miguel; Barreto Rodríguez, Roberto; Martínez Rey, Noelia; Santana Tschudi, Samuel; Barreto Cabrera, Maria; Patrón Recio, Jesús; Garzón López, Francisco

    2014-08-01

    EMIR is the NIR imager and multiobject spectrograph being built as a common user instrument for the 10-m class GTC. Big cryogenic instruments demand a reliable design and a specific hardware and software to increase its safety and productivity. EMIR vacuum, cooling and heating systems are monitored and partially controlled by a Programmable Logic Controller (PLC) in industrial format with a touch screen. The PLC aids the instrument operator in the maintenance tasks recovering autonomously vacuum if required or proposing preventive maintenance actions. The PLC and its associated hardware improve EMIR safety having immediate reactions against eventual failure modes in the instrument or in external supplies, including hardware failures during the heating procedure or failure in the PLC itself. EMIR PLC provides detailed information periodically about status and alarms of vacuum and cooling components or external supplies.

  8. Detection of High Quality Rainfall Data to Improve Flood Resilience

    NASA Astrophysics Data System (ADS)

    Hoang, T. C.; Tchiguirinskaia, I.; Schertzer, D. J.; Lovejoy, S.

    2012-12-01

    European flood management systems require reliable rainfall statistics, e.g. the Intensity-duration-Frequency curves for shorter and shorter durations and for a larger and larger range of return periods. Preliminary studies showed that the number of floods depends on the quality of available data, e.g. the time resolution quality. These facts suggest that a particular attention should be paid to the rainfall data quality in order to adequately investigate flood risk aiming to achieve flood resilience. The potential consequences of changes in measuring and recording techniques have been somewhat discussed in the literature with respect to a possible introduction of artificial inhomogeneities in time series. In this direction, we developed a first version of a SERQUAL procedure to automatically detect the effective time resolution of highly mixed data. We show that most of the rainfall time series have a lower recording frequency than that is assumed. This question is particularly important for operational hydrology, because an error on the effective recording high frequency introduces biases in the corresponding statistics. It is therefore essential to quantify the quality of the rainfall time series before their use. Due to the fact that the multiple scales and possible scaling behaviour of hydrological data are particularly important for many applications, including flood resilience research, this paper first investigates the sensitivity of the scaling estimates and methods to the deficit of short duration rainfall data, and consequently propose a few simple criteria for a reliable evaluation of the data quality. The SERQUAL procedure enable us to extract high quality sub-series from longer time series that will be much more reliable to calibrate and/or validate short duration quantiles and hydrological models.

  9. [The "quality house pediatric oncology" as an instrument for improving the performance of the trial centers].

    PubMed

    Creutzig, U; Hannemann, J; Krämer, I; Zimmermann, M; Herold, R; Marx, J F

    2005-01-01

    The project group "Central Trial Support" of the German Competence Network Pediatric Oncology and Haematology supports the members of the Society of Pediatric Oncology and Haematology in their effort to cope with the growing statutory, ethical and administrative requirements for therapy optimization studies (investigator-initiated, non-profit clinical trials). By these quality improvement measures the studies will become more revisable and reliable, but at the same time their processing will become more and more complex. The basic instrument of the project group "Central Trial Support" will be the so-called "Quality House" which has been built up in order to improve the performance of the associated study centres and to help put a systematic quality management system into practice. The "Quality House Pediatric Oncology" comprises detailed descriptions of the activities of all trial center co-workers. Its process map details all operational sequences which constitute an efficiently performing trial center. The so-called value adding processes are explained step by step, and the associated specific tasks are assigned to each respective co-worker. At each process step, the person in charge will have explanatory descriptions at her/his disposal and - if necessary - further problem solving means as well as references to possible optimization measures (e. g. Standard Operating Procedures and other documents). The German Competence Network Pediatric Oncology and Haematology will be implementing this electronic quality management system in trial centers which will convince both sponsors and authorities of the compliance with requirements and standards.

  10. Interdisciplinary teamwork and the power of a quality improvement collaborative in tertiary neonatal intensive care units.

    PubMed

    Grover, Theresa R; Pallotto, Eugenia K; Brozanski, Beverly; Piazza, Anthony J; Chuo, John; Moran, Susan; McClead, Richard; Mingrone, Teresa; Morelli, Lorna; Smith, Joan R

    2015-01-01

    Significant gaps in healthcare quality and outcomes can be reduced via quality improvement collaboratives (QICs), which improve care by leveraging data and experience from multiple organizations.The Children's Hospital Neonatal Consortium Collaborative Initiatives for Quality Improvement team developed an infrastructure for neonatal QICs. We describe the structure and components of an effective multi-institutional neonatal QIC that implemented the "SLUG Bug" project designed to reduce central line-associated bloodstream infections (CLABSIs).The operational infrastructure of SLUG Bug involved 17 tertiary care neonatal intensive care units with a goal to reduce CLABSI in high-risk neonates. Clinical Practice Recommendations were produced, and the Institute of Healthcare Improvement Breakthrough Series provided the framework for the collaborative. Process measures studied the effectiveness of the collaborative structure.CLABSI rates decreased by 20% during a 12-month study period. Compliance bundle reporting exceeded 80%. A QIC score of 2.5 or more ("improvement") was achieved by 94% of centers and a score 4 or more ("significant improvement") was achieved by 35%.Frequent interactive project meetings, well-defined project metrics, continual shared learning opportunities, and individual team coaching were key QIC success components. Through a coordinated approach and committed leadership, QICs can effectively implement change and improve the care of neonates with complex diagnoses and rare diseases.

  11. Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey

    PubMed Central

    Eldh, Ann Catrine; Wallin, Lars; Fredriksson, Mio; Vengberg, Sofie; Winblad, Ulrika; Halford, Christina; Dahlström, Tobias

    2016-01-01

    Objectives While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement. Methods Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression. Results A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R2=0.76) with ‘Colleagues’ call for local results’ (p=<0.001), ‘Management Request of Registry data’ (p=<0.001), and it was said to be ‘Simple to explain the results to colleagues’ (p=0.02). Using stepwise regression, ‘Colleagues’ call for local results’ was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results. Conclusions While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives. PMID

  12. Implementing a systems-oriented morbidity and mortality conference in remote rural Nepal for quality improvement

    PubMed Central

    Schwarz, Dan; Schwarz, Ryan; Gauchan, Bikash; Andrews, Jason; Sharma, Ranju; Karelas, Gregory; Rajbhandari, Ruma; Acharya, Bibhav; Mate, Kedar; Bista, Amir; Bista, Megha Giri; Sox, Colin

    2011-01-01

    Problem In hospitals in rural, resource-limited settings, there is an acute need for simple, practical strategies to improve healthcare quality. Setting A district hospital in remote western Nepal. Key measures for improvement To provide a mechanism for systems-level reflection so that staff can identify targets for quality improvement in healthcare delivery. Strategies for change To develop a morbidity and mortality conference (M&M) quality improvement initiative that aims to facilitate structured analysis of patient care and identify barriers to providing quality care, which can subsequently be improved. Design The authors designed an M&M involving clinical and non-clinical staff in conducting root-cause analyses of healthcare delivery at their hospital. Weekly conferences focus on seven domains of causal analysis: operations, supply chain, equipment, personnel, outreach, societal, and structural. Each conference focuses on assessing the care provided, and identifying ways in which services can be improved in the future. Effects of change Staff reception of the M&Ms was positive. In these M&Ms, staff identified problem areas in healthcare delivery and steps for improvement. Subsequently, changes were made in hospital workflow, supply procurement, and on-site training. Lessons learnt While widely practiced throughout the world, M&Ms typically do not involve both clinical and non-clinical staff members and do not take a systems-level approach. The authors' experience suggests that the adapted M&M conference is a simple, feasible tool for quality improvement in resource-limited settings. Senior managerial commitment is crucial to ensure successful implementation of M&Ms, given the challenging logistics of implementing these programmes in resource-limited health facilities. PMID:21949441

  13. [Improvement of routine works and quality control in mycobacterial laboratory].

    PubMed

    Suzuki, Katsuhiro; Higuchi, Takeshi

    2007-03-01

    Many new methods have been introduced into routine laboratory works in microbiology since 1990. Molecular biology, in particular, opened a new era and promoted a technician's skill much. PCR and hybridization technique have been ordinary one in many laboratories. Since old techniques such as smear and culture are still needed, amount of routine works is increasing gradually. Thus, improving efficiency and keeping quality of routine works are becoming more and more important issues. This symposium focused on such points, and four skilled technicians around Japan presented their own tips. 1. Coexistence of M. tuberculosis and M. avium complex (MAC) in the MGIT culture system: Yasushi WATANABE (Clinical Laboratory Division, NHO Nishi-Niigata Chuo National Hospital). Sputum samples of some tuberculosis patients yielded only MAC in the MGIT culture system. Such co-infected cases presented problems to mislead proper treatment and infection control. The detection rate of MAC was significantly high, and the growth speed of MAC was significantly rapid in the MGIT culture system, compared to those of M. tuberculosis. Additionally, M. tuberculosis was not detected with even more quantity than MAC in the small amount of mixed samples. Higher sensitivity and growth speed of MAC are the important characteristics of the MGIT system. 2. Internal quality control with ordinary examination results: Akio AONO (Department of Clinical Examination, Double-Barred Cross Hospital, Japan Anti-Tuberculosis Association). Our laboratory utilizes ordinary examination results as the internal quality control for specimen pretreatment, culture, and drug susceptibility testing. The contamination rate of MGIT culture system is useful for the evaluation of the decontamination process. It was 6.3% on average in our laboratory in 2005. The number of drug resistant strains is also useful to assess the performance of drug susceptibility testing. The incidence of each anti-tuberculosis drug resistance

  14. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    PubMed Central

    Kaye, Alan David; Okanlawon, Olutoyin J; Urman, Richard D

    2014-01-01

    Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The “buy-in” includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care. PMID:24833948

  15. Improving operational anodising process performance using simulation approach

    SciTech Connect

    Liong, Choong-Yeun Ghazali, Syarah Syahidah

    2015-10-22

    The use of aluminium is very widespread, especially in transportation, electrical and electronics, architectural, automotive and engineering applications sectors. Therefore, the anodizing process is an important process for aluminium in order to make the aluminium durable, attractive and weather resistant. This research is focused on the anodizing process operations in manufacturing and supplying of aluminium extrusion. The data required for the development of the model is collected from the observations and interviews conducted in the study. To study the current system, the processes involved in the anodizing process are modeled by using Arena 14.5 simulation software. Those processes consist of five main processes, namely the degreasing process, the etching process, the desmut process, the anodizing process, the sealing process and 16 other processes. The results obtained were analyzed to identify the problems or bottlenecks that occurred and to propose improvement methods that can be implemented on the original model. Based on the comparisons that have been done between the improvement methods, the productivity could be increased by reallocating the workers and reducing loading time.

  16. Improving operational anodising process performance using simulation approach

    NASA Astrophysics Data System (ADS)

    Liong, Choong-Yeun; Ghazali, Syarah Syahidah

    2015-10-01

    The use of aluminium is very widespread, especially in transportation, electrical and electronics, architectural, automotive and engineering applications sectors. Therefore, the anodizing process is an important process for aluminium in order to make the aluminium durable, attractive and weather resistant. This research is focused on the anodizing process operations in manufacturing and supplying of aluminium extrusion. The data required for the development of the model is collected from the observations and interviews conducted in the study. To study the current system, the processes involved in the anodizing process are modeled by using Arena 14.5 simulation software. Those processes consist of five main processes, namely the degreasing process, the etching process, the desmut process, the anodizing process, the sealing process and 16 other processes. The results obtained were analyzed to identify the problems or bottlenecks that occurred and to propose improvement methods that can be implemented on the original model. Based on the comparisons that have been done between the improvement methods, the productivity could be increased by reallocating the workers and reducing loading time.

  17. Reengineering Education with Quality: Using Quality Concepts, Techniques, and Tools To Improve Education.

    ERIC Educational Resources Information Center

    Spanbauer, Stanley J.

    Designed to assist educators in formulating Total Quality Improvement (TQI) plans, this book examines the processes of TQI, which allow for the review of college administration, student services, teaching, and institutional culture, and provides information on its implementation at two-year colleges. Chapter 1 describes background to educational…

  18. 21 CFR 111.110 - What quality control operations are required for laboratory operations associated with the...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false What quality control operations are required for laboratory operations associated with the production and process control system? 111.110 Section 111.110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD...

  19. Management of sickness absence: a quality improvement study from Slovenia

    PubMed Central

    Kersnik, J.

    1999-01-01

    Problem - A need to improve the communication system between general practitioners (GPs) and the national health insurance institute's (NHII) committee of experts for the referral and approval of sickness leave for patients. Design - A structured low cost quality improvement method for motivating GPs to change their current practice was developed. Background and setting - The study was done in Kranj health district in Slovenia. GPs and members of the committee of experts identified potential problems using a cause and effect diagram. The study period for baseline data collection was from November 1996 to December 1996, and the re-evaluation took place in May 1997. All GPs in Kranj health district (n=78) took part. Data were collected on 443 patients referred by GPs to the NHII committee during the first phase of the study and 590 patients during the re-evaluation phase. Key measures for improvement - Reducing the number of cases reported by members of the committee of experts as causing problems after the intervention. Feedback to GPs about the success of the process. Strategies for change - A combination of methods was used: posted feedback, a guideline on record keeping, and a guideline, called AID (analysis of incidental deviations from expected service - in Slovene: analiza izjemnih dogodkov), on processing medical documentation. Effects of change - An overall drop was observed in the number of cases that caused problems (from 44% to 26%, p<0.001). The most common problem at baseline (19.4% of the problems) was the seventh most common at the re-evaluation, then contributing only 9.2% of total problems (p=0.02). Lessons learnt - The results support a quality improvement philosophy that empowers "owners" of the process to be the key resource in managing change, and they show the importance of the inner motivation of those involved. Despite working in a country undergoing transition, medical professionals were still willing to improve their performance

  20. Building Perinatal Case Manager Capacity Using Quality Improvement.

    PubMed

    Fitzgerald, Elaine

    2015-01-01

    Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum.

  1. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    PubMed

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.

  2. Ethnographic process evaluation of a quality improvement project to improve transitions of care for older people

    PubMed Central

    Sutton, Elizabeth; Dixon-Woods, Mary; Tarrant, Carolyn

    2016-01-01

    Objectives Quality improvement projects to address transitions of care across care boundaries are increasingly common but meet with mixed success for reasons that are poorly understood. We aimed to characterise challenges in a project to improve transitions for older people between hospital and care homes. Design Independent process evaluation, using ethnographic observations and interviews, of a quality improvement project. Setting and participants An English hospital and two residential care homes for older people. Data 32 hours of non-participant observations and 12 semistructured interviews with project members, hospital and care home staff. Results A hospital-based improvement team sought to reduce unplanned readmissions from residential care homes using interventions including a community-based geriatric team that could be accessed directly by care homes and a communication tool intended to facilitate transfer of information between homes and hospital. Only very modest (if any) impacts of these interventions on readmission rates could be detected. The process evaluation identified multiple challenges in implementing interventions and securing improvement. Many of these arose because of lack of consensus on the nature of the problem and the proper solutions: while the hospital team was keen to reduce readmissions and saw the problems as lying in poor communication and lack of community-based support for care homes, the care home staff had different priorities. Care home staff were unconvinced that the improvement interventions were aligned with their needs or addressed their concerns, resulting in compromised implementation. Conclusions Process evaluations have a valuable role in quality improvement. Our study suggests that a key task for quality improvement projects aimed at transitions of care is that of developing a shared view of the problem to be addressed. A more participatory approach could help to surface assumptions, interpretations and interests

  3. Data Mining Methods Applied to Flight Operations Quality Assurance Data: A Comparison to Standard Statistical Methods

    NASA Technical Reports Server (NTRS)

    Stolzer, Alan J.; Halford, Carl

    2007-01-01

    In a previous study, multiple regression techniques were applied to Flight Operations Quality Assurance-derived data to develop parsimonious model(s) for fuel consumption on the Boeing 757 airplane. The present study examined several data mining algorithms, including neural networks, on the fuel consumption problem and compared them to the multiple regression results obtained earlier. Using regression methods, parsimonious models were obtained that explained approximately 85% of the variation in fuel flow. In general data mining methods were more effective in predicting fuel consumption. Classification and Regression Tree methods reported correlation coefficients of .91 to .92, and General Linear Models and Multilayer Perceptron neural networks reported correlation coefficients of about .99. These data mining models show great promise for use in further examining large FOQA databases for operational and safety improvements.

  4. Wireless live streaming video of surgical operations: an evaluation of communication quality.

    PubMed

    Schneider, Armin; Wilhelm, Dirk; Doll, Dietrich; Rauschenbach, Uwe; Finkenzeller, Michael; Wirnhier, Helga; Illgner, Klaus; Feussner, Hubertus

    2007-01-01

    We evaluated a mobile video system for surgical teleconsultation. A video streaming server in the operating room transmitted video and audio to a hand-held computer (personal digital assistant [PDA]) over a wireless local area network. Two groups of 20 surgeons (each with 12 qualified surgeons and eight surgeons between the 2nd and the 4th year of training) participated in the tests. For voice transmission, correct understanding of numbers was achieved in 100% of the cases (n = 1000) and 98% of medical terms (n = 400). The quality of the video displayed on the PDA was assessed by the recognition of different operating room scenarios. Only 62% (SD 17) of the structures were identified clearly on the hand-held device (n = 400). The accuracy improved to 78% (SD 15) (n = 400) if the same scenario was observed on a larger (50 cm) video screen (p < 0.001). Accuracy was significantly better if audio conversation was possible. The quality evaluation by the consultants showed that the PDA display size and quality were sufficient for clinical use.

  5. Effectiveness of a quality improvement curriculum for medical students.

    PubMed

    Tartaglia, Kimberly M; Walker, Curt

    2015-01-01

    Introduction As health systems find ways to improve quality of care, medical training programs are finding opportunities to prepare learners on principles of quality improvement (QI). The impact of QI curricula for medical students as measured by student learning is not well delineated. The aim of this study is to evaluate the effectiveness of a QI curriculum for senior medical students as measured by student knowledge and skills. Methods This study was an observational study that involved a self-assessment and post-test Quality Improvement Knowledge Application Tool (QIKAT) for intervention and control students. A QI curriculum consisting of online modules, live discussions, independent readings and reflective writing, and participation in a mentored QI project was offered to fourth-year medical students completing an honor's elective (intervention group). Senior medical students who received the standard QI curriculum only were recruited as controls. Results A total of 22 intervention students and 12 control students completed the self-assessment and QIKAT. At baseline, there was no difference between groups in self-reported prior exposure to QI principles. Students in the intervention group reported more comfort with their skills in QI overall and in 9 of the 12 domains (p<0.05). Additionally, intervention students performed better in each of the three case scenarios (p<0.01). Discussion A brief QI curriculum for senior medical students results in improved comfort and knowledge with QI principles. The strengths of our curriculum include effective use of classroom time and faculty mentorship with reliance on pre-existing online modules and written resources. Additionally, the curriculum is easily expandable to larger groups of students and transferable to other institutions.

  6. Improving urban air quality in China: Beijing case study.

    PubMed

    Hao, Jiming; Wang, Litao

    2005-09-01

    China is undergoing rapid urbanization because of unprecedented economic growth. As a result, many cities suffer from air pollution. Two-thirds of China's cities have not attained the ambient air quality standards applicable to urban residential areas (Grade II). Particulate matter (PM), rather than sulfur dioxide (SO2), is the major pollutant reflecting the shift from coal burning to mixed source pollution. In 2002, 63.2 and 22.4% of the monitored cities have PM and SO2 concentrations exceeding the Grade II standard, respectively. Nitrogen oxides (NOx) concentration kept a relatively stable level near the Grade II standard in the last decade and had an increasing potential in recent years because of the rapid motorization. In general, the air pollutants emission did not increase as quickly as the economic growth and energy consumption, and air quality in Chinese cities has improved to some extent. Beijing, a typical representative of rapidly developing cities, is an example to illustrate the possible options for urban air pollution control. Beijing's case provides hope that the challenges associated with improving air quality can be met during a period of explosive development and motorization.

  7. Improving urban air quality in China: Beijing case study

    SciTech Connect

    Jiming Hao; Litao Wang

    2005-09-01

    China is undergoing rapid urbanization because of unprecedented economic growth. As a result, many cities suffer from air pollution. Two-thirds of China's cities have not attained the ambient air quality standards applicable to urban residential areas (Grade II). Particulate matter (PM), rather than sulfur dioxide (SO{sub 2}), is the major pollutant reflecting the shift from coal burning to mixed source pollution. In 2002, 63.2 and 22.4% of the monitored cities have PM and SO{sub 2} concentrations exceeding the Grade II standard, respectively. Nitrogen oxides (NOx) concentration kept a relatively stable level near the Grade II standard in the last decade and had an increasing potential in recent years because of the rapid motorization. In general, the air pollutants emission did not increase as quickly as the economic growth and energy consumption, and air quality in Chinese cities has improved to some extent. Beijing, a typical representative of rapidly developing cities, is an example to illustrate the possible options for urban air pollution control. Beijing's case provides hope that the challenges associated with improving air quality can be met during a period of explosive development and motorization. 21 refs., 19 figs., 6 tabs.

  8. Geocoding coronial data: tools and techniques to improve data quality.

    PubMed

    Freestone, Darren; Williamson, Dianne; Wollersheim, Dennis

    2012-01-01

    Clinical, administrative and demographic health information is fundamental to understanding the nature of health and evaluating the effectiveness of efforts to reduce morbidity and mortality of the population. The demographic data item 'location' is an integral part of any injury surveillance tool or injury prevention strategy. The true value of location data can only be realised once these data have been appropriately classified and quality assured. Geocoding as a means of classifying location is increasingly used in various health fields to enable spatial analysis of data. This article reports on research carried out in Australia at the National Coroners Information System (NCIS). Trends in the use of NCIS location-based data by researchers were identified. The research also aimed to establish the factors that impacted on the quality of geocoded data and the extent of this impact. A systematic analysis of the geocoding process identified source documentation, data cleaning, and software settings as key factors impacting on data quality. Understanding and application of these processes can improve data quality and therefore inform the analysis and interpretation of these data by researchers.

  9. Overarching goals: a strategy for improving healthcare quality and safety?

    PubMed

    Nanji, Karen C; Ferris, Timothy G; Torchiana, David F; Meyer, Gregg S

    2013-03-01

    The management literature reveals that many successful organisations have strategic plans that include a bold 'stretch-goal' to stimulate progress over a ten-to-thirty-year period. A stretch goal is clear, compelling and easily understood. It serves as a unifying focal point for organisational efforts. The ambitiousness of such goals has been emphasised with the phrase Big Hairy Audacious Goal ('BHAG'). President Kennedy's proclamation in 1961 that 'this Nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to earth' provides a famous example. This goal energised the US National Aeronautics and Space Administration, and it captured the attention of the American public and resulted in one of the largest accomplishments of any organisation. The goal set by Sony, a small, cash-strapped electronics company in the 1950s, to change the poor image of Japanese products around the world represents a classic BHAG. Few examples of quality goals that conform to the BHAG definition exist in the healthcare literature. However, the concept may provide a useful framework for organisations seeking to transform the quality of care they deliver. This review examines the merits and cautions of setting overarching quality goals to catalyse quality improvement efforts, and assists healthcare organisations with determining whether to adopt these goals.

  10. Operational aspects of asynchronous filtering for improved flood forecasting

    NASA Astrophysics Data System (ADS)

    Rakovec, Oldrich; Weerts, Albrecht; Sumihar, Julius; Uijlenhoet, Remko

    2014-05-01

    Hydrological forecasts can be made more reliable and less uncertain by recursively improving initial conditions. A common way of improving the initial conditions is to make use of data assimilation (DA), a feedback mechanism or update methodology which merges model estimates with available real world observations. The traditional implementation of the Ensemble Kalman Filter (EnKF; e.g. Evensen, 2009) is synchronous, commonly named a three dimensional (3-D) assimilation, which means that all assimilated observations correspond to the time of update. Asynchronous DA, also called four dimensional (4-D) assimilation, refers to an updating methodology, in which observations being assimilated into the model originate from times different to the time of update (Evensen, 2009; Sakov 2010). This study investigates how the capabilities of the DA procedure can be improved by applying alternative Kalman-type methods, e.g., the Asynchronous Ensemble Kalman Filter (AEnKF). The AEnKF assimilates observations with smaller computational costs than the original EnKF, which is beneficial for operational purposes. The results of discharge assimilation into a grid-based hydrological model for the Upper Ourthe catchment in Belgian Ardennes show that including past predictions and observations in the AEnKF improves the model forecasts as compared to the traditional EnKF. Additionally we show that elimination of the strongly non-linear relation between the soil moisture storage and assimilated discharge observations from the model update becomes beneficial for an improved operational forecasting, which is evaluated using several validation measures. In the current study we employed the HBV-96 model built within a recently developed open source modelling environment OpenStreams (2013). The advantage of using OpenStreams (2013) is that it enables direct communication with OpenDA (2013), an open source data assimilation toolbox. OpenDA provides a number of algorithms for model calibration

  11. Improving Teacher Quality, a Keyword for Improving Education Facing Global Challenges

    ERIC Educational Resources Information Center

    Jusuf, Husain

    2005-01-01

    Research shows that teachers are the single most important factor in student learning in schools. Students who have access to highly qualified teachers achieve at a higher rate, regardless of other factors. Teachers to be highly qualified must be well prepared, especially in improving the quality of education facing global challenges. For this…

  12. TBDQ: A Pragmatic Task-Based Method to Data Quality Assessment and Improvement

    PubMed Central

    Vaziri, Reza; Mohsenzadeh, Mehran; Habibi, Jafar

    2016-01-01

    Organizations are increasingly accepting data quality (DQ) as a major key to their success. In order to assess and improve DQ, methods have been devised. Many of these methods attempt to raise DQ by directly manipulating low quality data. Such methods operate reactively and are suitable for organizations with highly developed integrated systems. However, there is a lack of a proactive DQ method for businesses with weak IT infrastructure where data quality is largely affected by tasks that are performed by human agents. This study aims to develop and evaluate a new method for structured data, which is simple and practical so that it can easily be applied to real world situations. The new method detects the potentially risky tasks within a process, and adds new improving tasks to counter them. To achieve continuous improvement, an award system is also developed to help with the better selection of the proposed improving tasks. The task-based DQ method (TBDQ) is most appropriate for small and medium organizations, and simplicity in implementation is one of its most prominent features. TBDQ is case studied in an international trade company. The case study shows that TBDQ is effective in selecting optimal activities for DQ improvement in terms of cost and improvement. PMID:27192547

  13. Macromolecule Crystal Quality Improvement in Microgravity: The Role of Impurities

    NASA Technical Reports Server (NTRS)

    Judge, Russell A.; Snell, Edward H.; Pusey, Marc L.; Sportiello, Michael G.; Todd, Paul; Bellamy, Henry; Borgstahl, Gloria E.; Pokros, Matt; Cassanto, John M.

    2000-01-01

    While macromolecule impurities may affect crystal size and morphology the over-riding question is; "How do macromolecule impurities effect crystal X-ray quality and diffraction resolution?" In the case of chicken egg white lysozyme, crystals can be grown in the presence of a number of impurities without affecting diffraction resolution. One impurity however, the lysozyme dimer, does negatively impact the X-ray crystal properties. Crystal quality improvement as a result of better partitioning of this impurity during crystallization in microgravity has been reported'. In our recent experimental work dimer partitioning was found to be not significantly different between the two environments. Mosaicity analysis of pure crystals showed a reduced mosaicity and increased signal to noise for the microgravity grown crystals. Dimer incorporation however, did greatly reduce the resolution limit in both ground and microgravity grown crystals. These results indicate that impurity effects in microgravity are complex and may rely on the conditions or techniques employed.

  14. Improving Forecast Skill by Assimilation of Quality Controlled AIRS Version 5 Temperature Soundings

    NASA Technical Reports Server (NTRS)

    Susskind, Joel; Reale, Oreste

    2009-01-01

    The AIRS Science Team Version 5 retrieval algorithm has been finalized and is now operational at the Goddard DAAC in the processing (and reprocessing) of all AIRS data. The AIRS Science Team Version 5 retrieval algorithm contains two significant improvements over Version 4: 1) Improved physics allows for use of AIRS observations in the entire 4.3 micron CO2 absorption band in the retrieval of temperature profile T(p) during both day and night. Tropospheric sounding 15 micron CO2 observations are now used primarily in the generation of cloud cleared radiances R(sub i). This approach allows for the generation of accurate values of R(sub i) and T(p) under most cloud conditions. 2) Another very significant improvement in Version 5 is the ability to generate accurate case-by-case, level-by-level error estimates for the atmospheric temperature profile, as well as for channel-by-channel error estimates for R(sub i). These error estimates are used for Quality Control of the retrieved products. We have conducted forecast impact experiments assimilating AIRS temperature profiles with different levels of Quality Control using the NASA GEOS-5 data assimilation system. Assimilation of Quality Controlled T(p) resulted in significantly improved forecast skill compared to that obtained from analyses obtained when all data used operationally by NCEP, except for AIRS data, is assimilated. We also conducted an experiment assimilating AIRS radiances uncontaminated by clouds, as done operationally by ECMWF and NCEP. Forecast resulting from assimilated AIRS radiances were of poorer quality than those obtained assimilating AIRS temperatures.

  15. Performance indicators: A tool for continuous quality improvement

    PubMed Central

    Bhatnagar, Nidhi M; Soni, Shital; Gajjar, Maitrey; Shah, Mamta; Shah, Sangita; Patel, Vaidehi

    2016-01-01

    Background: Performance monitoring is an important tool which can be used for setting priorities for process improvement. At our centre, we have been monitoring every step in the processes, right from inventory of consumables (both critical and routine) to number of donors reactive for TTI. We conducted a study to measure the impact of monitoring Performance Indicators and how it could be used as a tool for Continuous Quality Improvement (CQI). Materials and Methods: The present study was a retrospective study where the performance indicator (PI) data of blood bank was analyzed for over four years. For certain parameters, benchmarks or thresholds were set that represented warning limits or action limits. The yearly data were collated from monthly data. Shifts or Trends, if any, were identified and Corrective and Preventive Action (CAPA) taken accordingly. At the end, outcomes of the analysis were charted. Results: After the yearly data evaluation, outcomes obtained were used to plan, correct and amend processes and systems in the blood center. It was observed that the workload of the center showed an upward trend. This helped us to plan for the purchase of consumables and management of manpower. The monitoring of usage and discard of blood helped in the efficient management of blood stocks. The need for any new equipment could also be judged by the trends in workload. Conclusion: Performance indicators are indispensible tools which various stakeholders in the Blood Transfusion centres should implement to improve on quality performance. PMID:27011669

  16. Nursing Leader Collaboration to Drive Quality Improvement and Implementation Science.

    PubMed

    Ryan, Rosemary W; Harris, Karen K; Mattox, Lisa; Singh, Olivine; Camp, Melanie; Shirey, Maria R

    2015-01-01

    Nursing leadership opportunities to improve quality and align resources in health care exist. An estimated 18% of United States gross domestic product is spent on health care delivery systems that produce poor outcomes. The purpose of this article was to describe how quality improvement and implementation science initiatives enhance outcomes using nursing leadership strategies that play an integral role in aligning key colleagues to drive the collaborative process. A critical appraisal of the literature was conducted, which supports the importance of evidenced-based practice improvement, collaborative change process, and professional role of nursing leadership. Limited evidence exists related to practice strategies for nursing leaders to implement sustainable change at the unit level for successful alignment of resources. Strategies based on Rogers' Diffusion of Innovation Theory are recommended to address the gap in the literature. The strategies aim to increase meaningful knowledge or the "why," create a tipping point, and implement sustainable change starting with the end in mind. Nurse leaders are a central component for driving alignment and implementing change at the unit level. Uses of the described evidenced-based strategies have implications for nursing practice, education, and scholarship.

  17. Integrating health promotion with quality improvement in a Swedish hospital.

    PubMed

    Astnell, Sandra; von Thiele Schwarz, Ulrica; Hasson, Henna; Augustsson, Hanna; Stenfors-Hayes, Terese

    2016-09-01

    Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals.

  18. 42 CFR 460.132 - Quality assessment and performance improvement plan.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.132 Quality assessment and performance improvement plan. (a) Basic rule. A PACE organization must have a written quality... 42 Public Health 4 2010-10-01 2010-10-01 false Quality assessment and performance improvement...

  19. Transportation Safety Excellence in Operations Through Improved Transportation Safety Document

    SciTech Connect

    Dr. Michael A. Lehto; MAL

    2007-05-01

    A recent accomplishment of the Idaho National Laboratory (INL) Materials and Fuels Complex (MFC) Nuclear Safety analysis group was to obtain DOE-ID approval for the inter-facility transfer of greater-than-Hazard-Category-3 quantity radioactive/fissionable waste in Department of Transportation (DOT) Type A drums at MFC. This accomplishment supported excellence in operations through safety analysis by better integrating nuclear safety requirements with waste requirements in the Transportation Safety Document (TSD); reducing container and transport costs; and making facility operations more efficient. The MFC TSD governs and controls the inter-facility transfer of greater-than-Hazard-Category-3 radioactive and/or fissionable materials in non-DOT approved containers. Previously, the TSD did not include the capability to transfer payloads of greater-than-Hazard-Category-3 radioactive and/or fissionable materials using DOT Type A drums. Previous practice was to package the waste materials to less-than-Hazard-Category-3 quantities when loading DOT Type A drums for transfer out of facilities to reduce facility waste accumulations. This practice allowed operations to proceed, but resulted in drums being loaded to less than the Waste Isolation Pilot Plant (WIPP) waste acceptance criteria (WAC) waste limits, which was not cost effective or operations friendly. An improved and revised safety analysis was used to gain DOE-ID approval for adding this container configuration to the MFC TSD safety basis. In the process of obtaining approval of the revised safety basis, safety analysis practices were used effectively to directly support excellence in operations. Several factors contributed to the success of MFC’s effort to obtain approval for the use of DOT Type A drums, including two practices that could help in future safety basis changes at other facilities. 1) The process of incorporating the DOT Type A drums into the TSD at MFC helped to better integrate nuclear safety

  20. Innovative Tools for Water Quality/Quantity Management: New York City's Operations Support Tool

    NASA Astrophysics Data System (ADS)

    Wang, L.; Schaake, J. C.; Day, G. N.; Porter, J.; Sheer, D. P.; Pyke, G.

    2011-12-01

    statistical algorithm is a relatively simple and versatile, but lacks short-term skill critical for water quality and spill management. To improve short-term skill, OST will ultimately operate with meteorologically driven hydrologic forecasts provided by the National Weather Service (NWS). OST functionalities will support a wide range of DEP uses, including short term operational projections, outage planning and emergency management, operating rule development, and water supply planning. A core use of OST will be to inform reservoir management strategies to control and mitigate turbidity events while ensuring water supply reliability. OST will also allow DEP to manage its complex reservoir system to meet multiple objectives, including ecological flows, tailwater fisheries and recreational releases, and peak flow mitigation for downstream communities.

  1. Sleep Quality Improves During Treatment With Bryophyllum pinnatum

    PubMed Central

    Hassani, Taziri Al; Müller-Hübenthal, Boris; Pittl, Sandra; Kuck, Angela; Meden, Harald; Eberhard, Jutta; Decker, Michael; Fürer, Karin; von Mandach, Ursula

    2015-01-01

    Hypothesis. Cancer patients frequently suffer from poor sleep quality. Bryophyllum pinnatum is a herbal medication used in anthroposophic medicine, which has been shown to be associated with improvements in sleep quality during pregnancy with only few and minor or moderate side-effects reported. In this study, the sleep quality of cancer patients during treatment with B pinnatum was investigated. Study Design. In this prospective, observational study, cancer patients suffering from sleep problems were treated with B pinnatum (350 mg tablets, corresponding to 50% of leaf pressed juice [Weleda AG, Arlesheim, Switzerland], dosage at physician’s consideration, but most frequently 2 tablets with evening meal and 2 before going to bed). Methods. Sleep quality (Pittsburgh Sleep Quality Index [PSQI]), daily sleepiness (Epworth Sleeping Scale [ESS]), and fatigue (Fatigue Severity Scale [FSS]) were assessed at the beginning of the treatment and after 3 weeks. Possible adverse drug reactions perceived by the patients during the treatment were recorded. From the 28 recruited patients, 20 completed both questionnaires and were considered in the present analysis. Data are expressed as mean ± standard deviation. Results. Patients were 61 ± 10.4 years old and the majority were female (17 out of 20). During treatment with B pinnatum, the PSQI decreased from 12.2 ± 3.62 to 9.1 ± 3.61 (P < .01), and ESS changed from 8.4 ± 3.18 to 7.1 ± 3.98 (P < .05). There was no change in FSS. The treatment was well tolerated by the majority of patients, with only 6 patients reporting discomfort that might have been caused by B pinnatum (fatigue n = 3, dry throat n = 1, agitation n = 1, difficult digestion n = 1). No serious adverse drug reactions were detected. Conclusion. B pinnatum may be a suitable treatment for sleep problems of cancer patients. Controlled, randomized clinical trials of the use of B pinnatum in sleep disorders are urgently needed. PMID:25873294

  2. Lead/acid batteries in systems to improve power quality

    NASA Astrophysics Data System (ADS)

    Taylor, P.; Butler, P.; Nerbun, W.

    Increasing dependence on computer technology is driving needs for extremely high-quality power to prevent loss of information, material, and workers' time that represent billions of dollars annually. This cost has motivated commercial and Federal research and development of energy storage systems that detect and respond to power-quality failures in milliseconds. Electrochemical batteries are among the storage media under investigation for these systems. Battery energy storage systems that employ either flooded lead/acid or valve-regulated lead/acid battery technologies are becoming commercially available to capture a share of this emerging market. Cooperative research and development between the US Department of Energy and private industry have led to installations of lead/acid-based battery energy storage systems to improve power quality at utility and industrial sites and commercial development of fully integrated, modular battery energy storage system products for power quality. One such system by AC Battery Corporation, called the PQ2000, is installed at a test site at Pacific Gas and Electric Company (San Ramon, CA, USA) and at a customer site at Oglethorpe Power Corporation (Tucker, GA, USA). The PQ2000 employs off-the-shelf power electronics in an integrated methodology to control the factors that affect the performance and service life of production-model, low-maintenance, flooded lead/acid batteries. This system, and other members of this first generation of lead/acid-based energy storage systems, will need to compete vigorously for a share of an expanding, yet very aggressive, power quality market.

  3. Use of Pressure Activation in Food Quality Improvement.

    PubMed

    Shigematsu, Toru

    2015-01-01

    Beside intensive studies on inactivation microorganisms by high hydrostatic pressure (HP) for food storage, pressure effects on property of food materials have also been studied based on knowledge in pressure effect on biomolecules. Pressure effects on biological membranes and mass transfer in cellular biological materials and on enzyme activity would give an idea that HP treatment can introduce two types of activations into food materials: improved mass transfer and enzyme activity. Studies focusing on these pressure activations on food materials were then reviewed. Rice flour with an exclusively fine mean particle size and small starch damage was obtained due to improved water absorption properties and/or enzyme activity by HP. HP treatment increased of free amino acids and γ-aminobutyric acid (GABA) in rice and soybeans due to improved proteolysis and amino acid metabolism. Improvement of antioxidant activity and alteration of polyphenolic-compounds composition in food materials were also demonstrated by HP treatment. The HP-induced activations on food materials could contribute towards processing technologies for food quality improvement.

  4. Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review.

    PubMed

    Ackerman, Ilana N; Bennell, Kim L

    2004-01-01

    A systematic review of randomised controlled trials was performed to evaluate the effectiveness of pre-operative physiotherapy programmes on outcome following lower limb joint replacement surgery. A search of relevant key terms was used to find suitable trials, with five papers meeting the inclusion criteria for the review. The methodological quality of the trials was rated using the PEDro scale. Estimates of the size of treatment effects were calculated for each outcome in each trial, with 95% confidence intervals calculated where sufficient data were provided. Of the three trials pertaining to total knee replacement, only very small mean differences were found between control and intervention groups for all of the outcome measures. Where confidence intervals could be calculated, these showed no clinically important differences between the groups. Two papers (one study) pertaining to total hip replacements found significant improvements in WOMAC scores, hip strength and range of movement, walking distance, cadence, and gait velocity for the intervention group, compared to a control group. Estimates of treatment effect sizes for these outcomes were larger than for the total knee replacement studies, with confidence intervals showing potentially clinically important differences between group means. However, as the intervention group also received an additional intensive post-operative physiotherapy program, these results cannot be attributed solely to the pre-operative program. This systematic review shows that pre-operative physiotherapy programmes are not effective in improving outcome after total knee replacement but their effect on outcome from total hip replacement cannot be adequately determined.

  5. Virtual Patient Technology: Engaging Primary Care in Quality Improvement Innovations

    PubMed Central

    May, Christine N; Sadasivam, Rajani S; Houston, Thomas K

    2017-01-01

    Background Engaging health care staff in new quality improvement programs is challenging. Objective We developed 2 virtual patient (VP) avatars in the context of a clinic-level quality improvement program. We sought to determine differences in preferences for VPs and the perceived influence of interacting with the VP on clinical staff engagement with the quality improvement program. Methods Using a participatory design approach, we developed an older male smoker VP and a younger female smoker VP. The older male smoker was described as a patient with cardiovascular disease and was ethnically ambiguous. The female patient was younger and was worried about the impact of smoking on her pregnancy. Clinical staff were allowed to choose the VP they preferred, and the more they engaged with the VP, the more likely the VP was to quit smoking and become healthier. We deployed the VP within the context of a quality improvement program designed to encourage clinical staff to refer their patients who smoke to a patient-centered Web-assisted tobacco intervention. To evaluate the VPs, we used quantitative analyses using multivariate models of provider and practice characteristics and VP characteristic preference and analyses of a brief survey of positive deviants (clinical staff in practices with high rates of encouraging patients to use the quit smoking innovation). Results A total of 146 clinical staff from 76 primary care practices interacted with the VPs. Clinic staff included medical providers (35/146, 24.0%), nurse professionals (19/146, 13.0%), primary care technicians (5/146, 3.4%), managerial staff (67/146, 45.9%), and receptionists (20/146, 13.7%). Medical staff were mostly male, and other roles were mostly female. Medical providers (OR 0.031; CI 0.003-0.281; P=.002) and younger staff (OR 0.411; CI 0.177-0.952; P=.038) were less likely to choose the younger, female VP when controlling for all other characteristics. VP preference did not influence online patient

  6. From Local Quality Improvement to National Drug Recall

    PubMed Central

    Herzer, Kurt R.; Lim, Christine; Li, Matthew; Xie, Yanjun; Doyle, Peter A.; Cover, Renee; Mark, Lynette J.

    2014-01-01

    Medication errors due to look-alike drugs put patients at risk and can be fatal. Neuromuscular blocking agents, such as vecuronium, can cause awake-paralysis in patients if administered as a single agent. Recent literature reported six cases in which vecuronium was inadvertently administered instead of the antibiotic drug cefazolin. This article describes a standardized quality improvement process used at The Johns Hopkins Hospital that was locally implemented following an adverse drug event and culminated in a nationwide FDA-mandated drug recall of vecuronium. PMID:23508529

  7. Reliably Addressing "What Matters" Through a Quality Improvement Process.

    PubMed

    Rutherford, Patricia A

    2016-02-01

    Oncology nurses have a critical role in mitigating the intense vulnerability, loss of control, and fear of the unknown that characterizes the experiences of patients with cancer and their family members. Reliably inquiring about the issues that are at the forefront for patients and their loved ones can encourage a deeper dialogue-where nurses can understand and address the issues that are most important to them. A practical quality improvement approach can help to ensure that processes are in place to assist nurses in devoting time to reliably inquire about "what matters" to each patient at every encounter.

  8. Evidence-based quality improvement: the state of the science.

    PubMed

    Shojania, Kaveh G; Grimshaw, Jeremy M

    2005-01-01

    Routine practice fails to incorporate research evidence in a timely and reliable fashion. Many quality improvement (QI) efforts aim to close these gaps between clinical research and practice. However, in sharp contrast to the paradigm of evidence-based medicine, these efforts often proceed on the basis of intuition and anecdotal accounts of successful strategies for changing provider behavior or achieving organizational change. We review problems with current approaches to QI research and outline the steps required to make QI efforts based as much on evidence as the practices they seek to implement.

  9. Making quality improvement stick and stay: Two lines of insurance.

    PubMed

    Weaver, Lynda; Bossé, Isabelle; Sinclair, Dionne; Blais, Bernard; Pereira, José

    2016-01-01

    This article examines issues related to sustaining Quality Improvement (QI) initiatives in a Canadian subacute care hospital and recommends strategies to address them. The authors define two levels of sustainability, the QI project and the corporate/organizational and how they influence a LEADS (Lead Self, Engage Others, Achieve Results, Develop Coalition and System Transformation) culture. The authors then reflect on the differing factors for QI sustainability and present them under five essential categories of accountability, education, communication, monitoring and reporting, and structure and processes.

  10. Perinatal information systems for quality improvement: visions for today.

    PubMed

    Slagle, T A

    1999-01-01

    Today clinical information is used for a multitude of purposes beyond patient care documentation including quality review and improvement processes, allocation of resources, budgetary and long-term planning, productivity measurement, and justification to payers for services provided. Providers in perinatal medicine are faced with the challenge of finding methods to meet these information needs. Case examples of the different approaches to collecting and using obstetric and neonatal information are described. The role of computer-based patient records is outlined and solutions available to perinatal medicine are reviewed.

  11. Research to improve the quality of synthetic seismogram

    NASA Astrophysics Data System (ADS)

    Gao, Feng

    2017-03-01

    With the acceleration development of oilfield exploration and development, higher requirement for the precision of seismic interpretation is needed for that only higher accuracy of horizon calibration can match reservoir within the scope in the work area more effectively with full well to further lay a solid foundation of fine reservoir calibration which guarantee further fine structure interpretation and reservoir inversion. In this paper, some shallow understanding on how to improve the quality of synthetic seismogram is suggested including curve reconstruction, multi-resolution analysis, and extract wavelet in divided time window and so on to solve problems in the practical work.

  12. Air Quality in Mexico City: Policies Implemented for its Improvement

    NASA Astrophysics Data System (ADS)

    Paramo, V.

    2007-12-01

    Ozone and suspended particles (PM) are two pollutants in the atmosphere of Mexico City Metropolitan Area (MCMA) that still exceed the recommended Mexican health standards. The other criteria pollutants very seldom exceed their corresponding standards. In 2006, the maximum ozone concentrations were above the health standard (0.11 ppm in 1 hour) during 59 percent of the days for an average of 2.2 hours and 130 points of the Air Quality Index (Índice Metropolitano de la Calidad del Aire - IMECA). In contrast, in 1991, 98 percent of the days exceeded the ozone health standard for an average of 6.6 hours and 200 IMECA points. With regards to PM10, in 2006, 80 percent of the sampled concentrations were below the health standard of 120 µg/m3 in 24 hours. However, the annual health standard of 50 µg/m3 is still exceeded. The air quality management in the MCMA is a difficult task due to several adverse factors. The main one is the large population that increased from nearly 15 million in 1992 to more than 18 million at present. As a result, the urban area grows in the adjoined municipalities of the State of Mexico. The vehicular fleet increases also to almost 4 million and the number of industrial facilities is at present 50,000. Consequently, the fuel consumption is very high. The daily energy consumption is estimated to be 44 million liters of equivalent of gasoline. Despite the fact that the air quality has improved in recent years, the related health standards are still exceeded and therefore it is necessary to continue applying the most cost-effective actions to improve the environment quality. Some actions that have contributed most to the reduction of pollutant emissions are the following: Continuous update of the inspection and maintenance program of the vehicular fleet; substitution of the catalytic converters at the end of their useful life; self-regulation of the diesel fleet; use of alternative fuels; update the No-Driving-Day program; establishment of more

  13. Improved accounting of emissions from utility energy storage system operation

    SciTech Connect

    Paul Denholm; Tracey Holloway

    2005-12-01

    Several proposed utility-scale energy storage systems in the U.S. will use the spare output capacity of existing electric power systems to create the equivalent of new load-following plants that can rapidly respond to fluctuations in electricity demand and increase the flexibility of baseload generators. New energy storage systems using additional generation from existing plants can directly compete with new traditional sources of load-following and peaking electricity, yet this application of energy storage is not required to meet many of the Clean Air Act standards required of new electricity generators (e.g., coal- or gas-fired power plants). This study evaluates the total emissions that will likely result from the operation of a new energy storage facility when coupled with an average existing U.S. coal-fired power plant and estimates that the emission rates of SO{sub 2} and NOx will be considerably higher than the rate of a new plant meeting Clean Air Act standards, even accounting for the efficiency benefits of energy storage. This study suggests that improved emissions 'accounting' might be necessary to provide accurate environmental comparisons between energy storage and more traditional sources of electricity generation. 35 refs., 5 figs., 2 tabs.

  14. Improved accounting of emissions from utility energy storage system operation.

    PubMed

    Denholm, Paul; Holloway, Tracey

    2005-12-01

    Several proposed utility-scale energy storage systems in the U.S. will use the spare output capacity of existing electric power systems to create the equivalent of new load-following plants that can rapidly respond to fluctuations in electricity demand and increase the flexibility of baseload generators. New energy storage systems using additional generation from existing plants can directly compete with new traditional sources of load-following and peaking electricity, yet this application of energy storage is not required to meet many of the Clean Air Act standards required of new electricity generators (e.g., coal- or gas-fired power plants). This study evaluates the total emissions that will likely result from the operation of a new energy storage facility when coupled with an average existing U.S. coal-fired power plant and estimates that the emission rates of SO2 and NOx will be considerably higher than the rate of a new plant meeting Clean Air Act standards, even accounting for the efficiency benefits of energy storage. This study suggests that improved emissions "accounting" might be necessary to provide accurate environmental comparisons between energy storage and more traditional sources of electricity generation.

  15. [Radiology information systems: improved performance evaluation, economics and quality assurance?].

    PubMed

    Gross-Fengels, W; Weber, M

    1997-03-01

    By means of complete service control and standardized accounting processes, radiological information systems clearly contribute to improved results. They provide the prerequisites for the establishment of expanded networks and allow comparisons with comparable institutions. The quality of patient care can be improved since, for example, the production time from referral to finished result becomes shorter. Direct access to patient and findings data from several positions is possible. Preliminary results can be viewed immediately. The patient's history is accessible to authorized users at all times. The exact reproducibility and assignment of services leads to more clarity. By means of the information available form RIS, rapid adaptive processes can be undertaken. The system assists the to fulfill the requirements of health regulations. The above-mentioned relationships demonstrate that the EDP systems are well accepted by physicians, medical assistants, and administrators and represent an indispensable aid for solving problems.

  16. The practical problem of improving quality in multicenter dialysis facilities.

    PubMed

    Balter, Paul

    2003-01-01

    Multifacility dialysis groups are frequently interested in improving overall quality and find that there are major differences between individual units. Upper management must consider what strategy is needed for the whole company and what strategy must be formulated by individual facilities. To make substantive changes, management must decide to adopt a new culture of true teamwork, drive out fear, and emphasize leadership and education both at the management level and in the individual unit. Both at the corporate and unit levels, leaders must be chosen who are able to recognize people who have the ability, the educational background, the enthusiasm, and the time to direct change. Empowering the individual units and individual employees to make changes and be enthusiastic about improvement is the key to success.

  17. Balancing stakeholder needs in the evaluation of healthcare quality improvement

    PubMed Central

    Leviton, Laura C; Melichar, Lori

    2016-01-01

    Quality improvement (QI) efforts affect a broader range of people than we often assume. These are the potential stakeholders for QI and its evaluation, and they have valuable perspectives to offer when they are consulted in planning, conducting and interpreting evaluations. QI practitioners are accustomed to consulting stakeholders to assess unintended consequences or assess patient experiences of care, but in many cases there are additional benefits to a broad inclusion of stakeholders. These benefits are better adherence to ethical standards, to assure that all legitimate interests take part, more useful and relevant evaluation information and better political buy-in to improve impact. Balancing various stakeholder needs for information requires skill for both politics and research management. These challenges have few pat answers, but several preferred practices, which are illustrated with practical examples. PMID:26893512

  18. Quality assurance and improvement: the Pediatric Regional Anesthesia Network.

    PubMed

    Polaner, David M; Martin, Lynn D

    2012-01-01

    Quality assurance and improvement (QA/QI) is a critical activity in medicine. The use of large-scale collaborative databases is increasingly essential to obtain enough reports with which to establish standards of practice and define the incidence of complications and risk/benefit ratios for rare events. Such projects can enhance local QA/QI endeavors by enabling institutions to obtain benchmark data against which to compare their performance and can be used for prospective analyses of inter-institutional differences to determine 'best practice'. The pediatric regional anesthesia network (PRAN) is such a project. The first data cohort is currently being analyzed and offers insight into how such data can be used to detect trends in adverse events and improve care.

  19. Quality Improvement With Discrete Event Simulation: A Primer for Radiologists.

    PubMed

    Booker, Michael T; O'Connell, Ryan J; Desai, Bhushan; Duddalwar, Vinay A

    2016-04-01

    The application of simulation software in health care has transformed quality and process improvement. Specifically, software based on discrete-event simulation (DES) has shown the ability to improve radiology workflows and systems. Nevertheless, despite the successful application of DES in the medical literature, the power and value of simulation remains underutilized. For this reason, the basics of DES modeling are introduced, with specific attention to medical imaging. In an effort to provide readers with the tools necessary to begin their own DES analyses, the practical steps of choosing a software package and building a basic radiology model are discussed. In addition, three radiology system examples are presented, with accompanying DES models that assist in analysis and decision making. Through these simulations, we provide readers with an understanding of the theory, requirements, and benefits of implementing DES in their own radiology practices.

  20. Improvements in NOAA's Operational Tsunameter Network since December 2004

    NASA Astrophysics Data System (ADS)

    Bouchard, R.; Kohler, C.; McArthur, S.; Burnett, W. H.; Wells, W. I.; Luke, R.

    2009-12-01

    In December 2004 during the devastating Sumatran Tsunami, the National Oceanic and Atmospheric Administration (NOAA) had five tsunameter stations established in the North Pacific Ocean and one in the South Pacific Ocean operated and maintained by NOAA’s National Data Buoy Center (NDBC). The original six tsunameters employed the technology of the first generation Deep-ocean Assessment and Reporting of Tsunamis (DART I) developed by NOAA’s Pacific Marine Environmental Laboratory (PMEL) and successfully transitioned to NDBC in 2003. The technology consists of a Bottom Pressure Recorder (BPR) that makes pressure measurements near the sea-floor and a surface buoy. It takes less than three minutes for data to get from the BPR, which can reside to depths of 6000 m, to users. The BPR contains a tsunami detection algorithm that will place the BPR in rapid reporting mode(also know as Event Mode). The two most profound improvements to the network were its expansion to 39 stations and the transition and upgrade to the second generation DART II systems. In the aftermath of the Sumatran Tsunami, NOAA expanded the network to 39 stations to bolster the US tsunami warning system by providing coastal communities in the Pacific, Atlantic, Caribbean and the Gulf of Mexico with faster and more accurate tsunami warnings. Cooperating NOAA offices selected the sites in consultation with the US Geological Survey and other interested parties. Since their initial establishment, NDBC has relocated some stations to improve data availability by reducing the risks of vessel collision, extreme winds, seas, and currents. NDBC completed the network in March 2008. During the expansion of the NOAA network, NDBC assisted several countries in the deploying and distributing data from their own DART II tsunameters. NDBC completed the upgraded of all stations to the DART II systems by the end of 2007. The significant capability fielded by the DART II technology was the bi-directional communications

  1. All teach, all learn, all improve?: The role of interorganizational learning in quality improvement collaboratives

    PubMed Central

    Nembhard, Ingrid M.

    2016-01-01

    Background Quality improvement collaboratives are an increasingly common strategy for implementing evidence-based practices in health care. However, research shows that many participating organizations do not achieve the level of performance improvement desired. Purpose This study examined the use of interorganizational learning activities (inter-OLAs) as an explanation for mixed performance improvement among collaborative participants. We tested the hypotheses that inter-OLA use is positively associated with participants’ performance improvement and that this relationship is moderated by the use of intraorganizational learning activities (intra-OLAs) and quality-focused human resource (Q-HR) practices. Methodology We conducted a survey of organizational teams participating in 4 Institute for Healthcare Improvement Breakthrough Series collaboratives. Survey responses from 52 teams, regarding the use of inter-OLAs, intra-OLAs and Q-HR practices, were linked to performance improvement data obtained from the Institute for Healthcare Improvement and demographic data obtained from secondary sources. Findings The more collaborative teams used inter-OLAs, the more their organizations’ performance improved. Contrary to our hypothesis, the use of intra-OLAs did not moderate this relationship; teams’ use of intra-OLAs added to, but did not multiply, the effect of inter-OLA use. In contrast, an organization's use of Q-HR practices multiplied the performance benefit of inter-OLA use. Practice Implications Our findings suggest that organizations that participate in collaboratives are more likely to improve their performance if they use the inter-OLAs offered by the collaborative. Our results also suggest that complementing high use of inter-OLAs with intra-OLA use and Q-HR practices enhances performance improvement. For collaborative sponsors, our findings imply that including activities that facilitate interorganizational and intraorganizational learning are worthwhile

  2. Improvement of the environmental and operational characteristics of vehicles through decreasing the motor fuel density.

    PubMed

    Magaril, Elena

    2016-04-01

    The environmental and operational characteristics of motor transport, one of the main consumers of motor fuel and source of toxic emissions, soot, and greenhouse gases, are determined to a large extent by the fuel quality which is characterized by many parameters. Fuel density is one of these parameters and it can serve as an indicator of fuel quality. It has been theoretically substantiated that an increased density of motor fuel has a negative impact both on the environmental and operational characteristics of motor transport. The use of fuels with a high density leads to an increase in carbonization within the engine, adversely affecting the vehicle performance and increasing environmental pollution. A program of technological measures targeted at reducing the density of the fuel used was offered. It includes a solution to the problem posed by changes in the refining capacities ratio and the temperature range of gasoline and diesel fuel boiling, by introducing fuel additives and adding butanes to the gasoline. An environmental tax has been developed which allows oil refineries to have a direct impact on the production of fuels with improved environmental performance, taking into account the need to minimize the density of the fuel within a given category of quality.

  3. Applying Quality Function Deployment Model in Burn Unit Service Improvement.

    PubMed

    Keshtkaran, Ali; Hashemi, Neda; Kharazmi, Erfan; Abbasi, Mehdi

    2016-01-01

    Quality function deployment (QFD) is one of the most effective quality design tools. This study applies QFD technique to improve the quality of the burn unit services in Ghotbedin Hospital in Shiraz, Iran. First, the patients' expectations of burn unit services and their priorities were determined through Delphi method. Thereafter, burn unit service specifications were determined through Delphi method. Further, the relationships between the patients' expectations and service specifications and also the relationships between service specifications were determined through an expert group's opinion. Last, the final importance scores of service specifications were calculated through simple additive weighting method. The findings show that burn unit patients have 40 expectations in six different areas. These expectations are in 16 priority levels. Burn units also have 45 service specifications in six different areas. There are four-level relationships between the patients' expectations and service specifications and four-level relationships between service specifications. The most important burn unit service specifications have been identified in this study. The QFD model developed in the study can be a general guideline for QFD planners and executives.

  4. Doctors in China: improving quality through modernisation of residency education.

    PubMed

    Zhu, Jiming; Li, Wenkai; Chen, Lincoln

    2016-10-15

    There is growing recognition that the ultimate success of China's ambitious health reform (enacted in 2009) and higher education reform (1998) depends on well educated health professionals who have the clinical, ethical, and human competencies necessary for the provision of quality services. In this Review, we describe and analyse graduate education of doctors in China by discussing the country's health workforce and their clinical residency education. China has launched a new system called the 5 + 3 (5 year undergraduate and 3 year residency [standardised residency training]), which aims to set national quality standards. To improve understanding for the Chinese model, we present a comparative perspective with systems from the UK and USA. To succeed, the 5 + 3 model will need to overcome major challenges of accreditation and certification, alternative education pathways, and China's unique degree and credentialing system. We conclude by reviewing the challenges of clinical competencies in China, especially the complementarity of specialist training and general practitioner training, which are essential for the quality and equity of China's health-care system.

  5. Quality assurance and continuous quality improvement: history, current practice, and future directions.

    PubMed

    Thomas, P C; Kettrick, R G; Singsen, B H

    1992-08-01

    Quality Assurance (QA) provides opportunities for physicians and allied health professionals to improve patient care and disease outcomes. Its goals are increased efficiency and efficacy in healthcare. QA activities are based upon objective criteria and systematic review and make important contributions to the effectiveness of hospitals and other care facilities. Successful programs help to maximize health status of patients while minimizing resource utilization. Beginning in 1917, early QA efforts were often informal and subjective but now include standards for QA and strategies for monitoring and evaluating patient care. Central to its new "Agenda for Change," the Joint Commission on Accreditation of Healthcare Organizations has embraced the concept of continuous quality improvement (CQI). This moves the focus of review away from department- or practitioner-specific activities and toward a "systems" form of evaluation. CQI is rooted in patient-care realities, is easy to implement, is based upon scientific assessments, and solves practical problems in an incremental and ongoing fashion.

  6. Evaluation and measurement for improvement in service-level quality improvement initiatives.

    PubMed

    Russell, Nicholas C C; Wallace, Louise M; Ketley, Diane

    2011-11-01

    The National Health Service (NHS) in England, as with other health services worldwide, currently faces the need to reduce costs and to improve the quality of patient care. Evidence gathered through effective and appropriate measurement and evaluation, is essential to achieving this. Through interviews with service improvement managers and analysis of comments in a seminar of NHS staff involved in health service improvement, we found a lack of understanding regarding the definition and methodology of both measurement and evaluation, which decreases the likelihood that NHS staff will be competent to commission or provide these skills. In addition, we highlight the importance of managers assessing their organizations' 'readiness' to undergo change before embarking on a quality improvement (QI) initiative, to ensure that the initiative's impact can be adequately judged. We provide definitions of measurement for improvement and of evaluation, and propose a comparative framework from which to gauge an appropriate approach. Examples of two large-scale QI initiatives are also given, along with descriptions of some of their problems and solutions, to illustrate the use of the framework. We recommend that health service managers use the framework to determine the most appropriate approach to evaluation and measurement for improvement for their context, to ensure that their decisions are evidence based.

  7. Improving the quality of protein structures derived by NMR spectroscopy.

    PubMed

    Spronk, Christian A E M; Linge, Jens P; Hilbers, Cornelis W; Vuister, Geerten W

    2002-03-01

    Biomolecular structures provide the basis for many studies in several research areas such as homology modelling, structure-based drug design and functional genomics. It is an important prerequisite that the structure is reliable in terms of accurate description of the experimental data, and in terms of good quality of local- and overall geometry. Recent surveys indicate that structures solved by NMR-spectroscopy normally are of lower precision than high-resolution X-ray structures. Here, we present a refinement protocol that improves the quality of protein structures determined by NMR-spectroscopy to the level of those determined by high resolution X-ray crystallography in terms of local geometry. The protocol was tested on experimental data of the proteins IL4 and Ubiquitin and on simulated data of the protein Crambin. In almost all aspects, the protocol yielded better results in terms of accuracy and precision. Independent validation of the results for Ubiquitin, using residual dipolar couplings, indicates that the ensemble of NMR structure is substantially improved by the protocol.

  8. Method to improve optical parametric oscillator beam quality

    DOEpatents

    Smith, Arlee V.; Alford, William J.; Bowers, Mark S.

    2003-11-11

    A method to improving optical parametric oscillator (OPO) beam quality having an optical pump, which generates a pump beam at a pump frequency greater than a desired signal frequency, a nonlinear optical medium oriented so that a signal wave at the desired signal frequency and a corresponding idler wave are produced when the pump beam (wave) propagates through the nonlinear optical medium, resulting in beam walk off of the signal and idler waves, and an optical cavity which directs the signal wave to repeatedly pass through the nonlinear optical medium, said optical cavity comprising an equivalently even number of non-planar mirrors that produce image rotation on each pass through the nonlinear optical medium. Utilizing beam walk off where the signal wave and said idler wave have nonparallel Poynting vectors in the nonlinear medium and image rotation, a correlation zone of distance equal to approximately .rho.L.sub.crystal is created which, through multiple passes through the nonlinear medium, improves the beam quality of the OPO output.

  9. Evaluation of a continuous quality improvement program in anticoagulant therapy

    PubMed Central

    Cantin, Ariane; Lahaie, Alexandre; Odobasic, Bojan; Tremblay, Marie-Philip; Wazzan, Dana; Caron, Stéphanie; Leblanc, Caroline; Martineau, Josée; Lalonde, Lyne

    2016-01-01

    Background: The ACO Program (Programme ACO), a continuous quality improvement program (CQIP) in anticoagulation therapy, was offered in community pharmacies as a pilot project. Objective: To evaluate the participants’ appreciation for the various activities of the program. Methods: Participants had access to training activities, including an audit with feedback, online training activities (OTA), clinical tools and support from facilitators. Cognitive behavioural learning determinants were evaluated before and 5 months after the beginning of the program. Participants’ satisfaction and perception were documented via online questionnaires and a semistructured interview. Results: Of the 52 pharmacists in the ACO Program, 47 participated in this evaluation. Seventy-seven percent of the participants completed at least 1 OTA and 6% published on the forum. The feeling of personal effectiveness rose from 8.01 (7.67-8.35) to 8.62 (8.24-8.99). The audit and feedback, as well as the high-quality OTA and their lecturers, were the most appreciated elements. Discussion: There was a high OTA participation rate. The facilitators seemed to play a key role in the CQIP. The low level of participation in the forum reflects the known phenomenon of social loafing. Technical difficulties affecting the platform and data collection for the audit with feedback constituted limitations. Conclusion: The CQIP in anticoagulation therapy is appreciated by community pharmacists and is associated with an improved feeling of personal effectiveness. PMID:27829859

  10. Implementing quality/productivity improvement initiatives in an engineering environment

    NASA Technical Reports Server (NTRS)

    Ruda, R. R.

    1985-01-01

    Quality/Productivity Improvement (QPI) initiatives in the engineering environment at McDonnell Douglas-Houston include several different, distinct activities, each having its own application, yet all targeted toward one common goal - making continuous improvement a way of life. The chief executive and the next two levels of management demonstrate their commitment to QPI with hands-on involvement in several activities. Each is a member of a QPI Council which consists of six panels - Participative Management, Communications, Training, Performance/Productivity, Human Resources Management and Strategic Management. In addition, each manager conducts Workplace Visits and Bosstalks, to enhance communications with employees and to provide a forum for the identification of problems - both real and perceived. Quality Circles and Project Teams are well established within McConnel Douglas as useful and desirable employee involvement teams. The continued growth of voluntary membership in the circles program is strong evidence of the employee interest and management support that have developed within the organization.

  11. Systematic infrared image quality improvement using deep learning based techniques

    NASA Astrophysics Data System (ADS)

    Zhang, Huaizhong; Casaseca-de-la-Higuera, Pablo; Luo, Chunbo; Wang, Qi; Kitchin, Matthew; Parmley, Andrew; Monge-Alvarez, Jesus

    2016-10-01

    Infrared thermography (IRT, or thermal video) uses thermographic cameras to detect and record radiation in the longwavelength infrared range of the electromagnetic spectrum. It allows sensing environments beyond the visual perception limitations, and thus has been widely used in many civilian and military applications. Even though current thermal cameras are able to provide high resolution and bit-depth images, there are significant challenges to be addressed in specific applications such as poor contrast, low target signature resolution, etc. This paper addresses quality improvement in IRT images for object recognition. A systematic approach based on image bias correction and deep learning is proposed to increase target signature resolution and optimise the baseline quality of inputs for object recognition. Our main objective is to maximise the useful information on the object to be detected even when the number of pixels on target is adversely small. The experimental results show that our approach can significantly improve target resolution and thus helps making object recognition more efficient in automatic target detection/recognition systems (ATD/R).

  12. National Endoscopy Quality Improvement Program Remains Suboptimal in Korea

    PubMed Central

    Cha, Jae Myung; Moon, Jeong Seop; Chung, Il-Kwun; Kim, Jin-Oh; Im, Jong Pil; Cho, Yu Kyung; Kim, Hyun Gun; Lee, Sang Kil; Lee, Hang Lak; Jang, Jae Young; Kim, Eun Sun; Jung, Yunho; Moon, Chang Mo; Kim, Yeol; Park, Bo Young

    2016-01-01

    Background/Aims We evaluated the characteristics of the National Cancer Screening Program (NCSP) and opinions regarding the National Endoscopy Quality Improvement Program (NEQIP). Methods We surveyed physicians performing esophagogastroduodenoscopy and/or colonoscopy screenings as part of the NCSP via e-mail between July and August in 2015. The 32-item survey instrument included endoscopic capacity, sedation, and reprocessing of endoscopes as well as opinions regarding the NEQIP. Results A total of 507 respondents were analyzed after the exclusion of 40 incomplete answers. Under the current capacity of the NCSP, the typical waiting time for screening endoscopy was less than 4 weeks in more than 90% of endoscopy units. Performance of endoscopy reprocessing was suboptimal, with 28% of respondents using unapproved disinfectants or not knowing the main ingredient of their disinfectants and 15% to 17% of respondents not following reprocessing protocols. Agreement with the NEQIP was optimal, because only 5.7% of respondents did not agree with NEQIP; however, familiarity with the NEQIP was suboptimal, because only 37.3% of respondents were familiar with the NEQIP criteria. Conclusions The NEQ-IP remains suboptimal in Korea. Given the suboptimal performance of endoscopy reprocessing and low familiarity with the NEQIP, improved quality in endoscopy reprocessing and better understanding of the NEQIP should be emphasized in Korea. PMID:27282270

  13. Analysis of Power Quality Based on Real Data and Quality Improvement at Campus Distribution System

    NASA Astrophysics Data System (ADS)

    Kawasaki, Shoji; Matsuki, Junya; Hayashi, Yasuhiro; Ito, Akitoshi

    In recent years, a lot of equipments have been made using the inverter technology from home electric appliances to office automation apparatuses and industrial equipments with the development of power electronics technology. The voltage distortion of a distribution system has increased due to the harmonic currents generated from these apparatuses, and the increase in harmonics continues to be expected. In addition, the distribution system forms the circuit of harmonic distortion expansion by the prevalence of static capacitor without L for power factor improvement. Moreover, the voltage imbalance occurs by diversification of loads or imbalanced connection of single-phase loads. The deterioration of power quality in the distribution system causes various problems such as the overheating of equipments and malfunction of rotating machines. Since the power quality changes according to air temperature and date, it is desirable to measure the voltages and currents continuously for a long time. In this study, the authors focus attention on the distribution system in the University of Fukui campus, and the authors have measured the voltages and currents in the distribution system for a long period with WAMS (Wide Area Measurement System) using NCT (Network Computing Terminal). Based on the obtained data, the authors analyzed the power quality of the campus distribution system from viewpoints of voltage imbalance, current imbalance, voltage THD (Total Harmonic Distortion), and current THD. Furthermore, the improvement effect of power quality of the campus distribution system by exchange of single-phase load connection is described.

  14. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence)

    PubMed Central

    Ogrinc, Greg; Davies, Louise; Goodman, Daisy; Batalden, Paul; Davidoff, Frank; Stevens, David

    2015-01-01

    In the past several years, the science of health care improvement has advanced considerably. In this article, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes 3 key components of systematic efforts to improve the quality, value, and safety of health care: formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org). PMID:26497490

  15. A conceptual persistent healthcare quality improvement process for software development management.

    PubMed

    Lin, Jen-Chiun; Su, Mei-Ju; Cheng, Po-Hsun; Weng, Yung-Chien; Chen, Sao-Jie; Lai, Jin-Shin; Lai, Feipei

    2007-01-01

    This paper illustrates a sustained conceptual service quality improvement process for the management of software development within a healthcare enterprise. Our proposed process is revised from Niland's healthcare quality information system (HQIS). This process includes functions to survey the satisfaction of system functions, describe the operation bylaws on-line, and provide on-demand training. To achieve these goals, we integrate five information systems in National Taiwan University Hospital, including healthcare information systems, health quality information system, requirement management system, executive information system, and digital learning system, to form a full Deming cycle. A preliminary user satisfaction survey showed that our outpatient information system scored an average of 71.31 in 2006.

  16. An Improved Power Quality Based Sheppard-Taylor Converter Fed BLDC Motor Drive

    NASA Astrophysics Data System (ADS)

    Singh, Bhim; Bist, Vashist

    2015-12-01

    This paper deals with the design and analysis of a power factor correction based Sheppard-Taylor converter fed brushless dc motor (BLDCM) drive. The speed of the BLDCM is controlled by adjusting the dc link voltage of the voltage source inverter (VSI) feeding BLDCM. Moreover, a low frequency switching of the VSI is used for electronically commutating the BLDCM for reduced switching losses. The Sheppard-Taylor converter is designed to operate in continuous conduction mode to achieve an improved power quality at the ac mains for a wide range of speed control and supply voltage variation. The BLDCM drive is designed and its performance is simulated in a MATLAB/Simulink environment to achieve the power quality indices within the limits of the international power quality standard IEC-61000-3-2.

  17. Improving the quality of parameter estimates obtained from slug tests

    USGS Publications Warehouse

    Butler, J.J.; McElwee, C.D.; Liu, W.

    1996-01-01

    The slug test is one of the most commonly used field methods for obtaining in situ estimates of hydraulic conductivity. Despite its prevalence, this method has received criticism from many quarters in the ground-water community. This criticism emphasizes the poor quality of the estimated parameters, a condition that is primarily a product of the somewhat casual approach that is often employed in slug tests. Recently, the Kansas Geological Survey (KGS) has pursued research directed it improving methods for the performance and analysis of slug tests. Based on extensive theoretical and field research, a series of guidelines have been proposed that should enable the quality of parameter estimates to be improved. The most significant of these guidelines are: (1) three or more slug tests should be performed at each well during a given test period; (2) two or more different initial displacements (Ho) should be used at each well during a test period; (3) the method used to initiate a test should enable the slug to be introduced in a near-instantaneous manner and should allow a good estimate of Ho to be obtained; (4) data-acquisition equipment that enables a large quantity of high quality data to be collected should be employed; (5) if an estimate of the storage parameter is needed, an observation well other than the test well should be employed; (6) the method chosen for analysis of the slug-test data should be appropriate for site conditions; (7) use of pre- and post-analysis plots should be an integral component of the analysis procedure, and (8) appropriate well construction parameters should be employed. Data from slug tests performed at a number of KGS field sites demonstrate the importance of these guidelines.

  18. Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians.

    PubMed

    Broderick-Forsgren, Kathleen; Hunter, Wynn G; Schulteis, Ryan D; Liu, Wen-Wei; Boggan, Joel C; Sharma, Poonam; Thomas, Steven; Zaas, Aimee; Bae, Jonathan

    2016-05-01

    Background Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program. Objective This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools-business cards and white boards-to improve provider identification. Methods This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use. Results We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P < .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P < .05 for all), but had no effect on photograph recognition. Conclusions Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools.

  19. A strategy for improvement of postthaw quality of bison sperm.

    PubMed

    Hussain, S A; Lessard, C; Anzar, M

    2013-01-01

    The objective was to improve the postthaw quality of bison semen using zwitterion (ZI)-based extenders, glycerol addition at a lower temperature (4 °C), adding reduced glutathione (GSH) in extender, or treating bison sperm with cholesterol-loaded cyclodextrin (CLC) before freezing. Postthaw sperm motility and structural characteristics were analyzed using a computer-assisted sperm analyzer and flow cytometer respectively, at 0 and 3 hours postthaw incubation at 37 °C. In experiment 1, each ejaculate (N = 11) was diluted in Triladyl extender (control) or in ZI extenders (Tes-Tris or HEPES-Tris). In addition, glycerol in semen was added either at 37 °C or 4 °C before cryopreservation. Extenders had no significant effect on postthaw sperm motilities at 0 hour. However, sperm velocity parameters were higher (P < 0.05) in ZI extenders than in Triladyl. Sperm population with intact plasma membrane (IPM) and acrosomes (IACR) were higher in Triladyl than in ZI extenders (P < 0.05). Postthaw sperm total and progressive motilities, average path velocity, straight-line velocity, IPM, and IPM-IACR did not improve with the addition of glycerol at 4 °C. In experiment 2, semen was diluted (50 × 10(6) sperm per mL) in Triladyl extender containing 0 (control), 0.5, 1.0, or 2.0 mM GSH (an antioxidant) at 37 °C. Postthaw sperm motility and structural characteristics at 0 hour and percentage declined after 3 hour incubation, but did not differ because of GSH in the extender (P > 0.05). In experiment 3, fresh bison sperm (100 × 10(6) sperm in 1 mL) were pretreated with 0, 1, 2, or 3 mg/mL of CLC at 22 °C for 15 minutes and diluted to 50 × 10(6) sperm per mL in Tris-citric acid-egg yolk-glycerol extender before cryopreservation. The CLC pretreated sperm had higher (P < 0.05) postthaw total and progressive motilities, IPM, and IACR at 0 hour and less percentage of decline in these characteristics after 3 hour postthaw incubation. In conclusion, zwitterion extenders (Tes

  20. Sustainable cow-calf operations and water quality

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The current high demand for quality protein and fiber production because of increasing world population has resulted in an intensification of agricultural production systems. As animal-based agriculture has evolved to larger production in subtropical regions of United States, the problems associated...

  1. Refinery operating variables key to enhanced lube oil quality

    SciTech Connect

    Rhodes, A.K.

    1993-01-04

    This paper reports that lubricating oils are being used under increasingly severe conditions. Meanwhile, the growing use of synthetic and unconventional base stocks makes it more difficult to produce lube oils by simply modifying additive technology. These factors heighten the importance of developing high-quality lubricating oils with good oxidation stability and high viscosity index (VI).

  2. National Surgical Quality Improvement Program-Pediatric (NSQIP) and the Quality of Surgical Care in Pediatric Orthopaedics.

    PubMed

    Brighton, Brian K

    2015-01-01

    In recent years, the safety, quality, and value of surgical care have become increasingly important to surgeons and hospitals. Quality improvement in surgical care requires the ability to collect, measure, and act upon reliable and clinically relevant data. One example of a large-scale quality effort is the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-Pediatric), the only nationwide, risk-adjusted, outcomes-based program evaluating pediatric surgical care.

  3. 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

  4. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    Admissions for exacerbations of chronic obstructive pulmonary disease (COPD) present a significant proportion of patients in the acute medical take. The British Thoracic Society (BTS) provides guidelines for time specific interventions, that should be delivered to those with an acute exacerbation of COPD through the admission care bundle. These include correct diagnosis, correct assessment of oxygenation, early administration of treatment, recognition of respiratory failure, and specialist review. Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) chose improvement in acute COPD care to be a local Commissioning for Quality and Innovation (CQUIN) scheme, which enables commissioners to reward excellence by linking a proportion of English healthcare providers' income to the achievement of local quality improvement goals. The effects of initiatives put in place by senior clinicians had waned, and further improvements were required to meet the CQUIN target. The aim of the scheme was to improve compliance with the BTS guidelines and CQUIN scheme for patients admitted with an exacerbation of COPD. Specific bundle paperwork to be used for all patients admitted to the Trust with an exacerbation of COPD was introduced to the Trust in June 2014, with training and education of medical staff at that time. This had improved compliance rates from 10% to 63% by September 2014. Compliance with each intervention was audited through the examination of notes of patients admitted with an exacerbation of COPD. Compliance rates had plateaued over the last three months, and so a focus group involving junior medical staff met in September 2014 to try to increase awareness further, in order to drive greater improvements in care, and meet the CQUIN requirements. Their strategies were implemented, and then compliance with the CQUIN requirements was reaudited as described above. The December 2014 audit results showed a further improvement in overall COPD care, with 73% of patients

  5. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed Central

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    Admissions for exacerbations of chronic obstructive pulmonary disease (COPD) present a significant proportion of patients in the acute medical take. The British Thoracic Society (BTS) provides guidelines for time specific interventions, that should be delivered to those with an acute exacerbation of COPD through the admission care bundle. These include correct diagnosis, correct assessment of oxygenation, early administration of treatment, recognition of respiratory failure, and specialist review. Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) chose improvement in acute COPD care to be a local Commissioning for Quality and Innovation (CQUIN) scheme, which enables commissioners to reward excellence by linking a proportion of English healthcare providers’ income to the achievement of local quality improvement goals. The effects of initiatives put in place by senior clinicians had waned, and further improvements were required to meet the CQUIN target. The aim of the scheme was to improve compliance with the BTS guidelines and CQUIN scheme for patients admitted with an exacerbation of COPD. Specific bundle paperwork to be used for all patients admitted to the Trust with an exacerbation of COPD was introduced to the Trust in June 2014, with training and education of medical staff at that time. This had improved compliance rates from 10% to 63% by September 2014. Compliance with each intervention was audited through the examination of notes of patients admitted with an exacerbation of COPD. Compliance rates had plateaued over the last three months, and so a focus group involving junior medical staff met in September 2014 to try to increase awareness further, in order to drive greater improvements in care, and meet the CQUIN requirements. Their strategies were implemented, and then compliance with the CQUIN requirements was reaudited as described above. The December 2014 audit results showed a further improvement in overall COPD care, with 73% of patients

  6. Improving productivity and profitability of a bioanalytical business through sales and operation planning.

    PubMed

    Islam, Rafiqul

    2013-07-01

    Today's bioanalytical CROs face increasing global competition, highly variable demand, high fixed costs, pricing pressure, and increasing demand for quality and speed. Most bioanalytical laboratories have responded to these challenges by implementing automation and by implementing process improvement methodologies (e.g., Six Sigma). These solutions have not resulted in a significant improvement in productivity and profitability since none of them are able to predict the upturn or downturn in demand. High volatility of demand causes long lead times and high costs during peak demand and poor productivity during trough demand. Most bioanalytical laboratories lack the tools to align supply efficiently to meet changing demand. In this paper, sales and operation planning (S&OP) has been investigated as a tool to balance supply and demand. The S&OP process, when executed effectively, can be the single greatest determinant of profitability for a bioanalytical business.

  7. Accelerated chilling of carcasses to improve pork quality.

    PubMed

    Springer, M P; Carr, M A; Ramsey, C B; Miller, M F

    2003-06-01

    Our objectives were to determine the optimal accelerated chill time immediately postmortem necessary to improve the quality of pork muscle and to decrease the incidence of pale, soft, and exudative pork. Carcasses from 81 market hogs were cooled either by conventional chill (CC) at 2 degrees C or by accelerated chill (AC) at -32 degrees C for 60, 90, 120, or 150 min, and then placed into a 2 degrees C cooler for the remainder of the 24-h chill period. Loin muscle pH was higher (P < 0.05) for the carcasses that were accelerated chilled longer than 60 min. Although loin visual color, texture, and firmness scores increased (P < 0.05) with AC time, no improvements were noted beyond 60 min. Color, pH, texture, firmness, and CIE L*a*b* values of fresh ham muscles were not (P > 0.05) affected by AC. In addition, AC did not (P > 0.05) affect purge, drip, or thaw loss of fresh products, sensory scores of loins or processed hams (except initial juiciness; P < 0.05), water-holding capacity of processed hams, or processing characteristics of hams. Cooking loss and Warner-Bratzler shear values for hams and loins were not (P > 0.05) affected by AC. Accelerated chilling caused loins to be darker (lower L* value; P < 0.05) and to have lower (P < 0.05) b* values (less yellow) than CC loins. Accelerated chilling increased water-holding capacity in fresh hams, bound water being the greatest (P < 0.05) in the 120- and 150-min AC groups. These results demonstrate that improvements in pork loin quality can be made using freezer-accelerated chilling for carcasses.

  8. Strategies to sustain a quality improvement initiative in neonatal resuscitation

    PubMed Central

    van Heerden, Carlien; Janse van Rensburg, Elsie S.

    2016-01-01

    Background Many neonatal deaths can be prevented globally through effective resuscitation. South Africa (SA) committed towards attaining the Millennium Development Goal 4 (MDG4) set by the World Health Organization (WHO). However, SA’s district hospitals have the highest early neonatal mortality rates. Modifiable and avoidable causes associated with patient-related, administrative and health care provider factors contribute to neonatal mortality. A quality improvement initiative in neonatal resuscitation could contribute towards decreasing neonatal mortality, thereby contributing towards the attainment of the MDG4. Aim The aim of this study was, (1) to explore and describe the existing situation regarding neonatal resuscitation in a district hospital, (2) to develop strategies to sustain a neonatal resuscitation quality improvement initiative and (3) to decrease neonatal mortality. Changes that occurred and the sustainability of strategies were evaluated. Setting A maternity section of a district hospital in South Africa. Methods The National Health Service (NHS) Sustainability Model formed the theoretical framework for the study. The Problem Resolving Action Research model was applied and the study was conducted in three cycles. Purposive sampling was used for the quantitative and qualitative aspects of data collection. Data was analysed accordingly. Results The findings indicated that the strategies formulated and implemented to address factors related to neonatal resuscitation (training, equipment and stock, staff shortages, staff attitude, neonatal transport and protocols) had probable sustainability and contributed towards a reduction in neonatal mortality in the setting. Conclusion These strategies had the probability of sustainability and could potentially improve neonatal outcomes and reduce neonatal mortality to contribute toward South Africa’s’ drive to attain the MDG4. PMID:27380840

  9. Improving pneumococcal vaccination rates of medical inpatients in urban Nepal using quality improvement measures

    PubMed Central

    Bock, Allison; Chintamaneni, Kathan; Rein, Lisa; Frazer, Tifany; Kayastha, Gyan; MacKinney, Theodore

    2016-01-01

    Streptococcus pneumoniae infection is associated with high morbidity and mortality in low income countries. In Nepal, there is a high lung disease burden and incidence of pneumonia due to multiple factors including indoor air pollution, dust exposure, recurrent infections, and cigarette smoking. Despite the ready availability of effective pneumococcal vaccines (PNV), vaccine coverage rates remain suboptimal globally. Quality Improvement (QI) principles could be applied to improve compliance, but it is a virtually new technology in Nepal. This QI study for Patan Hospital sought to introduce the concept of QI there, to measure the baseline pneumococcal vaccination rate of qualifying adult patients discharged from the medical wards and to assess reasons for non-vaccination. QI interventions were instituted to improve this rate, measuring the effectiveness of QI methods to produce the desired outcomes using the Model for Improvement, Plan-Do-Study-Change (PDSA) methodology. In the three week baseline assessment, 2 out of 81 (2%) eligible patients recalled ever receiving a prior pneumococcal vaccine; 68 (84%) unvaccinated patients responded that they were not asked or were unaware of the PNV. After the QI interventions, the pneumococcal vaccination rate significantly increased to 42% (23/56, p<0.001). Post-intervention, the leading reason for non-vaccination was cost (20%, 11/56). Only 5 (9%) unvaccinated patients were not asked or were unaware of the PNV, a significant change in that process outcome from baseline (p<0.001). Quality improvement measures were effective in increasing pneumococcal vaccination rates, despite the limited familiarity with QI methods at this major teaching hospital. QI techniques may be useful in this and other efforts to improve quality in resource-limited settings, without great cost. PMID:27933153

  10. Improving critical care discharge summaries: a collaborative quality improvement project using PDSA

    PubMed Central

    Goulding, Lucy; Parke, Hannah; Maharaj, Ritesh; Loveridge, Robert; McLoone, Anne; Hadfield, Sophie; Helme, Eloise; Hopkins, Philip; Sandall, Jane

    2015-01-01

    Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and uncertainty when receiving patients from critical care. An innovative form of enhanced capability critical care outreach called ‘iMobile’ is being provided at King's College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries. A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken. Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries. The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders. The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work

  11. Improving Small Signal Stability through Operating Point Adjustment

    SciTech Connect

    Huang, Zhenyu; Zhou, Ning; Tuffner, Francis K.; Chen, Yousu; Trudnowski, Daniel J.; Mittelstadt, William; Hauer, John F.; Dagle, Jeffery E.

    2010-09-30

    ModeMeter techniques for real-time small signal stability monitoring continue to mature, and more and more phasor measurements are available in power systems. It has come to the stage to bring modal information into real-time power system operation. This paper proposes to establish a procedure for Modal Analysis for Grid Operations (MANGO). Complementary to PSS’s and other traditional modulation-based control, MANGO aims to provide suggestions such as increasing generation or decreasing load for operators to mitigate low-frequency oscillations. Different from modulation-based control, the MANGO procedure proactively maintains adequate damping for all time, instead of reacting to disturbances when they occur. Effect of operating points on small signal stability is presented in this paper. Implementation with existing operating procedures is discussed. Several approaches for modal sensitivity estimation are investigated to associate modal damping and operating parameters. The effectiveness of the MANGO procedure is confirmed through simulation studies of several test systems.

  12. Power-Quality Improvement in PFC Bridgeless SEPIC-Fed BLDC Motor Drive

    NASA Astrophysics Data System (ADS)

    Singh, Bhim; Bist, Vashist

    2013-06-01

    This article presents a design of a power factor correction (PFC)-based brushless DC (BLDC) motor drive. The speed control of BLDC motor is achieved by controlling the DC link voltage of the voltage source inverter (VSI) feeding BLDC motor using a single voltage sensor. A front-end bridgeless single-ended primary inductance converter (SEPIC) is used for DC link voltage control and PFC operation. A bridgeless SEPIC is designed to operate in discontinuous inductor current mode (DICM) thus utilizing a simple control scheme of voltage follower. An electronic commutation of BLDC motor is used for VSI to operate in a low-frequency operation for reduced switching losses in the VSI. Moreover, a bridgeless topology offers less conduction losses due to absence of diode bridge rectifier for further increasing the efficiency. The proposed BLDC motor drive is designed to operate over a wide range of speed control with an improved power-quality at the AC mains under the recommended international power-quality standards such as IEC 61000-3-2.

  13. Automation of P-3 Simulations to Improve Operator Workload

    DTIC Science & Technology

    2012-09-01

    is no training given on specific tactics for a certain platform, but tactical manuals are available to reference for a particular tactic. The...communication standard such as a ship’s communication manual . 4. Operation of JSAF Terminals The primary duty of the JSAF operator is to provide... manually is with the steering wheel tool shown in Figure 18. With the steering wheel tool turned on the operator can change the P-3s speed, course

  14. Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

    PubMed

    Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

    2016-01-01

    Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers.

  15. Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care

    PubMed Central

    Percival, Nikki; O’Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

    2016-01-01

    Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

  16. An assessment of the quality indicators of operative and non-operative times in a public university hospital

    PubMed Central

    Costa, Altair da Silva; Leão, Luiz Eduardo Villaça; de Novais, Maykon Anderson Pires; Zucchi, Paola

    2015-01-01

    ABSTRACT Objective To assess the operative time indicators in a public university hospital. Methods A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. Results We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6±110 and 129.8±97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8±113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3±17.3 minutes. The time to set the next patient in operating room was 119.8±79.6 minutes. Our total non-operative time was 155 minutes. Conclusion Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency. PMID:26761557

  17. Integrating Quality Improvement Education into the Nephrology Curricular Milestones Framework and the Clinical Learning Environment Review.

    PubMed

    Prince, Lisa K; Little, Dustin J; Schexneider, Katherine I; Yuan, Christina M

    2017-02-07

    The Accreditation Council for Graduate Medical Education requires that trainees show progressive milestone attainment in the practice-based learning and systems-based practice competencies. As part of the Clinical Learning Environment Review, sponsoring hospitals must educate trainees in health care quality improvement, provide them with specialty-specific quality data, and ensure trainee participation in quality improvement activities and committees. Subspecialty-specific quality improvement curricula in nephrology training programs have not been reported, although considerable curricular and assessment material exists for specialty residencies, including tools for assessing trainee and faculty competence. Nephrology-specific didactic material exists to assist nephrology fellows and faculty mentors in designing and implementing quality improvement projects. Nephrology is notable among internal medicine subspecialties for the emphasis placed on adherence to quality thresholds-specifically for chronic RRT shown by the Centers for Medicare and Medicaid Services Quality Incentive Program. We have developed a nephrology-specific curriculum that meets Accreditation Council for Graduate Medical Education and Clinical Learning Environment Review requirements, acknowledges regulatory quality improvement requirements, integrates with ongoing divisional quality improvement activities, and has improved clinical care and the training program. In addition to didactic training in quality improvement, we track trainee compliance with Kidney Disease Improving Global Outcomes CKD and ESRD quality indicators (emphasizing Quality Improvement Program indicators), and fellows collaborate on a yearly multidisciplinary quality improvement project. Over the past 6 years, each fellowship class has, on the basis of a successful quality improvement project, shown milestone achievement in Systems-Based Practice and Practice-Based Learning. Fellow quality improvement projects have improved

  18. Operational Risk Management: Increasing Mission Effectiveness Through Improved Planning and Execution of Joint Operations.

    DTIC Science & Technology

    2007-11-02

    operation plans. This deficiency should be remedied with the adoption of Operational Risk Management (ORM), an existing process which would provide...operations plans. The paper concludes that Operational Risk Management should be formally adopted into the deliberate and crisis action joint planning

  19. Delivery Room Quality Improvement Project Improved Compliance with Best Practices for a Community NICU

    PubMed Central

    Sauer, Charles W.; Boutin, Mallory A.; Fatayerji, Aayah N.; Proudfoot, James A.; Fatayerji, Nabil I.; Golembeski, David J.

    2016-01-01

    A Quality Improvement bundle was implemented with the goal of standardizing the multidisciplinary approach to delivery room management. We used a Pre-Post Quality Improvement initiative with the following aims: (1) Placement of a functioning pulse oximeter by two minutes after birth, (2) Delayed intubation, (3) Normothermia on Neonatal Intensive Care Unit Admission, (4) Use of a pre-brief, debrief, and delivery room checklist. Data was collected for 548 infants, which represents every admission to the Palomar Rady Children’s Hospital Neonatal Intensive Care Unit during the 35 month study period from January 1, 2010 to November 30, 2012. The intervention began on May 1, 2011. The objective of increasing the frequency of each goal was met. A significant decrease in rates of retinopathy of prematurity in our post-intervention group was found. Odds ratio 0.00 (0.000, 0.696) p = 0.008. However, this was not confirmed in the multivariable analysis so should be interpreted with caution. This quality improvement project had a positive effect on newborn resuscitation at Palomar Medical Center. PMID:27869210

  20. Evaluation of ride quality prediction methods for operational military helicopters

    NASA Technical Reports Server (NTRS)

    Leatherwood, J. D.; Clevenson, S. A.; Hollenbaugh, D. D.

    1984-01-01

    The results of a simulator study conducted to compare and validate various ride quality prediction methods for use in assessing passenger/crew ride comfort within helicopters are presented. Included are results quantifying 35 helicopter pilots' discomfort responses to helicopter interior noise and vibration typical of routine flights, assessment of various ride quality metrics including the NASA ride comfort model, and examination of possible criteria approaches. Results of the study indicated that crew discomfort results from a complex interaction between vibration and interior noise. Overall measures such as weighted or unweighted root-mean-square acceleration level and A-weighted noise level were not good predictors of discomfort. Accurate prediction required a metric incorporating the interactive effects of both noise and vibration. The best metric for predicting crew comfort to the combined noise and vibration environment was the NASA discomfort index.

  1. [Quality guidelines for presurgical epilepsy diagnosis and operative epilepsy therapy: 1st revised version].

    PubMed

    Rosenow, F; Bast, T; Czech, T; Hans, V; Helmstaedter, C; Huppertz, H-J; Seeck, M; Trinka, E; Wagner, K

    2014-06-01

    In patients with pharmacorefractory epilepsy, preoperative epilepsy evaluation and subsequent epilepsy surgery lead to a significant improvement of seizure control, proportion of seizure-free patients, quality of life and social participation. The aims of preoperative epilepsy evaluation are to define the chance of complete seizure freedom and the likelihood of inducing new neurological deficits in a given patient. As epilepsy surgery is an elective procedure quality standards are particularly high. As detailed in the first edition of these practice guidelines, quality control relates to seven different domains: (1) establishing centres with a sufficient number of sufficiently and specifically trained personnel, (2) minimum technical standards and equipment, (3) continuing medical education of employees, (4) surveillance by trained personnel during the video electroencephalography (EEG) monitoring (VEM), (5) systematic acquisition of clinical and outcome data, (6) the minimum number of preoperative evaluations and epilepsy surgery procedures and (7) cooperation of epilepsy centres. In the first edition of these practice guidelines published in 2000 it was defined which standards were desirable and that their implementation should be aimed for. These standards related especially to the certification required for different groups of medical doctors involved and to the minimum numbers of procedures required. In the subsequent decade quite a number of colleagues have been certified by the trinational Working Group (Arbeitsgemeinschaft, AG) for Presurgical Epilepsy Diagnosis and Operative Epilepsy Treatment (http://www.ag-epilepsiechirurgie.de) and therefore, on 8 May 2013 the executive board of the AG decided to now make these standards obligatory.

  2. The changing reimbursement landscape: nurses' role in quality and operational excellence.

    PubMed

    Hines, Patricia A; Yu, Kevin M

    2009-01-01

    Operational excellence, care quality, and financial performance are increasingly linked as key drivers of hospital performance. This environment may be seen as a challenge, but it is also an excellent opportunity for nursing services to further demonstrate their value in patient care outcomes and support financial performance. Nursing contributions toward reduced complications, reductions in length of stay, and lower costs per case should be measured, rewarded, and made transparent to the public. Staff nurses should not view quality as simply another task on which to focus their attention, but rather a continuous process that requires critical thinking about how care is delivered and its effect on the entire care progression of a patient. Nursing management must focus on continually educating their staff on appropriate care, as well as developing and supporting a culture of safety and accountability. Nursing leadership must improve nurse retention and recruiting efforts, encourage interdisciplinary collaboration and, most importantly, demonstrate to the rest of the organization the value nursing brings to the organization through consistently tracking quality and financial indicators and tying them to nursing initiatives.

  3. Indoor Air Quality Management for Operations and Maintenance Personnel

    DTIC Science & Technology

    1991-09-01

    about indoor air quality (IAQ). Items in the news-notably the outbreak of legionnaires disease in 1976-focused widespread public attention on the IAQ...humans can be transmitted by the air (Table 2). Legionnaires disease , a potentially fatal lung infection, has been associated with infiltration of...aerosols from exterior sources such as cooling towers. The most common means of spreading legionnaires disease involves air-cooling equipment that becomes

  4. Recommendations for Constructing Roadside Vegetation Barriers to Improve Near-Road Air Quality

    EPA Pesticide Factsheets

    The EPA report, Recommendations for Constructing Roadside Vegetation Barriers to Improve Near-Road Air Quality, summarizes the research findings on the best practices for building roadside vegetative barriers to improve air quality. This fact sheet describ

  5. San Pablo Bay Tidal Marsh Enhancement and Water Quality Improvement Project

    EPA Pesticide Factsheets

    Information about the SFBWQP San Pablo Bay Tidal Marsh Enhancement and Water Quality Improvement Project, part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

  6. Using Data to Improve Quality: the Pediatric Cardiac Care Consortium.

    PubMed

    Moller, James H

    2016-01-01

    A program to collect and analyze cardiac catheterization, electrophysiologic studies and cardiac operations in children was initiated in 1982. The purpose was to help centers compare their experience and outcomes with a group of centers to determine areas where their performance might improve. Cardiac centers became members of the Pediatric Cardiac Care Consortium and submitted demographic data and copies of procedure reports regularly to a central office. Data were extracted from the reports, coded by trained coders and entered into a computer database. Annually, the data were analyzed to compare the experience of an individual center with that of the entire group of centers. The annual data were adjusted for severity on the basis of eight factors selected after discussion with participants in the Consortium. Adjustment was by multivariate analysis. Reports were prepared for each center and distributed at an annual meeting. The data were used by centers to review operations where the mortality rate exceeded +2 standard deviations of the group. With discussion, the center staff often initiated changes to improve outcome. The outcome could then be monitored by the annual reports. Our data were also utilized in the creation of the Risk Adjustment for Surgery for Congenital Heart Disease (RACHS)-1 categories of disease severity. The mortality rates of our centers were comparable with the combined hospital discharge data from New York, Massachusetts, and California. From 1982 through 2007, the mortality rates of our centers dropped for each RACHS-1 category, falling to less than 1% for categories 1 and 2 for the last 5-year period. During the 25 years, we received data from 52 centers about 137 654 patients who underwent 117 756 cardiac operations.

  7. Application of a statistical post-processing technique to a gridded, operational, air quality forecast

    NASA Astrophysics Data System (ADS)

    Neal, L. S.; Agnew, P.; Moseley, S.; Ordóñez, C.; Savage, N. H.; Tilbee, M.

    2014-12-01

    An automated air quality forecast bias correction scheme based on the short-term persistence of model bias with respect to recent observations is described. The scheme has been implemented in the operational Met Office five day regional air quality forecast for the UK. It has been evaluated against routine hourly pollution observations for a year-long hindcast. The results demonstrate the value of the scheme in improving performance. For the first day of the forecast the post-processing reduces the bias from 7.02 to 0.53 μg m-3 for O3, from -4.70 to -0.63 μg m-3 for NO2, from -4.00 to -0.13 μg m-3 for PM2.5 and from -7.70 to -0.25 μg m-3 for PM10. Other metrics also improve for all species. An analysis of the variation of forecast skill with lead-time is presented and demonstrates that the post-processing increases forecast skill out to five days ahead.

  8. 42 CFR 460.136 - Internal quality assessment and performance improvement activities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Internal quality assessment and performance...) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.136 Internal quality assessment and performance improvement activities. (a) Quality assessment...

  9. 42 CFR 460.136 - Internal quality assessment and performance improvement activities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Internal quality assessment and performance...) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.136 Internal quality assessment and performance improvement activities. (a) Quality assessment...

  10. 42 CFR 460.136 - Internal quality assessment and performance improvement activities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Internal quality assessment and performance...) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.136 Internal quality assessment and performance improvement activities. (a) Quality assessment...

  11. 42 CFR 460.136 - Internal quality assessment and performance improvement activities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Internal quality assessment and performance...) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.136 Internal quality assessment and performance improvement activities. (a) Quality assessment...

  12. 42 CFR 460.136 - Internal quality assessment and performance improvement activities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Internal quality assessment and performance...) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) Quality Assessment and Performance Improvement § 460.136 Internal quality assessment and performance improvement activities. (a) Quality assessment...

  13. Improving Service Quality: Achieving High Performance in the Public and Private Sectors.

    ERIC Educational Resources Information Center

    Milakovich, Michael E.

    Quality-improvement principles are a sound means to respond to customer needs. However, when various quality and productivity theories and methods are applied, it is very difficult to consistently deliver quality results, especially in quasi-monopolistic, non-competitive, and regulated environments. This book focuses on quality-improvement methods…

  14. Quality Improvement: Lessons Learned from an Infant Mental Health-based Early Head Start Program.

    ERIC Educational Resources Information Center

    Brophy-Herb, Holly; Schiffman, Rachel; McKelvey, Lorraine; Cunningham-DeLuca, Mary; Hawver, Marshelle

    2001-01-01

    Continuous quality improvement efforts are vital to high-quality early intervention services. This article describes an ongoing quality improvement project within an infant mental health-based Early Head Start program. Both strategies and challenges in implementing issues and lessons learned in the initial 2-year phase of the quality improvement…

  15. Pump Early, Pump Often: A Continuous Quality Improvement Project.

    PubMed

    Spatz, Diane L; Froh, Elizabeth B; Schwarz, Jessica; Houng, Kathy; Brewster, Isabel; Myers, Carey; Prince, Judy; Olkkola, Michelle

    2015-01-01

    Research demonstrates that although many mothers initiate pumping for their critically ill children, few women are successful at maintaining milk supply throughout their infants' entire hospital stay. At the Garbose Family Special Delivery Unit (SDU) at the Children's Hospital of Philadelphia, we care for mothers who have critically ill infants born with complex cardiac and congenital anomalies. Human milk is viewed as a medical intervention at our institution. Therefore, nurses on the SDU wanted to ensure best practice in terms of pumping initiation. This article describes a continuous quality improvement project that ensured mothers pumped early and often. Childbirth educators can play a key role in preparing mothers who are anticipating an infant who will require hospitalization immediately post-birth.

  16. Training in quality improvement for the next generation of psychiatrists

    PubMed Central

    Ewins, Elizabeth; Macpherson, Rob; van der Linden, Geoff; Arnott, Stephen

    2017-01-01

    Quality improvement (QI) projects have been shown to positively influence patient care. They provide opportunities for trainees to present and publish their work locally and nationally, and to gain valuable leadership and management experience. We describe a pilot project to engage in QI trainees across a National Health Service trust and a school of psychiatry. After the first year of this programme over half of psychiatry trainees in the school (58% of core trainees and 47% of advanced trainees) are participating in 28 individual QI projects and QI project methodology is to become embedded in the core psychiatry training course. Specialty doctors, consultants, foundation doctors, general practitioner trainees, medical students and the wider multidisciplinary team have all become engaged alongside trainees, working with patients and their families to identify problems to tackle and ideas to test. PMID:28184318

  17. [Improving the quality of bathing water by oxygen releasing substances].

    PubMed

    Jessen, H J

    1989-06-01

    The bath water of an indoor swimming bath of 25m length has been preparatory acc. to TGL 37780/02 and by procedings of flocculation-filtration-chlorination. the filter drain water (clear water) had been supplemented by 20...30 percentage hydrogen peroxide or potassium peroxide sulphate. The reaction with chlorine existing in surplus and hydrogen peroxide results in a spontaneous formation of nascinating oxygen. The occurring wet oxidation of contents substances of the bath water also with an increased frequentation of the indoor swimming bath results in reduced rates of CSVMn and chloramine. This fact can be explained by the concurring reaction between oxygen and chlorine. Because of its low expense, the forced decomposition of hydrogen peroxide could be an alternative for utilization of ozone in small bathes. Contrary to this the combination potassium peroxide sulphate/chlorine will not result in such a significant improvement of the quality of bath water.

  18. Improving quality of life using removable and fixed implant prostheses.

    PubMed

    Pennington, Jeff; Parker, Sid

    2012-04-01

    Removable and fixed implant-retained prostheses can greatly enhance patients' quality of life, improving their speech, appearance, and ability to eat and otherwise function normally. Yet patients may resist this type of treatment due to barriers, including cost, fear, and lengthy treatment times. It is, therefore, important that clinicians engage in discovering and understanding their patients' concerns and expectations in addition to making a thorough and complete diagnosis of their dental conditions. In the case presented, emphasis was placed on patient-clinician communication to correctly facilitate the desired clinical result. The final restoration consisted of a maxillary removable, implant-assisted denture and a mandibular screw-retained, fixed, implant-supported prosthesis.

  19. Pump Early, Pump Often: A Continuous Quality Improvement Project

    PubMed Central

    Spatz, Diane L.; Froh, Elizabeth B.; Schwarz, Jessica; Houng, Kathy; Brewster, Isabel; Myers, Carey; Prince, Judy; Olkkola, Michelle

    2015-01-01

    ABSTRACT Research demonstrates that although many mothers initiate pumping for their critically ill children, few women are successful at maintaining milk supply throughout their infants’ entire hospital stay. At the Garbose Family Special Delivery Unit (SDU) at the Children’s Hospital of Philadelphia, we care for mothers who have critically ill infants born with complex cardiac and congenital anomalies. Human milk is viewed as a medical intervention at our institution. Therefore, nurses on the SDU wanted to ensure best practice in terms of pumping initiation. This article describes a continuous quality improvement project that ensured mothers pumped early and often. Childbirth educators can play a key role in preparing mothers who are anticipating an infant who will require hospitalization immediately post-birth. PMID:26834437

  20. A variation reduction allocation model for quality improvement to minimize investment and quality costs by considering suppliers’ learning curve

    NASA Astrophysics Data System (ADS)

    Rosyidi, C. N.; Jauhari, WA; Suhardi, B.; Hamada, K.

    2016-02-01

    Quality improvement must be performed in a company to maintain its product competitiveness in the market. The goal of such improvement is to increase the customer satisfaction and the profitability of the company. In current practice, a company needs several suppliers to provide the components in assembly process of a final product. Hence quality improvement of the final product must involve the suppliers. In this paper, an optimization model to allocate the variance reduction is developed. Variation reduction is an important term in quality improvement for both manufacturer and suppliers. To improve suppliers’ components quality, the manufacturer must invest an amount of their financial resources in learning process of the suppliers. The objective function of the model is to minimize the total cost consists of investment cost, and quality costs for both internal and external quality costs. The Learning curve will determine how the employee of the suppliers will respond to the learning processes in reducing the variance of the component.

  1. Quality Improvement of Pork Loin by Dry Aging

    PubMed Central

    Jo, Cheorun; Lee, Kyung Haeng; You, Insin

    2016-01-01

    This study aimed to investigate the effects of dry aging on the quality of pork loin. Longissimus lumborum muscles were dissected from the right half of five pork carcasses and were used as the control samples. The left halves of the carcasses were aged at 2±1℃ and a relative humidity of 80% for 40 d. The total aerobic bacteria count was similar between the control and dry-aged pork loin (p>0.05). Lactic-acid bacteria was absent in both the control and dry-aged pork loins. Dry-aged pork loin contained low moisture and high protein and ash compared to the controls (p<0.05). The pH was higher and cooking loss was lower in dry-aged pork loin compared to that in the control (p<0.05). Flavor related compounds, such as total free amino acid, hypoxanthine, and inosine of pork loin were higher in dry-aged pork loin; whereas, inosine 5'-monophosphate and guanosine 5'-monophosphate were low in dry-aged pork loin than control (p<0.05). There was no difference in carnosine and anserine content between dry-aged pork loin and the control (p>0.05). Dry-aged pork loin had lower hardness and shear force and received higher core in sensory evaluation than the control (p<0.05). According to the results, dry aging improved textural and sensorial quality of pork loin. PMID:27433108

  2. Guide to effective quality improvement reporting in radiology.

    PubMed

    Larson, David B; Duncan, James R; Nagy, Paul G; Kruskal, Jonathan B

    2014-05-01

    Substantial societal investments in biomedical research are contributing to an explosion in knowledge that the health delivery system is struggling to effectively implement. Managing this complexity requires ingenuity, research and development, and dedicated resources. Many innovative solutions can be found in quality improvement (QI) activities, defined as the "systematic, data-guided activities designed to bring about immediate, positive changes in the delivery of healthcare in particular settings." QI shares many similarities with biomedical research, but also differs in several important ways. Inclusion of QI in the peer-reviewed literature is needed to foster its advancement through the dissemination, testing, and refinement of theories, methods, and applications. QI methods and reporting standards are less mature in health care than those of biomedical research. A lack of widespread understanding and consensus regarding the purpose of publishing QI-related material also exists. In this document, guidance is provided in evaluating quality of QI-related material and in determining priority of submitted material for publication.

  3. Forensic mental health assessment in France: recommendations for quality improvement.

    PubMed

    Combalbert, Nicolas; Andronikof, Anne; Armand, Marine; Robin, Cécile; Bazex, Hélène

    2014-01-01

    The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called "experts" in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods.

  4. Embryo Aggregation in Pig Improves Cloning Efficiency and Embryo Quality

    PubMed Central

    Buemo, Carla Paola; Gambini, Andrés; Moro, Lucia Natalia; Hiriart, María Inés; Fernández-Martín, Rafael; Collas, Philippe; Salamone, Daniel Felipe

    2016-01-01

    In this study, we analyzed the effects of the cloned embryo aggregation on in vitro embryo development and embryo quality by measuring blastocyst diameter and cell number, DNA fragmentation levels and the expression of genes associated with pluripotency, apoptosis, trophoblast and DNA methylation in the porcine. Zona-free reconstructed cloned embryos were cultured in the well of the well system, placing one (1x non aggregated group) or three (3x group) embryos per microwell. Our results showed that aggregation of three embryos increased blastocyst formation rate and blastocyst diameter of cloned pig embryos. DNA fragmentation levels in 3x aggregated cloned blastocysts were significantly decreased compared to 1x blastocysts. Levels of Oct4, Klf4, Igf2, Bax and Dnmt 1 transcripts were significantly higher in aggregated embryos, whereas Nanog levels were not affected. Transcripts of Cdx2 and Bcl-xl were essentially non-detectable. Our study suggests that embryo aggregation in the porcine may be beneficial for cloned embryo development and embryo quality, through a reduction in apoptotic levels and an improvement in cell reprogramming. PMID:26894831

  5. Embryo Aggregation in Pig Improves Cloning Efficiency and Embryo Quality.

    PubMed

    Buemo, Carla Paola; Gambini, Andrés; Moro, Lucia Natalia; Hiriart, María Inés; Fernández-Martín, Rafael; Collas, Philippe; Salamone, Daniel Felipe

    2016-01-01

    In this study, we analyzed the effects of the cloned embryo aggregation on in vitro embryo development and embryo quality by measuring blastocyst diameter and cell number, DNA fragmentation levels and the expression of genes associated with pluripotency, apoptosis, trophoblast and DNA methylation in the porcine. Zona-free reconstructed cloned embryos were cultured in the well of the well system, placing one (1x non aggregated group) or three (3x group) embryos per microwell. Our results showed that aggregation of three embryos increased blastocyst formation rate and blastocyst diameter of cloned pig embryos. DNA fragmentation levels in 3x aggregated cloned blastocysts were significantly decreased compared to 1x blastocysts. Levels of Oct4, Klf4, Igf2, Bax and Dnmt 1 transcripts were significantly higher in aggregated embryos, whereas Nanog levels were not affected. Transcripts of Cdx2 and Bcl-xl were essentially non-detectable. Our study suggests that embryo aggregation in the porcine may be beneficial for cloned embryo development and embryo quality, through a reduction in apoptotic levels and an improvement in cell reprogramming.

  6. Quality Improvement of Pork Loin by Dry Aging.

    PubMed

    Lee, Cheol Woo; Lee, Ju Ri; Kim, Min Kyu; Jo, Cheorun; Lee, Kyung Haeng; You, Insin; Jung, Samooel

    2016-01-01

    This study aimed to investigate the effects of dry aging on the quality of pork loin. Longissimus lumborum muscles were dissected from the right half of five pork carcasses and were used as the control samples. The left halves of the carcasses were aged at 2±1℃ and a relative humidity of 80% for 40 d. The total aerobic bacteria count was similar between the control and dry-aged pork loin (p>0.05). Lactic-acid bacteria was absent in both the control and dry-aged pork loins. Dry-aged pork loin contained low moisture and high protein and ash compared to the controls (p<0.05). The pH was higher and cooking loss was lower in dry-aged pork loin compared to that in the control (p<0.05). Flavor related compounds, such as total free amino acid, hypoxanthine, and inosine of pork loin were higher in dry-aged pork loin; whereas, inosine 5'-monophosphate and guanosine 5'-monophosphate were low in dry-aged pork loin than control (p<0.05). There was no difference in carnosine and anserine content between dry-aged pork loin and the control (p>0.05). Dry-aged pork loin had lower hardness and shear force and received higher core in sensory evaluation than the control (p<0.05). According to the results, dry aging improved textural and sensorial quality of pork loin.

  7. Why ethics is indispensable for good-quality operational research.

    PubMed

    Edginton, M; Enarson, D; Zachariah, R; Reid, T; Satyanarayana, S; Bissell, K; Hinderaker, S G; Harries, T

    2012-03-21

    This article outlines challenges encountered when ethics is taught and promoted in the Operational Research courses of the International Union Against Tuberculosis and Lung Disease, with a focus on ethical issues related to studies that involve health records reviews. Problems observed by the Ethics Advisory Group include engagement of all stakeholders, maintenance of confidentiality and authorship. The omission of ethics in the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement and its explanatory commentary published in 2007 is highlighted and questioned.

  8. Quality assurance system using ISO 9000 series standards to improve the effectiveness and efficacy of the Headache Centre.

    PubMed

    Ferrari, A; Baraghini, G F; Sternieri, E; Cavazzuti, L; Roli, L

    2000-01-01

    The ISO 9000 series has been adopted as a reference standard and operating system for a Quality Assurance project involving all the units of the Polyclinic of Modena, within which the Headache Centre operates, to guarantee a clearly-defined standard of service to the client and the promotion of continuous quality improvement. The implementation of the quality system, which necessitated analysis and description of the process of headache diagnosis and treatment currently being applied, highlighted those aspects that did not conform with the quality objective, primarily, the long waiting list for admission. Since ready accessibility is a basic requisite for the quality of health care services, a new organisational set-up was introduced, and is still in place, with the aim of enabling patients who are really in need to be admitted to the Headache Centre without undue delay.

  9. A review of how the quality of HIV clinical services has been evaluated or improved.

    PubMed

    Hung, Anna; Pradel, Françoise

    2015-06-01

    To examine approaches being used to evaluate and improve quality of HIV clinical services we searched the MEDLINE, Cochrane Library collection, EMBASE, Global Health, and Web of Science databases for articles and abstracts focused on evaluating or improving quality of HIV clinical services. We extracted country income level, targeted clinical services, and quality evaluation approaches, data sources, and criteria. Fifty journal articles and 46 meeting abstracts were included. Of the 96 studies reviewed, 65% were programme evaluations, 71% focused on low- and middle-income countries, and 65% focused on antiretroviral therapy services. With regard to quality, 45% used a quality improvement model or programme, 13% set a quality threshold, and 51% examined patient records to evaluate quality. No studies provided a definition for quality HIV care. Quality assurance and improvement of HIV clinical services is increasingly important. This review highlights gaps in knowledge for future research, and may also help countries and programmes develop their HIV care quality improvement frameworks.

  10. An Improved Power Quality BIBRED Converter-Based VSI-Fed BLDC Motor Drive

    NASA Astrophysics Data System (ADS)

    Singh, Bhim; Bist, Vashist

    2014-01-01

    This paper presents an IHQRR (integrated high-quality rectifier regulator) BIBRED (boost integrated buck rectifier energy storage DC-DC) converter-based VSI (voltage source inverter)-fed BLDC (brushless DC) motor drive. The speed control of BLDC motor is achieved by controlling the DC link voltage of the VSI using a single voltage sensor. This allows VSI to operate in fundamental frequency switching mode for electronic commutation of BLDC motor which reduces the switching losses due to high-frequency switching used in conventional approach of PWM (pulse width modulation)-based VSI-fed BLDC motor drive. A BIBRED converter is operated in a dual-DCM (discontinuous conduction mode) thus using a voltage follower approach for PFC (power factor correction) and DC link voltage control. The performance of the proposed drive is evaluated for improved power quality over a wide range of speed control and supply voltage variation for demonstrating the behavior of proposed drive. The power quality indices thus obtained are within the recommended limits by international PQ (power quality) standards such as IEC 61000-3-2.

  11. Flying qualities criteria for GA single pilot IFR operations

    NASA Technical Reports Server (NTRS)

    Bar-Gill, A.

    1982-01-01

    The flying qualities criteria in general aviation (GA) to decrease accidents are discussed. The following in-flight research is discussed: (1) identification of key aerodynamic configurations; (2) implementation of an in-flight simulator; (3) mission matrix design; (4) experimental systems; (5) data reduction; (6) optimal flight path reconstruction. Some of the accomplished work is reported: an integrated flight testing and flight path reconstruction methodology was developd, high accuracy in trajectory estimation was achieved with an experimental setup, and a part of the flight test series was flown.

  12. Spatially-varying surface roughness and ground-level air quality in an operational dispersion model.

    PubMed

    Barnes, M J; Brade, T K; MacKenzie, A R; Whyatt, J D; Carruthers, D J; Stocker, J; Cai, X; Hewitt, C N

    2014-02-01

    Urban form controls the overall aerodynamic roughness of a city, and hence plays a significant role in how air flow interacts with the urban landscape. This paper reports improved model performance resulting from the introduction of variable surface roughness in the operational air-quality model ADMS-Urban (v3.1). We then assess to what extent pollutant concentrations can be reduced solely through local reductions in roughness. The model results suggest that reducing surface roughness in a city centre can increase ground-level pollutant concentrations, both locally in the area of reduced roughness and downwind of that area. The unexpected simulation of increased ground-level pollutant concentrations implies that this type of modelling should be used with caution for urban planning and design studies looking at ventilation of pollution. We expect the results from this study to be relevant for all atmospheric dispersion models with urban-surface parameterisations based on roughness.

  13. Impacts of waste from concentrated animal feeding operations on water quality

    USGS Publications Warehouse

    Burkholder, J.; Libra, B.; Weyer, P.; Heathcote, S.; Kolpin, D.; Thorne, P.S.; Wichman, M.

    2007-01-01

    Waste from agricultural livestock operations has been a long-standing concern with respect to contamination of water resources, particularly in terms of nutrient pollution. However, the recent growth of concentrated animal feeding operations (CAFOs) presents a greater risk to water quality because of both the increased volume of waste and to contaminants that may be present (e.g., antibiotics and other veterinary drugs) that may have both environmental and public health importance. Based on available data, generally accepted livestock waste management practices do not adequately or effectively protect water resources from contamination with excessive nutrients, microbial pathogens, and pharmaceuticals present in the waste. Impacts on surface water sources and wildlife have been documented in many agricultural areas in the United States. Potential impacts on human and environmental health from long-term inadvertent exposure to water contaminated with pharmaceuticals and other compounds are a growing public concern. This workgroup, which is part of the Conference on Environmental Health Impacts of Concentrated Animal Feeding Operations: Anticipating Hazards-Searching for Solutions, identified needs for rigorous ecosystem monitoring in the vicinity of CAFOs and for improved characterization of major toxicants affecting the environment and human health. Last, there is a need to promote and enforce best practices to minimize inputs of nutrients and toxicants from CAFOs into freshwater and marine ecosystems.

  14. Impacts of waste from concentrated animal feeding operations on water quality.

    PubMed

    Burkholder, Joann; Libra, Bob; Weyer, Peter; Heathcote, Susan; Kolpin, Dana; Thorne, Peter S; Wichman, Michael

    2007-02-01

    Waste from agricultural livestock operations has been a long-standing concern with respect to contamination of water resources, particularly in terms of nutrient pollution. However, the recent growth of concentrated animal feeding operations (CAFOs) presents a greater risk to water quality because of both the increased volume of waste and to contaminants that may be present (e.g., antibiotics and other veterinary drugs) that may have both environmental and public health importance. Based on available data, generally accepted livestock waste management practices do not adequately or effectively protect water resources from contamination with excessive nutrients, microbial pathogens, and pharmaceuticals present in the waste. Impacts on surface water sources and wildlife have been documented in many agricultural areas in the United States. Potential impacts on human and environmental health from long-term inadvertent exposure to water contaminated with pharmaceuticals and other compounds are a growing public concern. This work-group, which is part of the Conference on Environmental Health Impacts of Concentrated Animal Feeding Operations: Anticipating Hazards--Searching for Solutions, identified needs for rigorous ecosystem monitoring in the vicinity of CAFOs and for improved characterization of major toxicants affecting the environment and human health. Last, there is a need to promote and enforce best practices to minimize inputs of nutrients and toxicants from CAFOs into freshwater and marine ecosystems.

  15. Impacts of Waste from Concentrated Animal Feeding Operations on Water Quality

    PubMed Central

    Burkholder, JoAnn; Libra, Bob; Weyer, Peter; Heathcote, Susan; Kolpin, Dana; Thorne, Peter S.; Wichman, Michael

    2007-01-01

    Waste from agricultural livestock operations has been a long-standing concern with respect to contamination of water resources, particularly in terms of nutrient pollution. However, the recent growth of concentrated animal feeding operations (CAFOs) presents a greater risk to water quality because of both the increased volume of waste and to contaminants that may be present (e.g., antibiotics and other veterinary drugs) that may have both environmental and public health importance. Based on available data, generally accepted livestock waste management practices do not adequately or effectively protect water resources from contamination with excessive nutrients, microbial pathogens, and pharmaceuticals present in the waste. Impacts on surface water sources and wildlife have been documented in many agricultural areas in the United States. Potential impacts on human and environmental health from long-term inadvertent exposure to water contaminated with pharmaceuticals and other compounds are a growing public concern. This work-group, which is part of the Conference on Environmental Health Impacts of Concentrated Animal Feeding Operations: Anticipating Hazards—Searching for Solutions, identified needs for rigorous ecosystem monitoring in the vicinity of CAFOs and for improved characterization of major toxicants affecting the environment and human health. Last, there is a need to promote and enforce best practices to minimize inputs of nutrients and toxicants from CAFOs into freshwater and marine ecosystems. PMID:17384784

  16. 42 CFR 438.240 - Quality assessment and performance improvement program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Quality assessment and performance improvement... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Measurement and Improvement Standards § 438.240 Quality assessment and...

  17. 42 CFR 438.240 - Quality assessment and performance improvement program.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Quality assessment and performance improvement... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Measurement and Improvement Standards § 438.240 Quality assessment and...

  18. 42 CFR 438.240 - Quality assessment and performance improvement program.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Quality assessment and performance improvement... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Measurement and Improvement Standards § 438.240 Quality assessment and...

  19. 42 CFR 438.240 - Quality assessment and performance improvement program.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Quality assessment and performance improvement... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Measurement and Improvement Standards § 438.240 Quality assessment and...

  20. 42 CFR 438.240 - Quality assessment and performance improvement program.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Quality assessment and performance improvement... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Measurement and Improvement Standards § 438.240 Quality assessment and...