The Patient Protection and Affordable Care Act's provisions regarding medical loss ratios and quality: evidence from Texas.

PubMed

Quast, Troy

2013-01-01

The Patient Protection and Affordable Care Act (PPACA) includes a provision that penalizes insurance companies if their Medical Loss Ratio (MLR) falls below a specified threshold. The MLR is roughly measured as the ratio of health care expenses to premiums paid by enrollees. I investigate whether there is a relationship between MLRs and the quality of care provided by insurance companies. I employ a ten-year sample of market-level financial data and quality variables for Texas insurers, as well as relevant control variables, in regression analyses that utilize insurer and market fixed effects. Of the 15 quality measures, only one has a statistically significant relationship with the MLR. For this measure, the relationship is negative. Although the MLR provision may provide incentives for insurance companies to lower premiums, this sample does not suggest that there is likely to be a beneficial effect on quality.

Analysis of medical screening and surveillance in 21 Occupational Safety and Health Administration standards: support for a generic medical surveillance standard.

PubMed

Silverstein, M

1994-09-01

Twenty-one Occupational Safety and Health Act (OSHA) standards were identified which contain medical service provisions intended to help in the identification and control of harmful health effects of workplace exposures. The utility and effectiveness of these provisions have not previously been evaluated. All 21 standards were reviewed and assigned numerical scores for each of 24 potential medical program elements. Several of these elements were combined to calculate Quality Control, Screening Utility, and Surveillance Utility scores for each standard. Total scores varied greatly, suggesting a lack of consistency and uniformity which was even more obvious when the actual regulatory language was examined. The mean Quality score was only 26% of potential points. Seventeen of 21 standards received less than half the total possible Quality score. When arrayed on a two by two matrix only two standards scored above 50% for both Screening and Surveillance Utility. It was concluded that the medical service provisions in OSHA standards are lacking in consistency and coherence. Two major shortcomings are the lack of quality control elements and the absence of surveillance features which would permit medical program results to be utilized for prevention activities including the identification and control of workplace hazards. A generic occupational medical surveillance standard could address these current weaknesses. Elements of such a generic standard are proposed.

Outsourcing University Degrees: Implications for Quality Control

ERIC Educational Resources Information Center

Edwards, Julie; Crosling, Glenda; Edwards, Ron

2010-01-01

Education institutions worldwide have and continue to seek opportunities to spread their offerings abroad. While the provision of courses to students located overseas through partner institutions has many advantages, it raises questions about quality control that are not as applicable to other forms of international education. This paper uses a…

Laws of the United States Relating to Water Pollution Control and Environmental Quality.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Public Works.

This compilation of Federal legislation contains copies of twelve Public Laws, four Executive Orders, and five International Conventions relevant to water pollution control. It also contains two Public Laws and two Executive Orders pertaining to environmental quality. There is a brief introduction summarizing the provisions of each Act. (AL)

10 CFR 71.101 - Quality assurance requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... quality assurance actions related to control of the physical characteristics and quality of the material... through 71.137 and satisfying any specific provisions that are applicable to the licensee's activities... assurance requirement's importance to safety. (c) Approval of program. (1) Before the use of any package for...

77 FR 68087 - Approval and Promulgation of Implementation Plans and Designation of Areas for Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-15

... Source Review (NSR) permit programs); provisions for air pollution modeling; and provisions for public... the eastern United States (i.e., the Transport Rule, also known as the Cross-State Air Pollution Rule... and applicable federal air pollution control regulations and other permanent and enforceable...

Information provision for people with multiple sclerosis.

PubMed

Köpke, Sascha; Solari, Alessandra; Khan, Fary; Heesen, Christoph; Giordano, Andrea

2014-04-21

People with multiple sclerosis (MS) are confronted with a number of important uncertainties concerning many aspects of the disease. Among others, these include diagnosis, prognosis, disease course, disease-modifying therapies, symptomatic therapies and non-pharmacological interventions. It has been shown that people with MS demand adequate information to be able to actively participate in medical decision making and to self-manage their disease. On the other hand, it has been found that patients' disease-related knowledge is poor. Therefore, guidelines have recommended clear and concise high-quality information at all stages of the disease. Several studies have outlined communication and information deficits in the care of people with MS and, accordingly, a number of information and decision support programmes have been published. To evaluate the effectiveness of information provision interventions for people with MS that aim to promote informed choice and improve patient-relevant outcomes. We searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group Specialised Register which contains trials from CENTRAL (The Cochrane Library 2013, Issue 6), MEDLINE, EMBASE, CINAHL, LILACS, PEDro and clinical trials registries (12 June 2013) as well as other sources. In addition, we searched PsycINFO, trial registries, and reference lists of identified articles. We also contacted trialists. Randomised controlled trials, cluster randomised controlled trials and quasi-randomised trials comparing information provision for people with MS or suspected MS (intervention groups) with usual care or other types of information provision (control groups) were eligible. Two review authors independently assessed the retrieved articles for relevance and methodological quality, and extracted data. Critical appraisal of studies addressed the risk of selection bias, performance bias, attrition bias and detection bias. We contacted authors of relevant studies for additional information. Ten randomised controlled trials involving a total of 1314 participants met the inclusion criteria and were analysed. The interventions addressed a variety of topics using different approaches for information provision in different settings. Topics included disease-modifying therapy, relapse management, self-care strategies, fatigue management, family planning and general health promotion. The interventions contained decision aids, educational programmes, self-care interventions and personal interviews with physicians. All interventions were complex interventions using more than one active component, but the number and extent of the intervention components differed markedly between studies. The studies had a variable risk of bias. We did not perform meta-analyses due to marked clinical heterogeneity. All four studies assessing MS-related knowledge (524 participants; moderate-quality evidence) detected significant differences between groups as a result of the interventions indicating that information provision may successfully increase participants' knowledge. There were mixed results from four studies reporting effects on decision making (836 participants; low-quality evidence) and from five studies assessing quality of life (605 participants; low-quality evidence). There were no adverse events in the six studies reporting on adverse events. Information provision for people with MS seems to increase disease-related knowledge, with less clear results on decision making and quality of life. There seem to be no negative side effects from informing patients about their disease. Interpretation of study results remains challenging due to the marked heterogeneity of the interventions and outcome measures.

76 FR 58835 - Information Collection Activity: Revision for Subpart C, Pollution Prevention and Control...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-22

... provisions ``for compliance with the National Ambient Air Quality Standards [NAAQS] pursuant to the Clean Air... affect the air quality of any State.'' Section 1843(b) calls for ``regulations requiring all materials... State air quality requirement that was inadvertently submitted to OMB previously under 30 CFR 250...

Metrology: Measurement Assurance Program Guidelines

NASA Technical Reports Server (NTRS)

Eicke, W. G.; Riley, J. P.; Riley, K. J.

1995-01-01

The 5300.4 series of NASA Handbooks for Reliability and Quality Assurance Programs have provisions for the establishment and utilization of a documented metrology system to control measurement processes and to provide objective evidence of quality conformance. The intent of these provisions is to assure consistency and conformance to specifications and tolerances of equipment, systems, materials, and processes procured and/or used by NASA, its international partners, contractors, subcontractors, and suppliers. This Measurement Assurance Program (MAP) guideline has the specific objectives to: (1) ensure the quality of measurements made within NASA programs; (2) establish realistic measurement process uncertainties; (3) maintain continuous control over the measurement processes; and (4) ensure measurement compatibility among NASA facilities. The publication addresses MAP methods as applied within and among NASA installations and serves as a guide to: control measurement processes at the local level (one facility); conduct measurement assurance programs in which a number of field installations are joint participants; and conduct measurement integrity (round robin) experiments in which a number of field installations participate to assess the overall quality of particular measurement processes at a point in time.

Co-scheduling of network resource provisioning and host-to-host bandwidth reservation on high-performance network and storage systems

DOEpatents

Yu, Dantong; Katramatos, Dimitrios; Sim, Alexander; Shoshani, Arie

2014-04-22

A cross-domain network resource reservation scheduler configured to schedule a path from at least one end-site includes a management plane device configured to monitor and provide information representing at least one of functionality, performance, faults, and fault recovery associated with a network resource; a control plane device configured to at least one of schedule the network resource, provision local area network quality of service, provision local area network bandwidth, and provision wide area network bandwidth; and a service plane device configured to interface with the control plane device to reserve the network resource based on a reservation request and the information from the management plane device. Corresponding methods and computer-readable medium are also disclosed.

Embedding Quality Culture in Higher Education in Ghana: Quality Control and Assessment in Emerging Private Universities

ERIC Educational Resources Information Center

Ntim, Stephen

2014-01-01

High quality provision has been one of the key aims of the current reforms in higher educational institutions across the globe since the beginning of the century and the millennium. Consequently this has led to the increasing demand for quality assurance (QA). This report identifies those institutional processes and structures that support the…

40 CFR 52.1535 - Original identification of plan section.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Pollution Control Agency. (2) Non-regulatory provisions for retention and availability of air quality data submitted on March 23, 1972, by the New Hampshire Air Pollution Control Agency. (3) Attainment dates of... Pollution Control Agency. (4) Revision of regulation No. 5, section 111.A, limiting sulfur content of fuels...

40 CFR 52.1535 - Original identification of plan section.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Pollution Control Agency. (2) Non-regulatory provisions for retention and availability of air quality data submitted on March 23, 1972, by the New Hampshire Air Pollution Control Agency. (3) Attainment dates of... Pollution Control Agency. (4) Revision of regulation No. 5, section 111.A, limiting sulfur content of fuels...

40 CFR 52.1535 - Original identification of plan section.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Pollution Control Agency. (2) Non-regulatory provisions for retention and availability of air quality data submitted on March 23, 1972, by the New Hampshire Air Pollution Control Agency. (3) Attainment dates of... Pollution Control Agency. (4) Revision of regulation No. 5, section 111.A, limiting sulfur content of fuels...

40 CFR 52.1535 - Original identification of plan section.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Pollution Control Agency. (2) Non-regulatory provisions for retention and availability of air quality data submitted on March 23, 1972, by the New Hampshire Air Pollution Control Agency. (3) Attainment dates of... Pollution Control Agency. (4) Revision of regulation No. 5, section 111.A, limiting sulfur content of fuels...

40 CFR 52.1535 - Original identification of plan section.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Pollution Control Agency. (2) Non-regulatory provisions for retention and availability of air quality data submitted on March 23, 1972, by the New Hampshire Air Pollution Control Agency. (3) Attainment dates of... Pollution Control Agency. (4) Revision of regulation No. 5, section 111.A, limiting sulfur content of fuels...

78 FR 67327 - Approval and Promulgation of Air Quality Implementation Plans; State of Colorado; Revised...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-12

... shall include procedures for interagency consultation, conflict resolution, and public consultation... Determinations by the public, Air Quality Control Commission, and resolution of conflicts''. (2) 40 CFR 93.122(a... of 93.105(d) require specific procedures for resolving conflicts, and the provisions of 93.105(e...

40 CFR 75.59 - Certification, quality assurance, and quality control record provisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

...-minute readings and the run average); (B) The raw data and results for all required pre-test, post-test... error tests, and all off-line calibration demonstrations, including any follow-up tests after corrective... tests, a test number and reason for test; (ix) For 7-day calibration tests for certification or...

40 CFR 75.59 - Certification, quality assurance, and quality control record provisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

...-minute readings and the run average); (B) The raw data and results for all required pre-test, post-test... error tests, and all off-line calibration demonstrations, including any follow-up tests after corrective... tests, a test number and reason for test; (ix) For 7-day calibration tests for certification or...

40 CFR 75.59 - Certification, quality assurance, and quality control record provisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... and the run average); (B) The raw data and results for all required pre-test, post-test, pre-run and...-day calibration error tests, all daily system integrity checks (Hg monitors, only), and all off-line calibration demonstrations, including any follow-up tests after corrective action: (i) Component-system...

40 CFR 75.59 - Certification, quality assurance, and quality control record provisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

...-minute readings and the run average); (B) The raw data and results for all required pre-test, post-test... error tests, and all off-line calibration demonstrations, including any follow-up tests after corrective... tests, a test number and reason for test; (ix) For 7-day calibration tests for certification or...

40 CFR 75.59 - Certification, quality assurance, and quality control record provisions.

Code of Federal Regulations, 2014 CFR

2014-07-01

...-minute readings and the run average); (B) The raw data and results for all required pre-test, post-test... error tests, and all off-line calibration demonstrations, including any follow-up tests after corrective... tests, a test number and reason for test; (ix) For 7-day calibration tests for certification or...

40 CFR 52.70 - Identification of plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... nonattainment areas submitted by the Governor of Alaska on January 18, 1980 as follows: Volume II. Analysis of...: Volume II. Analysis of Problems, Control Actions Section V. Ambient Air Monitoring A. Purpose C. Air Monitoring Network E. Annual Review (9) Provisions of a State Air Quality Control Plan submitted by the...

40 CFR 52.70 - Identification of plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... nonattainment areas submitted by the Governor of Alaska on January 18, 1980 as follows: Volume II. Analysis of...: Volume II. Analysis of Problems, Control Actions Section V. Ambient Air Monitoring A. Purpose C. Air Monitoring Network E. Annual Review (9) Provisions of a State Air Quality Control Plan submitted by the...

77 FR 46361 - Partial Approval and Disapproval of Air Quality Implementation Plans; Nevada; Infrastructure...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-03

... as explicit or implicit reapproval of any existing provisions that relate to these four substantive... information concerning funding and personnel supporting the functions of the three air pollution control...

Factors Affecting Quality of Laboratory Services in Public and Private Health Facilities in Addis Ababa, Ethiopia.

PubMed

Mesfin, Eyob Abera; Taye, Binyam; Belay, Getachew; Ashenafi, Aytenew; Girma, Veronica

2017-10-01

Quality laboratory service is an essential component of health care system but in Sub-Saharan Africa such as Ethiopia, laboratories quality system remains weak due to several factors and it needs more attention to strengthen its capacity and quality system. A cross sectional study was conducted using a questionnaire to assess factors affecting the quality of laboratory service at private and public health institutions in Addis Ababa. A total of 213 laboratory professionals participated in the study and 131 (61.5%) participants had bachelor degree. Majority, 133 (62.4%), of the professionals did not attend any work related training. Seventy five (35.2%) respondents believed that their laboratories did not provide quality laboratory services and the major reported factors affecting provision of quality services were shortage of resources (64.3%), poor management support (57.3%), poor equipment quality (53.4%), high workload (41.1%), lack of equipment calibration (38.3%) and lack of knowledge (23.3%). Moreover logistic regression analysis showed that provision of quality laboratory service was significantly associated with result verification (AOR=9.21, 95% CI=2.26, 37.48), internal quality control (AOR= 6.11, 95% CI=2.11, 17.70), turnaround time (AOR=5.11, 95% CI=1.94, 13.46), shortage of equipment (AOR=7.76, 95% CI=2.55, 23.66), communication with clinicians (AOR=3.24, 95% CI=1.25, 8.41) and lack of job description (AOR=3.67, 95% CI=1.319, 10.22). In conclusion, the major factors that affecting the quality of laboratory service were associated with poor human resource management, poor resources provision, poor management commitment, ineffective communication system and lack of well-established quality management system.

Factors Affecting Quality of Laboratory Services in Public and Private Health Facilities in Addis Ababa, Ethiopia

PubMed Central

Taye, Binyam; Belay, Getachew; Ashenafi, Aytenew; Girma, Veronica

2017-01-01

Background Quality laboratory service is an essential component of health care system but in Sub-Saharan Africa such as Ethiopia, laboratories quality system remains weak due to several factors and it needs more attention to strengthen its capacity and quality system. Methodology A cross sectional study was conducted using a questionnaire to assess factors affecting the quality of laboratory service at private and public health institutions in Addis Ababa. Results A total of 213 laboratory professionals participated in the study and 131 (61.5%) participants had bachelor degree. Majority, 133 (62.4%), of the professionals did not attend any work related training. Seventy five (35.2%) respondents believed that their laboratories did not provide quality laboratory services and the major reported factors affecting provision of quality services were shortage of resources (64.3%), poor management support (57.3%), poor equipment quality (53.4%), high workload (41.1%), lack of equipment calibration (38.3%) and lack of knowledge (23.3%). Moreover logistic regression analysis showed that provision of quality laboratory service was significantly associated with result verification (AOR=9.21, 95% CI=2.26, 37.48), internal quality control (AOR= 6.11, 95% CI=2.11, 17.70), turnaround time (AOR=5.11, 95% CI=1.94, 13.46), shortage of equipment (AOR=7.76, 95% CI=2.55, 23.66), communication with clinicians (AOR=3.24, 95% CI=1.25, 8.41) and lack of job description (AOR=3.67, 95% CI=1.319, 10.22). Conclusion In conclusion, the major factors that affecting the quality of laboratory service were associated with poor human resource management, poor resources provision, poor management commitment, ineffective communication system and lack of well-established quality management system. PMID:29075171

Patient Preferences for Pain Management in Advanced Cancer: Results from a Discrete Choice Experiment.

PubMed

Meads, David M; O'Dwyer, John L; Hulme, Claire T; Chintakayala, Phani; Vinall-Collier, Karen; Bennett, Michael I

2017-10-01

Pain from advanced cancer remains prevalent, severe and often under-treated. The aim of this study was to conduct a discrete choice experiment with patients to understand their preferences for pain management services and inform service development. Focus groups were used to develop the attributes and levels of the discrete choice experiment. The attributes were: waiting time, type of healthcare professional, out-of-pocket costs, side-effect control, quality of communication, quality of information and pain control. Patients completed the discrete choice experiment along with clinical and health-related quality of life questions. Conditional and mixed logit models were used to analyse the data. Patients with cancer pain (n = 221) and within palliative care services completed the survey (45% were female, mean age 64.6 years; age range 21-92 years). The most important aspects of pain management were: good pain control, zero out-of-pocket costs and good side-effect control. Poor or moderate pain control and £30 costs drew the highest negative preferences. Respondents preferred control of side effects and provision of better information and communication, over access to certain healthcare professionals. Those with lower health-related quality of life were less willing to wait for treatment and willing to incur higher costs. The presence of a carer influenced preferences. Outcome attributes were more important than process attributes but the latter were still valued. Thus, supporting self-management, for example by providing better information on pain may be a worthwhile endeavour. However, service provision may need to account for individual characteristics given the heterogeneity in preferences.

40 CFR 49.154 - Permit application requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., production rates and operating schedules. (vii) Identification and description of any existing air pollution... pollution prevention techniques, air pollution control devices, design standards, equipment standards, work... ASSISTANCE INDIAN COUNTRY: AIR QUALITY PLANNING AND MANAGEMENT General Federal Implementation Plan Provisions...

40 CFR 49.154 - Permit application requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., production rates and operating schedules. (vii) Identification and description of any existing air pollution... pollution prevention techniques, air pollution control devices, design standards, equipment standards, work... ASSISTANCE INDIAN COUNTRY: AIR QUALITY PLANNING AND MANAGEMENT General Federal Implementation Plan Provisions...

40 CFR 49.154 - Permit application requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., production rates and operating schedules. (vii) Identification and description of any existing air pollution... pollution prevention techniques, air pollution control devices, design standards, equipment standards, work... ASSISTANCE INDIAN COUNTRY: AIR QUALITY PLANNING AND MANAGEMENT General Federal Implementation Plan Provisions...

40 CFR 49.154 - Permit application requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., production rates and operating schedules. (vii) Identification and description of any existing air pollution... pollution prevention techniques, air pollution control devices, design standards, equipment standards, work... ASSISTANCE INDIAN COUNTRY: AIR QUALITY PLANNING AND MANAGEMENT General Federal Implementation Plan Provisions...

How to Measure Motivational Interviewing Fidelity in Randomized Controlled Trials: Practical Recommendations.

PubMed

Jelsma, Judith G M; Mertens, Vera-Christina; Forsberg, Lisa; Forsberg, Lars

2015-07-01

Many randomized controlled trials in which motivational interviewing (MI) is a key intervention make no provision for the assessment of treatment fidelity. This methodological shortcoming makes it impossible to distinguish between high- and low-quality MI interventions, and, consequently, to know whether MI provision has contributed to any intervention effects. This article makes some practical recommendations for the collection, selection, coding and reporting of MI fidelity data, as measured using the Motivational Interviewing Treatment Integrity Code. We hope that researchers will consider these recommendations and include MI fidelity measures in future studies. Copyright © 2015 Elsevier Inc. All rights reserved.

Theoretical approach to society-wide environmental quality control

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

Ayano, K.

1982-01-01

The study outlines the basis for a theory of societal control of environmental quality in the US based on the concepts and philosophy of company-wide quality control which has developed in Japan as a cross-disciplinary approach to problem-solving in the industrial realm. The basic concepts are: 1) every member of society, as a producer of environmental products and services for future generations, in principle has the responsibility to control the quality of his output; 2) environment quality is the quality of life, or the fitness of use of environment for humans; and 3) societal control is any activity necessary formore » quality production of environmental products and services continuously or in the long run. A motivator-hygiene theory of environmental quality is identified, and a proposal is made that the policy provision must be formulated differently between those aimed at hygiene factors of environmental quality and those aimed at motivators, the former in a collectivistic manner, the latter as an individual problem. The concept of societal cost of environmental quality is introduced. Based on the motivator-hygiene theory of environmental quality, the collectivistic and individual approaches are differentiated and discussed.« less

The AGARD tip research agenda for Scientific and Technical Information (STI)

NASA Technical Reports Server (NTRS)

Blados, Walter R.

1992-01-01

The Research Agenda contains three themes: information management, provision of information, and access to information. Provision of information is further divided into two subordinate themes, dissemination and bibliographic control; access to information is also further divided into two subordinate themes, barriers and equity and networking. Each theme or sub-theme was examined from four possible aspects, namely, human resources, quality assurance, cost, and technology. It was concluded that, in fact, a theme or sub-theme need not contain all four aspects.

The Effect of Institutional Leadership on Quality of Higher Education Provision

ERIC Educational Resources Information Center

Garwe, Evelyn Chiyevo

2014-01-01

The study was carried out with the aim of examining the effect of institutional leadership on the quality of educational provision in higher education institutions in Zimbabwe. The study analysed the indicators determining provision of quality higher education in state and private universities and how they are influenced by institutional…

Providing activity for people with dementia in care homes: a cluster randomised controlled trial.

PubMed

Wenborn, Jennifer; Challis, David; Head, Jenny; Miranda-Castillo, Claudia; Popham, Carolyn; Thakur, Ruchi; Illes, Jacqueline; Orrell, Martin

2013-12-01

Activity levels remain low in care homes, but activity engagement can enhance residents' quality of life. This study aimed to assess an occupational therapy programme designed to enable care home staff to increase activity provision. A cluster randomised controlled trial with blinded assessment of outcome was conducted. A total of 210 residents with dementia in 16 care homes were recruited. Intervention homes received the programme, and control homes were provided usual care. Primary outcome is quality of life; secondary measures are dependency, challenging behaviour, depression, anxiety, severity of dementia and number and type of medication. Quality of life decreased overall with statistically significant change in staff ratings (p < 0.001). At follow-up, staff-rated quality of life was slightly lower in the intervention group (mean difference in staff ratings = -1.91, 95% CI -3.39 to -0.43, p = 0.01). There were no significant differences between the two groups for self-rated quality of life or secondary outcomes. The results may be related to the following: wide variability in how the intervention was implemented, such as low staff attendance at the education and coaching sessions, and patchy provision of additional activities to residents; or the residents' severity of dementia or the choice of outcome measures. Future studies need to pay more attention to process measures such as implementation and fidelity strategies, and outcome measures that better capture the focus of the intervention such as level of engagement and activity. Copyright © 2013 John Wiley & Sons, Ltd.

Incorporating Quality Control Information in the Sensor Web

NASA Astrophysics Data System (ADS)

Devaraju, Anusuriya; Kunkel, Ralf; Bogena, Heye

2013-04-01

The rapid development of sensing technologies had led to the creation of large amounts of heterogeneous environmental observations. The Sensor Web provides a wider access to sensors and observations via common protocols and specifications. Observations typically go through several levels of quality control, and aggregation before they are made available to end-users. Raw data are usually inspected, and related quality flags are assigned. Data are gap-filled, and errors are removed. New data series may also be derived from one or more corrected data sets. Until now, it is unclear how these kinds of information can be captured in the Sensor Web Enablement (SWE) framework. Apart from the quality measures (e.g., accuracy, precision, tolerance, or confidence), the levels of observational series, the changes applied, and the methods involved must be specified. It is important that this kind of quality control information is well described and communicated to end-users to allow for a better usage and interpretation of data products. In this paper, we describe how quality control information can be incorporated into the SWE framework. Concerning this, first, we introduce the TERENO (TERrestrial ENvironmental Observatories), an initiative funded by the large research infrastructure program of the Helmholtz Association in Germany. The main goal of the initiative is to facilitate the study of long-term effects of climate and land use changes. The TERENO Online Data RepOsitORry (TEODOOR) is a software infrastructure that supports acquisition, provision, and management of observations within TERENO via SWE specifications and several other OGC web services. Next, we specify changes made to the existing observational data model to incorporate quality control information. Here, we describe the underlying TERENO data policy in terms of provision and maintenance issues. We present data levels, and their implementation within TEODOOR. The data levels are adapted from those used by other similar systems such as CUAHSI, EarthScope and WMO. Finally, we outline recommendations for future work.

40 CFR Table 10 to Subpart Ddddd... - Applicability of General Provisions to Subpart DDDDD

Code of Federal Regulations, 2010 CFR

2010-07-01

... requirements; and internal and external QA procedures for testing Yes. § 63.7(d) Testing Facilities... must keep quality control plan on record for the life of the affected source. Keep old versions for 5...

40 CFR Table 3 to Subpart Cccccc... - Applicability of General Provisions

Code of Federal Regulations, 2010 CFR

2010-07-01

... procedures; performance audit requirements; internal and external QA procedures for testing Yes. § 63.7(d... quality control plan on record for 5 years; keep old versions for 5 years after revisions No. § 63.8(e...

40 CFR Table 7 to Subpart Ppppp of... - Applicability of General Provisions to Subpart PPPPP

Code of Federal Regulations, 2010 CFR

2010-07-01

... Yes. 3. Performance audit requirements Yes. 4. Internal and external QA procedures for testing Yes... keep quality control plan on record for 5 years. Keep old versions for 5 years after revisions Yes...

40 CFR Table 10 to Subpart Uuuu of... - Applicability of General Provisions to Subpart UUUU

Code of Federal Regulations, 2010 CFR

2010-07-01

... requirements; internal and external QA procedures for testing No. § 63.7(d) Testing Facilities Requirements for....; must keep quality control plan on record for 5 years; keep old versions for 5 years after revisions No...

7 CFR 981.442 - Quality control.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., pieces of kernels, meal accumulated in manufacturing, or other material, to crushers, feed manufacturers... contamination in accordance with the provisions of this section. (1) Treatment process. Treatment processes... Salmonella bacteria in almonds, pursuant to a letter of determination issued by the Food and Drug...

Safety, reliability, maintainability and quality provisions for the Space Shuttle program

NASA Technical Reports Server (NTRS)

1990-01-01

This publication establishes common safety, reliability, maintainability and quality provisions for the Space Shuttle Program. NASA Centers shall use this publication both as the basis for negotiating safety, reliability, maintainability and quality requirements with Shuttle Program contractors and as the guideline for conduct of program safety, reliability, maintainability and quality activities at the Centers. Centers shall assure that applicable provisions of the publication are imposed in lower tier contracts. Centers shall give due regard to other Space Shuttle Program planning in order to provide an integrated total Space Shuttle Program activity. In the implementation of safety, reliability, maintainability and quality activities, consideration shall be given to hardware complexity, supplier experience, state of hardware development, unit cost, and hardware use. The approach and methods for contractor implementation shall be described in the contractors safety, reliability, maintainability and quality plans. This publication incorporates provisions of NASA documents: NHB 1700.1 'NASA Safety Manual, Vol. 1'; NHB 5300.4(IA), 'Reliability Program Provisions for Aeronautical and Space System Contractors'; and NHB 5300.4(1B), 'Quality Program Provisions for Aeronautical and Space System Contractors'. It has been tailored from the above documents based on experience in other programs. It is intended that this publication be reviewed and revised, as appropriate, to reflect new experience and to assure continuing viability.

Medical Abortion Provision by Pharmacies and Drug Sellers in Low- and Middle-Income Countries: A Systematic Review.

PubMed

Footman, Katharine; Keenan, Katherine; Reiss, Kate; Reichwein, Barbara; Biswas, Pritha; Church, Kathryn

2018-03-01

We undertook a systematic review to assess 1) the level and quality of pharmacy and drug shop provision of medical abortion (MA) in low- and middle-income countries (LMICs) and 2) interventions to improve quality of provision. We used standardized terms to search six databases for peer-reviewed and grey literature. We double-extracted data using a standardized template, and double-graded studies for methodological quality. We identified 22 studies from 16 countries reporting on level and quality of MA provision through pharmacies and drug sellers, and three intervention studies. Despite widespread awareness and provision of MA drugs, even in legally restricted contexts, most studies found that pharmacy workers and drug sellers had poor knowledge of effective regimens. Evidence on interventions to improve pharmacy and drug shop provision of MA was limited and generally low quality, but indicated that training could be effective in improving knowledge. Programmatic attention should focus on the development and rigorous evaluation of innovative interventions to improve women's access to information about MA self-management in low-and middle-income countries. © 2018 The Population Council, Inc.

Effects of light quality on the accumulation of phytochemicals in vegetables produced in controlled environments: a review.

PubMed

Bian, Zhong Hua; Yang, Qi Chang; Liu, Wen Ke

2015-03-30

Phytochemicals in vegetables are important for human health, and their biosynthesis, metabolism and accumulation are affected by environmental factors. Light condition (light quality, light intensity and photoperiod) is one of the most important environmental variables in regulating vegetable growth, development and phytochemical accumulation, particularly for vegetables produced in controlled environments. With the development of light-emitting diode (LED) technology, the regulation of light environments has become increasingly feasible for the provision of ideal light quality, intensity and photoperiod for protected facilities. In this review, the effects of light quality regulation on phytochemical accumulation in vegetables produced in controlled environments are identified, highlighting the research progress and advantages of LED technology as a light environment regulation tool for modifying phytochemical accumulation in vegetables. © 2014 Society of Chemical Industry.

The urban FIA inventory: plot design, data collection, data flow and processing

Treesearch

Tonya Lister; Mark Majewsky; Mark A. Hatfield; Angie Rowe; Bill Dunning; Chris Edgar; Tom Brandeis

2015-01-01

More than 80 percent of the U.S. population lives in urban areas and tree cover in these areas offers a wide range of environmental benefits including the provision of wildlife habitat, aesthetic appeal and visual barriers, microclimate control, water quality improvement, and air and noise pollution control. Recognizing the importance of urban forests, and with...

Power Extension Package (PEP) system definition extension, orbital service module systems analysis study. Volume 4: PEP functional specification

NASA Technical Reports Server (NTRS)

1979-01-01

The functional, performance, design, and test requirements for the Orbiter power extension package and its associated ground support equipment are defined. Both government and nongovernment standards and specifications are cited for the following subsystems: electrical power, structural/mechanical, avionics, and thermal control. Quality control assurance provisions and preparation for delivery are also discussed.

H. R. 2538: A bill to amend the Federal Water Pollution Control Act, introduced in the US House of Representatives, One Hundred Second Congress, First Session, June 4, 1991

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

Not Available

1991-01-01

This bill was introduced into the US House of Representatives on June 4, 1991 to regulate water quality degradation. Key features of this legislation addressed include the following: water quality standards and implementation plans; certification; state ocean dumping requirements; enforcement of certification provisions; and ocean discharge criteria.

Competition and disclosure incentives: an empirical study of HMOs.

PubMed

Jin, Ginger Zhe

2005-01-01

I examine Health Maintenance Organizations' (HMOs) voluntary disclosure of product quality, which is not as complete as unraveling theories predict. After controlling for cost and demand factors, I find that HMOs use voluntary disclosure to differentiate from competitors, with lower disclosure rates in highly competitive markets. These findings are consistent with product differentiation, but challenge the intuition that competition should lead to more provision of quality information.

40 CFR 130.11 - Program management.

Code of Federal Regulations, 2011 CFR

2011-07-01

... quality standards (WQS), development of alternative approaches to control pollution, implementation and... primarily to manage the wastewater treatment works construction grants program pursuant to the provisions of 40 CFR part 35, subpart J. A State may also use part of the 205(g) funds to administer approved...

76 FR 69214 - Approval and Promulgation of Air Quality Implementation Plans; Virginia; Consumer and Commercial...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

... portable fuel containers, consumer products, architectural and industrial (AIM) coatings, adhesives and... the control technology, testing, monitoring, administrative, recordkeeping, and reporting requirements... and products subject to the standards subject to the provisions of Chapter 45, specify monitoring...

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

PubMed

Anderson, Niall; Ozakinci, Gozde

2018-03-27

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

Optimising the changing role of the community pharmacist: a randomised trial of the impact of audit and feedback

PubMed Central

Winslade, Nancy; Eguale, Tewodros; Tamblyn, Robyn

2016-01-01

Objective To evaluate the impact of comparative performance feedback to community pharmacists on provision of professional services and the quality of patients’ medication use. Design Randomised, controlled, single-blind trial. Setting All 1833 community pharmacies in the Quebec province, Canada. Participants 1814 pharmacies not opting out and with more than 5 dispensings of the target medications during the 6-month baseline were randomised by a 2×2 factorial design to feedback first for hypertension adherence (907 control, 907 intervention) followed by randomisation for asthma adherence (791 control, 807 intervention). 1422 of 1814 pharmacies had complete information available during the follow-up for hypertension intervention (706 intervention, 716 control), and 1301 of 1598 had the follow-up information for asthma (657 intervention, 644 control). Intervention Using provincial billing data to measure performance, mailed comparative feedback reported the pharmacy-level percentage of dispensings to patients non-adherent to antihypertensive medications or overusing asthma rescue inhalers. Primary and secondary outcome measures The number of hypertension/asthma services billed per pharmacy and percentage of dispensings to non-adherent patients over the 12 months post intervention. Results Feedback on the asthma measure led to increased provision of asthma services (control 0.2, intervention 0.4, RR 1.58, 95% CI 1.02 to 2.46). However, this did not translate into reductions in patients’ overuse of rescue inhalers (control 45.5%, intervention 44.6%, RR 0.99, 95% CI 0.98 to 1.01). For non-adherence to antihypertensive medications, feedback resulted in no difference in either provision of hypertension services (control 0.7, intervention 0.8, RR 1.25, 95% CI 0.86 to 1.82) or antihypertensive treatment adherence (control 27.9%, intervention 28.0%, RR 1.0, 95% CI 0.99 to 1.00). Baseline performance did not influence results, and there was no evidence of a cumulative effect with repeated feedback. Conclusions Comparative pharmacy performance feedback increased the provision of asthma pharmacists’ services but did not improve the performance on medication-use measures. Billing data can be used to evaluate the impact of billable services rendered by pharmacists on the quality of patients’ medication use. PMID:27207626

Automatic-Control System for Safer Brazing

NASA Technical Reports Server (NTRS)

Stein, J. A.; Vanasse, M. A.

1986-01-01

Automatic-control system for radio-frequency (RF) induction brazing of metal tubing reduces probability of operator errors, increases safety, and ensures high-quality brazed joints. Unit combines functions of gas control and electric-power control. Minimizes unnecessary flow of argon gas into work area and prevents electrical shocks from RF terminals. Controller will not allow power to flow from RF generator to brazing head unless work has been firmly attached to head and has actuated micro-switch. Potential shock hazard eliminated. Flow of argon for purging and cooling must be turned on and adjusted before brazing power applied. Provision ensures power not applied prematurely, causing damaged work or poor-quality joints. Controller automatically turns off argon flow at conclusion of brazing so potentially suffocating gas does not accumulate in confined areas.

40 CFR 52.1520 - Identification of plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... plan. (a) Purpose and scope. This section sets forth the applicable State Implementation Plan for New... provisions for retention and availability of air quality data Statewide 3/23/1972 7/27/1972, 37 FR 15080 See..., 1998 stating a negative declaration for the aerospace coating operations Control Techniques Guideline...

40 CFR 52.1520 - Identification of plan.

Code of Federal Regulations, 2011 CFR

2011-07-01

... plan. (a) Purpose and scope. This section sets forth the applicable State Implementation Plan for New... provisions for retention and availability of air quality data Statewide 3/23/1972 7/27/1972, 37 FR 15080 See..., 1998 stating a negative declaration for the aerospace coating operations Control Techniques Guideline...

40 CFR 60.63 - Monitoring of operations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... assurance or quality control activities (including, as applicable, calibration checks and required zero and... period. (7) The flow rate sensor must have provisions to determine the daily zero and upscale calibration... chapter for a discussion of CD). (i) Conduct the CD tests at two reference signal levels, zero (e.g., 0 to...

40 CFR 60.63 - Monitoring of operations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... assurance or quality control activities (including, as applicable, calibration checks and required zero and... period. (7) The flow rate sensor must have provisions to determine the daily zero and upscale calibration... chapter for a discussion of CD). (i) Conduct the CD tests at two reference signal levels, zero (e.g., 0 to...

Museums in the Commercial Marketplace: The Need for Licensing Agreements.

ERIC Educational Resources Information Center

Hodes, Scott; Gross, Karen

1978-01-01

Discussed are the major features of a Model Licensing Agreement to be used by museums in any commercial reproduction venture. They include rights and obligations of the respective parties, maintenance of quality control, payment of royalties, arbitration, and termination provisions. The Model Licensing Agreement is appended. (JMD)

Education by Choice: The Case for Family Control.

ERIC Educational Resources Information Center

Coons, John E.; Sugarman, Stephen D.

This book examines the philosophical issues, possible variations, and implementation of voucher plans of educational choice. The voucher system proposed here (the Quality Choice Model) is based on the assumption that a voucher system can ensure the equal provision of educational resources to children regardless of residential mobility or ability…

40 CFR 407.44 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 458.26 - Pretreatment standards for new sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... subpart that introduces process wastewater pollutants into a publicly owned treatment works must comply... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a new source subject to the provisions of this subpart: Pollutant or...

40 CFR 407.34 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 426.64 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... this subpart that introduces process wastewater pollutants into a publicly owned treatment works must... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this subpart. Pollutant or...

40 CFR 426.44 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... this subpart that introduces process wastewater pollutants into a publicly owned treatment works must... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this subpart. Pollutant or...

40 CFR 405.54 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2010 CFR

2010-07-01

... works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this subpart...

40 CFR 458.36 - Pretreatment standards for new sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... subpart that introduces process wastewater pollutants into a publicly owned treatment works must comply... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a new source subject to the provisions of this subpart: Pollutant or...

40 CFR 407.14 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this subpart...

40 CFR 426.106 - Pretreatment standards for new sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... subpart that introduces process wastewater pollutants into a publicly owned treatment works must comply... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a new point source subject to the provisions of this subpart. Pollutant...

40 CFR 408.24 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 458.46 - Pretreatment standards for new sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... subpart that introduces process wastewater pollutants into a publicly owned treatment works must comply... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a new source subject to the provisions of this subpart: Pollutant or...

40 CFR 405.64 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2010 CFR

2010-07-01

... this subpart that introduces process wastewater pollutants into a publicly owned treatment works must... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this subpart. Pollutant or...

40 CFR 408.34 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 408.194 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 408.94 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 408.164 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 407.54 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 408.154 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... this subpart that introduces process wastewater pollutants into a publicly owned treatment works must... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this subpart. Pollutant or...

40 CFR 407.86 - Pretreatment standards for new sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a new point source subject to the provisions of...

40 CFR 405.54 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this subpart...

40 CFR 408.186 - Pretreatment standards for new sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a new source subject to the provisions of this subpart...

40 CFR 408.104 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 408.166 - Pretreatment standards for new sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... this subpart that introduces process wastewater pollutants into a publicly owned treatment works must... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a new source subject to the provisions of this subpart: Pollutant or...

40 CFR 408.144 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... this subpart that introduces process wastewater pollutants into a publicly owned treatment works must... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this subpart. Pollutant or...

40 CFR 408.184 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 407.66 - Pretreatment standards for new sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a new point source subject to the provisions of this...

40 CFR 408.44 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 458.16 - Pretreatment standards for new sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... subpart that introduces process wastewater pollutants into a publicly owned treatment works must comply... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a new source subject to the provisions of this subpart: Pollutant or...

40 CFR 408.176 - Pretreatment standards for new sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... this subpart that introduces process wastewater pollutants into a publicly owned treatment works must... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a new source subject to the provisions of this subpart: Pollutant or...

40 CFR 407.24 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 407.76 - Pretreatment standards for new sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a new point source subject to the provisions of this...

40 CFR 426.24 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... this subpart that introduces process wastewater pollutants into a publicly owned treatment works must... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this subpart. Pollutant or...

40 CFR 408.54 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 426.34 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... this subpart that introduces process wastewater pollutants into a publicly owned treatment works must... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this subpart. Pollutant or...

40 CFR 408.174 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... treatment works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this...

40 CFR 427.86 - Pretreatment standards for new sources.

Code of Federal Regulations, 2011 CFR

2011-07-01

... subpart that introduces process wastewater pollutants into a publicly owned treatment works must comply... quality of pollutants or pollutant properties, controlled by this section, which may be discharged to a publicly owned treatment works by a new point source subject to the provisions of this subpart. Pollutant...

40 CFR 405.64 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... this subpart that introduces process wastewater pollutants into a publicly owned treatment works must... quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this subpart. Pollutant or...

40 CFR 408.14 - Pretreatment standards for existing sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... works must comply with 40 CFR part 403. In addition, the following pretreatment standard establishes the quantity or quality of pollutants or pollutant properties controlled by this section which may be discharged to a publicly owned treatment works by a point source subject to the provisions of this subpart...

48 CFR 2152.246-70 - Quality assurance requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Quality assurance... MANAGEMENT, FEDERAL EMPLOYEES GROUP LIFE INSURANCE FEDERAL ACQUISITION REGULATION CLAUSES AND FORMS PRECONTRACT PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 2152.246-70 Quality assurance...

48 CFR 2152.246-70 - Quality assurance requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Quality assurance... MANAGEMENT, FEDERAL EMPLOYEES GROUP LIFE INSURANCE FEDERAL ACQUISITION REGULATION CLAUSES AND FORMS PRECONTRACT PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 2152.246-70 Quality assurance...

48 CFR 2152.246-70 - Quality assurance requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Quality assurance... MANAGEMENT, FEDERAL EMPLOYEES GROUP LIFE INSURANCE FEDERAL ACQUISITION REGULATION CLAUSES AND FORMS PRECONTRACT PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 2152.246-70 Quality assurance...

48 CFR 2152.246-70 - Quality assurance requirements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Quality assurance... MANAGEMENT, FEDERAL EMPLOYEES GROUP LIFE INSURANCE FEDERAL ACQUISITION REGULATION CLAUSES AND FORMS PRECONTRACT PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 2152.246-70 Quality assurance...

48 CFR 2152.246-70 - Quality assurance requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Quality assurance... MANAGEMENT, FEDERAL EMPLOYEES GROUP LIFE INSURANCE FEDERAL ACQUISITION REGULATION CLAUSES AND FORMS PRECONTRACT PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 2152.246-70 Quality assurance...

Appearance Investment, Quality of Life, and Metabolic Control Among Women with Type 1 Diabetes.

PubMed

Gawlik, Nicola R; Elias, Anna J; Bond, Malcolm J

2016-06-01

Concomitants of Type 1 diabetes management include weight gain and dietary restraint. Body image concerns, particularly among women, are therefore common. The study evaluated associations between the appearance investment component of body image, age, quality of life and self-reported metabolic control were examined, along with the practice of insulin restriction as a weight control strategy. A questionnaire comprising demographic and diabetes-related information, the Appearance Schemas Inventory, and Diabetes Quality of Life Brief Clinical Inventory was completed by Australian women diagnosed with type 1 diabetes (N = 177). Self-evaluative salience was higher among younger participants, those with a lower quality of life, and those with better metabolic control of their diabetes, with the relationships between metabolic control and all of age, quality of life, and self-evaluative salience noted to be non-linear. Among participants who reported restricting insulin for weight control, self-evaluative salience was particularly relevant. Motivational salience was not related to other study variables. Clinically, the provision of information regarding appearance changes that might arise in order to mitigate later body image difficulties is a potentially beneficial adjunct to standard diabetes management protocols that may lead to more successful disease adjustment.

Dilemma of Access and Provision of Quality Basic Education in Central Region, Ghana

ERIC Educational Resources Information Center

Amakyi, Michael; Ampah-Mensah, Alfred

2016-01-01

A survey research was conducted to find out if reported improvements in access to education in Ghana are reflected in comparable improvements in delivery of quality education. The study examined theoretical constructs on adequacy and quality assurance in education to ascertain the state of quality provision in education, and whether there is a…

Self-Management Education for Rehabilitation Inpatients Suffering from Inflammatory Bowel Disease: A Cluster-Randomized Controlled Trial

ERIC Educational Resources Information Center

Reusch, A.; Weiland, R.; Gerlich, C.; Dreger, K.; Derra, C.; Mainos, D.; Tuschhoff, T.; Berding, A.; Witte, C.; Kaltz, B.; Faller, H.

2016-01-01

Although inflammatory bowel disease (IBD) affects patients' psychological well-being, previous educational programs have failed to demonstrate effects on psychosocial outcomes and quality of life. Therefore, we developed a group-based psychoeducational program that combined provision of both medical information and psychological self-management…

Coping with Quality Assurance Challenges Faced by Secondary Schools' Headteachers in Gucha District, Kenya

ERIC Educational Resources Information Center

Mobegi, Florence Osiri; Ondigi, Benjamin A.

2011-01-01

Since independence, the Kenyan government has demonstrated its commitment to the provision of quality secondary school education through allocation of financial resources, provision of trained teachers and establishment of quality assurance department. However, despite the substantial allocation of resources, secondary schools still face major…

Addressing challenges in scaling up TB and HIV treatment integration in rural primary healthcare clinics in South Africa (SUTHI): a cluster randomized controlled trial protocol.

PubMed

Naidoo, Kogieleum; Gengiah, Santhanalakshmi; Yende-Zuma, Nonhlanhla; Padayatchi, Nesri; Barker, Pierre; Nunn, Andrew; Subrayen, Priashni; Abdool Karim, Salim S

2017-11-13

A large and compelling clinical evidence base has shown that integrated TB and HIV services leads to reduction in human immunodeficiency virus (HIV)- and tuberculosis (TB)-associated mortality and morbidity. Despite official policies and guidelines recommending TB and HIV care integration, its poor implementation has resulted in TB and HIV remaining the commonest causes of death in several countries in sub-Saharan Africa, including South Africa. This study aims to reduce mortality due to TB-HIV co-infection through a quality improvement strategy for scaling up of TB and HIV treatment integration in rural primary healthcare clinics in South Africa. The study is designed as an open-label cluster randomized controlled trial. Sixteen clinic supervisors who oversee 40 primary health care (PHC) clinics in two rural districts of KwaZulu-Natal, South Africa will be randomized to either the control group (provision of standard government guidance for TB-HIV integration) or the intervention group (provision of standard government guidance with active enhancement of TB-HIV care integration through a quality improvement approach). The primary outcome is all-cause mortality among TB-HIV patients. Secondary outcomes include time to antiretroviral therapy (ART) initiation among TB-HIV co-infected patients, as well as TB and HIV treatment outcomes at 12 months. In addition, factors that may affect the intervention, such as conditions in the clinic and staff availability, will be closely monitored and documented. This study has the potential to address the gap between the establishment of TB-HIV care integration policies and guidelines and their implementation in the provision of integrated care in PHC clinics. If successful, an evidence-based intervention comprising change ideas, tools, and approaches for quality improvement could inform the future rapid scale up, implementation, and sustainability of improved TB-HIV integration across sub-Sahara Africa and other resource-constrained settings. Clinicaltrials.gov, NCT02654613 . Registered 01 June 2015.

The impact of the prospective payment system for skilled nursing facilities on therapy service provision: a transaction cost approach.

PubMed

Zinn, Jacqueline S; Mor, Vincent; Intrator, Orna; Feng, Zhanlian; Angelelli, Joseph; Davis, Jullet A

2003-12-01

To examine skilled nursing facilities (SNFs) "make-or-buy" decisions with respect to rehabilitation therapy service provision in the 1990s, both before and after implementation of Medicare's Prospective Payment System (PPS) for SNFs. Longitudinal On-line Survey Certification and Reporting (OSCAR) data (1992-2001) on a sample of 10,241 freestanding urban SNFs. We estimated a longitudinal multinomial logistic regression model derived from transaction cost economic theory to predict the probability of the outcome in each of four service provision categories (all employed staff, all contract, mixed, and no services provided). Transaction frequency, uncertainty, and complexity result in greater control over therapy services through employment as opposed to outside contracting. For-profit status and chain affiliation were associated with greater control over therapy services. Following PPS, nursing homes acted to limit transaction costs by either exiting the rehabilitation market or exerting greater control over therapy services by managing rehabilitation services in-house. The financial incentives associated with changes in reimbursement methodology have implications that extend beyond the boundaries of the health care industry segment directly affected. Unintended quality and access consequences need to be carefully monitored by the Medicare program.

High-quality Health Information Provision for Stroke Patients.

PubMed

Du, Hong-Sheng; Ma, Jing-Jian; Li, Mu

2016-09-05

High-quality information provision can allow stroke patients to effectively participate in healthcare decision-making, better manage the stroke, and make a good recovery. In this study, we reviewed information needs of stroke patients, methods for providing information to patients, and considerations needed by the information providers. The literature concerning or including information provision for patients with stroke in English was collected from PubMed published from 1990 to 2015. We included all the relevant articles on information provision for stroke patients in English, with no limitation of study design. Stroke is a major public health concern worldwide. High-quality and effective health information provision plays an essential role in helping patients to actively take part in decision-making and healthcare, and empowering them to effectively self-manage their long-standing chronic conditions. Different methods for providing information to patients have their relative merits and suitability, and as a result, the effective strategies taken by health professionals may include providing high-quality information, meeting patients' individual needs, using suitable methods in providing information, and maintaining active involvement of patients. It is suggested that to enable stroke patients to access high-quality health information, greater efforts need to be made to ensure patients to receive accurate and current evidence-based information which meets their individual needs. Health professionals should use suitable information delivery methods, and actively involve stroke patients in information provision.

Solidarity as a national health care strategy.

PubMed

West-Oram, Peter

2018-05-02

The Trump Administration's recent attempts to repeal the Affordable Care Act have reignited long-running debates surrounding the nature of justice in health care provision, the extent of our obligations to others, and the most effective ways of funding and delivering quality health care. In this article, I respond to arguments that individualist systems of health care provision deliver higher-quality health care and promote liberty more effectively than the cooperative, solidaristic approaches that characterize health care provision in most wealthy countries apart from the United States. I argue that these claims are mistaken and suggest one way of rejecting the implied criticisms of solidaristic practices in health care provision they represent. This defence of solidarity is phrased in terms of the advantages solidaristic approaches to health care provision have over individualist alternatives in promoting certain important personal liberties, and delivering high-quality, affordable health care. © 2018 John Wiley & Sons Ltd.

Urban ecosystem services for resilience planning and management in New York City.

PubMed

McPhearson, Timon; Hamstead, Zoé A; Kremer, Peleg

2014-05-01

We review the current state of knowledge about urban ecosystem services in New York City (NYC) and how these services are regulated, planned for, and managed. Focusing on ecosystem services that have presented challenges in NYC-including stormwater quality enhancement and flood control, drinking water quality, food provisioning and recreation-we find that mismatches between the scale of production and scale of management occur where service provision is insufficient. Adequate production of locally produced services and services which are more accessible when produced locally is challenging in the context of dense urban development that is characteristic of NYC. Management approaches are needed to address scale mismatches in the production and consumption of ecosystem services. By coordinating along multiple scales of management and promoting best management practices, urban leaders have an opportunity to ensure that nature and ecosystem processes are protected in cities to support the delivery of fundamental urban ecosystem services.

The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe.

PubMed

Mahdavi, Mahdi; Vissers, Jan; Elkhuizen, Sylvia; van Dijk, Mattees; Vanhala, Antero; Karampli, Eleftheria; Faubel, Raquel; Forte, Paul; Coroian, Elena; van de Klundert, Joris

2018-01-01

While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian's Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK. Data collection consisted of: a) systematic modelling of provider network's structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011-2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian's SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes. The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year. While the selected structure and process variables explain much of the variance in service satisfaction, this is less the case for quality of life. Moreover, it appears that the effect of the clinical outcome A1c control on processes is stronger than the other way around, as poorer control seems to relate to more service use, and higher cost. The standardized operational models used in this research prove to form a basis for expanding the network level evidence base for effective T2D service provisioning.

The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe

PubMed Central

Elkhuizen, Sylvia; van Dijk, Mattees; Vanhala, Antero; Karampli, Eleftheria; Faubel, Raquel; Forte, Paul; Coroian, Elena

2018-01-01

Background While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian’s Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK. Methods Data collection consisted of: a) systematic modelling of provider network’s structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011–2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian’s SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes. Results The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year. Conclusions While the selected structure and process variables explain much of the variance in service satisfaction, this is less the case for quality of life. Moreover, it appears that the effect of the clinical outcome A1c control on processes is stronger than the other way around, as poorer control seems to relate to more service use, and higher cost. The standardized operational models used in this research prove to form a basis for expanding the network level evidence base for effective T2D service provisioning. PMID:29447220

36 CFR 292.13 - Standards.

Code of Federal Regulations, 2010 CFR

2010-07-01

...-fourth acre of surface, smelters, sand, gravel and aggregate processing plants, fabricating plants... entertainment. (c) Protection of roadsides. Provisions to protect natural scenic qualities and maintain... standard. (d) Protection of shorelines. Provisions to protect scenic qualities and reduce potentials for...

Private Pre-University Education in Romania: Mixing Control with Lack of Strategy

ERIC Educational Resources Information Center

Stanus, Cristina

2014-01-01

This paper approaches private provision of pre-university education in Romania, exploring available data on the sector's size and main characteristics and evaluating the extent to which the current regulatory framework enables positive effects in terms of freedom of choice, quality, equity, and social cohesion. The paper argues that the lack of a…

The Great Balancing Act: Financial Equity and Local Control. Can Vermont's Act 60 Do It?

ERIC Educational Resources Information Center

Jimerson, Lorna

Vermont's Equal Educational Opportunity Act of 1997 (Act 60) has attracted attention because of its funding and quality components, and the highly publicized responses to its implementation. A key feature is its "recapture" provision in which property-wealthy towns contribute to a state educational fund that helps support education in…

The World Indigenous Research Alliance (WIRA): Mediating and Mobilizing Indigenous Peoples' Educational Knowledge and Aspirations

ERIC Educational Resources Information Center

Whitinui, Paul; McIvor, Onowa; Robertson, Boni; Morcom, Lindsay; Cashman, Kimo; Arbon, Veronica

2015-01-01

There is an Indigenous resurgence in education occurring globally. For more than a century Euro-western approaches have controlled the provision and quality of education to, and for Indigenous peoples. The World Indigenous Research Alliance (WIRA) established in 2012, is a grass-roots movement of Indigenous scholars passionate about making a…

76 FR 64015 - Approval and Promulgation of Air Quality Implementation Plans; Maryland; Adoption of Control...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-17

... miscellaneous metal and plastic products in 1978, which includes drum and pail coating, and revised them in 2008... drum and pail coatings, part of the EPA miscellaneous metal and plastic parts coatings CTG. EPA...); Does not impose an information collection burden under the provisions of the Paperwork Reduction Act...

Market reforms and public incentives: finding a balance in the Republic of Macedonia.

PubMed

Nordyke, Robert J; Peabody, John W

2002-03-01

The Republic of Macedonia is undertaking sweeping reforms of its health sector. Funded by a World Bank credit, the reforms seek to improve the efficiency and quality of primary health care (PHC) by significantly strengthening the role of the market in health care provision. On the supply-side, one of the key reform proposals is to implement a capitation payment system for PHC physicians. By placing individual physicians on productivity-based contracts, these reforms will effectively marketize all PHC provision. In addition, the Ministry of Health is considering the sale or concessions of public PHC clinics to private groups, indicating the government's commitment to marketization of health care provision. Macedonia is in a unique position to develop a new role for the private sector in PHC provision. The private provision of outpatient care was legalized soon after independence in 1991; private physicians now account for nearly 10% of all physicians and 22% of PHC physicians. If the reforms are fully realized, all PHC physicians-over 40% of all physicians-will be financially responsible for their clinical practices. This study draws on Macedonia's experience with limited development of private outpatient care starting in 1991 and the reform proposals for PHC, finding a network of policies and procedures throughout the health sector that negatively impact private and public sector provision. An assessment of the effects that this greater policy environment has on private sector provision identifies opportunities to strategically enhance the reforms. With respect to established market economies, the study finds justification for a greater role for government intervention in private health markets in transition economies. In addition to micro-level payment incentives and administrative controls, marketization in Central and Eastern Europe requires an examination of insurance contracting procedures, quality assurance practices, public clinic ownership, referral practices, hospital privileges, and capital investment policies.

How standard is standard care? Exploring control group outcomes in behaviour change interventions for young people with type 1 diabetes.

PubMed

Ayling, K; Brierley, S; Johnson, B; Heller, S; Eiser, C

2015-01-01

Poor descriptions of standard care may compromise interpretation of results in randomised controlled trials (RCTs) of health interventions. We investigated quality of standard care in RCTs of behaviour change interventions for young people with type 1 diabetes and consider implications for evaluating trial outcomes. We conducted systematic searches for articles published between 1999 and 2012. We extracted standard care descriptions and contacted trial authors to complete a checklist of standard care activities. The relationship between standard care quality and outcomes was examined via subgroup meta-analyses and meta-regression. Standard care descriptions, standard care quality, and relationships between standard care quality with medical and psychological outcomes. We identified 20 RCTs described across 26 articles. Published descriptions of standard care were limited to service-level features. Author responses indicated standard care provision extended beyond published accounts. Subgroup analyses suggested control groups receiving higher standard care quality showed larger improvements in both medical and psychological outcomes, although standard care quality did not predict outcomes significantly. The quality of care delivered to control group participants can influence outcomes of RCTs. Inadequate reporting exacerbates this issue by masking variations between trials. We argue for increased clarity in reporting standard care in future trials.

Is organizational justice associated with clinical performance in the care for patients with diabetes in primary care? Evidence from the improving Quality of care in Diabetes study.

PubMed

Elovainio, Marko; Steen, Nick; Presseau, Justin; Francis, Jill; Hrisos, Susan; Hawthorne, Gillian; Johnston, Marie; Stamp, Elaine; Hunter, Margaret; Grimshaw, Jeremy M; Eccles, Martin P

2013-02-01

Type 2 diabetes is an increasingly prevalent illness, and there is considerable variation in the quality of care provided to patients with diabetes in primary care. The aim of this study was to explore whether organizational justice and organizational citizenship behaviour are associated with the behaviours of clinical staff when providing care for patients with diabetes. The data were from an ongoing prospective multicenter study, the 'improving Quality of care in Diabetes' (iQuaD) study. Participants (N = 467) were clinical staff in 99 primary care practices in the UK. The outcome measures were six self-reported clinical behaviours: prescribing for glycaemic control, prescribing for blood pressure control, foot examination, giving advice about weight management, providing general education about diabetes and giving advice about self-management. Organizational justice perceptions were collected using a self-administered questionnaire. The associations between organizational justice and behavioural outcomes were tested using linear multilevel regression modelling. Higher scores on the procedural component of organizational justice were associated with more frequent weight management advice, self-management advice and provision of general education for patients with diabetes. The associations between justice and clinical behaviours were not explained by individual or practice characteristics, but evidence was found for the partial mediating role of organizational citizenship behaviour. Quality improvement efforts aimed at increasing advice and education provision in diabetes management in primary care could target also perceptions of procedural justice.

The Effect of Different Feedback on Writing Quality of College Students with Different Cognitive Styles

ERIC Educational Resources Information Center

Wahyuni, Sri

2017-01-01

Feedback provision in the process of writing has been believed that it is beneficial. However, different strategies of providing feedback may affect differently on writing quality of students. This study aimed at investigating the effect of different feedback provision on the writing quality of students having different cognitive styles. By…

How Good Is Our College? First Edition

ERIC Educational Resources Information Center

Education Scotland, 2016

2016-01-01

The new quality framework, "How good is our college?" is a tool to support and enable colleges to evaluate the quality of provision and services alongside reporting on progress in relation to outcome agreements. It is designed to be used by all college staff. Colleges will evaluate the quality of their provision and services using the 12…

Do efforts to standardize, assess and improve the quality of health service provision to adolescents by government-run health services in low and middle income countries, lead to improvements in service-quality and service-utilization by adolescents?

PubMed

Chandra-Mouli, Venkatraman; Chatterjee, Subidita; Bose, Krishna

2016-02-06

Researchers and implementers working in adolescent health, and adolescents themselves question whether government-run health services in conservative and resource-constrained settings can be made adolescent friendly. This paper aims to find out what selected low and middle income country (LMIC) governments have set out to do to improve the quality of health service provision to adolescents; whether their efforts led to measurable improvements in quality and to increased health service-utilization by adolescents. We gathered normative guidance and reports from eight LMICs in Asia, Africa, Central and Eastern Europe and the Western Pacific. We analysed national quality standards for adolescent friendly health services, findings from the assessments of the quality of health service provision, and findings on the utilization of health services. Governments of LMICs have set out to improve the accessibility, acceptability, equity, appropriateness and effectiveness of health service provision to adolescents by defining standards and actions to achieve them. Their actions have led to measurable improvements in quality and to increases in health service utilisation by adolescents. With support, government-run health facilities in LMICs can improve the quality of health services and their utilization by adolescents.

Towards Internet QoS provisioning based on generic distributed QoS adaptive routing engine.

PubMed

Haikal, Amira Y; Badawy, M; Ali, Hesham A

2014-01-01

Increasing efficiency and quality demands of modern Internet technologies drive today's network engineers to seek to provide quality of service (QoS). Internet QoS provisioning gives rise to several challenging issues. This paper introduces a generic distributed QoS adaptive routing engine (DQARE) architecture based on OSPFxQoS. The innovation of the proposed work in this paper is its undependability on the used QoS architectures and, moreover, splitting of the control strategy from data forwarding mechanisms, so we guarantee a set of absolute stable mechanisms on top of which Internet QoS can be built. DQARE architecture is furnished with three relevant traffic control schemes, namely, service differentiation, QoS routing, and traffic engineering. The main objective of this paper is to (i) provide a general configuration guideline for service differentiation, (ii) formalize the theoretical properties of different QoS routing algorithms and then introduce a QoS routing algorithm (QOPRA) based on dynamic programming technique, and (iii) propose QoS multipath forwarding (QMPF) model for paths diversity exploitation. NS2-based simulations proved the DQARE superiority in terms of delay, packet delivery ratio, throughput, and control overhead. Moreover, extensive simulations are used to compare the proposed QOPRA algorithm and QMPF model with their counterparts in the literature.

Towards Internet QoS Provisioning Based on Generic Distributed QoS Adaptive Routing Engine

PubMed Central

Haikal, Amira Y.; Badawy, M.; Ali, Hesham A.

2014-01-01

Increasing efficiency and quality demands of modern Internet technologies drive today's network engineers to seek to provide quality of service (QoS). Internet QoS provisioning gives rise to several challenging issues. This paper introduces a generic distributed QoS adaptive routing engine (DQARE) architecture based on OSPFxQoS. The innovation of the proposed work in this paper is its undependability on the used QoS architectures and, moreover, splitting of the control strategy from data forwarding mechanisms, so we guarantee a set of absolute stable mechanisms on top of which Internet QoS can be built. DQARE architecture is furnished with three relevant traffic control schemes, namely, service differentiation, QoS routing, and traffic engineering. The main objective of this paper is to (i) provide a general configuration guideline for service differentiation, (ii) formalize the theoretical properties of different QoS routing algorithms and then introduce a QoS routing algorithm (QOPRA) based on dynamic programming technique, and (iii) propose QoS multipath forwarding (QMPF) model for paths diversity exploitation. NS2-based simulations proved the DQARE superiority in terms of delay, packet delivery ratio, throughput, and control overhead. Moreover, extensive simulations are used to compare the proposed QOPRA algorithm and QMPF model with their counterparts in the literature. PMID:25309955

Assuring Quality in Collaborative Provision.

ERIC Educational Resources Information Center

Bocock, Jean; Edwards, Judith

1998-01-01

This bulletin is intended to help British further education colleges clarify their rationale for entering into collaborative programs, assess prospective partners, define and implement good practice at all stages of provision, and establish rigorous quality assurance procedures. Following an introduction, Further Education Funding Council…

Factoring quality laboratory diagnosis into the malaria control agenda for sub-Saharan Africa.

PubMed

Aidoo, Michael

2013-09-01

Recent progress in malaria control in sub-Saharan Africa has been achieved primarily through provision of insecticide-treated nets, indoor residual spraying, and antimalarial drugs. Although these interventions are important, proper case identification and accurate measurement of their impact depend on quality diagnostic testing. Current availability of diagnostic testing for malaria in sub-Saharan Africa is inadequate to support disease management, prevention programs, and surveillance needs. Challenges faced include a dearth of skilled workforce, inadequate health systems infrastructure, and lack of political will. A coordinated approach to providing pre-service clinical and laboratory training together with systems that support a scale-up of laboratory services could provide means not only for effective malaria case management but also, management of non-malaria febrile illnesses, disease surveillance, and accurate control program evaluation. A synthesis of the challenges faced in ensuring quality malaria testing and how to include this information in the malaria control and elimination agenda are presented.

Mitigating Provider Uncertainty in Service Provision Contracts

NASA Astrophysics Data System (ADS)

Smith, Chris; van Moorsel, Aad

Uncertainty is an inherent property of open, distributed and multiparty systems. The viability of the mutually beneficial relationships which motivate these systems relies on rational decision-making by each constituent party under uncertainty. Service provision in distributed systems is one such relationship. Uncertainty is experienced by the service provider in his ability to deliver a service with selected quality level guarantees due to inherent non-determinism, such as load fluctuations and hardware failures. Statistical estimators utilized to model this non-determinism introduce additional uncertainty through sampling error. Inability of the provider to accurately model and analyze uncertainty in the quality level guarantees can result in the formation of sub-optimal service provision contracts. Emblematic consequences include loss of revenue, inefficient resource utilization and erosion of reputation and consumer trust. We propose a utility model for contract-based service provision to provide a systematic approach to optimal service provision contract formation under uncertainty. Performance prediction methods to enable the derivation of statistical estimators for quality level are introduced, with analysis of their resultant accuracy and cost.

Incentives in Rheumatology: the Potential Contribution of Physician Responses to Financial Incentives, Public Reporting, and Treatment Guidelines to Health Care Sustainability.

PubMed

Harrison, Mark; Milbers, Katherine; Mihic, Tamara; Anis, Aslam H

2016-07-01

Concerns about the sustainability of current health care expenditure are focusing attention on the cost, quality and value of health care provision. Financial incentives, for example pay-for-performance (P4P), seek to reward quality and value in health care provision. There has long been an expectation that P4P schemes are coming to rheumatology. We review the available evidence about the use of incentives in this setting and provide two emerging examples of P4P schemes which may shape the future of service provision in rheumatology. Currently, there is limited and equivocal evidence in rheumatology about the impact of incentive schemes. However, reporting variation in the quality and provision of rheumatology services has highlighted examples of inefficiencies in the delivery of care. If financial incentives can improve the delivery of timely and appropriate care for rheumatology patients, then they may have an important role to play in the sustainability of health care provision.

Cultural Differences in Support Provision: The Importance of Relationship Quality.

PubMed

Chen, Jacqueline M; Kim, Heejung S; Sherman, David K; Hashimoto, Takeshi

2015-11-01

Emotional expression is highly valued in individualistic cultures, whereas emotional restraint is prioritized in collectivistic cultures. We hypothesized that high-quality relationships in these cultures would exhibit the forms of support provision congruent with their respective expectations. Study 1 examined support transactions among friends in response to a laboratory stressor and found that objectively judged relationship quality (RQ) more strongly positively predicted emotion-focused support provision behaviors by European Americans than by Asian Americans. Study 2, a questionnaire study, found that self-reported RQ predicted emotion-focused support provision more strongly among European Americans than among Japanese. Study 3 investigated more indirect forms of support and found that RQ more strongly predicted worrying about and monitoring close others enduring stressors and spending time with them without talking about the stressor among Asian Americans compared with European Americans. These findings suggest that RQ is expressed in terms of support provision in culturally normative ways. © 2015 by the Society for Personality and Social Psychology, Inc.

30 CFR 948.13 - State statutory and regulatory provisions set aside.

Code of Federal Regulations, 2010 CFR

2010-07-01

... wording in section 22A-3-23(c)(3) of the Code of West Virginia is inconsistent with section 519(c)(3) of..., That such a release may be made where the quality of the untreated postmining water discharged is...(e) of the Code of West Virginia is inconsistent with section 515(e) of the Surface Mining Control...

Open Learning Systems in Further Education. Some Aspects of Resource Management. Coombe Lodge Working Paper. Information Bank Number 1611.

ERIC Educational Resources Information Center

Birch, D. W.; Latcham, J.

Open learning systems require the development of learning materials. Potential economies of scale and quality control advantages argue in favor of the central development of materials packages. Instructors would be free to concentrate upon the provision of tutorial and counseling support and laboratory and workshop hands-on experience. Some method…

75 FR 36023 - Approval and Promulgation of Implementation Plans; Designation of Areas for Air Quality Planning...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-24

... a Maintenance Plan, Including a Contingency Plan, for the Area Under Section 175a of the CAA 1. An.... Contingency Provisions That EPA Deems Necessary to Promptly Correct Any Violation of the NAAQS That Occurs... available control measures, and contingency measures) no longer applies for so long as the area continues to...

75 FR 33421 - Supplemental Nutrition Assistance Program: Quality Control Provisions of Title IV of Public Law...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-11

... most recent approval of OMB Number 0584- 0034, the form FNS-247 (Statistical Summary of Sample... change paragraph (a) of 7 CFR 275.1 into a general introductory paragraph, and to remove 7 CFR 275.23(d... paragraphs (b)(1) and (2), changing paragraph (a) into a general introductory paragraph, and removing 7 CFR...

A fuzzy call admission control scheme in wireless networks

NASA Astrophysics Data System (ADS)

Ma, Yufeng; Gong, Shenguang; Hu, Xiulin; Zhang, Yunyu

2007-11-01

Scarcity of the spectrum resource and mobility of users make quality of service (QoS) provision a critical issue in wireless networks. This paper presents a fuzzy call admission control scheme to meet the requirement of the QoS. A performance measure is formed as a weighted linear function of new call and handoff call blocking probabilities. Simulation compares the proposed fuzzy scheme with an adaptive channel reservation scheme. Simulation results show that fuzzy scheme has a better robust performance in terms of average blocking criterion.

Report on Quality Control Review of the Raich Ende Malter & Co. LLP FY 2009 Single Audit of the Riverside Research Institute

DTIC Science & Technology

2012-03-07

compliance was based on a determination that 10 of the 14 compliance requirements were applicable to the Institute. However, the audit working papers...for all 14 of the compliance requirements were not adequate to support conclusions on applicability, internal control, and the audit opinion on...compliance with laws, regulations, and award provisions applicable to the R&D cluster program. In addition, the audit firm did not appropriately report an

Fostering High-Quality Teaching with an Enriched Curriculum and Professional Development Support: The Head Start REDI Program

PubMed Central

Domitrovich, Celene E.; Gest, Scott D.; Gill, Sukhdeep; Bierman, Karen L.; Welsh, Janet; Jones, Damon

2017-01-01

This randomized controlled trial tested whether teaching quality in Head Start classrooms could be improved with the addition of evidence-based curriculum components targeting emergent language/literacy and social-emotional development and the provision of associated professional development support. Participants were lead and assistant teachers in 44 Head Start classrooms. Teachers received 4 days of workshop training along with weekly in-class support from a mentor teacher. End-of-year observations indicated that, compared to the control group, intervention teachers talked with children more frequently and in more cognitively complex ways, established a more positive classroom climate, and used more preventive behavior management strategies. Results supported the conclusion that enriched curriculum components and professional development support can produce improvements in multiple domains of teaching quality. PMID:29081534

The Impact of the Prospective Payment System for Skilled Nursing Facilities on Therapy Service Provision: A Transaction Cost Approach

PubMed Central

Zinn, Jacqueline S; Mor, Vincent; Intrator, Orna; Feng, Zhanlian; Angelelli, Joseph; Davis, Jullet A

2003-01-01

Objective To examine skilled nursing facilities (SNFs) “make-or-buy” decisions with respect to rehabilitation therapy service provision in the 1990s, both before and after implementation of Medicare's Prospective Payment System (PPS) for SNFs. Data Sources Longitudinal On-line Survey Certification and Reporting (OSCAR) data (1992–2001) on a sample of 10,241 freestanding urban SNFs. Study Design We estimated a longitudinal multinomial logistic regression model derived from transaction cost economic theory to predict the probability of the outcome in each of four service provision categories (all employed staff, all contract, mixed, and no services provided). Principal Findings Transaction frequency, uncertainty, and complexity result in greater control over therapy services through employment as opposed to outside contracting. For-profit status and chain affiliation were associated with greater control over therapy services. Following PPS, nursing homes acted to limit transaction costs by either exiting the rehabilitation market or exerting greater control over therapy services by managing rehabilitation services in-house. Conclusions The financial incentives associated with changes in reimbursement methodology have implications that extend beyond the boundaries of the health care industry segment directly affected. Unintended quality and access consequences need to be carefully monitored by the Medicare program. PMID:14727783

Exploring the impact of austerity-driven policy reforms on the quality of the long-term care provision for older people in Belgium and the Netherlands.

PubMed

Janssen, David; Jongen, Wesley; Schröder-Bäck, Peter

2016-08-01

In this case study, European quality benchmarks were used to explore the contemporary quality of the long-term care provision for older people in the Belgian region of Flanders and the Netherlands following recent policy reforms. Semi-structured qualitative interviews were conducted with various experts on the long-term care provision. The results show that in the wake of the economic crisis and the reforms that followed, certain vulnerable groups of older people in Belgium and the Netherlands are at risk of being deprived of long-term care that is available, affordable and person-centred. Various suggestions were provided on how to improve the quality of the long-term care provision. The main conclusion drawn in this study is that while national and regional governments set the stage through regulatory frameworks and financing mechanisms, it is subsequently up to long-term care organisations, local social networks and informal caregivers to give substance to a high quality long-term care provision. An increased reliance on social networks and informal caregivers is seen as vital to ensure the sustainability of the long-term care systems in Belgium and in the Netherlands, although this simultaneously introduces new predicaments and difficulties. Structural governmental measures have to be introduced to support and protect informal caregivers and informal care networks. Copyright © 2016 Elsevier Inc. All rights reserved.

A randomized trial of peer review: the UK National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project: three-year evaluation.

PubMed

Roberts, Christopher M; Stone, Robert A; Buckingham, Rhona J; Pursey, Nancy A; Lowe, Derek; Potter, Jonathan M

2012-06-01

Peer review has been widely used within the National Health Service to facilitate health quality improvement but evaluation has been limited particularly over the longer-term. Change within the National Health Service (NHS) can take a prolonged period--1-2 years--to occur. We report here a 3-year evaluation of the largest randomized trial of peer review ever conducted in the UK. To evaluate whether targeted mutual peer review of respiratory units brings about improvements in services for chronic obstructive pulmonary disease (COPD) over 3 years. The peer review intervention was a reciprocal supportive exercise that included clinicians, hospital management, commissioners and patients, which focused on the quality of the provision of four specific evidence-based aspects of COPD care. Follow-up at 36 months demonstrated limited significant quantitative differences in the quality of services offered in the two groups but a strong trend in favour of intervention sites. Qualitative data suggested many benefits of peer review in most but not all intervention units and some control teams. The data identify factors that promote and obstruct change. The findings demonstrate significant change in service provision over 3 years in both control and intervention sites with great variability in both groups. The combined quantitative and qualitative findings indicate that targeted mutual peer review is associated with improved quality of care, improvements in service delivery and with changes within departments that promote and are precursors to quality improvement. The generic findings of this study have potential implications for the application of peer review throughout the NHS. © 2011 Blackwell Publishing Ltd.

29 CFR 458.32 - Provision for accounting and financial controls.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 2 2010-07-01 2010-07-01 false Provision for accounting and financial controls. 458.32... Additional Provisions Applicable § 458.32 Provision for accounting and financial controls. Every labor organization shall provide accounting and financial controls necessary to assure the maintenance of fiscal...

Patterns of Father Self Evaluations among Mexican and European American Men and Links to Adolescent Adjustment

PubMed Central

Perez-Brena, Norma J.; Cookston, Jeffrey T.; Fabricius, William V.; Saenz, Delia

2013-01-01

A mixed-method study identified profiles of fathers who mentioned key dimensions of their parenting and linked profile membership to adolescents’ adjustment using data from 337 European American, Mexican American and Mexican immigrant fathers and their early adolescent children. Father narratives about what fathers do well as parents were thematically coded for the presence of five fathering dimensions: emotional quality (how well father and child get along), involvement (amount of time spent together), provisioning (the amount of resources provided), discipline (the amount and success in parental control), and role modeling (teaching life lessons through example). Next, latent class analysis was used to identify three patterns of the likelihood of mentioning certain fathering dimensions: an emotionally-involved group mentioned emotional quality and involvement; an affective-control group mentioned emotional quality, involvement, discipline and role modeling; and an affective-model group mentioned emotional quality and role modeling. Profiles were significantly associated with subsequent adolescents’ reports of adjustment such that adolescents of affective-control fathers reported significantly more externalizing behaviors than adolescents of emotionally-involved fathers. PMID:24883049

The intercultural and interracial therapeutic relationship: challenges and recommendations.

PubMed

Qureshi, Adil; Collazos, Francisco

2011-01-01

Although research has demonstrated that mental health services function with patients from different cultural backgrounds, a variety of culture- and race-related factors can result in services being of lower quality than that which occurs when the clinician and patient are from the same culture. The provision of culturally competent care requires many institutional and organizational adaptations that lie beyond the control of most mental health professionals. The therapeutic relationship, however, remains a key factor of mental healthcare that can be attended to by individual therapists. The therapeutic relationship plays an important role in almost every therapeutic approach, and has been increasingly recognized as representing a means to the provision of quality intercultural and interracial treatment. At the same time, a host of cultural and racial factors relating to both the patient and clinician can compromise the development of the therapeutic relationship. This paper will explore some of the key issues that complicate therapeutic contact and communication, and will outline means by which to strengthen key components of the therapeutic relationship.

Promoting Distance Learners' Cognitive Engagement and Learning Outcomes: Design-Based Research in the Costa Rican National University of Distance Education

ERIC Educational Resources Information Center

Joo, K. P.; Andrés, Carmen; Shearer, Rick

2014-01-01

To explore effective learning design for students' cognitive engagement, a design-based case study was conducted in a quality control course in the Costa Rican National University of Distance Education between the 2011 and 2012 academic years. The course was revised for the 2012 provision in terms of the assignment structure, the number of…

Quality competition and hospital mergers-An experiment.

PubMed

Han, Johann; Kairies-Schwarz, Nadja; Vomhof, Markus

2017-12-01

On the basis of a Salop model with regulated prices, we investigate quality provision behaviour of competing hospitals before and after a merger. For this, we use a controlled laboratory experiment where subjects decided on the level of treatment quality as head of a hospital. We find that the post-merger average quality is significantly lower than the average pre-merger quality. However, for merger insiders and outsiders, average quality choices are significantly higher than predicted for pure profit-maximising hospitals. This upward deviation is potentially driven by altruistic behaviour towards patients. Furthermore, we find that in the case where sufficient cost synergies are realised by the merged hospitals, there is a significant increase in average quality choices compared to the scenario without synergies. Finally, we find that our results do not change when comparing individual decisions to team decisions. Copyright © 2017 John Wiley & Sons, Ltd.

Women's satisfaction and perception of control in childbirth in three Arab countries.

PubMed

Kabakian-Khasholian, Tamar; Bashour, Hyam; El-Nemer, Amina; Kharouf, Mayada; Sheikha, Salah; El Lakany, Nasser; Barakat, Rafik; Elsheikh, Ohoud; Nameh, Nadia; Chahine, Rabih; Portela, Anayda

2017-10-01

Women's satisfaction and perceived control in childbirth are important attributes of the childbirth experience and quality of care indicators. This article presents findings from the pre-intervention phase of a multi-centre implementation study in Egypt, Lebanon and Syria, to introduce a labour companionship model in these countries. A sample of 2620 women giving birth in three public teaching hospitals from November 2014 to July 2015 in Beirut and Mansoura, and from November 2014 to April 2015 in Damascus were interviewed by trained field workers. Additional information was abstracted from medical charts. An adapted version of the Mackey Childbirth Satisfaction Rating Scale was used to measure women's satisfaction and the shortened version of the Labor Agentry Scale was used to assess perception of control. The total satisfaction score was high in all sites with the lowest being in Egypt. Perceived control was directly related to satisfaction. Women with low education levels had higher levels of childbirth satisfaction. Women who had fewer children from Egypt and Lebanon, and those who received care by a team including both male and female physicians in the Syrian hospital were more likely to be dissatisfied than their counterparts. Variations in the management and provision of care between the three countries may explain the differences in satisfaction levels observed. Further qualitative research is needed to deepen our understanding of the concepts of control and satisfaction in the Arab culture as well as to establish the factors associated with women's positive childbirth experiences to inform the provision of quality maternity care.

Quality of service provision assessment in the healthcare information and telecommunications infrastructures.

PubMed

Babulak, Eduard

2006-01-01

The continuous increase in the complexity and the heterogeneity of corporate and healthcare telecommunications infrastructures will require new assessment methods of quality of service (QoS) provision that are capable of addressing all engineering and social issues with much faster speeds. Speed and accessibility to any information at any time from anywhere will create global communications infrastructures with great performance bottlenecks that may put in danger human lives, power supplies, national economy and security. Regardless of the technology supporting the information flows, the final verdict on the QoS is made by the end user. The users' perception of telecommunications' network infrastructure QoS provision is critical to the successful business management operation of any organization. As a result, it is essential to assess the QoS Provision in the light of user's perception. This article presents a cost effective methodology to assess the user's perception of quality of service provision utilizing the existing Staffordshire University Network (SUN) by adding a component of measurement to the existing model presented by Walker. This paper presents the real examples of CISCO Networking Solutions for Health Care givers and offers a cost effective approach to assess the QoS provision within the campus network, which could be easily adapted to any health care organization or campus network in the world.

Nuclear safety: is NRC enforcement working. Hearing before a Subcommittee of the Committee on Government Operations, House of Representatives, Ninety-Seventh Congress, First Session, December 14, 1981

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

Not Available

Nunzio Palladino, the new Chairman of the Nuclear Regulatory Commission, and associates testified at this hearing on the effectiveness of NRC's enforcement program and responded to allegations that quality assurance is inadequate. At issue were the value of NRC fines as a deterrent to utility misconduct and the NRC's reluctance to pursue new provisions for criminal penalties. Mr. Palladino was welcomed and applauded for his strong statements on the nuclear industry's need for strict quality control. (DCK)

The role of veterinary research laboratories in the provision of veterinary services.

PubMed

Verwoerd, D W

1998-08-01

Veterinary research laboratories play an essential role in the provision of veterinary services in most countries. These laboratories are the source of new knowledge, innovative ideas and improved technology for the surveillance, prevention and control of animal diseases. In addition, many laboratories provide diagnostic and other services. To ensure the optimal integration of various veterinary activities, administrators must understand the functions and constraints of research laboratories. Therefore, a brief discussion is presented of the following: organisational structures methods for developing research programmes outputs of research scientists and how these are measured the management of quality assurance funding of research. Optimal collaboration can only be attained by understanding the environment in which a research scientist functions and the motivational issues at stake.

Control of infection in an international airline.

PubMed

Kelly, M

1993-05-01

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

The Impact of Involving Students in Managing the Quality of Higher Education Provision

ERIC Educational Resources Information Center

Garwe, Evelyn Chiyevo

2015-01-01

This study was aimed at exploring the power of student involvement in improving quality of higher educational provision in private higher education institutions in Zimbabwe. A longitudinal approach involving two separate surveys and covering a period of three years was used. A preliminary survey aimed at assessing the issues that impact negatively…

Developing Professional Early Childhood Educators in England and Hungary: Where Has All the Love Gone?

ERIC Educational Resources Information Center

Campbell-Barr, Verity; Georgeson, Janet; Varga, Anikó Nagy

2015-01-01

European education agendas have emphasized the importance of early childhood education in providing the foundations for lifelong learning. Central to the success of early childhood education is the quality of provision, with the workforce being key. While qualifications levels are frequently cited as important for the quality of provision here we…

The Bottom Line: Quality/Consumer-Oriented Child Care.

ERIC Educational Resources Information Center

Jackson, Cheryl D.

Arguing that the provision of child care services is consistent with the role of the community college, this paper provides an overview of the current demand for and delivery of child care services and briefly discusses ways in which community colleges can assist in the development and provision of consumer-oriented, high-quality child care.…

75 FR 70487 - Proposed Rules for Implementing the Whistleblower Provisions of Section 21F of the Securities...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

.... With this possible tension in mind, we have included provisions in the proposed rules intended not to... submission of high- quality tips and to enhance the utility of the information reported to the Commission. More frequent reporting of high-quality information promotes greater deterrence by enhancing the...

Quality of pharmaceutical care at the pharmacy counter: patients' experiences versus video observation.

PubMed

Koster, Ellen S; Blom, Lyda; Overbeeke, Marloes R; Philbert, Daphne; Vervloet, Marcia; Koopman, Laura; van Dijk, Liset

2016-01-01

Consumer Quality Index questionnaires are used to assess quality of care from patients' experiences. To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations. Pharmaceutical encounters in four pharmacies were video-recorded. Patients completed a questionnaire based upon the Consumer Quality Index Pharmaceutical Care after the encounter containing questions about patients' experiences regarding information provision, medication counseling, and pharmacy staff's communication style. An observation protocol was used to code the recorded encounters. Agreement between video observation and patients' experiences was calculated. In total, 109 encounters were included for analysis. For the domains "medication counseling" and "communication style", agreement between patients' experiences and observations was very high (>90%). Less agreement (45%) was found for "information provision", which was rated more positive by patients compared to the observations, especially for the topic, encouragement of patients' questioning behavior. A questionnaire is useful to assess the quality of medication counseling and pharmacy staff's communication style, but might be less suitable to evaluate information provision and pharmacy staff's encouragement of patients' questioning behavior. Although patients may believe that they have received all necessary information to use their new medicine, some information on specific instructions was not addressed during the encounter. When using questionnaires to get insight into information provision, observations of encounters are very informative to validate the patient questionnaires and make necessary adjustments.

Quality Control in K-12 Digital Learning: Three (Imperfect) Approaches. Creating Healthy Policy for Digital Learning. A Working Paper Series from the Thomas B. Fordham Institute

ERIC Educational Resources Information Center

Hess, Frederick M.

2011-01-01

Digital learning makes possible the "unbundling" of school provisions--that is, it allows children to be served by providers from almost anywhere, in new and more customized ways. At the same time, because it destandardizes and decentralizes educational delivery, digital education is far harder to bring under the yoke of the…

Symbiotic essential amino acids provisioning in the American cockroach, Periplaneta americana (Linnaeus) under various dietary conditions.

PubMed

Ayayee, Paul A; Larsen, Thomas; Sabree, Zakee

2016-01-01

Insect gut microbes have been shown to provide nutrients such as essential amino acids (EAAs) to their hosts. How this symbiotic nutrient provisioning tracks with the host's demand is not well understood. In this study, we investigated microbial essential amino acid (EAA) provisioning in omnivorous American cockroaches (Periplaneta americana), fed low-quality (LQD) and comparatively higher-quality dog food (DF) diets using carbon stable isotope ratios of EAAs (δ (13)CEAA). We assessed non-dietary EAA input, quantified as isotopic offsets (Δ(13)C) between cockroach (δ (13)CCockroach EAA) and dietary (δ (13)CDietary EAA) EAAs, and subsequently determined biosynthetic origins of non-dietary EAAs in cockroaches using (13)C-fingerprinting with dietary and representative bacterial and fungal δ (13)CEAA. Investigation of biosynthetic origins of de novo non-dietary EAAs indicated bacterial origins of EAA in cockroach appendage samples, and a mixture of fungal and bacterial EAA origins in gut filtrate samples for both LQD and DF-fed groups. We attribute the bacteria-derived EAAs in cockroach appendages to provisioning by the fat body residing obligate endosymbiont, Blattabacterium and gut-residing bacteria. The mixed signatures of gut filtrate samples are attributed to the presence of unassimilated dietary, as well as gut microbial (bacterial and fungal) EAAs. This study highlights the potential impacts of dietary quality on symbiotic EAA provisioning and the need for further studies investigating the interplay between host EAA demands, host dietary quality and symbiotic EAA provisioning in response to dietary sufficiency or deficiency.

7 CFR 457.111 - Pear crop insurance provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... alternating or mixed pattern. Marketable. Pear production acceptable for processing or other human consumption... irrigation water supply, if caused by an insured peril that occurs during the insurance period. (b) In... provisions of the Basic Provisions are not applicable. 13. Pear Quality Adjustment Endorsement (a) This...

40 CFR 51.1102 - Classification and nonattainment area planning provisions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 2 2014-07-01 2014-07-01 false Classification and nonattainment area planning provisions. 51.1102 Section 51.1102 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Provisions for Implementation of the 2008 Ozone National Ambient Air Quality Standards § 51.1102...

40 CFR 51.1102 - Classification and nonattainment area planning provisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 2 2013-07-01 2013-07-01 false Classification and nonattainment area planning provisions. 51.1102 Section 51.1102 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Provisions for Implementation of the 2008 Ozone National Ambient Air Quality Standards § 51.1102...

40 CFR 51.1102 - Classification and nonattainment area planning provisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 2 2012-07-01 2012-07-01 false Classification and nonattainment area planning provisions. 51.1102 Section 51.1102 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Provisions for Implementation of the 2008 Ozone National Ambient Air Quality Standards § 51.1102...

Design of QoS-Aware Multi-Level MAC-Layer for Wireless Body Area Network.

PubMed

Hu, Long; Zhang, Yin; Feng, Dakui; Hassan, Mohammad Mehedi; Alelaiwi, Abdulhameed; Alamri, Atif

2015-12-01

With the advances in wearable computing and various wireless technologies, there is an increasing trend to outsource body signals from wireless body area network (WBAN) to outside world including cyber space, healthcare big data clouds, etc. Since the environmental and physiological data collected by multimodal sensors have different importance, the provisioning of quality of service (QoS) for the sensory data in WBAN is a critical issue. This paper proposes multiple level-based QoS design at WBAN media access control layer in terms of user level, data level and time level. In the proposed QoS provisioning scheme, different users have different priorities, various sensory data collected by different sensor nodes have different importance, while data priority for the same sensor node varies over time. The experimental results show that the proposed multi-level based QoS provisioning solution in WBAN yields better performance for meeting QoS requirements of personalized healthcare applications while achieving energy saving.

The effect of additional physiotherapy to hospital inpatients outside of regular business hours: a systematic review.

PubMed

Brusco, Natasha K; Paratz, Jennifer

2006-12-01

Provision of out of regular business hours (OBH) physiotherapy to hospital inpatients is widespread in the hospital setting. This systematic review evaluated the effect of additional OBH physiotherapy services on patient length of stay (LOS), pulmonary complications, discharge destination, discharge mobility status, quality of life, cost saving, adverse events, and mortality compared with physiotherapy only within regular business hours. A literature search was completed on databases with citation tracking using key words. Two reviewers completed data extraction and quality assessment independently by using modified scales for historical cohorts and case control studies as well as the PEDro scale for randomized controlled trials and quasi-randomised controlled trials. This search identified nine articles of low to medium quality. Four reported a significant reduction in LOS associated with additional OBH physiotherapy, with two articles reporting overall significance and two reporting only for specific subgroups. Two studies reported significant reduction in pulmonary complications for two different patient groups in an intensive care unit (ICU) with additional OBH physiotherapy. Three studies accounted for discharge destination and/or discharge mobility status with no significant difference reported. Quality of life, adverse events, and mortality were not reported in any studies. Cost savings were considered in three studies, with two reporting a cost saving. This systematic review was unable to conclude that the provision of additional OBH physiotherapy made significant improvement to patient outcomes for all subgroups of inpatients. One study in critical care reported that overnight physiotherapy decreased LOS and reduced pulmonary complications of patients in the ICU. However, the studies in the area of orthopaedics, neurology, postcardiac surgery, and rheumatology, which all considered additional daytime weekend physiotherapy intervention, did not provide strong evidence to indicate effective reduction in patient LOS or improving patient discharge mobility status or discharge destination. Investigation should continue in this area, but future trials should ensure factors such as random allocation, groups equal at baseline, blinded investigators, and proven intervention are included in the study design.

76 FR 47068 - Approval and Promulgation of Air Quality Implementation Plans; Delaware; Section 110(a)(2...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-04

... concerns involving provisions in existing SIPs and with EPA's statements in other proposals that it would...) Existing provisions related to excess emissions during periods of start-up, shutdown, or malfunction (SSM... (ii) existing provisions related to ``director's variance'' or ``director's discretion'' that purport...

Comprehensive assessment of toxic emissions from coal-fired power plants

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

NONE

1996-09-01

The 1990 Clean Air Act Amendments (CAAA) have two primary goals: pollution prevention and a market-based least-cost approach to emission control. To address air quality issues as well as permitting and enforcement, the 1990 CAAA contain 11 sections or titles. The individual amendment titles are as follows: Title I - National Ambient Air Quality Standards Title II - Mobile Sources Title III - Hazardous Air Pollutants Title IV - Acid Deposition Control Title V - Permits Title VI - Stratospheric Ozone Protection Chemicals Title VII - Enforcement Title VIII - Miscellaneous Provisions Title IX - Clean Air Research Title Xmore » - Disadvantaged Business Concerns Title XI - Clean Air Employment Transition Assistance Titles I, III, IV, and V will change or have the potential to change how operators of coal-fired utility boilers control, monitor, and report emissions. For the purpose of this discussion, Title III is the primary focus.« less

75 FR 56423 - Approval and Promulgation of Implementation Plans; Texas; Revisions to the New Source Review (NSR...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-15

...EPA is taking final action to disapprove submittals from the State of Texas, through the Texas Commission on Environmental Quality (TCEQ), to revise the Texas Major and Minor NSR SIP. We are disapproving the submittals because they do not meet the 2002 revised Major NSR SIP requirements. We are also disapproving the submittals as not meeting the Major Nonattainment NSR SIP requirements for implementation of the 1997 8-hour ozone national ambient air quality standard (NAAQS) and the 1-hour ozone NAAQS. EPA is disapproving the submitted Standard Permit (SP) for Pollution Control Projects (PCP) because it does not meet the requirements of the CAA for a minor NSR Standard Permit program. Finally, EPA is also disapproving a submitted severable definition of best available control technology (BACT) that is used by TCEQ in its Minor NSR SIP permitting program. EPA is not addressing the submitted revisions concerning the Texas Major PSD NSR SIP, which will be addressed in a separate action. EPA is taking no action on severable provisions that implement section 112(g) of the Act and is restoring a clarification to an earlier action that removed an explanation that a particular provision is not in the SIP because it implements section 112(g) of the Act. EPA is not addressing severable revisions to definitions submitted June 10, 2005, submittal, which will be addressed in a separate action. We are taking no action on a severable provision relating to Emergency and Temporary Orders, which we will address in a separate action. EPA is taking these actions under section 110, part C, and part D, of the Federal Clean Air Act (the Act or CAA).

Management to Insulate Ecosystem Services from the Effects of Catchment Development

NASA Astrophysics Data System (ADS)

Gell, Peter

2018-02-01

Natural ecosystems provide amenity to human populations in the form of ecosystem services. These services are grouped into four broad categories: provisioning - food and water production; regulating - control of climate and disease; supporting - crop pollination; and cultural - spiritual and recreational benefits. Aquatic systems provide considerable service through the provision of potable water, fisheries and aquaculture production, nutrient mitigation and the psychological benefits that accrue from the aesthetic amenity provided from lakes, rivers and other wetlands. Further, littoral and riparian ecosystems, and aquifers, protect human communities from sea level encroachment, and tidal and river flooding. Catchment and water development provides critical resources for human consumption. Where these provisioning services are prioritized over others, the level and quality of production may be impacted. Further, the benefits from these provisioning services comes with the opportunity cost of diminishing regulating, supporting and cultural services. This imbalance flags concerns for humanity as it exceeds recognised safe operating spaces. These concepts are explored by reference to long term records of change in some of the world's largest river catchments and lessons are drawn that may enable other communities to consider the balance of ecosystems services in natural resource management.

Arrangements for Assuring and Improving the Quality of Provision and Services in Scotland's Colleges

ERIC Educational Resources Information Center

Education Scotland, 2016

2016-01-01

The Scottish Funding Council (SFC) with Education Scotland is introducing new arrangements for assuring and improving the quality of provision delivered by Scotland's colleges commencing in AY 2016-17. The arrangements have been developed by Education Scotland and SFC at the end of a four-year cycle of external arrangements for review of colleges.…

Translation of the UNESCO/OECD Guidelines for Quality Provision in Cross-Border Higher Education into Local Policy Contexts: A Comparative Study of Finland and Russia

ERIC Educational Resources Information Center

Kallo, Johanna; Semchenko, Anzhelika

2016-01-01

This article analyses the localisation of the United Nations Educational Scientific and Cultural Organisation (UNESCO)/Organisation for Economic Co-operation and Development (OECD) "Guidelines for Quality Provision in Cross-Border Higher Education" (2005) at the national and university levels in Finland and Russia. The article engages…

The Continuing Development of Primary Sector Physical Education: Working Together to Raise Quality of Provision

ERIC Educational Resources Information Center

Sloan, Stephen

2010-01-01

This paper sets out to provide further insight as to the reasons why many schools within the primary sector continue to find it difficult to ensure quality provision for physical education (PE) and school sport. It examines why class teachers, including the subject coordinator, possess concerns about teaching PE. It asks the question of who is…

Physicians' perceptions of managed care.

PubMed

Levine, R A; Lieberson, A

1998-02-01

We wished to determine physicians' views and knowledge of managed care, particularly their beliefs about the provisions of managed care contracts in terms of legality and ethics. A questionnaire was sent to the 315 physicians of the medical staff of Norwalk Hospital in Connecticut regarding managed care and managed care contracts. Sixty-six responses were received within a 45-day period (20.9% return). Although only 1 of 11 contract provisions presented in one section of the questionnaire was illegal in Connecticut, a majority of physicians believed 7 of the 11 were illegal. On average, 50% of physicians polled thought each of the provisions was illegal, and a varying majority of physicians (53% to 95.4%) felt the various provisions were unethical. The majority of respondents (84.8% to 92.4%) believed that nondisclosure provisions were unethical. Ninety-seven percent thought managed care interferes with quality of care, and 72.7% of physicians felt that the managed care industry should be held legally responsible for ensuring quality of care. However, 92.4% of physicians considered themselves to be ethically responsible for ensuring quality of care. Physicians have a poor understanding of the legal aspects of managed care contracts but feel strongly that many provisions of these contracts are unethical. Physicians also believe that managed care is causing medicine to be practiced in a manner that is contrary to patients' interests and that legal recourse is needed to prevent this.

Efficiency of antenatal care and childbirth services in selected primary health care facilities in rural Tanzania: a cross-sectional study.

PubMed

Saronga, Happiness P; Duysburgh, Els; Massawe, Siriel; Dalaba, Maxwell A; Savadogo, Germain; Tonchev, Pencho; Dong, Hengjin; Sauerborn, Rainer; Loukanova, Svetla

2014-02-28

Cost studies are paramount for demonstrating how resources have been spent and identifying opportunities for more efficient use of resources. The main objective of this study was to assess the actual dimension and distribution of the costs of providing antenatal care (ANC) and childbirth services in selected rural primary health care facilities in Tanzania. In addition, the study analyzed determining factors of service provision efficiency in order to inform health policy and planning. This was a retrospective quantitative cross-sectional study conducted in 11 health centers and dispensaries in Lindi and Mtwara rural districts. Cost analysis was carried out using step down cost accounting technique. Unit costs reflected efficiency of service provision. Multivariate regression analysis on the drivers of observed relative efficiency in service provision between the study facilities was conducted. Reported personnel workload was also described. The health facilities spent on average 7 USD per capita in 2009. As expected, fewer resources were spent for service provision at dispensaries than at health centers. Personnel costs contributed a high approximate 44% to total costs. ANC and childbirth consumed approximately 11% and 12% of total costs; and 8% and 10% of reported service provision time respectively. On average, unit costs were rather high, 16 USD per ANC visit and 79.4 USD per childbirth. The unit costs showed variation in relative efficiency in providing the services between the health facilities. The results showed that efficiency in ANC depended on the number of staff, structural quality of care, process quality of care and perceived quality of care. Population-staff ratio and structural quality of basic emergency obstetric care services highly influenced childbirth efficiency. Differences in the efficiency of service provision present an opportunity for efficiency improvement. Taking into consideration client heterogeneity, quality improvements are possible and necessary. This will stimulate utilization of ANC and childbirth services in resource-constrained health facilities. Efficiency analyses through simple techniques such as measurement of unit costs should be made standard in health care provision, health managers can then use the performance results to gauge progress and reward efficiency through performance based incentives.

The quasi-market for adult residential care in the UK: Do for-profit, not-for-profit or public sector residential care and nursing homes provide better quality care?

PubMed

Barron, David N; West, Elizabeth

2017-04-01

There has been a radical transformation in the provision of adult residential and nursing home care in England over the past four decades. Up to the 1980s, over 80% of adult residential care was provided by the public sector, but today public sector facilities account for only 8% of the available places, with the rest being provided by a mixture of for-profit firms (74%) and non-profit charities (18%). The public sector's role is often now that of purchaser (paying the fees of people unable to afford them) and regulator. While the idea that private companies may play a bigger role in the future provision of health care is highly contentious in the UK, the transformation of the residential and nursing home care has attracted little comment. Concerns about the quality of care do emerge from time to time, often stimulated by high profile media investigations, scandals or criminal prosecutions, but there is little or no evidence about whether or not the transformation of the sector from largely public to private provision has had a beneficial effect on those who need the service. This study asks whether there are differences in the quality of care provided by public, non-profit or for-profit facilities in England. We use data on care quality for over 15,000 homes that are provided by the industry regulator in England: the Care Quality Commission (CQC). These data are the results of inspections carried out between April 2011 and October 2015. Controlling for a range of facility characteristics such as age and size, proportional odds logistic regression showed that for-profit facilities have lower CQC quality ratings than public and non-profit providers over a range of measures, including safety, effectiveness, respect, meeting needs and leadership. We discuss the implications of these results for the ongoing debates about the role of for-profit providers of health and social care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Perceptions of quality across the maternal care continuum in the context of a health financing intervention: Evidence from a mixed methods study in rural Malawi.

PubMed

Kambala, Christabel; Lohmann, Julia; Mazalale, Jacob; Brenner, Stephan; Sarker, Malabika; Muula, Adamson S; De Allegri, Manuela

2017-06-08

In 2013, Malawi with its development partners introduced a Results-Based Financing for Maternal and Newborn Health (RBF4MNH) intervention to improve the quality of maternal and newborn health-care services. Financial incentives are awarded to health facilities conditional on their performance and to women for delivering in the health facility. We assessed the effect of the RBF4MNH on quality of care from women's perspectives. We used a mixed-method prospective sequential controlled pre- and post-test design. We conducted 3060 structured client exit interviews, 36 in-depth interviews and 29 focus group discussions (FGDs) with women and 24 in-depth interviews with health service providers between 2013 and 2015. We used difference-in-differences regression models to measure the effect of the RBF4MNH on experiences and perceived quality of care. We used qualitative data to explore the matter more in depth. We did not observe a statistically significant effect of the intervention on women's perceptions of technical care, quality of amenities and interpersonal relations. However, in the qualitative interviews, most women reported improved health service provision as a result of the intervention. RBF4MNH increased the proportion of women reporting to have received medications/treatment during childbirth. Participants in interviews expressed that drugs, equipment and supplies were readily available due to the RBF4MNH. However, women also reported instances of neglect, disrespect and verbal abuse during the process of care. Providers attributed these negative instances to an increased workload resulting from an increased number of women seeking services at RBF4MNH facilities. Our qualitative findings suggest improvements in the availability of drugs and supplies due to RBF4MNH. Despite the intervention, challenges in the provision of quality care persisted, especially with regard to interpersonal relations. RBF interventions may need to consider including indicators that specifically target the provision of respectful maternity care as a means to foster providers' positive attitudes towards women in labour. In parallel, governments should consider enhancing staff and infrastructural capacity before implementing RBF.

Quality of antenatal care and client satisfaction in Kenya and Namibia.

PubMed

Do, Mai; Wang, Wenjuan; Hembling, John; Ametepi, Paul

2017-04-01

Despite much progress in maternal health service coverage, the quality of care has not seen parallel improvement. This study assessed the quality of antenatal care (ANC), an entry point to the health system for many women. The study used data from recent Service Provision Assessment (SPA) surveys of nationally representative health facilities in Kenya and Namibia. Kenya and Namibia represent the situation in much of sub-Saharan Africa, where ANC is relatively common but maternal mortality remains high. The SPA comprised an inventory of health facilities that provided ANC, interviews with ANC providers and clients, and observations of service delivery. Not applicable. Quality was measured in terms of structure and process of service provision, and client satisfaction as the outcome of service provision. Wide variations in structural and process attributes of quality of care existed in both Kenya and Namibia; however, better structural quality did not translate to better service delivery process or greater client satisfaction. Long waiting time was a common problem and was generally more serious in hospitals and health centers than in clinics and smaller facilities; it was consistently associated with lower client satisfaction. The study also indicates that the provider's technical preparedness may not be sufficient to provide good-quality services and to ensure client satisfaction. Findings highlight important program implications, including improving ANC services and promoting their use at health clinics and lower-level facilities, and ensuring that available supplies and equipment are used for service provision. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Using Quality of Family Life Factors to Explore Parents' Experience of Educational Provision for Children with Developmental Disabilities in Rural Australia

ERIC Educational Resources Information Center

Tait, Kathleen; Hussain, Rafat

2017-01-01

Australian education service provision includes the delivery of quality educational programmes to rural and remote living children. However, according to their parents, many children with developmental disabilities (such as Down Syndrome and Autism Spectrum Disorders) who are living in rural country areas in New South Wales (NSW) still do not have…

Principals' Responses to the Teacher Quality Provision of the No Child Left behind Act of 2001

ERIC Educational Resources Information Center

Flynn, Michael Lawrence

2012-01-01

Since the passage of the No Child Left Behind legislation in 2002, principals have been held accountable for fulfilling a segment of it known as the Teacher Quality provision. This study examines how principals with varying levels of capacity to address the problem were either successful or unsuccessful in meeting the mandate using a wide variety…

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-01-01

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

Effects of varying ruminally undegradable protein supplementation on forage digestion, nitrogen metabolism, and urea kinetics in Nellore cattle fed low-quality tropical forage.

PubMed

Batista, E D; Detmann, E; Titgemeyer, E C; Valadares Filho, S C; Valadares, R F D; Prates, L L; Rennó, L N; Paulino, M F

2016-01-01

Effects of supplemental RDP and RUP on nutrient digestion, N metabolism, urea kinetics, and muscle protein degradation were evaluated in Nellore heifers () consuming low-quality signal grass hay (5% CP and 80% NDF, DM basis). Five ruminally and abomasally cannulated Nellore heifers (248 ± 9 kg) were used in a 5 × 5 Latin square. Treatments were the control (no supplement) and RDP supplementation to meet 100% of the RDP requirement plus RUP provision to supply 0, 50, 100, or 150% of the RUP requirement. Supplemental RDP (casein plus NPN) was ruminally dosed twice daily, and RUP supply (casein) was continuously infused abomasally. Jugular infusion of [NN]-urea with measurement of enrichment in urine was used to evaluate urea kinetics. The ratio of urinary 3-methylhistidine to creatinine was used to estimate skeletal muscle protein degradation. Forage NDF intake (2.48 kg/d) was not affected ( ≥ 0.37) by supplementation, but supplementation did increase ruminal NDF digestion ( < 0.01). Total N intake (by design) and N retention increased ( < 0.001) with supplementation and also linearly increased with RUP provision. Urea entry rate and gastrointestinal entry rate of urea were increased by supplementation ( < 0.001). Supplementation with RUP linearly increased ( = 0.02) urea entry rate and tended ( = 0.07) to linearly increase gastrointestinal entry rate of urea. Urea use for anabolic purposes tended ( = 0.07) to be increased by supplementation, and RUP provision also tended ( = 0.08) to linearly increase the amount of urea used for anabolism. The fraction of recycled urea N incorporated into microbial N was greater ( < 0.001) for control (22%) than for supplemented (9%) heifers. Urinary 3-methylhistidine:creatinine of control heifers was more than double that of supplemented heifers ( < 0.001). Control heifers reabsorbed a greater ( < 0.001) fraction of urea from the renal tubule than did supplemented heifers. Overall, unsupplemented heifers had greater mobilization of AA from myofibrillar protein, which provided N for urea synthesis and subsequent recycling. Supplemental RUP, when RDP was supplied, not only increased N retention but also supported increased urea N recycling and increased ruminal microbial protein synthesis.

Measuring client satisfaction and the quality of family planning services: A comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana

PubMed Central

2011-01-01

Background Public and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients. This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates. Methods Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction. Results Private health facilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies. Conclusions Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities. In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries. PMID:21864335

Measuring client satisfaction and the quality of family planning services: a comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana.

PubMed

Hutchinson, Paul L; Do, Mai; Agha, Sohail

2011-08-24

Public and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients. This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates. Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction. Private health facilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies. Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities. In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries.

Survey on Monitoring and Quality Controlling of the Mobile Biosignal Delivery.

PubMed

Pawar, Pravin A; Edla, Damodar R; Edoh, Thierry; Shinde, Vijay; van Beijnum, Bert-Jan

2017-10-31

A Mobile Patient Monitoring System (MPMS) acquires patient's biosignals and transmits them using wireless network connection to the decision-making module or healthcare professional for the assessment of patient's condition. A variety of wireless network technologies such as wireless personal area networks (e.g., Bluetooth), mobile ad-hoc networks (MANET), and infrastructure-based networks (e.g., WLAN and cellular networks) are in practice for biosignals delivery. The wireless network quality-of-service (QoS) requirements of biosignals delivery are mainly specified in terms of required bandwidth, acceptable delay, and tolerable error rate. An important research challenge in the MPMS is how to satisfy QoS requirements of biosignals delivery in the environment characterized by patient mobility, deployment of multiple wireless network technologies, and variable QoS characteristics of the wireless networks. QoS requirements are mainly application specific, while available QoS is largely dependent on QoS provided by wireless network in use. QoS provisioning refers to providing support for improving QoS experience of networked applications. In resource poor conditions, application adaptation may also be required to make maximum use of available wireless network QoS. This survey paper presents a survey of recent developments in the area of QoS provisioning for MPMS. In particular, our contributions are as follows: (1) overview of wireless networks and network QoS requirements of biosignals delivery; (2) survey of wireless networks' QoS performance evaluation for the transmission of biosignals; and (3) survey of QoS provisioning mechanisms for biosignals delivery in MPMS. We also propose integrating end-to-end QoS monitoring and QoS provisioning strategies in a mobile patient monitoring system infrastructure to support optimal delivery of biosignals to the healthcare professionals.

The effects of integrated care on quality of work in nursing homes: a quasi-experiment.

PubMed

Boumans, Nicolle P G; Berkhout, Afke J M B; Vijgen, Sylvia M C; Nijhuis, Frans J N; Vasse, Rineke M

2008-08-01

In nursing homes there is a gradual move from traditional care to integrated care. Integrated care means a demand-oriented, small-scale, co-operated and coordinated provision of services by different caregivers. This integration has direct effect on the work of these separate disciplines. With the introduction of integrated care the quality of work of these caregivers should be assured or even be improved. The purpose of this study was to examine the implementation of integrated care in the nursing home sector and its effects on the quality of work of the caregivers (work content, communication and co-operation and worker's outcomes). A non-equivalent pre-test/post-test control group design was used in this study. Two nursing homes in the Netherlands participated in the study. One nursing home provided the five experimental nursing wards and the other nursing home provided four control wards. Data were selected by means of written questionnaires. The results showed that the intervention appeared to be only successful on the somatic wards. The caregivers of these wards were more able to create a home-like environment for their residents, to use a demand-oriented working method and to integrate the provision of care and services. Regarding the effects of the intervention on quality of work factors, the results included an increase of social support by the supervisor, an increase of the degree of collaboration and a decrease in job demands. No changes were found for the worker's outcomes such as job satisfaction. The intervention on the psycho-somatic wards was unsuccessful. Although the introduction of integrated care on the somatic wards was successful, the effects on quality of work were limited. Next to quantitative research, more qualitative in-depth research is needed to examine models of integrated care and their effects on the work of caregivers within health care organisations, with special attention for specific characteristics of different types of nursing home care (somatic vs. psycho-geriatric).

The impact of the World Health Organization 8-steps in wheelchair service provision in wheelchair users in a less resourced setting: a cohort study in Indonesia.

PubMed

Toro, Maria L; Eke, Chika; Pearlman, Jonathan

2016-01-22

For people who have a mobility impairment, access to an appropriate wheelchair is an important step towards social inclusion and participation. The World Health Organization Guidelines for the Provision of Manual Wheelchairs in Less Resourced Settings emphasize the eight critical steps for appropriate wheelchair services, which include: referral, assessment, prescription, funding and ordering, product preparation,fitting and adjusting, user training, and follow-up and maintenance/repairs. The purpose of this study was to investigate how the provision of wheelchairs according to the World Health Organization's service provision process by United Cerebral Palsy Wheels for Humanity in Indonesia affects wheelchair recipients compared to wait-listed controls. This study used a convenience sample (N = 344) of Children, Children with proxies, Adults, and Adults with proxies who were on a waiting list to receive a wheelchair as well as those who received one. Interviews were conducted at baseline and a 6 month follow-up to collect the following data: Demographics and wheelchair use questions, the World Health Organization Quality of Life-BREF, Functional Mobility Assessment, Craig Handicap Assessment Recording Technique Short Form. The Wheelchair Assessment Checklist and Wheelchair Skills Test Questionnaire were administered at follow up only. 167 participants were on the waiting list and 142 received a wheelchair. Physical health domain in the World Health Organization Quality of Life-BREF improved significantly for women who received a wheelchair (p = 0.044) and environmental health improved significantly for women and men who received a wheelchair as compared to those on the waiting list (p < 0.017). Satisfaction with the mobility device improved significantly for Adults with proxies and Children with proxies as compared to the waiting list (p < 0.022). Only 11 % of Adults who received a wheelchair reported being able to perform a "wheelie". The condition of Roughrider wheelchairs was significantly better than the condition of kids wheelchairs for Children with proxies as measured by the Wheelchair Assessment Checklist (p = 0.019). Wheelchair provision according to World Health Organization's 8-Steps in a less-resourced setting has a range of positive outcomes including increased satisfaction with the mobility device and better quality of life. Wheelchair provision service could be improved by providing more hours of wheelchair skills training. There is a need for outcome measures that are validated across cultures and languages.

Intelligent call admission control for multi-class services in mobile cellular networks

NASA Astrophysics Data System (ADS)

Ma, Yufeng; Hu, Xiulin; Zhang, Yunyu

2005-11-01

Scarcity of the spectrum resource and mobility of users make quality of service (QoS) provision a critical issue in mobile cellular networks. This paper presents a fuzzy call admission control scheme to meet the requirement of the QoS. A performance measure is formed as a weighted linear function of new call and handoff call blocking probabilities of each service class. Simulation compares the proposed fuzzy scheme with complete sharing and guard channel policies. Simulation results show that fuzzy scheme has a better robust performance in terms of average blocking criterion.

[The population's insurance protection as a mechanism responsible for provision of sanitary and epidemiological well-being].

PubMed

Iarushin, S V

2007-01-01

The paper describes a principal scheme of insurance protection organization due to the negative human influences of environmental factors and industrial risks as one of the most effective mechanisms responsible for controlling sanitary-and-epidemiological well-being and human health. It also considers how a voluntary medical collective insurance program and a civil responsibility insurance one are being implemented due to unforeseen damages done to the population's health and how the quality and safety of goods (work, services) are controlled. Organizational, methodic, and normative legal approaches are proposed to developing the population's insurance protection system.

Long-term assessment at field scale of Floating Treatment Wetlands for improvement of water quality and provision of ecosystem services in a eutrophic urban pond.

PubMed

Olguín, Eugenia J; Sánchez-Galván, Gloria; Melo, Francisco J; Hernández, Víctor J; González-Portela, Ricardo E

2017-04-15

Pollution of urban water bodies requires stringent control measures and the development of low-cost and highly efficient alternative technologies. In contrast to Constructed Wetlands, Floating Treatment Wetlands (FTWs) have the advantage of not requiring large surface of land since they operate in situ. However, there is limited information about their long-term evaluation while operating at field scale. The aim of this work was to assess the performance of FTWs using a combination of Pontederia sagittata and Cyperus papyrus for the improvement of the water quality and provision of ecosystem services of a eutrophic urban pond. The FTWs were built with low-cost material easy to acquire and to ensemble. Two FTWs (17.5m 2 and 33m 2 ) located in Pond 1 within a complex of 4 urban artificial ponds were evaluated for two years. They promoted an increase in the dissolved oxygen (D.O.) within a range of 15 to 67%, a removal of fecal coliforms in the range of 9 to 86% and a nitrate removal in the range of 9 to 76%. The plant productivity reached a maximum of 363g dm m -2 d -1 in the FTW1 and 536g dm m -2 d -1 in the FTW2 during the period March-June 2016. The TKN and the TP content in the plant were in the range of 18.3 to 28.1 and of 0.05 to 0.196gkg -1 dry matter, respectively. In conclusion, the tested FTWs have proved to be a very beneficial low-cost technology for the improvement of water quality and provision of ecosystem services. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of a standard provision versus an autonomy supportive exercise referral programme on physical activity, quality of life and well-being indicators: a cluster randomised controlled trial

PubMed Central

2014-01-01

Background The National Institute for Health and Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the feasibility and impact of a Self Determination Theory-based (SDT) exercise referral consultation. Methods An exploratory cluster randomised controlled trial comparing standard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory. Individuals (N = 347) referred to an exercise referral scheme were recruited into the trial from 13 centres. Outcomes and processes of change measured at baseline, 3 and 6-months: Minutes of self-reported moderate or vigorous physical activity (PA) per week (primary outcome), health status, positive and negative indicators of emotional well-being, anxiety, depression, quality of life (QOL), vitality, and perceptions of autonomy support from the advisor, need satisfaction (3 and 6 months only), intentions to be active, and motivational regulations for exercise. Blood pressure and weight were assessed at baseline and 6 months. Results Perceptions of the autonomy support provided by the health and fitness advisor (HFA) did not differ by arm. Between group changes over the 6-months revealed significant differences for reported anxiety only. Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months, which were not seen in the standard exercise referral group. A process model depicting hypothesized relationships between advisor autonomy support, need satisfaction and more autonomous motivation, enhanced well being and PA engagement at follow up was supported. Conclusions Significant gains in physical activity and improvements in quality of life and well-being outcomes emerged in both the standard provision exercise referral and the SDT-based intervention at programme end. At 6-months, observed between arm and within intervention arm differences for indicators of emotional health, and the results of the process model, were in line with SDT. The challenges in optimising recruitment and implementation of SDT-based training in the context of health and leisure services are discussed. Trial registration The trial is registered as Current Controlled trials ISRCTN07682833. PMID:24475766

Effects of a standard provision versus an autonomy supportive exercise referral programme on physical activity, quality of life and well-being indicators: a cluster randomised controlled trial.

PubMed

Duda, Joan L; Williams, Geoffrey C; Ntoumanis, Nikos; Daley, Amanda; Eves, Frank F; Mutrie, Nanette; Rouse, Peter C; Lodhia, Rekha; Blamey, Ruth V; Jolly, Kate

2014-01-29

The National Institute for Health and Clinical Excellence in the UK has recommended that the effectiveness of ongoing exercise referral schemes to promote physical activity should be examined in research trials. Recent empirical evidence in health care and physical activity promotion contexts provides a foundation for testing the feasibility and impact of a Self Determination Theory-based (SDT) exercise referral consultation. An exploratory cluster randomised controlled trial comparing standard provision exercise referral with an exercise referral intervention grounded in Self Determination Theory. Individuals (N = 347) referred to an exercise referral scheme were recruited into the trial from 13 centres.Outcomes and processes of change measured at baseline, 3 and 6-months: Minutes of self-reported moderate or vigorous physical activity (PA) per week (primary outcome), health status, positive and negative indicators of emotional well-being, anxiety, depression, quality of life (QOL), vitality, and perceptions of autonomy support from the advisor, need satisfaction (3 and 6 months only), intentions to be active, and motivational regulations for exercise.Blood pressure and weight were assessed at baseline and 6 months. Perceptions of the autonomy support provided by the health and fitness advisor (HFA) did not differ by arm. Between group changes over the 6-months revealed significant differences for reported anxiety only. Within arm contrasts revealed significant improvements in anxiety and most of the Dartmouth CO-OP domains in the SDT arm at 6 months, which were not seen in the standard exercise referral group. A process model depicting hypothesized relationships between advisor autonomy support, need satisfaction and more autonomous motivation, enhanced well being and PA engagement at follow up was supported. Significant gains in physical activity and improvements in quality of life and well-being outcomes emerged in both the standard provision exercise referral and the SDT-based intervention at programme end. At 6-months, observed between arm and within intervention arm differences for indicators of emotional health, and the results of the process model, were in line with SDT. The challenges in optimising recruitment and implementation of SDT-based training in the context of health and leisure services are discussed. The trial is registered as Current Controlled trials ISRCTN07682833.

Educating the Adult Educator: Quality Provision and Assessment in Europe. ESREA|ReNAdET e-Book Conference Proceedings (1st, Thessaloniki, Greece, November 6-8, 2009)

ERIC Educational Resources Information Center

Papastamatis, Adamantios, Ed; Valkanos, Efthymios, Ed.; Zarifis, Georgios K., Ed.; Panitsidou, Eugenia, Ed.

2009-01-01

This e-book contains the proceedings of the inaugural meeting of the ESREA Network on Adult Educators, Trainers and their Professional Development (ReNAdET): Educating the adult educator - Quality provision and assessment in Europe. The network's first conference meeting was held in Thessaloniki, Greece (6-8 November 2009) at the University of…

76 FR 69927 - Approval of Air Quality Implementation Plans; California; South Coast; Attainment Plan for 1997...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-09

...EPA is approving in part and disapproving in part state implementation plan (SIP) revisions submitted by California to provide for attainment of the 1997 fine particulate matter (PM2.5) national ambient air quality standards in the Los Angeles-South Coast area (South Coast). These SIP revisions are the South Coast 2007 Air Quality Management Plan (South Coast 2007 AQMP) (revised 2011) and South Coast-related provisions of the 2007 State Strategy (revised 2009 and 2011). EPA is approving the emissions inventory; reasonably available control measures/reasonably available control technology demonstration; the reasonable further progress and attainment demonstrations and associated air quality modeling; and the transportation conformity motor vehicle emissions budgets. EPA is also granting California's request to extend the attainment deadline for the South Coast to April 5, 2015 and approving commitments to measures and reductions by the South Coast Air Quality Management District and the California Air Resources Board. Finally, we are disapproving the SIP's contingency measures and issuing a protective finding under 40 CFR 93.120(a)(3), and we are rejecting the assignment of 10 tons per day (tpd) of nitrogen oxide (NOX) reductions to the federal government.

Extraneous agents testing for substrates of avian origin and viral vaccines for poultry: current provisions and proposals for future approaches.

PubMed

Jungbäck, Carmen; Motitschke, Andreas

2010-05-01

In the 1970s the European Pharmacopoeia (Ph. Eur.) established the first requirements for testing starting materials for vaccines and the vaccines themselves. These requirements also cover testing for freedom from extraneous agents of specific pathogen free (SPF) chicken flocks, the embryonated eggs derived from them and viral vaccines for poultry. This was the first common European approach initiated by the Ph. Eur. as an institution of the Council of Europe and it was the beginning of building a scientific basis for vaccine quality. In the following years, the increasingly detailed requirements concerning viral purity also impacted viral vaccines for poultry, SPF chicken flocks and the embryonated eggs derived from them. The core of these requirements is formed by the list of extraneous agents that must be tested for and the accepted test methods. In the early 1990s and in 2004, the next steps were taken towards the harmonization of quality regulations for the production and testing of veterinary immunological products, this time at the level of the European Community. With the first step, good manufacturing practices (GMP) and good laboratory practices (GLP) were introduced, ensuring more consistent production, validation of production procedures and testing. The next step introduced the risk assessment, which covers the evaluation of the quality of production and control. The intention of these efforts is to contribute to the quality, safety and purity of the products placed on the market. It makes sense that, based on the outcome of the risk-evaluation, a reduction of in-process and final product testing may be called for in certain cases. However, despite the fact that the quality of the starting materials and vaccines has been increased over the years, the provisions of the Ph. Eur. have not been adjusted. Progress made by the manufacturers of starting materials and vaccines with respect to increasing the quality of their products should be recognised. This review gives an analysis of the current provisions of the Ph. Eur. and makes some proposals on how the requirements concerning the testing of extraneous agents could be modified to take into consideration the increase in quality that has been achieved over the past few decades. 2010 The International Association for Biologicals. Published by Elsevier Ltd. All rights reserved.

75 FR 77798 - Interpretation of OSHA's Provisions for Feasible Administrative or Engineering Controls of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-14

... CFR Parts 1910 and 1926 Interpretation of OSHA's Provisions for Feasible Administrative or Engineering... Administrative or Engineering Controls of Occupational Noise, giving interested parties 60 days to comment. The... Provisions for Feasible Administrative or Engineering Controls of Occupational Noise. The notice proposed to...

Metropolitan Boston air quality control region: transportation control plan

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

Not Available

1975-02-28

The EPA is considering a number of amendments to the transportation control plan which it promulgated Nov. 8, 1973 for the Metropolitan Boston Intrastate Air Quality Control Region. Included in the proposed amendments is a revised regulation for reduction of commuter travel which would include students and employees. This program would be implemented in conjunction with the carpool matching program being developed by the Commonwealth of Massachusetts and the employee pass program offered by the Massachusetts Bay Transportation Authority. A new provision for limiting overall hydrocarbon emissions from major users of organic compounds is included. Also published are a proposalmore » for encouraging bicycle use, new proposals for controlling carbon monoxide levels outside the Boston core area, and a new procedure for periodic monitoring and updating of the plan. Other features of the original plan are retained with modifications in areas including the ceiling on the level of commercial parking spaces in the so-called ''freeze'' area, limitations of on-street commuter parking, a semiannual inspection and maintenance program, a retrofit program, and incentives for carpool and transit use.« less

The OBRA-87 nursing home regulations and implementation of the Resident Assessment Instrument: effects on process quality.

PubMed

Hawes, C; Mor, V; Phillips, C D; Fries, B E; Morris, J N; Steele-Friedlob, E; Greene, A M; Nennstiel, M

1997-08-01

To characterize changes in key aspects of process quality received by nursing home residents before and after the implementation of the national nursing home Resident Assessment Instrument (RAI) and other aspects of the Omnibus Budget Reconciliation Act (OBRA) nursing home reforms. A quasi-experimental study using a complex, multistage probability-based sample design, with data collected before (1990) and after (1993) implementation of the RAI and other OBRA provisions. Two independent cohorts (n > 2000) of residents in a random sample of 254 nursing facilities located in metropolitan statistical areas in 10 states. OBRA-87 enhanced the regulation of nursing homes and included new requirements on quality of care, resident assessment, care planning, and the use of neuroleptic drugs and physical restraints. One of the key provisions, used to help implement the OBRA requirements in daily nursing home practice, was the mandatory use of a standardized, comprehensive system, known as the RAI, to assist in assessment and care planning. OBRA provisions went into effect in federal law on October 1, 1990, although delays issuing the regulations led to actual implementation of the RAI during the Spring of 1991. MEASUREMENTS AND ANALYSES: Research nurses spent an average of 4 days per facility in each data collection round, assessing a sample of residents, collecting data through interviews with and observations of residents, interviews with multiple shifts of direct staff caregivers for the sampled residents, and review of medical records, including physician's orders, treatment and care plans, nursing progress notes, and medication records. The RNs collected data on the characteristics of the sampled residents, on the care they received, and on facility practices. The effect of being a member of the 1990 pre-OBRA or the 1993 post-OBRA cohort was assessed on the accuracy of information in the residents' medical records, the comprehensiveness of care plans, and on other key aspects of process quality while controlling for any changes in resident case-mix. The data were analyzed using contingency tables and logistic regression and a special statistical software (SUDAAN) to assure proper variance estimation. Overall, the process of care in nursing homes improved in several important areas. The accuracy of information in residents' medical records increased substantially, as did the comprehensiveness of care plans. In addition, several problematic care practices declined during this period, including use of physical restraints (37.4 to 28.1% (P < .001)) and indwelling urinary catheters (9.8 to 7% (P < .001)). There were also increases in good care practices, such as the presence of advanced directives, participation in activities, and use of toileting programs for residents with bowel incontinence. These results were sustained after controlling for differences in the resident characteristics between 1990 and 1993. Other practices, such as use of antipsychotic drugs, behavior management programs, preventive skin care, and provision of therapies were unaffected, or the differences were not statistically significant, after adjusting for changes in resident case-mix. The OBRA reforms and introduction of the RAI constituted an unprecedented implementation of comprehensive geriatric assessment in Medicare- and Medicaid-certified nursing homes. The evaluation of the effects of these interventions demonstrates significant improvements in the quality of care provided to residents. At the same time, these findings suggest that more needs to be done to improve process quality. The results suggest the RAI is one tool that facility staff, therapists, pharmacy consultants, and physicians can use to support their continuing efforts to provide high quality of care and life to the nation's 1.7 million nursing home residents.

Seasonal Variations in Maternal Provisioning of Crepidula fornicata (Gastropoda): Fatty Acid Composition of Females, Embryos and Larvae

PubMed Central

Leroy, Fanny; Meziane, Tarik; Riera, Pascal; Comtet, Thierry

2013-01-01

Recruitment success of marine invertebrate populations not only depends on the number of recruits but also on their quality which affects their survival. In species characterized by a mixed development (encapsulated embryonic development and release of planktotrophic larvae), the offspring quality depends on both maternal provisioning and larval feeding. Here, we investigated potential changes of maternal provisioning over the whole reproductive period in a gastropod with a mixed development: Crepidula fornicata . In its introduction area, C . fornicata reproduces from February to October, which implies that both adults and larvae are exposed to different food availabilities. Maternal provisioning was assessed by measuring the fatty acid (FA) composition of females, encapsulated embryos and larvae, in February, May, July and September 2009. FA are essential resources for the development of embryos and larvae, and are key biomarkers of offspring quality. Our results showed differences in FA composition between muscles, visceral masses, and encapsulated embryos. In particular, FA composition of embryos was similar to that of the visceral mass. Seasonal variations in FA composition were observed: in the middle of the reproductive season (May and July), female tissues and embryos showed a higher proportion of polyunsaturated fatty acids and especially ω3, as compared to the beginning and end of the reproductive season (February and September). This showed that through maternal provisioning the quality of C . fornicata offspring was higher in the middle of the reproductive season. Whether this would result in an increase of recruitment success and juvenile performance would require further investigations. PMID:24086505

Seasonal variations in maternal provisioning of Crepidula fornicata (Gastropoda): fatty acid composition of females, embryos and larvae.

PubMed

Leroy, Fanny; Meziane, Tarik; Riera, Pascal; Comtet, Thierry

2013-01-01

Recruitment success of marine invertebrate populations not only depends on the number of recruits but also on their quality which affects their survival. In species characterized by a mixed development (encapsulated embryonic development and release of planktotrophic larvae), the offspring quality depends on both maternal provisioning and larval feeding. Here, we investigated potential changes of maternal provisioning over the whole reproductive period in a gastropod with a mixed development: Crepidula fornicata. In its introduction area, C. fornicata reproduces from February to October, which implies that both adults and larvae are exposed to different food availabilities. Maternal provisioning was assessed by measuring the fatty acid (FA) composition of females, encapsulated embryos and larvae, in February, May, July and September 2009. FA are essential resources for the development of embryos and larvae, and are key biomarkers of offspring quality. Our results showed differences in FA composition between muscles, visceral masses, and encapsulated embryos. In particular, FA composition of embryos was similar to that of the visceral mass. Seasonal variations in FA composition were observed: in the middle of the reproductive season (May and July), female tissues and embryos showed a higher proportion of polyunsaturated fatty acids and especially ω3, as compared to the beginning and end of the reproductive season (February and September). This showed that through maternal provisioning the quality of C. fornicata offspring was higher in the middle of the reproductive season. Whether this would result in an increase of recruitment success and juvenile performance would require further investigations.

48 CFR 246.704 - Authority for use of warranties.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SYSTEM, DEPARTMENT OF DEFENSE CONTRACT MANAGEMENT QUALITY ASSURANCE Warranties 246.704 Authority for use... quality assurance provisions that reference higher-level contract quality requirements (see 246.202-4); or...

SEMPATH Ontology: modeling multidisciplinary treatment schemes utilizing semantics.

PubMed

Alexandrou, Dimitrios Al; Pardalis, Konstantinos V; Bouras, Thanassis D; Karakitsos, Petros; Mentzas, Gregoris N

2012-03-01

A dramatic increase of demand for provided treatment quality has occurred during last decades. The main challenge to be confronted, so as to increase treatment quality, is the personalization of treatment, since each patient constitutes a unique case. Healthcare provision encloses a complex environment since healthcare provision organizations are highly multidisciplinary. In this paper, we present the conceptualization of the domain of clinical pathways (CP). The SEMPATH (SEMantic PATHways) Oontology comprises three main parts: 1) the CP part; 2) the business and finance part; and 3) the quality assurance part. Our implementation achieves the conceptualization of the multidisciplinary domain of healthcare provision, in order to be further utilized for the implementation of a Semantic Web Rules (SWRL rules) repository. Finally, SEMPATH Ontology is utilized for the definition of a set of SWRL rules for the human papillomavirus) disease and its treatment scheme. © 2012 IEEE

The impact of social support and sense of coherence on health-related quality of life among nursing home residents--a questionnaire survey in Bergen, Norway.

PubMed

Drageset, Jorunn; Eide, Geir Egil; Nygaard, Harald A; Bondevik, Margareth; Nortvedt, Monica W; Natvig, Gerd Karin

2009-01-01

Few studies have examined the association between social support and health-related quality of life (HRQOL) among nursing home residents and whether the sense of coherence (SOC) modifies the effect of social support on health-related quality of life. The main aims of this study were to determine the relationship between social support and HRQOL and to investigate whether the SOC modifies the effect of social support on HRQOL. A cross-sectional, descriptive, correlational design. All 30 nursing homes in Bergen in western Norway. Two hundred and twenty-seven mentally intact long-term nursing home residents 65 years and older. Data were obtained through face-to-face interviews using the SF-36 Health Survey, Social Provisions Scale and Sense of Coherence Scale. Possible relationships between the Social Provisions Scale and the eight SF-36 subdimensions were analysed using multiple linear regression while controlling for age, sex, marital status, education and comorbid illness. Interactions between the Sense of Coherence Scale and Social Provisions Scale were investigated. Attachment affected the mental health subdimension (p=0.001), opportunity for nurturance affected social functioning (p=0.003) and reassurance of worth affected vitality (p=0.001) after adjustment for demographic variables and comorbid illness. After the analysis included the sense of coherence, nurturance still significantly affected social functioning and reassurance of worth still significantly affected vitality. No interaction with sense of coherence was found, and sense of coherence significantly affected all SF-36 subdimensions. The opportunity to provide nurturance for others appears to be important for social functioning, and sense of competence and sense of self-esteem appear to be important for vitality. Further, the residents' relationships with significant others comprise an important component of mental health. Finally, independent of the level of sense of coherence, social support is an important resource for better health-related quality of life. Clinical nurses should recognize that social support is associated with health-related quality of life and pay attention to the importance of social support for the residents in daily practice.

Antenatal care service quality increases the odds of utilizing institutional delivery in Bahir Dar city administration, North Western Ethiopia: A prospective follow up study.

PubMed

Ejigu Tafere, Tadese; Afework, Mesganaw Fanthahun; Yalew, Alemayehu Worku

2018-01-01

In Ethiopia, more than 62% of pregnant women attend antenatal care at least once, yet only about one in four women give birth at health facility. This gap has fueled the need to investigate on the quality of ANC services at public health facilities and its link with the use of institutional delivery. To assess the linkage between ANC quality and the use of institutional delivery among pregnant women attending ANC at public health facilities of BDR City Administration. A facility based prospective follow up study was conducted. and nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit were enrolled.Women were followed from their first ANC visit until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation (GEE) was carried out to control cluster effect among women who received ANC in the same facility. Among 823 pregnant women who completed follow up, only about one third (27.6%) received acceptable quality of ANC services. In one health facility syphilis test was not done at all for the last two years. The odds of giving birth at health institution among pregnant women who received acceptable ANC quality service was about 3.38 times higher than among pregnant women who received unacceptable ANC quality service (AOR = 3.38, 95% CI: 1.67, 6.83). In this study the quality of ANC service provision in public health facilities was compromised/low. Provision of quality ANC service had a great role in promoting institutional delivery. Therefore the local authorities at each level of health sector or the nongovernmental organizations working to improve maternal health need to provide training on focused antenatal care protocol for ANC providers.

Antenatal care service quality increases the odds of utilizing institutional delivery in Bahir Dar city administration, North Western Ethiopia: A prospective follow up study

PubMed Central

Afework, Mesganaw Fanthahun; Yalew, Alemayehu Worku

2018-01-01

Background In Ethiopia, more than 62% of pregnant women attend antenatal care at least once, yet only about one in four women give birth at health facility. This gap has fueled the need to investigate on the quality of ANC services at public health facilities and its link with the use of institutional delivery. Objective To assess the linkage between ANC quality and the use of institutional delivery among pregnant women attending ANC at public health facilities of BDR City Administration Methods A facility based prospective follow up study was conducted. and nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit were enrolled.Women were followed from their first ANC visit until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation (GEE) was carried out to control cluster effect among women who received ANC in the same facility. Results Among 823 pregnant women who completed follow up, only about one third (27.6%) received acceptable quality of ANC services. In one health facility syphilis test was not done at all for the last two years. The odds of giving birth at health institution among pregnant women who received acceptable ANC quality service was about 3.38 times higher than among pregnant women who received unacceptable ANC quality service (AOR = 3.38, 95% CI: 1.67, 6.83). Conclusion and recommendation In this study the quality of ANC service provision in public health facilities was compromised/low. Provision of quality ANC service had a great role in promoting institutional delivery. Therefore the local authorities at each level of health sector or the nongovernmental organizations working to improve maternal health need to provide training on focused antenatal care protocol for ANC providers. PMID:29420598

40 CFR 63.497 - Back-end process provisions-monitoring provisions for control and recovery devices.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Back-end process provisions-monitoring... Polymers and Resins § 63.497 Back-end process provisions—monitoring provisions for control and recovery devices. (a) An owner or operator complying with the residual organic HAP limitations in § 63.494(a) using...

Hierarchical and hybrid energy storage devices in data centers: Architecture, control and provisioning.

PubMed

Sun, Mengshu; Xue, Yuankun; Bogdan, Paul; Tang, Jian; Wang, Yanzhi; Lin, Xue

2018-01-01

Recently, a new approach has been introduced that leverages and over-provisions energy storage devices (ESDs) in data centers for performing power capping and facilitating capex/opex reductions, without performance overhead. To fully realize the potential benefits of the hierarchical ESD structure, we propose a comprehensive design, control, and provisioning framework including (i) designing power delivery architecture supporting hierarchical ESD structure and hybrid ESDs for some levels, as well as (ii) control and provisioning of the hierarchical ESD structure including run-time ESD charging/discharging control and design-time determination of ESD types, homogeneous/hybrid options, ESD provisioning at each level. Experiments have been conducted using real Google data center workloads based on realistic data center specifications.

Hierarchical and hybrid energy storage devices in data centers: Architecture, control and provisioning

PubMed Central

Xue, Yuankun; Bogdan, Paul; Tang, Jian; Wang, Yanzhi; Lin, Xue

2018-01-01

Recently, a new approach has been introduced that leverages and over-provisions energy storage devices (ESDs) in data centers for performing power capping and facilitating capex/opex reductions, without performance overhead. To fully realize the potential benefits of the hierarchical ESD structure, we propose a comprehensive design, control, and provisioning framework including (i) designing power delivery architecture supporting hierarchical ESD structure and hybrid ESDs for some levels, as well as (ii) control and provisioning of the hierarchical ESD structure including run-time ESD charging/discharging control and design-time determination of ESD types, homogeneous/hybrid options, ESD provisioning at each level. Experiments have been conducted using real Google data center workloads based on realistic data center specifications. PMID:29351553

40 CFR 52.1987 - Significant deterioration of air quality.

Code of Federal Regulations, 2014 CFR

2014-07-01

... quality. 52.1987 Section 52.1987 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The Oregon Department of Environmental Quality rules for the prevention of significant deterioration of air quality (provisions of OAR Chapter 340, Divisions 200, 202...

40 CFR 52.1987 - Significant deterioration of air quality.

Code of Federal Regulations, 2013 CFR

2013-07-01

... quality. 52.1987 Section 52.1987 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The Oregon Department of Environmental Quality rules for the prevention of significant deterioration of air quality (provisions of OAR Chapter 340, Divisions 200, 202...

40 CFR 52.1987 - Significant deterioration of air quality.

Code of Federal Regulations, 2012 CFR

2012-07-01

... quality. 52.1987 Section 52.1987 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The Oregon Department of Environmental Quality rules for the prevention of significant deterioration of air quality (provisions of OAR Chapter 340, Divisions 200, 202...

40 CFR 52.1987 - Significant deterioration of air quality.

Code of Federal Regulations, 2010 CFR

2010-07-01

... quality. 52.1987 Section 52.1987 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The Oregon Department of Environmental Quality rules for the prevention of significant deterioration of air quality (provisions of OAR chapter 340, Divisions 200, 202...

Water Quality Trading Toolkit for Permit Writers

EPA Pesticide Factsheets

The Water Quality Trading Toolkit for Permit Writers is EPA’s first “how-to” manual on designing and implementing water quality trading programs. It helps NPDES permitting authorities incorporate trading provisions into permits.

British Thoracic Society Quality Standards for acute non-invasive ventilation in adults

PubMed Central

Davies, Michael; Allen, Martin; Bentley, Andrew; Bourke, Stephen C; Creagh-Brown, Ben; D’Oliveiro, Rachel; Glossop, Alastair; Gray, Alasdair; Jacobs, Phillip; Mahadeva, Ravi; Moses, Rachael; Setchfield, Ian

2018-01-01

Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the provision of acute non-invasive ventilation in adults together with measurable markers of good practice. Methods Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 6 quality statements have been developed, each describing a standard of care for the provision of acute non-invasive ventilation in the UK, together with measurable markers of good practice. Conclusion BTS Quality Standards for acute non-invasive ventilation in adults form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline’s recommendations. PMID:29636979

[Primary quality control in Israel Air Force clinics].

PubMed

Gilutz, H; Shamis, A; Ben-Amitay, D; Burger, A; Caine, Y G

1994-05-15

The practice of primary medicine within a military framework differs from that in the civilian environment in: accessibility, its consumers, obligations of the providers, involvement of the funder (the commanders), and ability to define and enforce professional guide lines. These differences influence the scope of medical service, as well as affect the methods and results of quality control. A system of quality control evaluation and feedback of military primary care in 16 Israel Air Force clinics was carried out by a team of experienced physicians using peer group review and according to a specially prepared protocol. Emphasis was placed on medical record assessment using obligatory markers of adequate medical evaluation and treatment. Identification of the population at risk, further medical training, and medical administration with a direct effect on the quality of medical treatment were also evaluated. 2 quality control surveys with feedback were carried out 6 months apart. The overall mean score was 81.66 +/- 7.16% at the first evaluation, increasing to 88.60 +/- 7.46% at the second (p < 0.01). The greatest improvements were in follow-up of population at risk (increasing from 68.4% to 86.4%, p < 0.025), training of medical teams, (from 75.7% to 87.5%, p < 0.05) and patient case management (from 79.4% to 85.1%, N.S.). Categories in which there was no improvement were medical records, recovery of old medical files and patient education. The categories in which there was improvement had a common denominator: "recognition of importance" and "provision of patterns" by headquarters. The quality control system was designed for routine use, and not as a research project.(ABSTRACT TRUNCATED AT 250 WORDS)

Antenatal care and opportunities for quality improvement of service provision in resource limited settings: A mixed methods study

PubMed Central

van der Eem, Lisette; Nyanza, Elias C.; van Pelt, Sandra; Ndaki, Pendo; Basinda, Namanya; Sundby, Johanne

2017-01-01

Antenatal care is essential to improve maternal and newborn health and wellbeing. The majority of pregnant women in Tanzania attend at least one visit. Since implementation of the focused antenatal care model, quality of care assessments have mostly focused on utilization and coverage of routine interventions for antenatal care. This study aims to assess the quality of antenatal care provision from a holistic perspective in a rural district in Tanzania. Structure, process and outcome components of quality are explored. This paper reports on data collected over several periods from 2012 to 2015 through facility audits of supplies and services, ANC observations and exit interviews with pregnant women. Additional qualitative methods were used such as interviews, focus group observations and participant observations. Findings indicate variable performance of routine ANC services, partly explained by insufficient resources. Poor performance was also observed for appropriate history taking, attention for client’s wellbeing, basic physical examination and adequate counseling and education. Achieving quality improvement for ANC requires increased attention for the process of care provision beyond coverage, including attention for response-based services, which should be assessed based on locally determined criteria. PMID:29236699

Generic Airplane Model Concept and Four Specific Models Developed for Use in Piloted Simulation Studies

NASA Technical Reports Server (NTRS)

Hoffler, Keith D.; Fears, Scott P.; Carzoo, Susan W.

1997-01-01

A generic airplane model concept was developed to allow configurations with various agility, performance, handling qualities, and pilot vehicle interface to be generated rapidly for piloted simulation studies. The simple concept allows stick shaping and various stick command types or modes to drive an airplane with both linear and nonlinear components. Output from the stick shaping goes to linear models or a series of linear models that can represent an entire flight envelope. The generic model also has provisions for control power limitations, a nonlinear feature. Therefore, departures from controlled flight are possible. Note that only loss of control is modeled, the generic airplane does not accurately model post departure phenomenon. The model concept is presented herein, along with four example airplanes. Agility was varied across the four example airplanes without altering specific excess energy or significantly altering handling qualities. A new feedback scheme to provide angle-of-attack cueing to the pilot, while using a pitch rate command system, was implemented and tested.

Parental Roles in Provision of Mobility and Educational Resources for Children with Physical Challenges a Case of Joytown Special School, Kiambu County, Kenya

ERIC Educational Resources Information Center

Kamau, Joyce

2017-01-01

Children with physical challenges have developmental needs and rights like other children and due to their exceptionality they call for more attention in provision of adequate quality mobility and educational resources to enhance their holistic development. However, it is apparent that provision of resources to children with physical challenges…

78 FR 58460 - Revision of Air Quality Implementation Plan; California; Placer County Air Pollution Control...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-24

...EPA is finalizing a limited approval and limited disapproval of two permitting rules submitted by California as a revision to the Placer County Air Pollution Control District (PCAPCD) and Feather River Air Quality Management District (FRAQMD) portion of the California State Implementation Plan (SIP). These revisions were proposed in the Federal Register on February 22, 2013 and concern construction and modification of stationary sources of air pollution within each District. We are approving local rules that regulate these emission sources under the Clean Air Act as amended in 1990 (CAA). Final approval of these rules makes the rules federally enforceable and corrects program deficiencies identified in a previous EPA rulemaking (76 FR 44809, July 27, 2011). EPA is also making a technical amendment to the Code of Federal Regulations (CFR) to reflect this previous rulemaking, which removed an obsolete provision from the California SIP.

Barriers to providing quality emergency obstetric care in Addis Ababa, Ethiopia: Healthcare providers' perspectives on training, referrals and supervision, a mixed methods study.

PubMed

Austin, Anne; Gulema, Hanna; Belizan, Maria; Colaci, Daniela S; Kendall, Tamil; Tebeka, Mahlet; Hailemariam, Mengistu; Bekele, Delayehu; Tadesse, Lia; Berhane, Yemane; Langer, Ana

2015-03-29

Increasing women's access to and use of facilities for childbirth is a critical national strategy to improve maternal health outcomes in Ethiopia; however coverage alone is not enough as the quality of emergency obstetric services affects maternal mortality and morbidity. Addis Ababa has a much higher proportion of facility-based births (82%) than the national average (11%), but timely provision of quality emergency obstetric care remains a significant challenge for reducing maternal mortality and improving maternal health. The purpose of this study was to assess barriers to the provision of emergency obstetric care in Addis Ababa from the perspective of healthcare providers by analyzing three factors: implementation of national referral guidelines, staff training, and staff supervision. A mixed methods approach was used to assess barriers to quality emergency obstetric care. Qualitative analyses included twenty-nine, semi-structured, key informant interviews with providers from an urban referral network consisting of a hospital and seven health centers. Quantitative survey data were collected from 111 providers, 80% (111/138) of those providing maternal health services in the same referral network. Respondents identified a lack of transportation and communication infrastructure, overcrowding at the referral hospital, insufficient pre-service and in-service training, and absence of supportive supervision as key barriers to provision of quality emergency obstetric care. Dedicated transportation and communication infrastructure, improvements in pre-service and in-service training, and supportive supervision are needed to maximize the effective use of existing human resources and infrastructure, thus increasing access to and the provision of timely, high quality emergency obstetric care in Addis Ababa, Ethiopia.

Patient- and Family-Centered Care as an approach to reducing disparities in asthma outcomes in urban African American children: A review of the literature.

PubMed

Harper, Felicity W K; Eggly, Susan; Crider, Beverly; Kobayashi, Hitomi; Kathleen, R N; Meert, L; Ball, Allison; Penner, Louis A; Gray, Herman; Albrecht, Terrance L

2015-06-01

We thank Cathy Eames (Director, Library Services, Detroit Medical Center) for valuable input and assistance with the search strategy. Funding for this research was supported by a grant from Children's Hospital of Michigan Research Foundation (Principal Investigator: Terrance L. Albrecht, Ph.D.). Patient- and family-centered care (PFCC) has the potential to address disparities in access and quality of healthcare for African American pediatric asthma patients by accommodating and responding to the individual needs of patients and families. To identify and evaluate research on the impact of family-provider interventions that reflect elements of PFCC on reducing disparities in the provision, access, quality, and use of healthcare services for African American pediatric asthma patients. Electronic searches were conducted using PubMed, CINAHL, and Psyclnfo databases. Inclusion criteria were peer-reviewed, English-language articles on family-provider interventions that (a) reflected one or more elements of PFCC and (b) addressed healthcare disparities in urban African American pediatric asthma patients (≤18years). Thirteen interventions or programs were identified and reviewed. Designs included randomized clinical trials, controlled clinical trials, pre- and post-interventions, and program evaluations. Few interventions were identified as explicitly providing PFCC in a pediatric asthma context, possibly because of a lack of consensus on what constitutes PFCC in practice. Some studies have demonstrated that PFCC improves satisfaction and communication during clinical interactions. More empirical research is needed to understand whether PFCC interventions reduce care disparities and improve the provision, access, and quality of asthma healthcare for urban African American children. PubMed, CINAHL, and Psyclnfo AA-African American: CCT-Controlled clinical trial; ED-Emergency Department; ETS-Environmental tobacco smoke; FCC- Family Centered Care; PFCC-Patient and Family Centered Care; RCT- Randomized, controlled trial. © 2015 National Medical Association. Published by Elsevier Inc. All rights reserved.

40 CFR 131.2 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY STANDARDS General Provisions § 131.2 Purpose. A water quality standard defines the water quality goals of a water... criteria necessary to protect the uses. States adopt water quality standards to protect public health or...

40 CFR 131.2 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY STANDARDS General Provisions § 131.2 Purpose. A water quality standard defines the water quality goals of a water... criteria necessary to protect the uses. States adopt water quality standards to protect public health or...

40 CFR 58.2 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-07-01

... QUALITY SURVEILLANCE General Provisions § 58.2 Purpose. (a) This part contains requirements for measuring ambient air quality and for reporting ambient air quality data and related information. The monitoring criteria pertain to the following areas: (1) Quality assurance procedures for monitor operation and data...

40 CFR 58.2 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

... QUALITY SURVEILLANCE General Provisions § 58.2 Purpose. (a) This part contains requirements for measuring ambient air quality and for reporting ambient air quality data and related information. The monitoring criteria pertain to the following areas: (1) Quality assurance procedures for monitor operation and data...

40 CFR 58.2 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-07-01

... QUALITY SURVEILLANCE General Provisions § 58.2 Purpose. (a) This part contains requirements for measuring ambient air quality and for reporting ambient air quality data and related information. The monitoring criteria pertain to the following areas: (1) Quality assurance procedures for monitor operation and data...

40 CFR 58.2 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-07-01

... QUALITY SURVEILLANCE General Provisions § 58.2 Purpose. (a) This part contains requirements for measuring ambient air quality and for reporting ambient air quality data and related information. The monitoring criteria pertain to the following areas: (1) Quality assurance procedures for monitor operation and data...

Quality Program Provisions for Aeronautical and Space System Contractors

NASA Technical Reports Server (NTRS)

1969-01-01

This publication sets forth quality program requirements for NASA aeronautical and space programs, systems, subsystems, and related services. These requirements provide for the effective operation of a quality program which ensures that quality criteria and requirements are recognized, definitized, and performed satisfactorily.

77 FR 28423 - Final Rule To Implement the 1997 8-Hour Ozone National Ambient Air Quality Standard...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-14

...The EPA is revising the rules for implementing the 1997 8-hour ozone national ambient air quality standards (NAAQS) to address certain limited portions of the rules vacated by the U.S. Court of Appeals for the District of Columbia Circuit. This final rule assigns Clean Air Act (CAA or Act) classifications and associated state planning and control requirements to selected ozone nonattainment areas. This final rule also addresses three vacated provisions of the 1997 8-hour NAAQS--Phase 1 Implementation Rule (April 30, 2004) that provided exemptions from the anti-backsliding requirements relating to nonattainment area New Source Review (NSR), CAA section 185 penalty fees, and contingency measures, as these three requirements applied for the 1-hour standard. This rule also reinstates the 1-hour contingency measures as applicable requirements that must be retained until the area attains the 1997 8- hour ozone standard. Finally, this rule deletes an obsolete provision that stayed the EPA's authority to revoke the 1-hour ozone standard pending the Agency's issuance of a final rule that revises or reinstates its revocation authority and considers and addresses certain other issues. That rule has now been issued.

Development and status of data quality assurance program at NASA Langley research center: Toward national standards

NASA Technical Reports Server (NTRS)

Hemsch, Michael J.

1996-01-01

As part of a continuing effort to re-engineer the wind tunnel testing process, a comprehensive data quality assurance program is being established at NASA Langley Research Center (LaRC). The ultimate goal of the program is routing provision of tunnel-to-tunnel reproducibility with total uncertainty levels acceptable for test and evaluation of civilian transports. The operational elements for reaching such levels of reproducibility are: (1) statistical control, which provides long term measurement uncertainty predictability and a base for continuous improvement, (2) measurement uncertainty prediction, which provides test designs that can meet data quality expectations with the system's predictable variation, and (3) national standards, which provide a means for resolving tunnel-to-tunnel differences. The paper presents the LaRC design for the program and discusses the process of implementation.

40 CFR 131.20 - State review and revision of water quality standards.

Code of Federal Regulations, 2010 CFR

2010-07-01

... accordance with provisions of State law, EPA's water quality management regulation (40 CFR 130.3(b)(6)) and... quality standards. 131.20 Section 131.20 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY STANDARDS Procedures for Review and Revision of Water Quality...

21 CFR 820.5 - Quality system.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Quality system. 820.5 Section 820.5 Food and Drugs... QUALITY SYSTEM REGULATION General Provisions § 820.5 Quality system. Each manufacturer shall establish and maintain a quality system that is appropriate for the specific medical device(s) designed or manufactured...

21 CFR 820.5 - Quality system.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Quality system. 820.5 Section 820.5 Food and Drugs... QUALITY SYSTEM REGULATION General Provisions § 820.5 Quality system. Each manufacturer shall establish and maintain a quality system that is appropriate for the specific medical device(s) designed or manufactured...

21 CFR 820.5 - Quality system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Quality system. 820.5 Section 820.5 Food and Drugs... QUALITY SYSTEM REGULATION General Provisions § 820.5 Quality system. Each manufacturer shall establish and maintain a quality system that is appropriate for the specific medical device(s) designed or manufactured...

40 CFR 52.738 - Significant deterioration of air quality.

Code of Federal Regulations, 2012 CFR

2012-07-01

... quality. 52.738 Section 52.738 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.632 - Significant deterioration of air quality.

Code of Federal Regulations, 2011 CFR

2011-07-01

... quality. 52.632 Section 52.632 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.793 - Significant deterioration of air quality.

Code of Federal Regulations, 2011 CFR

2011-07-01

... quality. 52.793 Section 52.793 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.632 - Significant deterioration of air quality.

Code of Federal Regulations, 2014 CFR

2014-07-01

... quality. 52.632 Section 52.632 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.632 - Significant deterioration of air quality.

Code of Federal Regulations, 2012 CFR

2012-07-01

... quality. 52.632 Section 52.632 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.432 - Significant deterioration of air quality.

Code of Federal Regulations, 2011 CFR

2011-07-01

... quality. 52.432 Section 52.432 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulation for preventing significant deterioration of air quality. The provisions of...

40 CFR 52.738 - Significant deterioration of air quality.

Code of Federal Regulations, 2011 CFR

2011-07-01

... quality. 52.738 Section 52.738 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.632 - Significant deterioration of air quality.

Code of Federal Regulations, 2013 CFR

2013-07-01

... quality. 52.632 Section 52.632 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.432 - Significant deterioration of air quality.

Code of Federal Regulations, 2012 CFR

2012-07-01

... quality. 52.432 Section 52.432 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulation for preventing significant deterioration of air quality. The provisions of...

40 CFR 52.738 - Significant deterioration of air quality.

Code of Federal Regulations, 2014 CFR

2014-07-01

... quality. 52.738 Section 52.738 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.738 - Significant deterioration of air quality.

Code of Federal Regulations, 2013 CFR

2013-07-01

... quality. 52.738 Section 52.738 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.793 - Significant deterioration of air quality.

Code of Federal Regulations, 2012 CFR

2012-07-01

... quality. 52.793 Section 52.793 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.793 - Significant deterioration of air quality.

Code of Federal Regulations, 2013 CFR

2013-07-01

... quality. 52.793 Section 52.793 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.793 - Significant deterioration of air quality.

Code of Federal Regulations, 2014 CFR

2014-07-01

... quality. 52.793 Section 52.793 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.632 - Significant deterioration of air quality.

Code of Federal Regulations, 2010 CFR

2010-07-01

... quality. 52.632 Section 52.632 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.793 - Significant deterioration of air quality.

Code of Federal Regulations, 2010 CFR

2010-07-01

... quality. 52.793 Section 52.793 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

40 CFR 52.432 - Significant deterioration of air quality.

Code of Federal Regulations, 2010 CFR

2010-07-01

... quality. 52.432 Section 52.432 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulation for preventing significant deterioration of air quality. The provisions of...

40 CFR 52.738 - Significant deterioration of air quality.

Code of Federal Regulations, 2010 CFR

2010-07-01

... quality. 52.738 Section 52.738 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

Competition and quality in health care markets: a differential-game approach.

PubMed

Brekke, Kurt R; Cellini, Roberto; Siciliani, Luigi; Straume, Odd Rune

2010-07-01

We investigate the effect of competition on quality in health care markets with regulated prices taking a differential game approach, in which quality is a stock variable. Using a Hotelling framework, we derive the open-loop solution (health care providers set the optimal investment plan at the initial period) and the feedback closed-loop solution (providers move investments in response to the dynamics of the states). Under the closed-loop solution competition is more intense in the sense that providers observe quality in each period and base their investment on this information. If the marginal provision cost is constant, the open-loop and closed-loop solutions coincide, and the results are similar to the ones obtained by static models. If the marginal provision cost is increasing, investment and quality are lower in the closed-loop solution (when competition is more intense). In this case, static models tend to exaggerate the positive effect of competition on quality.

Contamination Control Changes to the Reusable Solid Rocket Motor Program: A Ten Year Review

NASA Technical Reports Server (NTRS)

Bushman, David M.

1998-01-01

During the post Challenger period, the National Aeronautics and Space Administration and Thiokol implemented changes to the Reusable Solid Rocket Motor (RSRM) contract to include provisions for contamination control to enhance the production environment. During the ten years since those agreements for contamination controls were made, many changes have taken place in the production facilities at Thiokol. These changes have led to the production of much higher quality shuttle solid rocket motors and improved cleanliness and safety of operations in the production facilities. The experience in contamination control over this past decade highlights the value these changes have brought to the RSRM program, and how the system can be improved to meet the challenges the program will face in the next ten years.

7 CFR 652.7 - Quality assurance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Quality assurance. 652.7 Section 652.7 Agriculture... AGRICULTURE SUPPORT ACTIVITIES TECHNICAL SERVICE PROVIDER ASSISTANCE General Provisions § 652.7 Quality assurance. (a) NRCS will review, in consultation with the Farm Service Agency, as appropriate, the quality...

Organizational Attributes Associated With Medicare ACO Quality Performance.

PubMed

Zhu, Xi; Mueller, Keith; Huang, Huang; Ullrich, Fred; Vaughn, Thomas; MacKinney, A Clinton

2018-05-08

To evaluate associations between geographic, structural, and service-provision attributes of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) and the ACOs' quality performance. We conducted cross-sectional and longitudinal analyses of ACO quality performance using data from the Centers for Medicare and Medicaid Services and additional sources. The sample included 322 and 385 MSSP ACOs that had successfully reported quality measures in 2014 and 2015, respectively. Results show that after adjusting for other organizational factors, rural ACOs' average quality score was comparable to that of ACOs serving other geographic categories. ACOs with hospital-system sponsorship, larger beneficiary panels, and higher posthospitalization follow-up rates achieved better quality performance. There is no significant difference in average quality performance between rural ACOs and other ACOs after adjusting for structural and service-provision factors. MSSP ACO quality performance is positively associated with hospital-system sponsorship, beneficiary panel size, and posthospitalization follow-up rate. © 2018 National Rural Health Association.

Redesigning a home oxygen assessment and review service.

PubMed

Wrench, Christine; Darwin, Ruth; Lawson, Rod

2015-03-01

The Sheffield home oxygen assessment and review service was developed as a nurse-led, protocol-driven service, offering high standards of care to a limited number of patients. In line with national changes to oxygen provision in 2011, the service team was approached to address inconsistencies and inequalities in the existing care pathway, with a view to becoming a fully commissioned service. This required a complete redesign of the service, using a collaborative approach to include relevant interested parties in planning and decision making. Additional support was gained through participation in the NHS Improvement lung national improvement project. This article outlines the process of service redesign, including some of the major challenges as well as the main learning points. It has led to the provision of an equitable and efficient service for all oxygen patients across the city, offering more community clinics and robust cost controls, while maintaining quality of care.

Quality-based purchasing in health care.

PubMed

Waters, Hugh R; Morlock, Laura L; Hatt, Laurel

2004-01-01

Quality-based purchasing is a growing trend that seeks to improve healthcare quality through the purchaser-provider relationship. This article provides a unifying conceptual framework, presents examples of the purchaser-provider relationship in countries at different income levels, and identifies important supporting mechanisms for quality-based purchasing. As countries become wealthier, a higher proportion of healthcare spending is channeled through pooled arrangements, allowing for greater involvement of purchasers in promoting the quality of service provision. Global and line item budgets are the most common type of provider payment system in low and middle-income countries. In these countries, improving public hospital performance through contracting and incentives is a key issue. In middle and high-income countries, there are several documented examples of governments contracting to private or non-governmental health care providers, resulting in higher perceived quality of care and lower delivery costs. Encouraging quality through employer purchasing arrangements has been promoted in several countries, particularly the United States. Community-based financing schemes are an increasingly common form of health financing in parts of sub-Saharan Africa and Asia, but these schemes still cover less than 10% of national populations in countries in which they are active. To date, there is little evidence of their impact on healthcare quality. The availability of information--concerning healthcare service provision and outcomes--determines the options for establishing and monitoring contract provisions and promoting quality. Regardless of the context, quality-based purchasing depends critically on informa-tion--reporting, monitoring, and providing useful information to healthcare consumers. In many low and middle-income countries, the lack of availability of information is the principal constraint on measuring performance, a critical component of quality-based purchasing.

Providing patient care in community pharmacies in Australia.

PubMed

Benrimoj, Shalom I; Roberts, Alison S

2005-11-01

To describe Australia's community pharmacy network in the context of the health system and outline the provision of services. The 5000 community pharmacies form a key component of the healthcare system for Australians, for whom health expenditures represent 9% of the Gross Domestic Product. A typical community pharmacy dispenses 880 prescriptions per week. Pharmacists are key partners in the Government's National Medicines Policy and contribute to its objectives through the provision of cognitive pharmaceutical services (CPS). The Third Community Pharmacy Agreement included funding for CPS including medication review and the provision of written drug information. Funding is also provided for a quality assurance platform with which the majority of pharmacies are accredited. Fifteen million dollars (Australian) have been allocated to research in community pharmacy, which has focused on achieving quality use of medicines (QUM), as well as developing new CPS and facilitating change. Elements of the Agreements have taken into account QUM principles and are now significant drivers of practice change. Although accounting for 10% of remuneration for community pharmacy, the provision of CPS represents a significant shift in focus to view pharmacy as a service provider. Delivery of CPS through the community pharmacy network provides sustainability for primary health care due to improvement in quality presumably associated with a reduction in healthcare costs. Australian pharmacy practice is moving strongly in the direction of CPS provision; however, change does not occur easily. The development of a change management strategy is underway to improve the uptake of professional and business opportunities in community pharmacy.

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

PubMed

Whelan, Jessica J; Willis, Karen

2007-01-01

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

Managing obesity in pharmacy: the Australian experience.

PubMed

Um, Irene S I; Armour, Carol; Krass, Ines; Gill, Timothy; Chaar, Betty B

2010-12-01

To explore pharmacists' opinions about the provision of weight management services in community pharmacy and their attitudes towards the establishment of an accredited training course in weight management in pharmacy. Interviews were conducted with practising pharmacists on site in various community pharmacies in metropolitan Sydney, Australia. In-depth, semi-structured interviews with twenty practising pharmacists were conducted. Of the twenty interviewed pharmacists, sixteen were involved in the provision of one or more pharmacy based weight management programs in their pharmacies. Interviews were audio-recorded, transcribed and analysed using the grounded theory approach. The data were thematically analysed to identify facilitators and perceived barriers to the provision of high quality services, and pharmacists' willingness to undertake training and accreditation. Participants clearly perceived a role for pharmacy in weight management. Key facilitators to provision of service were accessibility and the perception of pharmacists as trustworthy healthcare professionals. The pharmacists proposed collaboration with other healthcare professionals in order to provide a service incorporating diet, exercise and behavioural therapy. A program that was not-product-centred, and supported by ethical marketing was favoured. Appropriate training and accreditation were considered essential to assuring the quality of such services. Barriers to the provision of high quality services identified were: remuneration, pharmacy infrastructure, client demand and the current marketing of product-centred programs. Australian pharmacists believe there is a role for pharmacy in weight management, provided training in accredited programs is made available. A holistic, evidence-based, multi-disciplinary service model has been identified as ideal.

42 CFR 441.585 - Quality assurance system.

Code of Federal Regulations, 2012 CFR

2012-10-01

... provides information about the provisions of quality improvement and assurance to each individual receiving... 42 Public Health 4 2012-10-01 2012-10-01 false Quality assurance system. 441.585 Section 441.585...) § 441.585 Quality assurance system. (a) States must establish and maintain a comprehensive, continuous...

Quality specifications and standard-setting for stoma care patients.

PubMed

Primer, M A

1995-12-01

Quality specifications can be used as an information resource by purchasers of health care. The nature of service provision and nursing care can be positively influenced by the formalisation of standards and quality specifications. Auditing is essential in the ongoing evaluation of a quality system.

Ensuring the Quality of Stem Cell-Derived In Vitro Models for Toxicity Testing.

PubMed

Stacey, Glyn N; Coecke, Sandra; Price, Anna-Bal; Healy, Lyn; Jennings, Paul; Wilmes, Anja; Pinset, Christian; Ingelman-Sundberg, Magnus; Louisse, Jochem; Haupt, Simone; Kidd, Darren; Robitski, Andrea; Jahnke, Heinz-Georg; Lemaitre, Gilles; Myatt, Glenn

Quality control of cell cultures used in new in vitro toxicology assays is crucial to the provision of reliable, reproducible and accurate toxicity data on new drugs or constituents of new consumer products. This chapter explores the key scientific and ethical criteria that must be addressed at the earliest stages of developing toxicology assays based on human pluripotent stem cell (hPSC) lines. It also identifies key considerations for such assays to be acceptable for regulatory, laboratory safety and commercial purposes. Also addressed is the development of hPSC-based assays for the tissue and cell types of greatest interest in drug toxicology. The chapter draws on a range of expert opinion within the European Commission/Cosmetics Europe-funded alternative testing cluster SEURAT-1 and consensus from international groups delivering this guidance such as the International Stem Cell Banking Initiative. Accordingly, the chapter summarizes the most up-date best practices in the use and quality control of human Pluripotent Stem Cell lines in the development of in vitro toxicity assays from leading experts in the field.

21 CFR 26.81 - Final provisions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Final provisions. 26.81 Section 26.81 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL MUTUAL RECOGNITION OF PHARMACEUTICAL GOOD MANUFACTURING PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS...

The integrated management for renal replacement therapy in Portugal.

PubMed

Coelho, Anabela P; Sá, Helena O; Diniz, José A; Dussault, Gilles

2014-01-01

Portugal was the first European country to introduce an integrated management of end-stage renal disease (IM ESRD). This new program integrates various dialysis services and products, which are reimbursed at a fixed rate/patient/week called "comprehensive price payment." This initiative restructured the delivery of dialysis services, the monitoring of outcomes, and the funding of renal replacement therapy. This article described the implementation of a new model of comprehensive provision of hemodialysis (HD) services and aimed to assess its impact on dialysis care. Quality assessments and reports of patient satisfaction, produced by the Ministry of Health since 2008, as well as national registries and reports, provided the data for this review. Indicators of HD services in all continental facilities show positive results that have successively improved along the period of 2009-2011, in spite of an average annual growth of 3% of the population under HD treatment. Mortality rates for HD patients were 12.7%, 12%, and 11%, respectively in 2009, 2010, and 2011; annual hospitalization rates were 4.9%, 3.8%, and 4.4% for the same years; key performance indicators showed averages above the reference values such as hemoglobin, serum phosphorus, eKt/V, water quality, number of days of hospitalization per patient per year, and number of weekly dialysis sessions. The financing analysis of IM ESRD demonstrates a sustained control of global costs, without compromising quality. The IM ERSD program is an innovative and quality-driven approach that benefits both dialysis patients and providers, contributing toward the rationalization of service provision and the efficient use of resources. © 2013 International Society for Hemodialysis.

40 CFR 1051.510 - What special provisions apply for testing ATV engines? [Reserved

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false What special provisions apply for... PROTECTION AGENCY (CONTINUED) AIR POLLUTION CONTROLS CONTROL OF EMISSIONS FROM RECREATIONAL ENGINES AND VEHICLES Test Procedures § 1051.510 What special provisions apply for testing ATV engines? [Reserved] ...

50 CFR 221.74 - Has OMB approved the information collection provisions of this subpart?

Code of Federal Regulations, 2010 CFR

2010-10-01

... collection provisions of this subpart? Yes. This rule contains provisions that would collect information from... it displays a currently valid OMB control number that indicates OMB approval. OMB has reviewed the information collection in this rule and approved it under OMB control number 1094-0001. ...

Nutritional support for children with epidermolysis bullosa.

PubMed

Haynes, Lesley

Epidermolysis bullosa (EB) comprises a rare group of genetically determined skin blistering disorders characterized by extreme fragility of the skin and mucous membranes, with recurrent blister formation. The cornerstones of management are control of infection, wound management, pain relief, promotion of optimal nutritional status and mobility, surgical intervention and provision of the best possible quality of life. There is currently no cure for EB and, throughout life, those with the more severe types are at risk of significant nutritional compromise which impacts negatively on health and overall quality of life. Nutritional support is an important facet of holistic care and the dietetic challenges can be considerable. This paper describes some of the issues involved in optimizing the nutritional status of children with this disorder.

Evaluating Quality Management in University Departments

ERIC Educational Resources Information Center

Becket, Nina; Brookes, Maureen

2006-01-01

Purpose: Despite the abundance of research on quality management there is no universal consensus on how best to measure quality in higher education. This paper undertakes a critical evaluation of the different methods used to assess the quality of provision in higher education departments in the UK. Design/methodology/approach: Drawing on relevant…

48 CFR 552.246-70 - Source Inspection by Quality Approved Manufacturer.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Quality Approved Manufacturer. 552.246-70 Section 552.246-70 Federal Acquisition Regulations System... Provisions and Clauses 552.246-70 Source Inspection by Quality Approved Manufacturer. As prescribed in 546.302-70, insert the following clause: Source Inspection by Quality Approved Manufacturer (JUL 09) (a...

48 CFR 552.246-70 - Source Inspection by Quality Approved Manufacturer.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Quality Approved Manufacturer. 552.246-70 Section 552.246-70 Federal Acquisition Regulations System... Provisions and Clauses 552.246-70 Source Inspection by Quality Approved Manufacturer. As prescribed in 546.302-70, insert the following clause: Source Inspection by Quality Approved Manufacturer (JUL 09) (a...

21 CFR 26.43 - Transmission of quality system evaluation reports.

Code of Federal Regulations, 2010 CFR

2010-04-01

... QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN MEDICAL DEVICE PRODUCT EVALUATION REPORTS: UNITED STATES AND THE EUROPEAN COMMUNITY Specific Sector Provisions for Medical Devices § 26.43 Transmission of quality system... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Transmission of quality system evaluation reports...

40 CFR 52.2581 - Significant deterioration of air quality.

Code of Federal Regulations, 2011 CFR

2011-07-01

... quality. 52.2581 Section 52.2581 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a)-(c) [Reserved] (d) The requirements of sections 160 through 165... provisions for prevention of significant deterioration of air quality at 40 CFR 52.21 are applicable to the...

40 CFR 52.1116 - Significant deterioration of air quality.

Code of Federal Regulations, 2013 CFR

2013-07-01

... quality. 52.1116 Section 52.1116 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) The following provisions of 40 CFR 52.21 are hereby incorporated and made a...

40 CFR 52.2581 - Significant deterioration of air quality.

Code of Federal Regulations, 2013 CFR

2013-07-01

... quality. 52.2581 Section 52.2581 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a)-(c) [Reserved] (d) The requirements of sections 160 through 165... provisions for prevention of significant deterioration of air quality at 40 CFR 52.21 are applicable to the...

40 CFR 52.833 - Significant deterioration of air quality.

Code of Federal Regulations, 2012 CFR

2012-07-01

... quality. 52.833 Section 52.833 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are met... for preventing significant deterioration of air quality. The provisions of § 52.21 except paragraph (a...

40 CFR 52.833 - Significant deterioration of air quality.

Code of Federal Regulations, 2014 CFR

2014-07-01

... quality. 52.833 Section 52.833 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are met... for preventing significant deterioration of air quality. The provisions of § 52.21 except paragraph (a...

40 CFR 52.1116 - Significant deterioration of air quality.

Code of Federal Regulations, 2011 CFR

2011-07-01

... quality. 52.1116 Section 52.1116 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) The following provisions of 40 CFR 52.21 are hereby incorporated and made a...

40 CFR 52.2581 - Significant deterioration of air quality.

Code of Federal Regulations, 2012 CFR

2012-07-01

... quality. 52.2581 Section 52.2581 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a)-(c) [Reserved] (d) The requirements of sections 160 through 165... provisions for prevention of significant deterioration of air quality at 40 CFR 52.21 are applicable to the...

40 CFR 52.833 - Significant deterioration of air quality.

Code of Federal Regulations, 2013 CFR

2013-07-01

... quality. 52.833 Section 52.833 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are met... for preventing significant deterioration of air quality. The provisions of § 52.21 except paragraph (a...

40 CFR 52.1829 - Prevention of significant deterioration of air quality.

Code of Federal Regulations, 2011 CFR

2011-07-01

... of air quality. 52.1829 Section 52.1829 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Dakota § 52.1829 Prevention of significant deterioration of air quality. (a) The North Dakota plan, as... of significant deterioration of air quality. The provisions of § 52.21 except paragraph (a)(1) are...

40 CFR 52.1116 - Significant deterioration of air quality.

Code of Federal Regulations, 2014 CFR

2014-07-01

... quality. 52.1116 Section 52.1116 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) The following provisions of 40 CFR 52.21 are hereby incorporated and made a...

40 CFR 52.2581 - Significant deterioration of air quality.

Code of Federal Regulations, 2014 CFR

2014-07-01

... quality. 52.2581 Section 52.2581 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a)-(c) [Reserved] (d) The requirements of sections 160 through 165... provisions for prevention of significant deterioration of air quality at 40 CFR 52.21 are applicable to the...

40 CFR 52.833 - Significant deterioration of air quality.

Code of Federal Regulations, 2011 CFR

2011-07-01

... quality. 52.833 Section 52.833 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are met... for preventing significant deterioration of air quality. The provisions of § 52.21 except paragraph (a...

40 CFR 52.1382 - Prevention of significant deterioration of air quality.

Code of Federal Regulations, 2011 CFR

2011-07-01

... of air quality. 52.1382 Section 52.1382 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 52.1382 Prevention of significant deterioration of air quality. (a) The Montana plan, as submitted... significant deterioration of air quality. The provisions of § 52.21 except paragraph (a)(1) are hereby...

40 CFR 52.1116 - Significant deterioration of air quality.

Code of Federal Regulations, 2012 CFR

2012-07-01

... quality. 52.1116 Section 52.1116 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) The following provisions of 40 CFR 52.21 are hereby incorporated and made a...

40 CFR 52.2581 - Significant deterioration of air quality.

Code of Federal Regulations, 2010 CFR

2010-07-01

... quality. 52.2581 Section 52.2581 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a)-(c) [Reserved] (d) The requirements of sections 160 through 165... provisions for prevention of significant deterioration of air quality at 40 CFR 52.21 are applicable to the...

40 CFR 52.1116 - Significant deterioration of air quality.

Code of Federal Regulations, 2010 CFR

2010-07-01

... quality. 52.1116 Section 52.1116 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) The following provisions of 40 CFR 52.21 are hereby incorporated and made a...

40 CFR 52.833 - Significant deterioration of air quality.

Code of Federal Regulations, 2010 CFR

2010-07-01

... quality. 52.833 Section 52.833 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are met... for preventing significant deterioration of air quality. The provisions of § 52.21 except paragraph (a...

34 CFR 611.1 - What definitions apply to the Teacher Quality Enhancement Grants Program?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 3 2012-07-01 2012-07-01 false What definitions apply to the Teacher Quality... Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION TEACHER QUALITY ENHANCEMENT GRANTS PROGRAM General Provisions § 611.1 What definitions apply to the Teacher Quality Enhancement...

34 CFR 611.1 - What definitions apply to the Teacher Quality Enhancement Grants Program?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 3 2014-07-01 2014-07-01 false What definitions apply to the Teacher Quality... Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION TEACHER QUALITY ENHANCEMENT GRANTS PROGRAM General Provisions § 611.1 What definitions apply to the Teacher Quality Enhancement...

34 CFR 611.1 - What definitions apply to the Teacher Quality Enhancement Grants Program?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 3 2011-07-01 2011-07-01 false What definitions apply to the Teacher Quality... Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION TEACHER QUALITY ENHANCEMENT GRANTS PROGRAM General Provisions § 611.1 What definitions apply to the Teacher Quality Enhancement...

Perceptions of Higher Education Quality at Three Universities in Vietnam

ERIC Educational Resources Information Center

Pham, Huong Thi; Starkey, Louise

2016-01-01

Purpose: Vietnam is experiencing rapid expansion in the provision of higher education that requires quality assurance appropriate for the Vietnamese-centralised Confucian cultural context. This paper aims to examine the concept of quality from the perspectives of academic leaders, quality assurance members and academics at three higher education…

Patients' online access to their electronic health records and linked online services: a systematic review in primary care.

PubMed

Mold, Freda; de Lusignan, Simon; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Arvanitis, Theodoros N; Ellis, Beverley

2015-03-01

Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. A systematic review was conducted that focused on all studies about online record access and transactional services in primary care. Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King's Fund, Nuffield Health, PsycINFO, OpenGrey (1999-2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so. © British Journal of General Practice 2015.

Patients’ online access to their electronic health records and linked online services: a systematic review in primary care

PubMed Central

Mold, Freda; de Lusignan, Simon; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Arvanitis, Theodoros N; Ellis, Beverley

2015-01-01

Background Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. Aim To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. Design and setting A systematic review was conducted that focused on all studies about online record access and transactional services in primary care. Method Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King’s Fund, Nuffield Health, PsycINFO, OpenGrey (1999–2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. Results A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. Conclusion While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups. Professional concerns about privacy were unrealised and those about workload were only partly so. PMID:25733435

28 CFR 545.26 - Performance pay provisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... categories as quality of work, quantity of work, initiative, ability to learn, dependability, response to... inmate may receive special bonus pay based on the inmate's exceptional work in a temporary job assignment... WORK AND COMPENSATION Inmate Work and Performance Pay Program § 545.26 Performance pay provisions. (a...

28 CFR 545.26 - Performance pay provisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... categories as quality of work, quantity of work, initiative, ability to learn, dependability, response to... inmate may receive special bonus pay based on the inmate's exceptional work in a temporary job assignment... WORK AND COMPENSATION Inmate Work and Performance Pay Program § 545.26 Performance pay provisions. (a...

Reducing health care costs--potential and limitations of local authority health services.

PubMed

Ijsselmuiden, C B; De Beer, C

1990-08-04

Local authorities (LAs) currently provide preventive and promotive services. It is argued that, by extending the role of the LA to the provision of comprehensive services, including ambulatory and hospital curative care, both the quality and the cost-effectiveness of health care would be improved. Making health care the responsibility of the LA would minimise fragmentation, allow for the provision of a number of services that currently are neglected because they fall through the gap that exists between preventive and curative services, and result in the more effective use of personnel currently restricted to providing preventive care only. LAs offer an appropriate structure for effective community control over the health services, and are more likely to be sensitive to local needs and demands. In addition, their administrative proximity to other LA departments responsible for housing, town planning and parks and recreation allows for an effective multisectoral approach to health. The positive aspects of LA care can only be achieved in the context of racially integrated services provided by an LA elected by universal adult franchise. Smaller LAs may need to be grouped together in larger units for the purpose of achieving satisfactory economies of scale in the provision of health care.

Life sciences flight experiments program, life sciences project division, procurement quality provisions

NASA Technical Reports Server (NTRS)

House, G.

1980-01-01

Methods are defined for implementing quality assurance policy and requirements for life sciences laboratory equipment, experimental hardware, integration and test support equipment, and integrated payloads.

The contribution of the French Muskoka Fund to improving access to essential medicines and priority health products for mothers and children.

PubMed

Macé, C; Nikiema, J-B

2016-11-01

One objective of the French Muskoka Fund since 2011 has been to improve the availability of quality healthcare services for mothers and children and thus to contribute to the continued presence of essential drugs and affordable quality health products and to their rational use by healthcare personnel. This project thus contributed to reinforcing the work of the national regulatory authorities, guarantor of the quality of the products supplied to the populations, but also to strengthening the coordination of supplies at the country level. It also enabled the provision of support for the implementation of drug price controls and helped to strengthen the ability of healthcare staff to optimize their use of the products available to them. This work should be continued in these countries as they meet the agenda of the Sustainable Development Goals, which require the establishment of universal healthcare coverage.

The drug regulatory and review process in Guyana.

PubMed

Woo-Ming, R B

1993-01-01

After the old "Sale of Food and Drugs" Ordinance, Cap. 144 was repealed, the new Food and Drugs Act was enacted in 1971. This new Act has considerable flexibility and gives the Minister extensive authority to make Regulations (for carrying out the purposes and provisions of the Act). The Act controls the manufacture, importation, sale, advertising, labeling, packaging, and distribution of drug samples, and the testing of drugs. The Act also controls raw materials and finished products of drugs at the point of entry into the country, with a single agency coordinating both the inspection and analytical services. Developing countries could ensure the procurement of safe, good quality, and effective drugs and devices with the enactment of a similar Food and Drugs Act only. Rapid assessment of Drug Safety, Quality and Efficacy is done through Guyana's participation in the WHO Certification Scheme on the Quality of Pharmaceutical Products moving in International Commerce. This certification scheme is highly commendable especially to third-world countries. The Food and Drug Regulations (1977) have several unique features for drug, cosmetic and device control and they allow for a system of centralized control with limited staff to enforce the legislation. In summary, enforcement of legislative control of imported pharmaceuticals and product evaluation can be considered strong points in the drug regulatory and review process in Guyana. A cautious attitude is observed so as to ensure efficacy, safety, and quality of drugs entering the market. This Drug Regulatory and Review Process is recommended for implementation by third-world countries with outdated drug legislation.(ABSTRACT TRUNCATED AT 250 WORDS)

7 CFR 1000.93 - OMB control number assigned pursuant to the Paperwork Reduction Act.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE GENERAL PROVISIONS OF FEDERAL MILK MARKETING ORDERS Miscellaneous Provisions § 1000.93 OMB control number assigned... have been approved by the Office of Management and Budget (OMB) under the provisions of Title 44 U.S.C...

The development of NEdSERV: quantitative instrumentation to measure service quality in nurse education.

PubMed

Roberts, P

1999-07-01

The political climate of health care provision and education for health care in the latter years of the 20th century is evolving from the uncertainty of newly created markets to a more clearly focused culture of collaboration, dissemination of good practice, with an increased emphasis on quality provision and its measurement. The need for provider units to prove and improve efficiency and effectiveness through evidence-based quality strategies in order to stay firmly in the market place has never been more necessary. The measurement of customer expectations and perceptions of delivered service quality is widely utilized as a basis for customer retention and business growth in both commercial and non-profit organizations. This paper describes the methodological development of NEdSERV--quantitative instrumentation designed to measure and respond to ongoing stakeholder expectations and perceptions of delivered service quality within nurse education.

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2011 CFR

2011-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2012 CFR

2012-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2014 CFR

2014-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2013 CFR

2013-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2010 CFR

2010-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

40 CFR 58.1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... QUALITY SURVEILLANCE General Provisions § 58.1 Definitions. As used in this part, all terms not defined... his or her authorized representative. Air Quality System (AQS) means EPA's computerized system for storing and reporting of information relating to ambient air quality data. Approved regional method (ARM...

Small business, cash budgets and general practice.

PubMed

Jackson, A R

1991-01-01

In practice management, general practice falls into the category of small business with all its attendant generic problems. Disciplined planning and good financial management are not often seen in small business. These are required if general practitioners are to continue (or return to) the provision of high quality medical services. An effective budget process, especially cash-flow budgeting, is the key to successful planning and financial management. Budgeting will bring Control, Co-ordination, and Credibility to your practice. It will enable you to set goals and to achieve them.

Identification of Nonattainment Classification and Deadlines for Submission of State Implementation Plan (SIP) Provisions for the 1997 & 2006 Fine Particle National Ambient Air Quality Standards (NAAQS) Fact Sheet

EPA Pesticide Factsheets

This page contains the fact sheet for the Final Nonattainment Classification and Deadlines for Submission of State Implementation Plan (SIP) Provisions for the 1997 and 2006 Particulate Matter (PM) rule.

With Africa for Africa. Towards Quality Education for All. 1999 MLA Project.

ERIC Educational Resources Information Center

Chinapah, Vinayagum; H'ddigui, El Mostafa; Kanjee, Anil; Falayajo, Wole; Fomba, Cheik Omar; Hamissou, Oumarou; Rafalimanana, Albert; Byomugisha, Albert

Monitoring Learning Achievement (MLA), a joint UNESCO-UNICEF international education assessment initiative, obtains information on the "effectiveness of basic education provision[s] in terms of actual learning achievement." The empirical evidence from the 1999 MLA project countries provides both a diagnosis and possible actions to be…

"Wasted down There": Policy and Practice with the Under-Threes

ERIC Educational Resources Information Center

Clark, Rory McDowall; Baylis, Sue

2012-01-01

Although frameworks now exist for quality provision for under-threes, discourses underpinning policy remain conflicted. The split between care and education is still firmly entrenched in provision and a gap remains between rhetoric and practice. This paper explores how Early Years Professional Status, which requires practitioners to engage…

Improving uptake and use of malaria rapid diagnostic tests in the context of artemisinin drug resistance containment in eastern Myanmar: an evaluation of incentive schemes among informal private healthcare providers.

PubMed

Aung, Tin; White, Christopher; Montagu, Dominic; McFarland, Willi; Hlaing, Thaung; Khin, Hnin Su Su; San, Aung Kyaw; Briegleb, Christina; Chen, Ingrid; Sudhinaraset, May

2015-03-06

As efforts to contain artemisinin resistance and eliminate Plasmodium falciparum intensify, the accurate diagnosis and prompt effective treatment of malaria are increasingly needed in Myanmar and the Greater Mekong Sub-region (GMS). Rapid diagnostic tests (RDTs) have been shown to be safe, feasible, and effective at promoting appropriate treatment for suspected malaria, which are of particular importance to drug resistance containment. The informal private sector is often the first point of care for fever cases in malaria endemic areas across Myanmar and the GMS, but there is little published information about informal private provider practices, quality of service provision, or potential to contribute to malaria control and elimination efforts. This study tested different incentives to increase RDT use and improve the quality of care among informal private healthcare providers in Myanmar. The study randomized six townships in the Mon and Shan states of rural Myanmar into three intervention arms: 1) RDT price subsidies, 2) price subsidies with product-related financial incentives, and 3) price subsidies with intensified information, education and counselling (IEC). The study assessed the uptake of RDT use in the communities by cross-sectional surveys of 3,150 households at baseline and six months post-intervention (6,400 households total, 832 fever cases). The study also used mystery clients among 171 providers to assess quality of service provision across intervention arms. The pilot intervention trained over 600 informal private healthcare providers. The study found a price subsidy with intensified IEC, resulted in the highest uptake of RDTs in the community, as compared to subsidies alone or merchandise-related financial incentives. Moreover, intensified IEC led to improvements in the quality of care, with mystery client surveys showing almost double the number of correct treatment following diagnostic test results as compared to a simple subsidy. Results show that training and quality supervision of informal private healthcare providers can result in improved demand for, and appropriate use of RDTs in drug resistance containment areas in eastern Myanmar. Future studies should assess the sustainability of such interventions and the scale and level of intensity required over time as public sector service provision expands.

40 CFR 131.6 - Minimum requirements for water quality standards submission.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Minimum requirements for water quality standards submission. 131.6 Section 131.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY STANDARDS General Provisions § 131.6 Minimum requirements for water quality standards submission. The...

40 CFR 131.6 - Minimum requirements for water quality standards submission.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Minimum requirements for water quality standards submission. 131.6 Section 131.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY STANDARDS General Provisions § 131.6 Minimum requirements for water quality standards submission. The...

Teacher Quality: Equalizing Educational Opportunities and Outcomes

ERIC Educational Resources Information Center

Sunderman, Gail L.; Kim, Jimmy

2005-01-01

The No Child Left Behind (NCLB) teacher quality provisions recognize both the importance of teacher quality for improving student achievement and the unequal distribution of teachers across districts and schools. But the question of how to achieve the goal of a high quality teacher in every classroom is complicated because of the challenges of…

The quality of sputum smear microscopy in public-private mix directly observed treatment laboratories in West Amhara region, Ethiopia.

PubMed

Manalebh, Almaw; Demissie, Meaza; Mekonnen, Daniel; Abera, Bayeh

2015-01-01

Ethiopia adopted Public-Private Mix Directly Observed Treatment Short Course Chemotherapy (PPM-DOTS) strategy for tuberculosis (TB) control program. Quality of sputum smear microscopy has paramount importance for tuberculosis control program in resource-poor countries like Ethiopia. A cross-sectional study was conducted to assess the quality of sputum smear microscopy in 37 Public-Private Mix laboratories in West Amhara, Ethiopia. The three external quality assessment methods (onsite evaluation, panel testing and blind rechecking) were employed. Onsite assessment revealed that 67.6% of PPM-DOTS laboratories were below the standard physical space (5 X 6) m2. The average monthly workload per laboratory technician was 19.5 (SD±2.9) slides with 12.8% positivity rate. The quality of Acid Fast Bacilli (AFB) staining reagents was sub-standard. The overall agreement for blind rechecking of 1,123 AFB slides was 99.4% (Kappa = 0.97). Reading of 370 AFB panel slides showed 3.5% false reading (Kappa = 0.92). Moreover, the consistency of reading scanty bacilli slides was lower (93%) compared to 1+, 2+ and 3+ bacilli. Based on blind rechecking and panel testing results, PPM-DOTS site laboratories showed good agreement with the reference laboratory. Physical space and qualities of AFB reagents would be areas of intervention to sustain the quality of sputum smear microscopy. Therefore, regular external quality assessment and provision of basic laboratory supplies for TB diagnosis would be the way forward to improve the quality of sputum smear microscopy services in PPM-DOTS laboratories.

The Quality of Sputum Smear Microscopy in Public-Private Mix Directly Observed Treatment Laboratories in West Amhara Region, Ethiopia

PubMed Central

Manalebh, Almaw; Demissie, Meaza; Mekonnen, Daniel; Abera, Bayeh

2015-01-01

Ethiopia adopted Public-Private Mix Directly Observed Treatment Short Course Chemotherapy (PPM-DOTS) strategy for tuberculosis (TB) control program. Quality of sputum smear microscopy has paramount importance for tuberculosis control program in resource-poor countries like Ethiopia. A cross-sectional study was conducted to assess the quality of sputum smear microscopy in 37 Public-Private Mix laboratories in West Amhara, Ethiopia. The three external quality assessment methods (onsite evaluation, panel testing and blind rechecking) were employed. Onsite assessment revealed that 67.6% of PPM-DOTS laboratories were below the standard physical space (5 X 6) m2. The average monthly workload per laboratory technician was 19.5 (SD±2.9) slides with 12.8% positivity rate. The quality of Acid Fast Bacilli (AFB) staining reagents was sub-standard. The overall agreement for blind rechecking of 1,123 AFB slides was 99.4% (Kappa = 0.97). Reading of 370 AFB panel slides showed 3.5% false reading (Kappa = 0.92). Moreover, the consistency of reading scanty bacilli slides was lower (93%) compared to 1+, 2+ and 3+ bacilli. Based on blind rechecking and panel testing results, PPM-DOTS site laboratories showed good agreement with the reference laboratory. Physical space and qualities of AFB reagents would be areas of intervention to sustain the quality of sputum smear microscopy. Therefore, regular external quality assessment and provision of basic laboratory supplies for TB diagnosis would be the way forward to improve the quality of sputum smear microscopy services in PPM-DOTS laboratories. PMID:25849516

40 CFR 1051.630 - What special provisions apply to unique snowmobile designs for all manufacturers?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 33 2011-07-01 2011-07-01 false What special provisions apply to unique snowmobile designs for all manufacturers? 1051.630 Section 1051.630 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR POLLUTION CONTROLS CONTROL OF EMISSIONS FROM RECREATIONAL ENGINES AND VEHICLES Compliance Provisions §...

25 CFR 44.110 - What Indian Self-Determination Act provisions apply to grants under the Tribally Controlled...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false What Indian Self-Determination Act provisions apply to... Self-Determination Act provisions apply to grants under the Tribally Controlled Schools Act? (a) The... administrative cost grant; (4) Any dispute regarding new construction or facility improvement or repair; or (5...

25 CFR 44.110 - What Indian Self-Determination Act provisions apply to grants under the Tribally Controlled...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false What Indian Self-Determination Act provisions apply to... Self-Determination Act provisions apply to grants under the Tribally Controlled Schools Act? (a) The... administrative cost grant; (4) Any dispute regarding new construction or facility improvement or repair; or (5...

25 CFR 44.110 - What Indian Self-Determination Act provisions apply to grants under the Tribally Controlled...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true What Indian Self-Determination Act provisions apply to... Self-Determination Act provisions apply to grants under the Tribally Controlled Schools Act? (a) The... administrative cost grant; (4) Any dispute regarding new construction or facility improvement or repair; or (5...

25 CFR 44.110 - What Indian Self-Determination Act provisions apply to grants under the Tribally Controlled...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false What Indian Self-Determination Act provisions apply to... Self-Determination Act provisions apply to grants under the Tribally Controlled Schools Act? (a) The... administrative cost grant; (4) Any dispute regarding new construction or facility improvement or repair; or (5...

25 CFR 44.110 - What Indian Self-Determination Act provisions apply to grants under the Tribally Controlled...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false What Indian Self-Determination Act provisions apply to... Self-Determination Act provisions apply to grants under the Tribally Controlled Schools Act? (a) The... administrative cost grant; (4) Any dispute regarding new construction or facility improvement or repair; or (5...

76 FR 41337 - Approval and Promulgation of Implementation Plans; California; 2008 San Joaquin Valley PM2.5

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-13

...EPA is proposing to approve in part and disapprove in part state implementation plan (SIP) revisions submitted by California to provide for attainment of the 1997 fine particulate matter (PM2.5) national ambient air quality standards in the San Joaquin Valley (SJV). These SIP revisions are the SJV 2008 PM2.5 Plan (revised 2010 and 2011) and SJV-related provisions of the 2007 State Strategy (revised 2009 and 2011). EPA is proposing to approve the emissions inventories; air quality modeling; the reasonably available control measures/reasonably available control technology, reasonable further progress, and attainment demonstrations; and the transportation conformity motor vehicle emissions budgets. EPA is also proposing to grant California's request to extend the attainment deadline for the SJV to April 5, 2015 and to approve commitments to measures and reductions by the SJV Air Pollution Control District and the California Air Resources Board. Finally, it is proposing to disapprove the SIP's contingency measures. This proposed rule amends EPA's November 30, 2010 proposed rule (75 FR 74518) on the SJV 2008 PM2.5 Plan and 2007 State Strategy.

42 CFR 441.585 - Quality assurance system.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Quality assurance system. 441.585 Section 441.585 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... provides information about the provisions of quality improvement and assurance to each individual receiving...

42 CFR 441.585 - Quality assurance system.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Quality assurance system. 441.585 Section 441.585 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... provides information about the provisions of quality improvement and assurance to each individual receiving...

Nonrandom extinction patterns can modulate pest control service decline.

PubMed

Karp, Daniel S; Moeller, Holly V; Frishkoff, Luke O

2013-06-01

Changes in biodiversity will mediate the consequences of agricultural intensification and expansion for ecosystem services. Regulating services, like pollination and pest control, generally decline with species loss. In nature, however, relationships between service provision and species richness are not always strong, partially because anthropogenic disturbances purge species from communities in nonrandom orders. The same traits that make for effective service providers may also confer resistance or sensitivity to anthropogenic disturbances, which may either temper or accelerate declines in service provision with species loss. We modeled a community of predators interacting with insect pest prey, and identified the contexts in which pest control provision was most sensitive to species loss. We found pest populations increased rapidly when functionally unique and dietary-generalist predators were lost first, with up to 20% lower pest control provision than random loss. In general, pest abundance increased most in the scenarios that freed more pest species from predation. Species loss also decreased the likelihood that the most effective service providers were present. In communities composed of species with identical traits, predators were equally effective service providers and, when competing predators went extinct, remaining community members assumed their functional roles. In more realistic trait-diverse communities, predators differed in pest control efficacy, and remaining predators could not fully compensate for the loss of their competitors, causing steeper declines in pest control provision with predator species loss. These results highlight diet breadth in particular as a key predictor of service provision, as it affects both the way species respond to and alter their environments. More generally, our model provides testable hypotheses for predicting how nonrandom species loss alters relationships between biodiversity and pest control provision.

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

PubMed

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

2017-06-01

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

Antenatal care strengthening for improved quality of care in Jimma, Ethiopia: an effectiveness study.

PubMed

Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe; Tilahun, Abebech; Friis, Henrik; Rasch, Vibeke

2015-04-11

Interventions for curing most diseases and save lives of pregnant and delivering women exist, yet the power of health systems to deliver them to those in most need is not sufficient. The aims of this study were to design a participatory antenatal care (ANC) strengthening intervention and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. The intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems and increased overall user satisfaction with ANC) were distal project outcomes. The process of implementation was documented in monthly supervision reports. Household surveys, before (2008) and after (2010) intervention, were conducted amongst all women who had given birth within the previous 12 months. The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. The continued attention to the ANC provision during implementation stimulated increased priority of ANC among health care providers. The organizational structure of the facilities and lack of continuity in care provision turned out to be a major challenge for implementation. There was a positive effect of the intervention on health education on danger signs during pregnancy (OR: 3.9, 95% CI: 2.6;5.7), laboratory testing (OR for blood tests other than HIV 2.9, 95% CI: 1.9;4.5), health problem identification (OR 1.8, 95% CI: 1.1;3.1), and satisfaction with the service (OR: 0.4, 95% CI: 0.2;0.9). There was no effect of intervention on conduct of health professionals. The effect of intervention on various outcomes was significantly modified by maternal education. The quality of care can be improved in some important aspects with limited resources. Moreover, the study provides strategic perspectives on how to facilitate improved quality of ANC.

Analytical performance evaluation of a high-volume hematology laboratory utilizing sigma metrics as standard of excellence.

PubMed

Shaikh, M S; Moiz, B

2016-04-01

Around two-thirds of important clinical decisions about the management of patients are based on laboratory test results. Clinical laboratories are required to adopt quality control (QC) measures to ensure provision of accurate and precise results. Six sigma is a statistical tool, which provides opportunity to assess performance at the highest level of excellence. The purpose of this study was to assess performance of our hematological parameters on sigma scale in order to identify gaps and hence areas of improvement in patient care. Twelve analytes included in the study were hemoglobin (Hb), hematocrit (Hct), red blood cell count (RBC), mean corpuscular volume (MCV), red cell distribution width (RDW), total leukocyte count (TLC) with percentages of neutrophils (Neutr%) and lymphocytes (Lymph %), platelet count (Plt), mean platelet volume (MPV), prothrombin time (PT), and fibrinogen (Fbg). Internal quality control data and external quality assurance survey results were utilized for the calculation of sigma metrics for each analyte. Acceptable sigma value of ≥3 was obtained for the majority of the analytes included in the analysis. MCV, Plt, and Fbg achieved value of <3 for level 1 (low abnormal) control. PT performed poorly on both level 1 and 2 controls with sigma value of <3. Despite acceptable conventional QC tools, application of sigma metrics can identify analytical deficits and hence prospects for the improvement in clinical laboratories. © 2016 John Wiley & Sons Ltd.

Quality of pharmaceutical care at the pharmacy counter: patients’ experiences versus video observation

PubMed Central

Koster, Ellen S; Blom, Lyda; Overbeeke, Marloes R; Philbert, Daphne; Vervloet, Marcia; Koopman, Laura; van Dijk, Liset

2016-01-01

Introduction Consumer Quality Index questionnaires are used to assess quality of care from patients’ experiences. Objective To provide insight into the agreement about quality of pharmaceutical care, measured both by a patient questionnaire and video observations. Methods Pharmaceutical encounters in four pharmacies were video-recorded. Patients completed a questionnaire based upon the Consumer Quality Index Pharmaceutical Care after the encounter containing questions about patients’ experiences regarding information provision, medication counseling, and pharmacy staff’s communication style. An observation protocol was used to code the recorded encounters. Agreement between video observation and patients’ experiences was calculated. Results In total, 109 encounters were included for analysis. For the domains “medication counseling” and “communication style”, agreement between patients’ experiences and observations was very high (>90%). Less agreement (45%) was found for “information provision”, which was rated more positive by patients compared to the observations, especially for the topic, encouragement of patients’ questioning behavior. Conclusion A questionnaire is useful to assess the quality of medication counseling and pharmacy staff’s communication style, but might be less suitable to evaluate information provision and pharmacy staff’s encouragement of patients’ questioning behavior. Although patients may believe that they have received all necessary information to use their new medicine, some information on specific instructions was not addressed during the encounter. When using questionnaires to get insight into information provision, observations of encounters are very informative to validate the patient questionnaires and make necessary adjustments. PMID:27042025

What are the barriers of quality survivorship care for haematology cancer patients? Qualitative insights from cancer nurses.

PubMed

Langbecker, Danette; Ekberg, Stuart; Yates, Patsy; Chan, Alexandre; Chan, Raymond Javan

2016-02-01

Many haematological cancer survivors report long-term physiological and psychosocial effects beyond treatment completion. These survivors continue to experience impaired quality of life (QoL) as a result of their disease and aggressive treatment. As key members of the multidisciplinary team, the purpose of this study is to examine the insights of cancer nurses to inform future developments in survivorship care provision. Open text qualitative responses from two prospective Australian cross-sectional surveys of nurses (n = 136) caring for patients with haematological cancer. Data were analysed thematically, using an inductive approach to identify themes. This study has identified a number of issues that nurses perceive as barriers to quality survivorship care provision. Two main themes were identified: the first relating to the challenges nurses face in providing care ('care challenges') and the second relating to the challenges of providing survivorship care within contemporary health care systems ('system challenges'). Cancer nurses perceive the nature of haematological cancer and its treatment and of the health care system itself, as barriers to the provision of quality survivorship care. Care challenges such as the lack of a standard treatment path and the relapsing or remitting nature of haematological cancers may be somewhat intractable, but system challenges relating to clearly defining and delineating professional responsibilities and exchanging information with other clinicians are not. Addressing the issues identified will facilitate cancer nurses' provision of survivorship care and help address haematological survivors' needs with regard to the physical and psychosocial consequences of their cancer and treatment.

40 CFR 94.12 - Interim provisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... differences in testing will not affect NOX emission rates. (g) Flexibility for engines over 560kW...) CONTROL OF EMISSIONS FROM MARINE COMPRESSION-IGNITION ENGINES General Provisions for Emission Regulations for Compression-Ignition Marine Engines § 94.12 Interim provisions. This section contains provisions...

40 CFR 94.12 - Interim provisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... differences in testing will not affect NOX emission rates. (g) Flexibility for engines over 560kW...) CONTROL OF EMISSIONS FROM MARINE COMPRESSION-IGNITION ENGINES General Provisions for Emission Regulations for Compression-Ignition Marine Engines § 94.12 Interim provisions. This section contains provisions...

40 CFR 94.12 - Interim provisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... differences in testing will not affect NOX emission rates. (g) Flexibility for engines over 560kW...) CONTROL OF EMISSIONS FROM MARINE COMPRESSION-IGNITION ENGINES General Provisions for Emission Regulations for Compression-Ignition Marine Engines § 94.12 Interim provisions. This section contains provisions...

40 CFR 94.12 - Interim provisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... differences in testing will not affect NOX emission rates. (g) Flexibility for engines over 560kW...) CONTROL OF EMISSIONS FROM MARINE COMPRESSION-IGNITION ENGINES General Provisions for Emission Regulations for Compression-Ignition Marine Engines § 94.12 Interim provisions. This section contains provisions...

Palliative care in the neonatal unit: neonatal nursing staff perceptions of facilitators and barriers in a regional tertiary nursery.

PubMed

Kilcullen, Meegan; Ireland, Susan

2017-05-11

Neonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit. The study was conducted at the Townsville Hospital, which is the only regional tertiary neonatal unit in Australia. Semi-structured interviews were conducted with a purposive sample of eight neonatal nurses. Thematic analysis of the data was conducted within a phenomenological framework. Six themes emerged regarding family support and staff factors that were perceived to support the provision of palliative care of a high quality. Staff factors included leadership, clinical knowledge, and morals, values, and beliefs. Family support factors included emotional support, communication, and practices within the unit. Five themes emerged from the data that were perceived to be barriers to providing quality palliative care. Staff perceived education, lack of privacy, isolation, staff characteristics and systemic (policy, and procedure) factors to impact upon palliative care provision. The regional location of the unit also presented unique facilitators and barriers to care. This study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in supporting quality palliative care provision in the neonatal care setting. Study findings will be used to inform clinical education and practice.

75 FR 35632 - Transparency Provisions of Section 23 of the Natural Gas Act

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-23

... pipeline- quality natural gas. For instance, some Respondents questioned whether pipeline-quality natural gas that is sold directly into an interstate or intrastate natural gas pipeline without processing... reported transactions of pipeline-quality gas under the assumption that ``unprocessed natural gas'' was...

Three Quality Professional Documents to Guide Teachers for Puberty, Relationships and Sexuality Education

ERIC Educational Resources Information Center

Goldman, Juliette D. G.; Collier-Harris, Christine A.

2017-01-01

Quality school-based sexuality education is important for all children and adolescents. The global trend towards students' earlier, longer, and technologically connected pubertal experience makes the timely provision of such education particularly significant. Quality international sexuality education documents are available for teachers…

3 CFR 101.5 - Council on Environmental Quality.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 3 The President 1 2014-01-01 2014-01-01 false Council on Environmental Quality. 101.5 Section 101.5 Presidential Documents EXECUTIVE OFFICE OF THE PRESIDENT PUBLIC INFORMATION PROVISIONS OF THE ADMINISTRATIVE PROCEDURES ACT § 101.5 Council on Environmental Quality. Freedom of Information regulations for...

3 CFR 101.5 - Council on Environmental Quality.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 3 The President 1 2013-01-01 2013-01-01 false Council on Environmental Quality. 101.5 Section 101.5 Presidential Documents EXECUTIVE OFFICE OF THE PRESIDENT PUBLIC INFORMATION PROVISIONS OF THE ADMINISTRATIVE PROCEDURES ACT § 101.5 Council on Environmental Quality. Freedom of Information regulations for...

3 CFR 101.5 - Council on Environmental Quality.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 3 The President 1 2012-01-01 2012-01-01 false Council on Environmental Quality. 101.5 Section 101.5 Presidential Documents EXECUTIVE OFFICE OF THE PRESIDENT PUBLIC INFORMATION PROVISIONS OF THE ADMINISTRATIVE PROCEDURES ACT § 101.5 Council on Environmental Quality. Freedom of Information regulations for...

3 CFR 101.5 - Council on Environmental Quality.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 3 The President 1 2010-01-01 2010-01-01 false Council on Environmental Quality. 101.5 Section 101.5 Presidential Documents EXECUTIVE OFFICE OF THE PRESIDENT PUBLIC INFORMATION PROVISIONS OF THE ADMINISTRATIVE PROCEDURES ACT § 101.5 Council on Environmental Quality. Freedom of Information regulations for...

3 CFR 101.5 - Council on Environmental Quality.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 3 The President 1 2011-01-01 2011-01-01 false Council on Environmental Quality. 101.5 Section 101.5 Presidential Documents EXECUTIVE OFFICE OF THE PRESIDENT PUBLIC INFORMATION PROVISIONS OF THE ADMINISTRATIVE PROCEDURES ACT § 101.5 Council on Environmental Quality. Freedom of Information regulations for...

7 CFR 457.147 - Central and Southern potato crop insurance provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... payment. (c) The extent of any quality loss must be determined based on samples obtained no later than the..., load, location or other distinctive features. Planting period. The period of time between the calendar... one of the Basic Provisions, practical to replant is defined as our determination, after loss or...

7 CFR 457.147 - Central and Southern potato crop insurance provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... payment. (c) The extent of any quality loss must be determined based on samples obtained no later than the..., load, location or other distinctive features. Planting period. The period of time between the calendar... one of the Basic Provisions, practical to replant is defined as our determination, after loss or...

Resident-Directed Long-Term Care: Staff Provision of Choice during Morning Care

ERIC Educational Resources Information Center

Simmons, Sandra F.; Rahman, Annie; Beuscher, Linda; Jani, Victoria; Durkin, Daniel W.; Schnelle, John F.

2011-01-01

Purpose: To develop an observational protocol to assess the quality of staff-resident communication relevant to choice and describe staff-resident interactions as preliminary evidence of the usefulness of the tool to assess current nursing home practices related to offering choice during morning care provision. Design and Methods: This study…

Development and Face Validation of Strategies for Improving Consultation Skills

ERIC Educational Resources Information Center

Lefroy, Janet; Thomas, Adam; Harrison, Chris; Williams, Stephen; O'Mahony, Fidelma; Gay, Simon; Kinston, Ruth; McKinley, R. K.

2014-01-01

While formative workplace based assessment can improve learners' skills, it often does not because the procedures used do not facilitate feedback which is sufficiently specific to scaffold improvement. Provision of pre-formulated strategies to address predicted learning needs has potential to improve the quality and automate the provision of…

School Provisions for Gifted, Talented and Able Students: A Response to Freeman

ERIC Educational Resources Information Center

Vidergor, Hava

2012-01-01

In this response to Joan Freeman's "A Quality of Giftedness," Have Vidergor states that provisions for gifted, talented, and excellent students should be offered by regular schools, taking into consideration levels of giftedness, offering a variety of interdisciplinary elective courses and subjects to about 20% of the school population,…

Complementing the Mainstream: An Exploration of Partnership Work between Complementary Alternative Provisions and Mainstream Schools

ERIC Educational Resources Information Center

Pennacchia, Jodie; Thomson, Pat

2016-01-01

In the English context, complementary alternative provisions (APs) can make specific positive contributions for young people at risk of exclusion from mainstream school. Whilst recognising the potential value of all complementary AP that is carefully selected and of high quality, we problematise the "repair and return" rationale that…

What Influences Physical Activity Provision in After-School Childcare in the Absence of Policy Guidance? A Qualitative Exploration

ERIC Educational Resources Information Center

MacFarlane, Kendra; Wharf Higgins, Joan; Naylor, Patti-Jean

2018-01-01

Objective: This study explored factors affecting the implementation of good-quality physical activity provision in after-school childcare delivered in a Canadian jurisdiction without specific policy, standards or active interventions aimed at increasing physical activity underway. Design: Case study design theoretically guided by the…

DETERMINATION OF NATIONAL DIAGNOSTIC REFERENCE LEVELS IN COMPUTED TOMOGRAPHY EXAMINATIONS OF IRAN BY A NEW QUALITY CONTROL-BASED DOSE SURVEY METHOD.

PubMed

Sohrabi, Mehdi; Parsi, Masoumeh; Mianji, Fereidoun

2018-05-01

National diagnostic reference levels (NDRLs) of Iran were determined for the four most common CT examinations including head, sinus, chest and abdomen/pelvis. A new 'quality control (QC)-based dose survey method', as developed by us, was applied to 157 CT scanners in Iran (2014-15) with different slice classes, models and geographic spread across the country. The NDRLs for head, sinus, chest and abdomen/pelvis examinations are 58, 29, 12 and 14 mGy for CTDIVol and 750, 300, 300 and 650 mGy.cm for DLP, respectively. The 'QC-based dose survey method' was further proven that it is a simple, accurate and practical method for a time and cost-effective NDRLs determination. One effective approach for optimization of the CT examination protocols at the national level is the provision of an adequate standardized training of the radiologists, technicians and medical physicists on the patient radiation protection principles and implementation of the DRL concept in clinical practices.

Use of behavioral avoidance testing in natural resource damage assessment

USGS Publications Warehouse

Lipton, J.; Little, E.E.; Marr, J.C.A.; DeLonay, A.J.; Bengston, David A.; Henshel, Diane S.

1996-01-01

Natural Resource Damage Assessment (NRDA) provisions established under federal and state statutes enable natural resource trustees to recover compensation from responsible parties to restore injured natural resources. Behavioral avoidance testing with fish has been used in NRDAs to determine injuries to natural resources and to establish restoration thresholds. In this manuscript we evaluate the use of avoidance testing to NRDA. Specifically, we discuss potential “acceptance criteria” to evaluate the applicability and relevance of avoidance testing. These acceptance criteria include: (1) regulatory relevance, (2) reproducibility of testing, (3) ecological significance, (4) quality assurance/quality control, and (5) relevance to restoration. We discuss each of these criteria with respect to avoidance testing. Overall, we conclude that avoidance testing can be an appropriate, defensible, and desirable aspect of an NRDA.

76 FR 25652 - Approval and Promulgation of Air Quality Implementation Plans; North Dakota; Revisions to the Air...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-05

...EPA is proposing to approve revisions to the North Dakota State Implementation Plan that the Governor of North Dakota submitted with a letter dated April 6, 2009. The revisions affect North Dakota's air pollution control rules regarding general provisions (including rules regarding shutdowns and malfunctions), ambient air quality standards, emissions of particulate matter, permitting, and fees. In addition, EPA is proposing administrative corrections to the regulatory text for North Dakota that will be codified in the Code of Federal Regulations; we made errors in the identification of plan table when we approved the North Dakota State Implementation Plan revisions for Interstate Transport of pollution, which the Governor also submitted on April 6, 2009. This action is being taken under section 110 of the Clean Air Act.

76 FR 41561 - Approval and Promulgation of Implementation Plans; California; 2007 South Coast PM2.5

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-14

...EPA is proposing to approve in part and disapprove in part state implementation plan (SIP) revisions submitted by California to provide for attainment of the 1997 fine particulate matter (PM2.5) national ambient air quality standards in the Los Angeles-South Coast area (South Coast). These SIP revisions are the South Coast 2007 Air Quality Management Plan (South Coast 2007 AQMP) (revised 2011) and South Coast-related provisions of the 2007 State Strategy (revised 2009 and 2011). EPA is proposing to approve the emissions inventories; air quality modeling; reasonably available control measures/reasonably available control technology demonstration; the reasonable further progress and attainment demonstrations; and the transportation conformity motor vehicle emissions budgets. EPA is also proposing to grant California's request to extend the attainment deadline for the South Coast to April 5, 2015 and to approve commitments to measures and reductions by the South Coast Air Quality Management District and the California Air Resources Board. Finally, we are proposing to disapprove the SIP's contingency measures and to reject the assignment of 10 tpd of NOX reductions to the federal government. This proposed rule amends EPA's November 22, 2010 proposed rule (75 FR 91294) on the South Coast PM2.5 plan and 2007 State strategy.

US quality control in Italy: present and future

NASA Astrophysics Data System (ADS)

Balbis, S.; Musacchio, C.; Guiot, C.; Spagnolo, R.

2011-02-01

US diagnostic equipments are widely diffused in Italy but, in spite of recommendations (e.g. ISPESL-Ministry of Health (1999) and SIRM (Società Italiana di Radiologia Medica, 2004), US quality controls are restricted to only a few public sanitary structure and a national (or even regional) quality assurance program for testing the performances of the US equipments is still missing. A joint Research Centre among the three Piedmontese Universities and INRIM, partially funded by Regione Piemonte, has been established in 2009 as Reference Centre for Medical Ultrasounds (CRUM). In addition to research, development and training tasks, the Centre aims at the local diffusion of the quality assurance in clinical US equipments. According to data from the Ministry of Health (2006), around 7 % of the Italian US diagnostic equipments (946 over 13526) are located in Piedmont: mostly (75.6%) in public hospitals, 9.3 % in conventionated hospitals, 4.3% in public and 10.8% in private territorial structures. The goal is the provision of a regional database, which progressively includes data related to acceptance test, status and QC tests and maintenance, in order to drive equipment turnover and carefully monitoring the overall equipment efficiency. Moreover, facilities are available at CRUM for monitoring both beam geometry and acoustic power and performing quantitative assessment of the delivered energy intensity.

Design and implementation of community engagement interventions towards healthcare quality improvement in Ghana: a methodological approach.

PubMed

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

2016-12-01

Nearly four decades after the Alma-Ata declaration of 1978 on the need for active client/community participation in healthcare, not much has been achieved in this regard particularly in resource constrained countries like Ghana, where over 70 % of communities in rural areas access basic healthcare from primary health facilities. Systematic Community Engagement (SCE) in healthcare quality assessment remains a grey area in many health systems in Africa, albeit the increasing importance in promoting universal access to quality basic healthcare services. Design and implement SCE interventions that involve existing community groups engaged in healthcare quality assessment in 32 intervention primary health facilities. The SCE interventions form part of a four year randomized controlled trial (RCT) in the Greater Accra and Western regions of Ghana. Community groups (n = 52) were purposively recruited and engaged to assess non-technical components of healthcare quality, recommend quality improvement plans and reward best performing facilities. The interventions comprised of five cyclical implementation steps executed for nearly a year. Wilcoxon sign rank test was used to ascertain differences in group perceptions of service quality during the first and second assessments, and ordered logistic regression analysis performed to determine factors associated with groups' perception of healthcare quality. Healthcare quality was perceived to be lowest in non-technical areas such as: information provision to clients, directional signs in clinics, drug availability, fairness in queuing, waiting times, and information provision on use of suggestion boxes and feedback on clients' complaints. Overall, services in private health facilities were perceived to be better than public facilities (p < 0.05). Community groups dominated by artisans and elderly members (60 + years) had better perspectives on healthcare quality than youthful groups (Coef. =1.78; 95 % CI = [-0.16 3.72]) and other categories of community groups (Coef. = 0.98; 95 % CI = [-0.10 2.06]). Non-technical components of healthcare quality remain critical to clients and communities served by primary healthcare providers. The SCE concept is a potential innovative and complementary quality improvement strategy that could help enhance client experiences, trust and confidence in healthcare providers. SCE interventions are more cost effective, community-focused and could easily be scaled-up and sustained by local health authorities.

42 CFR 456.6 - Review by State medical agency of appropriateness and quality of services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and quality of services. 456.6 Section 456.6 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Provisions § 456.6 Review by State medical agency of appropriateness and quality of services. (a) The... professional health personnel of the appropriateness and quality of Medicaid services. (b) The purpose of this...

78 FR 48660 - Agency Information Collection Activities; Comment Request; Student Assistance General Provisions...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-09

...; Comment Request; Student Assistance General Provisions--Subpart K--Cash Management AGENCY: Federal Student... of Collection: Student Assistance General Provisions--Subpart K--Cash Management OMB Control Number... administration of 34 CFR 668 Subpart K Cash Management of the Student Assistance General Provisions. The...

Egg Speckling Patterns Do Not Advertise Offspring Quality or Influence Male Provisioning in Great Tits

PubMed Central

Stoddard, Mary Caswell; Fayet, Annette L.; Kilner, Rebecca M.; Hinde, Camilla A.

2012-01-01

Many passerine birds lay white eggs with reddish brown speckles produced by protoporphyrin pigment. However, the function of these spots is contested. Recently, the sexually selected eggshell coloration (SSEC) hypothesis proposed that eggshell color is a sexually selected signal through which a female advertises her quality (and hence the potential quality of her future young) to her male partner, thereby encouraging him to contribute more to breeding attempts. We performed a test of the SSEC hypothesis in a common passerine, the great tit Parus major. We used a double cross-fostering design to determine whether males change their provisioning behavior based on eggshell patterns they observe at the nest. We also tested the assumption that egg patterning reflects female and/or offspring quality. Because birds differ from humans in their color and pattern perception, we used digital photography and models of bird vision to quantify egg patterns objectively. Neither male provisioning nor chick growth was related to the pattern of eggs males observed during incubation. Although heavy females laid paler, less speckled eggs, these eggs did not produce chicks that grew faster. Therefore, we conclude that the SSEC hypothesis is an unlikely explanation for the evolution of egg speckling in great tits. PMID:22815730

30 CFR 71.601 - Drinking water; quality.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Drinking water; quality. 71.601 Section 71.601... Water § 71.601 Drinking water; quality. (a) Potable water provided in accordance with the provisions of § 71.600 shall meet the applicable minimum health requirements for drinking water established by the...

30 CFR 75.1718-1 - Drinking water; quality.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Drinking water; quality. 75.1718-1 Section 75... AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Miscellaneous § 75.1718-1 Drinking water; quality. (a) Potable water provided in accordance with the provisions of § 75.1718 shall meet the...

30 CFR 75.1718-1 - Drinking water; quality.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Drinking water; quality. 75.1718-1 Section 75... AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Miscellaneous § 75.1718-1 Drinking water; quality. (a) Potable water provided in accordance with the provisions of § 75.1718 shall meet the...

30 CFR 71.601 - Drinking water; quality.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Drinking water; quality. 71.601 Section 71.601... Water § 71.601 Drinking water; quality. (a) Potable water provided in accordance with the provisions of § 71.600 shall meet the applicable minimum health requirements for drinking water established by the...

30 CFR 75.1718-1 - Drinking water; quality.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Drinking water; quality. 75.1718-1 Section 75... AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Miscellaneous § 75.1718-1 Drinking water; quality. (a) Potable water provided in accordance with the provisions of § 75.1718 shall meet the...

30 CFR 75.1718-1 - Drinking water; quality.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Drinking water; quality. 75.1718-1 Section 75... AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Miscellaneous § 75.1718-1 Drinking water; quality. (a) Potable water provided in accordance with the provisions of § 75.1718 shall meet the...

30 CFR 71.601 - Drinking water; quality.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Drinking water; quality. 71.601 Section 71.601... Water § 71.601 Drinking water; quality. (a) Potable water provided in accordance with the provisions of § 71.600 shall meet the applicable minimum health requirements for drinking water established by the...

30 CFR 71.601 - Drinking water; quality.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Drinking water; quality. 71.601 Section 71.601... Water § 71.601 Drinking water; quality. (a) Potable water provided in accordance with the provisions of § 71.600 shall meet the applicable minimum health requirements for drinking water established by the...

30 CFR 75.1718-1 - Drinking water; quality.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Drinking water; quality. 75.1718-1 Section 75... AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Miscellaneous § 75.1718-1 Drinking water; quality. (a) Potable water provided in accordance with the provisions of § 75.1718 shall meet the...

30 CFR 71.601 - Drinking water; quality.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Drinking water; quality. 71.601 Section 71.601... Water § 71.601 Drinking water; quality. (a) Potable water provided in accordance with the provisions of § 71.600 shall meet the applicable minimum health requirements for drinking water established by the...

25 CFR 273.38 - Equal quality and standard of education.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Equal quality and standard of education. 273.38 Section... EDUCATION ASSISTANCE ACT PROGRAM EDUCATION CONTRACTS UNDER JOHNSON-O'MALLEY ACT Funding Provisions § 273.38 Equal quality and standard of education. Contracts with State education agencies or school districts...

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

PubMed

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

2016-09-21

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

Environmental sanitary interventions for preventing active trachoma.

PubMed

Rabiu, M; Alhassan, M; Ejere, H

2007-10-17

Trachoma is a major cause of avoidable blindness. It is responsible for about six million blind people worldwide, mostly in the poor communities of developing countries. One of the major strategies advocated for the control of the disease is the application of various environmental sanitary measures to such communities. To assess the evidence for the effectiveness of environmental sanitary measures on the prevalence of active trachoma in endemic areas. We searched the Cochrane Central Register of Controlled Trials - CENTRAL in The Cochrane Library (Issue 2, 2007), MEDLINE (1966 to July 2007), EMBASE (1980 to July 2007), LILACS (July 2007), reference list of trials and the Science Citation Index. We also contacted agencies, experts and researchers in trachoma control. We included randomised and quasi-randomised controlled trials comparing any form of environmental hygiene measures with no measure. These hygiene measures included fly control, provision of water and health education. Participants in the trials were people normally resident in the trachoma endemic areas. Two authors independently extracted data and assessed the quality of trials. Study authors were contacted for additional information. Four trials met the inclusion criteria but meta-analysis was not conducted due to heterogeneity of the studies. Two studies that assessed insecticide spray as a fly control measure found that trachoma is reduced by at least 55% to 61% with this measure compared to no intervention. However, another study did not find insecticide spray to be effective in reducing trachoma. One study found that another fly control measure, latrine provision, reduced trachoma by 29.5% compared to no intervention; this was, however, not statistically significantly different. Another study revealed that health education on personal and household hygiene reduced the incidence of trachoma such that the odds of reducing trachoma in the health education village was about twice that of the no intervention village. However, all the studies have some methodological concerns relating to concealment of allocation and non-consideration of clustering effect in data analysis. The role of insecticide spray as a fly control measure in reducing trachoma remains unclear. Latrine provision as a fly control measure has not demonstrated significant trachoma reduction. Health education may be effective in reducing trachoma. There is a dearth of data to determine the effectiveness of all aspects of environmental sanitation in the control of trachoma.

Environmental sanitary interventions for preventing active trachoma.

PubMed

Rabiu, M; Alhassan, M; Ejere, H

2005-04-18

Trachoma is the second or third major cause of blindness. It is responsible for about six million blind people worldwide, mostly in the poor communities of developing countries. One of the major strategies advocated for the control of the disease is the application of various environmental sanitary measures to such communities. To assess the evidence for the effectiveness of environmental sanitary measures on the prevalence of active trachoma in endemic areas. We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (Issue 4, 2004), MEDLINE (1966 to January 2005), EMBASE (1980 to January 2005), LILACS (April 2004), the reference list of trials and the Science Citation Index. We also contacted agencies, experts and researchers in trachoma control. This review included randomised and quasi-randomised controlled trials comparing any form of environmental hygiene measures with no measure. These hygienic measures included fly control, provision of water and health education. Participants in the trials were people normally resident in the trachoma endemic areas. Two authors independently extracted data and assessed the quality of trials. Study authors were contacted for additional information. Three trials met the inclusion criteria but meta-analysis was not conducted due to heterogeneity of the studies. Two studies that assessed insecticide spray as a fly control measure found that trachoma is reduced by at least 55% to 61% with this measure compared to no intervention. One study found that another fly control measure, latrine provision, reduced trachoma by 29.5% compared to no intervention; this was, however, not statistically significantly different. Another study revealed that health education on personal and household hygiene reduced the incidence of trachoma such that the odds of reducing trachoma in the health education village was about twice that of the no intervention village. However, all the studies have some methodological concerns relating to concealment of allocation and non-consideration of clustering effect in data analysis. There is evidence that insecticide spray as a fly control measure reduces trachoma significantly. Latrine provision as a fly control measure has not demonstrated significant trachoma reduction. Health education may be effective in reducing trachoma. There is a dearth of data to determine the effectiveness of all aspects of environmental sanitation in the control of trachoma.

Male-male competition and parental care in collared flycatchers (Ficedula albicollis): an experiment controlling for differences in territory quality.

PubMed

Qvarnström, A; Grifffith, S C; Gustafsson, L

2000-12-22

Females are known to benefit from mate choice in several different ways but the relationship between these benefits has received little attention. The quality of resources provided by males, such as nest sites, and paternal care are often assumed to covary positively However, because the location of the nest affects the cost of parental care, these two benefits from mate choice can easily be confounded. To investigate the provisioning ability of successful competitors while controlling for differences in territory quality we removed early-settled pairs of collared flycatchers (Ficedula albicollis) and allowed replacement by later-arriving males or floaters (i.e.'poor competitors'). A control group of early-settled males (i.e. 'good competitors') had their females removed. Females paired to good competitors enjoyed a significantly higher reproductive success and tended to receive more parental assistance from their mates compared with females mated to poor competitors. Thus, some males seem able not only to compete successfully over resources but also to feed their offspring at a relatively higher rate. An alternative explanation, that poor competitors invested less in offspring quality in response to a lower share of paternity, could be rejected. The rate of extra-pair paternity did not differ between the two treatment groups. Our results suggest that male- male competition can sometimes facilitate female choice of superior care-givers. Thus, a female's benefit from choosing a competitive male may not be restricted to the quality of the resource he defends but can also include superior paternal care.

40 CFR 63.126 - Transfer operations provisions-reference control technology.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 9 2011-07-01 2011-07-01 false Transfer operations provisions-reference control technology. 63.126 Section 63.126 Protection of Environment ENVIRONMENTAL PROTECTION... Wastewater § 63.126 Transfer operations provisions—reference control technology. (a) For each Group 1...

40 CFR 63.126 - Transfer operations provisions-reference control technology.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 10 2012-07-01 2012-07-01 false Transfer operations provisions-reference control technology. 63.126 Section 63.126 Protection of Environment ENVIRONMENTAL PROTECTION... Wastewater § 63.126 Transfer operations provisions—reference control technology. (a) For each Group 1...

40 CFR 63.126 - Transfer operations provisions-reference control technology.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 10 2013-07-01 2013-07-01 false Transfer operations provisions-reference control technology. 63.126 Section 63.126 Protection of Environment ENVIRONMENTAL PROTECTION... Wastewater § 63.126 Transfer operations provisions—reference control technology. (a) For each Group 1...

40 CFR 63.126 - Transfer operations provisions-reference control technology.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Transfer operations provisions-reference control technology. 63.126 Section 63.126 Protection of Environment ENVIRONMENTAL PROTECTION... Wastewater § 63.126 Transfer operations provisions—reference control technology. (a) For each Group 1...

Assuring fish safety and quality in international fish trade.

PubMed

Ababouch, Lahsen

2006-01-01

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

Rehabilitation therapies for older clients of the Ontario home care system: regional variation and client-level predictors of service provision.

PubMed

Armstrong, Joshua J; Zhu, Mu; Hirdes, John P; Stolee, Paul

2015-01-01

To examine regional variation in service provision and identify the client characteristics associated with occupational therapy (OT) and physiotherapy (PT) services for older adults in the Ontario Home Care System. Secondary analyses of a provincial database containing comprehensive assessments (RAI-HC) linked with service utilization data from every older long-stay home care client in the system between 2005 and 2010 (n = 299 262). Hierarchical logistic regression models were used to model the dependent variables of OT and PT service use within 90 d of the initial assessment. Regional differences accounted for 9% of the variation in PT service provision and 20% of OT service provision. After controlling for the differences across regions, the most powerful predictors of service provision were identified for both OT and PT. The most highly associated client characteristics related to PT service provision were hip fracture, impairments in activities of daily living/instrumental activities of daily living, cerebrovascular accidents, and cognitive impairment. For OT, hazards in the home environment was the most powerful predictor of future service provision. Where a client lived was an important determinant of service provision in Ontario, raising the possibility of inequities in access to rehabilitation services. Health care planners and policy makers should review current practices and make adjustments to meet the increasing and changing needs for rehabilitation therapies of the aging population. Implications for Rehabilitation For older adults in home care, the goal of rehabilitation therapy services is to allow individuals to maintain or improve physical functioning, quality of life and overall independence while living within their community. Previous research has demonstrated that a large proportion of home care clients specifically identified as having rehabilitation potential do not receive it. This article used clinical assessment data to identify the predictors of and barriers to rehabilitation services for older adults in the Ontario Home Care System. Barriers of PT included dementia diagnosis and French as a first language. Barriers to OT included dementia diagnosis. Policies and practices related to service provision for older adults should be reconsidered if we are going to meet the demands of aging populations and increasing rates of functional and cognitive impairments.

Use of action planning to increase provision of smoking cessation care by general practitioners: role of plan specificity and enactment.

PubMed

Verbiest, Marjolein E A; Presseau, Justin; Chavannes, Niels H; Scharloo, Margreet; Kaptein, Ad A; Assendelft, Willem J J; Crone, Mathilde R

2014-12-30

Strategies are needed to help general practitioners (GPs) promote smoking cessation as recommended by guidelines. This study examines whether the quality of action planning among GPs improves their provision of smoking cessation care. The effectiveness of a 1-h training programme was examined in a cluster randomised controlled trial in which 49 GPs participated. GPs who followed the training (intervention group; n = 25) formulated action plans related to i) enquiring about smoking, ii) advising to quit smoking, and iii) arranging follow-up for smokers motivated to quit. GPs also formulated a coping plan for encountering smokers not motivated to quit. The quality of these plans (plan specificity) was rated and, 6 weeks after the training, GPs reported on the performance of these plans (plan enactment). Multilevel regression analyses were used to examine the effects of plan specificity and plan enactment on patient-reported smoking cessation activities of the GPs in the intervention group (n = 1,632 patients) compared with the control group (n = 1,769 patients). Compared to the control group, GPs who formulated a highly specific action plan during the training asked their patients about smoking more often after the training compared to prior to the training (OR 2.11, 95% CI 1.51-2.95). GPs were most likely to have asked patients about smoking after the training compared to prior to the training when they had enacted a highly specific formulated action plan (OR 3.08, 95% CI 2.04-4.64). The effects of GP plan specificity and plan enactment on asking patient about smoking were most prominent among GPs who, at baseline, intended to provide smoking cessation care. A highly specific action plan formulated by a GP on when, how, and by whom patients will be asked about smoking had a positive effect on GPs' asking patients about smoking, especially when these professionals also reported to have enacted this plan. This effect was most prominent among GPs who intended to provide smoking cessation care prior to the intervention. Training in devising personalised coping plans is recommended to further increase GPs' provision of advice to quit smoking and arranging follow-up support to quit smoking.

7 CFR 1466.1 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS ENVIRONMENTAL QUALITY INCENTIVES PROGRAM General Provisions... promote agricultural production, forest management, and environmental quality as compatible goals, and to... program are achieved by planning and implementing conservation practices on eligible land. (b) EQIP is...

7 CFR 1466.1 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS ENVIRONMENTAL QUALITY INCENTIVES PROGRAM General Provisions... promote agricultural production, forest management, and environmental quality as compatible goals, and to... program are achieved by planning and implementing conservation practices on eligible land. (b) EQIP is...

E-learning: controlling costs and increasing value.

PubMed

Walsh, Kieran

2015-04-01

E-learning now accounts for a substantial proportion of medical education provision. This progress has required significant investment and this investment has in turn come under increasing scrutiny so that the costs of e-learning may be controlled and its returns maximised. There are multiple methods by which the costs of e-learning can be controlled and its returns maximised. This short paper reviews some of those methods that are likely to be most effective and that are likely to save costs without compromising quality. Methods might include accessing free or low-cost resources from elsewhere; create short learning resources that will work on multiple devices; using open source platforms to host content; using in-house faculty to create content; sharing resources between institutions; and promoting resources to ensure high usage. Whatever methods are used to control costs or increase value, it is most important to evaluate the impact of these methods.

Emerging Partnership Practices in VET Provision in the Senior Years of Schooling in Australia

ERIC Educational Resources Information Center

Klatt, Gosia; Angelico, Teresa; Polesel, John

2018-01-01

School partnerships support the effective provision of Vocational Education and Training (VET) in the senior years of secondary schooling, to a varying degree, in most OECD nations. However, the nature and quality of these partnerships vary considerably from school to school and, indeed, from nation to nation (see Murray and Polesel, "Eur J…

21 CFR Appendix A to Subpart A of... - List of Applicable Laws, Regulations, and Administrative Provisions

Code of Federal Regulations, 2012 CFR

2012-04-01

... PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN MEDICAL DEVICE PRODUCT...://dg3.eudra.org.] Council Directive 65/65/EEC of 26 January 1965 on the approximation of provisions laid... extended, widened, and amended. Council Directive 75/319/EEC of 20 May 1975 on the approximation of...

21 CFR Appendix A to Subpart A of... - List of Applicable Laws, Regulations, and Administrative Provisions

Code of Federal Regulations, 2013 CFR

2013-04-01

... PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN MEDICAL DEVICE PRODUCT...://dg3.eudra.org.] Council Directive 65/65/EEC of 26 January 1965 on the approximation of provisions laid... extended, widened, and amended. Council Directive 75/319/EEC of 20 May 1975 on the approximation of...

21 CFR Appendix A to Subpart A of... - List of Applicable Laws, Regulations, and Administrative Provisions

Code of Federal Regulations, 2014 CFR

2014-04-01

... PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN MEDICAL DEVICE PRODUCT...://dg3.eudra.org.] Council Directive 65/65/EEC of 26 January 1965 on the approximation of provisions laid... extended, widened, and amended. Council Directive 75/319/EEC of 20 May 1975 on the approximation of...

21 CFR Appendix A to Subpart A of... - List of Applicable Laws, Regulations, and Administrative Provisions

Code of Federal Regulations, 2011 CFR

2011-04-01

... PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN MEDICAL DEVICE PRODUCT...://dg3.eudra.org.] Council Directive 65/65/EEC of 26 January 1965 on the approximation of provisions laid... extended, widened, and amended. Council Directive 75/319/EEC of 20 May 1975 on the approximation of...

75 FR 62429 - Notice of Intent to Award-Grant Awards for the Provision of Civil Legal Services to Eligible Low...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-08

... LEGAL SERVICES CORPORATION Notice of Intent to Award--Grant Awards for the Provision of Civil Legal Services to Eligible Low-Income Clients Beginning January 1, 2011 AGENCY: Legal Services... economical and effective delivery of high quality civil legal services to eligible low-income clients...

77 FR 73575 - Approval and Promulgation of Air Quality Implementation Plans; West Virginia; Redesignation of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-11

...) and Cross State Air Pollution Rule (CSAPR or the Transport Rule) On May 12, 2005, EPA published CAIR...) for the purpose of reducing SO 2 and NO X emissions. The monitoring data used to demonstrate the Area... Source Review (NSR) permit programs; Provisions for air pollution modeling; and Provisions for public and...

40 CFR 51.902 - Which classification and nonattainment area planning provisions of the CAA shall apply to areas...

Code of Federal Regulations, 2011 CFR

2011-07-01

... area planning provisions of the CAA shall apply to areas designated nonattainment for the 8-hour NAAQS? 51.902 Section 51.902 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Implementation of 8-hour Ozone National Ambient Air Quality Standard § 51.902 Which classification and...

40 CFR 51.902 - Which classification and nonattainment area planning provisions of the CAA shall apply to areas...

Code of Federal Regulations, 2014 CFR

2014-07-01

... area planning provisions of the CAA shall apply to areas designated nonattainment for the 1997 8-hour NAAQS? 51.902 Section 51.902 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Implementation of 8-hour Ozone National Ambient Air Quality Standard § 51.902 Which classification and...

40 CFR 51.902 - Which classification and nonattainment area planning provisions of the CAA shall apply to areas...

Code of Federal Regulations, 2012 CFR

2012-07-01

... area planning provisions of the CAA shall apply to areas designated nonattainment for the 1997 8-hour NAAQS? 51.902 Section 51.902 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Implementation of 8-hour Ozone National Ambient Air Quality Standard § 51.902 Which classification and...

40 CFR 51.902 - Which classification and nonattainment area planning provisions of the CAA shall apply to areas...

Code of Federal Regulations, 2013 CFR

2013-07-01

... area planning provisions of the CAA shall apply to areas designated nonattainment for the 1997 8-hour NAAQS? 51.902 Section 51.902 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Implementation of 8-hour Ozone National Ambient Air Quality Standard § 51.902 Which classification and...

40 CFR 51.902 - Which classification and nonattainment area planning provisions of the CAA shall apply to areas...

Code of Federal Regulations, 2010 CFR

2010-07-01

... area planning provisions of the CAA shall apply to areas designated nonattainment for the 8-hour NAAQS? 51.902 Section 51.902 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Implementation of 8-hour Ozone National Ambient Air Quality Standard § 51.902 Which classification and...

77 FR 36400 - Approval and Promulgation of Air Quality Implementation Plans; Texas; Determination of Failure To...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-19

... contingency measures [section 172(c)(9)] and a major stationary source fee provision [sections 182(d)(3) and... Under Subpart 1: Revision to the Anti- backsliding Provisions to Address 1-Hour Contingency Measure... contingency measures. While BCCA claims that its comment was prompted by EPA's May 14 Rulemaking, that...

40 CFR 52.1870 - Identification of plan.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 20, 1972, by the Ohio Air Pollution Control Board. (2) State provisions for making emissions data... authority for controlling auto emissions. (4) Amendments to air pollution regulations AP-3-11, 12, 13, 14... rules establish general provisions for the control of air pollution and were previously codified and...

40 CFR 63.119 - Storage vessel provisions-reference control technology.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 9 2011-07-01 2011-07-01 false Storage vessel provisions-reference control technology. 63.119 Section 63.119 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 63.119 Storage vessel provisions—reference control technology. (a) For each storage vessel to which...

40 CFR 63.119 - Storage vessel provisions-reference control technology.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 10 2012-07-01 2012-07-01 false Storage vessel provisions-reference control technology. 63.119 Section 63.119 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 63.119 Storage vessel provisions—reference control technology. (a) For each storage vessel to which...

40 CFR 63.119 - Storage vessel provisions-reference control technology.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 10 2013-07-01 2013-07-01 false Storage vessel provisions-reference control technology. 63.119 Section 63.119 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 63.119 Storage vessel provisions—reference control technology. (a) For each storage vessel to which...

40 CFR 63.119 - Storage vessel provisions-reference control technology.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 10 2014-07-01 2014-07-01 false Storage vessel provisions-reference control technology. 63.119 Section 63.119 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 63.119 Storage vessel provisions—reference control technology. (a) For each storage vessel to which...

40 CFR 63.119 - Storage vessel provisions-reference control technology.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Storage vessel provisions-reference control technology. 63.119 Section 63.119 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 63.119 Storage vessel provisions—reference control technology. (a) For each storage vessel to which...

Sustainability of ARV provision in developing countries: challenging a framework based on program history.

PubMed

Azeredo, Thiago Botelho; Oliveira, Maria Auxiliadora; Santos-Pinto, Cláudia Du Bocage; Miranda, Elaine Silva; Osorio-de-Castro, Claudia Garcia Serpa

2017-08-01

The provision of ARVs is central to HIV/AIDS programs, because of its impact on the course of the disease and on quality of life. Although first-line treatments costs have declined, treatment-associated expenses are steeper each year. Sustainability is therefore an important variable for the success of treatment programs. A conceptual framework on sustainability of ARV provision was developed, followed by data collection instruments. The pilot study was undertaken in Brazil. Bolivia, Peru and Mozambique, were visited. Key informants were identified and interviewed. Investigation of sustainability related to ARV provision involved implementation and routinization events of provision schemes. Evidence of greater sustainability potential was observed in Peru, where provision is implemented and routinized by the National HIV/AIDS program and expenditures met by the government. In Mozambique, provision is dependent on donations and external aid, but the country displays a great effort to incorporate ARV provision and care in routine healthcare activities. Bolivia, in addition to external dependence on financing and management of drug supply, presents problems regarding implementation and routinization. The conceptual framework was useful in recognizing events that influence sustainable ARV provision in these countries.

Occupation Choices of High School and College Students with Special Reference to Teaching and Research

ERIC Educational Resources Information Center

Dastidar, Ananya G.; Sikdar, Soumyen

2015-01-01

As India's higher education sector is poised to grow at a tremendous pace, one of its main challenges would be provision of quality education. Teacher quality has been identified as one of the most critical factors affecting educational quality. As such, the immense importance of attracting high-quality entrants into the teaching profession cannot…

Using the ACEI Global Guidelines Assessment to Evaluate the Quality of Early Child Care in Greek Settings

ERIC Educational Resources Information Center

Rentzou, Konstantina

2010-01-01

In recent years, there has been a significant growth of interest in ensuring that child care provision for children is of a high quality. This interest has been stimulated by research evidence according to which good quality child care has a positive influence on children's overall development. The global quality in Greek preschool and…

Quality and Impact of Centre-Based Early Childhood Education and Care. Research Report

ERIC Educational Resources Information Center

Janta, Barbara; van Belle, Janna; Stewart, Katherine

2016-01-01

There is a strong association between the quality of Early Childhood Education and Care (ECEC) provision and the outcomes for children, with high quality ECEC being associated with better child outcomes later in life. This brief reviewed the broad range of indicators that have been linked to quality, with a focus on understanding how these…

Provider perceptions of reproductive health service quality in jordanian public community health centers.

PubMed

Al-Qutob, Raeda; Nasir, Laeth S

2008-05-01

Enhancing the quality of reproductive health care delivery in developing countries is a key prerequisite to increased utilization and sustainability of these services in the target population. Our objective was to assess the perception of quality of reproductive health (RH) care services provided by Jordanian Ministry of Health community-based centers from the perspective of service providers in these settings. A purposeful nationwide sample of 50 primary health care providers took part in five focus group discussions with the purpose of exploring their perceptions of the quality of care provided by their centers and perceived barriers to the provision of quality RH care. Health care providers felt that the quality of RH care provided by their centers was suboptimal. Focus group participants reported numerous barriers to the provision of high quality-care in the clinical setting. These included issues related to patient overload, patient and physician characteristics, as well as problems inherent to supervisory and administrative functions. Exploring and aligning goals and expectations of RH care providers and administrators may result in improvements in the quality of RH care service delivery and morale in public health settings in Jordan, which is a requirement for public sector reform.

A Systematic Review of Genetic Testing and Lifestyle Behaviour Change: Are We Using High-Quality Genetic Interventions and Considering Behaviour Change Theory?

PubMed

Horne, Justine; Madill, Janet; O'Connor, Colleen; Shelley, Jacob; Gilliland, Jason

2018-04-10

Studying the impact of genetic testing interventions on lifestyle behaviour change has been a priority area of research in recent years. Substantial heterogeneity exists in the results and conclusions of this literature, which has yet to be explained using validated behaviour change theory and an assessment of the quality of genetic interventions. The theory of planned behaviour (TPB) helps to explain key contributors to behaviour change. It has been hypothesized that personalization could be added to this theory to help predict changes in health behaviours. This systematic review provides a detailed, comprehensive identification, assessment, and summary of primary research articles pertaining to lifestyle behaviour change (nutrition, physical activity, sleep, and smoking) resulting from genetic testing interventions. The present review further aims to provide in-depth analyses of studies conducted to date within the context of the TPB and the quality of genetic interventions provided to participants while aiming to determine whether or not genetic testing facilitates changes in lifestyle habits. This review is timely in light of a recently published "call-to-action" paper, highlighting the need to incorporate the TPB into personalized healthcare behaviour change research. Three bibliographic databases, one key website, and article reference lists were searched for relevant primary research articles. The PRISMA Flow Diagram and PRISMA Checklist were used to guide the search strategy and manuscript preparation. Out of 32,783 titles retrieved, 26 studies met the inclusion criteria. Three quality assessments were conducted and included: (1) risk of bias, (2) quality of genetic interventions, and (3) consideration of theoretical underpinnings - primarily the TPB. Risk of bias in studies was overall rated to be "fair." Consideration of the TPB was "poor," with no study making reference to this validated theory. While some studies (n = 11; 42%) made reference to other behaviour change theories, these theories were generally mentioned briefly, and were not thoroughly incorporated into the study design or analyses. The genetic interventions provided to participants were overall of "poor" quality. However, a separate analysis of studies using controlled intervention research methods demonstrated the use of higher-quality genetic interventions (overall rated to be "fair"). The provision of actionable recommendations informed by genetic testing was more likely to facilitate behaviour change than the provision of genetic information without actionable lifestyle recommendations. Several studies of good quality demonstrated changes in lifestyle habits arising from the provision of genetic interventions. The most promising lifestyle changes were changes in nutrition. It is possible to facilitate behaviour change using genetic testing as the catalyst. Future research should ensure that high-quality genetic interventions are provided to participants, and should consider validated theories such as the TPB in their study design and analyses. Further recommendations for future research are provided. © 2018 S. Karger AG, Basel.

Potential collaboration with the private sector for the provision of ambulatory care in the Mekong region, Vietnam

PubMed Central

Duc, Ha Anh; Sabin, Lora L.; Cuong, Le Quang; Thien, Duong Duc; Feeley, Rich

2012-01-01

Background Over the past two decades, health insurance in Vietnam has expanded nationwide. Concurrently, Vietnam's private health sector has developed rapidly and become an increasingly integral part of the health system. To date, however, little is understood regarding the potential for expanding public-private partnerships to improve health care access and outcomes in Vietnam. Objective To explore possibilities for public-private collaboration in the provision of ambulatory care at the primary level in the Mekong region, Vietnam. Design We employed a mixed methods research approach. Qualitative methods included focus group discussions with health officials and in-depth interviews with managers of private health facilities. Quantitative methods encompassed facility assessments, and exit surveys of clients at the same private facilities. Results Discussions with health officials indicated generally favorable attitudes towards partnerships with private providers. Concerns were also voiced, regarding the over- and irrational use of antibiotics, and in terms of limited capacity for regulation, monitoring, and quality assurance. Private facility managers expressed a willingness to collaborate in the provision of ambulatory care, and private providers facilites were relatively well staffed and equipped. The client surveys indicated that 80% of clients first sought treatment at a private facility, even though most lived closer to a public provider. This choice was motivated mainly by perceptions of quality of care. Clients who reported seeking care at both a public and private facility were more satisfied with the latter. Conclusions Public-private collaboration in the provision of ambulatory care at the primary level in Vietnam has substantial potential for improving access to quality services. We recommend that such collaboration be explored by Vietnamese policy-makers. If implemented, we strongly urge attention to effectively managing such partnerships, establishing a quality assurance system, and strengthening regulatory mechanisms. PMID:22548036

Establishing Key Performance Indicators [KPIs] and Their Importance for the Surgical Management of Inflammatory Bowel Disease-Results From a Pan-European, Delphi Consensus Study.

PubMed

Morar, Pritesh S; Hollingshead, James; Bemelman, Willem; Sevdalis, Nick; Pinkney, Thomas; Wilson, Graeme; Dunlop, Malcolm; Davies, R Justin; Guy, Richard; Fearnhead, Nicola; Brown, Steven; Warusavitarne, Janindra; Edwards, Cathryn; Faiz, Omar

2017-10-27

Key performance indicators [KPIs] exist across a range of areas in medicine. They help to monitor outcomes, reduce variation, and drive up standards across services. KPIs exist for inflammatory bowel disease [IBD] care, but none specifically cover inflammatory bowel disease [IBD] surgical service provision. This was a consensus-based study using a panel of expert IBD clinicians from across Europe. Items were developed and fed through a Delphi process to achieve consensus. Items were ranked on a Likert scale from 1 [not important] to 5 [very important]. Consensus was defined when the inter quartile range was ≤ 1, and items with a median score > 3 were considered for inclusion. A panel of 21 experts [14 surgeons and 7 gastroenterologists] was recruited. Consensus was achieved on procedure-specific KPIs for ileocaecal and perianal surgery for Crohn's disease, [N = 10] with themes relating to morbidity [N = 7], multidisciplinary input [N = 2], and quality of life [N = 1]; and for subtotal colectomy, proctocolectomy and ileoanal pouch surgery for ulcerative colitis [N = 11], with themes relating to mortality [N = 2], morbidity [N = 8], and service provision [N = 1]. Consensus was also achieved for measures of the quality of IBD surgical service provision and quality assurance in IBD surgery. This study has provided measurable KPIs for the provision of surgical services in IBD. These indicators cover IBD surgery in general, the governance and structures of the surgical services, and separate indicators for specific subareas of surgery. Monitoring of IBD services with these KPIs may reduce variation across services and improve quality. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

Patient empowerment and choice in chronic pain management.

PubMed

Barrie, Janette

Service provision and access to pain services vary considerably in the UK, with only a small percentage of people with chronic pain accessing specialist services. Government policy supports giving patients more choice and control over their care. Empowerment involves ensuring patients have the knowledge, skills, attitudes and self-awareness to improve the quality of their lives. As most healthcare professionals provide care to people with chronic pain at some point, it is their responsibility to prepare patients to make informed decisions about their treatment. Empowering patients to self-manage their chronic pain can lead to improved person-centred outcomes.

7 CFR 457.161 - Canola and rapeseed crop insurance provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... grass or legume. 7. Insurable Acreage In addition to the provisions of section 9 of the Basic Provisions... application of disease control measures; (e) Wildlife; (f) Earthquake; (g) Volcanic eruption; or (h) Failure...

Advanced quality systems : probabilistic optimization for profit (Prob.O.Prof) software

DOT National Transportation Integrated Search

2009-04-01

Contractors constantly have to make decisions regarding how to maximize profit and minimize risk on paving projects. With more and more States adopting incentive/disincentive pay adjustment provisions for quality, as measured by various acceptance qu...

18 CFR 1304.202 - General sediment and erosion control provisions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false General sediment and erosion control provisions. 1304.202 Section 1304.202 Conservation of Power and Water Resources TENNESSEE...). (c) Disturbed sites must be promptly stabilized with seeding, vegetative planting, erosion control...

18 CFR 1304.202 - General sediment and erosion control provisions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false General sediment and erosion control provisions. 1304.202 Section 1304.202 Conservation of Power and Water Resources TENNESSEE...). (c) Disturbed sites must be promptly stabilized with seeding, vegetative planting, erosion control...

75 FR 64216 - Interpretation of OSHA's Provisions for Feasible Administrative or Engineering Controls of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-19

... CFR Parts 1910 and 1926 Interpretation of OSHA's Provisions for Feasible Administrative or Engineering... feasible administrative or engineering controls as used in the applicable sections of OSHA's General... administrative or engineering controls rather than personal protective equipment (PPE) to reduce noise exposures...

40 CFR 63.113 - Process vent provisions-reference control technology.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 10 2012-07-01 2012-07-01 false Process vent provisions-reference control technology. 63.113 Section 63.113 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 63.113 Process vent provisions—reference control technology. (a) The owner or operator of a Group 1...

40 CFR 63.113 - Process vent provisions-reference control technology.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 10 2013-07-01 2013-07-01 false Process vent provisions-reference control technology. 63.113 Section 63.113 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 63.113 Process vent provisions—reference control technology. (a) The owner or operator of a Group 1...

40 CFR 63.113 - Process vent provisions-reference control technology.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 9 2011-07-01 2011-07-01 false Process vent provisions-reference control technology. 63.113 Section 63.113 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 63.113 Process vent provisions—reference control technology. (a) The owner or operator of a Group 1...

40 CFR 63.113 - Process vent provisions-reference control technology.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 10 2014-07-01 2014-07-01 false Process vent provisions-reference control technology. 63.113 Section 63.113 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 63.113 Process vent provisions—reference control technology. (a) The owner or operator of a Group 1...

40 CFR 63.113 - Process vent provisions-reference control technology.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Process vent provisions-reference control technology. 63.113 Section 63.113 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 63.113 Process vent provisions—reference control technology. (a) The owner or operator of a Group 1...

Improving the public health sector in South Africa: eliciting public preferences using a discrete choice experiment.

PubMed

Honda, Ayako; Ryan, Mandy; van Niekerk, Robert; McIntyre, Diane

2015-06-01

The introduction of national health insurance (NHI), aimed at achieving universal coverage, is the most important issue currently on the South African health policy agenda. Improvement in public sector health-care provision is crucial for the successful implementation of NHI as, regardless of whether health-care services become more affordable and available, if the quality of the services provided is not acceptable, people will not use the services. Although there has been criticism of the quality of public sector health services, limited research is available to identify what communities regard as the greatest problems with the services. A discrete choice experiment (DCE) was undertaken to elicit public preferences on key dimensions of quality of care when selecting public health facilities in South Africa. Qualitative methods were applied to establish attributes and levels for the DCE. To elicit preferences, interviews with community members were held in two South African provinces: 491 in Western Cape and 499 in Eastern Cape. The availability of necessary medicine at health facilities has the greatest impact on the probability of attending public health facilities. Other clinical quality attributes (i.e. provision of expert advice and provision of a thorough examination) are more valued than non-clinical quality of care attributes (i.e. staff attitude, treatment by doctors or nurses, and waiting time). Treatment by a doctor was less valued than all other attributes. Communities are prepared to tolerate public sector health service characteristics such as a long waiting time, poor staff attitudes and lack of direct access to doctors if they receive the medicine they need, a thorough examination and a clear explanation of the diagnosis and prescribed treatment from health professionals. These findings prioritize issues that the South African government must address in order to meet their commitment to improve public sector health-care service provision. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Development of a Hybrid Course on Wheelchair Service Provision for clinicians in international contexts.

PubMed

Burrola-Mendez, Yohali; Goldberg, Mary; Gartz, Rachel; Pearlman, Jon

2018-01-01

Wheelchair users worldwide are at high risk of developing secondary health conditions and premature death due to inappropriate wheelchair provision by untrained providers. The International Society of Wheelchair Professionals (ISWP) has developed a Hybrid Course based on the World Health Organization's Wheelchair Service Training Package-Basic Level. The Hybrid Course leverages online modules designed for low-bandwidth internet access that reduces the in-person training exposure from five to three and a half days, making it less expensive and more convenient for both trainees and trainers. The Hybrid Course was designed using a systematic approach guided by an international group of stakeholders. The development followed the Quality Matters Higher Educational Rubric, web design guidelines for low bandwidth, experts' opinions, and the best practices for blended course design. A quasi-experimental approach was used to evaluate the effectiveness of the Hybrid Course taken by six graduate students in Rehabilitation Sciences at the University of Pittsburgh by measuring pre- and post knowledge using the validated ISWP Wheelchair Service Provision-Basic Test. The outcome measure was assessed using a paired sample t-test between pretest and posttest scores. The quality of the Hybrid Course was evaluated by three external reviewers using the Quality Matters Higher Educational Rubric who were blind to each others' evaluation and the results of the training intervention. Hybrid Course participants reported significant increases in scores on the ISWP Wheelchair Service Provision-Basic Test after participating in the training, with an average increase of 10.84±5.42, p = 0.004, Cohen's d = 1.99. In addition, the Hybrid Course met the Quality Matters Standards in two out of three evaluations and reported a percentage of agreement between evaluators of 84%. The Hybrid Course met quality standards and proved to be effective in increasing basic level wheelchair knowledge in a group of Rehabilitation Science graduate students.

23 CFR 750.713 - Bonus provisions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 23 Highways 1 2012-04-01 2012-04-01 false Bonus provisions. 750.713 Section 750.713 Highways... BEAUTIFICATION Outdoor Advertising Control § 750.713 Bonus provisions. 23 U.S.C. 131(j) specifically provides... States are not exempt from the other provisions of 23 U.S.C. 131. If a State elects to comply with both...

Reduction of provisioning effort in response to experimental manipulation of chick nutritional status in the Horned Puffin

USGS Publications Warehouse

Harding, A.M.A.; van Pelt, Thomas I.; Piatt, John F.; Kitaysky, A.S.

2002-01-01

Using a supplemental feeding experiment, we investigated the ability of adult Horned Puffins to decrease provisioning effort in response to reduced nutritional requirements of chicks. We found no difference between experimental and control groups in parental provisioning before supplementary feeding was initiated. After receiving supplemental food for seven days, experimental chicks grew faster, gained more mass and received 87% less food from their parents than did control chicks. These results demonstrate that Horned Puffin parents can decrease food provisioning in response to a decrease in their chick nutritional requirements. ?? The Cooper Ornithological Society 2002.

76 FR 76405 - Agency Information Collection Activities; Submission to OMB for Review and Approval; Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-07

... Activities; Submission to OMB for Review and Approval; Comment Request; Water Quality Standards Regulations....regulations.gov . Title: Water Quality Standards Regulation (Renewal). ICR numbers: EPA ICR No. 0988.11, OMB...: Water quality standards are provisions of State, Tribal, and Federal law that consist of designated uses...

Academic Libraries and Quality: An Analysis and Evaluation Framework

ERIC Educational Resources Information Center

Atkinson, Jeremy

2017-01-01

The paper proposes and describes a framework for academic library quality to be used by new and more experienced library practitioners and by others involved in considering the quality of academic libraries' services and provision. The framework consists of eight themes and a number of questions to examine within each theme. The framework was…

75 FR 62026 - Approval and Promulgation of Implementation Plans and Designation of Areas for Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-07

... techniques, provisions for the establishment and operation of appropriate devices necessary to collect data... information.) Ambient air quality monitoring data for the 3-year period must meet a data completeness requirement. The ambient air quality monitoring data completeness requirement is met when the percent of days...

Assessing Reading Fluency in Kenya: Oral or Silent Assessment?

ERIC Educational Resources Information Center

Piper, Benjamin; Zuilkowski, Stephanie Simmons

2015-01-01

In recent years, the Education for All movement has focused more intensely on the quality of education, rather than simply provision. Many recent and current education quality interventions focus on literacy, which is the core skill required for further academic success. Despite this focus on the quality of literacy instruction in developing…

The Massification of Higher Education in the UK: Aspects of Service Quality

ERIC Educational Resources Information Center

Giannakis, Mihalis; Bullivant, Nicola

2016-01-01

This article explores several aspects of service quality for the provision of higher education. Alongside the trend of the massification of higher education over the past two decades, higher education institutions are required to review quality across a range of outputs, besides teaching and learning. The study was undertaken within the…

Quality Assurance in Australian Higher Education: Historical and Future Development

ERIC Educational Resources Information Center

Shah, Mahsood; Nair, Sid; Wilson, Mark

2011-01-01

Higher education policies related to quality assurance are implemented in many countries. The purposes of such policies are to ensure the provision for high-quality education, university accountability and transparency in the use of public funding and meeting the needs of the diverse stakeholders. The current Australian Higher Education Quality…

Quality Assurance Challenges and Opportunities Faced by Private Universities in Zimbabwe

ERIC Educational Resources Information Center

Garwe, Evelyn Chiyevo

2014-01-01

The study sought to provide an understanding of the quality assurance challenges and opportunities faced by private universities in Zimbabwe. The study analyzed the factors determining provision of quality higher education in private universities and the resultant effects of failing to achieve the minimum acceptable standards. The author employed…

Overcoming Exclusion through Quality Schooling. Pathways to Access. Research Monograph No. 65

ERIC Educational Resources Information Center

Govinda, R.; Bandyopadhyay, Madhumita

2011-01-01

In the era of globalisation, provision of quality education is increasingly gaining importance across the world. Like elsewhere, it has already been realised in India that equal attention is needed simultaneously on access, equity and quality to achieve the goal of universalisation of elementary education. It has also been experienced that…

Latitudinal variation in avian incubation attentiveness and a test of the food limitation hypothesis

USGS Publications Warehouse

Chalfoun, A.D.; Martin, T.E.

2007-01-01

Avian incubation attentiveness has important fitness consequences through its influence on the number and quality of hatched young and energetic costs imposed on parents. Nest attentiveness is highly variable across species and geographical regions. We reviewed the literature and found a worldwide pattern that nest attentiveness of passerines is generally lower in south temperate and tropical regions than in north temperate regions. We also conducted a food manipulation experiment to assess the extent to which nest attentiveness may reflect proximate responses versus an evolved behaviour. We used the karoo prinia, Prinia maculosa, in South Africa, which has very low nest attentiveness (???49%) compared with that of many passerine birds. We provided supplemental food during early incubation to experimental females and compared nest attentiveness and on- and off-bout lengths of experimental and paired control females.??Nest attentiveness of females at food-provisioned nests was significantly higher than that of control females (57% versus 49%). Food-supplemented females also spent significantly less time off the nest than did control females, whereas mean on-bout lengths did not differ. However, mean nest attentiveness of food-provisioned females was still substantially below that of other similar bird species worldwide. Food can be an important proximate influence on parental care behaviour, but proximate influences of food do not explain broad latitudinal patterns of attentiveness. ?? 2007 The Association for the Study of Animal Behaviour.

[Theoretical grounds of a structural and functional model for quality assurance of radiation diagnostics under conditions of development of the modern health care system in Ukraine].

PubMed

Korop, Oleg A; Lenskykh, Sergiy V

2018-01-01

Introduction: Modern changes in the health care system of Ukraine are focused on financial support in providing medical and diagnostic care to the population and are based on deep and consistent structural and functional transformations. They are aimed at providing adequate quality care, which is the main target function and a principal criterion for operation of health care system. The urgency of this problem is increasing in the context of reforming the health care system and global changes in the governmental financial guarantees for the provision of medical services to the population. The aim of the work is to provide theoretical grounds for a structural and functional model of quality assurance of radiation diagnostics at all levels of medical care given to the population under the current health care reform in Ukraine. Materials and methods: The object of the study is organizing the operation of the radiation diagnostic service; the information is based on the actual data on the characteristics of radiation diagnosis at different levels of medical care provision. Methods of systematic approach, system analysis and structural and functional analysis of the operating system of radiation diagnostics are used. Review: The basis of the quality assurance model is the cyclical process, which includes the stages of the problem identifition, planning of its solution, organization of the system for implementation of decisions, monitoring the quality management process of the radiation diagnostics, and factors influencing the quality of the radiation diagnostics service. These factors include the quality of the structure, process, results, organization of management and control of current processes and the results of radiation diagnostics management. Conclusions: The advantages of the proposed model for ensuring the quality of the radiation diagnostics service are its systemacy and complexity, elimination of identified defects and deficiencies, and achievement of profitability through modern redistribution and use of existing resources of the health care system. The results of adequate service quality management activities in radiation diagnostics are the improvement of organizational and economic principles along with legislative regulation, the implementation of a modern system of radiation diagnostics in the state health care at the national and regional levels, the increase of the accessibility, quality and efficiency of the radiation diagnostics service.

Improving education and supervision of Queensland X-ray Operators through video conference technology: A teleradiography pilot project.

PubMed

Rawle, Marnie; Oliver, Tanya; Pighills, Alison; Lindsay, Daniel

2017-12-01

X-ray Operator (XO) supervision in Queensland is performed by radiographers in a site removed from the XO site. This has historically been performed by telephone when the XO requires immediate help, as well as post-examination through radiographer review and the provision of written feedback on images produced. This project aimed to improve image quality through the provision of real-time support of XOs by the introduction of video conference (VC) supervision. A 6-month pilot project compared image quality with and without VC supervision. VC equipment was installed in the X-ray room at two rural sites, as well as at the radiographer site, to enable visual and oral supervision. The VC unit enabled visualisation of the X-ray examination technique as it was being undertaken, as well as the images produced prior to transmission to the Picture Archiving and Communication System (PACS). Statistically significant improvement in image quality criteria measures were seen for patient positioning (P = 0.008), image quality (P < 0.001) and diagnostic value (P < 0.001) of images taken during this project. No statistically significant differences were seen during case level assessment in the inclusion of only appropriate imaging (P = 0.06), and the inclusion of unacceptable imaging (P = 0.06), however improvements were seen in both of these criteria. The survey revealed 24.6% of examinations performed would normally have involved the XO contacting the radiographer for assistance, although, assistance was actually provided in 88.3% of examinations. This project has demonstrated that significant improvement in image quality is achievable with VC supervision. A larger study with a control arm that did not receive direct supervision should be used to validate the findings of this study. © 2017 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.

Hearing aids: indications, technology, adaptation, and quality control

PubMed Central

Hoppe, Ulrich; Hesse, Gerhard

2017-01-01

Hearing loss can be caused by a number of different pathological conditions. Some of them can be successfully treated, mainly by surgery, depending on the individual’s disease process. However, the treatment of chronic sensorineural hearing loss with damaged cochlear structures usually needs hearing rehabilitation by means of technical amplification. During the last two decades tremendous improvements in hearing aid technology led to a higher quality of the hearing rehabilitation process. For example, due to sophisticated signal processing acoustic feedback could be reduced and hence open fitting options are available even for more subjects with higher degrees of hearing loss. In particular for high-frequency hearing loss, the use of open fitting is an option. Both the users’ acceptance and the perceived sound quality were significantly increased by open fittings. However, we are still faced with a low level of readiness in many hearing impaired subjects to accept acoustic amplification. Since ENT specialists play a key-role in hearing aid provision, they should promote early hearing aid rehabilitation and include this in the counselling even in subjects with mild and moderate hearing loss. Recent investigations demonstrated the benefit of early hearing aid use in this group of patients since this may help to reduce subsequent damages as auditory deprivation, social isolation, development of dementia, and cognitive decline. For subjects with tinnitus, hearing aids may also support masking by environmental sounds and enhance cortical inhibition. The present paper describes the latest developments of hearing aid technology and the current state of the art for amplification modalities. Implications for both hearing aid indication and provision are discussed. PMID:29279726

The role of maternal age and context-dependent maternal effects in the offspring provisioning of a long-lived marine teleost

PubMed Central

Smith, Wade D.; Spencer, Paul D.; Evans, Allison N.; Heppell, Scott A.; Heppell, Selina S.

2018-01-01

Despite evidence of maternal age effects in a number of teleost species, there have been challenges to the assertion that maternal age intrinsically influences offspring quality. From an evolutionary perspective, maternal age effects result in young females paradoxically investing in less fit offspring despite a greater potential fitness benefit that might be gained by allocating this energy to individual somatic growth. Although a narrow range of conditions could lead to a maternal fitness benefit via the production of lower quality offspring, evolutionary theorists suggest these conditions are seldom met and that the reported maternal age effects are more likely products of the environmental context. Our goal was to determine if maternal effects operated on offspring provisioning in a long-lived rockfish (genus Sebastes), and to evaluate any such effects as an intrinsic function of maternal age or a context-dependent effect of the offspring release environment. We found that offspring provisioning is a function of both maternal age and the timing of offspring release; older females exhibit increased provisioning over younger females throughout the spawning season despite a decrease in provisioning across all maternal ages as the season progresses. These findings suggest a role for both maternal age effects and a potential context-dependent maternal effect in population productivity, carrying important implications when modelling population persistence and resilience. PMID:29410808

42 CFR 475.1 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATIONS General Provisions § 475.1 Definitions. For... than a self-insured employer, which makes payments directly or indirectly to health care practitioners...), in which the CMS contract directs the QIO to perform. Quality improvement initiative has the same...

Universal Basic Education and the Provision of Quality Mathematics in Southern Africa

ERIC Educational Resources Information Center

Kazima, Mercy

2014-01-01

In this paper, I discuss Universal Basic Education (UBE) in relation to the teaching and learning of mathematics in Southern Africa. I present the status of UBE for all countries in the region and then use 3 selected examples: Botswana, Malawi, and Zambia, to illustrate the provision of mathematics in the general framework of UBE in the countries.…

Teacher Migration Impact: A Review in the Context of Quality Education Provision and Teacher Training in Higher Education in Southern Africa

ERIC Educational Resources Information Center

Brown, B.

2008-01-01

Teacher mobility has become a common feature of the cross-border flows and transnational networks that constitute globalisation. International and intraregional migration of teachers is an important factor in education provision and management in countries in the Southern Africa region, for example Botswana and South Africa. In an increasingly…

78 FR 49685 - Approval and Promulgation of Air Quality Implementation Plans; State of Wyoming; Revised General...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-15

..., particulate matter (PM), and sulfur dioxide (SO 2 ). Because certain provisions of section 176(c) of the CAA...), ``Prohibition'', was modified to remove obsolete provisions in (a)(iii) and now makes this section reserved. 2. Section 3(a), ``Prohibition'', was modified to define NEPA in (a)(iv) and to add a new section (v) that...

An Elaborated Model of Student Support to Allow for Gender Considerations in Asian Distance Education

ERIC Educational Resources Information Center

Jung, Insung; Seongyoun, Hong

2014-01-01

Research indicates that distance education (DE) students regard learner support systems as the key element in quality provision. This study sought to identify the key concerns of Asian DE students regarding support provision in different types of DE and dual-mode providers and formulate a student support model which took account of gender issues.…

Relative influence of male and female care in determining nestling mass in a migratory songbird

Treesearch

Kirk Stodola; Eric Linder; David A. Buehler; Kathlee Franzreb; Daniel Kim; Robert Cooper

2010-01-01

Biparental care is common in birds with the allocation of effort being highly variable between the sexes. In most songbird species, the female typically provides the most care in the breeding cycle with both parents providing care when provisioning young. Food provisioning should be directly related to offspring quality; however, the relative influence each parent has...

Will MOOCs Transform Learning and Teaching in Higher Education? Engagement and Course Retention in Online Learning Provision

ERIC Educational Resources Information Center

de Freitas, Sara Isabella; Morgan, John; Gibson, David

2015-01-01

Massive open online courses (MOOCs) have been the subject of much polarised debate around their potential to transform higher education in terms of opening access. Although MOOCs have been attracting large learner cohorts, concerns have emerged from the early evidence base centring upon issues of quality in learning and teaching provision, and…

A randomised trial of peer review: the UK National Chronic Obstructive Pulmonary Disease Resources and Outcomes Project.

PubMed

Roberts, C M; Stone, R A; Buckingham, R J; Pursey, N A; Harrison, B D W; Lowe, D; Potter, J M

2010-06-01

Peer review has been widely employed within the NHS to facilitate health quality improvement but has not been rigorously evaluated. This article reports the largest randomised trial of peer review ever conducted in the UK. The peer review intervention was a reciprocal supportive exercise that included clinicians, hospital management, commissioners and patients which focused on the quality of the provision of four specific evidence-based aspects of chronic obstructive pulmonary disease care. Follow up at 12 months demonstrated few quantitative differences in the number or quality of services offered in the two groups. Qualitative data in contrast suggested many benefits of peer review in most but not all intervention units and some control teams. Findings suggest peer review in this format is a positive experience for most participants but is ineffective in some situations. Its longer term benefits and cost effectiveness require further study. The generic findings of this study have potential implications for the application of peer review throughout the NHS.

Effects of user fee exemptions on the provision and use of maternal health services: a review of literature.

PubMed

Hatt, Laurel E; Makinen, Marty; Madhavan, Supriya; Conlon, Claudia M

2013-12-01

User fee removal has been put forward as an approach to increasing priority health service utilization, reducing impoverishment, and ultimately reducing maternal and neonatal mortality. However, user fees are a source of facility revenue in many low-income countries, often used for purchasing drugs and supplies and paying incentives to health workers. This paper reviews evidence on the effects of user fee exemptions on maternal health service utilization, service provision, and outcomes, including both supply-side and demand-side effects. We reviewed 19 peer-reviewed research articles addressing user fee exemptions and maternal health services or outcomes published since 1990. Studies were identified through a USAID-commissioned call for evidence, key word search, and screening process. Teams of reviewers assigned criteria-based quality scores to each paper and prepared structured narrative reviews. The grade of the evidence was found to be relatively weak, mainly from short-term, non-controlled studies. The introduction of user fee exemptions appears to have resulted in increased rates of facility-based deliveries and caesarean sections in some contexts. Impacts on maternal and neonatal mortality have not been conclusively demonstrated; exemptions for delivery care may contribute to modest reductions in institutional maternal mortality but the evidence is very weak. User fee exemptions were found to have negative, neutral, or inconclusive effects on availability of inputs, provider motivation, and quality of services. The extent to which user fee revenue lost by facilities is replaced can directly affect service provision and may have unintended consequences for provider motivation. Few studies have looked at the equity effects of fee removal, despite clear evidence that fees disproportionately burden the poor. This review highlights potential and documented benefits (increased use of maternity services) as well as risks (decreased provider motivation and quality) of user fee exemption policies for maternal health services. Governments should link user fee exemption policies with the replacement of lost revenue for facilities as well as broader health system improvements, including facility upgrades, ensured supply of needed inputs, and improved human resources for health. Removing user fees may increase uptake but will not reduce mortality proportionally if the quality of facility-based care is poor. More rigorous evaluations of both demand- and supply-side effects of mature fee exemption programmes are needed.

7 CFR 4288.137 - Succession and loss of control of advanced biofuel facilities and production.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 15 2014-01-01 2014-01-01 false Succession and loss of control of advanced biofuel... PROGRAMS Advanced Biofuel Payment Program General Provisions Payment Provisions § 4288.137 Succession and loss of control of advanced biofuel facilities and production. (a) Contract succession. An entity who...

Quality and safety in medical care: what does the future hold?

PubMed

Liang, Bryan A; Mackey, Tim

2011-11-01

The rapid changes in health care policy, embracing quality and safety mandates, have culminated in programs and initiatives under the Patient Protection and Affordable Care Act. To review the context of, and anticipated quality and patient safety mandates for, delivery systems, incentives under health care reform, and models for future accountability for outcomes of care. Assessment of the provisions of Patient Protection and Affordable Care Act, other reform efforts, and reform initiatives focusing on future quality and safety provisions for health care providers. Health care reform and other efforts focus on consumerism in the context of price. Quality and safety efforts will be structured using financial incentives, best-practices research, and new delivery models that focus on reaching benchmarks while reducing costs. In addition, patient experience will be a key component of reimbursement, and a move toward "retail" approaches directed at the individual patient may supplant traditional "wholesale" efforts at attracting employers. Quality and safety have always been of prime importance in medicine. However, in the future, under health care reform and associated initiatives, a shift in the paradigm of medicine will integrate quality and safety measurement with financial incentives and a new emphasis on consumerism.

The outcome competency framework for practitioners in infection prevention and control: use of the outcome logic model for evaluation.

PubMed

Burnett, E; Curran, E; Loveday, H P; Kiernan, M A; Tannahill, M

2014-01-01

Healthcare is delivered in a dynamic environment with frequent changes in populations, methods, equipment and settings. Infection prevention and control practitioners (IPCPs) must ensure that they are competent in addressing the challenges they face and are equipped to develop infection prevention and control (IPC) services in line with a changing world of healthcare provision. A multifaceted Framework was developed to assist IPCPs to enhance competence at an individual, team and organisational level to enable quality performance and improved quality of care. However, if these aspirations are to be met, it is vital that competency frameworks are fit for purpose or they risk being ignored. The aim of this unique study was to evaluate short and medium term outcomes as set out in the Outcome Logic Model to assist with the evaluation of the impact and success of the Framework. This study found that while the Framework is being used effectively in some areas, it is not being used as much or in the ways that were anticipated. The findings will enable future work on revision, communication and dissemination, and will provide intelligence to those initiating education and training in the utilisation of the competences.

The outcome competency framework for practitioners in infection prevention and control: use of the outcome logic model for evaluation

PubMed Central

Curran, E; Loveday, HP; Kiernan, MA; Tannahill, M

2013-01-01

Healthcare is delivered in a dynamic environment with frequent changes in populations, methods, equipment and settings. Infection prevention and control practitioners (IPCPs) must ensure that they are competent in addressing the challenges they face and are equipped to develop infection prevention and control (IPC) services in line with a changing world of healthcare provision. A multifaceted Framework was developed to assist IPCPs to enhance competence at an individual, team and organisational level to enable quality performance and improved quality of care. However, if these aspirations are to be met, it is vital that competency frameworks are fit for purpose or they risk being ignored. The aim of this unique study was to evaluate short and medium term outcomes as set out in the Outcome Logic Model to assist with the evaluation of the impact and success of the Framework. This study found that while the Framework is being used effectively in some areas, it is not being used as much or in the ways that were anticipated. The findings will enable future work on revision, communication and dissemination, and will provide intelligence to those initiating education and training in the utilisation of the competences. PMID:28989348

Retailer adherence to Family Smoking Prevention and Tobacco Control Act, North Carolina, 2011.

PubMed

Rose, Shyanika W; Myers, Allison E; D'Angelo, Heather; Ribisl, Kurt M

2013-04-04

The Family Smoking Prevention and Tobacco Control Act regulates the sales and marketing of tobacco products in the United States; poor adherence by tobacco retailers may reduce the effectiveness of the Act's provisions. The objectives of this study were 1) to assess whether and to which provisions retailers were adherent and 2) to examine differences in adherence by county, retailer neighborhood, and retailer characteristics. We conducted multivariate analysis of tobacco retailers' adherence to 12 point-of-sale provisions of the Tobacco Control Act in 3 North Carolina counties. We conducted observational audits of 324 retailers during 3 months in 2011 to assess adherence. We used logistic regression to assess associations between adherence to provisions and characteristics of each county, retailer neighborhood, and retailer. We found 15.7% of retailers did not adhere to at least 1 provision; 84.3% adhered to all provisions. The provisions most frequently violated were the ban on sales of cigarettes with modified-risk labels (eg, "light" cigarettes) (43 [13.3%] retailers nonadherent) and the ban on self-service for cigarettes and smokeless tobacco (6 [1.9%] retailers nonadherent). We found significant differences in rates of nonadherence by county and type of retailer. Pharmacies and drug stores were more than 3 times as likely as grocery stores to be nonadherent. Most tobacco retailers have implemented regulatory changes without enforcement by the US Food and Drug Administration. Monitoring rates of adherence by store type and locale (eg, county) may help retailers comply with point-of-sale provisions.

40 CFR 1045.701 - General provisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 34 2013-07-01 2013-07-01 false General provisions. 1045.701 Section 1045.701 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR POLLUTION CONTROLS CONTROL OF EMISSIONS FROM SPARK-IGNITION PROPULSION MARINE ENGINES AND VESSELS Averaging, Banking, and...

40 CFR 1045.701 - General provisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false General provisions. 1045.701 Section 1045.701 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR POLLUTION CONTROLS CONTROL OF EMISSIONS FROM SPARK-IGNITION PROPULSION MARINE ENGINES AND VESSELS Averaging, Banking, and...

12 CFR 614.4359 - Attribution rules.

Code of Federal Regulations, 2010 CFR

2010-01-01

... controlling influence over management of a related borrower's operations through the provisions of management... borrower, or (3) Exercises a controlling influence over management of a related borrower's operations through the provisions of management placement or marketing agreements, or providing services such as...

25 CFR 41.11 - General provisions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION GRANTS TO TRIBALLY CONTROLLED COMMUNITY COLLEGES AND NAVAJO COMMUNITY COLLEGE Tribally Controlled Community Colleges § 41.11 General provisions. The general... to Community Colleges: (a) Services or assistance provided to Indians by Community Colleges aided...

Using Students' Experiences to Derive Quality in an E-Learning System: An Institution's Perspective

ERIC Educational Resources Information Center

Alexander, Shirley; Golja, Tanja

2007-01-01

Higher education institutions undertake a range of approaches to evaluating and making judgments about the quality of their e-learning provision. This paper begins by exploring benchmarking as one current strategy in common use in universities to identify and implement quality practices: from the use of checklists (for example, of best practices…

75 FR 57220 - Rule To Implement the 1997 8-Hour Ozone National Ambient Air Quality Standard: New Source Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-20

... Rule To Implement the 1997 8-Hour Ozone National Ambient Air Quality Standard: New Source Review Anti-Backsliding Provisions for Former 1-Hour Ozone Standard--Public Hearing Notice AGENCY: Environmental... be held for the proposed ``Rule to Implement the 1997 8-Hour Ozone National Ambient Air Quality...

Standards to Assure Quality in Tertiary Education: The Case of Tanzania

ERIC Educational Resources Information Center

Manyaga, Timothy

2008-01-01

Purpose: The purpose of this paper is to provide information on development of standards in Tanzania which may be of help to training providers in other countries as they seek to improve the quality and standards of their provision. Design/methodology/approach: The need to provide quality assured tertiary qualifications in Tanzania to win both…

34 CFR 611.2 - What management plan must be included in a Teacher Quality Enhancement Grants Program application?

Code of Federal Regulations, 2010 CFR

2010-07-01

... TEACHER QUALITY ENHANCEMENT GRANTS PROGRAM General Provisions § 611.2 What management plan must be... 34 Education 3 2010-07-01 2010-07-01 false What management plan must be included in a Teacher Quality Enhancement Grants Program application? 611.2 Section 611.2 Education Regulations of the Offices...

Quality Services Management: A Consumer-Oriented Model for Systems Audit and Strategic Intervention.

ERIC Educational Resources Information Center

Baker, Pamela C.

The paper describes Quality Service Management (QSM) as applied to the provision of services to disabled and other special needs persons. QSM is defined as a systems approach to consumer relations based on the belief that quality care may be achieved only within the context of overall services management. Differences among "quality…

Differentiation among Schools as a Factor of the Quality of General Education

ERIC Educational Resources Information Center

Kozochkina, T. L.

2009-01-01

Russian schools differ widely in the quality of education they provide and in the socioeconomic status of the students they teach. More needs to be done to provide quality education for children from all social strata, including provision of remedial or extra tutoring where necessary. General school education provides the basic body of knowledge…

Child Care Quality and Cognitive Development: Trajectories Leading to Better Preacademic Skills

ERIC Educational Resources Information Center

Cote, Sylvana M.; Mongeau, Chantal; Japel, Christa; Xu, Qian; Seguin, Jean R.; Tremblay, Richard E.

2013-01-01

The associations between trajectories of child care quality from ages 2 to 4 years and children's cognitive performance at 4 years ("n" = 250) were tested. Distinct quality trajectories were identified: low and high ascending Teaching and Interactions trajectory; low and high Provision for Learning trajectory. Membership in the high…

The Quality and Accessibility of Primary School Music Education: Provision, Perceptions and Hopes in Six Non-Metropolitan Schools

ERIC Educational Resources Information Center

Hardcastle, Adam

2009-01-01

The National Review of School Music Education has systematically documented the variations in quality and accessibility of school music education in Australia. Rural and remote schools were found to be particularly vulnerable to relatively poorer quality and accessibility. These findings were not new; they echoed similar observations made by…

Social characteristics and care needs of older persons with medically unexplained symptoms: a case-control study.

PubMed

Hanssen, Denise J C; Oude Voshaar, Richard C; Naarding, Paul; Rabeling-Keus, Inge M; Olde Hartman, Tim C; Lucassen, Peter L B J

2016-12-01

Research in younger patients with medically unexplained symptoms (MUS) has shown impairments in social functioning, such as loneliness and a reduced quality of the patient-doctor relationship. As far as we know, no studies have been performed on social functioning in older MUS patients; self-reported care needs of older MUS patients remain unknown. To explore social characteristics and care needs of older persons with chronic MUS, when compared to older persons with chronic medically explained symptoms (MES). Patient characteristics of 107 older persons (>60 years) with chronic MUS were compared to 150 older persons with chronic MES in a case-control design. Participants were recruited via advertisements, general practices and a specialized clinic. All participants completed questionnaires on social functioning; the Camberwell Assessment of Need for the Elderly was used to draw up care needs. Linear regression analyses were performed to explore the association between social characteristics and group (MUS/MES), adjusted for demographic and physical determinants. Multiple chi-square tests were performed to detect between-group differences regarding care needs. After adjustments, older MUS patients were slightly but significantly lonelier, reported a somewhat lower quality of their patient-doctor relationship, but reported equal social support levels when compared to MES patients. MUS patients more often reported unmet care needs regarding health and information provision about their health status. Only small differences in social functioning were found between older MUS and MES patients. Possibly, training future doctors in giving acceptable explanations for the patient's complaints could improve the unmet care need of information provision in older MUS patients. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Air Quality Conformity for Fiscal Years 1997-2000 Transportation Improvement Program for the Cincinnati Nonattainment Region

DOT National Transportation Integrated Search

1996-06-01

The Clean Air Act Amendments (CAAA) of 1990 required emissions reductions in : nonattainment areas. The CAAA contains conformity provisions requiring : transportation plans and programs to conform to air quality plans. Based on the : documented analy...

Predicting effects of environmental change on river inflows to Tillamook Bay, Oregon

EPA Science Inventory

Estuarine river watersheds provide valued ecosystem services to their surrounding communities including drinking water, fish habitat, and regulation of estuarine water quality. However, the provisioning of these services can be affected by changes in the quantity and quality of ...

Quality Assurance for Higher Education Franchising.

ERIC Educational Resources Information Center

Yorke, Mantz

1993-01-01

The practice of "franchising" higher education programs, or provision of educational programs through vendors, is examined as it occurs in the United Kingdom as a result of recent educational policy changes. A set of principles for assuring the quality of such programs is proposed. (MSE)

Patient experiences of colonoscopy, barium enema and CT colonography: a qualitative study.

PubMed

Von Wagner, C; Knight, K; Halligan, S; Atkin, W; Lilford, R; Morton, D; Wardle, J

2009-01-01

Previous studies of patient experience with bowel screening tests, in particular CT colonography (CTC), have superimposed global rating scales and not explored individual experience in detail. To redress this, we performed qualitative interviews in order to characterize patient expectations and experiences in depth. Following ethical permission, 16 patients undergoing CTC, 18 undergoing colonoscopy and 15 undergoing barium enema agreed to a semi-structured interview by a health psychologist. Interviews were recorded, responses transcribed and themes extracted with the aim of assimilating individual experiences to facilitate subsequent development and interpretation of quantitative surveys of overall satisfaction with each diagnostic test. Transcript analysis identified three principal themes: physical sensations, social interactions and information provision. Physical sensations differed for each test but were surprisingly well tolerated overall. Social interactions with staff were perceived as very important in colouring the whole experience, particularly in controlling the feelings of embarrassment, which was critical for all procedures. Information provision was also an important determinant of experience. Verbal feedback was most common during colonoscopy and invariably reassuring. However, patients undergoing CTC received little visual or verbal feedback and were often confused regarding the test outcome. Barium enema had no specific advantage over other tests. Qualitative interviews provided important perspectives on patient experience. Our data demonstrated that models describing the quality of medical encounters are applicable to single diagnostic episodes. Staff interactions and information provision were particularly important. We found advantages specific to both CTC and colonoscopy but none for barium enema. CTC could benefit greatly from improved information provision following examination.

Service provision and quality outcomes in home health for rural Medicare beneficiaries at high risk for unplanned care.

PubMed

Mroz, Tracy M; Andrilla, C Holly A; Garberson, Lisa A; Skillman, Susan M; Patterson, Davis G; Larson, Eric H

2018-06-11

Multiple barriers exist to providing home health care in rural areas. This study examined relationships between service provision and quality outcomes among rural, fee-for-service Medicare beneficiaries who received home health care between 2011 and 2013 for conditions associated with high-risk for unplanned care. More skilled nursing visits, visits by more types of providers, more timely care, and shorter lengths of stay were associated with significantly higher odds of hospital readmission and emergency department use and significantly lower odds of community discharge. Results may indicate unmeasured clinical severity and care needs among this population. Additional research regarding the accuracy of current severity measures and adequacy of case-mix adjustment for quality metrics is warranted, especially given the continued focus on value-based payment policies.

Implementation research to improve quality of maternal and newborn health care, Malawi.

PubMed

Brenner, Stephan; Wilhelm, Danielle; Lohmann, Julia; Kambala, Christabel; Chinkhumba, Jobiba; Muula, Adamson S; De Allegri, Manuela

2017-07-01

To evaluate the impact of a performance-based financing scheme on maternal and neonatal health service quality in Malawi. We conducted a non-randomized controlled before and after study to evaluate the effects of district- and facility-level performance incentives for health workers and management teams. We assessed changes in the facilities' essential drug stocks, equipment maintenance and clinical obstetric care processes. Difference-in-difference regression models were used to analyse effects of the scheme on adherence to obstetric care treatment protocols and provision of essential drugs, supplies and equipment. We observed 33 health facilities, 23 intervention facilities and 10 control facilities and 401 pregnant women across four districts. The scheme improved the availability of both functional equipment and essential drug stocks in the intervention facilities. We observed positive effects in respect to drug procurement and clinical care activities at non-intervention facilities, likely in response to improved district management performance. Birth assistants' adherence to clinical protocols improved across all studied facilities as district health managers supervised and coached clinical staff more actively. Despite nation-wide stock-outs and extreme health worker shortages, facilities in the study districts managed to improve maternal and neonatal health service quality by overcoming bottlenecks related to supply procurement, equipment maintenance and clinical performance. To strengthen and reform health management structures, performance-based financing may be a promising approach to sustainable improvements in quality of health care.

[Recommendations for inspections of the French nuclear safety authority].

PubMed

Rousse, C; Chauvet, B

2015-10-01

The French nuclear safety authority is responsible for the control of radiation protection in radiotherapy since 2002. Controls are based on the public health and the labour codes and on the procedures defined by the controlled health care facility for its quality and safety management system according to ASN decision No. 2008-DC-0103. Inspectors verify the adequacy of the quality and safety management procedures and their implementation, and select process steps on the basis of feedback from events notified to ASN. Topics of the inspection are communicated to the facility at the launch of a campaign, which enables them to anticipate the inspectors' expectations. In cases where they are not physicians, inspectors are not allowed to access information covered by medical confidentiality. The consulted documents must therefore be expunged of any patient-identifying information. Exchanges before the inspection are intended to facilitate the provision of documents that may be consulted. Finally, exchange slots between inspectors and the local professionals must be organized. Based on improvements achieved by the health care centres and on recommendations from a joint working group of radiotherapy professionals and the nuclear safety authority, changes will be made in the control procedure that will be implemented when developing the inspection program for 2016-2019. Copyright © 2015. Published by Elsevier SAS.

The effect of an anti-malarial subsidy programme on the quality of service provision of artemisinin-based combination therapy in Kenya: a cluster-randomized, controlled trial

PubMed Central

2013-01-01

Background Many patients with suspected malaria in sub-Saharan Africa seek treatment from private providers, but this sector suffers from sub-standard medicine dispensing practices. To improve the quality of care received for presumptive malaria from the highly accessed private retail sector in western Kenya, subsidized pre-packaged artemether-lumefantrine (AL) was provided to private retailers, together with a one day training for retail staff on malaria diagnosis and treatment, job aids and community engagement activities. Methods The intervention was assessed using a cluster-randomized, controlled design. Provider and mystery-shopper cross-sectional surveys were conducted at baseline and eight months post-intervention to assess provider practices. Data were analysed based on cluster-level summaries, comparing control and intervention arms. Results On average, 564 retail outlets were interviewed per year. At follow-up, 43% of respondents reported that at least one staff member had attended the training in the intervention arm. The intervention significantly increased the percentage of providers knowing the first line treatment for uncomplicated malaria by 24.2% points (confidence interval (CI): 14.8%, 33.6%; adjusted p=0.0001); the percentage of outlets stocking AL by 31.7% points (CI: 22.0%, 41.3%; adjusted p=0.0001); and the percentage of providers prescribing AL for presumptive malaria by 23.6% points (CI: 18.7%, 28.6%; adjusted p=0.0001). Generally outlets that received training and job aids performed better than those receiving one or none of these intervention components. Conclusion Overall, subsidizing ACT and retailer training can significantly increase the percentage of outlets stocking and selling AL for the presumptive treatment of malaria, but further research is needed on strategies to improve the provision of counselling advice to retail customers. PMID:23452547

The Effect of Performance-Based Financial Incentives on Improving Health Care Provision in Burundi: A Controlled Cohort Study

PubMed Central

Rudasingwa, Martin; Soeters, Robert; Bossuyt, Michel

2015-01-01

To strengthen the health care delivery, the Burundian Government in collaboration with international NGOs piloted performance-based financing (PBF) in 2006. The health facilities were assigned - by using a simple matching method - to begin PBF scheme or to continue with the traditional input-based funding. Our objective was to analyse the effect of that PBF scheme on the quality of health services between 2006 and 2008. We conducted the analysis in 16 health facilities with PBF scheme and 13 health facilities without PBF scheme. We analysed the PBF effect by using 58 composite quality indicators of eight health services: Care management, outpatient care, maternity care, prenatal care, family planning, laboratory services, medicines management and materials management. The differences in quality improvement in the two groups of health facilities were performed applying descriptive statistics, a paired non-parametric Wilcoxon Signed Ranks test and a simple difference-in-difference approach at a significance level of 5%. We found an improvement of the quality of care in the PBF group and a significant deterioration in the non-PBF group in the same four health services: care management, outpatient care, maternity care, and prenatal care. The findings suggest a PBF effect of between 38 and 66 percentage points (p<0.001) in the quality scores of care management, outpatient care, prenatal care, and maternal care. We found no PBF effect on clinical support services: laboratory services, medicines management, and material management. The PBF scheme in Burundi contributed to the improvement of the health services that were strongly under the control of medical personnel (physicians and nurses) in a short time of two years. The clinical support services that did not significantly improved were strongly under the control of laboratory technicians, pharmacists and non-medical personnel. PMID:25948432