An integrated fuzzy-based advanced eutrophication simulation model to develop the best management scenarios for a river basin.

PubMed

Srinivas, Rallapalli; Singh, Ajit Pratap

2018-03-01

Assessment of water quality status of a river with respect to its discharge has become prerequisite to sustainable river basin management. The present paper develops an integrated model for simulating and evaluating strategies for water quality management in a river basin management by controlling point source pollutant loadings and operations of multi-purpose projects. Water Quality Analysis and Simulation Program (WASP version 8.0) has been used for modeling the transport of pollutant loadings and their impact on water quality in the river. The study presents a novel approach of integrating fuzzy set theory with an "advanced eutrophication" model to simulate the transmission and distribution of several interrelated water quality variables and their bio-physiochemical processes in an effective manner in the Ganges river basin, India. After calibration, simulated values are compared with the observed values to validate the model's robustness. Fuzzy technique of order preference by similarity to ideal solution (F-TOPSIS) has been used to incorporate the uncertainty associated with the water quality simulation results. The model also simulates five different scenarios for pollution reduction, to determine the maximum pollutant loadings during monsoon and dry periods. The final results clearly indicate how modeled reduction in the rate of wastewater discharge has reduced impacts of pollutants in the downstream. Scenarios suggesting a river discharge rate of 1500 m 3 /s during the lean period, in addition to 25 and 50% reduction in the load rate, are found to be the most effective option to restore quality of river Ganges. Thus, the model serves as an important hydrologic tool to the policy makers by suggesting appropriate remediation action plans.

Exploring the life cycle management of industrial solid waste in the case of copper slag.

PubMed

Song, Xiaolong; Yang, Jianxin; Lu, Bin; Li, Bo

2013-06-01

Industrial solid waste has potential impacts on soil, water and air quality, as well as human health, during its whole life stages. A framework for the life cycle management of industrial solid waste, which integrates the source reduction process, is presented and applied to copper slag management. Three management scenarios of copper slag are developed: (i) production of cement after electric furnace treatment, (ii) production of cement after flotation, and (iii) source reduction before the recycling process. A life cycle assessment is carried out to estimate the environmental burdens of these three scenarios. Life cycle assessment results showed that the environmental burdens of the three scenarios are 2710.09, 2061.19 and 2145.02 Pt respectively. In consideration of the closed-loop recycling process, the environmental performance of the flotation approach excelled that of the electric furnace approach. Additionally, although flash smelting promotes the source reduction of copper slag compared with bath smelting, it did not reduce the overall environmental burdens resulting from the complete copper slag management process. Moreover, it led to the shifting of environmental burdens from ecosystem quality damage and resources depletion to human health damage. The case study shows that it is necessary to integrate the generation process into the whole life cycle of industrial solid waste, and to make an integrated assessment for quantifying the contribution of source reduction, rather than to simply follow the priority of source reduction and the hierarchy of waste management.

The eighth NASA total quality management accomplishments report, 1990

NASA Technical Reports Server (NTRS)

1990-01-01

The eighth annual accomplishments report provides numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. NASA's continuous improvement efforts can provide insight for others to succeed in their own endeavors. The report covers: top management leadership and support, strategic planning, focus on the customer, employee training and recognition, employee empowerment and teamwork, measurement and analysis, and quality assurance.

Lean-Six Sigma: tools for rapid cycle cost reduction.

PubMed

Caldwell, Chip

2006-10-01

Organizational costs can be grouped as process cost, cost of quality, and cost of poor quality. Providers should train managers in the theory and application of Lean-Six Sigma, including the seven categories of waste and how to remove them. Healthcare financial executives should work with managers in eliminating waste to improve service and reduce costs.

Managing Air Quality - Control Strategies to Achieve Air Pollution Reduction

EPA Pesticide Factsheets

Considerations in designing an effective control strategy related to air quality, controlling pollution sources, need for regional or national controls, steps to developing a control strategy, and additional EPA resources.

Assessment of coastal management options by means of multilayered ecosystem models

NASA Astrophysics Data System (ADS)

Nobre, Ana M.; Ferreira, João G.; Nunes, João P.; Yan, Xiaojun; Bricker, Suzanne; Corner, Richard; Groom, Steve; Gu, Haifeng; Hawkins, Anthony J. S.; Hutson, Rory; Lan, Dongzhao; Silva, João D. Lencart e.; Pascoe, Philip; Telfer, Trevor; Zhang, Xuelei; Zhu, Mingyuan

2010-03-01

This paper presents a multilayered ecosystem modelling approach that combines the simulation of the biogeochemistry of a coastal ecosystem with the simulation of the main forcing functions, such as catchment loading and aquaculture activities. This approach was developed as a tool for sustainable management of coastal ecosystems. A key feature is to simulate management scenarios that account for changes in multiple uses and enable assessment of cumulative impacts of coastal activities. The model was applied to a coastal zone in China with large aquaculture production and multiple catchment uses, and where management efforts to improve water quality are under way. Development scenarios designed in conjunction with local managers and aquaculture producers include the reduction of fish cages and treatment of wastewater. Despite the reduction in nutrient loading simulated in three different scenarios, inorganic nutrient concentrations in the bay were predicted to exceed the thresholds for poor quality defined by Chinese seawater quality legislation. For all scenarios there is still a Moderate High to High nutrient loading from the catchment, so further reductions might be enacted, together with additional decreases in fish cage culture. The model predicts that overall, shellfish production decreases by 10%-28% using any of these development scenarios, principally because shellfish growth is being sustained by the substances to be reduced for improvement of water quality. The model outcomes indicate that this may be counteracted by zoning of shellfish aquaculture at the ecosystem level in order to optimize trade-offs between productivity and environmental effects. The present case study exemplifies the value of multilayered ecosystem modelling as a tool for Integrated Coastal Zone Management and for the adoption of ecosystem approaches for marine resource management. This modelling approach can be applied worldwide, and may be particularly useful for the application of coastal management regulation, for instance in the implementation of the European Marine Strategy Framework Directive.

Raising the Bar of Teacher Quality: Accountability, Collaboration, and Social Justice

ERIC Educational Resources Information Center

Ganley, DeLacy Derin; Quintanar, Anita P.; Loop, Lisa S.

2007-01-01

Historically, reform efforts to address poor student achievement have focused on a variety of issues other than teacher quality. Movements such as TQM (Total Quality Management), class size reduction (CSR), school leadership, parental involvement, and multicultural curriculum have not directly addressed the power or influence of the individual…

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

PubMed

Callaly, Tom; Arya, Dinesh; Minas, Harry

2005-03-01

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

Managed care and the quality of substance abuse treatment.

PubMed

Shepard, Donald S; Daley, Marilyn; Ritter, Grant A; Hodgkin, Dominic; Beinecke, Richard H

2002-12-01

In the US, the spiraling costs of substance abuse and mental health treatment caused many state Medicaid agencies to adopt managed behavioral health care (MBHC) plans during the 1990s. Although research suggests that these plans have successfully reduced public sector spending, their impact on the quality of substance abuse treatment has not been established. The Massachusetts Medicaid program started a risk-sharing contract with MHMA, a private, for-profit specialty managed behavioral health care (MBHC) carve-out vendor on July 1, 1992. This paper evaluates the carve-out s impact on spending per inpatient episode and three proxy measures of quality: (i) access to inpatient treatment (ii) 30-day re-admissions and (iii) continuity of care. Medicaid claims for inpatient treatment were collapsed into episodes. Clients were tracked across the five-year period and an interrupted time series design was used to compare the three quality outcomes and spending in the year prior to (FY1992) and the four years during MHMA (FY1993-FY1996). Logistic and linear regression models were used to control for race, disability status, age, gender and primary diagnosis. Despite a 99% reduction in the use of hospital-based settings, access to 24-hour services overall increased by 38%, largely due to an expansion in the use of freestanding detoxification and acute residential services. Continuity improved by 73%. Nevertheless, rates of 7-day (58%) and 30-day (24%) readmission increased significantly, even after controlling for increases in disability status. Per episode spending decreased by 76% ($2,773), characterized by a dramatic spending reduction in FY1993 that was maintained but not augmented in subsequent years. The carve-out had mixed effects on the quality of substance abuse treatment. While one of the three measures (readmission rates) deteriorated, two improved (access and continuity). Rapid re-admissions were strongly associated with shorter lengths of stay, suggesting that strengthening discharge planning may preserve the benefits of MBHC while avoiding its risks. Since reductions in Medicaid spending were impressive but finite, MBHC may not be the permanent solution to inflation in behavioral health care. MBHC firms should implement quality-monitoring programs to ensure that aggressive utilization management strategies do not compromise quality of care. The impact of managed behavioral health care should ideally be evaluated in randomized controlled studies. In addition, research is needed to establish that the quality measures employed in this evaluation - improved access, enhanced continuity and fewer rapid re-admissions actually correspond to reductions in drug or alcohol use and other favorable outcomes obtained through client self-report or urinalysis.

Assessing Concentrations and Health Impacts of Air Quality Management Strategies: Framework for Rapid Emissions Scenario and Health impact ESTimation (FRESH-EST)

PubMed Central

Milando, Chad W.; Martenies, Sheena E.; Batterman, Stuart A.

2017-01-01

In air quality management, reducing emissions from pollutant sources often forms the primary response to attaining air quality standards and guidelines. Despite the broad success of air quality management in the US, challenges remain. As examples: allocating emissions reductions among multiple sources is complex and can require many rounds of negotiation; health impacts associated with emissions, the ultimate driver for the standards, are not explicitly assessed; and long dispersion model run-times, which result from the increasing size and complexity of model inputs, limit the number of scenarios that can be evaluated, thus increasing the likelihood of missing an optimal strategy. A new modeling framework, called the "Framework for Rapid Emissions Scenario and Health impact ESTimation" (FRESH-EST), is presented to respond to these challenges. FRESH-EST estimates concentrations and health impacts of alternative emissions scenarios at the urban scale, providing efficient computations from emissions to health impacts at the Census block or other desired spatial scale. In addition, FRESH-EST can optimize emission reductions to meet specified environmental and health constraints, and a convenient user interface and graphical displays are provided to facilitate scenario evaluation. The new framework is demonstrated in an SO2 non-attainment area in southeast Michigan with two optimization strategies: the first minimizes emission reductions needed to achieve a target concentration; the second minimizes concentrations while holding constant the cumulative emissions across local sources (e.g., an emissions floor). The optimized strategies match outcomes in the proposed SO2 State Implementation Plan without the proposed stack parameter modifications or shutdowns. In addition, the lower health impacts estimated for these strategies suggest the potential for FRESH-EST to identify pollution control alternatives for air quality management planning. PMID:27318620

Innovative Stormwater Quality Tools by SARA for Holistic Watershed Master Planning

NASA Astrophysics Data System (ADS)

Thomas, S. M.; Su, Y. C.; Hummel, P. R.

2016-12-01

Stormwater management strategies such as Best Management Practices (BMP) and Low-Impact Development (LID) have increasingly gained attention in urban runoff control, becoming vital to holistic watershed master plans. These strategies can help address existing water quality impairments and support regulatory compliance, as well as guide planning and management of future development when substantial population growth and urbanization is projected to occur. However, past efforts have been limited to qualitative planning due to the lack of suitable tools to conduct quantitative assessment. The San Antonio River Authority (SARA), with the assistance of Lockwood, Andrews & Newnam, Inc. (LAN) and AQUA TERRA Consultants (a division of RESPEC), developed comprehensive hydrodynamic and water quality models using the Hydrological Simulation Program-FORTRAN (HSPF) for several urban watersheds in the San Antonio River Basin. These models enabled watershed management to look at water quality issues on a more refined temporal and spatial scale than the limited monitoring data. They also provided a means to locate and quantify potential water quality impairments and evaluate the effects of mitigation measures. To support the models, a suite of software tools were developed. including: 1) SARA Timeseries Utility Tool for managing and processing of large model timeseries files, 2) SARA Load Reduction Tool to determine load reductions needed to achieve screening levels for each modeled constituent on a sub-basin basis, and 3) SARA Enhanced BMP Tool to determine the optimal combination of BMP types and units needed to achieve the required load reductions. Using these SARA models and tools, water quality agencies and stormwater professionals can determine the optimal combinations of BMP/LID to accomplish their goals and save substantial stormwater infrastructure and management costs. The tools can also help regulators and permittees evaluate the feasibility of achieving compliance using BMP/LID. The project has gained national attention, being showcased in multiple newsletters, professional magazines, and conference presentations. The project also won the Texas American Council of Engineering Companies (ACEC) Gold Medal Award and the ACEC National Recognition Award in 2016.

Simulation and evaluation of pollution load reduction scenarios for water environmental management: a case study of inflow river of Taihu Lake, China.

PubMed

Zhang, Ruibin; Qian, Xin; Zhu, Wenting; Gao, Hailong; Hu, Wei; Wang, Jinhua

2014-09-09

In the beginning of the 21st century, the deterioration of water quality in Taihu Lake, China, has caused widespread concern. The primary source of pollution in Taihu Lake is river inflows. Effective pollution load reduction scenarios need to be implemented in these rivers in order to improve the water quality of Taihu Lake. It is important to select appropriate pollution load reduction scenarios for achieving particular goals. The aim of this study was to facilitate the selection of appropriate scenarios. The QUAL2K model for river water quality was used to simulate the effects of a range of pollution load reduction scenarios in the Wujin River, which is one of the major inflow rivers of Taihu Lake. The model was calibrated for the year 2010 and validated for the year 2011. Various pollution load reduction scenarios were assessed using an analytic hierarchy process, and increasing rates of evaluation indicators were predicted using the Delphi method. The results showed that control of pollution from the source is the optimal method for pollution prevention and control, and the method of "Treatment after Pollution" has bad environmental, social and ecological effects. The method applied in this study can assist for environmental managers to select suitable pollution load reduction scenarios for achieving various objectives.

Simulation and Evaluation of Pollution Load Reduction Scenarios for Water Environmental Management: A Case Study of Inflow River of Taihu Lake, China

PubMed Central

Zhang, Ruibin; Qian, Xin; Zhu, Wenting; Gao, Hailong; Hu, Wei; Wang, Jinhua

2014-01-01

In the beginning of the 21st century, the deterioration of water quality in Taihu Lake, China, has caused widespread concern. The primary source of pollution in Taihu Lake is river inflows. Effective pollution load reduction scenarios need to be implemented in these rivers in order to improve the water quality of Taihu Lake. It is important to select appropriate pollution load reduction scenarios for achieving particular goals. The aim of this study was to facilitate the selection of appropriate scenarios. The QUAL2K model for river water quality was used to simulate the effects of a range of pollution load reduction scenarios in the Wujin River, which is one of the major inflow rivers of Taihu Lake. The model was calibrated for the year 2010 and validated for the year 2011. Various pollution load reduction scenarios were assessed using an analytic hierarchy process, and increasing rates of evaluation indicators were predicted using the Delphi method. The results showed that control of pollution from the source is the optimal method for pollution prevention and control, and the method of “Treatment after Pollution” has bad environmental, social and ecological effects. The method applied in this study can assist for environmental managers to select suitable pollution load reduction scenarios for achieving various objectives. PMID:25207492

Review of the logging residue problem and its reduction through marketing practices.

Treesearch

Thomas C. Adams; Richard C. Smith

1976-01-01

This study notes the increasing concern over logging residue in forest land management and describes the various administrative and technological means for accomplishing reductions of logging residue. Alternative sales arrangements can include such things as reduction of stumpage charges for low quality logs or required yarding of unutilized material to the landing or...

Investigation of Cost and Energy Optimization of Drinking Water Distribution Systems.

PubMed

Cherchi, Carla; Badruzzaman, Mohammad; Gordon, Matthew; Bunn, Simon; Jacangelo, Joseph G

2015-11-17

Holistic management of water and energy resources through energy and water quality management systems (EWQMSs) have traditionally aimed at energy cost reduction with limited or no emphasis on energy efficiency or greenhouse gas minimization. This study expanded the existing EWQMS framework and determined the impact of different management strategies for energy cost and energy consumption (e.g., carbon footprint) reduction on system performance at two drinking water utilities in California (United States). The results showed that optimizing for cost led to cost reductions of 4% (Utility B, summer) to 48% (Utility A, winter). The energy optimization strategy was successfully able to find the lowest energy use operation and achieved energy usage reductions of 3% (Utility B, summer) to 10% (Utility A, winter). The findings of this study revealed that there may be a trade-off between cost optimization (dollars) and energy use (kilowatt-hours), particularly in the summer, when optimizing the system for the reduction of energy use to a minimum incurred cost increases of 64% and 184% compared with the cost optimization scenario. Water age simulations through hydraulic modeling did not reveal any adverse effects on the water quality in the distribution system or in tanks from pump schedule optimization targeting either cost or energy minimization.

Management Practices Used in Agricultural Drainage Ditches to Reduce Gulf of Mexico Hypoxia.

PubMed

Faust, Derek R; Kröger, Robert; Moore, Matthew T; Rush, Scott A

2018-01-01

Agricultural non-point sources of nutrients and sediments have caused eutrophication and other water quality issues in aquatic and marine ecosystems, such as the annual occurrence of hypoxia in the Gulf of Mexico. Management practices have been implemented adjacent to and in agricultural drainage ditches to promote their wetland characteristics and functions, including reduction of nitrogen, phosphorus, and sediment losses downstream. This review: (1) summarized studies examining changes in nutrient and total suspended solid concentrations and loads associated with management practices in drainage ditches (i.e., riser and slotted pipes, two-stage ditches, vegetated ditches, low-grade weirs, and organic carbon amendments) with emphasis on the Lower Mississippi Alluvial Valley, (2) quantified management system effects on nutrient and total suspended solid concentrations and loads and, (3) identified information gaps regarding water quality associated with these management practices and research needs in this area. In general, management practices used in drainage ditches at times reduced losses of total suspended solids, N, and P. However, management practices were often ineffective during storm events that were uncommon and intense in duration and volume, although these types of events could increase in frequency and intensity with climate change. Studies on combined effects of management practices on drainage ditch water quality, along with research towards improved nutrient and sediment reduction efficiency during intense storm events are urgently needed.

Integrating automated support for a software management cycle into the TAME system

NASA Technical Reports Server (NTRS)

Sunazuka, Toshihiko; Basili, Victor R.

1989-01-01

Software managers are interested in the quantitative management of software quality, cost and progress. An integrated software management methodology, which can be applied throughout the software life cycle for any number purposes, is required. The TAME (Tailoring A Measurement Environment) methodology is based on the improvement paradigm and the goal/question/metric (GQM) paradigm. This methodology helps generate a software engineering process and measurement environment based on the project characteristics. The SQMAR (software quality measurement and assurance technology) is a software quality metric system and methodology applied to the development processes. It is based on the feed forward control principle. Quality target setting is carried out before the plan-do-check-action activities are performed. These methodologies are integrated to realize goal oriented measurement, process control and visual management. A metric setting procedure based on the GQM paradigm, a management system called the software management cycle (SMC), and its application to a case study based on NASA/SEL data are discussed. The expected effects of SMC are quality improvement, managerial cost reduction, accumulation and reuse of experience, and a highly visual management reporting system.

Principles and Practices of Water Quality Monitoring

Treesearch

J.L. Michael

2001-01-01

There are many activities in forest management that may affect water quality, i.e., timber harvestine, road building,mechanical and chemical site preparation, release operations, fuel reduction,wildlife opening maintenance, etc. How severely they affect water quality depends on how well the person in charge of the operation understands the activity itself, the...

NONPOINT SOURCES AND WATER QUALITY TRADING

EPA Science Inventory

Management of nonpoint sources (NPS) of nutrients may reduce discharge levels more cost effectively than can additional controls on point sources (PS); water quality trading (WQT), where a PS buys nutrient or sediment reductions from an NPS, may be an alternative means for the PS...

Can There Ever Be Enough to Impact Water Quality? Evaluating BMPs in Elliot Ditch, Indiana Using the LTHIA-LID Model

NASA Astrophysics Data System (ADS)

Rahman, M. S.; Hoover, F. A.; Bowling, L. C.

2017-12-01

Elliot Ditch is an urban/urbanizing watershed located in the city of Lafayette, IN, USA. The city continues to struggle with stormwater management and combined sewer overflow (CSO) events. Several best-management practices (BMP) such as rain gardens, green roofs, and bioswales have been implemented in the watershed, but the level of adoption needed to achieve meaningful impact is currently unknown. This study's goal is to determine what level of BMP coverage is needed to impact water quality, whether meaningful impact is determined by achieving water quality targets or statistical significance. A power analysis was performed using water quality data for total suspended solids (TSS), E.coli, total phosphorus (TP) and nitrate (NO3-N) from Elliot Ditch from 2011 to 2015. The minimum detectable difference (MDD) was calculated as the percent reduction in load needed to detect a significant change in the watershed. The water quality targets were proposed by stakeholders as part of a watershed management planning process. The water quality targets and the MDD percentages were then compared to simulated load reductions due to BMP implementation using the Long-term Hydrologic Impact Assessment-Low Impact Development (LTHIA-LID) model. Seven baseline model scenarios were simulated by implementing the maximum number of each of six types of BMPs (rain barrels, permeable patios, green roofs, grassed swale/bioswales, bioretention/rain gardens, and porous pavement), as well as all the practices combined in the watershed. These provide the baseline for targeted implementation scenarios designed to determine if statistically and physically meaningful load reductions can be achieved through BMP implementation alone.

Health impact assessment of decreases in PM10 and ozone concentrations in the Mexico City Metropolitan Area: a basis for a new air quality management program.

PubMed

Riojas-Rodríguez, Horacio; Álamo-Hernández, Urinda; Texcalac-Sangrador, José Luis; Romieu, Isabelle

2014-01-01

To conduct a health impact assessment (HIA) to quantify health benefits for several PM and O3 air pollution reduction scenarios in the Mexico City Metropolitan Area (MCMA). Results from this HIA will contribute to the scientific support of the MCMA air quality management plan (PROAIRE) for the period 2011-2020. The HIA methodology consisted of four steps: 1) selection of the air pollution reduction scenarios, 2) identification of the at-risk population and health outcomes for the 2005 baseline scenario, 3) selection of concentration-response functions and 4) estimation of health impacts. Reductions of PM10 levels to 20 μg/m³ and O3 levels to 0.050ppm (98 µg/m³) would prevent 2300 and 400 annual deaths respectively. The greatest health impact was seen in the over-65 age group and in mortality due to cardiopulmonary and cardiovascular disease. Improved air quality in the MCMA could provide significant health benefits through focusing interventions by exposure zones.

A web tool for STORET/WQX water quality data retrieval and Best Management Practice scenario suggestion.

PubMed

Park, Youn Shik; Engel, Bernie A; Kim, Jonggun; Theller, Larry; Chaubey, Indrajeet; Merwade, Venkatesh; Lim, Kyoung Jae

2015-03-01

Total Maximum Daily Load is a water quality standard to regulate water quality of streams, rivers and lakes. A wide range of approaches are used currently to develop TMDLs for impaired streams and rivers. Flow and load duration curves (FDC and LDC) have been used in many states to evaluate the relationship between flow and pollutant loading along with other models and approaches. A web-based LDC Tool was developed to facilitate development of FDC and LDC as well as to support other hydrologic analyses. In this study, the FDC and LDC tool was enhanced to allow collection of water quality data via the web and to assist in establishing cost-effective Best Management Practice (BMP) implementations. The enhanced web-based tool provides use of water quality data not only from the US Geological Survey but also from the Water Quality Portal for the U.S. via web access. Moreover, the web-based tool identifies required pollutant reductions to meet standard loads and suggests a BMP scenario based on ability of BMPs to reduce pollutant loads, BMP establishment and maintenance costs. In the study, flow and water quality data were collected via web access to develop LDC and to identify the required reduction. The suggested BMP scenario from the web-based tool was evaluated using the EPA Spreadsheet Tool for the Estimation of Pollutant Load model to attain the required pollutant reduction at least cost. Copyright © 2014 Elsevier Ltd. All rights reserved.

Impact of standardized clinical assessment and management plans on resource utilization and costs in children after the arterial switch operation.

PubMed

Rathod, Rahul H; Jurgen, Brittney; Hamershock, Rose A; Friedman, Kevin G; Marshall, Audrey C; Samnaliev, Mihail; Graham, Dionne A; Jenkins, Kathy; Lock, James E; Powell, Andrew J

2017-12-01

Standardized Clinical Assessment and Management Plans (SCAMPs) are a quality improvement initiative designed to reduce unnecessary utilization, decrease practice variation, and improve patient outcomes. We created a novel methodology, the SCAMP managed episode of care (SMEOC), which encompasses multiple encounters to assess the impact of the arterial switch operation (ASO) SCAMP on total costs. All ASO SCAMP patients (dates March 2009 to July 2015) were compared to a control group of ASO patients (January 2001 to February 2009). Patients were divided into "younger" (<2 years) and "older" (2-18 years) subgroups. Utilization included all cardiology visits, tests, and procedures. Standardized costs were applied to each unit of utilization. There were 100 historical and 63 SCAMP patients in the younger subgroup, and 163 historical and 165 SCAMP patients in the older subgroup. In the younger subgroup, the SCAMP had a 28% reduction in outpatient clinic visits (P < .001), a 52% reduction in chest radiographs (P < .001), a 21% reduction in electrocardiograms (P < .001), and a 30% total reduction in costs. In the older subgroup, the SCAMP had a 21% reduction in outpatient clinic visits (P < .001), a 20% reduction in chest radiographs (P = .05), a 10% reduction in echocardiograms (P = .05), a 25% reduction in exercise stress tests (P = .01), and a 14% total reduction in costs. The total cost savings of the ASO SCAMP was $216 649 in the first 6 years of the SCAMP. There was no difference in clinical outcomes between the historical and SCAMP cohorts. SCAMPs can improve resource utilization and reduce costs after the ASO operation while maintaining quality of care. © 2017 Wiley Periodicals, Inc.

Raising the Bar of Teacher Quality: Accountability, Collaboration, and Social Justice. The Claremont Letter. Volume 1, Issue 4

ERIC Educational Resources Information Center

Ganley, DeLacy Derin; Quintanar, Anita P.; Loop, Lisa S.

2006-01-01

Historically, reform efforts to address poor student achievement have focused on a variety of issues other than teacher quality. Movements such as TQM (Total Quality Management), class size reduction (CSR), school leadership, parental involvement, and multicultural curriculum have not directly addressed the power or influence of the individual…

Neglected environmental health impacts of China's supply-side structural reform.

PubMed

Zhang, Wei; Zhang, Lei; Li, Ying; Tian, Yuling; Li, Xiaoran; Zhang, Xue; Mol, Arthur P J; Sonnenfeld, David A; Liu, Jianguo; Ping, Zeyu; Chen, Long

2018-06-01

"Supply-side structural reform" (SSSR) has been the most important ongoing economic reform in China since 2015, but its important environmental health effects have not been properly assessed. The present study addresses that gap by focusing on reduction of overcapacity in the coal, steel, and iron sectors, combined with reduction of emissions of sulfur dioxide (SO 2 ), nitrogen oxide (NO x ), and fine particulate matter (PM 2.5 ), and projecting resultant effects on air quality and public health across cities and regions in China. Modeling results indicate that effects on air quality and public health are visible and distributed unevenly across the country. This assessment provides quantitative evidence supporting projections of the transregional distribution of such effects. Such uneven transregional distribution complicates management of air quality and health risks in China. The results challenge approaches that rely solely on cities to improve air quality. The article concludes with suggestions on how to integrate SSSR measures with cities' air quality improvement attainment planning and management performance evaluation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Optimizing Resource and Energy Recovery for Municipal Solid Waste Management

EPA Science Inventory

Significant reductions of carbon emissions and air quality impacts can be achieved by optimizing municipal solid waste (MSW) as a resource. Materials and discards management were found to contribute ~40% of overall U.S. GHG emissions as a result of materials extraction, transpo...

Motivating Language and Empathic Leadership Drives Aircraft Readiness

DTIC Science & Technology

2017-03-01

4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188) Washington, DC 20503. 1. AGENCY USE ONLY (Leave blank...language theory, empathic leadership, caring leader, leadership- management exchange (LMX), high quality connections, unit support, organizational justice...critical thinking, Marine Aviation Logistics, Marine Air Group, Marine Aircraft Wing, supply chain management , Squadron, AIRSPEED, lean-six-sigma

Does bacteriology laboratory automation reduce time to results and increase quality management?

PubMed

Dauwalder, O; Landrieve, L; Laurent, F; de Montclos, M; Vandenesch, F; Lina, G

2016-03-01

Due to reductions in financial and human resources, many microbiological laboratories have merged to build very large clinical microbiology laboratories, which allow the use of fully automated laboratory instruments. For clinical chemistry and haematology, automation has reduced the time to results and improved the management of laboratory quality. The aim of this review was to examine whether fully automated laboratory instruments for microbiology can reduce time to results and impact quality management. This study focused on solutions that are currently available, including the BD Kiestra™ Work Cell Automation and Total Lab Automation and the Copan WASPLab(®). Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Chronically critically ill patients: health-related quality of life and resource use after a disease management intervention.

PubMed

Douglas, Sara L; Daly, Barbara J; Kelley, Carol Genet; O'Toole, Elizabeth; Montenegro, Hugo

2007-09-01

Chronically critically ill patients often have high costs of care and poor outcomes and thus might benefit from a disease management program. To evaluate how adding a disease management program to the usual care system affects outcomes after discharge from the hospital (mortality, health-related quality of life, resource use) in chronically critically ill patients. In a prospective experimental design, 335 intensive care patients who received more than 3 days of mechanical ventilation at a university medical center were recruited. For 8 weeks after discharge, advanced practice nurses provided an intervention that focused on case management and interdisciplinary communication to patients in the experimental group. A total of 74.0% of the patients survived and completed the study. Significant predictors of death were age (P = .001), duration of mechanical ventilation (P = .001), and history of diabetes (P = .04). The disease management program did not have a significant impact on health-related quality of life; however, a greater percentage of patients in the experimental group than in the control group had "improved" physical health-related quality of life at the end of the intervention period (P = .02). The only significant effect of the intervention was a reduction in the number of days of hospital readmission and thus a reduction in charges associated with readmission. The intervention was not associated with significant changes in any outcomes other than duration of readmission, but the supportive care coordination program could be provided without increasing overall charges.

[Management, quality of health and occupational safety and hospital organization: is integration possible?].

PubMed

Corrao, Carmela Romana Natalina

2011-01-01

The evolution of the national and European legislation has progressively transformed the working environments into organized environments. Specific models for its management are being proposed, which should be integrated into general management strategies. In the case of hospitals this integration should consider the peculiar organizational complexity, where the management of the occupational risk needs to be integrated with clinical risk management and economic risk management. Resources management should also consider that Occupational Medicine has not a direct monetary benefit for the organisation, but only indirect health consequences in terms of reduction of accidents and occupational diseases. The deep and simultaneous analysis of the current general management systems and the current management methods of occupational safety and health protection allows one to hyphotesise a possible integration between them. For both of them the Top Management is the main responsible of the quality management strategies and the use of specific documents in the managerial process, such as the document of risks evaluation in the occupational management and the quality manual in the general management, is of paramount importance. An integrated management has also the scope to pursue a particular kind of quality management, where ethics and job satisfaction are innovative, as established by recent European guidelines, management systems and national legislations.

Comparison of greenhouse gas offset quantification protocols for nitrogen management in dryland wheat cropping systems in the Pacific Northwest

USDA-ARS?s Scientific Manuscript database

In the carbon market, greenhouse gas (GHG) offset protocols need to ensure that emission reductions are of high quality, quantifiable and real. However, lack of consistency across protocols for quantifying emission reductions compromise the credibility of offsets generated. Thus, protocol quantifica...

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-05

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

On-line measurements of emissions and atmospheric fate of compounds from agricultural waste management

USDA-ARS?s Scientific Manuscript database

Agricultural emissions impact air quality on a local and regional basis. Research on the emissions and reduction of greenhouse gases from agriculture has become commonplace due to concerns about climate but other chemical compounds also impact air quality. These include compounds that are photochemi...

Assessing concentrations and health impacts of air quality management strategies: Framework for Rapid Emissions Scenario and Health impact ESTimation (FRESH-EST).

PubMed

Milando, Chad W; Martenies, Sheena E; Batterman, Stuart A

2016-09-01

In air quality management, reducing emissions from pollutant sources often forms the primary response to attaining air quality standards and guidelines. Despite the broad success of air quality management in the US, challenges remain. As examples: allocating emissions reductions among multiple sources is complex and can require many rounds of negotiation; health impacts associated with emissions, the ultimate driver for the standards, are not explicitly assessed; and long dispersion model run-times, which result from the increasing size and complexity of model inputs, limit the number of scenarios that can be evaluated, thus increasing the likelihood of missing an optimal strategy. A new modeling framework, called the "Framework for Rapid Emissions Scenario and Health impact ESTimation" (FRESH-EST), is presented to respond to these challenges. FRESH-EST estimates concentrations and health impacts of alternative emissions scenarios at the urban scale, providing efficient computations from emissions to health impacts at the Census block or other desired spatial scale. In addition, FRESH-EST can optimize emission reductions to meet specified environmental and health constraints, and a convenient user interface and graphical displays are provided to facilitate scenario evaluation. The new framework is demonstrated in an SO2 non-attainment area in southeast Michigan with two optimization strategies: the first minimizes emission reductions needed to achieve a target concentration; the second minimizes concentrations while holding constant the cumulative emissions across local sources (e.g., an emissions floor). The optimized strategies match outcomes in the proposed SO2 State Implementation Plan without the proposed stack parameter modifications or shutdowns. In addition, the lower health impacts estimated for these strategies suggest that FRESH-EST could be used to identify potentially more desirable pollution control alternatives in air quality management planning. Copyright © 2016 Elsevier Ltd. All rights reserved.

Stormwater management criteria for on-site pollution control: a comparative assessment of international practices.

PubMed

Sage, Jérémie; Berthier, Emmanuel; Gromaire, Marie-Christine

2015-07-01

Over the last decade, a growing interest has been shown toward innovative stormwater management practices, breaking away from conventional "end of pipe" approaches (based on conveying water offsite to centralized detention facilities). Innovative strategies, referred to as sustainable urban drainage systems, low impact development (LID) or green infrastructures, advocating for management of runoff as close to its origin as possible, have therefore gained a lot of popularity among practitioners and public authorities. However, while the need for pollution control is generally well accepted, there is no wide agreement about management criteria to be given to developers. This article hence aims to compare these criteria through literature analysis of different state or local stormwater management manuals or guidelines, investigating both their suitability for pollution control and their influence on best management practices selection and design. Four categories of criteria were identified: flow-rate limitations, "water quality volumes" (to be treated), volume reduction (through infiltration or evapotranspiration), and non-hydrologic criteria (such as loads reduction targets or maximum effluent concentrations). This study suggests that hydrologic criteria based on volume reduction (rather than treatment) might generally be preferable for on-site control of diffuse stormwater pollution. Nonetheless, determination of an appropriate management approach for a specific site is generally not straightforward and presents a variety of challenges for site designers seeking to satisfy local requirements in addressing stormwater quantity and quality issues. The adoption of efficient LID solution may therefore strongly depend on the guidance given to practitioners to account for these management criteria.

Stormwater Management Criteria for On-Site Pollution Control: A Comparative Assessment of International Practices

NASA Astrophysics Data System (ADS)

Sage, Jérémie; Berthier, Emmanuel; Gromaire, Marie-Christine

2015-07-01

Over the last decade, a growing interest has been shown toward innovative stormwater management practices, breaking away from conventional "end of pipe" approaches (based on conveying water offsite to centralized detention facilities). Innovative strategies, referred to as sustainable urban drainage systems, low impact development (LID) or green infrastructures, advocating for management of runoff as close to its origin as possible, have therefore gained a lot of popularity among practitioners and public authorities. However, while the need for pollution control is generally well accepted, there is no wide agreement about management criteria to be given to developers. This article hence aims to compare these criteria through literature analysis of different state or local stormwater management manuals or guidelines, investigating both their suitability for pollution control and their influence on best management practices selection and design. Four categories of criteria were identified: flow-rate limitations, "water quality volumes" (to be treated), volume reduction (through infiltration or evapotranspiration), and non-hydrologic criteria (such as loads reduction targets or maximum effluent concentrations). This study suggests that hydrologic criteria based on volume reduction (rather than treatment) might generally be preferable for on-site control of diffuse stormwater pollution. Nonetheless, determination of an appropriate management approach for a specific site is generally not straightforward and presents a variety of challenges for site designers seeking to satisfy local requirements in addressing stormwater quantity and quality issues. The adoption of efficient LID solution may therefore strongly depend on the guidance given to practitioners to account for these management criteria.

Implementation and evaluation of a nursing home fall management program.

PubMed

Rask, Kimberly; Parmelee, Patricia A; Taylor, Jo A; Green, Diane; Brown, Holly; Hawley, Jonathan; Schild, Laura; Strothers, Harry S; Ouslander, Joseph G

2007-03-01

To evaluate the feasibility and effectiveness of a falls management program (FMP) for nursing homes (NHs). A quality improvement project with data collection throughout FMP implementation. NHs in Georgia owned and operated by a single nonprofit organization. All residents of participating NHs. A convenience sample of 19 NHs implemented the FMP. The FMP is a multifaceted quality improvement and culture change intervention. Key components included organizational leadership buy-in and support, a designated facility-based falls coordinator and interdisciplinary team, intensive education and training, and ongoing consultation and oversight by advanced practice nurses with expertise in falls management. Process-of-care documentation using a detailed 24-item audit tool and fall and physical restraint use rates derived from quality improvement software currently used in all Georgia NHs (MyInnerView). Care process documentation related to the assessment and management of fall risk improved significantly during implementation of the FMP. Restraint use decreased substantially during the project period, from 7.9% to 4.4% in the intervention NHs (a relative reduction of 44%), and decreased in the nonintervention NHs from 7.0% to 4.9% (a relative reduction of 30%). Fall rates remained stable in the intervention NHs (17.3 falls/100 residents per month at start and 16.4 falls/100 residents per month at end), whereas fall rates increased 26% in the NHs not implementing the FMP (from 15.0 falls/100 residents/per month to 18.9 falls/100 residents per month). Implementation was associated with significantly improved care process documentation and a stable fall rate during a period of substantial reduction in the use of physical restraints. In contrast, fall rates increased in NHs owned by the same organization that did not implement the FMP. The FMP may be a helpful tool for NHs to manage fall risk while attempting to reduce physical restraint use in response to the Centers for Medicare and Medicaid Services quality initiatives.

Effectiveness of disease-specific self-management education on health outcomes in patients with chronic obstructive pulmonary disease: An updated systematic review and meta-analysis.

PubMed

Wang, Tao; Tan, Jing-Yu; Xiao, Lily Dongxia; Deng, Renli

2017-08-01

To update a previously published systematic review on the effectiveness of self-management education (SME) for patients with chronic obstructive pulmonary disease (COPD). Electronic databases were accessed (from inception to July 2016) to find relevant randomized controlled trials. Studies that compared SME with routine methods of care in COPD patients were retrieved. Both data synthesis and descriptive analysis were used for outcome assessment (e.g. quality of life and healthcare utilization). Twenty-four studies were included. Data synthesis showed better quality of life among COPD patients receiving SME. Significant reductions in COPD-related hospital admissions and emergency department visits were identified in the SME group. SME may positively affect the reduction of COPD patients' emotional distress. No significant reduction in smoking rate and mortality rate was observed between groups. No clear evidence supports the improvement of pulmonary functions, dyspnea, and nutritional status in COPD patients with the use of SME. SME can be a useful strategy to improve quality of life and disease-specific knowledge in patients with COPD. It also reduces respiratory-related hospital admissions and emergency department visits in COPD patients. Inclusion of SME as one of the key components for the comprehensive management of COPD is encouraged. Copyright © 2017 Elsevier B.V. All rights reserved.

Environmental Policy--a Priority for Schools in the '90s.

ERIC Educational Resources Information Center

Ehrhardt, Cathryn

1989-01-01

A transformation of public attitudes on the environment has resulted in more stringent standards on almost all school programs for hazardous waste management, air quality, groundwater, and emergency planning and response. A comprehensive environmental risk reduction and management policy should highlight the potential for environmental risks in…

A Primer on the Financial Management of Experiential Learning Assessment Programs.

ERIC Educational Resources Information Center

MacTaggart, Terrence

1983-01-01

The success and failure of experiential learning assessment programs rests not only on their academic quality, but also on their financial management. Types of cost and the meaning of cost-effectiveness are discussed. Break-even analysis, cost-reduction activities, and revenue-enhancement techniques are described. (Author/MLW)

Development of quality standards in inflammatory bowel disease management and design of an evaluation tool of nursing care.

PubMed

Torrejón, Antonio; Oltra, Lorena; Hernández-Sampelayo, Paloma; Marín, Laura; García-Sánchez, Valle; Casellas, Francesc; Alfaro, Noelia; Lázaro, Pablo; Vera, María Isabel

2013-01-01

nursing management of inflammatory bowel disease (IBD) is highly relevant for patient care and outcomes. However, there is evidence of substantial variability in clinical practices. The objectives of this study were to develop standards of healthcare quality for nursing management of IBD and elaborate the evaluation tool "Nursing Care Quality in IBD Assessment" (NCQ-IBD) based on these standards. a 178-item healthcare quality questionnaire was developed based on a systematic review of IBD nursing management literature. The questionnaire was used to perform two 2-round Delphi studies: Delphi A included 27 IBD healthcare professionals and Delphi B involved 12 patients. The NCQ-IBD was developed from the list of items resulting from both Delphi studies combined with the Scientific Committee´s expert opinion. the final NCQ-IBD consists of 90 items, organized in13 sections measuring the following aspects of nursing management of IBD: infrastructure, services, human resources, type of organization, nursing responsibilities, nurse-provided information to the patient, nurses training, annual audits of nursing activities, and nursing research in IBD. Using the NCQ-IBD to evaluate these components allows the rating of healthcare quality for nursing management of IBD into 4 categories: A (highest quality) through D (lowest quality). the use of the NCQ-IBD tool to evaluate nursing management quality of IBD identifies areas in need of improvement and thus contribute to an enhancement of care quality and reduction in clinical practice variations.

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

PubMed

Tazawa, Hiromitsu

2004-03-01

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

Part II: managing perioperative hyperglycemia in total hip and knee replacement surgeries.

PubMed

Agos, Florence; Shoda, Casey; Bransford, Deborah

2014-09-01

Perioperative hyperglycemia management is an important factor in reducing the risk of surgical site infections (SSIs) in all patients regardless of existing history of diabetes. Reduction of SSIs is one of the quality indicators reported by the National Healthcare Safety Networks of the Centers for Disease Control and Prevention (CDC). In 2009 and 2010, the orthopedic surgical unit had an increased number of SSIs above the CDC benchmark. This article describes the impact of an evidence-based practice standard for perioperative hyperglycemia management in the reduction of SSIs in patients having total hip and knee replacement surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

Demonstrating PQS Effectiveness and Driving Continual Improvement: Evidence-Based Risk Reduction.

PubMed

Ramnarine, Emma; O'Donnell, Kevin

2018-04-18

Product knowledge grows and evolves during the life of a product. In order to maintain a state of control and deliver product with consistent quality throughout its commercial life, continuous improvement and product lifecycle management become essential. The practical link between product and process knowledge, risk-based control strategies, and continual improvement and innovation can be made stronger through evidence-based risk reduction. Regulatory relief and flexibility in post approval change management and overall product lifecycle management will only be possible with effective application of science and risk-based concepts and demonstrated effectiveness of the PQS in assuring a state of control. Copyright © 2018, Parenteral Drug Association.

Constraints on mechanized treatment significantly limit mechanical fuels reduction extent in the Sierra Nevada

Treesearch

Malcolm P. North; April Brough; Jonathan W. Long; Brandon M. Collins; Phil Bowden; Don Yasuda; Jay Miller; Neil Suighara

2015-01-01

With air quality, liability, and safety concerns, prescribed burning and managed wildfire are often considered impractical treatments for extensive fuels reduction in western US forests. For California's Sierra Nevada forests, we evaluated the alternative and analyzed the amount and distribution of constraints on mechanical fuels treatments on USDA Forest Service...

Assessing and Predicting the Effectiveness of Stormwater BMPs on Water Quality, Flow, Thermal Regime, and Substrate Integrity in the Delaware River Basin

EPA Science Inventory

Assessments of the effectiveness of stormwater best management practices (BMPs) have focused on measurement of load or concentration reductions, which can be translated to predict biological impacts based on chemical water quality criteria. However, many of the impacts of develo...

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.

Diabetes self-management education is not associated with a reduction in long-term diabetes complications: an effectiveness study in an elderly population.

PubMed

Shah, Baiju R; Hwee, Jeremiah; Cauch-Dudek, Karen; Ng, Ryan; Victor, J Charles

2015-08-01

The efficacy of diabetes self-management education on glycaemic control, self-care behaviour and knowledge has been established by short-term studies in experimental settings. The objective of this study was to assess its effectiveness to improve quality of care and reduce the risk of long-term diabetes complications in unselected older patients with recently diagnosed diabetes in routine clinical care. Using population-level health care administrative databases and registries, all patients aged ≥66 years in Ontario, Canada with diabetes for <5 years were identified. Self-management education programme attendees (n = 8485) in 2006 were matched with non-attendees using high-dimensional propensity scores, creating extremely well-balanced study arms. Quality of care measures and the long-term risk of diabetes complications were compared. Self-management programme attendees were more likely than non-attendees to achieve process measures of quality of care such as retinal screening examinations (75.3% versus 70.3%, adjusted relative risk 1.05, 99% confidence interval 1.03-1.08), and ≥2 glycated haemoglobin tests (57.5% versus 53.3%, adjusted relative risk 1.08, 99% confidence interval 1.05-1.11). However, with a median follow-up of 5.3 years, diabetes complications and mortality were not different between arms. In real-world clinical care, self-management education for older patients with recently diagnosed diabetes was associated with modest improvements in quality of care, but no reductions in long-term clinical events. © 2015 John Wiley & Sons, Ltd.

Water Quality Improvement through Reductions of Pollutant Loads on Small Scale of Bioretention System

NASA Astrophysics Data System (ADS)

Elyza Muha, Norshafa; Mohd Sidek, Lariyah; Jajarmizadeh, Milad

2016-03-01

Bioretention system is introduced as an important topic namely Urban Storm Water Management Manual for Malaysia (MSMA) by the Department of Irrigation and Drainage Malaysia (DID) in May 2012. The main objective of this paper is to evaluate the performance of water quality for small scale bioretention system under tropical climate via MUSIC model. Two bioretention systems 1 and 2 are observed based on the difference media depth. The result of bioretention system is compared with a reference model which has infrastructure with Urban Stormwater Improvement Conceptualisation (MUSIC) for pollutants load reduction and water quality results. Assessment of results via MUSIC software indicates a significant percentage of reduction for Total Suspended Solid (TSS), Total Phosphorus (TP) and Total Nitrogen (TN). The prediction of pollutant reduction via using MUSIC has the harmony for requirement in MSMA. TSS pollutant reduction is more than 80%, while for TP and TN more than 50%. The outcome of this study can be helpful for improvement of the existing MSMA guidelines for application of bioretention systems in Malaysia.

[The use of benchmarking to manage the healthcare supply chain: effects on purchasing cost and quality].

PubMed

Naranjo-Gil, David; Ruiz-Muñoz, David

2015-01-01

Healthcare supply expenses consume a large part of the financial resources allocated to public health. The aim of this study was to analyze the use of a benchmarking process in the management of hospital purchases, as well as its effect on product cost reduction and quality improvement. Data were collected through a survey conducted in 29 primary healthcare districts from 2010 to 2011, and through a healthcare database on the prices, quality, delivery time and supplier characteristics of 5373 products. The use of benchmarking processes reduced or eliminated products with a low quality and high price. These processes increased the quality of products by 10.57% and reduced their purchase price by 28.97%. The use of benchmarking by healthcare centers can reduce expenditure and allow more efficient management of the healthcare supply chain. It also facilitated the acquisition of products at lower prices and higher quality. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Using the integrated nurse leadership program to reduce sepsis mortality.

PubMed

Kliger, Julie; Singer, Sara J; Hoffman, Frank H

2015-06-01

The Integrated Nurse Leadership Program (INLP) is a collaborative improvement model focused on developing practical leadership skills of nurses and other frontline clinicians to lead quality improvement efforts. Sepsis is a major challenge to treat because it arises unpredictably and can progress rapidly. Nine San Francisco Bay Area hospitals participated in a 22-month INLP Sepsis Mortality Reduction Project to improve sepsis detection and management. The INLP focused on developing leadership and process improvement skills of nurses and other frontline clinicians. Teams of trained clinicians then implemented three strategies to improve early identification and timely treatment of sepsis: (1) sepsis screening of all patients, with diagnostic testing according to protocol; (2) timely treatment on the basis of key elements of Early Goal-Directed Therapy (EGDT); and (3) ongoing data review. Each hospital agreed to pursue the goal of reducing sepsis mortality by 15% by the end of the project. In the data collection period (baseline, July-December 2008 and project completion, January-June 2011), team members showed strong improvement in perceived leadership skills, team effectiveness, and ability to improve care quality. During this period, sepsis mortality for eight of the participating hospitals (Hospital 9 joined the project six months after it began) decreased by 43.7%-from 28% in the baseline period to 16% at project completion. Sepsis mortality rates trended downward for all hospitals, significantly decreasing (p<.05 at one hospital, p<.01 for four hospitals). In addition to improvement in safety culture and management of septic patients, hospitals participating in the INLP Sepsis Mortality Reduction Project achieved reductions in sepsis mortality during the study period and sustained reductions for more than one year later. The INLP model can be readily applied beyond sepsis management and mortality to other quality problems.

Ecosystem responses to long-term nutrient management in an urban estuary: Tampa Bay, Florida, USA

NASA Astrophysics Data System (ADS)

Greening, H.; Janicki, A.; Sherwood, E. T.; Pribble, R.; Johansson, J. O. R.

2014-12-01

In subtropical Tampa Bay, Florida, USA, we evaluated restoration trajectories before and after nutrient management strategies were implemented using long-term trends in nutrient loading, water quality, primary production, and seagrass extent. Following citizen demands for action, reduction in wastewater nutrient loading of approximately 90% in the late 1970s lowered external total nitrogen (TN) loading by more than 50% within three years. Continuing nutrient management actions from public and private sectors were associated with a steadily declining TN load rate and with concomitant reduction in chlorophyll-a concentrations and ambient nutrient concentrations since the mid-1980s, despite an increase of more than 1 M people living within the Tampa Bay metropolitan area. Water quality (chlorophyll-a concentration, water clarity as indicated by Secchi disk depth, total nitrogen concentration and dissolved oxygen) and seagrass coverage are approaching conditions observed in the 1950s, before the large increases in human population in the watershed. Following recovery from an extreme weather event in 1997-1998, water clarity increased significantly and seagrass is expanding at a rate significantly different than before the event, suggesting a feedback mechanism as observed in other systems. Key elements supporting the nutrient management strategy and concomitant ecosystem recovery in Tampa Bay include: 1) active community involvement, including agreement about quantifiable restoration goals; 2) regulatory and voluntary reduction in nutrient loadings from point, atmospheric, and nonpoint sources; 3) long-term water quality and seagrass extent monitoring; and 4) a commitment from public and private sectors to work together to attain restoration goals. A shift from a turbid, phytoplankton-based system to a clear water, seagrass-based system that began in the 1980s following comprehensive nutrient loading reductions has resulted in a present-day Tampa Bay which looks and functions much like it did in the relatively pre-disturbance 1950s period.

Experimental application of Business Process Management technology to manage clinical pathways: a pediatric kidney transplantation follow up case.

PubMed

Andellini, Martina; Fernandez Riesgo, Sandra; Morolli, Federica; Ritrovato, Matteo; Cosoli, Piero; Petruzzellis, Silverio; Rosso, Nicola

2017-11-03

To test the application of Business Process Management technology to manage clinical pathways, using a pediatric kidney transplantation as case study, and to identify the benefits obtained from using this technology. Using a Business Process Management platform, we implemented a specific application to manage the clinical pathway of pediatric patients, and monitored the activities of the coordinator in charge of the case management during a 6-month period (from June 2015 to November 2015) using two methodologies: the traditional procedure and the one under study. The application helped physicians and nurses to optimize the amount of time and resources devoted to management purposes. In particular, time reduction was close to 60%. In addition, the reduction of data duplication, the integrated event management and the efficient data collection improved the quality of the service. The use of Business Process Management technology, usually related to well-defined processes with high management costs, is an established procedure in multiple environments; its use in healthcare, however, is innovative. The use of already accepted clinical pathways is known to improve outcomes. The combination of these two techniques, well established in their respective areas of application, could represent a revolution in clinical pathway management. The study has demonstrated that the use of this technology in a clinical environment, using a proper architecture and identifying a well-defined process, leads to real benefits in terms of resources optimization and quality improvement.

Extending results from agricultural fields with intensively monitored data to surrounding areas for water quality management

USDA-ARS?s Scientific Manuscript database

A 45% reduction in riverine total nitrogen flux from the 1980-1996 time period is needed to meet water quality goals in the Mississippi Basin and Gulf of Mexico. This paper addresses the goal of reducing nitrogen in the Mississippi River through three objectives. First, the paper outlines an approac...

Evaluating and Predicting the Effectiveness of Green Infrastructure on a Small Watershed Scale - Emphasis on Water Quality, Flow, Thermal Regime, Substrate Integrity, and Biological Condition

EPA Science Inventory

Assessments of the effectiveness of stormwater best management practices (BMPs) have focused on measurement of load or concentration reductions, which can be translated to predict biological impacts based on chemical water quality criteria. However, many of the impacts of develo...

Earth Observatory Satellite system definition study. Report no. 4: Management approach recommendations

NASA Technical Reports Server (NTRS)

1974-01-01

A management approach for the Earth Observatory Satellite (EOS) which will meet the challenge of a constrained cost environment is presented. Areas of consideration are contracting techniques, test philosophy, reliability and quality assurance requirements, commonality options, and documentation and control requirements. The various functional areas which were examined for cost reduction possibilities are identified. The recommended management approach is developed to show the primary and alternative methods.

A review of treatment and management modalities for premenstrual dysphoric disorder.

PubMed

Kelderhouse, Kelli; Taylor, Julie Smith

2013-01-01

Premenstrual dysphoric disorder (PMDD) affects 5 to 8 percent of women and can significantly decrease their quality of life. Symptoms generally present during the late luteal phase of the menstrual cycle and can affect women emotionally, behaviorally, cognitively and physiologically. This article reviews the clinical literature on PMDD and the evidence behind various methods of symptom management. Evidence suggests that a holistic approach, including lifestyle modifications, pharmacotherapy and cognitive behavioral therapy, is most beneficial for symptom reduction and improvement in daily functioning and quality of life. © 2013 AWHONN.

Modeling soil erosion and transport on forest landscape

Treesearch

Ge Sun; Steven G McNulty

1998-01-01

Century-long studies on the impacts of forest management in North America suggest sediment can cause major reduction on stream water quality. Soil erosion patterns in forest watersheds are patchy and heterogeneous. Therefore, patterns of soil erosion are difficult to model and predict. The objective of this study is to develop a user friendly management tool for land...

Hayward Youth-Based Trash Capture, Reduction, and Watershed Education Project

EPA Pesticide Factsheets

Information about the SFBWQP City of Hayward, CA Trash Managment Project, part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

Predicting the impact of logging activities on soil erosion and water quality in steep, forested tropical islands

NASA Astrophysics Data System (ADS)

Wenger, Amelia S.; Atkinson, Scott; Santini, Talitha; Falinski, Kim; Hutley, Nicholas; Albert, Simon; Horning, Ned; Watson, James E. M.; Mumby, Peter J.; Jupiter, Stacy D.

2018-04-01

Increasing development in tropical regions provides new economic opportunities that can improve livelihoods, but it threatens the functional integrity and ecosystem services provided by terrestrial and aquatic ecosystems when conducted unsustainably. Given the small size of many islands, communities may have limited opportunities to replace loss and damage to the natural resources upon which they depend for ecosystem service provisioning, thus heightening the need for proactive, integrated management. This study quantifies the effectiveness of management strategies, stipulated in logging codes-of-practice, at minimizing soil erosion and sediment runoff as clearing extent increases, using Kolombangara Island, Solomon Islands as a case study. Further, we examine the ability of erosion reduction strategies to maintain sustainable soil erosion rates and reduce potential downstream impacts to drinking water and environmental water quality. We found that increasing land clearing—even with best management strategies in place—led to unsustainable levels of soil erosion and significant impacts to downstream water quality, compromising the integrity of the land for future agricultural uses, consistent access to clean drinking water, and important downstream ecosystems. Our results demonstrate that in order to facilitate sustainable development, logging codes of practice must explicitly link their soil erosion reduction strategies to soil erosion and downstream water quality thresholds, otherwise they will be ineffective at minimizing the impacts of logging activities. The approach taken here to explicitly examine soil erosion rates and downstream water quality in relation to best management practices and increasing land clearing should be applied more broadly across a range of ecosystems to inform decision-making about the socioeconomic and environmental trade-offs associated with logging, and other types of land use change.

A multi-stakeholder framework for urban runoff quality management: Application of social choice and bargaining techniques.

PubMed

Ghodsi, Seyed Hamed; Kerachian, Reza; Zahmatkesh, Zahra

2016-04-15

In this paper, an integrated framework is proposed for urban runoff management. To control and improve runoff quality and quantity, Low Impact Development (LID) practices are utilized. In order to determine the LIDs' areas and locations, the Non-dominated Sorting Genetic Algorithm-II (NSGA-II), which considers three objective functions of minimizing runoff volume, runoff pollution and implementation cost of LIDs, is utilized. In this framework, the Storm Water Management Model (SWMM) is used for stream flow simulation. The non-dominated solutions provided by the NSGA-II are considered as management scenarios. To select the most preferred scenario, interactions among the main stakeholders in the study area with conflicting utilities are incorporated by utilizing bargaining models including a non-cooperative game, Nash model and social choice procedures of Borda count and approval voting. Moreover, a new social choice procedure, named pairwise voting method, is proposed and applied. Based on each conflict resolution approach, a scenario is identified as the ideal solution providing the LIDs' areas, locations and implementation cost. The proposed framework is applied for urban water quality and quantity management in the northern part of Tehran metropolitan city, Iran. Results show that the proposed pairwise voting method tends to select a scenario with a higher percentage of reduction in TSS (Total Suspended Solid) load and runoff volume, in comparison with the Borda count and approval voting methods. Besides, the Nash method presents a management scenario with the highest cost for LIDs' implementation and the maximum values for percentage of runoff volume reduction and TSS removal. The results also signify that selection of an appropriate management scenario by stakeholders in the study area depends on the available financial resources and the relative importance of runoff quality improvement in comparison with reducing the runoff volume. Copyright © 2016 Elsevier B.V. All rights reserved.

Battling Costs for Quality and Quantity: Emerging Responses in Early Childhood Care and Education. Notes, Comments...(Child, Family, Community). Digest No. II.

ERIC Educational Resources Information Center

Prakasha, Veda

This digest explores the possibilities of cost reduction in extending the coverage and upgrading the quality of preschool education especially in developing countries. The digest also seeks to highlight the importance of community participation in developing and managing preschool institutions and programs. Chapters cover the following topics: the…

48 CFR 49.202 - Profit.

Code of Federal Regulations, 2011 CFR

2011-10-01

....202 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT... with the total work required by the contract (engineering estimates of the percentage of completion... contractor, with particular regard to— (i) Attainment of quantity and quality production; (ii) Reduction of...

Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management

PubMed Central

Fu, Mei R

2014-01-01

The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 2008, accounting for 23% of all diagnosed cancers in women. Given that the 5-year survival rate for breast cancer is now 90%, experiencing breast cancer is ultimately about quality of life. Women treated for breast cancer are facing a life-time risk of developing lymphedema, a chronic condition that occurs in up to 40% of this population and negatively affects breast cancer survivors’ quality of life. This review offers an insightful understanding of the condition by providing clinically relevant and evidence based knowledge regarding lymphedema symptoms, diagnosis, risk reduction, and management with the intent to inform health care professionals so that they might be better equipped to care for patients. PMID:25114841

Integrated watershed planning across jurisdictional boundaries

NASA Astrophysics Data System (ADS)

Watts, A. W.; Roseen, R.; Stacey, P.; Bourdeau, R.

2014-12-01

We will present the foundation for an Coastal Watershed Integrated Plan for three communities in southern New Hampshire. Small communities are often challenged by complex regulatory requirements and limited resources, but are wary of perceived risks in engaging in collaborative projects with other communities. Potential concerns include loss of control, lack of resources to engage in collaboration, technical complexity, and unclear benefits. This project explores a multi-town subwatershed application of integrated planning across jurisdictional boundaries that addresses some of today's highest priority water quality issues: wastewater treatment plant upgrades for nutrient removal; green infrastructure stormwater management for developing and re-developing areas; and regional monitoring of ecosystem indicators in support of adaptive management to achieve nutrient reduction and other water quality goals in local and downstream waters. The project outcome is a collaboratively-developed inter-municipal integrated plan, and a monitoring framework to support cross jurisdictional planning and assess attainment of water quality management goals. This research project has several primary components: 1) assessment of initial conditions, including both the pollutant load inputs and the political, economic and regulatory status within each community, 2) a pollutant load model for point and non-point sources, 3) multi-criteria evaluation of load reduction alternatives 4) a watershed management plan optimized for each community, and for Subwatersheds combining multiple communities. The final plan will quantify the financial and other benefits/drawbacks to each community for both inter municipal and individual pollution control approaches. We will discuss both the technical and collaborative aspects of the work, with lessons learned regarding science to action, incorporation of social, economic and water quality assessment parameters, and stakeholder/researcher interaction.

Managed aquifer recharge of treated wastewater: water quality changes resulting from infiltration through the vadose zone.

PubMed

Bekele, Elise; Toze, Simon; Patterson, Bradley; Higginson, Simon

2011-11-01

Secondary treated wastewater was infiltrated through a 9 m-thick calcareous vadose zone during a 39 month managed aquifer recharge (MAR) field trial to determine potential improvements in the recycled water quality. The water quality improvements of the recycled water were based on changes in the chemistry and microbiology of (i) the recycled water prior to infiltration relative to (ii) groundwater immediately down-gradient from the infiltration gallery. Changes in the average concentrations of several constituents in the recycled water were identified with reductions of 30% for phosphorous, 66% for fluoride, 62% for iron and 51% for total organic carbon when the secondary treated wastewater was infiltrated at an applied rate of 17.5 L per minute with a residence time of approximately four days in the vadose zone and less than two days in the aquifer. Reductions were also noted for oxazepam and temazepam among the pharmaceuticals tested and for a range of microbial pathogens, but reductions were harder to quantify as their magnitudes varied over time. Total nitrogen and carbamazepine persisted in groundwater down-gradient from the infiltration galleries. Infiltration does potentially offer a range of water quality improvements over direct injection to the water table without passage through the unsaturated zone; however, additional treatment options for the non-potable water may still need to be considered, depending on the receiving environment or the end use of the recovered water. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Survey of piloting factors in V/STOL aircraft with implications for flight control system design

NASA Technical Reports Server (NTRS)

Ringland, R. F.; Craig, S. J.

1977-01-01

Flight control system design factors involved for pilot workload relief are identified. Major contributors to pilot workload include configuration management and control and aircraft stability and response qualities. A digital fly by wire stability augmentation, configuration management, and configuration control system is suggested for reduction of pilot workload during takeoff, hovering, and approach.

Impact of river basin management on coastal water quality and ecosystem services: A southern Baltic estuary

NASA Astrophysics Data System (ADS)

Schernewski, Gerald; Hürdler, Jens; Neumann, Thomas; Stybel, Nardine; Venohr, Markus

2010-05-01

Eutrophication management is still a major challenge in the Baltic Sea region. Estuaries or coastal waters linked to large rivers cannot be managed independently. Nutrient loads into these coastal ecosystems depend on processes, utilisation, structure and management in the river basin. In practise this means that we need a large scale approach and integrated models and tools to analyse, assess and evaluate the effects of nutrient loads on coastal water quality as well as the efficiency of river basin management measures on surface waters and especially lagoons and estuaries. The Odra river basin, the Szczecin Lagoon and its coastal waters cover an area of about 150,000 km² and are an eutrophication hot-spot in the Baltic region. To be able to carry out large scale, spatially integrative analyses, we linked the river basin nutrient flux model MONERIS to the coastal 3D-hydrodynamic and ecosystem model ERGOM. Objectives were a) to analyse the eutrophication history in the river basin and the resulting functional changes in the coastal waters between early 1960's and today and b) to analyse the effects of an optimal nitrogen and phosphorus management scenario in the Oder/Odra river basin on coastal water quality. The models show that an optimal river basin management with reduced nutrient loads (e.g. N-load reduction of 35 %) would have positive effects on coastal water quality and algae biomass. The availability of nutrients, N/P ratios and processes like denitrification and nitrogen-fixation would show spatial and temporal changes. It would have positive consequences for ecosystems functions, like the nutrient retention capacity, as well. However, this optimal scenario is by far not sufficient to ensure a good coastal water quality according to the European Water Framework Directive. A "good" water quality in the river will not be sufficient to ensure a "good" water quality in the coastal waters. Further, nitrogen load reductions bear the risk of increased potentially toxic, blue-green algae blooms. The presentation will summarize recent results (Behrendt et al. 2009, Schernewski et al. 2009, Schernewski et al. in press, Schernewski et al. submitted) and give an overview how Climate Change and socio-economic transformation processes in the river basin will effect coastal water quality during the next decades. The opportunities and threats of a changing lagoon ecosystem for tourism and fisheries, the major economic activities, will be shown.

Raw Water Ammonia: Implications on Water Quality, Regulatory Compliance, and Management Strategies

EPA Science Inventory

The objective of the talk will be to present engineering design considerations associated with the biological reduction of ammonia from source water. Also, the application of ion exchange softening to address elevated ammonia is presented.

2008 Combat Vehicles Conference

DTIC Science & Technology

2008-10-22

reduction — Reduced logistics burdens — Regenerative braking / energy recovery • Enhance functionality, flexibility, power quality, and management...ground based maneuver tasks. The MPC, as the medium capability category platform, provides a bridge in capability between the EFV and JLTV and a

Design of a Decision Support Tool for Nutrient Credit Exchange Feasibility in Stormwater Regulatory Compliance

DOT National Transportation Integrated Search

2015-06-01

Virginia Stormwater Management Program (VSMP) regulations require transportation projects to account for stormwater runoff impacts from increased impervious surfaces in order to prevent water quality reduction, erosion, and flooding.1 Organizations l...

Evidence for the effect of disease management: is $1 billion a year a good investment?

PubMed

Mattke, Soeren; Seid, Michael; Ma, Sai

2007-12-01

To assess the evidence for the effect of disease management on quality of care, disease control, and cost, with a focus on population-based programs. Literature review. We conducted a literature search for and a structured review of studies on population-based disease management programs, as well as for reviews and meta-analyses of disease management interventions. We identified 3 evaluations of large-scale population-based programs, as well as 10 meta-analyses and 16 systematic reviews, covering 317 unique studies. We found consistent evidence that disease management improves processes of care and disease control but no conclusive support for its effect on health outcomes. Overall, disease management does not seem to affect utilization except for a reduction in hospitalization rates among patients with congestive heart failure and an increase in outpatient care and prescription drug use among patients with depression. When the costs of the intervention were appropriately accounted for and subtracted from any savings, there was no conclusive evidence that disease management leads to a net reduction of direct medical costs. Although disease management seems to improve quality of care, its effect on cost is uncertain. Most of the evidence to date addresses small-scale programs targeting high-risk individuals, while only 3 studies evaluate large population-based interventions, implying that little is known about their effect. Payers and policy makers should remain skeptical about vendor claims and should demand supporting evidence based on transparent and scientifically sound methods.

Role of future scenarios in understanding deep uncertainty in long-term air quality management.

PubMed

Gamas, Julia; Dodder, Rebecca; Loughlin, Dan; Gage, Cynthia

2015-11-01

The environment and its interactions with human systems, whether economic, social, or political, are complex. Relevant drivers may disrupt system dynamics in unforeseen ways, making it difficult to predict future conditions. This kind of "deep uncertainty" presents a challenge to organizations faced with making decisions about the future, including those involved in air quality management. Scenario Planning is a structured process that involves the development of narratives describing alternative future states of the world, designed to differ with respect to the most critical and uncertain drivers. The resulting scenarios are then used to understand the consequences of those futures and to prepare for them with robust management strategies. We demonstrate a novel air quality management application of Scenario Planning. Through a series of workshops, important air quality drivers were identified. The most critical and uncertain drivers were found to be "technological development" and "change in societal paradigms." These drivers were used as a basis to develop four distinct scenario storylines. The energy and emissions implications of each storyline were then modeled using the MARKAL energy system model. NOx emissions were found to decrease for all scenarios, largely a response to existing air quality regulations, whereas SO2 emissions ranged from 12% greater to 7% lower than 2015 emissions levels. Future-year emissions differed considerably from one scenario to another, however, with key differentiating factors being transition to cleaner fuels and energy demand reductions. Application of scenarios in air quality management provides a structured means of sifting through and understanding the dynamics of the many complex driving forces affecting future air quality. Further, scenarios provide a means to identify opportunities and challenges for future air quality management, as well as a platform for testing the efficacy and robustness of particular management options across wide-ranging conditions.

Linking Spatial Variations in Water Quality with Water and Land Management using Multivariate Techniques.

PubMed

Wan, Yongshan; Qian, Yun; Migliaccio, Kati White; Li, Yuncong; Conrad, Cecilia

2014-03-01

Most studies using multivariate techniques for pollution source evaluation are conducted in free-flowing rivers with distinct point and nonpoint sources. This study expanded on previous research to a managed "canal" system discharging into the Indian River Lagoon, Florida, where water and land management is the single most important anthropogenic factor influencing water quality. Hydrometric and land use data of four drainage basins were uniquely integrated into the analysis of 25 yr of monthly water quality data collected at seven stations to determine the impact of water and land management on the spatial variability of water quality. Cluster analysis (CA) classified seven monitoring stations into four groups (CA groups). All water quality parameters identified by discriminant analysis showed distinct spatial patterns among the four CA groups. Two-step principal component analysis/factor analysis (PCA/FA) was conducted with (i) water quality data alone and (ii) water quality data in conjunction with rainfall, flow, and land use data. The results indicated that PCA/FA of water quality data alone was unable to identify factors associated with management activities. The addition of hydrometric and land use data into PCA/FA revealed close associations of nutrients and color with land management and storm-water retention in pasture and citrus lands; total suspended solids, turbidity, and NO + NO with flow and Lake Okeechobee releases; specific conductivity with supplemental irrigation supply; and dissolved O with wetland preservation. The practical implication emphasizes the importance of basin-specific land and water management for ongoing pollutant loading reduction and ecosystem restoration programs. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

A comprehensive review of the SLMTA literature part 2: Measuring success.

PubMed

Luman, Elizabeth T; Yao, Katy; Nkengasong, John N

2014-01-01

Since its introduction in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has been implemented in 617 laboratories in 47 countries. We completed a systematic review of the published literature on SLMTA. The review consists of two companion papers; this article examines quantitative evidence presented in the publications along with a meta-analysis of selected results. We identified 28 published articles with data from SLMTA implementation. The SLMTA programme was evaluated through audits based on a standard checklist, which is divided into 12 sections corresponding to the 12 Quality System Essentials (QSEs). Several basic service delivery indicators reported by programmes were also examined. Results for various components of the programme were reviewed and summarised; a meta-analysis of QSE results grouped by the three stages of the quality cycle was conducted for 126 laboratories in 12 countries. Global programme data show improved quality in SLMTA laboratories in every country, with average improvements on audit scores of 25 percentage points. Meta-analysis identified Improvement Management as the weakest stage, with internal audit (8%) and occurrence management (16%) showing the lowest scores. Studies documented 19% - 95% reductions in turn-around times, 69% - 93% reductions in specimen rejection rates, 76% - 81% increases in clinician satisfaction rates, 67% - 85% improvements in external quality assessment results, 50% - 66% decreases in nonconformities and 67% increases in staff punctuality. The wide array of results reported provides a comprehensive picture of the SLMTA programme overall, suggesting a substantive impact on provision of quality laboratory services and patient care. These comprehensive results establish a solid data-driven foundation for program improvement and further expansion.

Implementation of occupational health service improvements through application of total quality management processes.

PubMed

Thomas, Elizabeth Anne

2011-06-01

The occupational health services department for a manufacturing division of a high-technology firm was redesigned from an outsourced model, in which most services were provided by an outside clinic vendor, to an in-house service model, in which services were provided by an on-site nurse practitioner. The redesign and implementation, accomplished by a cross-functional team using Total Quality Management processes, resulted in a comprehensive occupational health services department that realized significant cost reduction, increased compliance with regulatory and company requirements, and improved employee satisfaction. Implications of this project for occupational health nurses are discussed.

Impact of set-aside management on soil mesofauna

NASA Astrophysics Data System (ADS)

Landi, Silvia; d'Errico, Giada; Mazza, Giuseppe; Mocali, Stefano; Bazzoffi, Paolo; Roversi, Pio Federico

2014-05-01

To contrast the biodiversity decline, the current Common Agricultural Policy (CAP) 2014-2020 responds to urgent environmental challenges and provides some new greening attempts as pastures, rotations, orchard grasses, ecological set-aside and organic farming. This study, supported by the Italian National Project MONACO (MIPAAF), aims to provide preliminary indications about the ecological impact of set-aside on soil biodiversity. Soil invertebrates, mainly nematodes and microarthropods, are excellent candidates to study the human activity impacts on the environment. Indeed, invertebrates are abundant, relatively easy to sample, and they can quickly respond to soil disturbance. Nematode assemblages offer several advantages for assessing the quality of terrestrial ecosystems because of their permeable cuticle through which they are in direct contact with solvents in the soil capillary water. Moreover, nematodes have high diversity and represent a trophically heterogeneous group. The Maturity Index (MI), based on the nematode fauna, represents a gauge of the conditions of the soil ecosystem. Edaphic microarthropods play an important role in the soil system in organic matter degradation and nutrient cycling. They show morphological characters that reveal adaptation to soil environments, such as reduction or loss of pigmentation and visual apparatus, streamlined body form with appendages reduction, reduction or loss of flying, jumping or running adaptations, thinner cuticle for reduced water-retention capacity. The "Qualità Biologica del Suolo" (QBS) index, namely "Biological Quality of Soil", is based on the types of edaphic microarthropods to assess soil biological quality. Three different set-aside managements were compared with a conventional annual crop in three Italian sites (Caorle, VE; Fagna, FI; Metaponto, MT). After five years the biological quality of soils using MI and QBS was evaluated. Regarding nematodes, the family richness and the biological quality (MI) resulted significantly higher in set-aside managements than in conventional crops in Fagna and Metaponto sites. In contrast, Caorle was characterized by a significant soil degradation (prevalence of extreme colonizers) and any increase of MI values in the set-aside have been not detected. About microarthropods, the taxa richness was significantly higher in set-aside managements than conventional crops in all the sites sampled. QBS index showed the same trend, but the differences were not significant. Caorle site was characterized by a lack of balance in the relative abundance among soil microarthropods taxa. In particular, set-aside managements showed a strong prevalence of an aggressive ants Solenopsis fugax (Hymenoptera: Formicidae). In conclusion, the best results were observed in Fagna and Metaponto sites, where MI and QBS values increased under set-aside management as compared to the conventional. Further analyses will be carried out over a long period to better understand the possible correlation between the enhancement of the organic matter observed in the soils less degraded and the biological quality improvement.

Evaluation of erosion control BMPs on ditched haul road stream crossing approaches following reconstruction

Treesearch

A.J. Lang; W.M. Aust; M.C. Bolding; E.B. Schilling

2016-01-01

Ditched forest roads leading to stream crossings and used for log transportation have recently been a topic of water quality concern and legal controversy. Best management practices (BMPs) can reduce potential water quality issues, yet few research studies have quantified BMP costs and reductions in sediment from implementing specific ditch BMPs. Researchers...

Mother-infant home care drives quality in a managed care environment.

PubMed

Malnory, M

1997-04-01

Advocates of inpatient managed care employing clinical pathways are confident that this patient management strategy reduces cost while promoting equivalent patient outcomes. Other health care professionals are concerned that cost reductions place patients at higher risk for adverse health events. Research is needed to demonstrate the true impact of cost-containment strategies on clinical outcomes. The article describes a study in progress comparing patients conventionally managed by their physicians with similar patients whose overall management involved a nurse case manager. This study explores the issue of resource costs that can be linked to clinical and financial outcome measures.

Trends in the extremes of sulfur concentration distributions.

PubMed

Iyer, H; Patterson, P; Malm, W C

2000-05-01

Understanding the response of air quality parameters such as visibility to the implementation of new air quality regulations, population growth and redistribution, and federal land managing practices is essential to the evaluation of air quality management plans on air quality in federal Class I areas. For instance, the reduction of SO2 emissions from large single point sources should result in the decrease of extreme sulfate concentrations, while population growth in geographic areas outside of urban centers could cause a slow widespread increase of sulfate and organic concentrations. The change in federal land managing practice of increased prescribed fire on a year-round basis in lieu of large naturally occurring wild fires could have the same effect; that is, the frequency of high sulfur days increase and low sulfur days decrease as the result of the management practice. Therefore, it is of interest to examine the trends associated with the proportion of days during which the concentration of some aerosol species is above or below a certain threshold and decide whether this proportion of days is increasing or decreasing or shows a lack of trend. This is a direct indication of whether the quality of the environment is improving or worsening, or neither.

Analysis and Evaluation of Forecasting Methods and Tools to Predict Future Demand for Secondary Chemical-Biological Configuration Items

DTIC Science & Technology

2013-06-01

quantity, the lead time, the process quality and the number of deliveries (Yang & Pan, 2004). Inventory management systems are classified as either...22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188) Washington DC 20503. 1. AGENCY USE ONLY (Leave blank... managed by the Defense Logistics Agency (DLA), Edgewood Chemical Biological Center (ECBC) must be able to complete reviews of all procurement

Management case study: Tampa Bay, Florida

USGS Publications Warehouse

Morrison, Gerold; Greening, Holly; Yates, Kimberly K.; Wolanski, Eric; McLusky, Donald S.

2011-01-01

Tampa Bay, Florida, USA, is a shallow, subtropical estuary that experienced severe cultural eutrophication between the 1940s and 1980s, a period when the human population of its watershed quadrupled. In response, citizen action led to the formation of a public- and private-sector partnership (the Tampa Bay Estuary Program), which adopted a number of management objectives to support the restoration and protection of the bay’s living resources. These included numeric chlorophyll a and water-clarity targets, as well as long-term goals addressing the spatial extent of seagrasses and other selected habitat types, to support estuarine-dependent faunal guilds. Over the past three decades, nitrogen controls involving sources such as wastewater treatment plants, stormwater conveyance systems, fertilizer manufacturing and shipping operations, and power plants have been undertaken to meet these and other management objectives. Cumulatively, these controls have resulted in a 60% reduction in annual total nitrogen (TN) loads relative to earlier worse-case (latter 1970s) conditions. As a result, annual water-clarity and chlorophyll a targets are currently met in most years, and seagrass cover measured in 2008 was the highest recorded since 1950. Factors that have contributed to the observed improvements in Tampa Bay over the past several decades include the following: (1) Development of numeric, science-based water-quality targets to meet a long-term goal of restoring seagrass acreage to 1950s levels. Empirical and mechanistic models found that annual average chlorophyll a concentrations were a primary manageable factor affecting light attenuation. The models also quantified relationships between TN loads, chlorophyll a concentrations, light attenuation, and fluctuations in seagrass cover. The availability of long-term monitoring data, and a systematic process for using the data to evaluate the effectiveness of management actions, has allowed managers to track progress and make adaptive changes when needed. (2) Citizen involvement, that is, the initial reductions in TN loads, which occurred in the late 1970s and early 1980s, was a result of state regulations that were developed in response to citizens’ call for action. Improved water clarity and better fishing and swimming conditions were identified as primary goals by citizens again in the early 1990s, and led to development of numeric water-quality targets and seagrass restoration goals. More recent citizen actions, from pet waste campaigns to support of reductions in residential fertilizer use, are important elements of the nitrogen management strategy. (3) Collaborative actions, that is, in addition to numerous other collaborative ventures that have benefitted Tampa Bay, the public/private Nitrogen Management Consortium, which includes more than 40 participating organizations, has implemented over 250 nutrient-reduction projects. These projects have addressed stormwater treatment, fertilizer manufacturing and shipping, agricultural practices, reclaimed water use, and atmospheric emissions from local power stations, providing more than 300 tons of TN load reductions since 1995. (4) State and federal regulatory programs, that is, regulatory requirements, such as state statutes and rules requiring compliance with advanced wastewater treatment standards by municipal sewerage works, have played a key role in Tampa Bay management efforts. The technical basis and implementation plan of the Tampa Bay nitrogen management strategy have been developed in cooperation with state and federal regulatory agencies, and the strategy has been recognized by them as an appropriate tool for meeting water-quality standards, including federally mandated total maximum daily loads. Subsequent management efforts have focused on maintaining and extending those improvements in Tampa Bay’s environmental resources by addressing water and sediment quality and habitat protection and restoration. Implementation of a collaborative, watershed-based management process, driven by an integrated science approach, has played a central role in supporting progress toward the achievement of science-based estuary management goals.

Options for reducing food waste by quality-controlled logistics using intelligent packaging along the supply chain.

PubMed

Heising, Jenneke K; Claassen, G D H; Dekker, Matthijs

2017-10-01

Optimising supply chain management can help to reduce food waste. This paper describes how intelligent packaging can be used to reduce food waste when used in supply chain management based on quality-controlled logistics (QCL). Intelligent packaging senses compounds in the package that correlate with the critical quality attribute of a food product. The information on the quality of each individual packaged food item that is provided by the intelligent packaging can be used for QCL. In a conceptual approach it is explained that monitoring food quality by intelligent packaging sensors makes it possible to obtain information about the variation in the quality of foods and to use a dynamic expiration date (IP-DED) on a food package. The conceptual approach is supported by quantitative data from simulations on the effect of using the information of intelligent packaging in supply chain management with the goal to reduce food waste. This simulation shows that by using the information on the quality of products that is provided by intelligent packaging, QCL can substantially reduce food waste. When QCL is combined with dynamic pricing based on the predicted expiry dates, a further waste reduction is envisaged.

Comparison of Measured to Predicted Estimations of Nonpoint Source Contaminants Using Conservation Practices in an Agriculturally-Dominated Watershed in Northeast Arkansas, USA.

PubMed

Frasher, Sarah K; Woodruff, Tracy M; Bouldin, Jennifer L

2016-06-01

In efforts to reduce nonpoint source runoff and improve water quality, Best Management Practices (BMPs) were implemented in the Outlet Larkin Creek Watershed. Farmers need to make scientifically informed decisions concerning BMPs addressing contaminants from agricultural fields. The BMP Tool was developed from previous studies to estimate BMP effectiveness at reducing nonpoint source contaminants. The purpose of this study was to compare the measured percent reduction of dissolved phosphorus (DP) and total suspended solids to the reported percent reductions from the BMP Tool for validation. Similarities were measured between the BMP Tool and the measured water quality parameters. Construction of a sedimentation pond resulted in 74 %-76 % reduction in DP as compared to 80 % as predicted with the BMP Tool. However, further research is needed to validate the tool for additional water quality parameters. The BMP Tool is recommended for future BMP implementation as a useful predictor for farmers.

Future water supply management adaptation measures - case study of Ljubljana field aquifer

NASA Astrophysics Data System (ADS)

Čenčur Curk, B.; Zajc Benda, T.; Souvent, P.; Bračič Železnik, B.; Bogardi, I.

2012-04-01

The main drinking water supply problems are related to the significant change of groundwater quantity and quality observed in the last decades as an effect of land use practices and very likely also climate change. The latter may affect the ability of drinking water suppliers to provide enough water of sufficient quality to the consumers. These topics were studied in the frame of SEE project CC-WaterS (Climate Change and Impact on Water Supply) with the main goal to develop a water supply management system regarding optimisation of water extraction and land use restrictions under climate change scenarios for water suppliers, since existing management practices are mostly inadequate to reduce impacts of CC on water supply reliability. The main goal was a designation of appropriate measures and risk assessment to adapt water supply to changing climate and land use activities considering socio-economic aspects. This was accomplished by using 'Fuzzy Decimaker', which is a tool for selecting and ranking risk reduction measures or management actions for local waterworks or water authorities under the pressure of climate change. Firstly, management options were selected and ranked. For public water supply of Ljubljana, the capital of Slovenia, several management options were selected. For improvement of water supply and preservation of water resource quantities there is a need for engineering interventions, such as reducing water losses on pipelines. For improving drinking water safety and preserving water resource quality farmers are not allowed to use fertilisers in the first safeguarding zone and they get compensations for income reduction because of lower farming production. Compensations for farming restrictions in the second safeguarding zone were applied as additional management option. On the other hand, drinking water treatment is another management option to be considered. Trends in groundwater level are decreasing, above all recharge areas of waterworks; therefore there is a threat of reduction of water resource availability. For this following management options were proposed: artificial recharge with infiltration wells, setting up new and additional waterworks (one with river bank filtration, one with exploitation of local porous aquifer and one with deep groundwater exploitation from dolomite aquifer). Management actions can be evaluated according to several criteria, such as water supply risk reduction for the various users (drinking, agricultural, industrial and ecological), realization of the actions (cost, flexibility and leg time). Ranking criteria are characterized by different units (e.g. units of water supply (quantity) risk may involve number of unsupplied people, monetary terms, agricultural area or habitat loss). Decision making process is followed by defining relative weights, balancing factors and best and worst values for the indicators; calculating base risk and risk elements for each management option and sensitivity analysis. The result of this decision making process is evaluation of preferred management option(s) according to the ranking results.

The Relationship Among Heart Failure Disease Management, Quality of Care, and Hospitalizations.

PubMed

Chung, Eugene S; Bartone, Cheryl; Daly, Kathleen; Menon, Santosh; McDonald, Mark

2015-01-01

Heart failure (HF) affects 5.1 million adult patients, accounting for over 1 million hospitalizations, 1.8 million office visits, and nearly 680,000 emergency department visits annually. HF hospitalizations have been incorporated into a national measure of hospital and provider quality, with associated financial penalties based on the 30-day readmission rate after an index hospitalization for HF. However, it is not clear whether the number of HF-related hospitalizations or 30-day readmissions is consistently related to quality of care. The relationships between various measures of HF care quality and hospitalization rates were evaluated by performing a cohort study of an HF disease management program in a clinical practice setting. Following the statistical analyses assessing outcomes and survival, the conclusion was that an HF disease management program in clinical practice associated with improved utilization of evidence-based medical and device therapies tends to improve ejection fraction and survival, and reduce sex and race disparities, but not with an associated reduction in hospitalizations or total hospital days.

Effects of best-management practices in Bower Creek in the East River priority watershed, Wisconsin, 1991-2009

USGS Publications Warehouse

Corsi, Steven R.; Horwatich, Judy A.; Rutter, Troy D.; Bannerman, Roger T.

2013-01-01

Hydrologic and water-quality data were collected at Bower Creek during the periods before best-management practices (BMPs), and after BMPs were installed for evaluation of water-quality improvements. The monitoring was done between 1990 and 2009 with the pre-BMP period ending in July 1994 and the post-BMP period beginning in October 2006. BMPs installed in this basin included streambank protection and fencing, stream crossings, grade stabilization, buffer strips, various barnyard-runoff controls, nutrient management, and a low degree of upland BMPs. Water-quality evaluations included base-flow concentrations and storm loads for total suspended solids, total phosphorus, and ammonia nitrogen. The only reductions detected between the base-flow samples of the pre- and post-BMP periods were in median concentrations of total phosphorus from base-flow samples, but not for total suspended solids or dissolved ammonia nitrogen. Differences in storm loads for the three water-quality constituents monitored were not observed during the study period.

Umbilical vein injection for management of retained placenta.

PubMed

Nardin, Juan Manuel; Weeks, Andrew; Carroli, Guillermo

2011-05-11

If a retained placenta is left untreated, there is a high risk of maternal death. However, manual removal of the placenta is an invasive procedure with serious complications of haemorrhage, infection or genital tract trauma. To assess the use of umbilical vein injection (UVI) of saline solution alone or with oxytocin in comparison either with expectant management or with an alternative solution or other uterotonic agent for retained placenta. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2011). Randomized trials comparing UVI of saline or other fluids, with or without oxytocics, either with expectant management or with an alternative solution or other uterotonic agent, in the management of retained placenta. Two review authors assessed the methodological quality of the studies and extracted the data. We included 15 trials (1704 women). The trials were of variable quality. Compared with expectant management, UVI of saline solution alone did not show any significant difference in the incidence of manual removal of the placenta (risk ratio (RR) 0.99; 95% confidence interval (CI) 0.84 to 1.16). UVI of oxytocin solution compared with expectant management showed no reduction in the need for manual removal (RR 0.87; 95% CI 0.74 to 1.03).Oxytocin solution compared with saline solution alone showed a reduction in manual removal of the placenta, but this was not statistically significant (RR 0.91; 95% CI 0.82 to 1.00). When only high-quality studies were assessed, there was no statistical difference (RR 0.92; 95% CI 0.83 to 1.01). We detected no differences in any of the other outcomes.UVI of oxytocin solution compared with UVI of plasma expander showed no statistically significant difference in the outcomes assessed by the only one small trial included. Prostaglandin solution compared with saline solution alone was associated with a statistically significant lower incidence in manual removal of placenta (RR 0.42; 95% CI 0.22 to 0.82) but we observed no difference in the other outcomes evaluated. Prostaglandin plus saline solution showed a statistically significant reduction in manual removal of placenta when compared with oxytocin plus saline solution (RR 0.43; 95% CI 0.25 to 0.75), and we also observed a small reduction in time from injection to placental delivery (mean difference -6.00; 95% CI -8.78 to -3.22). However, there were only two small trials contributing to this meta-analysis. UVI of oxytocin solution is an inexpensive and simple intervention that could be performed while placental delivery is awaited. However, high-quality randomized trials show that the use of oxytocin has little or no effect. Further research into the optimal timing of manual removal and into UVI of prostaglandins or plasma expander is warranted.

Chronically Critically Ill Patients

PubMed Central

Douglas, Sara L.; Daly, Barbara J.; Kelley, Carol Genet; O’Toole, Elizabeth; Montenegro, Hugo

2007-01-01

Background Chronically critically ill patients often have high costs of care and poor outcomes and thus might benefit from a disease management program. Objectives To evaluate how adding a disease management program to the usual care system affects outcomes after discharge from the hospital (mortality, health-related quality of life, resource use) in chronically critically ill patients. Methods In a prospective experimental design, 335 intensive care patients who received more than 3 days of mechanical ventilation at a university medical center were recruited. For 8 weeks after discharge, advanced practice nurses provided an intervention that focused on case management and interdisciplinary communication to patients in the experimental group. Results A total of 74.0% of the patients survived and completed the study. Significant predictors of death were age (P = .001), duration of mechanical ventilation (P = .001), and history of diabetes (P = .04). The disease management program did not have a significant impact on health-related quality of life; however, a greater percentage of patients in the experimental group than in the control group had “improved” physical health-related quality of life at the end of the intervention period (P = .02). The only significant effect of the intervention was a reduction in the number of days of hospital readmission and thus a reduction in charges associated with readmission. Conclusion The intervention was not associated with significant changes in any outcomes other than duration of readmission, but the supportive care coordination program could be provided without increasing overall charges. PMID:17724242

An information system to improve financial management, resource allocation and activity planning: evaluation results.

PubMed

Ruland, C M; Ravn, I H

2001-01-01

An important strategy for improving resource management and cost containment in health care is to develop information systems that assist hospital managers in financial management, resource allocation, and activity planning. A crucial part of such development is a rigorous evaluation to assess whether the system accomplishes it's intended goals. To evaluate CLASSICA, a Decision Support System (DSS), that assists nurse managers in financial management, resource allocation, staffing, and activity planning. Using a pre-post test design with control units, CLASSICA was evaluated in four test units. Baseline data and simultaneous parallel measures were collected prior to system implementation at test sites and control units. Using expense reports, staffing and financial statistics, surveys, interviews with nurse managers, and logs as data sources, CLASSICA was evaluated on: cost reduction, quality of management information; usefulness as decision support for improved financial management and decision-making; user satisfaction; and ease of use. Evaluation results showed a 41% reduction in expenditures for overtime and extra hours as compared to a 1.8% reduction in control units during the same time period. Users reported a significant improvement in management information; nurse managers stated that they had gained control over costs. The system helped them analyze the relationships between patient activity staffing, and cost of care. Users reported high satisfaction with the system, the information and decision support it provided, and its ease of use. These results suggest that CLASSICA is a DSS that successfully assists nurse managers in cost effective management of their units.

Energy and water quality management systems for water utility's operations: a review.

PubMed

Cherchi, Carla; Badruzzaman, Mohammad; Oppenheimer, Joan; Bros, Christopher M; Jacangelo, Joseph G

2015-04-15

Holistic management of water and energy resources is critical for water utilities facing increasing energy prices, water supply shortage and stringent regulatory requirements. In the early 1990s, the concept of an integrated Energy and Water Quality Management System (EWQMS) was developed as an operational optimization framework for solving water quality, water supply and energy management problems simultaneously. Approximately twenty water utilities have implemented an EWQMS by interfacing commercial or in-house software optimization programs with existing control systems. For utilities with an installed EWQMS, operating cost savings of 8-15% have been reported due to higher use of cheaper tariff periods and better operating efficiencies, resulting in the reduction in energy consumption of ∼6-9%. This review provides the current state-of-knowledge on EWQMS typical structural features and operational strategies and benefits and drawbacks are analyzed. The review also highlights the challenges encountered during installation and implementation of EWQMS and identifies the knowledge gaps that should motivate new research efforts. Copyright © 2015 Elsevier Ltd. All rights reserved.

Perceptions of Physical Inspections as a Tool to Protect Housing Quality and Promote Health Equity.

PubMed

Holtzen, Holly; Klein, Elizabeth G; Keller, Brittney; Hood, Nancy

2016-01-01

Physical inspections that assess how well affordable housing properties meet quality and safety standards help to ensure that low-income tenants live in a healthy built environment. This study was part of a larger Health Impact Assessment (HIA) conducted between January 2012 and November 2013 to inform policymakers about the potential health consequences of a proposed policy decision to align the physical inspections required by housing funding agencies, which would result in a reduction of the frequency of physical inspections. Key informant interviews (n=18) of property managers and tenants were used to explore the inspection process, identification of housing quality issues, and potential effects on the health of affordable housing tenants and the impact on property management practices. Results indicate that physical inspection frequency may be an important trigger for property managers and tenants to adhere to proper maintenance schedules.

Klang River water quality modelling using music

NASA Astrophysics Data System (ADS)

Zahari, Nazirul Mubin; Zawawi, Mohd Hafiz; Muda, Zakaria Che; Sidek, Lariyah Mohd; Fauzi, Nurfazila Mohd; Othman, Mohd Edzham Fareez; Ahmad, Zulkepply

2017-09-01

Water is an essential resource that sustains life on earth; changes in the natural quality and distribution of water have ecological impacts that can sometimes be devastating. Recently, Malaysia is facing many environmental issues regarding water pollution. The main causes of river pollution are rapid urbanization, arising from the development of residential, commercial, industrial sites, infrastructural facilities and others. The purpose of the study was to predict the water quality of the Connaught Bridge Power Station (CBPS), Klang River. Besides that, affects to the low tide and high tide and. to forecast the pollutant concentrations of the Biochemical Oxygen Demand (BOD) and Total Suspended Solid (TSS) for existing land use of the catchment area through water quality modeling (by using the MUSIC software). Besides that, to identifying an integrated urban stormwater treatment system (Best Management Practice or BMPs) to achieve optimal performance in improving the water quality of the catchment using the MUSIC software in catchment areas having tropical climates. Result from MUSIC Model such as BOD5 at station 1 can be reduce the concentration from Class IV to become Class III. Whereas, for TSS concentration from Class III to become Class II at the station 1. The model predicted a mean TSS reduction of 0.17%, TP reduction of 0.14%, TN reduction of 0.48% and BOD5 reduction of 0.31% for Station 1 Thus, from the result after purposed BMPs the water quality is safe to use because basically water quality monitoring is important due to threat such as activities are harmful to aquatic organisms and public health.

Assessing the impacts of Best Management Practices on nitrate pollution in an agricultural dominated lowland catchment considering environmental protection versus economic development.

PubMed

Haas, Marcelo B; Guse, Björn; Fohrer, Nicola

2017-07-01

Water quality is strongly affected by nitrate inputs in agricultural catchments. Best Management Practices (BMPs) are alternative practices aiming to mitigate the impacts derived from agricultural activities and to improve water quality. Management activities are influenced by different governmental policies like the Water Framework Directive (WFD) and the Renewable Energy Sources Act (EEG). Their distinct goals can be contrasting and hamper an integrated sustainable development. Both need to be addressed in the actual conjuncture in rural areas. Ecohydrological models like the SWAT model are important tools for land cover and land use changes investigation and the assessment of BMPs implementation effects on water quality. Thus, in this study, buffer strip, fertilization reduction and alternative crops were considered as BMPs and were implemented in the SWAT model for the Treene catchment. Their efficiency in terms of nitrate loads reduction related to implementation costs at the catchment scale was investigated. The practices correspond to the catchment conditions and are based on small and mid areal changes. Furthermore, the BMPs were evaluated from the perspective of ecologic and economic policies. The results evidenced different responses of the BMPs. The critical periods in winter were addressed by most of the BMPs. However, some practices like pasture land increase need to be implemented in greater area for better results in comparison to current activities. Furthermore, there is a greater nitrate reduction potential by combining BMPs containing fertilization reduction, buffer strips and soil coverage in winter. The discussion about efficiency showed the complexity of costs stipulation and the relation with arable land and yield losses. Furthermore, as the government policies can be divergent an integrated approach considering all the involved actors is important and seeks a sustainable development. Copyright © 2017 Elsevier Ltd. All rights reserved.

Spreadsheet WATERSHED modeling for nonpoint-source pollution management in a Wisconsin basin

USGS Publications Warehouse

Walker, J.F.; Pickard, S.A.; Sonzogni, W.C.

1989-01-01

Although several sophisticated nonpoint pollution models exist, few are available that are easy to use, cover a variety of conditions, and integrate a wide range of information to allow managers and planners to assess different control strategies. Here, a straightforward pollutant input accounting approach is presented in the form of an existing model (WATERSHED) that has been adapted to run on modern electronic spreadsheets. As an application, WATERSHED is used to assess options to improve the quality of highly eutrophic Delavan Lake in Wisconsin. WATERSHED is flexible in that several techniques, such as the Universal Soil Loss Equation or unit-area loadings, can be used to estimate nonpoint-source inputs. Once the model parameters are determined (and calibrated, if possible), the spreadsheet features can be used to conduct a sensitivity analysis of management options. In the case of Delavan Lake, it was concluded that, although some nonpoint controls were cost-effective, the overall reduction in phosphorus would be insufficient to measurably improve water quality.A straightforward pollutant input accounting approach is presented in the form of an existing model (WATERSHED) that has been adapted to run on modern electronic spreadsheets. As an application, WATERSHED is used to assess options to improve the quality of highly eutrophic Delavan Lake in Wisconsin. WATERSHED is flexible in that several techniques, such as the Universal Soil Loss Equation or unit-area loadings, can be used to estimate nonpoint-source inputs. Once the model parameters are determined (and calibrated, if possible), the spreadsheet features can be used to conduct a sensitivity analysis of management options. In the case of Delavan Lake, it was concluded that, although some nonpoint controls were cost-effective, the overall reduction in phosphorus would be insufficient to measurably improve water quality.

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

PubMed Central

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

2005-01-01

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

The optimality of hospital financing system: the role of physician-manager interactions.

PubMed

Crainich, David; Leleu, Hervé; Mauleon, Ana

2008-12-01

The ability of a prospective payment system to ensure an optimal level of both quality and cost reducing activities in the hospital industry has been stressed by Ma (Ma, J Econ Manage Strategy 8(2):93-112, 1994) whose analysis assumes that decisions about quality and costs are made by a single agent. This paper examines whether this result holds when the main decisions made within the hospital are shared between physicians (quality of treatment) and hospital managers (cost reduction). Ma's conclusions appear to be relevant in the US context (where the hospital managers pay the whole cost of treatment). Nonetheless, when physicians partly reimburse hospitals for the treatment cost as it is the case in many European countries, we show that the ability of a prospective payment system to achieve both objectives is sensitive to the type of interaction (simultaneous, sequential or joint decision-making) between the agents. Our analysis suggests that regulation policies in the hospital sector should not be exclusively focused on the financing system but should also take the interaction between physicians and hospital managers into account.

Development of EPA aircraft piston engine emission standards. [for air quality

NASA Technical Reports Server (NTRS)

Houtman, W.

1976-01-01

Piston engine light aircraft are significant sources of carbon monoxide in the vicinity of high activity general aviation airports. Substantial reductions in carbon monoxide were achieved by fuel mixture leaning using improved fuel management systems. The air quality impact of the hydrocarbon and oxides of nitrogen emissions from piston engine light aircraft were insufficient to justify the design constraints being confronted in present control system developments.

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.

NOAA - National Oceanic and Atmospheric Administration - Information

Science.gov Websites

Council Committees Services & Programs Freedom of Information Act (FOIA) Commerce Geospatial Resources Homeland Security and Employee Check-In Information Quality NOAA Libraries NOAALink Paperwork Reduction & Information Collection Privacy Radio Frequency Management Contact Us Staff Directory IT Workforce

Reducing variation in general practitioner referral rates through clinical engagement and peer review of referrals: a service improvement project.

PubMed

Evans, Elizabeth; Aiking, Harry; Edwards, Adrian

2011-01-01

General practitioner (GP) referral rates to hospital services vary widely, without clearly identified explanatory factors, introducing important quality and patient safety issues. Referrals are rising everywhere year on year; some of these may be more appropriately redirected to lower technology services. To use peer review with consultant engagement to influence GPs to improve the quality and effectiveness of their referrals. Service development project. Ten out of 13 GP practices in Torfaen, Gwent; consultants from seven specialties in Gwent Healthcare NHS Trust; project designed and managed within Torfaen Local Health Board between 2008 and 2009. GPs discussed the appropriateness of referrals in selected specialties, including referral information and compatibility with local guidelines, usually on a weekly basis and were provided with regular feedback of 'benchmarked' referral rates. Six-weekly 'cluster groups', involving GPs, hospital specialists and community health practitioners discussed referral pathways and appropriate management in community based services. Overall there was a reduction in variation in individual GP referral rates (from 2.6-7.7 to 3.0-6.5 per 1000 patients per quarter) and a related reduction in overall referral rate (from 5.5 to 4.3 per 1000 patients per quarter). Both reductions appeared sustainable whilst the intervention continued, and referral rates rose in keeping with local trends once the intervention finished. This intervention appeared acceptable to GPs because of its emphasis on reviewing appropriateness and quality of referrals and was effective and sustainable while the investment in resources continued. Consultant involvement in discussions appeared important. The intervention's cost-effectiveness requires evaluation for consideration of future referral management strategies.

Integrating water quality responses to best management practices in Portugal.

PubMed

Fonseca, André; Boaventura, Rui A R; Vilar, Vítor J P

2018-01-01

Nutrient nonpoint pollution has a significant impact on water resources worldwide. The main challenge of this work was to assess the application of best management practices in agricultural land to comply with water quality legislation for surface waters. The Hydrological Simulation Program-FORTRAN was used to evaluate water quality of Ave River in Portugal. Best management practices (infiltration basin) (BMP) were applied to agricultural land (for 3, 6, 9, 12, and 15% area) with removal efficiencies of 50% for fecal coliforms and 30% for nitrogen, phosphorus, and biochemical oxygen demand. The inflow of water quality constituents was reduced for all scenarios, with fecal coliforms achieving the highest reduction between 5.8 and 28.9% and nutrients and biochemical oxygen demand between 2 and 13%. Biochemical oxygen demand and orthophosphates concentrations achieved a good water quality status according to the European Legislation for scenarios of BMP applied to 3 and 12% agricultural area, respectively. Fecal coliform levels in Ave River basin require further treatment to fall below the established value in the abovementioned legislation. This study shows that agricultural watersheds such as Ave basins demand special attention in regard to nonpoint pollution sources effects on water quality and nutrient loads.

Identifying biogeochemical processes beneath stormwater infiltration ponds in support of a new best management practice for groundwater protection

USGS Publications Warehouse

O'Reilly, Andrew M.; Chang, Ni-Bin; Wanielista, Martin P.; Xuan, Zhemin; Schirmer, Mario; Hoehn, Eduard; Vogt, Tobias

2011-01-01

 When applying a stormwater infiltration pond best management practice (BMP) for protecting the quality of underlying groundwater, a common constituent of concern is nitrate. Two stormwater infiltration ponds, the SO and HT ponds, in central Florida, USA, were monitored. A temporal succession of biogeochemical processes was identified beneath the SO pond, including oxygen reduction, denitrification, manganese and iron reduction, and methanogenesis. In contrast, aerobic conditions persisted beneath the HT pond, resulting in nitrate leaching into groundwater. Biogeochemical differences likely are related to soil textural and hydraulic properties that control surface/subsurface oxygen exchange. A new infiltration BMP was developed and a full-scale application was implemented for the HT pond. Preliminary results indicate reductions in nitrate concentration exceeding 50% in soil water and shallow groundwater beneath the HT pond.

Contribution to systematic education of quality management in Slovak health care.

PubMed

Rusnakova, V; Bacharova, L

2001-01-01

Of the study was to contribute to quality improvement initiatives in Slovak health services through systematic approach to the education and training in quality management (QM). Consequently, the main objectives were to analyse the content of the education in QM abroad, to conduct an audit of perceived training needs in Slovakia, and to propose the design of QM training programme to be applied within CME scheme based on the study results. Triangular method in the design of the study was implemented. Review of relevant information, data from the questionnaire and semi-structured interview in the sample of 67 Slovak trainees from Health Management School and School of Public Health--were adopted in complementary fashion. Highlighted in the survey are positive attitudes to training in quality management documented by the median score higher than 6 in all tested areas, on scale 0-10. No significant differences in profession groups as physicians, nurses, HC managers or among training institutions involved were displayed. However, potential obstacles were identified in deeper study using interviews. The absence of knowledge and skills in management in general and in quality management approaches especially are observed. Typically, the role of strategic planning is undermined. The large scale of quality management approaches is converted to problems of accreditation. Barriers to participative culture, innovation, devolution of accountability, resistance to change and to team based management are authentic findings as well. Drawn from the study were related to: fostering managers--"transformational leaders" for locally driven decision making in health care policy and practice; need of training activities for the continuing education in quality with respect to specific target groups interests and their level of knowledge in management; content of training oriented towards combination of rational utilization of information, critical analytical skills and planning for quality with human resource development-interpersonal skills, team building (soft skills), not just reduction of quality management tools to hard techniques (statistics, ISO norms); methods of education, where the usage of experiential learning methods, participative training inclusive action learning is highlighted; team training complemented with individual professional development support inclusive a coaching and mentoring scheme. AS IMPLICATIONS: Four types of CME training: Basic Module QM, Training for QM teams, Training Trainers Scheme and Guiding through Accreditation and Quality Award were proposed. (Tab. 9, Ref. 38.)

Achieving performance breakthroughs in an HMO business process through quality planning.

PubMed

Hanan, K B

1993-01-01

Kaiser Permanente's Georgia Region commissioned a quality planning team to design a new process to improve payments to its suppliers and vendors. The result of the team's effort was a 73 percent reduction in cycle time. This team's experiences point to the advantages of process redesign as a quality planning model, as well as some general guidelines for its most effective use in teams. If quality planning project teams are carefully configured, sufficiently expert in the existing process, and properly supported by management, organizations can achieve potentially dramatic improvements in process performance using this approach.

A comprehensive review of the SLMTA literature part 2: Measuring success

PubMed Central

Yao, Katy; Nkengasong, John N.

2014-01-01

Background Since its introduction in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has been implemented in 617 laboratories in 47 countries. Objective We completed a systematic review of the published literature on SLMTA. The review consists of two companion papers; this article examines quantitative evidence presented in the publications along with a meta-analysis of selected results. Methods We identified 28 published articles with data from SLMTA implementation. The SLMTA programme was evaluated through audits based on a standard checklist, which is divided into 12 sections corresponding to the 12 Quality System Essentials (QSEs). Several basic service delivery indicators reported by programmes were also examined. Results for various components of the programme were reviewed and summarised; a meta-analysis of QSE results grouped by the three stages of the quality cycle was conducted for 126 laboratories in 12 countries. Results Global programme data show improved quality in SLMTA laboratories in every country, with average improvements on audit scores of 25 percentage points. Meta-analysis identified Improvement Management as the weakest stage, with internal audit (8%) and occurrence management (16%) showing the lowest scores. Studies documented 19% – 95% reductions in turn-around times, 69% – 93% reductions in specimen rejection rates, 76% – 81% increases in clinician satisfaction rates, 67% – 85% improvements in external quality assessment results, 50% – 66% decreases in nonconformities and 67% increases in staff punctuality. Conclusions The wide array of results reported provides a comprehensive picture of the SLMTA programme overall, suggesting a substantive impact on provision of quality laboratory services and patient care. These comprehensive results establish a solid data-driven foundation for program improvement and further expansion. PMID:29043201

Creating patient value in glaucoma care: applying quality costing and care delivery value chain approaches--a five-year case study in the Rotterdam Eye Hospital.

PubMed

de Korne, Dirk F; Sol, Kees; Custers, Thomas; van Sprundel, Esther; van Ineveld, B Martin; Lemij, Hans G; Klazinga, Niek S

2009-01-01

The purpose of this paper is to explore in a specific hospital care process the applicability in practice of the theories of quality costing and value chains. In a retrospective case study an in-depth evaluation of the use of a quality cost model (QCM) and the applicability of Porter's care delivery value chain (CDVC) was performed in a specific care process: glaucoma care over the period 2001 to 2006 in the Rotterdam Eye Hospital in The Netherlands. The case study shows a reduction of costs per product by increasing the number of outpatient visits and surgery combined with a higher patient satisfaction. Reduction of costs of non-compliance by using the QCM is small, due to the absence of (external) financial incentives for both the hospital and individual physicians. For CDVC to be supportive to an integrated quality and cost management the notion "patient value" needs far more specification as mutually agreed on by the stakeholders involved and related reimbursement needs to depend on realised outcomes. The case study just focused on one specific care process in one hospital. To determine effects in other areas of health care, it is important to study the use and applicability of the QCM and the CDVC in other care processes and settings. QCM and a CDVC can be useful tools for hospital management to manage the outcomes on both quality and costs, but impact is dependent on the incentives in the context of the existing organisational and reimbursement system and asks for an agreed on operationalisation among the various stakeholders of the notion of patient value.

[Quality control in anesthesiology].

PubMed

Muñoz-Ramón, J M

1995-03-01

The process of quality control and auditing of anesthesiology allows us to evaluate care given by a service and solve problems that are detected. Quality control is a basic element of care giving and is only secondarily an area of academic research; it is therefore a meaningless effort if the information does not serve to improve departmental procedures. Quality assurance procedures assume certain infrastructural requirements and an initial period of implementation and adjustment. The main objectives of quality control are the reduction of morbidity and mortality due to anesthesia, assurance of the availability and proper management of resources and, finally, the well-being and safety of the patient.

Effects of agricultural management on productivity, soil quality and climate change mitigation - evaluations within the EU Project (FP 7) CATCH-C

NASA Astrophysics Data System (ADS)

Spiegel, Heide; Schlatter, Norman; Haslmayr, Hans-Peter; Baumgarten, Andreas; ten Berge, Hein

2014-05-01

Soils are the main basis for the production of food and feed. Furthermore, the production of biomass for energy and material use is becoming increasingly important. Goals for an optimal management of agricultural soils are, on the one hand, the maintenance or improvement of soil quality and, on the other hand, high productivity and climate change mitigation (reduction of GHG emissions and C sequestration). Thus, the EU project CATCH-C aims to evaluate current management practices concerning these three goals based on indicators derived from long-term field experiments of the project partners and from literature data. A maximum of 72 indicators for productivity, soil quality and the potential for carbon storage in the soil and the reduction of greenhouse gas emissions were selected by the project partners. As indicators for productivity, crop yields are determined in almost all field trials. The content of soil organic carbon (SOC) is an indicator for chemical, physical and biological soil quality and was analysed in the topsoil in all field trials. Less data exist for SOC contents in the subsoil. An important physical soil quality indicator is the bulk density, however, it is not determined in all field trials of the project partners. Therefore, information on SOC stocks, with relevance to carbon storage and climate change mitigation, is not available in all field experiments. Other physical indicators, such as penetration resistance, runoff coefficient and soil losses are evaluated. Essential biological indicators are microbial biomass and the number and weight of earthworms, which have been tested in several field trials. The evaluation of all these indicators will help to select "best management practices" and to address trade-offs and synergies for all indicators under consideration of major European farm type zones. CATCH-C is funded within the 7th Framework Programme for Research, Technological Development and Demonstration, Theme 2 - Biotechnologies, Agriculture & Food. (Grant Agreement N° 289782).

Three types of rescue can avert extinction in a changing environment

USDA-ARS?s Scientific Manuscript database

Setting aside high quality, large areas of habitat to protect threatened populations is becoming increasingly difficult as humans fragment and degrade the environment. Biologists and managers therefore must determine the best way to shepherd small populations through the dual challenges of reduction...

Opening the black box: evaluation of nutrient nonpoint source management for estuarine watersheds

EPA Science Inventory

Over the last 40 years, there have been significant improvements in water quality and ecosystem condition in estuaries stressed by nutrient enrichment. However, documented improvements have been largely attributed to reductions in point sources. In contrast, improvement of coasta...

WATERSHED CENTRAL: AN INTEGRATED WATERSHED ASSESSMENT AND MANAGEMENT WEBSITE

EPA Science Inventory

The Clean Water Act (CWA) requires that States develop pollution reduction targets for impaired or threatened waters often referred to as total maximum daily loads (TMDLs). These are waters that do not meet state water quality standards or will have impending problems meeting th...

What Is the Return on Investment for Implementation of a Crew Resource Management Program at an Academic Medical Center?

PubMed

Moffatt-Bruce, Susan D; Hefner, Jennifer L; Mekhjian, Hagop; McAlearney, John S; Latimer, Tina; Ellison, Chris; McAlearney, Ann Scheck

Crew Resource Management (CRM) training has been used successfully within hospital units to improve quality and safety. This article presents a description of a health system-wide implementation of CRM focusing on the return on investment (ROI). The costs included training, programmatic fixed costs, time away from work, and leadership time. Cost savings were calculated based on the reduction in avoidable adverse events and cost estimates from the literature. Between July 2010 and July 2013, roughly 3000 health system employees across 12 areas were trained, costing $3.6 million. The total number of adverse events avoided was 735-a 25.7% reduction in observed relative to expected events. Savings ranged from a conservative estimate of $12.6 million to as much as $28.0 million. Therefore, the overall ROI for CRM training was in the range of $9.1 to $24.4 million. CRM presents a financially viable way to systematically organize for quality improvement.

Fishing for ecosystem services.

PubMed

Pope, Kevin L; Pegg, Mark A; Cole, Nicholas W; Siddons, Stephen F; Fedele, Alexis D; Harmon, Brian S; Ruskamp, Ryan L; Turner, Dylan R; Uerling, Caleb C

2016-12-01

Ecosystems are commonly exploited and manipulated to maximize certain human benefits. Such changes can degrade systems, leading to cascading negative effects that may be initially undetected, yet ultimately result in a reduction, or complete loss, of certain valuable ecosystem services. Ecosystem-based management is intended to maintain ecosystem quality and minimize the risk of irreversible change to natural assemblages of species and to ecosystem processes while obtaining and maintaining long-term socioeconomic benefits. We discuss policy decisions in fishery management related to commonly manipulated environments with a focus on influences to ecosystem services. By focusing on broader scales, managing for ecosystem services, and taking a more proactive approach, we expect sustainable, quality fisheries that are resilient to future disturbances. To that end, we contend that: (1) management always involves tradeoffs; (2) explicit management of fisheries for ecosystem services could facilitate a transition from reactive to proactive management; and (3) adaptive co-management is a process that could enhance management for ecosystem services. We propose adaptive co-management with an ecosystem service framework where actions are implemented within ecosystem boundaries, rather than political boundaries, through strong interjurisdictional relationships. Published by Elsevier Ltd.

Fishing for ecosystem services

USGS Publications Warehouse

Pope, Kevin L.; Pegg, Mark A.; Cole, Nicholas W.; Siddons, Stephen F.; Fedele, Alexis D.; Harmon, Brian S.; Ruskamp, Ryan L.; Turner, Dylan R.; Uerling, Caleb C.

2016-01-01

Ecosystems are commonly exploited and manipulated to maximize certain human benefits. Such changes can degrade systems, leading to cascading negative effects that may be initially undetected, yet ultimately result in a reduction, or complete loss, of certain valuable ecosystem services. Ecosystem-based management is intended to maintain ecosystem quality and minimize the risk of irreversible change to natural assemblages of species and to ecosystem processes while obtaining and maintaining long-term socioeconomic benefits. We discuss policy decisions in fishery management related to commonly manipulated environments with a focus on influences to ecosystem services. By focusing on broader scales, managing for ecosystem services, and taking a more proactive approach, we expect sustainable, quality fisheries that are resilient to future disturbances. To that end, we contend that: (1) management always involves tradeoffs; (2) explicit management of fisheries for ecosystem services could facilitate a transition from reactive to proactive management; and (3) adaptive co-management is a process that could enhance management for ecosystem services. We propose adaptive co-management with an ecosystem service framework where actions are implemented within ecosystem boundaries, rather than political boundaries, through strong interjurisdictional relationships.

Trace organic chemical attenuation during managed aquifer recharge: Insights from a variably saturated 2D tank experiment

NASA Astrophysics Data System (ADS)

Regnery, Julia; Lee, Jonghyun; Drumheller, Zachary W.; Drewes, Jörg E.; Illangasekare, Tissa H.; Kitanidis, Peter K.; McCray, John E.; Smits, Kathleen M.

2017-05-01

Meaningful model-based predictions of water quality and quantity are imperative for the designed footprint of managed aquifer recharge installations. A two-dimensional (2D) synthetic MAR system equipped with automated sensors (temperature, water pressure, conductivity, soil moisture, oxidation-reduction potential) and embedded water sampling ports was used to test and model fundamental subsurface processes during surface spreading managed aquifer recharge operations under controlled flow and redox conditions at the meso-scale. The fate and transport of contaminants in the variably saturated synthetic aquifer were simulated using the finite element analysis model, FEFLOW. In general, the model concurred with travel times derived from contaminant breakthrough curves at individual sensor locations throughout the 2D tank. However, discrepancies between measured and simulated trace organic chemical concentrations (i.e., carbamazepine, sulfamethoxazole, tris (2-chloroethyl) phosphate, trimethoprim) were observed. While the FEFLOW simulation of breakthrough curves captured overall shapes of trace organic chemical concentrations well, the model struggled with matching individual data points, although compound-specific attenuation parameters were used. Interestingly, despite steady-state operation, oxidation-reduction potential measurements indicated temporal disturbances in hydraulic properties in the saturated zone of the 2D tank that affected water quality.

Assessment of health benefits related to air quality improvement strategies in urban areas: An Impact Pathway Approach.

PubMed

Silveira, Carlos; Roebeling, Peter; Lopes, Myriam; Ferreira, Joana; Costa, Solange; Teixeira, João P; Borrego, Carlos; Miranda, Ana I

2016-12-01

Air pollution is, increasingly, a concern to our society given the threats to human health and the environment. Concerted actions to improve air quality have been taken at different levels, such as through the development of Air Quality Plans (AQPs). However, air quality impacts associated with the implementation of abatement measures included in AQPs are often neglected. In order to identify the major gaps and strengths in current knowledge, a literature review has been performed on existing methodologies to estimate air pollution-related health impacts and subsequent external costs. Based on this review, the Impact Pathway Approach was adopted and applied within the context of the MAPLIA research project to assess the health impacts and benefits (or avoided external costs) derived from improvements in air quality. Seven emission abatement scenarios, based on individual and combined abatement measures, were tested for the major activity sectors (traffic, residential and industrial combustion and production processes) of a Portuguese urban area (Grande Porto) with severe particular matter (PM10) air pollution problems. Results revealed a strong positive correlation between population density and health benefits obtained from the assessed reduction scenarios. As a consequence, potential health benefits from reduction scenarios are largest in densely populated areas with high anthropic activity and, thus, where air pollution problems are most alarming. Implementation of all measures resulted in a reduction in PM10 emissions by almost 8%, improving air quality by about 1% and contributing to a benefit of 8.8 million €/year for the entire study domain. The introduction of PM10 reduction technologies in industrial units was the most beneficial abatement measure. This study intends to contribute to policy support for decision-making on air quality management. Copyright © 2016 Elsevier Ltd. All rights reserved.

Youpi: YOUr processing PIpeline

NASA Astrophysics Data System (ADS)

Monnerville, Mathias; Sémah, Gregory

2012-03-01

Youpi is a portable, easy to use web application providing high level functionalities to perform data reduction on scientific FITS images. Built on top of various open source reduction tools released to the community by TERAPIX (http://terapix.iap.fr), Youpi can help organize data, manage processing jobs on a computer cluster in real time (using Condor) and facilitate teamwork by allowing fine-grain sharing of results and data. Youpi is modular and comes with plugins which perform, from within a browser, various processing tasks such as evaluating the quality of incoming images (using the QualityFITS software package), computing astrometric and photometric solutions (using SCAMP), resampling and co-adding FITS images (using SWarp) and extracting sources and building source catalogues from astronomical images (using SExtractor). Youpi is useful for small to medium-sized data reduction projects; it is free and is published under the GNU General Public License.

A qualitative analysis of case managers' use of harm reduction in practice.

PubMed

Tiderington, Emmy; Stanhope, Victoria; Henwood, Benjamin F

2013-01-01

The harm reduction approach has become a viable framework within the field of addictions, yet there is limited understanding about how this approach is implemented in practice. For people who are homeless and have co-occurring psychiatric and substance use disorders, the Housing First model has shown promising results in employing such an approach. This qualitative study utilizes ethnographic methods to explore case managers' use of harm reduction within Housing First with a specific focus on the consumer-provider relationship. Analysis of observational data and in-depth interviews with providers and consumers revealed how communication between the two regarding the consumer's substance use interacted with the consumer-provider relationship. From these findings emerged a heuristic model of harm reduction practice that highlighted the profound influence of relationship quality on the paths of communication regarding substance use. This study provides valuable insight into how harm reduction is implemented in clinical practice that ultimately has public health implications in terms of more effectively addressing high rates of addiction that contribute to homelessness and health disparities. Copyright © 2013 Elsevier Inc. All rights reserved.

Trade-off between Photon Management Efficacy and Material Quality in Thin-Film Solar Cells on Nanostructured Substrates of High Aspect Ratio Structures

DOE PAGES

Chin, Alan; Keshavarz, Majid; Wang, Qi

2018-04-13

Although texturing of the transparent electrode of thin-film solar cells has long been used to enhance light absorption via light trapping, such texturing has involved low aspect ratio features. With the recent development of nanotechnology, nanostructured substrates enable improved light trapping and enhanced optical absorption via resonances, a process known as photon management, in thin-film solar cells. Despite the progress made in the development of photon management in thin-film solar cells using nanostructures substrates, the structural integrity of the thin-film solar cells deposited onto such nanostructured substrates is rarely considered. Here, we report the observation of the reduction in themore » open circuit voltage of amorphous silicon solar cells deposited onto a nanostructured substrate with increasing areal number density of high aspect ratio structures. For a nanostructured substrate with the areal number density of such nanostructures increasing in correlation with the distance from one edge of the substrate, a correlation between the open circuit voltage reduction and the increase of the areal number density of high aspect ratio nanostructures of the front electrode of the small-size amorphous silicon solar cells deposited onto different regions of the substrate with graded nanostructure density indicates the effect of the surface morphology on the material quality, i.e., a trade-off between photon management efficacy and material quality. Lastly, this observed trade-off highlights the importance of optimizing the morphology of the nanostructured substrate to ensure conformal deposition of the thin-film solar cell.« less

Trade-off between Photon Management Efficacy and Material Quality in Thin-Film Solar Cells on Nanostructured Substrates of High Aspect Ratio Structures

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

Chin, Alan; Keshavarz, Majid; Wang, Qi

Although texturing of the transparent electrode of thin-film solar cells has long been used to enhance light absorption via light trapping, such texturing has involved low aspect ratio features. With the recent development of nanotechnology, nanostructured substrates enable improved light trapping and enhanced optical absorption via resonances, a process known as photon management, in thin-film solar cells. Despite the progress made in the development of photon management in thin-film solar cells using nanostructures substrates, the structural integrity of the thin-film solar cells deposited onto such nanostructured substrates is rarely considered. Here, we report the observation of the reduction in themore » open circuit voltage of amorphous silicon solar cells deposited onto a nanostructured substrate with increasing areal number density of high aspect ratio structures. For a nanostructured substrate with the areal number density of such nanostructures increasing in correlation with the distance from one edge of the substrate, a correlation between the open circuit voltage reduction and the increase of the areal number density of high aspect ratio nanostructures of the front electrode of the small-size amorphous silicon solar cells deposited onto different regions of the substrate with graded nanostructure density indicates the effect of the surface morphology on the material quality, i.e., a trade-off between photon management efficacy and material quality. Lastly, this observed trade-off highlights the importance of optimizing the morphology of the nanostructured substrate to ensure conformal deposition of the thin-film solar cell.« less

Ammonia emissions from land application of manures

USDA-ARS?s Scientific Manuscript database

Ammonia volatilization can be a major nitrogen (N) loss process for surface-applied manures. There is concern that current manure management practices are contributing to ammonia losses in the Mid-Atlantic region with subsequent reductions in air quality and increases in N losses to streams and est...

38 CFR 52.120 - Quality of care.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... (f) Range of motion. Based on the comprehensive assessment of a participant, the program management must ensure that— (1) A participant who enters the program without a limited range of motion does not experience reduction in range of motion unless the participant's clinical condition demonstrates that a...

38 CFR 52.120 - Quality of care.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... (f) Range of motion. Based on the comprehensive assessment of a participant, the program management must ensure that— (1) A participant who enters the program without a limited range of motion does not experience reduction in range of motion unless the participant's clinical condition demonstrates that a...

Watershed Central: An Integrated Watershed Assessment and Management Website - St. Louis

EPA Science Inventory

The Clean Water Act (CWA) requires that States develop pollution reduction targets for impaired or threatened waters often referred to as total maximum daily loads (TMDLs). These are waters that do not meet state water quality standards or will have impending problems meeting th...

WATERSHED CENTRAL: AN INTEGRATED WATERSHED ASSESSMENT AND MANAGEMENT WEBSITE (PRESENTATION)

EPA Science Inventory

The Clean Water Act (CWA) requires that States develop pollution reduction targets for impaired or threatened waters often referred to as total maximum daily loads (TMDLs). These are waters that do not meet state water quality standards or will have impending problems meeting th...

WATERSHED CENTRAL: AN INTEGRATED WATERSHED ASSESSMENT AND MANAGEMENT WEBSITE (2)

EPA Science Inventory

The Clean Water Act (CWA) requires that States develop pollution reduction targets for impaired or threatened waters often referred to as total maximum daily loads (TMDLs). These are waters that do not meet state water quality standards or will have impending problems meeting th...

Connecting Seasonal Riparian Buffer Metrics and Nitrogen Concentrations in a Pulse-Driven Agricultural System

EPA Science Inventory

Riparian buffers have been well studied as best management practices for nutrient reduction at field scales yet their effectiveness for bettering water quality at watershed scales has been difficult to determine. Seasonal dynamics of the stream network are often overlooked when ...

The future of salmonid communities in the Laurentian Great Lakes

USGS Publications Warehouse

Smith, Stanford H.

1972-01-01

The effects of human population growth, industrialization, and the introduction of marine fishes have reduced the suitability of each of the Great Lakes for oligotrophic fish communities. The ultimate consequence has been a reduction of fishery productivity that has ranged from extreme in Lake Ontario to moderate in Lake Superior. If measures are not taken to alleviate the adverse effects of marine invaders and trends in environmental quality, a major reduction in fishery productivity can eventually be expected throughout the Great Lakes.Prospects for the next century will be improved if the lakes can be intensively managed. More stringent control of the sea lamprey (Petromyzon marinus), and subsequent reduction of the alewife (Alosa pseudoharengus), by the reestablishment of populations of large piscivores, should permit the recovery of some of the previous predator and prey species, or the development of populations of new species that are more compatible with a reduced number of lampreys. Even if marine species can be reduced greatly, the full restoration of the former fishery productivity remains uncertain and will require a high degree of coordination among all management and research agencies that have responsibilities on the Great Lakes.Unfavorable trends toward progressive degradation of water quality pose the greatest threat to restoration of the fishery resources of the Great Lakes. Where changes in water quality have been the greatest, oligotrophic species have become scarce or absent, and in the deepwater regions no other species have reoccupied the vacated niches.

Safe surgical technique for associated acetabular fractures

PubMed Central

2013-01-01

Associated acetabular fractures are challenging injuries to manage. The complex surgical approaches and the technical difficulty in achieving anatomical reduction imply that the learning curve to achieve high-quality care of patients with such challenging injuries is extremely steep. This first article in the Journal’s “Safe Surgical Technique” section presents the standard surgical care, in conjunction with intraoperative tips and tricks, for the safe management of all subgroups of associated acetabular fractures. PMID:23414782

My Treatment Approach to Rheumatoid Arthritis

PubMed Central

Davis, John M.; Matteson, Eric L.

2012-01-01

The past decade has brought important advances in the understanding of rheumatoid arthritis and its management and treatment. New classification criteria for rheumatoid arthritis, better definitions of treatment outcome and remission, and the introduction of biologic response-modifying drugs designed to inhibit the inflammatory process have greatly altered the approach to managing this disease. More aggressive management of rheumatoid arthritis early after diagnosis and throughout the course of the disease has resulted in improvement in patient functioning and quality of life, reduction in comorbid conditions, and enhanced survival. PMID:22766086

Paying for disease management.

PubMed

Levy, Phillip; Nocerini, Robert; Grazier, Kyle

2007-08-01

Disease Management (DM) first appeared in the United States in the early 1990s. Since then its incorporation into health plans has increased dramatically, yet proof of its effectiveness in terms of quality improvement and cost reduction remains to be seen. The following review provides an exploratory analysis of the basic principles of DM, its evolution and differences from traditional managed care, the ways in which programs are currently being used in the private and public sectors, and the challenges to determining a payment structure for incorporating DM into the current health insurance system.

Consequential environmental and economic life cycle assessment of green and gray stormwater infrastructures for combined sewer systems.

PubMed

Wang, Ranran; Eckelman, Matthew J; Zimmerman, Julie B

2013-10-01

A consequential life cycle assessment (LCA) is conducted to evaluate the trade-offs between water quality improvements and the incremental climate, resource, and economic costs of implementing green (bioretention basin, green roof, and permeable pavement) versus gray (municipal separate stormwater sewer systems, MS4) alternatives of stormwater infrastructure expansions against a baseline combined sewer system with combined sewer overflows in a typical Northeast US watershed for typical, dry, and wet years. Results show that bioretention basins can achieve water quality improvement goals (e.g., mitigating freshwater eutrophication) for the least climate and economic costs of 61 kg CO2 eq. and $98 per kg P eq. reduction, respectively. MS4 demonstrates the minimum life cycle fossil energy use of 42 kg oil eq. per kg P eq. reduction. When integrated with the expansion in stormwater infrastructure, implementation of advanced wastewater treatment processes can further reduce the impact of stormwater runoff on aquatic environment at a minimal environmental cost (77 kg CO2 eq. per kg P eq. reduction), which provides support and valuable insights for the further development of integrated management of stormwater and wastewater. The consideration of critical model parameters (i.e., precipitation intensity, land imperviousness, and infrastructure life expectancy) highlighted the importance and implications of varying local conditions and infrastructure characteristics on the costs and benefits of stormwater management. Of particular note is that the impact of MS4 on the local aquatic environment is highly dependent on local runoff quality indicating that a combined system of green infrastructure prior to MS4 potentially provides a more cost-effective improvement to local water quality.

Effects of a One-to-One Fatigue Management Course for People With Chronic Conditions and Fatigue.

PubMed

Van Heest, Katy N L; Mogush, Ashley R; Mathiowetz, Virgil G

We assessed the impact of a one-to-one fatigue management course on participants' fatigue, self-efficacy, quality of life, and energy conservation behaviors. This observational study used a one-group, pretest-posttest, follow-up design. Forty-nine people with chronic conditions and fatigue participated in the one-to-one fatigue management course in outpatient and community-based settings. The Functional Assessment of Chronic Illness Therapy-Fatigue Scale was used to measure fatigue; the Functional Assessment of Cancer Therapy-General measured quality of life; and the Self-Efficacy for Performing Energy Conservation Strategies Assessment was used to measure self-efficacy. Participants showed significant reductions in fatigue and significant increases in self-efficacy and quality of life at posttest. These beneficial effects were maintained at follow-up. The Social Well-Being subscale was the only measure on which outcomes did not change significantly. The one-to-one fatigue management course is a beneficial intervention for people with chronic conditions and fatigue. Copyright © 2017 by the American Occupational Therapy Association, Inc.

Using Large-Scale Roughness Elements to Control Sand and Dust Flux at the Keeler Dunes, Keeler, CA

NASA Astrophysics Data System (ADS)

Gillies, John; McCarley-Holder, Grace

2014-05-01

Controlling dust emission from areas that subsequently degrade air quality and threaten human and animal health and reduce the quality of life for people residing in proximity to such sources is necessary, but also challenging. Recent research has indicated that arrays of large roughness elements (height >0.3 m) can be used effectively to modulate sand transport and the associated dust emissions. Prediction of the rate of sand flux reduction as a function of downwind distance upon entering an array of roughness elements, and the equilibrium flux reduction in the interior of the array is possible using the known geometric properties of the roughness elements, their number, and published relationships. Air quality in the town of Keeler, CA (36 deg 29' 17.92" N, 117 deg 52' 24.62" W) is degraded by levels of particulate matter <10 µm aerodynamic diameter (PM10) during periods of elevated wind speeds due to sand transport and dust emissions in the nearby Keeler Dunes. A demonstration project was designed to evaluate the effectiveness of an array of roughness elements composed of solid elements and managed vegetation to meet sand and dust flux reduction criteria. This project has two major goals: 1) to demonstrate that solid roughness elements placed on areas of the Keeler Dunes immediately arrest sand movement to specified levels (target of 85% reduction), and 2) to assess whether native plant species, planted in the sheltered area of the solid roughness elements can effectively thrive and subsequently replace the solid roughness to achieve the desired sand flux reduction control efficiency. This poster describes the results related mostly to objective one, as considerable time has to pass before sufficient data will be obtained to evaluate the success of the planted and managed vegetation to achieve a control level provided by the solid element roughness array.

How best management practices affect emissions in gas turbine power plants-An important factor to consider when strengthening emission standards.

PubMed

Zeng, Jinghai; Xing, Min; Hou, Min; England, Glenn C; Yan, Jing

2018-04-27

The Beijing Municipal Environmental Protection Bureau (EPB) is considering strengthening the Emission Standard of Air Pollutants for Stationary Gas Turbines, originally published in 2011 (DB11/847-2011), with a focus on reducing nitrogen oxides (NOx) emissions. A feasibility study was conducted to evaluate the current operation of 12 existing combined-cycle gas turbine power plants and the design of two new plants in Beijing and their emission reduction potential, in comparison with a state-of-the-art power plant in California. The study found that best management practices (BMPs) could potentially improve the emission level of the power plants, and should be implemented to minimize emissions under current design characteristics. These BMPs include (1) more frequent tuning of turbine combustors; (2) onsite testing of natural gas characteristics in comparison to turbine manufacturer's specifics and tuning of turbine to natural gas quality; (3) onsite testing of aqueous ammonia to ensure adequate ammonia concentration in the mixed solution, and the purity of the solution; (4) more careful inspection of the heat recovery steam generator (HRSG), and the selective catalytic reduction (SCR) during operation and maintenance; (5) annual testing of the catalyst coupon on the SCR to ensure catalyst effectiveness; and (6) annual ammonia injection grid (AIG) tuning. The study found that without major modification to the plants, improving the management of the Beijing gas turbine power plants may potentially reduce the current hourly average NOx emission level of 5-10 parts per million (ppm; ranges reflects plant variation) by up to 20%. The exact improvement associated with each BMP for each facility requires more detailed analysis, and requires engagement of turbine, HRSG, and SCR manufacturers. This potential improvement is an important factor to consider when strengthening the emission standard. However, note that with the continuous needs of improving air quality within the area, more expensive control measures, such as retrofitting the turbines or the HRSGs, may be considered. This study analyzed the potential emission reductions associated with implementing the best management practices (BMPs) on the combined cycle and cogeneration power plants in Beijing. It determined that implementing the BMPs could potentially achieve up to 580 metric tonnes, or 0.6%, reductions of all NOx emissions in Beijing. Many other cities in China and Asia battling air quality issues may find the information useful in order to evaluate the emission reduction potential of their own gas turbine power plants.

36 CFR 223.30 - Consistency with plans, environmental standards, and other management requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE SALE AND DISPOSAL OF NATIONAL FOREST SYSTEM TIMBER...) Providing favorable conditions of water flow and quality; (f) Utilization of the timber resource to provide... characteristics; (g) Reduction of the likelihood of loss to destructive agencies; and (h) Minimizing adverse...

Science and Policy Interactions: A Case Study with Acid Rain

EPA Science Inventory

Management of air pollution has a long history in the United States. A succession of laws, with the first Federal law, passed in 1955, has lead to substantial reductions in emissions and improvements in air quality. These laws were simulated originally by acute local effects on ...

The tree BVOC index

Treesearch

J.R. Simpson; E.G. McPherson

2011-01-01

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

Advisory on Relocatable and Renovated Classrooms. IAQ Info Sheet.

ERIC Educational Resources Information Center

California State Dept. of Health Services, Berkeley.

Many California school districts, in complying with the Class Size Reduction Program, will obtain relocatable classrooms directly from manufacturers who are under no specific guidelines or codes relative to indoor air quality (IAQ). This document, designed to aid school facility managers in minimizing potential IAQ problems, summarizes the indoor…

Reduction of accounts receivable through total quality management.

PubMed

LaFleur, N

1994-01-01

On October 1, 1990, The Miriam Hospital in Providence, R.I., converted to a new computer system for patient accounting applications and on-line registration functions. The new system automated the hospital's patient accounting, registration, and medical records functions and interfaced registration with patient accounts for billing purposes.

Gains from trans-boundary water quality management in linked catchment and coastal socio-ecological systems: a case study for the Minho region

NASA Astrophysics Data System (ADS)

Roebeling, P. C.; Brito, A. G.; Rocha, J.; Alves, H.; Mamede, J.

2012-04-01

Worldwide, aquatic and coastal ecosystems are affected by point and diffuse source water pollution originating from rural, urban and industrial land uses in catchments, even though these ecosystems are of vital importance from an environmental and economic perspective. Integrated Catchment and Coastal Zone Management (ICCZM) specifically takes into account this inherent relationship between terrestrial land use, surface and ground water pollution, aquatic and coastal ecosystem state, and associated environmental values. To warrant sustainable regional economic development, we need to balance the marginal costs from terrestrial water pollution abatement and the associated marginal benefits from aquatic and coastal resource appreciation. In doing so, however, we need to differentiate between intra- and trans-boundary catchments because benefactors and beneficiaries from water quality improvement are not one and the same. In trans-boundary catchments, private (national) welfare maximizing rates of water quality improvement differ across nations as benefits from water quality improvement generally accrue to one nation while the costs are paid by multiple nations. While approaches for water quality management in linked catchment and coastal socio-ecological systems are fairly recent though existent, water quality management in trans-boundary catchments poses additional challenges. The objective of this paper is to develop and apply a deterministic optimal control approach that allows us to explore private and social welfare maximizing rates of water pollution abatement in linked catchment and coastal socio-ecological systems. For a case study of the Minho region in the Iberian Peninsula, we estimate nation-specific water pollution abatement cost (based on management practice adoption) and benefit (based on aquatic and coastal environmental values) functions, to determine as well as compare private (national) and social (trans-national) welfare maximizing rates of water pollution abatement. The presented approach differs from existing approaches in a number of ways. First, we explicitly present an analytical derivation of private (national) and social (trans-national) welfare maximizing rates of water pollution abatement using nation-specific abatement cost functions. Second, the analytical optimal control approach provides an elegant and easily understandable solution concept that contributes to the development of efficient water quality improvement targets. Finally, we go beyond the usual cost-effectiveness analysis based on arbitrary 'tolerable' or target levels of pollution as we specifically account for the negative external costs of increased water pollution in the downstream aquatic and coastal environment. Results for the Minho region show that some private (national) welfare gains can be obtained through the adoption of win-win management practices, leading to a 12% reduction in the annual rate of water pollution and an almost 7% increase in annual regional income. Maximum social (trans-national) welfare gains can, however, be obtained through the adoption of win-win and lose-win management practices across Spain and Portugal, leading to a 36% reduction in water pollution and a 14% increase in regional income. Yet, non-cooperation in water pollution mitigation would only lead to a 16%-32% reduction in water pollution and a 8%-13% increase in regional income. Hence, social (trans-national) welfare losses from non-cooperation between Spain and Portugal would equate to between 16 and 81 million Euros per year.

Does lean muddy the quality improvement waters? A qualitative study of how a hospital management team understands lean in the context of quality improvement.

PubMed

Savage, Carl; Parke, Louise; von Knorring, Mia; Mazzocato, Pamela

2016-10-19

Health care has experimented with many different quality improvement (QI) approaches with greater variation in name than content. This has been dubbed pseudoinnovation. However, it could also be that the subtleties and differences are not clearly understood. To explore this further, the purpose of this study was to explore how hospital managers perceive lean in the context of QI. We used a qualitative study design with semi-structured interviews to explore twelve top managers' perceptions of the relationship between lean and quality improvement (QI) at a university-affiliated hospital. Managers described that QI and lean shared the same overall purpose: focus on patient needs and improve efficiency and effectiveness. Employee involvement was emphasized in both strategies, as well as the support offered by managers of staff initiatives. QI was perceived as a strategy that could support structural changes at the organizational level whereas lean was seen as applicable at the operational level. Moreover, lean carried a negative connotation, lacked the credibility of QI, and was perceived as a management fad. Aspects of QI and lean were misunderstood. In a context where lean remains an abstract term, and staff associate lean with automotive applications and cost reduction, it may be fruitful for managers to invest time and resources to develop a strategy for continual improvement and utilize vocabulary that resonates with health care staff. This could reduce the risk that improvement efforts are rejected out of hand.

Weight management program for treatment-emergent weight gain in olanzapine-treated patients with schizophrenia or schizoaffective disorder: A 12-week randomized controlled clinical trial.

PubMed

Kwon, Jun Soo; Choi, Jung-Seok; Bahk, Won-Myoung; Yoon Kim, Chang; Hyung Kim, Chan; Chul Shin, Young; Park, Byung-Joo; Geun Oh, Chang

2006-04-01

The main objective was to assess the efficacy of a weight management program designed for outpatients taking olanzapine for schizophrenia or schizoaffective disorder and to compare these patients with a randomized control group. The effects of the weight management program were also assessed with regard to safety and quality of life. Forty-eight patients were enrolled in a 12-week, randomized, multicenter weight management study. Thirty-three patients were randomly allocated to an intervention group in which they received olanzapine within a weight management program. Fifteen patients were allocated to a control group in which they were given olanzapine treatment as usual outpatients. Weight, body mass index (BMI), and measurements of safety and quality of life were evaluated. The study was conducted from January 7, 2003, to September 16, 2003. Thirty-six patients (75%) completed this study. We found significant differences in weight (-3.94 +/- 3.63 kg vs. -1.48 +/- 1.88 kg, p = .006) and BMI (-1.50 +/- 1.34 vs. -0.59 +/- 0.73, p = .007) change from baseline to endpoint between the intervention and control groups, respectively. Significant differences in weight reduction were initially observed at week 8 (p = .040). No significant differences were found with regard to the safety outcomes. When the ratio of low-density lipoproteins to high-density lipoproteins was calculated, change from baseline was greater in the intervention group than the control group (-0.19 vs. -0.04), but the difference was not statistically significant (p = .556). After the completion of the weight management program, there was a trend toward statistical difference in the physical health score changes between the weight management and control groups (1.12 in the intervention group vs. -0.93 in the control group, p = .067). The weight management program was effective in terms of weight reduction in patients with schizophrenia or schizoaffective disorder taking olanzapine and was also found to be safe in terms of psychiatric symptoms, vital signs, and laboratory data. In addition, such a weight management program might improve quality of life in patients with schizophrenia or schizoaffective disorder with respect to their physical well-being.

Flexible NO(x) abatement from power plants in the eastern United States.

PubMed

Sun, Lin; Webster, Mort; McGaughey, Gary; McDonald-Buller, Elena C; Thompson, Tammy; Prinn, Ronald; Ellerman, A Denny; Allen, David T

2012-05-15

Emission controls that provide incentives for maximizing reductions in emissions of ozone precursors on days when ozone concentrations are highest have the potential to be cost-effective ozone management strategies. Conventional prescriptive emissions controls or cap-and-trade programs consider all emissions similarly regardless of when they occur, despite the fact that contributions to ozone formation may vary. In contrast, a time-differentiated approach targets emissions reductions on forecasted high ozone days without imposition of additional costs on lower ozone days. This work examines simulations of such dynamic air quality management strategies for NO(x) emissions from electric generating units. Results from a model of day-specific NO(x) pricing applied to the Pennsylvania-New Jersey-Maryland (PJM) portion of the northeastern U.S. electrical grid demonstrate (i) that sufficient flexibility in electricity generation is available to allow power production to be switched from high to low NO(x) emitting facilities, (ii) that the emission price required to induce EGUs to change their strategies for power generation are competitive with other control costs, (iii) that dispatching strategies, which can change the spatial and temporal distribution of emissions, lead to ozone concentration reductions comparable to other control technologies, and (iv) that air quality forecasting is sufficiently accurate to allow EGUs to adapt their power generation strategies.

Psychiatric comorbidity and response to preventative therapy in the treatment of severe migraine trial.

PubMed

Seng, Elizabeth K; Holroyd, Kenneth A

2012-04-01

Mood and anxiety disorders are comorbid with migraine and commonly assumed to portend a poor response to preventive migraine therapies. However, there is little evidence to support this assumption. We examined impact of a mood and/or anxiety disorder diagnosis using American Psychiatric Association Diagnostic and Statistical Manual criteria on response to the three preventative migraine therapies evaluated in the Treatment of Severe Migraine trial (n = 177): β-blocker, behavioral migraine management, or behavioral migraine management +β-blocker. Daily diaries assessed migraine activity for the 16 months of the trial. The Migraine Specific Quality of Life Questionnaire and Headache Disability Inventory assessed headache-related disability at regular intervals. Mixed models for repeated measures examined changes in these three outcomes with preventative migraine therapy in participants with and without a mood or anxiety disorder diagnosis. Participants with a comorbid mood or anxiety disorder diagnosis recorded larger reductions in migraine days (p < .05) and larger reductions in the Migraine Specific Quality of Life Questionnaire (p < .001) and Headache Disability Inventory (p < .01) than did participants with neither diagnosis. Significantly larger reductions in migraine activity and migraine-related disability were observed in participants with a mood and/or anxiety disorder diagnosis than in participants who did not receive either diagnosis.

Impact of a pharmacist-led warfarin self-management program on quality of life and anticoagulation control: a randomized trial.

PubMed

Verret, Lucie; Couturier, Justine; Rozon, Andréanne; Saudrais-Janecek, Sarah; St-Onge, Amélie; Nguyen, Angela; Basmadjian, Arsène; Tremblay, Simon; Brouillette, Denis; de Denus, Simon

2012-10-01

To evaluate the impact of a pharmacist-led warfarin patient self-management program on quality of life and anticoagulation control compared with management in a physician-led specialized anticoagulation clinic. Prospective, randomized, controlled, open-label trial. Tertiary care academic medical center. A total of 114 patients aged 18-75 years who were followed at a specialized anticoagulation clinic, had received warfarin for at least 6 months, and were expected to continue warfarin for a minimum of 4 months. All patients attended an educational session on anticoagulation provided by a pharmacist. Patients randomized to the self-management group (58 patients) also received practical training to use the CoaguChek XS device and a self-management dosing algorithm. Patients in the control group (56 patients) continued to undergo standard management at the anticoagulation clinic. Patients completed a validated quality-of-life questionnaire and the validated Oral Anticoagulation Knowledge test at the beginning and end of the study. The quality of anticoagulation control was evaluated by using the time spent in therapeutic range. After 4 months of follow-up, a significant improvement in the self-management group was observed compared with the control group in four of the five quality-of-life topics (p<0.05). Improvements in knowledge were observed in both groups after the training session and persisted after 4 months (p<0.05 for all). The time spent in the therapeutic range (80.0% in the self-management group vs 75% in the control group, p=0.79) and in the extended therapeutic range ([target international normalized ratio ± 0.3] 93.2% in the self-management group vs 91.1% in the control group, p=0.30) were similar between groups. A self-management warfarin program led by pharmacists resulted in significant improvement in the quality of life of patients receiving warfarin therapy as well as a reduction in the time required for anticoagulation monitoring, while maintaining a level of anticoagulation control similar to a high-quality specialized anticoagulation clinic. © 2012 Pharmacotherapy Publications, Inc.

Health-related quality of life in randomized controlled trials of lorcaserin for obesity management: what mediates improvement?

PubMed

Kolotkin, R L; Crosby, R D; Wang, Z

2017-12-01

Lorcaserin, plus diet and exercise, has demonstrated significant weight loss and improved cardiometabolic parameters vs. placebo in patients with overweight/obesity in three randomized, placebo-controlled trials. We examined whether lorcaserin is also associated with greater improvements in health-related quality of life (HRQOL) and whether these improvements are wholly attributable to weight loss. Pooled data from Behavioral Modification and Lorcaserin for Overweight and Obesity Management (BLOOM), Behavioral Modification and Lorcaserin Second Study for Obesity Management (BLOSSOM) and BLOOM-Diabetes Mellitus (BLOOM-DM) trials were analysed (n = 5624). HRQOL was assessed at baseline and 52 weeks using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire. Multiple mediation analyses were conducted to evaluate the mechanisms underlying improved HRQOL. Greater HRQOL improvements were observed at 52 weeks in lorcaserin vs. placebo (P < 0.0001). A greater percentage of lorcaserin patients (54.1%) experienced meaningful improvements in IWQOL-Lite total score than placebo patients (48.2%) (P < 0.001). Body mass index (BMI) reduction was the primary driver of improved HRQOL (P < 0.0001), with depressive symptoms and total cholesterol also playing a role (P < 0.05). Improved HRQOL varied by gender, age, race and presence of diabetes and other comorbidities. Lorcaserin treatment significantly improves HRQOL compared with placebo. Although BMI reduction accounts for the majority of these improvements, improvement in depressive symptoms and total cholesterol are contributing factors. © 2017 World Obesity Federation.

Report of the FELASA Working Group on evaluation of quality systems for animal units.

PubMed

Howard, B; van Herck, H; Guillen, J; Bacon, B; Joffe, R; Ritskes-Hoitinga, M

2004-04-01

This report compares and considers the merits of existing, internationally available quality management systems suitable for implementation in experimental animal facilities. These are: the Good Laboratory Practice Guidelines, ISO 9000:2000 (International Organization for Standardization) and AAALAC International (Association for Assessment and Accreditation of Laboratory Animal Care International). Good laboratory practice (GLP) is a legal requirement for institutions undertaking non-clinical health and environmental studies for the purpose of registering or licensing for use and which have to be 'GLP-compliant'. GLP guidelines are often only relevant for and obtainable by those institutions. ISO is primarily an external business standard, which provides a management tool to master and optimize a business activity; it aims to implement and enhance 'customer satisfaction'. AAALAC is primarily a peer-reviewed system of accreditation which evaluates the organization and procedures in programmes of animal care and use to ensure the appropriate use of animals, safeguard animal well-being (ensuring state-of-the-art housing, management, procedural techniques, etc.) as well as the management of health and safety of staff. Management needs to determine, on the basis of a facility's specific goals, whether benefits would arise from the introduction of a quality system and, if so, which system is most appropriate. The successful introduction of a quality system confers peer-recognition against an independent standard, thereby providing assurance of standards of animal care and use, improving the quality of animal studies, and contributing to the three Rs-reduction, refinement and replacement.

Optimum Landscape Allocation of Conservation Practices for Water Quality and Ecosystem Service Valuation

NASA Astrophysics Data System (ADS)

Dalzell, B. J.; Pennington, D.; Nelson, E.; Mulla, D.; Polasky, S.; Taff, S.

2012-12-01

This study links a spatially-explicit biophysical model (SWAT) with an economic model (InVEST) to identify the economically optimum allocation of conservation practices on the landscape. Combining biophysical and economic analysis allows assessment of the benefits and costs of alternative policy choices through consideration of direct costs and benefits as measured by market transactions as well as non-market benefits and costs from changes in environmental conditions that lead to changes in the provision of ecosystem services. When applied to an agricultural watershed located in South-Central Minnesota, this approach showed that: (1) some modest gains (20% improvement, relative to baseline conditions) in water quality can be achieved without diminishing current economic returns, but that (2) more dramatic reductions in sediment and phosphorus required to meet water quality goals (50% reductions in loadings) will require transitioning land from row crops into perennial vegetation. This shift in land cover will result in a reduction in economic returns unless non-market ecosystem services are also valued. Further results showed that traditional best management practices such as conservation tillage and reduced fertilizer application rates are not sufficient to achieve water quality goals by themselves. Finally, if crop prices drop to pre-2007 levels or valuation of ecosystem services increases, then achieving water quality goals can occur with less of an economic impact to the watershed.

A new method based on fuzzy logic to evaluate the contract service provider performance.

PubMed

Miguel, C A; Barr, C; Moreno, M J L

2008-01-01

This paper puts forward a fuzzy inference system for evaluating the service quality performance of service contract providers. An application service provider (ASP) model for computerized maintenance management was used in establishing common performance indicators of the quality of service. This model was implemented in 10 separate hospitals. As a result, inference produced a service cost/acquisition cost (SC/AC) ratio reduction from 16.14% to 6.09%, an increase of 20.9% in availability, with a maintained repair quality (NRR) in the period of December 2001 to January 2003.

Exploring the Relationship Between Treatment Satisfaction, Perceived Improvements in Functioning and Well-Being and Gambling Harm Reduction Among Clients of Pathological Gambling Treatment Programs

PubMed Central

Bernhard, Bo; Abarbanel, Brett L. L.; St. John, Sarah; Kalina, Ashlee

2014-01-01

The objective of this study was to evaluate the relationship between treatment service quality, perceived improvement in social, functional, and material well-being and reduction in gambling behaviors among clients of Nevada state-funded pathological gambling treatment programs. Utilizing survey data from 361 clients from 2009 to 2010, analyses revealed that client satisfaction with treatment services is positively associated with perceived improvements in social, functional, and material well-being, abstinence from gambling, reduction in gambling thoughts and reduction in problems associated with gambling, even after controlling for various respondent characteristics. These findings can be useful to treatment program staff in managing program development and allocating resources. PMID:23756725

Navigating the socio-bio-geo-chemistry and engineering of nitrogen management in two illinois tile-drained watersheds.

PubMed

David, Mark B; Flint, Courtney G; Gentry, Lowell E; Dolan, Mallory K; Czapar, George F; Cooke, Richard A; Lavaire, Tito

2015-03-01

Reducing nitrate loads from corn and soybean, tile-drained, agricultural production systems in the Upper Mississippi River basin is a major challenge that has not been met. We evaluated a range of possible management practices from biophysical and social science perspectives that could reduce nitrate losses from tile-drained fields in the Upper Salt Fork and Embarras River watersheds of east-central Illinois. Long-term water quality monitoring on these watersheds showed that nitrate losses averaged 30.6 and 23.0 kg nitrate N ha yr (Embarras and Upper Salt Fork watersheds, respectively), with maximum nitrate concentrations between 14 and 18 mg N L. With a series of on-farm studies, we conducted tile monitoring to evaluate several possible nitrate reduction conservation practices. Fertilizer timing and cover crops reduced nitrate losses (30% reduction in a year with large nitrate losses), whereas drainage water management on one tile system demonstrated the problems with possible retrofit designs (water flowed laterally from the drainage water management tile to the free drainage system nearby). Tile woodchip bioreactors had good nitrate removal in 2012 (80% nitrate reduction), and wetlands had previously been shown to remove nitrate (45% reductions) in the Embarras watershed. Interviews and surveys indicated strong environmental concern and stewardship ethics among landowners and farmers, but the many financial and operational constraints that they operate under limited their willingness to adopt conservation practices that targeted nitrate reduction. Under the policy and production systems currently in place, large-scale reductions in nitrate losses from watersheds such as these in east-central Illinois will be difficult. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Auditing of suppliers as the requirement of quality management systems in construction

NASA Astrophysics Data System (ADS)

Harasymiuk, Jolanta; Barski, Janusz

2017-07-01

The choice of a supplier of construction materials can be important factor of increase or reduction of building works costs. Construction materials present from 40 for 70% of investment task depending on kind of works being provided for realization. There is necessity of estimate of suppliers from the point of view of effectiveness of construction undertaking and necessity from the point of view of conformity of taken operation by executives of construction job and objects within the confines of systems of managements quality being initiated in their organizations. The estimate of suppliers of construction materials and subexecutives of special works is formal requirement in quality management systems, which meets the requirements of the ISO 9001 standard. The aim of this paper is to show possibilities of making use of anaudit for estimate of credibility and reliability of the supplier of construction materials. The article describes kinds of audits, that were carried in quality management systems, with particular taking into consideration audits called as second-site. One characterizes the estimate criterions of qualitative ability and method of choice of the supplier of construction materials. The paper shows also propositions of exemplary questions, that would be estimated in audit process, the way of conducting of this estimate and conditionality of estimate.

Data management in clinical research: An overview

PubMed Central

Krishnankutty, Binny; Bellary, Shantala; Kumar, Naveen B.R.; Moodahadu, Latha S.

2012-01-01

Clinical Data Management (CDM) is a critical phase in clinical research, which leads to generation of high-quality, reliable, and statistically sound data from clinical trials. This helps to produce a drastic reduction in time from drug development to marketing. Team members of CDM are actively involved in all stages of clinical trial right from inception to completion. They should have adequate process knowledge that helps maintain the quality standards of CDM processes. Various procedures in CDM including Case Report Form (CRF) designing, CRF annotation, database designing, data-entry, data validation, discrepancy management, medical coding, data extraction, and database locking are assessed for quality at regular intervals during a trial. In the present scenario, there is an increased demand to improve the CDM standards to meet the regulatory requirements and stay ahead of the competition by means of faster commercialization of product. With the implementation of regulatory compliant data management tools, CDM team can meet these demands. Additionally, it is becoming mandatory for companies to submit the data electronically. CDM professionals should meet appropriate expectations and set standards for data quality and also have a drive to adapt to the rapidly changing technology. This article highlights the processes involved and provides the reader an overview of the tools and standards adopted as well as the roles and responsibilities in CDM. PMID:22529469

Software Quality Measurement for Distributed Systems. Volume 3. Distributed Computing Systems: Impact on Software Quality.

DTIC Science & Technology

1983-07-01

Distributed Computing Systems impact DrnwrR - aehR on Sotwar Quaity. PERFORMING 010. REPORT NUMBER 7. AUTNOW) S. CONTRACT OR GRANT "UMBER(*)IS ThomasY...C31 Application", "Space Systems Network", "Need for Distributed Database Management", and "Adaptive Routing". This is discussed in the last para ...data reduction, buffering, encryption, and error detection and correction functions. Examples of such data streams include imagery data, video

Maintaining Momentum and Quality in a Time of Decline: A Case Study.

ERIC Educational Resources Information Center

Potter, David; And Others

1992-01-01

A discussion of the response of George Mason University (Virginia) to economic decline in 1989-92 looks at four stages in the downturn and examines a variety of planning and policy issues, including management of both unplanned and planned reductions, continued uncertainty, politics of decline, organizational communication and morale,…

Increased Use of Productivity Management Can Help Control Government Costs.

DTIC Science & Technology

1983-11-10

estimated that 34 percent of agency spend- ing reductions made to balance the budget in fiscal year 1984 can be attributed to the productivity program. The...result in the services 5. [] use of employee incentives (9) of some employees no longer being required in the unit in which they 6. [) quality of worklife

Application of Artificial Intelligence to the DoD Corporate Information Management (CIM) Program

DTIC Science & Technology

1992-04-01

problem of balancing the investments of the corporation between several possible assets; buildings, machine tools, training, R&D and "information...and quality of worklife /learning/empowerment. For the moment the driving factor for the DoD has been identified as cost reduction, however it is clear

76 FR 20993 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-14

... delivered by the SCDNBSP and SCDTDP networks to individuals affected by sickle cell disease who present at... review by the Office of Management and Budget (OMB), in compliance with the Paperwork Reduction Act of... Act of 1995: Proposed Project: Sickle Cell Disease Program Evaluations and Quality Improvement...

Subsurface drainage volume reduction with drainage water management: Case studies in Ohio, USA

USDA-ARS?s Scientific Manuscript database

One of the main contributors to poor water quality in the Mississippi River and aeral increase in the hypoxic zone in the Gulf of Mexico is intensive drainage of the cropland within the watershed. Controlled drainage has been demonstrated as an approach to curb totla drainage outflow and nutrient di...

A total quality management approach to healthcare waste management in Namazi Hospital, Iran.

PubMed

Askarian, Mehrdad; Heidarpoor, Peigham; Assadian, Ojan

2010-11-01

Healthcare waste comprises all wastes generated at healthcare facilities, medical research centers and laboratories. Although 75-90% of these wastes are classified as household waste posing no potential risk, 10-25% are deemed to be hazardous, representing a potential threat to healthcare workers, patients, the environment and even the general population, if not disposed of appropriately. If hazardous and non-hazardous waste is mixed and not segregated prior to disposal, costs will increase substantially. Medical waste management is a worldwide issue. In Iran, the majority of problems are associated with an exponential growth in the healthcare sector together with low- or non-compliance with guidelines and recommendations. The aim of this study was to reduce the amounts of infectious waste by clear definition and segregation of waste at the production site in Namazi Hospital in Shiraz, Iran. Namazi Hospital was selected as a study site with an aim to achieving a significant decrease in infectious waste and implementing a total quality management (TQM) method. Infectious and non-infectious waste was weighed at 29 admission wards over a 1-month period. Before the introduction of the new guidelines and the new waste management concept, weight of total waste was 6.67 kg per occupied bed per day (kg/occupied bed/day), of which 73% was infectious and 27% non-infectious waste. After intervention, total waste was reduced to 5.92 kg/occupied bed/day, of which infectious waste represented 61% and non-infectious waste 30%. The implementation of a new waste management concept achieved a 26% reduction in infectious waste. A structured waste management concept together with clear definitions and staff training will result in waste reduction, consequently leading to decreased expenditure in healthcare settings. Copyright © 2010 Elsevier Ltd. All rights reserved.

Burnout syndrome and wellbeing in anesthesiologists: the importance of emotion regulation strategies.

PubMed

Lapa, Teresa A; Madeira, Filipa M; Viana, Joaquim S; Pinto-Gouveia, José

2017-02-01

Anesthesiologists face stressful working conditions that can culminate in burnout syndrome. Despite various studies and protective measures which have attempted to prevent this situation, burnout continues to be a problem within the profession, impacting negatively on physicians' lives and their performance. In this review article mechanisms and consequences of burnout are described in addition to individual strategies for stress management and burnout reduction with potential impact on health care quality and wellbeing in anesthesiologists. Organizational strategies appear to have an important role in burnout reduction but need to be used in conjunction with individual programs. The latter are essential to both reducing stress and burnout in anesthesiologists and improving happiness and wellbeing. New measures of emotion regulation strategies such as mindfulness, self-compassion, resilience and empathy promotion have been shown to be approaches with substantial supporting evidence for reducing burnout and improving stress management. The evaluation and implementation of these self-regulatory competencies is a challenge. Further research is necessary to identify which programs will best suit the needs of anesthesiologists and to measure their effects on patient care and health care system quality.

Before and After Integrated Catchment Management in a Headwater Catchment: Changes in Water Quality

NASA Astrophysics Data System (ADS)

Hughes, Andrew O.; Quinn, John M.

2014-12-01

Few studies have comprehensively measured the effect on water quality of catchment rehabilitation measures in comparison with baseline conditions. Here we have analyzed water clarity and nutrient concentrations and loads for a 13-year period in a headwater catchment within the western Waikato region, New Zealand. For the first 6 years, the entire catchment was used for hill-country cattle and sheep grazing. An integrated catchment management plan was implemented whereby cattle were excluded from riparian areas, the most degraded land was planted in Pinus radiata, channel banks were planted with poplar trees and the beef cattle enterprise was modified. The removal of cattle from riparian areas without additional riparian planting had a positive and rapid effect on stream water clarity. In contrast, the water clarity decreased in those sub-catchments where livestock was excluded but riparian areas were planted with trees and shrubs. We attribute the decrease in water clarity to a reduction in groundcover vegetation that armors stream banks against preparatory erosion processes. Increases in concentrations of forms of P and N were recorded. These increases were attributed to: (i) the reduction of instream nutrient uptake by macrophytes and periphyton due to increased riparian shading; (ii) uncontrolled growth of a nitrogen fixing weed (gorse) in some parts of the catchment, and (iii) the reduction in the nutrient attenuation capacity of seepage wetlands due to the decrease in their areal coverage in response to afforestation. Our findings highlight the complex nature of the water quality response to catchment rehabilitation measures.

Reducing microbial contamination in storm runoff from high use areas on California coastal dairies.

PubMed

Lewis, D J; Atwill, E R; Lennox, M S; Pereira, M D G; Miller, W A; Conrad, P A; Tate, K W

2009-01-01

High use areas are a fundamental part of California coastal dairies and grazing livestock ranches as feeding areas, nurseries, and sick pens. High stocking densities and daily use in these areas lead to soil surfaces devoid of vegetation and covered in manure, with high potential for manure transport during winter rains to receiving waters regulated for shellfish harvesting and recreation. We characterized the association between California's Mediterranean climate and a series of existing and proposed management practices on fecal coliform bacteria (FCB) transport from high use areas on dairies and ranches. Results from 351 storm runoff samples collected below 35 high-use areas indicate that removal of cattle during winter, locating high use areas on level ground, application of straw and seeding, and vegetative buffer strip implementation were significantly associated with FCB concentration and load reductions. These results complement our findings for reductions of specific pathogens in runoff from these areas. These findings have practical significance because they document surface water quality benefits that the studied management practices provide in application on working farms and ranches. This direction is critical and timely for on-farm management efforts seeking to reduce microbial pollution in runoff and comply with indicator bacteria water quality criteria.

Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting.

PubMed

Steel, Jennifer L; Geller, David A; Kim, Kevin H; Butterfield, Lisa H; Spring, Michael; Grady, Jonathan; Sun, Weiing; Marsh, Wallis; Antoni, Michael; Dew, Mary Amanda; Helgeson, Vicki; Schulz, Richard; Tsung, Allan

2016-04-15

The aim of this study was to examine the efficacy of a collaborative care intervention in reducing depression, pain, and fatigue and improve quality of life. A total of 261 patients with advanced cancer and 179 family caregivers were randomized to a web-based collaborative care intervention or enhanced usual care. The intervention included the following: 1) a web site with written and audiovisual self-management strategies, a bulletin board, and other resources; 2) visits with a care coordinator during a physician's appointment every 2 months; and 3) telephone follow-up every 2 weeks. Primary patient outcomes included measures of depression, pain, fatigue, and health-related quality of life. Secondary outcomes included Interleukin (IL)-1α, IL-1β, IL-6, and IL-8 levels, Natural Killer (NK) cell numbers, and caregiver stress and depression. At the baseline, 51% of the patients reported 1 or more symptoms in the clinical range. For patients who presented with clinical levels of symptoms and were randomized to the intervention, reductions in depression (Cohen's d = 0.71), pain (Cohen's d = 0.62), and fatigue (Cohen's d = 0.26) and improvements in quality of life (Cohen's d = 0.99) were observed when compared to those in the enhanced usual car arm at 6 months. Reductions in IL-6 (φ = 0.18), IL-1β (φ = 0.35), IL-1α (φ = 0.19), and IL-8 (φ = 0.15) and increases in NK cell numbers (φ = 0.23) were observed in comparison with enhanced usual care arm at 6 months. Reductions in caregiver stress (Cohen's d = 0.75) and depression (Cohen's d = 0.37) were observed at 6 months for caregivers whose loved ones were randomized to the intervention arm. The integration of screening and symptom management into cancer care is recommended. © 2016 American Cancer Society.

Does colostomy irrigation affect functional outcomes and quality of life in persons with a colostomy?

PubMed

Kent, Dea J; Long, Mary Arnold; Bauer, Carole

2015-01-01

Colostomy irrigation may be used by patients with colostomies to regulate bowel evacuations by stimulating emptying of the colon at regularly scheduled times. This Evidence-Based Report Card reviews the effect of colostomy irrigation on frequency of bowel evacuation, flatus production, odor, and health-related quality of life. We systematically reviewed the literature for studies that evaluated health-related quality of life in persons aged 18 years or older with colostomies of the sigmoid or descending left colon. A professional librarian performed the literature search, which yielded 499 articles using the search terms "colostomy," "colostomies," "therapeutic irrigation," "irrigation," and "irrigator." Following title and abstract reviews, we identified and retrieved 4 studies that met inclusion criteria. Colostomy irrigation reduces the frequency of bowel evacuations when compared to spontaneous evacuation and containment using a pouching system. Regular irrigation is associated with reductions in pouch usage. This change in bowel evacuation function frequently results in absence of bowel evacuations for 24 hours or longer, enabling some to discontinue ongoing use of a pouching system. Subjects using CI report reductions in flatus and odors associated with presence of a colostomy. One study was identified that found persons using CI reported higher health-related quality of life than did those who managed their colostomies with spontaneous evacuation using the Digestive Disease Quality of Life-15, but no differences were found when health-related quality of life was measured using the more generic instrument, the Medical Outcomes Study: Short Form-36. Instruction on principles and techniques of colostomy irrigation should be considered when managing patients with a permanent, left-sided colostomy.

A Multifactorial Weight Reduction Programme for Children with Overweight and Asthma: A Randomized Controlled Trial

PubMed Central

Willeboordse, Maartje; van de Kant, Kim D. G.; Tan, Frans E. S.; Mulkens, Sandra; Schellings, Julia; Crijns, Yvonne; van der Ploeg, Liesbeth; van Schayck, Constant P.; Dompeling, Edward

2016-01-01

Background There is increasing evidence that obesity is related to asthma development and severity. However, it is largely unknown whether weight reduction can influence asthma management, especially in children. Objective To determine the effects of a multifactorial weight reduction intervention on asthma management in overweight/obese children with (a high risk of developing) asthma. Methods An 18-month weight-reduction randomized controlled trial was conducted in 87 children with overweight/obesity and asthma. Every six months, measurements of anthropometry, lung function, lifestyle parameters and inflammatory markers were assessed. Analyses were performed with linear mixed models for longitudinal analyses. Results After 18 months, the body mass index-standard deviation score decreased by -0.14±0.29 points (p<0.01) in the intervention group and -0.12±0.34 points (p<0.01) in the control group. This change over time did not differ between groups (p>0.05). Asthma features (including asthma control and asthma-related quality of life) and lung function indices (static and dynamic) improved significantly over time in both groups. The FVC% predicted improved over time by 10.1 ± 8.7% in the intervention group (p<0.001), which was significantly greater than the 6.1 ± 8.4% in the control group (p<0.05). Conclusions & clinical relevance Clinically relevant improvements in body weight, lung function and asthma features were found in both the intervention and control group, although some effects were more pronounced in the intervention group (FVC, asthma control, and quality of life). This implies that a weight reduction intervention could be clinically beneficial for children with asthma. Trial Registration ClinicalTrials.gov NCT00998413 PMID:27294869

Ecosystem Modeling Applied to Nutrient Criteria Development in Rivers

NASA Astrophysics Data System (ADS)

Carleton, James N.; Park, Richard A.; Clough, Jonathan S.

2009-09-01

Threshold concentrations for biological impairment by nutrients are difficult to quantify in lotic systems, yet States and Tribes in the United States are charged with developing water quality criteria to protect these ecosystems from excessive enrichment. The analysis described in this article explores the use of the ecosystem model AQUATOX to investigate impairment thresholds keyed to biological indexes that can be simulated. The indexes selected for this exercise include percentage cyanobacterial biomass of sestonic algae, and benthic chlorophyll a. The calibrated model was used to analyze responses of these indexes to concurrent reductions in phosphorus, nitrogen, and suspended sediment in an enriched upper Midwestern river. Results suggest that the indexes would respond strongly to changes in phosphorus and suspended sediment, and less strongly to changes in nitrogen concentration. Using simulated concurrent reductions in all three water quality constituents, a total phosphorus concentration of 0.1 mg/l was identified as a threshold concentration, and therefore a hypothetical water quality criterion, for prevention of both excessive periphyton growth and sestonic cyanobacterial blooms. This kind of analysis is suggested as a way to evaluate multiple contrasting impacts of hypothetical nutrient and sediment reductions and to define nutrient criteria or target concentrations that balance multiple management objectives concurrently.

[The relevance of clinical risk management].

PubMed

Gulino, Matteo; Vergallo, Gianluca Montanari; Frati, Paola

2011-01-01

Medical activity includes a risk of possible injury or complications for the patients, that should drive the Health Care Institutions to introduce and/ or improve clinical Risk management instruments. Although Italy is still lacking a National project of Clinical Risk Management, a number of efforts have been made by different Italian Regions to introduce instruments of risk management. In addition, most of National Health Care Institutions include actually a Department specifically in charge to manage the clinical risk. Despite the practical difficulties, the results obtained until now suggest that the risk management may represent a useful instrument to contribute to the reduction of errors in clinical conduct. Indeed, the introduction of adequate instruments of prevention and management of clinical risk may help to ameliorate the quality of health care Institution services.

CMS keeps raising the stakes on quality improvement.

PubMed

2014-10-01

A significant portion of the Centers for Medicare & Medicaid Services (CMS) 2015 Inpatient Prospective Payment System final rule focuses on quality and raises the percentage of the Medicare base payment hospitals can lose if they perform poorly. Case managers must be involved with patients from the minute they come in the door, through the hospital stay, and after discharge, experts say. Reimbursement is affected by risk-adjustment, which means case managers must make sure the documentation is as complete and specific as possible to show the full picture of the patient's severity of illness as well as any conditions that were present on admission. As the readmission reduction program expands to add new diagnoses and the penalties for poor performance increase, case managers must change their focus from discharge planning to transition planning that takes into account what resources patients need after discharge, experts say.

Water quality management library. 2. edition

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

Eckenfelder, W.W.; Malina, J.F.; Patterson, J.W.

1998-12-31

A series of ten books offered in conjunction with Water Quality International, the Biennial Conference and Exposition of the International Association on Water Pollution Research and Control (IAWPRC). Volume 1, Activated Sludge Process, Design and Control, 2nd edition, 1998: Volume 2, Upgrading Wastewater Treatment Plants, 2nd edition, 1998: Volume 3, Toxicity Reduction, 2nd edition, 1998: Volume 4, Municipal Sewage Sludge Management, 2nd edition, 1998: Volume 5, Design and Retrofit of Wastewater Treatment Plants for Biological Nutrient Removal, 1st edition, 1992: Volume 6, Dynamics and Control of the Activated Sludge Process, 2nd edition, 1998: Volume 7: Design of Anaerobic Processes formore » the Treatment of Industrial and Municipal Wastes, 1st edition, 1992: Volume 8, Groundwater Remediation, 1st edition, 1992: Volume 9, Nonpoint Pollution and Urban Stormwater Management, 1st edition, 1995: Volume 10, Wastewater Reclamation and Reuse, 1st edition, 1998.« less

Proposals for the mitigation of the environmental impact of clinical laboratories.

PubMed

Lopez, Joseph B; Badrick, Tony

2012-03-24

Laboratories should be aware of the carbon footprint resulting from their activities and take steps to mitigate it as part of their societal responsibilities. Once committed to a mitigation programme, they should announce an environmental policy, secure the support of senior management, initiate documentation, institute a staff training programme, schedule environmental audits and appoint an environmental manager. Laboratories may aspire to be accredited to one of the standards for environmental management, such as the ISO 14000. As environmental and quality issues are linked, the improvement in the environmental management of an organisation will ultimately lead to improved quality system performance. Indeed, environmental management could conceivably come under overall quality management. Although there will be initial costs, good environmental practices can bring savings. Environmental improvement should be based on the 3R concept to reduce, reuse and recycle. Several policy initiatives may be introduced. These include a green purchasing policy for equipment, laboratory furniture and reagents as well as the management of packaging wastes. There are several ways to reduce energy, water usage and wastage. A reduction of test numbers and collection tubes should be attempted. Paper management involves all aspects of 3R. The recycling of solvents and general wastes should be practised where feasible. The construction new laboratories or renovations to existing ones are opportunities to make them more environmentally-friendly. The advocacy of policies to associates and the inclusion of environmentally-friendly conditions on contractors are integral parts of the programme.

Declining nitrate-N yields in the Upper Potomac River Basin: What is really driving progress under the Chesapeake Bay restoration?

NASA Astrophysics Data System (ADS)

Eshleman, Keith N.; Sabo, Robert D.

2016-12-01

Reducing nutrient pollution of surface and coastal waters in the U.S. and elsewhere remains a major environmental and engineering challenge for the 21st century. In the case of the Chesapeake Bay restoration, we still lack scientific proof that watershed-based management actions have been effective at reducing nonpoint-source nutrient loads from the land to this estuary in accordance with restoration goals. While the conventional wisdom is that implementation of best management practices (BMP's) and wastewater treatment have turned the tide against nutrient pollution, we examined long-term (1986-present) nitrate-N trends in streams and major tributaries of the Upper Potomac River Basin (UPRB) and found that: 1) dramatic reductions in annual discharge-weighted mean nitrate-N concentrations and yields across the UPRB can be almost universally attributed to reductions in atmospheric N deposition as opposed to on-the-ground management actions such as implementation of BMP's; 2) observed water quality changes generally comport with a modified kinetic N saturation model (MKNSM); 3) the MKNSM can separate the nitrate-N yield that is responsive to atmospheric deposition from a "non-responsive" yield; and 4) N saturation from atmospheric N deposition appears to be an inherently reversible process across most of the landscape. These unanticipated region-wide water quality benefits can be attributed to NOx emission controls brought about by the 1990 Clean Air Act Amendments (and subsequent U.S. NOX control programs) and reflect a water quality "success story" in the Chesapeake Bay restoration.

Using Biomass to Improve Site Quality and Carbon Sequestration

Treesearch

Bryce J. Stokes; Felipe G. Sanchez; Emily A. Carter

1998-01-01

The future demands on forest lands are a concern because of reduced productivity, especially on inherently poor sites, sites with long-depleted soils, or those soils that bear repeated, intensive short rotations. Forests are also an important carbon sink and, when well managed, can make even more significant contributions to sequestration and to reduction of greenhouse...

Epicormic Branches and Lumber Grade of Bottomland Oak

Treesearch

James S. Meadows

1995-01-01

Epicormic branches can be a serious problem in management of hardwood forests for high-quality sawtimber production. In one study in central Alabama, defects caused by epicormic branches that developed following a partial cutting resulted in a 13 percent reduction in the value of willow oak lumber. Production of epicormic branches along the boles of hardwood trees is...

Improving Quality and Efficiency for Intussusception Management After Successful Enema Reduction.

PubMed

Raval, Mehul V; Minneci, Peter C; Deans, Katherine J; Kurtovic, Kelli J; Dietrich, Ann; Bates, D Gregory; Rangel, Shawn J; Moss, R Lawrence; Kenney, Brian D

2015-11-01

The purpose of this project was to implement a protocol facilitating discharge from the emergency department (ED) after successful radiologic ileocolic intussusception reduction in a pediatric referral center. A multidisciplinary team identified drivers for successful quality improvement including educational brochures, a standardized radiologic report, an observation period in the ER with oral hydration challenges, and follow-up phone calls the day after discharge. Patient outcomes were tracked, and quarterly feedback was provided. Of 80 patients identified over a 24-month period, 34 (42.5%) did not qualify for discharge home due to need for surgical intervention (n = 9), specific radiologic findings (n = 11), need for additional intravenous hydration (n = 4), or other reasons (n = 7). Of 46 patients who qualified for discharge, 30 (65.2%) were successfully sent home from the ED. One patient returned with recurrent symptoms that required repeat enema reduction. Sixteen patients were observed and discharged within 23 hours. Adherence with discharge from the ED improved over time. Discharge from the ED was associated with cost savings and improved net margins at the hospital level for each encounter. A sustainable multidisciplinary quality improvement project to discharge intussusception patients from the ED after air-contrast enema reduction was successfully integrated in a high-volume referral center through education, standardized radiologic reporting, and protocoled follow-up. Copyright © 2015 by the American Academy of Pediatrics.

Quality improvement in childhood obesity management through the maintenance of certification process.

PubMed

Huang, Jeannie S; Chun, Stanford; Sandhu, Amanpreet; Terrones, Laura

2013-11-01

To assess the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a web-based clinician education program that promotes appropriate screening, prevention, and management of weight among youth by pediatric practitioners, based on the 2007 Expert Committee recommendations. The project currently provides Maintenance of Certification (MOC) Part 4 credit through the American Board of Pediatrics. Participants identified themselves to the HOPE MOC Part 4 program. Enrollees were required to complete all continuing medical education modules (10.5 hours). Knowledge acquisition and self-reported confidence levels related to screening, prevention, and management practices of pediatric obesity were measured using preknowledge and postknowledge questionnaires. Participants were also required to perform a quality improvement project and submit practice performance data from repeated medical chart reviews over time. Knowledge acquisition, self-efficacy, and practice performance data were analyzed using repeated-measures analyses. The 51 participants demonstrated significant improvements in knowledge acquisition and self-efficacy scores after viewing individual modules. In addition, participants demonstrated significant improvements in measured clinical compliance with recommended practices over time. Participation in the HOPE MOC Part 4 program appeared to improve knowledge acquisition, self-efficacy, and physician compliance with recommended practice recommendations for the screening, prevention, and management of pediatric obesity. Further data are required to determine whether such practice-based improvements translate into actual reduction in patient weight and/or reduction in health-related costs related to overweight and obesity in youth. Copyright © 2013 Mosby, Inc. All rights reserved.

Urban local air quality management framework for non-attainment areas in Indian cities.

PubMed

Gulia, Sunil; Nagendra, S M Shiva; Barnes, Jo; Khare, Mukesh

2018-04-01

Increasing urban air pollution level in Indian cities is one of the major concerns for policy makers due to its impact on public health. The growth in population and increase in associated motorised road transport demand is one of the major causes of increasing air pollution in most urban areas along with other sources e.g., road dust, construction dust, biomass burning etc. The present study documents the development of an urban local air quality management (ULAQM) framework at urban hotspots (non-attainment area) and a pathway for the flow of information from goal setting to policy making. The ULAQM also includes assessment and management of air pollution episodic conditions at these hotspots, which currently available city/regional-scale air quality management plans do not address. The prediction of extreme pollutant concentrations using a hybrid model differentiates the ULAQM from other existing air quality management plans. The developed ULAQM framework has been applied and validated at one of the busiest traffic intersections in Delhi and Chennai cities. Various scenarios have been tested targeting the effective reductions in elevated levels of NO x and PM 2.5 concentrations. The results indicate that a developed ULAQM framework is capable of providing an evidence-based graded action to reduce ambient pollution levels within the specified standard level at pre-identified locations. The ULAQM framework methodology is generalised and therefore can be applied to other non-attainment areas of the country. Copyright © 2017 Elsevier B.V. All rights reserved.

A retrospective explanatory case study of the implementation of a bleeding management quality initiative, in an Australian cardiac surgery unit.

PubMed

Pearse, Bronwyn Louise; Rickard, Claire M; Keogh, Samantha; Lin Fung, Yoke

2018-03-09

Bleeding management in cardiac surgery is challenging. Many guidelines exist to support bleeding management; however, literature demonstrates wide variation in practice. In 2012, a quality initiative was undertaken at The Prince Charles Hospital, Australia to improve bleeding management for cardiac surgery patients. The implementation of the quality initiative resulted in significant reductions in the incidence of blood transfusion, re-exploration for bleeding; superficial leg and chest wound infections; length of hospital stay, and cost. Given the success of the initiative, we sought to answer the question; "How and why was the process of implementing a bleeding management quality initiative in the cardiac surgery unit successful, and sustainable?" A retrospective explanatory case study design was chosen to explore the quality initiative. Analysis of the evidence was reviewed through phases of the 'Knowledgeto Action' planned change model. Data was derived from: (1) document analysis, (2) direct observation of the local environment, (3) clinical narratives from interviews, and analysed with a triangulation approach. The study period extended from 10/2011 to 6/2013. Results demonstrated the complexity of changing practice, as well as the significant amount of dedicated time and effort required to support individual, department and system wide change. Results suggest that while many clinicians were aware of the potential to apply improved practice, numerous barriers and challenges needed to be overcome to implement change across multiple disciplines and departments. The key successful components of the QI were revealed through the case study analysis as: (1) an appropriately skilled project manager to facilitate the implementation process; (2) tools to support changes in workflow and decision making including a bleeding management treatment algorithm with POCCTs; (3) strong clinical leadership from the multidisciplinary team and; (4) the evolution of the project manager position into a perpetual clinical position to support sustainability. Copyright © 2018 Australian College of Critical Care Nurses Ltd. All rights reserved.

Psychological interventions for coronary heart disease

PubMed Central

Rees, Karen; Bennett, Paul; West, Robert; Smith, George Davey; Ebrahim, Shah

2014-01-01

Background Psychological interventions can form part of comprehensive cardiac rehabilitation programmes (CCR). These interventions may include stress management interventions, which aim to reduce stress, either as an end in itself or to reduce risk for further cardiac events in patients with heart disease. Objectives To determine the effectiveness of psychological interventions, in particular stress management interventions, on mortality and morbidity, psychological measures, quality of life, and modifiable cardiac risk factors, in patients with coronary heart disease (CHD). Search strategy We searched CCTR to December 2001 (Issue 4, 2001), MEDLINE 1999 to December 2001 and EMBASE 1998 to the end of 2001, PsychINFO and CINAHL to December 2001. In addition, searches of reference lists of papers were made and expert advice was sought. Selection criteria RCTs of non-pharmacological psychological interventions, administered by trained staff, either single modality interventions or a part of CCR with minimum follow up of 6 months. Adults of all ages with CHD (prior myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty, angina pectoris or coronary artery disease defined by angiography). Stress management (SM) trials were identified and reported in combination with other psychological interventions and separately. Data collection and analysis Studies were selected, and data were abstracted, independently by two reviewers. Authors were contacted where possible to obtain missing information. Main results Thirty six trials with 12,841 patients were included. Of these, 18 (5242 patients) were SM trials. Quality of many trials was poor with the majority not reporting adequate concealment of allocation, and only 6 blinded outcome assessors. Combining the results of all trials showed no strong evidence of effect on total or cardiac mortality, or revascularisation. There was a reduction in the number of non-fatal reinfarctions in the intervention group (OR 0.78 (0.67, 0.90), but the two largest trials (with 4809 patients randomized) were null for this outcome, and there was statistical evidence of publication bias. Similar results were seen for the SM subgroup of trials. Provision of any psychological intervention or SM intervention caused small reductions in anxiety and depression. Few trials reported modifiable cardiac risk factors or quality of life. Authors’ conclusions Overall psychological interventions showed no evidence of effect on total or cardiac mortality, but did show small reductions in anxiety and depression in patients with CHD. Similar results were seen for SM interventions when considered separately. However, the poor quality of trials, considerable heterogeneity observed between trials and evidence of significant publication bias make the pooled finding of a reduction in non-fatal myocardial infarction insecure. PMID:15106183

Taguchi Approach to Design Optimization for Quality and Cost: An Overview

NASA Technical Reports Server (NTRS)

Unal, Resit; Dean, Edwin B.

1990-01-01

Calibrations to existing cost of doing business in space indicate that to establish human presence on the Moon and Mars with the Space Exploration Initiative (SEI) will require resources, felt by many, to be more than the national budget can afford. In order for SEI to succeed, we must actually design and build space systems at lower cost this time, even with tremendous increases in quality and performance requirements, such as extremely high reliability. This implies that both government and industry must change the way they do business. Therefore, new philosophy and technology must be employed to design and produce reliable, high quality space systems at low cost. In recognizing the need to reduce cost and improve quality and productivity, Department of Defense (DoD) and National Aeronautics and Space Administration (NASA) have initiated Total Quality Management (TQM). TQM is a revolutionary management strategy in quality assurance and cost reduction. TQM requires complete management commitment, employee involvement, and use of statistical tools. The quality engineering methods of Dr. Taguchi, employing design of experiments (DOE), is one of the most important statistical tools of TQM for designing high quality systems at reduced cost. Taguchi methods provide an efficient and systematic way to optimize designs for performance, quality, and cost. Taguchi methods have been used successfully in Japan and the United States in designing reliable, high quality products at low cost in such areas as automobiles and consumer electronics. However, these methods are just beginning to see application in the aerospace industry. The purpose of this paper is to present an overview of the Taguchi methods for improving quality and reducing cost, describe the current state of applications and its role in identifying cost sensitive design parameters.

Management of Plantar Hyperhidrosis with Endoscopic Lumbar Sympathectomy.

PubMed

Rieger, Roman

2016-11-01

Primary plantar hyperhidrosis is defined as excessive secretion of the sweat glands of the feet and may lead to significant limitations in private and professional lifestyle and reduction of health-related quality of life. Conservative therapy measures usually fail to provide sufficient relieve of symptoms and do not allow long-lasting elimination of hyperhidrosis. Endoscopic lumbar sympathectomy appears to be a safe and effective procedure for eliminating excessive sweating of the feet and improves quality of life of patients with severe plantar hyperhidrosis. Copyright © 2016 Elsevier Inc. All rights reserved.

The integration of studio cycling into a worksite stress management programme.

PubMed

Clark, Matthew M; Soyring, Jason E; Jenkins, Sarah M; Daniels, Denise C; Berkland, Bridget E; Werneburg, Brooke L; Hagen, Philip T; Lopez-Jimenez, Francisco; Warren, Beth A; Olsen, Kerry D

2014-04-01

High stress is a prevalent problem in the worksite. To reduce stress, improve productivity, reduce absenteeism, and lower healthcare costs, many companies offer exercise classes or stress management programmes. Although physical activity is an important component of stress management, few worksites have integrated physical activity into their comprehensive stress reduction programmes. The purpose of this single-arm pilot project was to examine the potential effectiveness of an integrated exercise (studio cycling) and cognitive-behavioural stress management programme. Eighty-four adults, 75% female, mostly aged 40+ years, participated in an integrated 12-week cycling studio and cognitive-behavioural stress management programme. Participants experienced a significant and clinically meaningful reduction on the Perceived Stress Scale (p < 0.01), rating of current stress level and confidence to manage stress at the programme's end and at a 1-month follow-up. Participants also reported having significantly improved overall health, improved nutritional habits, higher physical activity level, greater confidence in their ability to follow a healthy diet, higher spiritual well-being, improved sleep, receiving more support for maintaining healthy living and improved quality of life at the completion of the 12-week programme and 1-month follow-up. These findings provide further support for an integrated exercise and stress management programme. © 2013 John Wiley & Sons, Ltd.

Changes in Water Quality of Grand Lake St. Marys Watershed Following Implementation of a Distressed Watershed Rules Package.

PubMed

Jacquemin, Stephen J; Johnson, Laura T; Dirksen, Theresa A; McGlinch, Greg

2018-01-01

Grand Lake St. Marys watershed has drawn attention over the past decade as water quality issues resulting from nutrient loading have come to the forefront of public opinion, political concern, and scientific study. The objective of this study was to assess long-term changes in water quality (nutrient and sediment concentrations) following the distressed watershed rules package instituted in 2011. Since that time, a variety of rules (e.g., winter manure ban) and best management practices (cover crops, manure storage or transfers, buffers, etc.) have been implemented. We used a general linear model to assess variation in total suspended solids, particulate phosphorus, soluble reactive phosphorus (SRP), nitrate N, and total Kjeldahl nitrogen concentrations from daily Chickasaw Creek (drains ∼25% of watershed) samples spanning 2008 to 2016. Parameters were related to flow (higher values during high flows), timing (lower values during winter months), and the implementation of the distressed watershed rules package (lower values following implementation). Overall, reductions following the distressed designation for all parameters ranged from 5 to 35% during medium and high flow periods (with exception of SRP). Reductions were even more pronounced during winter months covered by the manure ban, where all parameters (including SRP) exhibited decreases at medium and high flows between 20 and 60%. While the reductions seen in this study are significant, concentrations are still highly elevated and continue to be a problem. We are optimistic that this study will serve to inform future management in the region and elsewhere. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Modeling riverine nitrate export from an East-Central Illinois watershed using SWAT.

PubMed

Hu, X; McIsaac, G F; David, M B; Louwers, C A L

2007-01-01

Reliable water quality models are needed to forecast the water quality consequences of different agricultural nutrient management scenarios. In this study, the Soil and Water Assessment Tool (SWAT), version 2000, was applied to simulate streamflow, riverine nitrate (NO(3)) export, crop yield, and watershed nitrogen (N) budgets in the upper Embarras River (UER) watershed in east-central Illinois, which has extensive maize-soybean cultivation, large N fertilizer input, and extensive tile drainage. During the calibration (1994-2002) and validation (1985-1993) periods, SWAT simulated monthly and annual stream flows with Nash-Sutcliffe coefficients (E) ranging from 0.67 to 0.94 and R(2) from 0.75 to 0.95. For monthly and annual NO(3) loads, E ranged from -0.16 to 0.45 and R(2) from 0.36 to 0.74. Annual maize and soybean yields were simulated with relative errors ranging from -10 to 6%. The model was then used to predict the changes in NO(3) output with N fertilizer application rates 10 to 50% lower than original application rates in UER. The calibrated SWAT predicted a 10 to 43% decrease in NO(3) export from UER and a 6 to 38% reduction in maize yield in response to the reduction in N fertilizer. The SWAT model markedly overestimated NO(3) export during major wet periods. Moreover, SWAT estimated soybean N fixation rates considerably greater than literature values, and some simulated changes in the N cycle in response to fertilizer reduction seemed to be unrealistic. Improving these aspects of SWAT could lead to more reliable predictions in the water quality outcomes of nutrient management practices in tile-drained watersheds.

Reduction of Cancer-Specific Thought Intrusions and Anxiety Symptoms With a Stress Management Intervention Among Women Undergoing Treatment for Breast Cancer

PubMed Central

Antoni, Michael H.; Wimberly, Sarah R.; Lechner, Suzanne C.; Kazi, Aisha; Sifre, Tammy; Urcuyo, Kenya R.; Phillips, Kristin; Smith, Roselyn G.; Petronis, Vida M.; Guellati, Sophie; Wells, Kurrie A.; Blomberg, Bonnie; Carver, Charles S.

2017-01-01

Objective After surgery for breast cancer, many women experience anxiety relating to the cancer that can adversely affect quality of life and emotional functioning during the year postsurgery. Symptoms such as intrusive thoughts may be ameliorated during this period with a structured, group-based cognitive behavior intervention. Method A 10-week group cognitive behavior stress management intervention that included anxiety reduction (relaxation training), cognitive restructuring, and coping skills training was tested among 199 women newly treated for stage 0-III breast cancer. They were then followed for 1 year after recruitment. Results The intervention reduced reports of thought intrusion, interviewer ratings of anxiety, and emotional distress across 1 year significantly more than was seen with the control condition. The beneficial effects were maintained well past the completion of adjuvant therapy. Conclusions Structured, group-based cognitive behavior stress management may ameliorate cancer-related anxiety during active medical treatment for breast cancer and for 1 year following treatment. Group-based cognitive behavior stress management is a clinically useful adjunct to offer to women treated for breast cancer. PMID:17012691

[Influence of stress factors and socio-demographic characteristics on the sleep quality of nursing students].

PubMed

Benavente, Sonia Betzabeth Ticona; Silva, Rodrigo Marques da; Higashi, Aline Baraldi; Guido, Laura de Azevedo; Costa, Ana Lucia Siqueira

2014-06-01

To analyze the influence of stress factors and socio-demographic characteristics on the sleep quality of nursing students. An analytical cross-sectional and quantitative study, conducted with 151 nursing students in São Paulo between March and April of 2012. A form for socio-demographic characteristics, the Instrument to Evaluate Stress in Nursing Students and the Pittsburgh Sleep Index were applied. High levels of stress was predominant for Time Management (27.8%) and Professional Training (30.5%) and low sleep quality (78.8%). The Professional Communication, Professional Training and Theoretical Activity are positively correlated to sleep quality. Work activity, academic year and time for daily studies contributed to a low quality of sleep. Few stress factors from the academic environment and some socio-demographic characteristics contributed to the reduction of sleep quality in students.

Unravelling the quality of HIV counselling and testing services in the private and public sectors in Zambia

PubMed Central

Ron Levey, Ilana; Wang, Wenjuan

2014-01-01

Background Despite the substantial investment for providing HIV counselling and testing (VCT) services in Zambia, there has been little effort to systematically evaluate the quality of VCT services provided by various types of health providers. This study, conducted in 2009, examines VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula. Methods The study used five primary data collection methods to gauge quality of VCT services: closed-ended client interviews with clients exiting VCT sites; open-ended client interviews; interviews with facility managers; review of service statistics; and an observation of the physical environment for VCT by site. Over 400 clients and 87 facility managers were interviewed from almost 90 facilities. Sites were randomly selected and results are generalizable at the provincial level. Results The study shows concerning levels of underperformance in VCT services across the sectors. It reveals serious underperformance in counselling about key risk-reduction methods. Less than one-third of clients received counselling on reducing number of sexual partners and only approximately 5% of clients received counselling about disclosing test results to partners. In terms of client profiles, the NGO sector attracts the most educated clients and less educated Zambians seek VCT services at very low rates (7%). The private for-profit performs equally or sometimes better than other sectors even though this sector is not adequately integrated into the Zambian national response to HIV. Conclusion The private for-profit sector provides VCT services on par in quality with the other sectors. Most clients did not receive counselling on partner reduction or disclosure of HIV test results to partners. In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease, risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling. PMID:25012796

Unravelling the quality of HIV counselling and testing services in the private and public sectors in Zambia.

PubMed

Ron Levey, Ilana; Wang, Wenjuan

2014-07-01

Despite the substantial investment for providing HIV counselling and testing (VCT) services in Zambia, there has been little effort to systematically evaluate the quality of VCT services provided by various types of health providers. This study, conducted in 2009, examines VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula. The study used five primary data collection methods to gauge quality of VCT services: closed-ended client interviews with clients exiting VCT sites; open-ended client interviews; interviews with facility managers; review of service statistics; and an observation of the physical environment for VCT by site. Over 400 clients and 87 facility managers were interviewed from almost 90 facilities. Sites were randomly selected and results are generalizable at the provincial level. The study shows concerning levels of underperformance in VCT services across the sectors. It reveals serious underperformance in counselling about key risk-reduction methods. Less than one-third of clients received counselling on reducing number of sexual partners and only approximately 5% of clients received counselling about disclosing test results to partners. In terms of client profiles, the NGO sector attracts the most educated clients and less educated Zambians seek VCT services at very low rates (7%). The private for-profit performs equally or sometimes better than other sectors even though this sector is not adequately integrated into the Zambian national response to HIV. The private for-profit sector provides VCT services on par in quality with the other sectors. Most clients did not receive counselling on partner reduction or disclosure of HIV test results to partners. In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease, risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Digital data used to relate nutrient inputs to water quality in the Chesapeake Bay watershed, version 3.0

USGS Publications Warehouse

Brakebill, John W.; Preston, Stephen D.

2004-01-01

Chesapeake Bay restoration efforts are focused on improving water quality, living resources, and ecological habitats by 2010. One aspect of the water-quality restoration is the refinement of strategies designed to implement nutrient-reduction practices within the Bay watershed. These strategies are being refined and implemented by resource managers of the Chesapeake Bay Program (CBP), a partnership comprised of various Federal, State, and local agencies that includes jurisdictions within Delaware, Maryland, New York, Pennsylvania, Virginia, West Virginia, and the District of Columbia. The U.S. Geological Survey (USGS), an active member of the CBP, provides necessary water-quality information for these Chesapeake Bay nutrient-reduction strategy revisions and evaluations. The formulation and revision of effective nutrient-reduction strategies requires detailed scientific information and an analytical understanding of the sources, transport, and delivery of nutrients to the Chesapeake Bay. The USGS is supporting these strategies by providing scientific information to resource managers that can help them evaluate and understand these processes. One statistical model available to resource managers is a collection of SPAtially Referenced Regressions On Watershed (SPARROW) attributes, which uses a nonlinear regression approach to spatially relate nutrient sources and watershed characteristics to nutrient loads of streams throughout the Chesapeake Bay watershed. Developed by the USGS, information generated by SPARROW can help resource managers determine the geographical distribution and relative contribution of nutrient sources and the factors that affect their transport to the Bay. Nutrient source information representing the late 1990s time period was obtained from several agencies and used to create and compile digital spatial datasets of total nitrogen and total phosphorus contributions that served as input sources to the SPARROW models. These data represent atmospheric deposition, point-source locations, land-use, land-cover, and agricultural sources such as commercial fertilizer and manure applications. Watershed-characteristics datasets representing factors that affect the transport of nutrients also were compiled from previous applications of the SPARROW models in the Chesapeake Bay watershed. Datasets include average-annual precipitation and temperature, slope, soil permeability, and hydrogeomorphic regions. Nutrient-input and watershed-characteristics datasets representing conditions during the late 1990s were merged with a connected network of stream reaches and watersheds to provide the spatial detail required by SPARROW. Stream-nutrient load estimates for 125 sampling sites (87 for total nitrogen and 103 for total phosphorus) served as the dependent variables for the regressions, and were used to calibrate models of total nitrogen and total phosphorus depicting late 1990s conditions in the Chesapeake Bay watershed. Spatial data generated for the models can be used to identify the location of nutrient sources, while the models' nutrient estimates can be used to evaluate stream-nutrient load contributed locally by each source evaluated, the amount of local load generated that is transported to the Bay, and the factors that affect the nutrient transport. Applying the SPARROW methodology to late 1990s information completes three time periods (late 1980s, early 1990s, and late 1990s) of viable data that resource managers can use to evaluate the water-quality conditions within the Bay watershed in order to refine restoration goals and nutrient-reduction strategies.

Using the Internet to deliver health care value.

PubMed

MacStravic, S

2001-01-01

Beyond the popular uses of the Internet by HCOs--for recruiting employees, purchasing supplies and promoting brand and service awareness--lie a host of opportunities to add value to consumers online. All HCO programs can be enhanced through online initiatives: wellness and health promotion, risk reduction, prevention, early detection, symptom management, life event management, acute treatment and rehabilitation, disease management and end-of-life improvement. And beyond online initiatives in each of these categories lies the potential to use the Net for reminding consumers, individually and collectively, of the health and quality of life benefits they are gaining, thereby adding to the HCO's marketing and PR success.

Statistics for stochastic modeling of volume reduction, hydrograph extension, and water-quality treatment by structural stormwater runoff best management practices (BMPs)

USGS Publications Warehouse

Granato, Gregory E.

2014-01-01

The U.S. Geological Survey (USGS) developed the Stochastic Empirical Loading and Dilution Model (SELDM) in cooperation with the Federal Highway Administration (FHWA) to indicate the risk for stormwater concentrations, flows, and loads to be above user-selected water-quality goals and the potential effectiveness of mitigation measures to reduce such risks. SELDM models the potential effect of mitigation measures by using Monte Carlo methods with statistics that approximate the net effects of structural and nonstructural best management practices (BMPs). In this report, structural BMPs are defined as the components of the drainage pathway between the source of runoff and a stormwater discharge location that affect the volume, timing, or quality of runoff. SELDM uses a simple stochastic statistical model of BMP performance to develop planning-level estimates of runoff-event characteristics. This statistical approach can be used to represent a single BMP or an assemblage of BMPs. The SELDM BMP-treatment module has provisions for stochastic modeling of three stormwater treatments: volume reduction, hydrograph extension, and water-quality treatment. In SELDM, these three treatment variables are modeled by using the trapezoidal distribution and the rank correlation with the associated highway-runoff variables. This report describes methods for calculating the trapezoidal-distribution statistics and rank correlation coefficients for stochastic modeling of volume reduction, hydrograph extension, and water-quality treatment by structural stormwater BMPs and provides the calculated values for these variables. This report also provides robust methods for estimating the minimum irreducible concentration (MIC), which is the lowest expected effluent concentration from a particular BMP site or a class of BMPs. These statistics are different from the statistics commonly used to characterize or compare BMPs. They are designed to provide a stochastic transfer function to approximate the quantity, duration, and quality of BMP effluent given the associated inflow values for a population of storm events. A database application and several spreadsheet tools are included in the digital media accompanying this report for further documentation of methods and for future use. In this study, analyses were done with data extracted from a modified copy of the January 2012 version of International Stormwater Best Management Practices Database, designated herein as the January 2012a version. Statistics for volume reduction, hydrograph extension, and water-quality treatment were developed with selected data. Sufficient data were available to estimate statistics for 5 to 10 BMP categories by using data from 40 to more than 165 monitoring sites. Water-quality treatment statistics were developed for 13 runoff-quality constituents commonly measured in highway and urban runoff studies including turbidity, sediment and solids; nutrients; total metals; organic carbon; and fecal coliforms. The medians of the best-fit statistics for each category were selected to construct generalized cumulative distribution functions for the three treatment variables. For volume reduction and hydrograph extension, interpretation of available data indicates that selection of a Spearman’s rho value that is the average of the median and maximum values for the BMP category may help generate realistic simulation results in SELDM. The median rho value may be selected to help generate realistic simulation results for water-quality treatment variables. MIC statistics were developed for 12 runoff-quality constituents commonly measured in highway and urban runoff studies by using data from 11 BMP categories and more than 167 monitoring sites. Four statistical techniques were applied for estimating MIC values with monitoring data from each site. These techniques produce a range of lower-bound estimates for each site. Four MIC estimators are proposed as alternatives for selecting a value from among the estimates from multiple sites. Correlation analysis indicates that the MIC estimates from multiple sites were weakly correlated with the geometric mean of inflow values, which indicates that there may be a qualitative or semiquantitative link between the inflow quality and the MIC. Correlations probably are weak because the MIC is influenced by the inflow water quality and the capability of each individual BMP site to reduce inflow concentrations.

150 patient experiences with a soft silicone foam dressing.

PubMed

Bateman, Sharon Dawn

Pain, malodour and exudate from acute and chronic wounds can be catastrophic to the patient. Excessive exudate results in significant tissue damage to the wound bed and surrounding skin, reduces quality of life, and often requires costly specialist service input. Effective wound assessment and management including appropriate dressing choice is, therefore, paramount to ensure wound healing can take place in a timely manner. This observational evaluation explores 150 ward-based patients who presented with acute and chronic exuding wounds; it examines and evaluates the proposed benefits of the Cutimed(®) Siltec foam dressing range over a 4-month period in an acute hospital setting. The outcomes of the evaluation were exudate management, maceration reduction, atraumatic application and removal, non-adherence and patient experience. The evaluation highlights not only an overall positive improvement in exudate management and maceration reduction, non-adherence, atraumatic application and removal but also emphasises the importance of a positive patient experience in the wound-care journey.

Case management's value is finally recognized. What happens now? .

PubMed

2015-10-01

In recent years, case management has been recognized as a key in improving healthcare quality and reducing costs, but while hospitals are giving case managers more responsibilities, many administrators are not approving an increase in staff to handle the extra work. Case managers can help their hospital succeed with the Centers for Medicare & Medicaid Services' Value-based Purchasing program, the readmission reduction program, and bundled payments. Case management directors should make sure the hospital's senior leadership understands the roles and responsibilities of case managers and how their interventions can affect outcomes and the bottom line. The number of caseloads depends on the case management model, the responsibilities of case managers, and whether they have assistants or case management extenders who can take over some tasks and allow the licensed staff to work at the top of their licenses. Don't let technology replace communication and patient-centered interactions.

Effectiveness of barnyard best management practices in Wisconsin

USGS Publications Warehouse

Stuntebeck, Todd D.; Bannerman, Roger T.

1998-01-01

In 1978, the Wisconsin Legislature committed to protecting water quality by enacting the Nonpoint Source Water Pollution Abatement Program. Through this program, cost-share money is provided within priority watersheds to control sources of nonpoint pollution. Most of the cost-share dollars for rural watersheds have been used to implement barnyard Best Management Practices (BMPs) because barnyards are believed to be a major source of pollutants, most notably phosphorus. Reductions in phosphorus loads of as much as 95 percent have been predicted for the barnyard BMPs recommended for priority watersheds.

Collaborating for care: initial experience of embedded case managers across five medical homes.

PubMed

Treadwell, Janet; Giardino, Angelo

2014-01-01

The purpose of this intervention was to answer the following question: Does an embedded nurse case manager from a health plan performing embedded care coordination and supporting a quality improvement project impact medical home service use, role satisfaction, and per member per month expense? The setting for this study was primary care medical home practices with a minimum of 1,000 lives, contracted with a health plan delivering Medicaid and Children's Health Insurance coverage. Five medical home practice sites were selected for the intervention. The study began with case manager training and project permission in 5 medical homes, followed by implementation of care coordination with health plan clients. The nurse case manager performed care coordination functions for clients and initiated a Lean Six Sigma quality improvement project at the medical home site. The analysis strategy was to compare each medical home with itself before and after the intervention, as well as to obtain satisfaction information from medical home staff and care coordinators. Reductions in expense, as demonstrated by decreased per member per month claim cost, admissions per thousand, and reduced variation in days per thousand, were documented. Quality projects attained significant improvements in 4 out of 5 sites, and practice staff as well as case managers described satisfaction with the embedded nurse case manager role. These findings support medical homes as being an effective delivery model of the Affordable Care Act. Case managers who practice in primary care sites can make a significant difference in patient outcomes and practice efficiencies. Embedded case managers have the ability to impact the population being served through modeling and supporting interprofessional relationships and case management expertise. Use of motivational interviewing, assessment skills, advocacy, and joint care planning engage patients in their own care, whereas quality initiatives bring efficiencies and effectiveness to overall operations. There is need for research to be conducted across a larger number of practice sites and diverse populations to substantiate the effect of embedded case management in medical home.

Variability in nest density, occupancy, and home range size of western bluebirds after forest treatments

Treesearch

Sarah Hurteau; Thomas Sisk; Brett Dickson; William Block

2010-01-01

Complex land use and fuels management histories have resulted in significant changes in composition, structure, and function of southwestern forests and subsequent changes in the extent and quality of wildlife habitats. We evaluated how several currently used fuel reduction treatments (e.g., mechanical thinning and prescribed fire alone and in combination) affect nest...

Procedures, Requirements and Challenges Associated with Analysis of Environmental Samples for Chemical Warfare Material (CWM)

DTIC Science & Technology

2012-03-29

DOD Environmental Monitoring Data Quality (EMDQ) Workshop John Schwarz, Laboratory Manager; Environmental Monitoring Laboratory ( EML ) March 29, 2012...Center (ECBC),Environmental Monitoring Laboratory ( EML ),5183 Blackhawk RD,Aberdeen Proving Ground,MD,21010-5424 8. PERFORMING ORGANIZATION REPORT...Biological Applications and Risk Reduction (CBARR) Environmental Monitoring Laboratory ( EML ) Approved for Public Release Environmental Monitoring

Trees and Streets as Drivers of Urban Stormwater Nutrient Pollution.

PubMed

Janke, Benjamin D; Finlay, Jacques C; Hobbie, Sarah E

2017-09-05

Expansion of tree cover is a major management goal in cities because of the substantial benefits provided to people, and potentially to water quality through reduction of stormwater volume by interception. However, few studies have addressed the full range of potential impacts of trees on urban runoff, which includes deposition of nutrient-rich leaf litter onto streets connected to storm drains. We analyzed the influence of trees on stormwater nitrogen and phosphorus export across 19 urban watersheds in Minneapolis-St. Paul, MN, U.S.A., and at the scale of individual streets within one residential watershed. Stormwater nutrient concentrations were highly variable across watersheds and strongly related to tree canopy over streets, especially for phosphorus. Stormwater nutrient loads were primarily related to road density, the dominant control over runoff volume. Street canopy exerted opposing effects on loading, where elevated nutrient concentrations from trees near roads outweighed the weak influence of trees on runoff reduction. These results demonstrate that vegetation near streets contributes substantially to stormwater nutrient pollution, and therefore to eutrophication of urban surface waters. Urban landscape design and management that account for trees as nutrient pollution sources could improve water quality outcomes, while allowing cities to enjoy the myriad benefits of urban forests.

Sleep quality and fatigue after a stress management intervention for women with early-stage breast cancer in southern Florida.

PubMed

Vargas, Sara; Antoni, Michael H; Carver, Charles S; Lechner, Suzanne C; Wohlgemuth, William; Llabre, Maria; Blomberg, Bonnie B; Glück, Stefan; DerHagopian, Robert P

2014-12-01

Sleep disruption and fatigue are ubiquitous among cancer patients and are sources of stress that may compromise treatment outcomes. Previously, we showed that a cognitive behavioral stress management (CBSM) intervention reduced anxiety and other stress-related processes in women undergoing primary treatment for breast cancer. This study examined secondary outcomes from a CBSM intervention trial for women with early-stage breast cancer to test if CBSM would improve sleep quality and fatigue among these patients at a single site in southern Florida. CBSM-related effects have already been demonstrated for indicators of psychosocial adaptation (e.g., general and cancer-related anxiety). Patients were randomized to CBSM (n= 120) or a 1-day psychoeducation control group (n= 120). The Pittsburgh Sleep Quality Index (PSQI) and Fatigue Symptom Inventory were completed prior to randomization and 6 and 12 months after the baseline assignment. In latent growth analyses, women in CBSM reported greater improvements in PSQI sleep quality scores than controls, although there were no significant differences between conditions on PSQI total scores. Women in CBSM also reported greater reductions in fatigue-related daytime interference than controls, though there were no significant differences in changes in fatigue intensity. Changes in sleep quality were associated with changes in fatigue. Future work may consider integrating sleep and fatigue content into stress management interventions for women with early-stage breast cancer.

Use of the quality management system "JACIE" and outcome after hematopoietic stem cell transplantation.

PubMed

Gratwohl, Alois; Brand, Ronald; McGrath, Eoin; van Biezen, Anja; Sureda, Anna; Ljungman, Per; Baldomero, Helen; Chabannon, Christian; Apperley, Jane

2014-05-01

Competent authorities, healthcare payers and hospitals devote increasing resources to quality management systems but scientific analyses searching for an impact of these systems on clinical outcome remain scarce. Earlier data indicated a stepwise improvement in outcome after allogeneic hematopoietic stem cell transplantation with each phase of the accreditation process for the quality management system "JACIE". We therefore tested the hypothesis that working towards and achieving "JACIE" accreditation would accelerate improvement in outcome over calendar time. Overall mortality of the entire cohort of 107,904 patients who had a transplant (41,623 allogeneic, 39%; 66,281 autologous, 61%) between 1999 and 2006 decreased over the 14-year observation period by a factor of 0.63 per 10 years (hazard ratio: 0.63; 0.58-0.69). Considering "JACIE"-accredited centers as those with programs having achieved accreditation by November 2012, at the latest, this improvement was significantly faster in "JACIE"-accredited centers than in non-accredited centers (approximately 5.3% per year for 49,459 patients versus approximately 3.5% per year for 58,445 patients, respectively; hazard ratio: 0.83; 0.71-0.97). As a result, relapse-free survival (hazard ratio 0.85; 0.75-0.95) and overall survival (hazard ratio 0.86; 0.76-0.98) were significantly higher at 72 months for those patients transplanted in the 162 "JACIE"-accredited centers. No significant effects were observed after autologous transplants (hazard ratio 1.06; 0.99-1.13). Hence, working towards implementation of a quality management system triggers a dynamic process associated with a steeper reduction in mortality over the years and a significantly improved survival after allogeneic stem cell transplantation. Our data support the use of a quality management system for complex medical procedures.

Application of uncertainty and sensitivity analysis to the air quality SHERPA modelling tool

NASA Astrophysics Data System (ADS)

Pisoni, E.; Albrecht, D.; Mara, T. A.; Rosati, R.; Tarantola, S.; Thunis, P.

2018-06-01

Air quality has significantly improved in Europe over the past few decades. Nonetheless we still find high concentrations in measurements mainly in specific regions or cities. This dimensional shift, from EU-wide to hot-spot exceedances, calls for a novel approach to regional air quality management (to complement EU-wide existing policies). The SHERPA (Screening for High Emission Reduction Potentials on Air quality) modelling tool was developed in this context. It provides an additional tool to be used in support to regional/local decision makers responsible for the design of air quality plans. It is therefore important to evaluate the quality of the SHERPA model, and its behavior in the face of various kinds of uncertainty. Uncertainty and sensitivity analysis techniques can be used for this purpose. They both reveal the links between assumptions and forecasts, help in-model simplification and may highlight unexpected relationships between inputs and outputs. Thus, a policy steered SHERPA module - predicting air quality improvement linked to emission reduction scenarios - was evaluated by means of (1) uncertainty analysis (UA) to quantify uncertainty in the model output, and (2) by sensitivity analysis (SA) to identify the most influential input sources of this uncertainty. The results of this study provide relevant information about the key variables driving the SHERPA output uncertainty, and advise policy-makers and modellers where to place their efforts for an improved decision-making process.

Simulating and evaluating best management practices for integrated landscape management scenarios in biofuel feedstock production: Evaluating Best Management Practices for Biofuel Feedstock Production

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

Ha, Miae; Wu, May

Sound crop and land management strategies can maintain land productivity and improve the environmental sustainability of agricultural crop and feedstock production. This study evaluates the improvement of water sustainability through an integrated landscaping management strategy, where landscaping design, land management operations, crop systems, and agricultural best management practices (BMPs) play equal roles. The strategy was applied to the watershed of the South Fork Iowa River in Iowa, with a focus on implementing riparian buffers and converting low productivity land to provide cellulosic biomass while benefiting soil and water quality. The Soil and Water Assessment Tool (SWAT) was employed to simulatemore » the impact of integrated landscape design on nutrients, suspended sediments, and flow on the watershed and subbasin scales. First, the study evaluated the representation of buffer strip as a vegetative barrier and as a riparian buffer using trapping efficiency and area ratio methods in SWAT. For the riparian buffer, the area ratio method tends to be more conservative, especially in nitrate loadings, while the trapping efficiency method generates more optimistic results. The differences between the two methods increase with buffer width. The two methods may not be comparable for the field-scale vegetative barrier simulation because of limitations in model spatial resolution. Landscape scenarios were developed to quantify water quality under (1) current land use, (2) partial land conversion to switchgrass, and (3) riparian buffer implementation. Results show that when low productivity land (15.2% of total watershed land area) is converted to grow switchgrass, suspended sediment, total nitrogen, total phosphorus, and nitrate loadings are reduced by 69.3%, 55.5%, 46.1%, and 13.4%, respectively, in the watershed surface streams. The reduction was less extensive when riparian buffer strips (30 m or 50 m) were applied to the stream network at 1.4% of total land area in the watershed. At the subbasin level, the degree of nutrient and suspended sediment reduction varies extensively, ranging from a few percent up to 55%. Results indicate that effective landscape design on current agricultural land can potentially bring marked improvements in water quality and soil erosion control while producing food and fuel feedstock in the South Fork Iowa River watershed. The concept can be integrated with other watershed management programs to improve sustainability of land, water, and the ecosystem.« less

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors.

PubMed

Mahmood, Mohammad Afzal; Mufidah, Ismi; Scroggs, Steven; Siddiqui, Amna Rehana; Raheel, Hafsa; Wibdarminto, Koentijo; Dirgantoro, Bernardus; Vercruyssen, Jorien; Wahabi, Hayfaa A

2018-01-01

Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped.

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors

PubMed Central

Mufidah, Ismi; Scroggs, Steven; Siddiqui, Amna Rehana; Raheel, Hafsa; Wibdarminto, Koentijo; Dirgantoro, Bernardus; Vercruyssen, Jorien

2018-01-01

Background Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Method Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. Findings The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. Conclusion There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped. PMID:29682538

Conceptualizing the role of sediment in sustaining ecosystem services: Sediment-ecosystem regional assessment (SEcoRA).

PubMed

Apitz, Sabine E

2012-01-15

There is a growing trend to include a consideration of ecosystem services, the benefits that people obtain from ecosystems, within decision frameworks. Not more than a decade ago, sediment management efforts were largely site-specific and held little attention except in terms of managing contaminant inputs and addressing sediments as a nuisance at commercial ports and harbors. Sediments figure extensively in the Millennium Ecosystem Assessment; however, contaminated sediment is not the dominant concern. Rather, the focus is on land and water use and management on the landscape scale, which can profoundly affect soil and sediment quality, quantity and fate. Habitat change and loss, due to changes in sediment inputs, whether reductions (resulting in the loss of beaches, storm protection, nutrient inputs, etc.) or increases (resulting in lake, reservoir and wetland infilling, coral reef smothering, etc.); eutrophication and reductions in nutrient inputs, and disturbance due to development and fishing practices are considered major drivers, with significant consequences for biodiversity and the provision and resilience of ecosystem functions and services. As a mobile connecting medium between various parts of the ecosystem via the hydrocycle, sediments both contaminated and uncontaminated, play both positive and negative roles in the viability and sustainability of social, economic, and ecological objectives. How these roles are interpreted depends upon whether sediment status (defined in terms of sediment quality, quantity, location and transport) is appropriate to the needs of a given endpoint; understanding and managing the dynamic interactions of sediment status on a diverse range of endpoints at the landscape or watershed scale should be the focus of sediment management. This paper seeks to provide a language and conceptual framework upon which sediment-ecosystem regional assessments (SEcoRAs) can be developed in support of that goal. Copyright © 2011 Elsevier B.V. All rights reserved.

Managing water and salinity with desalination, conveyance, conservation, waste-water treatment and reuse to counteract climate variability in Gaza

NASA Astrophysics Data System (ADS)

Rosenberg, D. E.; Aljuaidi, A. E.; Kaluarachchi, J. J.

2009-12-01

We include demands for water of different salinity concentrations as input parameters and decision variables in a regional hydro-economic optimization model. This specification includes separate demand functions for saline water. We then use stochastic non-linear programming to jointly identify the benefit maximizing set of infrastructure expansions, operational allocations, and use of different water quality types under climate variability. We present a detailed application for the Gaza Strip. The application considers building desalination and waste-water treatment plants and conveyance pipelines, initiating water conservation and leak reduction programs, plus allocating and transferring water of different qualities among agricultural, industrial, and urban sectors and among districts. Results show how to integrate a mix of supply enhancement, conservation, water quality improvement, and water quality management actions into a portfolio that can economically and efficiently respond to changes and uncertainties in surface and groundwater availability due to climate variability. We also show how to put drawn-down and saline Gaza aquifer water to more sustainable and economical use.

Savings opportunities through Medicaid disease management.

PubMed

Lewis, Alfred

2004-01-01

In their attempts to control spending in Medicaid, a few states have looked beyond the obvious reductions in reimbursement, tightened eligibility requirements, and institution of copays to disease management outsourcing. While the traditional panoply of cutbacks will save money the year they are instituted, they tend to have trade-offs. Reducing reimbursement, for example, may encourage providers to leave the program. As a result, several states are implementing outsourced medical management programs, which together at maturity will, as shown below, noticeably reduce Medicaid spending by improving the way health care is delivered. These purely voluntary, quality-enhancing outsourced medical management programs are also fully guaranteed by a wide variety of vendors to save money starting in the first year they are implemented.

Why (just) information is not enough: The contributions of information services in the management of healthcare information

NASA Astrophysics Data System (ADS)

Kostagiolas, P.; Lappa, E.

2015-02-01

Information is at the centre of every hospital activity including clinical decisions and healthcare service delivery systems. Although information is an important hospital asset, several issues related to its management and organization needs to be addressed within the hospitals. The management of healthcare information is a strategic goal related to the reduction of healthcare service provision costs, and to the improvement of quality and safety of healthcare services. By discussing the rather obvious necessity for information organization and management in the healthcare domain, this work aims at the role of healthcare information services, i.e. hospital libraries and patient medical records. Finally, a typology of information services' contributions to hospital environment is presented.

Declining nitrate-N yields in the Upper Potomac River basin: what is really driving progress under the Chesapeake Bay restoration?

NASA Astrophysics Data System (ADS)

Eshleman, K. N.; Sabo, R.

2015-12-01

Reducing nutrient pollution of surface and coastal waters in the U.S. and elsewhere remains a major environmental and engineering challenge for the 21st century. In the case of the Chesapeake Bay restoration, we still lack scientific proof that previous watershed-based management actions have been effective at reducing nonpoint-source nutrient loads from the land to this estuary in accordance with restoration goals. While the conventional wisdom is that implementation of best management practices (BMP's) has turned the against nutrient pollution, we examined long-term (1986-present) nitrate-N trends in streams and major tributaries of the Upper Potomac River Basin (UPRB) and found that: 1) dramatic reductions in annual discharge-weighted nitrate-N concentrations and yields across the UPRB can be almost universally attributed to reductions in atmospheric N deposition as opposed to on-the-ground management actions such as implementation of BMP's; 2) observed water quality changes comport with a modified kinetic N saturation model (MKNSM); 3) the MKNSM can separate the nitrate-N yield that is responsive to atmospheric deposition from a "legacy" yield; and 4) N saturation from atmospheric N deposition appears to be an inherently reversible process across most of the landscape. These unanticipated region-wide water quality benefits can be attributed to NOx emission controls brought about by the 1990 Clean Air Act Amendments (and subsequent U.S. NOX control programs) and reflect one of a very few water quality "success stories" in the Chesapeake Bay restoration; the results have important ramifications for the 2017 "mid-point assessment" that is part of the latest Chesapeake Bay Watershed Agreement.

Guidelines for overcoming hospital managerial challenges: a systematic literature review

PubMed Central

Crema, Maria; Verbano, Chiara

2013-01-01

Purpose The need to respond to accreditation institutes’ and patients’ requirements and to align health care results with increased medical knowledge is focusing greater attention on quality in health care. Different tools and techniques have been adopted to measure and manage quality, but clinical errors are still too numerous, suggesting that traditional quality improvement systems are unable to deal appropriately with hospital challenges. The purpose of this paper is to grasp the current tools, practices, and guidelines adopted in health care to improve quality and patient safety and create a base for future research on this young subject. Methods A systematic literature review was carried out. A search of academic databases, including papers that focus not only on lean management, but also on clinical errors and risk reduction, yielded 47 papers. The general characteristics of the selected papers were analyzed, and a content analysis was conducted. Results A variety of managerial techniques, tools, and practices are being adopted in health care, and traditional methodologies have to be integrated with the latest ones in order to reduce errors and ensure high quality and patient safety. As it has been demonstrated, these tools are useful not only for achieving efficiency objectives, but also for providing higher quality and patient safety. Critical indications and guidelines for successful implementation of new health managerial methodologies are provided and synthesized in an operative scheme useful for extending and deepening knowledge of these issues with further studies. Conclusion This research contributes to introducing a new theme in health care literature regarding the development of successful projects with both clinical risk management and health lean management objectives, and should address solutions for improving health care even in the current context of decreasing resources. PMID:24307833

Navy Nurse Corps manpower management model.

PubMed

Kinstler, Daniel P; Johnson, Raymond W; Richter, Anke; Kocher, Kathryn

2008-01-01

The Navy Nurse Corps is part of a team of professionals that provides high quality, economical health care to approximately 700,000 active duty Navy and Marine Corps members, as well as 2.6 million retired and family members. Navy Nurse Corps manpower management efficiency is critical to providing this care. This paper aims to focus on manpower planning in the Navy Nurse Corps. The Nurse Corps manages personnel primarily through the recruitment process, drawing on multiple hiring sources. Promotion rates at the lowest two ranks are mandated, but not at the higher ranks. Retention rates vary across pay grades. Using these promotion and attrition rates, a Markov model was constructed to model the personnel flow of junior nurse corps officers. Hiring sources were shown to have a statistically significant effect on promotion and retention rates. However, these effects were not found to be practically significant in the Markov model. Only small improvements in rank imbalances are possible given current recruiting guidelines. Allowing greater flexibility in recruiting practices, fewer recruits would generate a 25 percent reduction in rank imbalances, but result in understaffing. Recruiting different ranks at entry would generate a 65 percent reduction in rank imbalances without understaffing issues. Policies adjusting promotion and retention rates are more powerful in controlling personnel flows than adjusting hiring sources. These policies are the only means for addressing the fundamental sources of rank imbalances in the Navy Nurse Corps arising from current manpower guidelines. The paper shows that modeling to improve manpower management may enable the Navy Nurse Corps to more efficiently fulfill its mandate for high-quality healthcare.

[Quality and effectiveness of smoking cessation interventions in workplaces sites].

PubMed

Iwanowicz, Eliza

2008-01-01

According to the survey carried out by the National Centre for Workplace Health Promotion at the Nofer Institute of Occupational Medicine, the level and quality of smoking cessation interventions implemented in Polish enterprises are insufficient. Therefore, the dissemination of good practices in this field is needed. The paper presents (on the basis of the literature review) chosen outcomes of the research focused on the effectiveness of workplace smoking cessation interventions. These are mostly methods influencing the turnout in such programs as well as reduction of smoking in the workplace. According to the papers in question, partnership relationships between the organizers of the program and its participants as well as ensuring the employees in the process of quitting various forms of social support are factors, which may contribute to effective reduction of smoking in the workplace. It seems necessary to increase awareness of this issue among Polish managers.

Benefits and Barriers of Implementation and Utilization of Radio-Frequency Identification (RFID) Systems in Transfusion Medicine.

PubMed

Coustasse, Alberto; Cunningham, Brian; Deslich, Stacie; Willson, Eric; Meadows, Pamela

2015-01-01

Radio-frequency identification (RFID) technology is used by hospital supply chains to track medical products and monitor inventories. Hospitals have also begun incorporating RFID technology as part of their transfusion processes. The purpose of this review was to analyze how healthcare organization supply chains can benefit from the utilization of RFID systems in transfusion service departments. The methodology for this study was a literature review following the steps of a systematic review with a total of 52 sources referenced. RFID technology is used to manage and track blood products from the initial donor phlebotomy to final disposition or product transfusion. RFID-enabled transfusion practices have successfully increased provider productivity and product quality through work-time reduction and error reduction. Findings of this research study suggest that RFID has provided improvements in quality of care and efficiency, while initial costs, security, and privacy appear to be the principal barriers to adoption.

Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal

PubMed Central

Naidoo, Logandran

2016-01-01

Background Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. Aim The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. Setting The study was conducted at the Catherine Booth Hospital (CBH) – a rural district hospital in KwaZulu-Natal, South Africa. Methods This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. Results All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). Conclusion The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators. PMID:27543283

Medicaid program choice, inertia and adverse selection.

PubMed

Marton, James; Yelowitz, Aaron; Talbert, Jeffery C

2017-12-01

In 2012, Kentucky implemented Medicaid managed care statewide, auto-assigned enrollees to three plans, and allowed switching. Using administrative data, we find that the state's auto-assignment algorithm most heavily weighted cost-minimization and plan balancing, and placed little weight on the quality of the enrollee-plan match. Immobility - apparently driven by health plan inertia - contributed to the success of the cost-minimization strategy, as more than half of enrollees auto-assigned to even the lowest quality plans did not opt-out. High-cost enrollees were more likely to opt-out of their auto-assigned plan, creating adverse selection. The plan with arguably the highest quality incurred the largest initial profit margin reduction due to adverse selection prior to risk adjustment, as it attracted a disproportionate share of high-cost enrollees. The presence of such selection, caused by differential degrees of mobility, raises concerns about the long run viability of the Medicaid managed care market without such risk adjustment. Copyright © 2017 Elsevier B.V. All rights reserved.

Concurrent Engineering for the Management of Research and Development

NASA Technical Reports Server (NTRS)

DelRosario, Ruben; Petersen, Paul F.; Keys, L. Ken; Chen, Injazz J.

2004-01-01

The Management of Research and Development (R&D) is facing the challenges of reducing time from R&D to customer, reducing the cost of R&D, having higher accountability for results (improved quality), and increasing focus on customers. Concurrent engineering (CE) has shown great success in the automotive and technology industries resulting in significant decreases in cycle time, reduction of total cost, and increases in quality and reliability. This philosophy of concurrency can have similar implications or benefits for the management of R&D organizations. Since most studies on the application of CE have been performed in manufacturing environments, research into the benefits of CE into other environments is needed. This paper presents research conducted at the NASA Glenn Research Center (GRC) investigating the application of CE in the management of an R&D organization. In particular the paper emphasizes possible barriers and enhancers that this environment presents to the successful implementation of CE. Preliminary results and recommendations are based on a series of interviews and subsequent surveys, from which data has been gathered and analyzed as part of the GRC's Continuous Improvement Process.

EO Underpinning the Quality of Ecosystem Services with Geospatial Data- The Case of Sustainable Forest Management

NASA Astrophysics Data System (ADS)

Crosthwaite Eyre, Charles

2010-12-01

Payments for Ecosystem Services (PES) is an exciting and expanding opportunity for sustainably managed forests. PES are derived from a range of ecosystem benefits from forests including climate change mitigation through afforestation and avoided deforestation, green power generation, wetland and watershed rehabilitation, water quality improvement, marine flood defence and the reduction in desertification and soil erosion. Forests are also the ancestral home to many vulnerable communities which need protection. Sustainable forest management plays a key role in many of these services which generates a potentially critical source of finance. However, for forests to realise revenues from these PES, they must meet demanding standards of project validation and service verification. They also need geospatial data to manage and monitor operational risk. In many cases the data is difficult to collect on the ground - in some cases impossible. This will create a new demand for data that must be impartial, timely, area wide, accurate and cost effective. This presentation will highlight the unique capacity of EO to provide these geospatial inputs required in the generation of PES from forestry and demonstrate products with practical examples.

Clinical process analysis and activity-based costing at a heart center.

PubMed

Ridderstolpe, Lisa; Johansson, Andreas; Skau, Tommy; Rutberg, Hans; Ahlfeldt, Hans

2002-08-01

Cost studies, productivity, efficiency, and quality of care measures, the links between resources and patient outcomes, are fundamental issues for hospital management today. This paper describes the implementation of a model for process analysis and activity-based costing (ABC)/management at a Heart Center in Sweden as a tool for administrative cost information, strategic decision-making, quality improvement, and cost reduction. A commercial software package (QPR) containing two interrelated parts, "ProcessGuide and CostControl," was used. All processes at the Heart Center were mapped and graphically outlined. Processes and activities such as health care procedures, research, and education were identified together with their causal relationship to costs and products/services. The construction of the ABC model in CostControl was time-consuming. However, after the ABC/management system was created, it opened the way for new possibilities including process and activity analysis, simulation, and price calculations. Cost analysis showed large variations in the cost obtained for individual patients undergoing coronary artery bypass grafting (CABG) surgery. We conclude that a process-based costing system is applicable and has the potential to be useful in hospital management.

Impacts of agricultural management practices on soil quality in Europe and China - an assessment within the framework of the EU iSQAPER project

NASA Astrophysics Data System (ADS)

Alaoui, Abdallah; Schwilch, Gudrun; Barão, Lúcia; Basch, Gottlieb; Sukkel, Wijnand; Lemesle, Julie; Ferreira, Carla; Garcia-Orenes, Fuensanta; Morugan, Alicia; Mataix, Jorge; Kosmas, Costas; Glavan, Matjaž; Tóth, Brigitta; Petrutza Gate, Olga; Lipiec, Jerzy; Reintam, Endla; Xu, Minggang; Di, Jiaying; Fan, Hongzhu; Geissen, Violette

2017-04-01

Agricultural soils are under a wide variety of pressures, including from increasing global demand for food associated with population growth, changing diets, land degradation, and associated productivity reductions potentially exacerbated by climate change. To manage the use of agricultural soils well, decision-makers need science-based, easily applicable, and cost-effective tools for assessing soil quality and soil functions. Since a practical assessment of soil quality requires the integrated consideration of key soil properties and their variations in space and time, providing such tools remains a challenging task. This study aims to assess the impact of innovative agricultural management practices on soil quality in 14 study sites across Europe (10) and China (4), covering the major pedo-climatic zones. The study is part of the European H2020 project iSQAPER, which involves 25 partners across Europe and China and is coordinated by Wageningen University, The Netherlands. iSQAPER is aimed at interactive soil quality assessment in Europe and China for agricultural productivity and environmental resilience. The study began with a thorough literature analysis to inform the selection of indicators for the assessment of soil structure and soil functions. A manual was then developed in order to standardize and facilitate the task of inventorying soil quality and management practices at the case study sites. The manual provides clear and precise instructions on how to assess the 11 selected soil quality indicators based on a visual soil assessment methodology. A newly developed infiltrometer was used to easily assess the soil infiltration capacity in the field and investigate hydrodynamic flow processes. Based on consistent calibration, the infiltrometer enables reliable prediction of key soil hydraulic properties. The main aim of this inventory is to link agricultural management practices to the soil quality status at the case study sites, and to identify innovative practices that have improved soil quality. The inventory and the scoring of soil quality are done together with land users at each study site. The idea is to compare the soil quality on a farm where management practices have changed 3 or more years ago with that on a control farm where practices have not changed, with both farms located in the same pedo-climatic zone and having comparable soil conditions. The case study partners were requested to identify at least 3 newly adopted management practices (or combinations thereof) and 3 related control farms. First results show that among 88 sets of paired plots, 60 pairs (68 %) show a positive impact of innovative agricultural management practices on soil quality. 18 pairs (21 %) do not show any difference in soil quality between soils under innovative practices and soils in the control plots, and the remaining 10 plots (11 %) show an inverse effect. The non-detectable effect of the innovative practices on soil quality are due to type of tillage management, soil type and fertility that mask the effect of management practices on soil and also due to time of the assessment. This assessment will be repeated in the coming years, with the aim of providing sound data on soil quality and its improvement through innovative management practices across Europe and China.

Air quality impacts of transit improvement, preferential lane, and carpool/vanpool programs. Final report

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

DiRenzo, J.F.; Rubin, R.B.

1978-03-01

The report was prepared in accordance with Section 108(f) of the Clean Air Act, as amended, August 1977. It is intended to assist urban areas in developing State Implementation Plans and integrating their transportation system management and air quality planning programs as required by FHWA, UMTA, and EPA. The report analyzes the air quality, travel, energy consumption, economic, and cost impacts of three types of transportation programs: priority treatment for high occupancy vehicles on freeways and arterials; areawide carpool and vanpool programs; and transit fare reductions and service improvements. Important factors (e.g., meteorological conditions, traffic volumes and speeds, and changesmore » in modal choice) likely to influence air quality and emissions for the above programs are also analyzed.« less

The Statistical point of view of Quality: the Lean Six Sigma methodology

PubMed Central

Viti, Andrea; Terzi, Alberto

2015-01-01

Six Sigma and Lean are two quality improvement methodologies. The Lean Six Sigma methodology is applicable to repetitive procedures. Therefore, the use of this methodology in the health-care arena has focused mainly on areas of business operations, throughput, and case management and has focused on efficiency outcomes. After the revision of methodology, the paper presents a brief clinical example of the use of Lean Six Sigma as a quality improvement method in the reduction of the complications during and after lobectomies. Using Lean Six Sigma methodology, the multidisciplinary teams could identify multiple modifiable points across the surgical process. These process improvements could be applied to different surgical specialties and could result in a measurement, from statistical point of view, of the surgical quality. PMID:25973253

The Statistical point of view of Quality: the Lean Six Sigma methodology.

PubMed

Bertolaccini, Luca; Viti, Andrea; Terzi, Alberto

2015-04-01

Six Sigma and Lean are two quality improvement methodologies. The Lean Six Sigma methodology is applicable to repetitive procedures. Therefore, the use of this methodology in the health-care arena has focused mainly on areas of business operations, throughput, and case management and has focused on efficiency outcomes. After the revision of methodology, the paper presents a brief clinical example of the use of Lean Six Sigma as a quality improvement method in the reduction of the complications during and after lobectomies. Using Lean Six Sigma methodology, the multidisciplinary teams could identify multiple modifiable points across the surgical process. These process improvements could be applied to different surgical specialties and could result in a measurement, from statistical point of view, of the surgical quality.

A systematic review of integrated use of disease-management interventions in asthma and COPD.

PubMed

Lemmens, Karin M M; Nieboer, Anna P; Huijsman, Robbert

2009-05-01

The effectiveness of multiple interventions in asthma and chronic obstructive pulmonary disease (COPD) is unclear. To examine the effectiveness of multiple interventions as compared to single interventions or usual care on health outcomes and health care utilisation within the context of integrated disease management in asthma and COPD. MEDLINE and the Cochrane Library (1995-May 2008) were searched for controlled trials. Two reviewers independently extracted data and assessed study quality. Meta-analyses were performed on quality of life and health care utilisation data. Furthermore, the effects of multiple interventions versus single interventions and usual care were assessed qualitatively. Of the 36 studies included, 17 targeted double interventions (patient-related and organisational interventions); 19 studies performed triple interventions (patient-related, professional-directed and organisational interventions). They were heterogeneous in terms of (combinations of) interventions, outcomes measured, study design and setting. Pooled data showed that studied disease management programmes significantly improved quality of life on several domains. Patients within triple intervention programmes had less chance of at least one hospital admission compared with usual care. No significant effects were found in number of emergency department visits. Qualitative analyses revealed positive trends on process improvements and satisfaction. Inconclusive results were reported on symptoms; no effects were found in lung function. In spite of the heterogeneity of disease management studies in asthma and COPD care, this review showed promising improvements in quality of life and reductions in hospitalisations, especially for triple intervention programmes.

Decontamination of an Extracorporeal Membrane Oxygenator Contaminated With Mycobacterium chimaera.

PubMed

Garvey, Mark I; Phillips, Natalie; Bradley, Craig W; Holden, Elisabeth

2017-10-01

Water samples taken from extracorporeal membrane oxygenator (ECMO) devices used at University Hospitals Birmingham yielded high total viable counts (TVCs) containing a variety of microorganisms, including M. chimaera. Disinfection resulted in the reduction of TVCs and eradication of Mycobacterium chimaera. Weekly disinfection and water sampling are required to manage the water quality in these devices. Infect Control Hosp Epidemiol 2017;38:1244-1246.

Pharmacist managed diabetes and cardiovascular risk reduction clinic in kidney transplant recipients: bridging the gap in care transition.

PubMed

Pinelli, Nicole R; Clark, Lindsey M; Carrington, Anne C; Carrington, Julia L; Malinzak, Lauren; Patel, Anita

2014-12-01

The purpose was to assess the feasibility of a care transition intervention for kidney transplant recipients (KTRs) with diabetes. Results document improved quality indicators and reduced resource utilization. These findings imply that a care transition intervention for KTRs with diabetes is feasible and associated with improved patient outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

ESR/ERS white paper on lung cancer screening

PubMed Central

Bonomo, Lorenzo; Gaga, Mina; Nackaerts, Kristiaan; Peled, Nir; Prokop, Mathias; Remy-Jardin, Martine; von Stackelberg, Oyunbileg; Sculier, Jean-Paul

2015-01-01

Lung cancer is the most frequently fatal cancer, with poor survival once the disease is advanced. Annual low dose computed tomography has shown a survival benefit in screening individuals at high risk for lung cancer. Based on the available evidence, the European Society of Radiology and the European Respiratory Society recommend lung cancer screening in comprehensive, quality-assured, longitudinal programmes within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres. Minimum requirements include: standardised operating procedures for low dose image acquisition, computer-assisted nodule evaluation, and positive screening results and their management; inclusion/exclusion criteria; expectation management; and smoking cessation programmes. Further refinements are recommended to increase quality, outcome and cost-effectiveness of lung cancer screening: inclusion of risk models, reduction of effective radiation dose, computer-assisted volumetric measurements and assessment of comorbidities (chronic obstructive pulmonary disease and vascular calcification). All these requirements should be adjusted to the regional infrastructure and healthcare system, in order to exactly define eligibility using a risk model, nodule management and quality assurance plan. The establishment of a central registry, including biobank and image bank, and preferably on a European level, is strongly encouraged. PMID:25929956

Performance management of Clostridium difficile infection in hospitals - The carrot or stick approach?

PubMed

Fitzpatrick, Fidelma; Riordan, Mary O

2016-02-01

Public and political pressure for healthcare quality indicator monitoring, specifically healthcare-associated infection (HAI) has intensified the debate regarding the merits of public reporting and target setting as policy approaches. This paper reviews the evidence for these approaches with a focus on HAI, including Clostridium difficile infection (CDI). Healthcare key performance indicators (KPIs) and associated targets have been used widely with little evaluation. While targets are associated with some HAI reductions including CDI, as their control is multi-factorial, it is likely that reductions are due to numerous, concurrent control measures. Targets may help tackle organizational-wide issues that require high level management engagement and have contributed to the increased access and influence of infection control teams. HAI public reporting has also gained traction and is mandatory in many countries despite little scientific evaluation. CDI is one of the KPIs used but there is little consensus as to the best KPI for public reporting. Countries without public reporting have also seen improvements. Using indicator-based strategies rather than evidence-based ones risk improving the KPI but not necessarily quality of care. 'Bottom-up' approaches focussing on quality improvement and innovation generated by front line staff are seen as a lever for sustainable change. Positive deviance, where the resourcefulness and problem solving abilities of staff is harnessed, enables 'bottom-up' changes with process and outcome improvements. As implementation of best practice in healthcare is dependent on behavioural and cultural change, it is most likely that a combination of 'top-down' and 'bottom-up' approaches are required for sustainable improvement. This combined approach was used to improve staff influenza vaccination rates. Regulation may initially direct the spot-light onto infection control needs but true sustainable HAI reduction will only be fostered with concurrent cultural and behavioural shifts in practice and ownership of the HAI burden across clinical, policy and management domains. It will be interesting if this approach will be increasingly used by policy makers, however, irrespective it is clear that there is a need for rigorous evaluation of our HAI policy approaches from this point forward. Copyright © 2015 Elsevier Ltd. All rights reserved.

Learning from death: a hospital mortality reduction programme.

PubMed

Wright, John; Dugdale, Bob; Hammond, Ian; Jarman, Brian; Neary, Maria; Newton, Duncan; Patterson, Chris; Russon, Lynne; Stanley, Philip; Stephens, Rose; Warren, Erica

2006-06-01

There are wide variations in hospital mortality. Much of this variation remains unexplained and may reflect quality of care. A large acute hospital in an urban district in the North of England. Before and after evaluation of a hospital mortality reduction programme. Audit of hospital deaths to inform an evidence-based approach to identify processes of care to target for the hospital strategy. Establishment of a hospital mortality reduction group with senior leadership and support to ensure the alignment of the hospital departments to achieve a common goal. Robust measurement and regular feedback of hospital deaths using statistical process control charts and summaries of death certificates and routine hospital data. Whole system working across a health community to provide appropriate end of life care. Training and awareness in processes of high quality care such as clinical observation, medication safety and infection control. Hospital standardized mortality ratios fell significantly in the 3 years following the start of the programme from 94.6 (95% confidence interval 89.4, 99.9) in 2001 to 77.5 (95% CI 73.1, 82.1) in 2005. This translates as 905 fewer hospital deaths than expected during the period 2002-2005. Improving the safety of hospital care and reducing hospital deaths provides a clear and well supported goal from clinicians, managers and patients. Good leadership, good information, a quality improvement strategy based on good local evidence and a community-wide approach may be effective in improving the quality of processes of care sufficiently to reduce hospital mortality.

Management of Hip Fractures in Lateral Position without a Fracture Table.

PubMed

Pahlavanhosseini, Hamid; Valizadeh, Sima; Banadaky, Seyyed Hossein Saeed; Karbasi, Mohammad H Akhavan; Abrisham, Seyed Mohammad J; Fallahzadeh, Hossein

2014-09-01

Hip fracture Management in supine position on a fracture table with biplane fluoroscopic views has some difficulties which leads to prolongation of surgery and increasing x- rays' dosage. The purpose of this study was to report the results and complications of hip fracture management in lateral position on a conventional operating table with just anteroposterior fluoroscopic view. 40 hip fractures (31 trochanteric and 9 femoral neck fractures) were operated in lateral position between Feb 2006 and Oct 2012. Age, gender, fracture classification, operation time, intra-operation blood loss, reduction quality, and complications were extracted from patients' medical records. The mean follow-up time was 30.78±22.73 months (range 4-83). The mean operation time was 76.50 ± 16.88 min (range 50 - 120 min).The mean intra-operative blood loss was 628.75 ± 275.00 ml (range 250-1300ml). Anatomic and acceptable reduction was observed in 95%of cases. The most important complications were malunion (one case in trochanteric group), avascular necrosis of femoral head and nonunion (each one case in femoral neck group). It sounds that reduction and fixation of hip fractures in lateral position with fluoroscopy in just anteroposterior view for small rural hospitals may be executable and probably safe.

Management of Hip Fractures in Lateral Position without a Fracture Table

PubMed Central

Pahlavanhosseini, Hamid; Valizadeh, Sima; Banadaky, Seyyed Hossein Saeed; Karbasi, Mohammad H Akhavan; Abrisham, Seyed Mohammad J; Fallahzadeh, Hossein

2014-01-01

Background: Hip fracture Management in supine position on a fracture table with biplane fluoroscopic views has some difficulties which leads to prolongation of surgery and increasing x- rays' dosage. The purpose of this study was to report the results and complications of hip fracture management in lateral position on a conventional operating table with just anteroposterior fluoroscopic view. Methods: 40 hip fractures (31 trochanteric and 9 femoral neck fractures) were operated in lateral position between Feb 2006 and Oct 2012. Age, gender, fracture classification, operation time, intra-operation blood loss, reduction quality, and complications were extracted from patients' medical records. The mean follow-up time was 30.78±22.73 months (range 4-83). Results: The mean operation time was 76.50 ± 16.88 min (range 50 - 120 min).The mean intra-operative blood loss was 628.75 ± 275.00 ml (range 250-1300ml). Anatomic and acceptable reduction was observed in 95%of cases. The most important complications were malunion (one case in trochanteric group), avascular necrosis of femoral head and nonunion (each one case in femoral neck group). Conclusions: It sounds that reduction and fixation of hip fractures in lateral position with fluoroscopy in just anteroposterior view for small rural hospitals may be executable and probably safe. PMID:25386577

Summary appraisals of the Nation's ground-water resources; Pacific Northwest region

USGS Publications Warehouse

Foxworthy, Bruce L.

1979-01-01

Management opportunities in the region include: (1) Development of new supplies and additional uses of ground water; (2) protection and enhancement of water quality; (3) reduction of waterlogging; (4) energy development from some ground-water reservoirs; (5) improving access to the ground water; (6) increased use of underground space for storage and disposal; and (7) greater use of advanced management and conservation techniques. Conjunctive use of surface and ground water to provide greater available supplies probably is the most promising water-management opportunity. However, if the full potential of the ground-water resources is to be realized, important constraints, including present water-right structures and serious deficiencies in information, must be overcome.

[Changes in the forms of industrial production and their effects on workers' health].

PubMed

Fernandes, Rita de Cássia Pereira; Assunção, Ada Avila; Carvalho, Fernando Martins

2010-06-01

This study aimed to identify determinants of health in workers of plastic industries. Production organization, machinery from maintenance and productive areas, and workers' characteristics of 14 plastic industries from Greater Salvador, Bahia State, Brazil, were described. Data were collected about development policy of each company; marketing, operational procedures; production and quality requirements, and formal rules of work organization. High strain management techniques for production time reduction have been implemented. The increase of work rhythm, reduction of break time, and a situation of high cognitive demand impose to workers anomalous body positioning for performing tasks that imply repetitive movements. Physical and psychosocial demands (repetitive work, lower control of the worker on his own tasks, time pressure and job dissatisfaction) compose a complex of conditions adverse to workers' health. Changes in production management, personnel and business impose new strains into the development of task by the workers and bringing in new risk factors to workers' health.

Precision Herbicide Application Technologies To Decrease Herbicide Losses in Furrow Irrigation Outflows in a Northeastern Australian Cropping System.

PubMed

Davis, Aaron M; Pradolin, Jordan

2016-05-25

This study compared water quality benefits of using precision herbicide application technologies in relation to traditional spraying approaches across several pre- and postemergent herbicides in furrow-irrigated canefarming systems. The use of shielded sprayers (herbicide banding) provided herbicide load reductions extending substantially beyond simple proportionate decreases in amount of active herbicide ingredient applied to paddocks. These reductions were due largely to the extra management control available to irrigating growers in relation to where both herbicides and irrigation water can be applied to paddocks, coupled with knowledge of herbicide toxicological and physicochemical properties. Despite more complex herbicide mixtures being applied in banded practices, banding provided capacity for greatly reduced environmental toxicity in off-paddock losses. Similar toxicological and loss profiles of alternative herbicides relative to recently regulated pre-emergent herbicides highlight the need for a carefully considered approach to integrating alternative herbicides into improved pest management.

Dynamic Management of NOx and SO2 Emissions in the Texas and Mid-Atlantic Electric Power Systems and Implications for Air Quality.

PubMed

McDonald-Buller, Elena; Kimura, Yosuke; Craig, Michael; McGaughey, Gary; Allen, David; Webster, Mort

2016-02-02

Cap and trade programs have historically been designed to achieve annual or seasonal reductions in emissions of nitrogen oxides and sulfur dioxide from power plants. Emissions reductions may not be temporally coincident with meteorological conditions conducive to the formation of peak ozone and fine particulate matter concentrations. Integrated power system and air quality modeling methods were developed to evaluate time-differentiated emissions price signals on high ozone days in the Mid-Atlantic portion of the Pennsylvania-New Jersey-Maryland (PJM) Interconnection and Electric Reliability Council of Texas (ERCOT) grids. Sufficient flexibility exists in the two grids with marked differences in demand and fuel generation mix to accommodate time-differentiated emissions pricing alone or in combination with a season-wide program. System-wide emissions reductions and production costs from time-differentiated pricing are shown to be competitive with those of a season-wide program on high ozone days and would be more cost-effective if the primary policy goal was to target emissions reductions on these days. Time-differentiated pricing layered as a complement to the Cross-State Air Pollution Rule had particularly pronounced benefits for the Mid-Atlantic PJM system that relies heavily on coal-fired generation. Time-differentiated pricing aimed at reducing ozone concentrations had particulate matter reduction co-benefits, but if particulate matter reductions are the primary objective, other approaches to time-differentiated pricing may lead to greater benefits.

An Observer's View of the ORAC System at UKIRT

NASA Astrophysics Data System (ADS)

Wright, G. S.; Bridger, A. B.; Pickup, D. A.; Tan, M.; Folger, M.; Economou, F.; Adamson, A. J.; Currie, M. J.; Rees, N. P.; Purves, M.; Kackley, R. D.

The Observatory Reduction and Acquisition Control system (ORAC) was commissioned with its first instrument at the UK Infrared Telescope (UKIRT) in October 1999, and with all of the other UKIRT instrumentation this year. ORAC's advance preparation Observing Tool makes it simpler to prepare and carry out observations. Its Observing Manager gives observers excellent feedback on their observing as it goes along, reducing wasted time. The ORAC pipelined Data Reduction system produces near-publication quality reduced data at the telescope. ORAC is now in use for all observing at UKIRT, including flexibly scheduled nights and service observing. This paper provides an observer's perspective of the system and its performance.

Distributed and dynamic modelling of hydrology, phosphorus and ecology in the Hampshire Avon and Blashford Lakes: evaluating alternative strategies to meet WFD standards.

PubMed

Whitehead, P G; Jin, L; Crossman, J; Comber, S; Johnes, P J; Daldorph, P; Flynn, N; Collins, A L; Butterfield, D; Mistry, R; Bardon, R; Pope, L; Willows, R

2014-05-15

The issues of diffuse and point source phosphorus (P) pollution in the Hampshire Avon and Blashford Lakes are explored using a catchment model of the river system. A multibranch, process based, dynamic water quality model (INCA-P) has been applied to the whole river system to simulate water fluxes, total phosphorus (TP) and soluble reactive phosphorus (SRP) concentrations and ecology. The model has been used to assess impacts of both agricultural runoff and point sources from waste water treatment plants (WWTPs) on water quality. The results show that agriculture contributes approximately 40% of the phosphorus load and point sources the other 60% of the load in this catchment. A set of scenarios have been investigated to assess the impacts of alternative phosphorus reduction strategies and it is shown that a combined strategy of agricultural phosphorus reduction through either fertiliser reductions or better phosphorus management together with improved treatment at WWTPs would reduce the SRP concentrations in the river to acceptable levels to meet the EU Water Framework Directive (WFD) requirements. A seasonal strategy for WWTP phosphorus reductions would achieve significant benefits at reduced cost. Copyright © 2014 Elsevier B.V. All rights reserved.

The effectiveness of non-surgical interventions in the treatment of Charcot foot.

PubMed

Smith, Caroline; Kumar, Saravana; Causby, Ryan

2007-12-01

Background  Charcot neuropathic osteoarthropathy is commonly known as 'Charcot foot'. It is a serious foot complication of diabetes mellitus that can frequently lead to foot ulceration, gangrene, hospital admission and foot amputation. A multidisciplinary approach to the management of Charcot foot is taken involving medical and allied health professionals. The management approach may also differ between different countries. To date, there is no systematic review of the literature undertaken to identify the clinical effectiveness of non-operative interventions in the treatment of acute Charcot foot. Objective  The objective of this review was to identify the effectiveness of non-surgical interventions with reducing lesions, ulceration, the rate of surgical intervention, reducing hospital admissions and improve the quality of life of subjects with Charcot foot. Search strategy  A comprehensive search strategy was undertaken on databases available from University of South Australia from their inception to November 2006. Selection criteria  Randomised controlled trials or clinical controlled trials were primarily sought. Critical appraisal of study quality and data extraction was undertaken using Joanna Briggs Institute instruments. Review Manager software was used to calculate comparative statistics. Results  This review identified 11 trials and five trials were included in the review. Three trials involved the use of bisphosphonate, a pharmacological agent. Two experimental treatments were also included, evaluating palliative radiology and magnetic fields. No trials were found using immobilisation and off-loading interventions for acute Charcot foot. The overall methodological quality score of the five studies was moderate. Owing to heterogeneous data, meta-analysis could not be performed. The trials did not report on reducing lesions, ulceration, rate of surgical intervention, hospital admissions and the quality of life of subjects with Charcot foot. The trials evaluating bisphosphonates reported greater reduction in foot temperature and disease activity for intervention subjects compared with controls. Another outcome of this review indicated additional beneficial effects of bisphosphonates in reducing pain and discomfort. The trial evaluating palliative radiotherapy found no difference between groups on any outcome. A significant reduction in the amount of deformity and reduced healing time to consolidation was found after treatment in the group receiving magnetic therapy treatment. Discussion  There is a lack of clinical trials evaluating the effectiveness of non-operative interventions for the management of Charcot foot (immobilisation, removable cast walkers, advice/dispensing of footwear and prescribing of orthotics). Bisphosphonates may be useful adjuncts to standard management of Charcot foot by improved healing demonstrated by a reduction in disease activity indicated by skin temperature and bone destruction. Magnetic therapy may reduce deformity, joint destruction and improve mobility. Conclusion  There is a lack of evidence supporting the use of pharmacological or non-surgical interventions with reducing lesions, ulceration, rate of surgical intervention, hospital admissions and improving the quality of life of subjects with Charcot foot. Bisphosphonates may improve the healing of Charcot foot by reducing skin temperature and disease activity of Charcot foot, when applied in addition to standard interventions to control the position and shape of the foot.

Interacting Physical and Biological Processes Affecting Nutrient Transport Through Human Dominated Landscapes

NASA Astrophysics Data System (ADS)

Finlay, J. C.

2015-12-01

Human activities increasingly dominate biogeochemical cycles of limiting nutrients on Earth. Urban and agricultural landscapes represent the largest sources of excess nutrients that drive water quality degradation. The physical structure of both urban and agricultural watersheds has been extensively modified, and these changes have large impacts on water and nutrient transport. Despite strong physical controls over nutrient transport in human dominated landscapes, biological processes play important roles in determining the fates of both nitrogen and phosphorus. This talk uses examples from research in urban and agricultural watersheds in the Midwestern USA to illustrate interactions of physical and biological controls over nutrient cycles that have shifted nitrogen (N) and phosphorus (P) sources and cycling in unexpected ways in response to management changes. In urban watersheds, efforts to improve water quality have been hindered by legacy sources of phosphorus added to storm water through transport to drainage systems by vegetation. Similarly, reductions in field erosion in agricultural watersheds have not led to major reductions in phosphorus transport, because of continued release of biological sources of P. Where management of phosphorus has been most effective in reducing eutrophication of lakes, decreases in N removal processes have led to long term increases in N concentration and transport. Together, these examples show important roles for biological processes affecting nutrient movement in highly modified landscapes. Consideration of the downstream physical and biological responses of management changes are thus critical toward identification of actions that will most effectively reduce excess nutrients watersheds and coastal zones.

Implementation of the quality management system improves postoperative pain treatment: a prospective pre-/post-interventional questionnaire study

PubMed Central

Usichenko, T. I.; Röttenbacher, I.; Kohlmann, T.; Jülich, A.; Lange, J.; Mustea, A.; Engel, G.; Wendt, M.

2013-01-01

Background An organizational approach is proposed as an immediate solution for improving postoperative pain (POP) management. The aim was to evaluate the clinical effectiveness of a quality management system (QMS), based on procedure-specific, multimodal analgesic protocols, modified to meet the individual patients’ requirements. Methods Patients from the orthopaedic, gynaecological, visceral, and trauma surgery departments of the university hospital were involved in two prospective surveys. Survey 1 was performed at baseline and survey 2 was performed after the implementation of QMS within an interval of 1 year. The patients were asked to report pain intensity on the visual rating scale, incidence of analgesia-related side-effects, and incidence of pain interference with the items of life quality and their satisfaction with the treatment of POP. Results Patients from Survey 2 (n=251) reported 25–30% less pain than those from Survey 1 (n=269) (P<0.0001). Nausea was reported by 40% of the patients from Survey 1 vs 17% from Survey 2, vomiting by 25 vs 11% and fatigue by 76% in Survey 1 vs 30% in Survey 2 (P<0.0001). Life quality and patients’ satisfaction improved in Survey 2 vs Survey 1 (P<0.001). Conclusions The implementation of QMS allowed the reduction in POP intensity with a simultaneous decrease in analgesia-related side-effects. This has led to an increased quality of life and patient satisfaction. PMID:23048069

Public-Private Partnerships Working Beyond Scale Challenges toward Water Quality Improvements from Private Lands

NASA Astrophysics Data System (ADS)

Enloe, Stephanie K.; Schulte, Lisa A.; Tyndall, John C.

2017-10-01

In recognition that Iowa agriculture must maintain long-term production of food, fiber, clean water, healthy soil, and robust rural economies, Iowa recently devised a nutrient reduction strategy to set objectives for water quality improvements. To demonstrate how watershed programs and farmers can reduce nutrient and sediment pollution in Iowa waters, the Iowa Water Quality Initiative selected the Boone River Watershed Nutrient Management Initiative as one of eight demonstration projects. For over a decade, diverse public, private, and non-profit partner organizations have worked in the Boone River Watershed to engage farmers in water quality management efforts. To evaluate social dynamics in the Boone River Watershed and provide partners with actionable recommendations, we conducted and analyzed semi-structured interviews with 33 program leaders, farmers, and local agronomists. We triangulated primary interview data with formal analysis of Boone River Watershed documents such as grant applications, progress reports, and outreach materials. Our evaluation suggests that while multi-stakeholder collaboration has enabled partners to overcome many of the traditional barriers to watershed programming, scale mismatches caused by external socio-economic and ecological forces still present substantial obstacles to programmatic resilience. Public funding restrictions and timeframes, for example, often cause interruptions to adaptive management of water quality monitoring and farmer engagement. We present our findings within a resilience framework to demonstrate how multi-stakeholder collaboration can help sustain adaptive watershed programs to improve socio-ecological function in agricultural watersheds such as the Boone River Watershed.

Sleep Quality and Fatigue After A Stress Management Intervention For Women With Early-Stage Breast Cancer in Southern Florida

PubMed Central

Vargas, Sara; Antoni, Michael H.; Carver, Charles S.; Lechner, Suzanne C.; Wohlgemuth, William; Llabre, Maria; Blomberg, Bonnie B.; Glück, Stefan; DerHagopian, Robert P.

2015-01-01

Background Sleep disruption and fatigue are ubiquitous among cancer patients and is a source of stress that may compromise treatment outcomes. Previously we showed that a cognitive behavioral stress management (CBSM) intervention reduced anxiety and other stress-related processes in women undergoing primary treatment for breast cancer. Purpose This study examined secondary outcomes from a CBSM intervention trial for women with early-stage breast cancer to test if CBSM would improve sleep quality and fatigue among these patients at a single site in Southern Florida. CBSM-related effects have already been demonstrated for indicators of psychosocial adaptation (e.g., general and cancer-related anxiety). Methods Patients were randomized to CBSM (n = 120) or a one-day psychoeducation control group (n = 120). The Pittsburgh Sleep Quality Index (PSQI) and Fatigue Symptom Inventory were completed prior to randomization and 6 and 12 months after the baseline assignment. Results In latent growth analyses, women in CBSM reported greater improvements in PSQI sleep quality scores than controls, although there were no significant differences between conditions on PSQI total scores. Women in CBSM also reported greater reductions in fatigue-related daytime interference than controls, though there were no significant differences in changes in fatigue intensity. Changes in sleep quality were associated with changes in fatigue. Conclusions Future work may consider integrating sleep and fatigue content into stress management interventions for women with early-stage breast cancer. PMID:24318654

Mitigating Greenhouse Gas and Ammonia Emissions from Swine Manure Management: A System Analysis.

PubMed

Wang, Yue; Dong, Hongmin; Zhu, Zhiping; Gerber, Pierre J; Xin, Hongwei; Smith, Pete; Opio, Carolyn; Steinfeld, Henning; Chadwick, Dave

2017-04-18

Gaseous emissions from animal manure are considerable contributor to global ammonia (NH 3 ) and agriculture greenhouse gas (GHG) emissions. Given the demand to promote mitigation of GHGs while fostering sustainable development of the Paris Agreement, an improvement of management systems is urgently needed to help mitigate climate change and to improve atmospheric air quality. This study presents a meta-analysis and an integrated assessment of gaseous emissions and mitigation potentials for NH 3 , methane (CH 4 ), and nitrous oxide (N 2 O) (direct and indirect) losses from four typical swine manure management systems (MMSs). The resultant emission factors and mitigation efficiencies allow GHG and NH 3 emissions to be estimated, as well as mitigation potentials for different stages of swine operation. In particular, changing swine manure management from liquid systems to solid-liquid separation systems, coupled with mitigation measures, could simultaneously reduce GHG emissions by 65% and NH 3 emissions by 78%. The resultant potential reduction in GHG emissions from China's pig production alone is greater than the entire GHG emissions from agricultural sector of France, Australia, or Germany, while the reduction in NH 3 emissions is equivalent to 40% of the total NH 3 emissions from the European Union. Thus, improved swine manure management could have a significant impact on global environment issues.

Why (just) information is not enough: The contributions of information services in the management of healthcare information

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

Kostagiolas, P., E-mail: pkostagiolas@ionio.gr; Lappa, E., E-mail: evlappa@med.uoa.gr

Information is at the centre of every hospital activity including clinical decisions and healthcare service delivery systems. Although information is an important hospital asset, several issues related to its management and organization needs to be addressed within the hospitals. The management of healthcare information is a strategic goal related to the reduction of healthcare service provision costs, and to the improvement of quality and safety of healthcare services. By discussing the rather obvious necessity for information organization and management in the healthcare domain, this work aims at the role of healthcare information services, i.e. hospital libraries and patient medical records.more » Finally, a typology of information services’ contributions to hospital environment is presented.« less

Everglades Landscape Model: Integrated Assessment of Hydrology, Biogeochemistry, and Biology

NASA Astrophysics Data System (ADS)

Fitz, H. C.; Wang, N.; Sklar, F. H.

2002-05-01

Water management infrastructure and operations have fragmented the greater Everglades into separate, impounded basins, altering flows and hydropatterns. A significant area of this managed system has experienced anthropogenic eutrophication. This combination of altered hydrology and water quality has interacted to degrade vegetative habitats and other ecological characteristics of the Everglades. One of the modeling tools to be used in developing restoration alternatives is the Everglades Landscape Model (ELM), a process-based, spatially explicit simulation of ecosystem dynamics across a heterogeneous, 10,000 km2 region. The model has been calibrated to capture hydrologic and surface water quality dynamics across most of the Everglades landscape over decadal time scales. We evaluated phosphorus loading throughout the Everglades system under two base scenarios. The 1995 base case assumed current management operations, with phosphorus inflow concentrations fixed at their long term, historical average. The 2050 base case assumed future modifications in water and nutrient management, with all managed inflows to the Everglades having reduced phosphorus concentrations. In an example indicator subregion that currently is highly eutrophic, the 31-yr simulations predicted that desirable periphyton and macrophyte communities were maintained under the 2050 base case, whereas in the 1995 base case, periphyton biomass and production decreased to negligible levels and macrophytes became extremely dense. The negative periphyton response in the 1995 base case was due to high phosphorus loads and rapid macrophyte growth that shaded this algal community. Along an existing 11 km eutrophication gradient, the model indicated that the 2050 base case had ecologically significant reductions in phosphorus accumulation compared to the 1995 base case. Indicator regions (in Everglades National Park) distant from phosphorus inflow points also exhibited reductions in phosphorus accumulation under the 2050 base case, albeit to a lesser extent due to its distance from phosphorus inflows. The ELM fills a critical information need in Everglades management, and has become an accepted tool in evaluating scenarios of potential restoration of the natural system.

Re-engineering Nascom's network management architecture

NASA Technical Reports Server (NTRS)

Drake, Brian C.; Messent, David

1994-01-01

The development of Nascom systems for ground communications began in 1958 with Project Vanguard. The low-speed systems (rates less than 9.6 Kbs) were developed following existing standards; but, there were no comparable standards for high-speed systems. As a result, these systems were developed using custom protocols and custom hardware. Technology has made enormous strides since the ground support systems were implemented. Standards for computer equipment, software, and high-speed communications exist and the performance of current workstations exceeds that of the mainframes used in the development of the ground systems. Nascom is in the process of upgrading its ground support systems and providing additional services. The Message Switching System (MSS), Communications Address Processor (CAP), and Multiplexer/Demultiplexer (MDM) Automated Control System (MACS) are all examples of Nascom systems developed using standards such as, X-windows, Motif, and Simple Network Management Protocol (SNMP). Also, the Earth Observing System (EOS) Communications (Ecom) project is stressing standards as an integral part of its network. The move towards standards has produced a reduction in development, maintenance, and interoperability costs, while providing operational quality improvement. The Facility and Resource Manager (FARM) project has been established to integrate the Nascom networks and systems into a common network management architecture. The maximization of standards and implementation of computer automation in the architecture will lead to continued cost reductions and increased operational efficiency. The first step has been to derive overall Nascom requirements and identify the functionality common to all the current management systems. The identification of these common functions will enable the reuse of processes in the management architecture and promote increased use of automation throughout the Nascom network. The MSS, CAP, MACS, and Ecom projects have indicated the potential value of commercial-off-the-shelf (COTS) and standards through reduced cost and high quality. The FARM will allow the application of the lessons learned from these projects to all future Nascom systems.

Advancing Nursing Practice: Management of Neuropathic Pain With Capsaicin 8% Without Physician Supervision.

PubMed

O'Brien, Joanne; Keaveny, Joseph; Pollard, Valerie; Nugent, Linda Elizabeth

The purpose of this study was to examine the management of patient's neuropathic pain with capsaicin 8% in a nurse-led clinic when administered by 1 registered advanced nurse practitioner without physician supervision. A longitudinal, single-group, descriptive research design was used to assess pain scores and quality of life 3 times over 3 months after treatment. Patients with a diagnosis of neuropathic pain were assessed and treated with capsaicin 8% by 1 advanced nurse practitioner with prescriptive authority in a nurse-led clinic. Pain scores were collected at baseline, and self-assessed pain, activity level, and quality of life were assessed at 1 week, 4 weeks, and 3 months after treatment. Twenty-four patients were recruited, and data were analyzed using Friedman's test. In post hoc analysis, Wilcoxon signed-rank test was used with Bonferroni correction. Pain scores differed from pretreatment to posttreatment at each of the 3 time points, at rest (χ3 = 20.54, P = .001) and on movement (χ3 = 23.644, P = .001), and remained significant after Bonferroni correction. Overall, 62.5% (n = 15) of patients achieved at least a 30% reduction in self-reported pain at rest from pretreatment to 3 months, and 54% (n = 13) achieved the same reduction in pain on movement. Most improvements in patient's quality of life occurred between 1 and 4 weeks. Patient satisfaction was high, with 83% stating that they would be happy to have the treatment repeated. Single-dose capsaicin 8% decreased neuropathic pain after being administered in an outpatient setting by an experienced registered advanced nurse practitioner. Further multicenter research led by advanced nurse practitioners is needed to support high-quality, safe treatment of neuropathic pain with high-concentration capsaicin in nurse-led chronic pain clinics.

Comparative analysis of hospital energy use: pacific northwest and scandinavia.

PubMed

Burpee, Heather; McDade, Erin

2014-01-01

This study aimed to establish the potential for significant energy reduction in hospitals in the United States by providing evidence of Scandinavian operational precedents with high Interior Environmental Quality (IEQ) and substantially lower energy profiles than comparable U.S. facilities. These facilities set important precedents for design teams seeking operational examples for achieving aggressive energy and interior environmental quality goals. This examination of operational hospitals is intended to offer hospital owners, designers, and building managers a strong case and concrete framework for strategies to achieve exceptionally high performing buildings. Energy efficient hospitals have the potential to significantly impact the U.S.'s overall energy profile, and key stakeholders in the hospital industry need specific, operationally grounded precedents in order to successfully implement informed energy reduction strategies. This study is an outgrowth of previous research evaluating high quality, low energy hospitals that serve as examples for new high performance hospital design, construction, and operation. Through extensive interviews, numerous site visits, the development of case studies, and data collection, this team has established thorough qualitative and quantitative analyses of several contemporary hospitals in Scandinavia and the Pacific Northwest. Many Scandinavian hospitals demonstrate a low energy profile, and when analyzed in comparison with U.S. hospitals, such Scandinavian precedents help define the framework required to make significant changes in the U.S. hospital building industry. Eight hospitals, four Scandinavian and four Pacific Northwest, were quantitatively compared using the Environmental Protection Agency's Portfolio Manager, allowing researchers to answer specific questions about the impact of energy source and architectural and mechanical strategies on energy efficiency in operational hospitals. Specific architectural, mechanical, and plant systems make these Scandinavian hospitals more energy efficient than their Pacific Northwest counterparts. More importantly, synergistic systems integration allows for their significant reductions in energy consumption. This quantitative comparison of operational Scandinavian and Pacific Northwest hospitals resulted in compelling evidence of the potential for deep energy savings in the U.S., and allowed researchers to outline specific strategies for achieving such reductions. © 2014 Vendome Group, LLC.

Provider and systems factors in diabetes quality of care.

PubMed

Ghaznavi, Kimia; Malik, Shaista

2012-02-01

A gap exists in knowledge and the observed frequency with which patients with diabetes actually receive treatment for optimal cardiovascular risk reduction. Many interventions to improve quality of care have been targeted at the health systems level and provider organizations. Changes in several domains of care and investment in quality by organizational leaders are needed to make long-lasting improvements. In the studies reviewed, the most effective strategies often have multiple components, whereas the use of one single strategy, such as reminders only or an educational intervention, is less effective. More studies are needed to examine the effect of several care management strategies simultaneously, such as use of clinical information systems, provider financial incentives, and organizational model on processes of care and outcomes.

Management of obesity after spinal cord injury: a systematic review.

PubMed

Shojaei, Mir Hatef; Alavinia, Seyed Mohammad; Craven, B Catharine

2017-11-01

Individuals with chronic spinal cord injury (SCI) are susceptible to central and visceral obesity and it's metabolic consequences; consensus based guidelines for obesity management after SCI have not yet been stablished. To identify and compare effective means of obesity management among SCI individuals. This systematic review included English and non-English articles, published prior to April 2017 found in the PubMed/Medline, Embase, CINAHL Psychinfo and Cochrane databases. Studies evaluating any obesity management strategy, alone or in combination, including: diet therapy, voluntary and involuntary exercise such as neuro-muscular electric stimulation (NMES), pharmacotherapy, and surgery, among individuals with chronic SCI were included. Outcomes of interest were reductions in waist circumference, body weight (BW), body mass index (BMI) and total fat mass (TFM) and increases in total lean body mass (TLBM) from baseline. From 3,553 retrieved titles and abstracts, 34 articles underwent full text review and 23 articles were selected for data abstraction. Articles describing weight loss due to inflammation, cancer or B12 deficiency were excluded. The Downs and Black reported poor to moderate quality of the studies. Bariatric surgery produced the greatest permanent weight reduction and BMI correction followed by combinations of physical exercise and diet therapy. Generally, NMES and pharmacotherapy improved TLBM and reduced TFM but not weight. The greatest weight reduction and BMI correction was produced by bariatric surgery, followed by a combination of physical exercise and diet therapy. NMES and pharmacologic treatment did not reduce weight or TFM but increased in TLBM.

Quality of hip and knee osteoarthritis management in primary health care in a Norwegian county: a cross-sectional survey.

PubMed

Grønhaug, Gudmund; Østerås, Nina; Hagen, Kåre Birger

2014-11-25

Osteoarthritis (OA) is one of the most common causes of pain and disability in the adult population. Several studies have documented discordance between general practioners (GP) practice and management recommendations, but there is limited published information about patient reported experience of quality of care. The primary aim of this study was to assess the patient perceived quality of OA management in primary health care. Secondly, we wanted to explore the factors associated with the perceived quality of OA care. A cross-sectional survey in six general practices in the county of Nord-Trøndelag in Norway, patients with radiologically diagnosed OA, according to ICPC codes L89, L90 or L91 or clinical signs and symptoms corresponding to OA in the hip or knee and patient-reported quality of OA care on the 17-item OsteoArthritis Quality Indicator questionnaire (OA-QI). OA-QI summary pass rates were calculated, in which the numerator represents the number with indicators passed and the denominator represents the total number of eligible persons. Associations with summary pass rates were explored with demographic, disease related and health care related factors as independent variables. A total of 119 patients were included (response rate 42%). The median summary QI pass rate for all 17 QIs was 47% (Inter Quartile Range 33-65%), but there were large variation between the different items. The referral for weight reduction had the lowest pass rate (8%), whereas the highest pass rate was having received information about the importance of physical activity and exercise (84%). The median summary QI pass rates for both non-pharmacological- (QIs 1-11) and pharmacological (QIs 13-16) treatments were 50% (IQR 25-75). In bivariate regression analyses, only overall treatment satisfaction was significantly associated with QI pass rate (p = 0.001), with unstandardized beta = 6.1 (95% CI 2.7 to 9.5), i.e. a one-point increase on the five-point satisfaction scale was associated with a 6% increase in pass rate. Considering that the median summary QI pass rate was 47%, there might be room for improvement in OA care. Advice and the referral of OA patients in need of weight reduction seem to have the greatest potential for improvement.

Selection and placement of best management practices used to reduce water quality degradation in Lincoln Lake watershed

NASA Astrophysics Data System (ADS)

Rodriguez, Hector German; Popp, Jennie; Maringanti, Chetan; Chaubey, Indrajeet

2011-01-01

An increased loss of agricultural nutrients is a growing concern for water quality in Arkansas. Several studies have shown that best management practices (BMPs) are effective in controlling water pollution. However, those affected with water quality issues need water management plans that take into consideration BMPs selection, placement, and affordability. This study used a nondominated sorting genetic algorithm (NSGA-II). This multiobjective algorithm selects and locates BMPs that minimize nutrients pollution cost-effectively by providing trade-off curves (optimal fronts) between pollutant reduction and total net cost increase. The usefulness of this optimization framework was evaluated in the Lincoln Lake watershed. The final NSGA-II optimization model generated a number of near-optimal solutions by selecting from 35 BMPs (combinations of pasture management, buffer zones, and poultry litter application practices). Selection and placement of BMPs were analyzed under various cost solutions. The NSGA-II provides multiple solutions that could fit the water management plan for the watershed. For instance, by implementing all the BMP combinations recommended in the lowest-cost solution, total phosphorous (TP) could be reduced by at least 76% while increasing cost by less than 2% in the entire watershed. This value represents an increase in cost of 5.49 ha-1 when compared to the baseline. Implementing all the BMP combinations proposed with the medium- and the highest-cost solutions could decrease TP drastically but will increase cost by 24,282 (7%) and $82,306 (25%), respectively.

Simulation of water environmental capacity and pollution load reduction using QUAL2K for water environmental management.

PubMed

Zhang, Ruibin; Qian, Xin; Yuan, Xingcheng; Ye, Rui; Xia, Bisheng; Wang, Yulei

2012-12-07

In recent years, water quality degradation associated with rapid socio-economic development in the Taihu Lake Basin, China, has attracted increasing attention from both the public and the Chinese government. The primary sources of pollution in Taihu Lake are its inflow rivers and their tributaries. Effective water environmental management strategies need to be implemented in these rivers to improve the water quality of Taihu Lake, and to ensure sustainable development in the region. The aim of this study was to provide a basis for water environmental management decision-making. In this study, the QUAL2K model for river and stream water quality was applied to predict the water quality and environmental capacity of the Hongqi River, which is a polluted tributary in the Taihu Lake Basin. The model parameters were calibrated by trial and error until the simulated results agreed well with the observed data. The calibrated QUAL2K model was used to calculate the water environmental capacity of the Hongqi River, and the water environmental capacities of COD(Cr) NH(3)-N, TN, and TP were 17.51 t, 1.52 t, 2.74 t and 0.37 t, respectively. The results showed that the NH(3)-N, TN, and TP pollution loads of the studied river need to be reduced by 50.96%, 44.11%, and 22.92%, respectively to satisfy the water quality objectives. Thus, additional water pollution control measures are needed to control and reduce the pollution loads in the Hongqi River watershed. The method applied in this study should provide a basis for water environmental management decision-making.

Gut-directed hypnotherapy for irritable bowel syndrome: piloting a primary care-based randomised controlled trial

PubMed Central

Roberts, Lesley; Wilson, Sue; Singh, Sukhdev; Roalfe, Andrea; Greenfield, Sheila

2006-01-01

Background In western populations irritable bowel syndrome (IBS) affects between 10% and 30% of the population and has a significant effect on quality of life. It generates a substantial workload in both primary and secondary care and has significant cost implications. Gut-directed hypnotherapy has been demonstrated to alleviate symptoms and improve quality of life but has not been assessed outside of secondary and tertiary referral centres. Aim To assess the effectiveness of gut-directed hypnotherapy as a complementary therapy in the management of IBS. Design of study Randomised controlled trial. Setting Primary care patients aged 18–65 years inclusive, with a diagnosis of IBS of greater than 6 weeks' duration and having failed conventional management, located in South Staffordshire and North Birmingham, UK. Method Intervention patients received five sessions of hypnotherapy in addition to their usual management. Control patients received usual management alone. Data regarding symptoms and quality of life were collected at baseline and again 3, 6, and 12 months post-randomisation. Results Both groups demonstrated a significant improvement in all symptom dimensions and quality of life over 12 months. At 3 months the intervention group had significantly greater improvements in pain, diarrhoea and overall symptom scores (P<0.05). No significant differences between groups in quality of life were identified. No differences were maintained over time. Intervention patients, however, were significantly less likely to require medication, and the majority described an improvement in their condition. Conclusions Gut-directed hypnotherapy benefits patients via symptom reduction and reduced medication usage, although the lack of significant difference between groups beyond 3 months prohibits its general introduction without additional evidence. A large trial incorporating robust economic analysis is, therefore, urgently recommended. PMID:16464325

Simulation of Water Environmental Capacity and Pollution Load Reduction Using QUAL2K for Water Environmental Management

PubMed Central

Zhang, Ruibin; Qian, Xin; Yuan, Xingcheng; Ye, Rui; Xia, Bisheng; Wang, Yulei

2012-01-01

In recent years, water quality degradation associated with rapid socio-economic development in the Taihu Lake Basin, China, has attracted increasing attention from both the public and the Chinese government. The primary sources of pollution in Taihu Lake are its inflow rivers and their tributaries. Effective water environmental management strategies need to be implemented in these rivers to improve the water quality of Taihu Lake, and to ensure sustainable development in the region. The aim of this study was to provide a basis for water environmental management decision-making. In this study, the QUAL2K model for river and stream water quality was applied to predict the water quality and environmental capacity of the Hongqi River, which is a polluted tributary in the Taihu Lake Basin. The model parameters were calibrated by trial and error until the simulated results agreed well with the observed data. The calibrated QUAL2K model was used to calculate the water environmental capacity of the Hongqi River, and the water environmental capacities of CODCr NH3-N, TN, and TP were 17.51 t, 1.52 t, 2.74 t and 0.37 t, respectively. The results showed that the NH3-N, TN, and TP pollution loads of the studied river need to be reduced by 50.96%, 44.11%, and 22.92%, respectively to satisfy the water quality objectives. Thus, additional water pollution control measures are needed to control and reduce the pollution loads in the Hongqi River watershed. The method applied in this study should provide a basis for water environmental management decision-making. PMID:23222206

Adaptive Radar Data Quality Control and Ensemble-Based Assimilation for Analyzing and Forecasting High-Impact Weather

DTIC Science & Technology

2014-05-22

velocity prognostic equation was derived for the 3.5Var in a concise and accurate form by considering atmospheric refraction and earth curvature (Xu and... atmospheric refraction and earth curvature. J. Atmos. Sci, 70, 3328-3338. [published, refereed]. ...Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget , Paperwork Reduction Project (0704-0188) Washington, DC 20503

Adaptive management for mitigating Cryptosporidium risk in source water: a case study in an agricultural catchment in South Australia.

PubMed

Bryan, Brett A; Kandulu, John; Deere, Daniel A; White, Monique; Frizenschaf, Jacqueline; Crossman, Neville D

2009-07-01

Water-borne pathogens such as Cryptosporidium pose a significant human health risk and catchments provide the first critical pollution 'barrier' in mitigating risk in drinking water supply. In this paper we apply an adaptive management framework to mitigating Cryptosporidium risk in source water using a case study of the Myponga catchment in South Australia. Firstly, we evaluated the effectiveness of past water quality management programs in relation to the adoption of practices by landholders using a socio-economic survey of land use and management in the catchment. The impact of past management on the mitigation of Cryptosporidium risk in source water was also evaluated based on analysis of water quality monitoring data. Quantitative risk assessment was used in planning the next round of management in the adaptive cycle. Specifically, a pathogen budget model was used to identify the major remaining sources of Cryptosporidium in the catchment and estimate the mitigation impact of 30 alternative catchment management scenarios. Survey results show that earlier programs have resulted in the comprehensive adoption of best management practices by dairy farmers including exclusion of stock from watercourses and effluent management from 2000 to 2007. Whilst median Cryptosporidium concentrations in source water have decreased since 2004 they remain above target levels and put pressure on other barriers to mitigate risk, particularly the treatment plant. Non-dairy calves were identified as the major remaining source of Cryptosporidium in the Myponga catchment. The restriction of watercourse access of non-dairy calves could achieve a further reduction in Cryptosporidium export to the Myponga reservoir of around 90% from current levels. The adaptive management framework applied in this study was useful in guiding learning from past management, and in analysing, planning and refocusing the next round of catchment management strategies to achieve water quality targets.

Exploring the effects of nitrogen fertilization management alternatives on nitrate loss and crop yields in tile-drained fields in Illinois.

PubMed

Jeong, Hanseok; Bhattarai, Rabin

2018-05-01

It is vital to manage the excessive use of nitrogen (N) fertilizer in corn production, the single largest consumer of N fertilizer in the United States, in order to achieve more sustainable agroecosystems. This study comprehensively explored the effects of N fertilization alternatives on nitrate loss and crop yields using the Root Zone Water Quality Model (RZWQM) in tile-drained fields in central Illinois. The RZWQM was tested for the prediction of tile flow, nitrate loss, and crop yields using eight years (1993-2000) of observed data and showed satisfactory model performances from statistical and graphical evaluations. Our model simulations demonstrated the maximum return to nitrogen (MRTN) rate (193 kgha -1 ), a newly advised N recommendation by the Illinois Nutrient Loss Reduction Strategy (INLRS), can be further reduced. Nitrate loss was reduced by 10.3% and 29.8%, but corn yields decreased by 0.3% and 1.9% at 156 and 150 kgha -1 of N fertilizer rate in the study sites A and E, respectively. Although adjustment of N fertilization timing presented a further reduction in nitrate loss, there was no optimal timing to ensure nitrate loss reduction and corn productivity. For site A, 100% spring application was the most productive and 40% fall, 10% pre-plant, and 50% side dress application generated the lowest nitrate loss. For site E, the conventional N application timing was verified as the best practice in both corn production and nitrate loss reduction. Compared to surface broadcast placement, injected N fertilizer in spring increased corn yield, but may also escalate nitrate loss. This study presented the need of an adaptive N fertilizer management due to the heterogeneity in agricultural systems, and raised the importance of timing and placement of N fertilizer, as well as further reduction in fertilizer rate to devise a better in-field N management practice. Copyright © 2018 Elsevier Ltd. All rights reserved.

Influence of agricultural management on chemical quality of a clay soil of semi-arid Morocco

NASA Astrophysics Data System (ADS)

Ibno Namr, Khalid; Mrabet, Rachid

2004-06-01

Morocco's semi-arid lands are characterized by unique challenges. The most important obstacles to the development of durable agriculture are (1) limited and unpredictable supply of soil moisture and (2) low soil quality. Intensive use of soil throughout history has led to depletion in soil quality, leading in return to reduced yields because of the consequent reduced organic matter. Recognizing the need to recover soil quality and production decline, INRA scientists began, in the early 1980s, research on the effects of crop rotations, tillage and residue management on the productivity and quality of cropped soils. The present study concerns the short-term effect of rotation, tillage and residue management on selected quality indices of a calcixeroll (organic matter, nitrogen, particulate organic carbon (Cpom), particulate organic nitrogen (Npom) and pH). Hence, three rotations (wheat-wheat, WW; fallow-wheat, FW; and fallow-wheat-barley, FWB), two tillage systems (conventional offset disking, CT and no-tillage, NT), and three levels of residue in the NT system (NT 0 = no-residue cover, NT 50 = half surface residue cover, NT 100 = full surface residue cover) were selected. Three surface horizons were sampled (0-2.5, 2.5-7 and 7-20 cm). The study results showed an improvement of measured soil chemical properties under NT compared to CT, at the surface layer. No-tillage system helped sequestration of carbon and nitrogen, build-up of particulate organic carbon and nitrogen and sensible reduction of pH only at the surface layer. Continuous wheat permitted a slight improvement of soil quality, mainly at the 0-2.5 cm depth. Effects of rotation, tillage and residue level were reduced with depth of measurements.

Innovations in Medication Preparation Safety and Wastage Reduction: Use of a Workflow Management System in a Pediatric Hospital.

PubMed

Davis, Stephen Jerome; Hurtado, Josephine; Nguyen, Rosemary; Huynh, Tran; Lindon, Ivan; Hudnall, Cedric; Bork, Sara

2017-01-01

Background: USP <797> regulatory requirements have mandated that pharmacies improve aseptic techniques and cleanliness of the medication preparation areas. In addition, the Institute for Safe Medication Practices (ISMP) recommends that technology and automation be used as much as possible for preparing and verifying compounded sterile products. Objective: To determine the benefits associated with the implementation of the workflow management system, such as reducing medication preparation and delivery errors, reducing quantity and frequency of medication errors, avoiding costs, and enhancing the organization's decision to move toward positive patient identification (PPID). Methods: At Texas Children's Hospital, data were collected and analyzed from January 2014 through August 2014 in the pharmacy areas in which the workflow management system would be implemented. Data were excluded for September 2014 during the workflow management system oral liquid implementation phase. Data were collected and analyzed from October 2014 through June 2015 to determine whether the implementation of the workflow management system reduced the quantity and frequency of reported medication errors. Data collected and analyzed during the study period included the quantity of doses prepared, number of incorrect medication scans, number of doses discontinued from the workflow management system queue, and the number of doses rejected. Data were collected and analyzed to identify patterns of incorrect medication scans, to determine reasons for rejected medication doses, and to determine the reduction in wasted medications. Results: During the 17-month study period, the pharmacy department dispensed 1,506,220 oral liquid and injectable medication doses. From October 2014 through June 2015, the pharmacy department dispensed 826,220 medication doses that were prepared and checked via the workflow management system. Of those 826,220 medication doses, there were 16 reported incorrect volume errors. The error rate after the implementation of the workflow management system averaged 8.4%, which was a 1.6% reduction. After the implementation of the workflow management system, the average number of reported oral liquid medication and injectable medication errors decreased to 0.4 and 0.2 times per week, respectively. Conclusion: The organization was able to achieve its purpose and goal of improving the provision of quality pharmacy care through optimal medication use and safety by reducing medication preparation errors. Error rates decreased and the workflow processes were streamlined, which has led to seamless operations within the pharmacy department. There has been significant cost avoidance and waste reduction and enhanced interdepartmental satisfaction due to the reduction of reported medication errors.

Integration of Tidal Prism Model and HSPF for simulating indicator bacteria in coastal watersheds

NASA Astrophysics Data System (ADS)

Sobel, Rose S.; Rifai, Hanadi S.; Petersen, Christina M.

2017-09-01

Coastal water quality is strongly influenced by tidal fluctuations and water chemistry. There is a need for rigorous models that are not computationally or economically prohibitive, but still allow simulation of the hydrodynamics and bacteria sources for coastal, tidally influenced streams and bayous. This paper presents a modeling approach that links a Tidal Prism Model (TPM) implemented in an Excel-based modeling environment with a watershed runoff model (Hydrologic Simulation Program FORTRAN, HSPF) for such watersheds. The TPM is a one-dimensional mass balance approach that accounts for loading from tidal exchange, runoff, point sources and bacteria die-off at an hourly time step resolution. The novel use of equal high-resolution time steps in this study allowed seamless integration of the TPM and HSPF. The linked model was calibrated to flow and E. Coli data (for HSPF), and salinity and enterococci data (for the TPM) for a coastal stream in Texas. Sensitivity analyses showed the TPM to be most influenced by changes in net decay rates followed by tidal and runoff loads, respectively. Management scenarios were evaluated with the developed linked models to assess the impact of runoff load reductions and improved wastewater treatment plant quality and to determine the areas of critical need for such reductions. Achieving water quality standards for bacteria required load reductions that ranged from zero to 90% for the modeled coastal stream.

Money's (not) on my mind: a qualitative study of how staff and managers understand health care's triple Aim.

PubMed

Storkholm, Marie Höjriis; Mazzocato, Pamela; Savage, Mairi; Savage, Carl

2017-01-31

The "Triple Aim" - provision of a better care experience and improved population health at a lower cost - may be theoretically sound, but paradoxical in practice as it forces together the logics of management and medicine. The aim of this study was to explore how staff and managers understand the change imperative inherent to the Triple Aim and the mental models underlying their understanding. This qualitative study builds on thirty semi-structured interviews conducted with managers, nurses, midwives, medical secretaries, and physicians at a department of Gynecology and Obstetrics in Denmark who successfully cut costs through staff and bed reductions and, from what we can ascertain, maintained care quality. Mental models were articulated from a content analysis of the interviews. Staff and managers identified with the different dimensions of the Triple Aim along classic professional divides, i.e. nurses and midwives focused on patient experience, physicians on health outcomes, and manager on all three. Underlying these, we found four mental models. The understanding of change was guided by a Professional ethos (inner drive to improve care) and a Socio-political discourse (external requirement to become more efficient) mental model. The understanding of economics was guided by a You-get-what-you-pay-for and by a More-bang-for-the-buck mental model. A complex interplay could be discerned between all four, which led staff to see the Triple Aim as a dilemma between quality and economics and a threat to clinical care and quality, whereas managers saw it as a paradox that invited improvement efforts. Despite these differences, managers chose a change strategy in line with staff mental models. The practical challenges inherent to the Triple Aim may be symptomatic of the interactions between the different mental models that guide staff and managers' understanding and choice of change strategies. Pursuit of quality improvement in the face of financial constraints (the essence of the Triple Aim) may be facilitated through conscious exploration of these empirically identified mental models. Managers might do well to translate the socio-political discourse into a change process that resonates with the mental models held by staff.

Health-Mining: a Disease Management Support Service based on Data Mining and Rule Extraction.

PubMed

Bei, Andrea; De Luca, Stefano; Ruscitti, Giancarlo; Salamon, Diego

2005-01-01

The disease management is the collection of the processes aimed to control the health care and improving the quality at same time reducing the overall cost of the procedures. Our system, Health-Mining, is a Decision Support System with the objective of controlling the adequacy of hospitalization and therapies, determining the effective use of standard guidelines and eventually identifying better ones emerged from the medical practice (Evidence Based Medicine). In realizing the system, we have the aim of creation of a path to admissions- appropriateness criteria construction, valid at an international level. A main goal of the project is rule extraction and the identification of the rules adequate in term of efficacy, quality and cost reduction, especially in the view of fast changing technologies and medicines. We tested Health-Mining in a real test case for an Italian Region, Regione Veneto, on the installation of pacemaker and ICD.

Intractable epilepsy: management and therapeutic alternatives.

PubMed

Schuele, Stephan U; Lüders, Hans O

2008-06-01

More than half of patients with newly diagnosed epilepsy achieve complete seizure control without major side-effects. Patients who continue to have seizures after initial medical therapy should have an early and detailed assessment to confirm the diagnosis, to determine the underlying cause and epilepsy syndrome, and to choose an adequate treatment strategy. The risks and potential benefits of surgical procedures or experimental therapy have to be weighed against the chance of improvement and the potential side-effects of additional medical therapy. Surgery for temporal lobe epilepsy, the most common cause of focal epilepsy, can control seizures and improve quality of life in appropriately selected patients. However, around 20-30% of patients do not respond to medical or surgical treatment. The management of chronic intractable epilepsy requires comprehensive care to address the adverse events of medical treatment, quality of life issues, and comorbid disorders. Much research focuses on the experimental treatment options that offer hope of seizure reduction or cure.

Allergen source materials: state-of-the-art.

PubMed

Esch, Robert E

2009-01-01

A variety of positive outcomes can be realized from validation and risk management activities (see Table 4). They are dependent on the participation of multiple functional groups including the quality unit, regulatory and legal affairs, engineering and production operations, research and development, and sales and marketing. Quality risk management is receiving increased attention in the area of public health, pharmacovigilance, and pharmaceutical manufacturing. Recent examples of its regulatory use in our industry include the assessment of the potential risks of transmissible spongiform encephalopathies (TSE) agents through contaminated products], the risks of precipitates in allergenic extracts, and the revision of the potency limits for standardized dust mite and grass allergen vaccines. Its application to allergen source material process validation activities allowed for a practical strategy, especially in a complex manufacturing environment involving hundreds of products with multiple intended uses. In addition, the use of tools such as FMEA was useful in evaluating proposed changes made to manufacturing procedures and product specifications, new regulatory actions, and customer feedback or complaints. The success of such a quality assurance programs will ultimately be reflected in the elimination or reduction of product failures, improvement in the detection and prediction of potential product failures, and increased confidence in product quality.

Fluvial sediment in the environment: a national challenge

USGS Publications Warehouse

Larsen, Matthew C.; Gellis, Allen C.; Glysson, G. Douglas; Gray, John R.; Horowitz, Arthur J.

2010-01-01

Sediment and sediment-associated constituents can contribute substantially to water-quality impairment. In the past, sediment was viewed mainly as an engineering problem that affected reservoir storage capacity, shipping channel maintenance, and bridge scour, as well as the loss of agricultural soil. Sediment is now recognized as a major cause of aquatic system degradation in many rivers and streams as a result of light attenuation, loss of spawning substrate due to fine-grained sediment infilling, reduction in primary productivity, decreases in biotic diversity, and effects from sediment-associated chemical constituents. Recent advances in sediment measurement, assessment, source-identification, and analytical protocols provide new capabilities to quantify sediment and solid-phase chemical fluxes in aquatic systems. Developing, maintaining, and augmenting current sediment- and water-quality-monitoring networks is essential for determining the health of U.S. waterways and for evaluating the effectiveness of management actions in reducing sediment-related problems. The application of new scientific capabilities that address the adverse effects of sediment and sediment- associated constituents represents a major step in managing the Nation’s water quality. A robust Federal, national-scale eff rt, in collaboration with vested stakeholders, is needed to address these sediment-related water-quality issues across the United States.

Reduction of Fusarium rot and maintenance of fruit quality in melon using eco-friendly hot water treatment.

PubMed

Sui, Yuan; Droby, Samir; Zhang, Danfeng; Wang, Wenjie; Liu, Yongsheng

2014-12-01

Significant losses in harvested fruit can be directly attributable to decay fungi and quality deterioration. Hot water treatment (HWT) has been demonstrated to be an effective and economic environment-friendly approach for managing postharvest decay and maintaining fruit quality. In this study, the effects of HWT (45 °C for 10, 15, 20, and 25 min) on in vitro growth of Fusarium oxysporum, in vivo Fusarium rot, and natural decay of melon were investigated. HWT inhibited spore germination and germ tube elongation of F. oxysporum. Protein impairment and ATP consumption triggered by HWT contributed to the inhibitory effect. Results of in vivo studies showed that HWT effectively controlled Fusarium rot and natural decay of melon. Correspondingly, HWT induced a significant increase in content of total phenolic compounds and lignin of melon. These findings indicate that the effects of HWT on Fusarium rot may be associated with the direct fungal inhibition and the elicitation of defense responses in fruit. Importantly, HWT used in this study had beneficial effects on fruit quality as well. HWT may represent an effective non-chemical approach for management of postharvest Fusarium rot.

Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients

PubMed Central

Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm. Thomas

2017-01-01

Background Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. Objectives To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. Methods The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre–quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post–quality improvement program as well as the difference between the validation cohort and the post–quality improvement program, respectively. Results As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre–quality improvement program baseline cohort, and $4,896,758 versus the pre–quality improvement program in the validation cohort. When these costs were assessed across the entire patient population enrolled in the quality improvement program, per-patient net savings of $1499 when using the baseline cohort as the comparator and savings per patient treated of $3858 when using the validated cohort as the comparator were achieved. Conclusion The nutrition-focused quality improvement program reduced the per-patient healthcare costs by avoiding 30-day readmissions and through reduced length of hospital stay. These clinical and economic outcomes provide a rationale for merging patient care and financial modeling to advance the delivery of value-based medicine in a malnourished hospitalized population. The use of a novel web-based budget impact model supports the integration of comparative effectiveness analytics and healthcare resource management in the hospital setting to provide optimal quality of care at a reduced overall cost. PMID:28975010

Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients.

PubMed

Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm Thomas

2017-07-01

Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre-quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post-quality improvement program as well as the difference between the validation cohort and the post-quality improvement program, respectively. As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre-quality improvement program baseline cohort, and $4,896,758 versus the pre-quality improvement program in the validation cohort. When these costs were assessed across the entire patient population enrolled in the quality improvement program, per-patient net savings of $1499 when using the baseline cohort as the comparator and savings per patient treated of $3858 when using the validated cohort as the comparator were achieved. The nutrition-focused quality improvement program reduced the per-patient healthcare costs by avoiding 30-day readmissions and through reduced length of hospital stay. These clinical and economic outcomes provide a rationale for merging patient care and financial modeling to advance the delivery of value-based medicine in a malnourished hospitalized population. The use of a novel web-based budget impact model supports the integration of comparative effectiveness analytics and healthcare resource management in the hospital setting to provide optimal quality of care at a reduced overall cost.

Lifestyle Therapy for the Management of Atrial Fibrillation.

PubMed

Abdul-Aziz, Ahmad A; Altawil, Mahmoud; Lyon, Amanda; MacEachern, Mark; Richardson, Caroline R; Rubenfire, Melvyn; Pelosi, Frank; Jackson, Elizabeth A

2018-05-01

Atrial fibrillation (AF) is a common arrhythmia associated with increased risk of morbidity and mortality. There is evidence that lifestyle interventions may serve as complementary treatments to reduce AF burden. The objective of this review was to summarize the efficacy of lifestyle interventions for the management of AF. Studies which included patients with systolic heart failure (ejection fraction ≤40%), and those limited to an examination of vigorous physical activity were excluded from our search. Studies were identified through a search of the following databases: MEDLINE, EMBASE, CINAHIL, and PubMed, run from inception through August 2016. All studies were graded for quality using the Oxford Centre for Evidence-based Medicine recommendations. Meta-analyses of the studies were not performed due to the heterogeneity of the studies. From a total of 1,811 publications, 10 articles were identified and included. Selected publications included 1 study on yoga, 2 studies on acupuncture, 3 studies that examined weight loss programs, and 4 studies that evaluated the impact of moderate physical activity. Yoga was associated with less symptomatic AF episodes and improved quality of life. Acupuncture was associated with reduced AF occurrence in patients with persistent and paroxysmal AF. Weight loss was associated with a significant reduction AF burden and symptoms. Moderate exercise resulted in greater arrhythmia free survival and a mean reduction in AF burden. In conclusion, evidence exists to suggest that yoga, weight loss, and moderate exercise are associated with reductions in AF burden and symptoms. Evidence is greatest for weight loss and moderate exercise. Copyright © 2018 Elsevier Inc. All rights reserved.

Mitigating agricultural impacts on groundwater using distributed managed aquifer recharge ponds

NASA Astrophysics Data System (ADS)

Schmidt, C. M.; Russo, T. A.; Fisher, A. T.; Racz, A. J.; Wheat, C. G.; Los Huertos, M.; Lockwood, B. S.

2010-12-01

Groundwater is likely to become increasingly important for irrigated agriculture due to anticipated changes to the hydrologic cycle associated with climate change. Protecting the quantity and quality of subsurface water supplies will require flexible management strategies that can enhance groundwater recharge. We present results from a study of managed aquifer recharge (MAR) in central coastal California, and propose the use of distributed, small-scale (1-5 ha) MAR systems to improve the quantity and quality of recharge in agricultural basins. Our field site is located in a basin where the primary use of groundwater is irrigation for agriculture, and groundwater resources are increasingly threatened by seawater intrusion and nutrient contamination from fertilizer application. The MAR system we are monitoring is supplied by stormwater and irrigation runoff of variable quality, which is diverted from a wetland during periods of high flow. This MAR system delivers approximately 1x106 m3 of recharge annually to the underlying aquifer, a portion of which is recovered and distributed to growers during the dry season. Our sampling and measurements (at high spatial and temporal resolution) show that a significant percentage of the nitrogen load added during MAR operation is eliminated from recharge during shallow infiltration (~30% to 60%, ~40 kg NO3-N/d). Isotopic analyses of the residual nitrate indicate that a significant fraction of the nitrate load reduction is attributable to denitrification. When normalized to infiltration pond area, this system achieves a mean load reduction of 7 kg NO3-N/d/ha, which compares favorably with the nitrogen load reduction efficiency achieved by treatment wetlands receiving agricultural runoff. Much of the reduction in nitrogen load occurs during periods of rapid infiltration (0.2 to 2.0 m/day), as demonstrated with point measurements of infiltration rate collocated with fluid samples. These results suggest that developing a network of small-scale MAR ponds could be a useful strategy for improving groundwater conditions in this basin. Although the efficiency of small recharge ponds can be high, numerous projects would be needed to impact the overall water balance of a basin such as ours. We are applying a GIS-based approach to assess how small-scale MAR systems could be distributed to achieve significant benefit. This analysis involves determining where topography, soil type, land ownership, groundwater conditions, and cropping practices are the most favorable for locating recharge systems. Results of this work should be applicable to other basins facing similar challenges, ultimately helping to improve the sustainability of groundwater supplies.

A regional programme to improve skin cancer management.

PubMed

McGeoch, Graham R; Sycamore, Mark J; Shand, Brett I; Simcock, Jeremy W

2015-12-01

In 2008, public specialist and general practice services in Canterbury were unable to manage demand for skin cancer treatment. Local clinicians decided the solution was to develop a see-and-treat skin excision clinic staffed by plastic surgeons and general practitioners (GPs), and the introduction of subsidised excisions in general practice. This paper describes the collaboration between clinicians, managers and funders and the results and quality management measures of these initiatives. There is an increasing incidence of skin cancer. GPs in Canterbury were unable to meet increasing demand for skin cancer treatment because some lacked confidence and competence in skin cancer management. There was no public funding for primary care management of skin cancer, driving patients to fully funded secondary care services. Secondary care services were at capacity, with no coordinated programme across primary and secondary care. The programme has resulted in a greater number of skin cancers being treated by the public health system, a reduction in waiting times for treatment, and fewer minor skin lesions being referred to secondary care. Quality measures have been achieved and are improving steadily. Development of the programme has improved working relationships between primary and secondary care clinicians. The strategy was to facilitate the working relationship between primary and secondary care and increase the capacity for skin lesion excisions in both sectors. Skin cancer management can be improved by a coordinated approach between primary and secondary care.

Efficacy of community-based multidisciplinary disease management of chronic heart failure.

PubMed

Omar, A R; Suppiah, N; Chai, P; Chan, Y H; Seow, Y H; Quek, L L; Poh, K K; Tan, H C

2007-06-01

A multidisciplinary disease management (DM) programme in chronic heart failure (CHF) improves clinical outcome. The efficacy of such a programme in a heterogeneous Asian community is not well established. Therefore, we undertook the evaluation of the efficacy of the multidisciplinary community-based DM CHF programme. This was a prospective study involving 154 patients (54 percent male) with a primary diagnosis of CHF, New York Heart Association functional class III/IV CHF, with left ventricular ejection fraction (LVEF) less than 40 percent. The mean age was 65 +/- 12 years and mean LVEF was 27 +/- 9 percent. We evaluated CHF hospitalisation, quality of life, activity status and quality of care (percentage of patients who received ACE inhibitors/angiotensin receptor blockers (ARB) and beta blockers after a period of six months. At six months, there was improvement in the quality of life and activity status (p < 0.001). ACE inhibitors/ARB were maintained in 97 percent of the patients and there was an increased usage of beta blockers (p-value equals 0.001). The rate of CHF hospitalisation was reduced by 68 percent (p-value is less than 0.001) and there was no mortality. The multidisciplinary DM of CHF in a heterogeneous Asian community showed significant improvement in quality of life, quality of care and reduction in CHF hospitalisation.

Degradation and resilience of soils

PubMed Central

Lal, R.

1997-01-01

Debate on global soil degradation, its extent and agronomic impact, can only be resolved through understanding of the processes and factors leading to establishment of the cause-effect relationships for major soils, ecoregions, and land uses. Systematic evaluation through long-term experimentation is needed for establishing quantitative criteria of (i) soil quality in relation to specific functions; (ii) soil degradation in relation to critical limits of key soil properties and processes; and (iii) soil resilience in relation to the ease of restoration through judicious management and discriminate use of essential input. Quantitative assessment of soil degradation can be obtained by evaluating its impact on productivity for different land uses and management systems. Interdisciplinary research is needed to quantify soil degradation effects on decrease in productivity, reduction in biomass, and decline in environment quality throught pollution and eutrophication of natural waters and emission of radiatively-active gases from terrestrial ecosystems to the atmosphere. Data from long-term field experiments in principal ecoregions are specifically needed to (i) establish relationships between soil quality versus soil degradation and soil quality versus soil resilience; (ii) identify indicators of soil quality and soil resilience; and (iii) establish critical limits of important properties for soil degradation and soil resilience. There is a need to develop and standardize techniques for measuring soil resilience.

Community pharmacy-delivered interventions for public health priorities: a systematic review of interventions for alcohol reduction, smoking cessation and weight management, including meta-analysis for smoking cessation

PubMed Central

Brown, Tamara J; Todd, Adam; O'Malley, Claire; Moore, Helen J; Husband, Andrew K; Bambra, Clare; Kasim, Adetayo; Sniehotta, Falko F; Steed, Liz; Smith, Sarah; Nield, Lucie; Summerbell, Carolyn D

2016-01-01

Objectives To systematically review the effectiveness of community pharmacy-delivered interventions for alcohol reduction, smoking cessation and weight management. Design Systematic review and meta-analyses. 10 electronic databases were searched from inception to May 2014. Eligibility criteria for selecting studies Study design: randomised and non-randomised controlled trials; controlled before/after studies, interrupted times series. Intervention: any relevant intervention set in a community pharmacy, delivered by the pharmacy team. No restrictions on duration, country, age, or language. Results 19 studies were included: 2 alcohol reduction, 12 smoking cessation and 5 weight management. Study quality rating: 6 ‘strong’, 4 ‘moderate’ and 9 ‘weak’. 8 studies were conducted in the UK, 4 in the USA, 2 in Australia, 1 each in 5 other countries. Evidence from 2 alcohol-reduction interventions was limited. Behavioural support and/or nicotine replacement therapy are effective and cost-effective for smoking cessation: pooled OR was 2.56 (95% CI 1.45 to 4.53) for active intervention vs usual care. Pharmacy-based interventions produced similar weight loss compared with active interventions in other primary care settings; however, weight loss was not sustained longer term in a range of primary care and commercial settings compared with control. Pharmacy-based weight management interventions have similar provider costs to those delivered in other primary care settings, which are greater than those delivered by commercial organisations. Very few studies explored if and how sociodemographic or socioeconomic variables moderated intervention effects. Insufficient information was available to examine relationships between effectiveness and behaviour change strategies, implementation factors, or organisation and delivery of interventions. Conclusions Community pharmacy-delivered interventions are effective for smoking cessation, and demonstrate that the pharmacy is a feasible option for weight management interventions. Given the potential reach, effectiveness and associated costs of these interventions, commissioners should consider using community pharmacies to help deliver public health services. PMID:26928025

Potential effects of structural controls and street sweeping on stormwater loads to the lower Charles River, Massachusetts

USGS Publications Warehouse

Zarriello, Phillip J.; Breault, Robert F.; Weiskel, Peter K.

2002-01-01

The water quality of the lower Charles River is periodically impaired by combined sewer overflows (CSOs) and non-CSO stormwater runoff. This study examined the potential non-CSO load reductions of suspended solids, fecal coliform bacteria, total phosphorus, and total lead that could reasonably be achieved by implementation of stormwater best management practices, including both structural controls and systematic street sweeping. Structural controls were grouped by major physical or chemical process; these included infiltration-filtration (physical separation), biofiltration-bioretention (biological mechanisms), or detention-retention (physical settling). For each of these categories, upper and lower quartiles, median, and average removal efficiencies were compiled from three national databases of structural control performance. Removal efficiencies obtained indicated a wide range of performance. Removal was generally greatest for infiltration-filtration controls and suspended solids, and least for biofiltration-bioretention controls and fecal coliform bacteria. Street sweeping has received renewed interest as a water-quality control practice because of reported improvements in sweeper technology and the recognition that opportunities for implementing structural controls are limited in highly urbanized areas. The Stormwater Management Model that was developed by the U.S. Geological Survey for the lower Charles River Watershed was modified to simulate the effects of street sweeping in a single-family land-use basin. Constituent buildup and washoff variable values were calibrated to observed annual and storm-event loads. Once calibrated, the street sweeping model was applied to various permutations of four sweeper efficiencies and six sweeping frequencies that ranged from every day to once every 30 days. Reduction of constituent loads to the lower Charles River by the combined hypothetical practices of structural controls and street sweeping was estimated for a range of removal efficiencies because of their inherent variability and uncertainty. This range of efficiencies, with upper and lower estimates, provides reasonable bounds on the load that could be removed by the practices examined. The upper estimated load reduction from combined street sweeping and structural controls, as a percentage of the total non-CSO load entering the lower Charles River downstream of Watertown Dam, was 44 percent for suspended solids, 34 percent for total lead, 14 percent for total phosphorus, and 17 percent for fecal coliform bacteria. The lower estimated load reduction from combined street sweeping and structural controls from non-CSO sources downstream of Watertown Dam, was 14 percent for suspended solids, 11 percent for total lead, 4.9 percent for total phosphorus, and 7.5 percent for fecal coliform bacteria. Load reductions by these combined management practices can be a small as 1.4 percent for total phosphorus to about 4 percent for the other constituents if the total load above Watertown Dam is added to the load from below the dam. Although the reductions in stormwater loads to the lower Charles River from the control practices examined appear to be minor, these practices would likely provide water-quality benefits to portions of the river during those times that they are most impaired-during and immediately after storms. It should also be recognized that only direct measurements of changes in stormwater loads before and after implementation of control practices can provide definitive evidence of the beneficial effects of these practices on water-quality conditions in the lower Charles River.

Investigating the effects of point source and nonpoint source pollution on the water quality of the East River (Dongjiang) in South China

USGS Publications Warehouse

Wu, Yiping; Chen, Ji

2013-01-01

Understanding the physical processes of point source (PS) and nonpoint source (NPS) pollution is critical to evaluate river water quality and identify major pollutant sources in a watershed. In this study, we used the physically-based hydrological/water quality model, Soil and Water Assessment Tool, to investigate the influence of PS and NPS pollution on the water quality of the East River (Dongjiang in Chinese) in southern China. Our results indicate that NPS pollution was the dominant contribution (>94%) to nutrient loads except for mineral phosphorus (50%). A comprehensive Water Quality Index (WQI) computed using eight key water quality variables demonstrates that water quality is better upstream than downstream despite the higher level of ammonium nitrogen found in upstream waters. Also, the temporal (seasonal) and spatial distributions of nutrient loads clearly indicate the critical time period (from late dry season to early wet season) and pollution source areas within the basin (middle and downstream agricultural lands), which resource managers can use to accomplish substantial reduction of NPS pollutant loadings. Overall, this study helps our understanding of the relationship between human activities and pollutant loads and further contributes to decision support for local watershed managers to protect water quality in this region. In particular, the methods presented such as integrating WQI with watershed modeling and identifying the critical time period and pollutions source areas can be valuable for other researchers worldwide.

The Marshall Islands Data Management Program

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

Stoker, A.C.; Conrado, C.L.

1995-09-01

This report is a resource document of the methods and procedures used currently in the Data Management Program of the Marshall Islands Dose Assessment and Radioecology Project. Since 1973, over 60,000 environmental samples have been collected. Our program includes relational database design, programming and maintenance; sample and information management; sample tracking; quality control; and data entry, evaluation and reduction. The usefulness of scientific databases involves careful planning in order to fulfill the requirements of any large research program. Compilation of scientific results requires consolidation of information from several databases, and incorporation of new information as it is generated. The successmore » in combining and organizing all radionuclide analysis, sample information and statistical results into a readily accessible form, is critical to our project.« less

Management of Hyposalivation and Xerostomia: Criteria for Treatment Strategies.

PubMed

Epstein, Joel B; Beier Jensen, Siri

2015-09-01

Saliva management in patients with hyposalivation is potentially complex. Future development of oral care products and treatment strategies requires attention to the biology of saliva and the best means of providing a continuum of relief for people with xerostomia--the sensation of dry mouth--and hyposalivation--documented reduction in saliva flow. Improvement in patient care requires that clinicians be aware of approaches to management, desirable qualities of methods and products, and that they seek the development of products that support the functions of saliva and promote comfort and health. In this brief review of the epidemiology of hyposalivation, the biology and functions of saliva are presented in order to guide clinical decision-making to address the needs of patients with dry mouth.

ESRD in the geriatric population: the crisis of managed care and the opportunity of disease management.

PubMed

Steinman, Theodore I

2002-01-01

The geriatric population with end-stage renal disease (ESRD) is placed at risk with regards to the quality and extent of medical coverage because of the rapidly changing financial environment. Managed care organizations (MCOs) are generally for-profit companies that must focus on the bottom line. While the verbal commitment to quality care is voiced, the financial pressures on MCOs have led to a decrease in coverage of many services and outright denial for some necessary treatments. While denying services, the MCOs have also reduced payments to providers for services rendered. The coverage crisis is compounded by health maintenance organizations (HMOs) quitting Medicare because the reimbursement from the Health Care Financing Administration (HCFA) is less than their costs. Because of the above issues which can potentially impact on the quality of care delivered to the ESRD geriatric population, a new approach to disease management has created the opportunity to improve total patient care to a level not yet achieved in the United States. Disease management encompasses integrated care across all disciplines. Every component of care can be tracked by a dedicated information system. Improvement in outcomes has far exceeded the U.S. Renal Data System (USRDS) benchmark performance measurements with a disease management model approach. The key to success is the health service coordinator (HSC), a senior nurse with many years of ESRD experience. This individual coordinates care across all disciplines and expedites necessary referrals. With rapid attention to patient needs there has been a significant reduction in hospital admissions, hospital length of stay, and emergency room visits. Patient care will steadily improve as the disease management system matures as a consequence of understanding the patients total physical and psychosocial needs.

Learning from death: a hospital mortality reduction programme

PubMed Central

Wright, John; Dugdale, Bob; Hammond, Ian; Jarman, Brian; Neary, Maria; Newton, Duncan; Patterson, Chris; Russon, Lynne; Stanley, Philip; Stephens, Rose; Warren, Erica

2006-01-01

Problem: There are wide variations in hospital mortality. Much of this variation remains unexplained and may reflect quality of care. Setting: A large acute hospital in an urban district in the North of England. Design: Before and after evaluation of a hospital mortality reduction programme. Strategies for change: Audit of hospital deaths to inform an evidence-based approach to identify processes of care to target for the hospital strategy. Establishment of a hospital mortality reduction group with senior leadership and support to ensure the alignment of the hospital departments to achieve a common goal. Robust measurement and regular feedback of hospital deaths using statistical process control charts and summaries of death certificates and routine hospital data. Whole system working across a health community to provide appropriate end of life care. Training and awareness in processes of high quality care such as clinical observation, medication safety and infection control. Effects: Hospital standardized mortality ratios fell significantly in the 3 years following the start of the programme from 94.6 (95% confidence interval 89.4, 99.9) in 2001 to 77.5 (95% CI 73.1, 82.1) in 2005. This translates as 905 fewer hospital deaths than expected during the period 2002-2005. Lessons learnt: Improving the safety of hospital care and reducing hospital deaths provides a clear and well supported goal from clinicians, managers and patients. Good leadership, good information, a quality improvement strategy based on good local evidence and a community-wide approach may be effective in improving the quality of processes of care sufficiently to reduce hospital mortality. PMID:16738373

Use of the quality management system “JACIE” and outcome after hematopoietic stem cell transplantation

PubMed Central

Gratwohl, Alois; Brand, Ronald; McGrath, Eoin; van Biezen, Anja; Sureda, Anna; Ljungman, Per; Baldomero, Helen; Chabannon, Christian; Apperley, Jane

2014-01-01

Competent authorities, healthcare payers and hospitals devote increasing resources to quality management systems but scientific analyses searching for an impact of these systems on clinical outcome remain scarce. Earlier data indicated a stepwise improvement in outcome after allogeneic hematopoietic stem cell transplantation with each phase of the accreditation process for the quality management system “JACIE”. We therefore tested the hypothesis that working towards and achieving “JACIE” accreditation would accelerate improvement in outcome over calendar time. Overall mortality of the entire cohort of 107,904 patients who had a transplant (41,623 allogeneic, 39%; 66,281 autologous, 61%) between 1999 and 2006 decreased over the 14-year observation period by a factor of 0.63 per 10 years (hazard ratio: 0.63; 0.58–0.69). Considering “JACIE“-accredited centers as those with programs having achieved accreditation by November 2012, at the latest, this improvement was significantly faster in “JACIE”-accredited centers than in non-accredited centers (approximately 5.3% per year for 49,459 patients versus approximately 3.5% per year for 58,445 patients, respectively; hazard ratio: 0.83; 0.71–0.97). As a result, relapse-free survival (hazard ratio 0.85; 0.75–0.95) and overall survival (hazard ratio 0.86; 0.76–0.98) were significantly higher at 72 months for those patients transplanted in the 162 “JACIE“-accredited centers. No significant effects were observed after autologous transplants (hazard ratio 1.06; 0.99–1.13). Hence, working towards implementation of a quality management system triggers a dynamic process associated with a steeper reduction in mortality over the years and a significantly improved survival after allogeneic stem cell transplantation. Our data support the use of a quality management system for complex medical procedures. PMID:24488562

Two-year comprehensive medical management of degenerative lumbar spine disease (lumbar spondylolisthesis, stenosis, or disc herniation): a value analysis of cost, pain, disability, and quality of life: clinical article.

PubMed

Parker, Scott L; Godil, Saniya S; Mendenhall, Stephen K; Zuckerman, Scott L; Shau, David N; McGirt, Matthew J

2014-08-01

Current health care reform calls for a reduction of procedures and treatments that are less effective, more costly, and of little value (high cost/low quality). The authors assessed the 2-year cost and effectiveness of comprehensive medical management for lumbar spondylolisthesis, stenosis, and herniation by utilizing a prospective single-center multidisciplinary spine center registry in a real-world practice setting. Analysis was performed on a prospective longitudinal quality of life spine registry. Patients with lumbar spondylolisthesis (n = 50), stenosis (n = 50), and disc herniation (n = 50) who had symptoms persisting after 6 weeks of medical management and who were eligible for surgical treatment were entered into a prospective registry after deciding on nonsurgical treatment. In all cases, comprehensive medical management included spinal steroid injections, physical therapy, muscle relaxants, antiinflammatory medication, and narcotic oral agents. Two-year patient-reported outcomes, back-related medical resource utilization, and occupational work-day losses were prospectively collected and used to calculate Medicare fee-based direct and indirect costs from the payer and societal perspectives. The maximum health gain associated with medical management was defined as the improvement in pain, disability, and quality of life experienced after 2 years of medical treatment or at the time a patient decided to cross over to surgery. The maximum health gain in back pain, leg pain, disability, quality of life, depression, and general health state did not achieve statistical significance by 2 years of medical management, except for pain and disability in patients with disc herniation and back pain in patients with lumbar stenosis. Eighteen patients (36%) with spondylolisthesis, 11 (22%) with stenosis, and 17 (34%) with disc herniation eventually required surgical management due to lack of improvement. The 2-year improvement did not achieve a minimum clinically important difference in any outcome measure. The mean 2-year total cost (direct plus indirect) of medical management was $6606 for spondylolisthesis, $7747 for stenosis, and $7097 for herniation. In an institution-wide, prospective, longitudinal quality of life registry that measures cost and effectiveness of all spine care provided, comprehensive medical management did not result in sustained improvement in pain, disability, or quality of life for patients with surgically eligible degenerative lumbar spondylolisthesis, stenosis, or disc herniation. From both the societal and payer perspective, continued medical management of patients with these lumbar pathologies in whom 6 weeks of conservative therapy failed was of minimal value given its lack of health utility and effectiveness and its health care costs. The findings from this real-world practice setting may more accurately reflect the true value and effectiveness of nonoperative care in surgically eligible patient populations.

Challenges in the management of glaucoma in developing countries.

PubMed

Butt, Nadeem Hafeez; Ayub, Muhammad Hammad; Ali, Muhammad Hassaan

2016-01-01

Glaucoma is the most common optic neuropathy characterized by normal to raised intraocular pressure (IOP), visual field defects, loss of retinal nerve fiber layer, thinning of the neuroretinal rim, and cupping of the optic disc. IOP reduction by medical, laser, or surgical therapies remains the only clinically proven treatment of glaucoma. The challenges in glaucoma management are diverse. They include early detection and diagnosis, setting of appropriate target IOP, choice of treatment, monitoring of quality of life and sight, and compliance with the treatment. Early diagnosis can be made by assessing optic nerve structure using imaging devices and optic nerve function through perimetry. Reducing IOP and controlling its fluctuations are considered to be the most important factors in limiting progression of glaucoma. Selection of the best suitable therapy out of medical, surgical, or laser treatment options is yet another management challenge. Patients suffering from glaucoma experience poor quality of life owing to the diagnosis itself, functional visual loss, inconvenience and cost of treatment, and side effects of treatment. All these factors lead to poor compliance, adherence, and persistence to treatment, and further progression of the disease. It is, therefore, important that ophthalmologists keep all the aforementioned factors in mind when managing patients with glaucoma.

Efficacy of manual therapy in the treatment of tension-type headache. A systematic review from 2000-2013.

PubMed

Lozano López, C; Mesa Jiménez, J; de la Hoz Aizpurúa, J L; Pareja Grande, J; Fernández de Las Peñas, C

2016-01-01

To study the efficacy of manual therapy in the treatment of tension-type headache (TTH) by assessing the quality of randomized control trials (RCTs) published from the year 2000 to April 2013. A search was performed in the following databases: MEDLINE, EBSCO, CINAHL, SCOPUS, PEDRO and OVID. An analysis was made of RCT including patients with TTH receiving any manual therapy, and assessing outcome measures including the intensity, and frequency or duration of the headache. Two independent referees reviewed the methodological quality of RCTs using the Jadad scale. Data from the studies were extracted by two different reviewers. A total of fourteen RCTs were selected. Twelve studies showed acceptable quality (Jadad scale ≥3), and the remaining 2 had low quality (Jadad=2). The studies showed positive results, including reduction in headache intensity and/or frequency, reduction of medication consumption, and improvement in quality of life. The effectiveness of manual therapy for TTH cannot be completely assessed due to the heterogeneity in study design, outcome measures, and different treatments. Nevertheless, the results suggest patients with TTH receiving manual therapies showed better progress than those receiving conventional treatment or placebo. Further studies of high quality using manual therapy protocols, and also including standardized outcome measures, are now needed to clarify the efficacy of manual therapy in the management of TTH. Copyright © 2013 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review.

PubMed

Price, Laura C; Wort, Stephen J; Finney, Simon J; Marino, Philip S; Brett, Stephen J

2010-01-01

Pulmonary vascular dysfunction, pulmonary hypertension (PH), and resulting right ventricular (RV) failure occur in many critical illnesses and may be associated with a worse prognosis. PH and RV failure may be difficult to manage: principles include maintenance of appropriate RV preload, augmentation of RV function, and reduction of RV afterload by lowering pulmonary vascular resistance (PVR). We therefore provide a detailed update on the management of PH and RV failure in adult critical care. A systematic review was performed, based on a search of the literature from 1980 to 2010, by using prespecified search terms. Relevant studies were subjected to analysis based on the GRADE method. Clinical studies of intensive care management of pulmonary vascular dysfunction were identified, describing volume therapy, vasopressors, sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators, and mechanical devices. The following GRADE recommendations (evidence level) are made in patients with pulmonary vascular dysfunction: 1) A weak recommendation (very-low-quality evidence) is made that close monitoring of the RV is advised as volume loading may worsen RV performance; 2) A weak recommendation (low-quality evidence) is made that low-dose norepinephrine is an effective pressor in these patients; and that 3) low-dose vasopressin may be useful to manage patients with resistant vasodilatory shock. 4) A weak recommendation (low-moderate quality evidence) is made that low-dose dobutamine improves RV function in pulmonary vascular dysfunction. 5) A strong recommendation (moderate-quality evidence) is made that phosphodiesterase type III inhibitors reduce PVR and improve RV function, although hypotension is frequent. 6) A weak recommendation (low-quality evidence) is made that levosimendan may be useful for short-term improvements in RV performance. 7) A strong recommendation (moderate-quality evidence) is made that pulmonary vasodilators reduce PVR and improve RV function, notably in pulmonary vascular dysfunction after cardiac surgery, and that the side-effect profile is reduced by using inhaled rather than systemic agents. 8) A weak recommendation (very-low-quality evidence) is made that mechanical therapies may be useful rescue therapies in some settings of pulmonary vascular dysfunction awaiting definitive therapy. This systematic review highlights that although some recommendations can be made to guide the critical care management of pulmonary vascular and right ventricular dysfunction, within the limitations of this review and the GRADE methodology, the quality of the evidence base is generally low, and further high-quality research is needed.

Statistical Techniques for Assessing water‐quality effects of BMPs

USGS Publications Warehouse

Walker, John F.

1994-01-01

Little has been published on the effectiveness of various management practices in small rural lakes and streams at the watershed scale. In this study, statistical techniques were used to test for changes in water‐quality data from watersheds where best management practices (BMPs) were implemented. Reductions in data variability due to climate and seasonality were accomplished through the use of regression methods. This study discusses the merits of using storm‐mass‐transport data as a means of improving the ability to detect BMP effects on stream‐water quality. Statistical techniques were applied to suspended‐sediment records from three rural watersheds in Illinois for the period 1981–84. None of the techniques identified changes in suspended sediment, primarily because of the small degree of BMP implementation and because of potential errors introduced through the estimation of storm‐mass transport. A Monte Carlo sensitivity analysis was used to determine the level of discrete change that could be detected for each watershed. In all cases, the use of regressions improved the ability to detect trends.Read More: http://ascelibrary.org/doi/abs/10.1061/(ASCE)0733-9437(1994)120:2(334)

Association Between State Assistance on the Topic of Indoor Air Quality and School District-Level Policies That Promote Indoor Air Quality in Schools.

PubMed

Everett Jones, Sherry; Doroski, Brenda; Glick, Sherry

2015-12-01

Nationally representative data from the 2012 School Health Policies and Practices Study examined whether state assistance on indoor air quality (IAQ) was associated with district-level policies and practices related to IAQ and integrated pest management (IPM). Districts in states that provided assistance on IAQ were more likely than districts not in such states to (1) have an IAQ management program (p < .001); (2) require schools to conduct periodic inspections of the heating, ventilation, and air conditioning system (p < .05); of the building for cracks, leaks, or past water damage (p < .01); for mold (p < .01); for clutter that prevents effective cleaning and maintenance (p < .05); of the plumbing system (p < .01); and for condensation in and around school facilities (p < .001); (3) have an engine idling reduction program ( < .001); (4) have a policy to purchase low-emitting products (p < .05); and (5) require IPM strategies (p < .05). Increasing the number of states that provide IAQ-related assistance to school districts and schools may improve school IAQ. © The Author(s) 2015.

Electrical resistivity tomography to delineate greenhouse soil variability

NASA Astrophysics Data System (ADS)

Rossi, R.; Amato, M.; Bitella, G.; Bochicchio, R.

2013-03-01

Appropriate management of soil spatial variability is an important tool for optimizing farming inputs, with the result of yield increase and reduction of the environmental impact in field crops. Under greenhouses, several factors such as non-uniform irrigation and localized soil compaction can severely affect yield and quality. Additionally, if soil spatial variability is not taken into account, yield deficiencies are often compensated by extra-volumes of crop inputs; as a result, over-irrigation and overfertilization in some parts of the field may occur. Technology for spatially sound management of greenhouse crops is therefore needed to increase yield and quality and to address sustainability. In this experiment, 2D-electrical resistivity tomography was used as an exploratory tool to characterize greenhouse soil variability and its relations to wild rocket yield. Soil resistivity well matched biomass variation (R2=0.70), and was linked to differences in soil bulk density (R2=0.90), and clay content (R2=0.77). Electrical resistivity tomography shows a great potential in horticulture where there is a growing demand of sustainability coupled with the necessity of stabilizing yield and product quality.

The Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care.

PubMed

Ouslander, Joseph G; Bonner, Alice; Herndon, Laurie; Shutes, Jill

2014-03-01

Interventions to Reduce Acute Care Transfers (INTERACT) is a publicly available quality improvement program that focuses on improving the identification, evaluation, and management of acute changes in condition of nursing home residents. Effective implementation has been associated with substantial reductions in hospitalization of nursing home residents. Familiarity with and support of program implementation by medical directors and primary care clinicians in the nursing home setting are essential to effectiveness and sustainability of the program over time. In addition to helping nursing homes prevent unnecessary hospitalizations and their related complications and costs, and thereby continuing to be or becoming attractive partners for hospitals, health care systems, managed care plans, and accountable care organizations, effective INTERACT implementation will assist nursing homes in meeting the new requirement for a robust quality assurance performance improvement program, which is being rolled out by the federal government over the next year. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Managing sewer solids for the reduction of foul flush effects--Forfar WTP.

PubMed

Fraser, A G; Sakrabani, R; Ashley, R M; Johnstone, F M

2002-01-01

In times of high sewer flow, conditions can exist which enable previously deposited material to be re-entrained back into the body of the flow column. Pulses of this highly polluted flow have been recorded in many instances at the recently constructed wastewater treatment plant (WTP) in Forfar, Scotland. Investigations have been undertaken to characterise the incoming flows and to suggest remedial measures to manage the quality fluctuations. Initial visits to the works and incoming pipes indicated a high degree of sediment deposition in the two inlet pipes. Analyses were carried out and consequently, changes to the hydraulic regime were made. Measurements of sediment level, sediment quality, wall slime and bulk water quality were monitored in the period following the remedial works to observe any improvements. Dramatic alterations in each of the determinands measured were recorded. Analyses were then undertaken to determine long term sediment behaviour and to assess the future usefulness of existing upstream sediment traps. It was concluded that with proper maintenance of the traps, the new hydraulic regime is sufficient to prevent further significant build up of sediment deposits and reduce impacts on the WTP. Further investigations made by North of Scotland Water Authority highlighted trade inputs to the system which may also have contributed to the now managed foul flush problem.

Chronic case management: Clinical governance with cost reductions.

PubMed

Costa, Élide Sbardellotto Mariano da; Hyeda, Adriano

2016-01-01

With increasing global impact of chronic degenerative non-communicable diseases (CDNCD), multidisciplinary chronic disease management care programs (CDMCP) come as a solution to improve the quality of patients care. We conducted a cross-sectional epidemiologic prospective cohort study with data comparing a group of patients monitored by a CDMCP with subjects without CDMCP care, from 2010 to 2012. The patients monitored in this program were selected because they presented CDNCD with frequent hospitalization and/or emergency care in the year prior to study selection. Also, the patients could be referred to the program by their physicians and/or other programs such as HomeCare or family medicine. All costs related to the program were included and compared with the costs of users with the same epidemiological profile who opted for not participating in the CDMCP. We analyzed data from 1,256 cases, including 639 (51%) men and 617 (49%) women. The mean age was 56.99 years and 73% were older than 50 years. There was a prevalence of 34% (428) cases with ischemic heart disease (myocardial infarction and stroke) and 17% (210) with neoplasms. The cases studied showed a reduction of 79% in the number of days of hospitalization compared with the cases without CDMCP monitoring. The average reduction of total costs (hospitalizations, emergency room visits and/or disease complications) was 31.94%, with average reduction of 8.36% in monthly costs. Multidisciplinary monitoring carried out by CDNCD patient management programs can reduce hospitalizations, emergency room visits and complications, positively impacting the costs with health care.

Spatial optimization of watershed management practices for nitrogen load reduction using a modeling-optimization framework.

PubMed

Yang, Guoxiang; Best, Elly P H

2015-09-15

Best management practices (BMPs) can be used effectively to reduce nutrient loads transported from non-point sources to receiving water bodies. However, methodologies of BMP selection and placement in a cost-effective way are needed to assist watershed management planners and stakeholders. We developed a novel modeling-optimization framework that can be used to find cost-effective solutions of BMP placement to attain nutrient load reduction targets. This was accomplished by integrating a GIS-based BMP siting method, a WQM-TMDL-N modeling approach to estimate total nitrogen (TN) loading, and a multi-objective optimization algorithm. Wetland restoration and buffer strip implementation were the two BMP categories used to explore the performance of this framework, both differing greatly in complexity of spatial analysis for site identification. Minimizing TN load and BMP cost were the two objective functions for the optimization process. The performance of this framework was demonstrated in the Tippecanoe River watershed, Indiana, USA. Optimized scenario-based load reduction indicated that the wetland subset selected by the minimum scenario had the greatest N removal efficiency. Buffer strips were more effective for load removal than wetlands. The optimized solutions provided a range of trade-offs between the two objective functions for both BMPs. This framework can be expanded conveniently to a regional scale because the NHDPlus catchment serves as its spatial computational unit. The present study demonstrated the potential of this framework to find cost-effective solutions to meet a water quality target, such as a 20% TN load reduction, under different conditions. Copyright © 2015 Elsevier Ltd. All rights reserved.

IPAD products and implications for the future

NASA Technical Reports Server (NTRS)

Miller, R. E., Jr.

1980-01-01

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

[Customer and patient satisfaction. An appropriate management tool in hospitals?].

PubMed

Pawils, S; Trojan, A; Nickel, S; Bleich, C

2012-09-01

Recently, the concept of patient satisfaction has been established as an essential part of the quality management of hospitals. Despite the concept's lack of theoretical and methodological foundations, patient surveys on subjective hospital experiences contribute immensely to the improvement of hospitals. What needs to be considered critically in this context is the concept of customer satisfaction for patients, the theoretical integration of empirical results, the reduction of false satisfaction indications and the application of risk-adjusted versus naïve benchmarking of data. This paper aims to contribute to the theoretical discussion of the topic and to build a basis for planning methodologically sound patient surveys.

[Clinical guidelines for diagnosis, treatment and monitoring of patients with non-invasive breast cancer].

PubMed

Brnijć, Zoran; Brkljacić, Boris; Drinković, Ivan; Jakić-Razumović, Jasminka; Kardum-Skelin, Ika; Krajina, Zdenko; Margaritoni, Marko; Strnad, Marija; Sarcević, Bozena; Tomić, Snjezana; Zic, Rado

2012-01-01

Breast cancer is the most common malignancy in women. Early diagnosis and more effective treatment of invasive breast cancer resulted in significant mortality reduction, improvement of survival and the quality of life of the patients. The management od non-invasive breast cancer, on the contrary, is still controversial and the problem of overdiagnosis and overtreatment of patients come to evidence. In the following text a multidisciplinary team of experts brings the first consensus guidelines aimed to standardize and optimize the criteria and management in diagnosis, treatment and monitoring of non-invasive breast cancer patients in the Republic of Croatia.

A Novel Integrated Cognitive-Behavioral Therapy for Anxiety and Medication Adherence Among Persons Living With HIV/AIDS.

PubMed

Brandt, Charles P; Paulus, Daniel J; Garza, Monica; Lemaire, Chad; Norton, Peter J; Zvolensky, Michael J

2018-02-01

Persons living with HIV/AIDS (PLHIV) are able to live full lifespans after infection, however, rates of anxiety disorders among this population are elevated compared to national samples. Importantly, these anxiety symptoms and disorders have a negative effect on medication adherence, quality of life and other psychological disorders, such as depression. In order to reduce the impact of anxiety among PLHIV, a six-session transdiagnostic CBT-based treatment manual for anxiety among PLHIV named the HIV/Anxiety Management-Reduction Treatment (HAMRT) was developed and implemented. The current manuscript discusses the content of this manual as well as results from three cases examining the impact of HAMRT. Results indicated that HAMRT was effective in reducing symptoms of anxiety, anxiety sensitivity, depression, and negative affect among our sample. Additionally, results indicated that HAMRT was effective in increasing HIV medication adherence as well as quality of life. Results are discussed in terms of the potential utility of an anxiety-reduction therapy program aimed at increasing medication adherence among PLHIV.

Benefits and Barriers of Implementation and Utilization of Radio-Frequency Identification (RFID) Systems in Transfusion Medicine

PubMed Central

Coustasse, Alberto; Cunningham, Brian; Deslich, Stacie; Willson, Eric; Meadows, Pamela

2015-01-01

Radio-frequency identification (RFID) technology is used by hospital supply chains to track medical products and monitor inventories. Hospitals have also begun incorporating RFID technology as part of their transfusion processes. The purpose of this review was to analyze how healthcare organization supply chains can benefit from the utilization of RFID systems in transfusion service departments. The methodology for this study was a literature review following the steps of a systematic review with a total of 52 sources referenced. RFID technology is used to manage and track blood products from the initial donor phlebotomy to final disposition or product transfusion. RFID-enabled transfusion practices have successfully increased provider productivity and product quality through work-time reduction and error reduction. Findings of this research study suggest that RFID has provided improvements in quality of care and efficiency, while initial costs, security, and privacy appear to be the principal barriers to adoption. PMID:26396555

Evaluation of Approaches for Managing Nitrate Loading from On-Site Wastewater Systems near La Pine, Oregon

USGS Publications Warehouse

Morgan, David S.; Hinkle, Stephen R.; Weick, Rodney J.

2007-01-01

This report presents the results of a study by the U.S. Geological Survey, done in cooperation with the Oregon Department of Environmental Quality and Deschutes County, to develop a better understanding of the effects of nitrogen from on-site wastewater disposal systems on the quality of ground water near La Pine in southern Deschutes County and northern Klamath County, Oregon. Simulation models were used to test the conceptual understanding of the system and were coupled with optimization methods to develop the Nitrate Loading Management Model, a decision-support tool that can be used to efficiently evaluate alternative approaches for managing nitrate loading from on-site wastewater systems. The conceptual model of the system is based on geologic, hydrologic, and geochemical data collected for this study, as well as previous hydrogeologic and water quality studies and field testing of on-site wastewater systems in the area by other agencies. On-site wastewater systems are the only significant source of anthropogenic nitrogen to shallow ground water in the study area. Between 1960 and 2005 estimated nitrate loading from on-site wastewater systems increased from 3,900 to 91,000 pounds of nitrogen per year. When all remaining lots are developed (in 2019 at current building rates), nitrate loading is projected to reach nearly 150,000 pounds of nitrogen per year. Low recharge rates (2-3 inches per year) and ground-water flow velocities generally have limited the extent of nitrate occurrence to discrete plumes within 20-30 feet of the water table; however, hydraulic-gradient and age data indicate that, given sufficient time and additional loading, nitrate will migrate to depths where many domestic wells currently obtain water. In 2000, nitrate concentrations greater than 4 milligrams nitrogen per liter (mg N/L) were detected in 10 percent of domestic wells sampled by Oregon Department of Environmental Quality. Numerical simulation models were constructed at transect (2.4 square miles) and study-area (247 square miles) scales to test the conceptual model and evaluate processes controlling nitrate concentrations in ground water and potential ground-water discharge of nitrate to streams. Simulation of water-quality conditions for a projected future build-out (base) scenario in which all existing lots are developed using conventional on-site wastewater systems indicates that, at equilibrium, average nitrate concentrations near the water table will exceed 10 mg N/L over areas totaling 9,400 acres. Other scenarios were simulated where future nitrate loading was reduced using advanced treatment on-site systems and a development transfer program. Seven other scenarios were simulated with total nitrate loading reductions ranging from 15 to 94 percent; simulated reductions in the area where average nitrate concentrations near the water table exceed 10 mg N/L range from 22 to 99 percent at equilibrium. Simulations also show that the ground-water system responds slowly to changes in nitrate loading due to low recharge rates and ground-water flow velocity. Consequently, reductions in nitrate loading will not immediately reduce average nitrate concentrations and the average concentration in the aquifer will continue to increase for 25-50 years depending on the level and timing of loading reduction. The capacity of the ground-water system to receive on-site wastewater system effluent, which is related to the density of homes, presence of upgradient residential development, ground-water recharge rate, ground-water flow velocity, and thickness of the oxic part of the aquifer, varies within the study area. Optimization capability was added to the study-area simulation model and the combined simulation-optimization model was used to evaluate alternative approaches to management of nitrate loading from on-site wastewater systems to the shallow alluvial aquifer. The Nitrate Loading Management Model (NLMM) was formulated to find the minimum red

Evaluating barnyard Best Management Practices in Wisconsin using upstream-downstream monitoring

USGS Publications Warehouse

Stuntebeck, Todd D.

1995-01-01

The Nonpoint Source Water Pollution Abatement Program was created in 1978 by the Wisconsin Legislature. The goal of the program is to improve and protect the water quality of lakes, streams, wetlands, and ground water within selected priority watersheds by controlling sources of nonpoint pollution. For each selected watershed, the Wisconsin Department of Natural Resources drafts a management plan that guides the implementation of pollution-control strategies known as Best Management Practices (BMP's). This plan summarizes resource and land-use inventories, describes the results of pollution-source modeling, and suggests pollution reduction goals. The U.S. Geological Survey, through a cooperative effort with the Wisconsin Department of Natural Resources, is monitoring water-quality improvements that result from the implementation of BMP's. The data collected are then compared to the watershed plans to assess progress and determine whether goals are being realized. This fact sheet describes the data-collection efforts, preliminary results, and planned data-analysis techniques of monitoring projects for pre-BMP conditions at two barnyards, one each on Otter Creek and Halfway Prairie Creek.

A pilot quality assurance scheme for diabetic retinopathy risk reduction programmes.

PubMed

Garvican, L; Scanlon, P H

2004-10-01

We describe a pilot study of measurement of quality assurance targets for diabetic retinopathy screening and performance comparison between 10 existing services, in preparation for the roll-out of the national programme. In 1999 the UK National Screening Committee approved proposals for a national diabetic retinopathy risk reduction programme, including recommendations for quality assurance, but implementation was held pending publication of the National Service Framework for Diabetes. Existing services requested the authors to perform a pilot study of a QA scheme, indicating willingness to contribute data for comparison. Objectives and quality standards were developed, following consultation with diabetologists, ophthalmologists and retinal screeners. Services submitted 2001/2 performance data, in response to a questionnaire, for anonymization, central analysis and comparison. The 17 quality standards encompass all aspects of the programme from identification of patients to timeliness of treatment. Ten programmes took part, submitting all the data available. All returns were incomplete, but especially so from the optometry-based schemes. Eight or more services demonstrated they could reach the minimum level in only five of the 17 standards. Thirty per cent could not provide coverage data. All were running behind. Reasons for difficulties in obtaining data and/or failing to achieve standards included severe under-funding and little previous experience of QA. Information systems were limited and incompatible between diabetes and eye units, and there was a lack of co-ordinated management of the whole programme. Quality assurance is time-consuming, expensive and inadequately resourced. The pilot study identified priorities for local action. National programme implementation must involve integral quality assurance mechanisms from the outset.

Cancer Pain Management Education Rectifies Patients' Misconceptions of Cancer Pain, Reduces Pain, and Improves Quality of Life.

PubMed

Koh, Su-Jin; Keam, Bhumsuk; Hyun, Min Kyung; Ju Seo, Jeong; Uk Park, Keon; Oh, Sung Yong; Ahn, Jinseok; Lee, Ja Youn; Kim, JinShil

2018-03-26

More than half of the patients have reported improper management of breakthrough cancer pain. Empirical evidence is lacking concerning the effectiveness of cancer pain education on breakthrough pain control. This study aimed to examine the effects of individual pain education on pain control, use of short-acting analgesics for breakthrough pain, quality of life outcomes, and rectification of patients' misconceptions regarding cancer pain. A quasi-experimental design was used. In total, 176 (102 inpatients and 74 outpatients) and 163 (93 inpatients and 70 outpatients) cancer patients completed questionnaires on pain intensity, quality of life, use of short-acting medication for breakthrough pain, and misconceptions about cancer pain and opioid use before and immediately and/or seven days after individual pain education. The mean age of the participants was 60.9 years (±11.2), and 56.3% were male. The most common cancers were lung cancer (17.0%), colon cancer (15.9%), and breast cancer (12.5%). The subjects' reasons for attrition were conditional deterioration, death, or voluntary withdrawal (N = 13, 7.4%). Following the education, there was a significant reduction in overall pain intensity over 24 hours (P < 0.001). The outpatients showed more use of short-acting analgesics for breakthrough pain. Sleep quality change was most significantly associated with intervention; other quality of life aspects (e.g., general feelings and life enjoyment) also improved. Pain education also significantly reduced misconceptions regarding cancer pain management. The present educational intervention was effective in encouraging short-acting analgesic use for breakthrough pain, improving quality of life outcomes, and rectifying patients' misconceptions about analgesic use.

Improved Image Quality in Head and Neck CT Using a 3D Iterative Approach to Reduce Metal Artifact.

PubMed

Wuest, W; May, M S; Brand, M; Bayerl, N; Krauss, A; Uder, M; Lell, M

2015-10-01

Metal artifacts from dental fillings and other devices degrade image quality and may compromise the detection and evaluation of lesions in the oral cavity and oropharynx by CT. The aim of this study was to evaluate the effect of iterative metal artifact reduction on CT of the oral cavity and oropharynx. Data from 50 consecutive patients with metal artifacts from dental hardware were reconstructed with standard filtered back-projection, linear interpolation metal artifact reduction (LIMAR), and iterative metal artifact reduction. The image quality of sections that contained metal was analyzed for the severity of artifacts and diagnostic value. A total of 455 sections (mean ± standard deviation, 9.1 ± 4.1 sections per patient) contained metal and were evaluated with each reconstruction method. Sections without metal were not affected by the algorithms and demonstrated image quality identical to each other. Of these sections, 38% were considered nondiagnostic with filtered back-projection, 31% with LIMAR, and only 7% with iterative metal artifact reduction. Thirty-three percent of the sections had poor image quality with filtered back-projection, 46% with LIMAR, and 10% with iterative metal artifact reduction. Thirteen percent of the sections with filtered back-projection, 17% with LIMAR, and 22% with iterative metal artifact reduction were of moderate image quality, 16% of the sections with filtered back-projection, 5% with LIMAR, and 30% with iterative metal artifact reduction were of good image quality, and 1% of the sections with LIMAR and 31% with iterative metal artifact reduction were of excellent image quality. Iterative metal artifact reduction yields the highest image quality in comparison with filtered back-projection and linear interpolation metal artifact reduction in patients with metal hardware in the head and neck area. © 2015 by American Journal of Neuroradiology.

The effect of nurse-led education on hospitalisation, readmission, quality of life and cost in adults with heart failure. A systematic review.

PubMed

Rice, Helena; Say, Richard; Betihavas, Vasiliki

2018-03-01

The purpose of this systematic review was to highlight the effect of nurse-led 1:1 patient education sessions on Quality of Life (QoL), readmission rates and healthcare costs for adults with heart failure (HF) living independently in the community. A systematic review of randomised control trials was undertaken. Using the search terms nurse, education, heart failure, hospitalisation, readmission, rehospitalisation, economic burden, cost, expenditure and quality of life in PubMed, CINAHL and Google Scholar databases were searched. Papers pertaining to nurse-led 1:1 HF disease management of education of adults in the community with a history of HF were reviewed. The results of this review identified nurse-led education sessions for adults with HF contribute to reduction in hospital readmissions, reduction in hospitalisation and a cost benefit. Additionally, higher functioning and improved QoL were also identified. These results suggest that nurse-led patient education for adults with HF improves QoL and reduces hospital admissions and readmissions. Nurse-led education can be delivered utilising diverse methods and impact to reduce readmission as well as hospitalisation. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

MO-B-BRB-02: Maintain the Quality of Treatment Planning for Time-Constraint Cases

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

Chang, J.

The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less

An Adaptive Multi-Purpose Inventory Management System for Military Aircraft Maintenance: A Case Study of Royal Jordanian Air Force (RJAF)

NASA Astrophysics Data System (ADS)

Al-Khawaldeh, Ihsan Naji

Inventory management is a vital tool for any organization to survive the competency and reduce the operating cost. In the field of aviation its importance is more provident as the spares are more on the move. Apart from the aspects related to inventory management like quantity, quality, price, lead time...etc., inventory in aviation caters for those items, where to store them and how and when to circulate them. On other hand, safety which is a prominent crucial factor in aviation field makes it more and more demanding to have an inventory management as an integral part of both aviation maintenance management and quality assurance program. Just-in Time (JIT) inventory management systems that worked well in reducing the waste and increasing the profit might not work well in aviation field both civil and military. Hence, a need for an adaptive management system that takes care of cost reduction along with high readiness is of a vital need. The Inventory Management System (IMS) in aviation and especially in military is seen to follow a mix of the different inventory management methods. In other word, it is a combination of Fixed-Order Quantity (Q-Model), and Fixed-Time Period Reordering (P-model) to cope with the dynamics of aviation maintenance needs. The uniqueness feature of aviation inventory, where a shortage of trivial spares like nuts, bolts may at some point be considered as critical, grounding a complete fleet especially one that matters a flight safety issue. Different Platforms, operating locations, aging and many others influence the need for an adaptive inventory system. Using Access software for a simple programming and using it as inventory management system that will help in defining the rate of usage of spares, and consumables, and on the other hand may give an insight in material deficiency, that will lead for engineering design improvement and modification. The main aim of this (IMS) is reduction of both A.O.G chances, and inventory cost related to effective usage of needed items based on the maintenance requirements. The key to success lies in the perseverance to use the software and develop its capabilities continuously, through a qualified workforce.

Effectiveness of disease-management programs for improving diabetes care: a meta-analysis.

PubMed

Pimouguet, Clément; Le Goff, Mélanie; Thiébaut, Rodolphe; Dartigues, Jean François; Helmer, Catherine

2011-02-08

We conducted a meta-analysis of randomized controlled trials to assess the effectiveness of disease-management programs for improving glycemic control in adults with diabetes mellitus and to study which components of programs are associated with their effectiveness. We searched several databases for studies published up to December 2009. We included randomized controlled trials involving adults with type 1 or 2 diabetes that evaluated the effect of disease-management programs on glycated hemoglobin (hemoglobin A₁(C)) concentrations. We performed a meta-regression analysis to determine the effective components of the programs. We included 41 randomized controlled trials in our review. Across these trials, disease-management programs resulted in a significant reduction in hemoglobin A₁(C) levels (pooled standardized mean difference between intervention and control groups -0.38 [95% confidence interval -0.47 to -0.29], which corresponds to an absolute mean difference of 0.51%). The finding was robust in the sensitivity analyses based on quality assessment. Programs in which the disease manager was able to start or modify treatment with or without prior approval from the primary care physician resulted in a greater improvement in hemoglobin A₁(C) levels (standardized mean difference -0.60 v. -0.28 in trials with no approval to do so; p < 0.001). Programs with a moderate or high frequency of contact reported a significant reduction in hemoglobin A₁(C) levels compared with usual care; nevertheless, only programs with a high frequency of contact led to a significantly greater reduction compared with low-frequency contact programs (standardized mean difference -0.56 v. -0.30, p = 0.03). Disease-management programs had a clinically moderate but significant impact on hemoglobin A₁(C) levels among adults with diabetes. Effective components of programs were a high frequency of patient contact and the ability for disease managers to adjust treatment with or without prior physician approval.

Effectiveness of disease-management programs for improving diabetes care: a meta-analysis

PubMed Central

Pimouguet, Clément; Le Goff, Mélanie; Thiébaut, Rodolphe; Dartigues, Jean François; Helmer, Catherine

2011-01-01

Background We conducted a meta-analysis of randomized controlled trials to assess the effectiveness of disease-management programs for improving glycemic control in adults with diabetes mellitus and to study which components of programs are associated with their effectiveness. Methods We searched several databases for studies published up to December 2009. We included randomized controlled trials involving adults with type 1 or 2 diabetes that evaluated the effect of disease-management programs on glycated hemoglobin (hemoglobin A1C) concentrations. We performed a meta-regression analysis to determine the effective components of the programs. Results We included 41 randomized controlled trials in our review. Across these trials, disease-management programs resulted in a significant reduction in hemoglobin A1C levels (pooled standardized mean difference between intervention and control groups −0.38 [95% confidence interval −0.47 to −0.29], which corresponds to an absolute mean difference of 0.51%). The finding was robust in the sensitivity analyses based on quality assessment. Programs in which the disease manager was able to start or modify treatment with or without prior approval from the primary care physician resulted in a greater improvement in hemoglobin A1C levels (standardized mean difference −0.60 v. −0.28 in trials with no approval to do so; p < 0.001). Programs with a moderate or high frequency of contact reported a significant reduction in hemoglobin A1C levels compared with usual care; nevertheless, only programs with a high frequency of contact led to a significantly greater reduction compared with low-frequency contact programs (standardized mean difference −0.56 v. −0.30, p = 0.03). Interpretation Disease-management programs had a clinically moderate but significant impact on hemoglobin A1C levels among adults with diabetes. Effective components of programs were a high frequency of patient contact and the ability for disease managers to adjust treatment with or without prior physician approval. PMID:21149524

Consistent ozone-induced decreases in pasture forage quality across several grassland types and consequences for UK lamb production.

PubMed

Hayes, Felicity; Mills, Gina; Jones, Laurence; Abbott, John; Ashmore, Mike; Barnes, Jeremy; Neil Cape, J; Coyle, Mhairi; Peacock, Simon; Rintoul, Naomi; Toet, Sylvia; Wedlich, Kerstin; Wyness, Kirsten

2016-02-01

In this study we have demonstrated that rising background ozone has the potential to reduce grassland forage quality and explored the implications for livestock production. We analysed pasture samples from seven ozone exposure experiments comprising mesotrophic, calcareous, haymeadow and sanddune unimproved grasslands conducted in open-top chambers, solardomes and a field release system. Across all grassland types, there were significant increases in acid detergent fibre, crude fibre and lignin content with increasing ozone concentration, resulting in decreased pasture quality in terms of the metabolisable energy content of the vegetation. We derived a dose-response function for metabolisable energy of the grassland with ozone concentration, applicable to a range of grassland types, and used this to predict effects on pasture quality of UK vegetation at 1 km resolution using modelled ozone data for 2007 and for predicted higher average ozone concentrations in 2020. This showed a potential total reduction in lamb production in the UK of approximately 4% in 2020 compared to 2007. The largest impacts were in geographical areas of modest ozone increases between the two years, but where large numbers of lambs were present. For an individual farmer working to a very small cost margin this could represent a large reduction in profit, both in regions where the impacts per lamb and those where the impacts per km(2) of grazing land are largest. In the short term farmers could adapt their lamb management in response to changed forage quality by additional supplementary feed of high metabolisable energy content. Nationally this increase in annual additional feed in 2020 compared to 2007 would be 2,166 tonnes (an increase of 0.7%). Of added concern are the longer-term consequences of continual deterioration of pasture quality and the implications for changes in farming practices to compensate for potential reductions in livestock production capacity. Copyright © 2015 Elsevier B.V. All rights reserved.

The potential impacts of electric vehicles on air quality in the urban areas of Barcelona and Madrid (Spain)

NASA Astrophysics Data System (ADS)

Soret, A.; Guevara, M.; Baldasano, J. M.

2014-12-01

This work analyses the potential air quality improvements resulting from three fleet electrification scenarios (∼13, 26 and 40%) by replacing conventional vehicles with Electric Battery Vehicles (EBVs), Plug-in Hybrid Electric Vehicles (PHEVs) and Hybrid Electric Vehicles (HEVs). This study has been performed for the cities of Barcelona and Madrid (Spain), where road transport is the primary emission source. In these urban areas, several air quality problems are present, mainly related to NO2 and particulate matter. The WRF-ARW/HERMESv2/CMAQ model system has been applied at high spatial (1 × 1 km2) and temporal (1 h) resolution. The results show that fleet electrification offers a potential for emission abatement, especially related to NOx and CO. Regarding the more ambitious scenario (∼40% fleet electrification), reductions of 11% and 17% of the total NOx emissions are observed in Barcelona and Madrid respectively. These emissions reductions involve air quality improvements in NO2 maximum hourly values up to 16%: reductions up to 30 and 35 μg m-3 in Barcelona and Madrid, respectively. Furthermore, an additional scenario has been defined considering electric generation emissions associated with EBVs and PHEVs charging from a combined-cycle power plant. These charging emissions would produce slight NO2 increases in the downwind areas of <3 μg m-3. Thus, fleet electrification would improve urban air quality even when considering emissions associated with charging electric vehicles. However, two further points should be considered. First, fleet electrification cannot be considered a unique solution, and other management strategies may be defined. This is especially important with respect to particulate matter emissions, which are not significantly reduced by fleet electrification (<5%) due to the high weight of non-exhaust emissions. Second, a significant introduction of electric vehicles (26-40%) involving all vehicle categories is required to improve urban air quality.

Analyzing the cost effectiveness of Santiago, Chile's policy of using urban forests to improve air quality.

PubMed

Escobedo, Francisco J; Wagner, John E; Nowak, David J; De la Maza, Carmen Luz; Rodriguez, Manuel; Crane, Daniel E

2008-01-01

Santiago, Chile has the distinction of having among the worst urban air pollution problems in Latin America. As part of an atmospheric pollution reduction plan, the Santiago Regional Metropolitan government defined an environmental policy goal of using urban forests to remove particulate matter less than 10 microm (PM(10)) in the Gran Santiago area. We used cost effectiveness, or the process of establishing costs and selecting least cost alternatives for obtaining a defined policy goal of PM(10) removal, to analyze this policy goal. For this study, we quantified PM(10) removal by Santiago's urban forests based on socioeconomic strata and using field and real-time pollution and climate data via a dry deposition urban forest effects model. Municipal urban forest management costs were estimated using management cost surveys and Chilean Ministry of Planning and Cooperation documents. Results indicate that managing municipal urban forests (trees, shrubs, and grass whose management is under the jurisdiction of Santiago's 36 municipalities) to remove PM(10) was a cost-effective policy for abating PM(10) based on criteria set by the World Bank. In addition, we compared the cost effectiveness of managing municipal urban forests and street trees to other control policies (e.g. alternative fuels) to abate PM(10) in Santiago and determined that municipal urban forest management efficiency was similar to these other air quality improvement measures.

Results of the Medicare Health Support disease-management pilot program.

PubMed

McCall, Nancy; Cromwell, Jerry

2011-11-03

In the Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services to test the commercial disease-management model in the Medicare fee-for-service program. The Medicare Health Support Pilot Program was a large, randomized study of eight commercial programs for disease management that used nurse-based call centers. We randomly assigned patients with heart failure, diabetes, or both to the intervention or to usual care (control) and compared them with the use of a difference-in-differences method to evaluate the effects of the commercial programs on the quality of clinical care, acute care utilization, and Medicare expenditures for Medicare fee-for-service beneficiaries. The study included 242,417 patients (163,107 in the intervention group and 79,310 in the control group). The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits, as compared with usual care. We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures. In this large study, commercial disease-management programs using nurse-based call centers achieved only modest improvements in quality-of-care measures, with no demonstrable reduction in the utilization of acute care or the costs of care.

Riparian Meadow Response to Modern Conservation Grazing Management

NASA Astrophysics Data System (ADS)

Oles, Kristin M.; Weixelman, Dave A.; Lile, David F.; Tate, Kenneth W.; Snell, Laura K.; Roche, Leslie M.

2017-09-01

Riparian meadows occupy a small proportion of the public lands in the western United States but they provide numerous ecosystem services, including the production of high-quality forage for livestock grazing. Modern conservation management strategies (e.g., reductions in livestock stocking rates and adoption of new riparian grazing standards) have been implemented to better balance riparian conservation and livestock production objectives on publicly managed lands. We examined potential relationships between long-term changes in plant community, livestock grazing pressure and environmental conditions at two spatial scales in meadows grazed under conservation management strategies. Changes in plant community were not associated with either livestock stocking rate or precipitation at the grazing allotment (i.e., administrative) scale. Alternatively, both grazing pressure and precipitation had significant, albeit modest, associations with changes in plant community at the meadow (i.e., ecological site) scale. These results suggest that reductions in stocking rate have improved the balance between riparian conservation and livestock production goals. However, associations between elevation, site wetness, precipitation, and changes in plant community suggest that changing climate conditions (e.g., reduced snowpack and changes in timing of snowmelt) could trigger shifts in plant communities, potentially impacting both conservation and agricultural services (e.g., livestock and forage production). Therefore, adaptive, site-specific management strategies are required to meet grazing pressure limits and safeguard ecosystem services within individual meadows, especially under more variable climate conditions.

Riparian Meadow Response to Modern Conservation Grazing Management.

PubMed

Oles, Kristin M; Weixelman, Dave A; Lile, David F; Tate, Kenneth W; Snell, Laura K; Roche, Leslie M

2017-09-01

Riparian meadows occupy a small proportion of the public lands in the western United States but they provide numerous ecosystem services, including the production of high-quality forage for livestock grazing. Modern conservation management strategies (e.g., reductions in livestock stocking rates and adoption of new riparian grazing standards) have been implemented to better balance riparian conservation and livestock production objectives on publicly managed lands. We examined potential relationships between long-term changes in plant community, livestock grazing pressure and environmental conditions at two spatial scales in meadows grazed under conservation management strategies. Changes in plant community were not associated with either livestock stocking rate or precipitation at the grazing allotment (i.e., administrative) scale. Alternatively, both grazing pressure and precipitation had significant, albeit modest, associations with changes in plant community at the meadow (i.e., ecological site) scale. These results suggest that reductions in stocking rate have improved the balance between riparian conservation and livestock production goals. However, associations between elevation, site wetness, precipitation, and changes in plant community suggest that changing climate conditions (e.g., reduced snowpack and changes in timing of snowmelt) could trigger shifts in plant communities, potentially impacting both conservation and agricultural services (e.g., livestock and forage production). Therefore, adaptive, site-specific management strategies are required to meet grazing pressure limits and safeguard ecosystem services within individual meadows, especially under more variable climate conditions.

Metabolic syndrome and hypertension: regular exercise as part of lifestyle management.

PubMed

Lackland, Daniel T; Voeks, Jenifer H

2014-11-01

The incorporation of physical activity and exercise represents a clinically important aspect in the management of metabolic syndrome, hypertension, and diabetes. While the benefit of exercise and active lifestyles is well documented for prevention and risk reduction of cardiovascular and stroke outcomes, the detailed regiment and recommendations are less clear. The components of a prescribed physical activity include consideration of activity type, frequency of an activity, activity duration, and intensity of a specific physical movement. The exercise parameters prescribed as part of the management of metabolic syndrome, diabetes, and elevated blood pressure are most often proposed as separate documents while the general recommendations are similar. The evidence is strong such that physical activity and exercise recommendations in disease management guidelines are considered high quality. The general recommendations for both blood pressure and glycemic management include a regiment of physical activity with moderate- to high-intensity exercise of 30-min bouts on multiple days with a desired goal of a total of 150 min of exercise per week. While additional research is needed to identify the specific exercise/activity mode, frequencies for exercise training, intensity levels, and duration of exercise that achieve maximal blood pressure and glycemic lowering, this general recommendation showed a consistent and significant benefit in risk reduction. Similarly, the current available evidence also indicates that aerobic exercise, dynamic resistance exercise, and isometric exercises can lower blood pressure and improve glycemic control.

Systematic review of studies on telemonitoring of patients with congestive heart failure: a meta-analysis.

PubMed

Clarke, Malcolm; Shah, Anila; Sharma, Urvashi

2011-01-01

We conducted a systematic review of large, well-conducted randomised trials designed to evaluate the effectiveness of telemonitoring on patients with congestive heart failure (CHF). Two people reviewed 125 articles independently and selected 13 articles for final review. These studies concerned 3480 patients. The follow-up period of the studies was 3-15 months. Pooled estimate results showed that there was an overall reduction in all-cause mortality (P = 0.02). There was no overall reduction in all-cause hospital admission (P = 0.84), although there was a reduction in CHF hospital admission (P = 0.0004). There was no reduction in all-cause emergency admission (P = 0.67). There was no significant difference in length of stay in hospital, medication adherence or cost. Telemonitoring in conjunction with nurse home visiting and specialist unit support can be effective in the clinical management of patients with CHF and help to improve their quality of life.

Strategic performance in hospitals: the use of the balanced scorecard by nurse managers.

PubMed

Naranjo-Gil, David

2009-01-01

The competitive and dynamic health care sector has spurred hospitals into delivering greater flexibility and quality of services while cutting the hospital cost at the same time. However, hospitals differ in the extent to which they achieve these strategic goals. This article explores the use of a new management tool-the balanced scorecard-which facilitates managers to meet multiple strategic goals. It also analyzes how nurse managers use the balanced scorecard in an interactive or diagnostic way and its subsequent effect on strategic goal achievement (cost reduction and flexibility). It also examines how "balanced" is the balanced scorecard in terms of financial versus nonfinancial measures. Data were collected from a mail survey sent to 218 nurse managers in Spanish public hospitals. A satisfactory response rate was achieved, with 114 (52.29%) useful answered questionnaires. The results show that younger, more tenured, and clinically trained nurse managers would be more likely to use the balanced scorecard in an interactive way. Conversely, older, less tenured, and administratively trained managers would use it diagnostically. The results also indicate that the balanced scorecard facilitates the cost reduction and flexibility in hospitals only when it is used interactively. This article provides evidence that not only the technical design of the balanced scorecard matters, but also an appropriate use of the balanced scorecard is paramount for achievement of multiple strategic goals. An effective use of the balanced scorecard requires managers to actively stimulate dialogue and agreement among hospital's staff about desirable financial and nonfinancial performance measures in alignment with multiple strategic goals.

Managing cardiovascular risks with Tai Chi in people with coronary artery disease.

PubMed

Park, In Sook; Song, Rhayun; Oh, Kyong Ok; So, Hee Young; Kim, Dal Sook; Kim, Jong Im; Kim, Tae Sook; Kim, Hyun Li; Ahn, Suk Hee

2010-02-01

The paper is a report of the study to determine the effects of the cardiovascular risk management programme with Tai Chi on cardiovascular risks, health behaviours and quality of life in individuals with coronary artery disease. Many eligible patients with coronary artery disease do not participate in programmes for cardiovascular risk management, mainly because of lack of motivation, high cost or limited accessibility. Tai Chi has been introduced by health professionals to promote cardiovascular functioning and quality of life. A quasi-experimental design with a non-equivalent control group was used. Eighty-five people with a mean age of 66 years completed pretest and 6-month follow-up measures in the following three groups: Tai Chi with education (n = 33), Tai Chi only (n = 19) and control (n = 33). Analysis of covariance was used to compare outcome variables with pretest variables as covariates to adjust for baseline differences. The data were collected in 2005-2006. In the Tai-Chi-with-education group there were statistically significant reductions in modifiable cardiovascular risk factors (F = 3.49, P = 0.035) and improvements in health behaviours (F = 6.12, P = 0.003), mental scores (F = 3.96, P = 0.023), and in the role-emotional (F = 7.30, P = 0.001) and vitality (F = 3.81, P = 0.026) dimensions of quality of life. Tai Chi was safely implemented as an alternative form of exercise in a cardiovascular risk management programme. Whether the beneficial effects of Tai Chi in cardiovascular risk management are comparable with those induced by other types of aerobic exercise requires further investigation.

Overview of waste reduction techniques leading to pollution prevention

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

Hunt, G.E.

Liquid, solid, and/or gaseous waste materials are always generated during the manufacture of any product. In addition to creating environmental hazards, these wastes represent losses of valuable materials and energy from the production process and require a significant investment in pollution control. Traditionally, pollution control relies on ``end-of-the-pipe`` and ``out-the-back-door`` management approaches that require labor hours, energy, materials, and capital expenditures. Such an approach removes pollutants from one source, such as wastewater, but places them somewhere else, such as in a landfill. More regulations, higher disposal expenses, increased liability costs, and increased public awareness have caused industrial and governmental leadersmore » to begin critical examinations of end-of-the-pipe control technologies. The value of reducing waste during the manufacturing process has become apparent to many industries. These companies are looking at broader environmental management objectives, rather than concentrating solely on pollution control. Waste reduction not only is very often economically beneficial for an industry, it also improves the quality of the environment.« less

Evaluating agricultural nonpoint-source pollution using integrated geographic information systems and hydrologic/water quality model

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

Tim, U.S.; Jolly, R.

1994-01-01

Considerable progress has been made in developing physically based, distributed parameter, hydrologic/water quality (HIWQ) models for planning and control of nonpoint-source pollution. The widespread use of these models is often constrained by the excessive and time-consuming input data demands and the lack of computing efficiencies necessary for iterative simulation of alternative management strategies. Recent developments in geographic information systems (GIS) provide techniques for handling large amounts of spatial data for modeling nonpoint-source pollution problems. Because a GIS can be used to combine information from several sources to form an array of model input data and to examine any combinations ofmore » spatial input/output data, it represents a highly effective tool for HiWQ modeling. This paper describes the integration of a distributed-parameter model (AGNPS) with a GIS (ARC/INFO) to examine nonpoint sources of pollution in an agricultural watershed. The ARC/INFO GIS provided the tools to generate and spatially organize the disparate data to support modeling, while the AGNPS model was used to predict several water quality variables including soil erosion and sedimentation within a watershed. The integrated system was used to evaluate the effectiveness of several alternative management strategies in reducing sediment pollution in a 417-ha watershed located in southern Iowa. The implementation of vegetative filter strips and contour buffer (grass) strips resulted in a 41 and 47% reduction in sediment yield at the watershed outlet, respectively. In addition, when the integrated system was used, the combination of the above management strategies resulted in a 71% reduction in sediment yield. In general, the study demonstrated the utility of integrating a simulation model with GIS for nonpoini-source pollution control and planning. Such techniques can help characterize the diffuse sources of pollution at the landscape level. 52 refs., 6 figs., 1 tab.« less

Implementation of efficient irrigation management for a sustainable agriculture. LIFE+ project IRRIMAN

NASA Astrophysics Data System (ADS)

Pérez-Pastor, Alejandro; Garcia-Vila, Margarita; Gamero-Ojeda, Pedro; Ascensión Carmona, M.°; Hernandez, David; José Alarcón, Juan; Nicolás, Emilio; Nortes, Pedro; Aroca, Antonio; María de la Rosa, Jose; Zornoza, Raúl; Faz, Ángel; Molina, Angel; Torres, Roque; Ruiz, Manuel; Calatrava, Javier

2016-04-01

In water scarcity areas, it must be highlighted that the maximum productions of the crops do not necessarily imply maximum profitability. Therefore, during the last years a special interest in the development of deficit irrigation strategies based on significant reductions of the seasonal ET without affecting production or quality has been observed. The strategies of regulated deficit irrigation (RDI) are based on the reduction of water supply during non critical periods, the covering of water needs during critical periods and maximizing, at the same time, the production by unit of applied water. But its success greatly depends on the adequate application of the water deficit and requires a continuous and precise control of the plant and soil water status to adjust the water supplies at every crop phenological period. The main objective of this project is to implement, demonstrate and disseminate a sustainable irrigation strategy based on deficit irrigation to promote its large scale acceptance and use in woody crops in Mediterranean agroecosystems, characterized by water scarcity, without affecting the quality standards demanded by exportation markets. With the adoption of this irrigation management we mean to ensure efficient use of water resources, improving quantitative water management, preserving high level of water quality and avoiding misuse and deterioration of water resources. The adoption of efficient irrigation will also lead to increments in water productivity, increments in the potential carbon fixation of the agroecosystem, and decrease energy costs of pressurized irrigation, together with mitigation and adaptation to climate change. The project will achieve the general objective by implication of farmers, irrigation communities, agronomists, industry, consultants, associations and public administration, by increments in social awareness for sustainable irrigation benefits, optimization of irrigation scheduling, improvements in technology, and dissemination of sustainable irrigation guidelines. Acknowledgements This work has been funded by the European Union LIFE+ project IRRIMAN (LIFE13 ENV/ES/000539).

Climate change mitigation for agriculture: water quality benefits and costs.

PubMed

Wilcock, Robert; Elliott, Sandy; Hudson, Neale; Parkyn, Stephanie; Quinn, John

2008-01-01

New Zealand is unique in that half of its national greenhouse gas (GHG) inventory derives from agriculture--predominantly as methane (CH4) and nitrous oxide (N2O), in a 2:1 ratio. The remaining GHG emissions predominantly comprise carbon dioxide (CO2) deriving from energy and industry sources. Proposed strategies to mitigate emissions of CH4 and N2O from pastoral agriculture in New Zealand are: (1) utilising extensive and riparian afforestation of pasture to achieve CO2 uptake (carbon sequestration); (2) management of nitrogen through budgeting and/or the use of nitrification inhibitors, and minimizing soil anoxia to reduce N2O emissions; and (3) utilisation of alternative waste treatment technologies to minimise emissions of CH4. These mitigation measures have associated co-benefits and co-costs (disadvantages) for rivers, streams and lakes because they affect land use, runoff loads, and receiving water and habitat quality. Extensive afforestation results in lower specific yields (exports) of nitrogen (N), phosphorus (P), suspended sediment (SS) and faecal matter and also has benefits for stream habitat quality by improving stream temperature, dissolved oxygen and pH regimes through greater shading, and the supply of woody debris and terrestrial food resources. Riparian afforestation does not achieve the same reductions in exports as extensive afforestation but can achieve reductions in concentrations of N, P, SS and faecal organisms. Extensive afforestation of pasture leads to reduced water yields and stream flows. Both afforestation measures produce intermittent disturbances to waterways during forestry operations (logging and thinning), resulting in sediment release from channel re-stabilisation and localised flooding, including formation of debris dams at culverts. Soil and fertiliser management benefits aquatic ecosystems by reducing N exports but the use of nitrification inhibitors, viz. dicyandiamide (DCD), to achieve this may under some circumstances impair wetland function to intercept and remove nitrate from drainage water, or even add to the overall N loading to waterways. DCD is water soluble and degrades rapidly in warm soil conditions. The recommended application rate of 10 kg DCD/ha corresponds to 6 kg N/ha and may be exceeded in warm climates. Of the N2O produced by agricultural systems, approximately 30% is emitted from indirect sources, which are waterways draining agriculture. It is important therefore to focus strategies for managing N inputs to agricultural systems generally to reduce inputs to wetlands and streams where these might be reduced to N2O. Waste management options include utilizing the CH4 resource produced in farm waste treatment ponds as a source of energy, with conversion to CO2 via combustion achieving a 21-fold reduction in GHG emissions. Both of these have co-benefits for waterways as a result of reduced loadings. A conceptual model derived showing the linkages between key land management practices for greenhouse gas mitigation and key waterway values and ecosystem attributes is derived to aid resource managers making decisions affecting waterways and atmospheric GHG emissions. Copyright (c) IWA Publishing 2008.

Taguchi's off line method and Multivariate loss function approach for quality management and optimization of process parameters -A review

NASA Astrophysics Data System (ADS)

Bharti, P. K.; Khan, M. I.; Singh, Harbinder

2010-10-01

Off-line quality control is considered to be an effective approach to improve product quality at a relatively low cost. The Taguchi method is one of the conventional approaches for this purpose. Through this approach, engineers can determine a feasible combination of design parameters such that the variability of a product's response can be reduced and the mean is close to the desired target. The traditional Taguchi method was focused on ensuring good performance at the parameter design stage with one quality characteristic, but most products and processes have multiple quality characteristics. The optimal parameter design minimizes the total quality loss for multiple quality characteristics. Several studies have presented approaches addressing multiple quality characteristics. Most of these papers were concerned with maximizing the parameter combination of signal to noise (SN) ratios. The results reveal the advantages of this approach are that the optimal parameter design is the same as the traditional Taguchi method for the single quality characteristic; the optimal design maximizes the amount of reduction of total quality loss for multiple quality characteristics. This paper presents a literature review on solving multi-response problems in the Taguchi method and its successful implementation in various industries.

23 CFR 450.320 - Congestion management process in transportation management areas.

Code of Federal Regulations, 2010 CFR

2010-04-01

... travel demand reduction and operational management strategies. (b) The development of a congestion... appropriate analysis of reasonable (including multimodal) travel demand reduction and operational management... the analysis demonstrates that travel demand reduction and operational management strategies cannot...

Towards knowledge-based systems in clinical practice: development of an integrated clinical information and knowledge management support system.

PubMed

Kalogeropoulos, Dimitris A; Carson, Ewart R; Collinson, Paul O

2003-09-01

Given that clinicians presented with identical clinical information will act in different ways, there is a need to introduce into routine clinical practice methods and tools to support the scientific homogeneity and accountability of healthcare decisions and actions. The benefits expected from such action include an overall reduction in cost, improved quality of care, patient and public opinion satisfaction. Computer-based medical data processing has yielded methods and tools for managing the task away from the hospital management level and closer to the desired disease and patient management level. To this end, advanced applications of information and disease process modelling technologies have already demonstrated an ability to significantly augment clinical decision making as a by-product. The wide-spread acceptance of evidence-based medicine as the basis of cost-conscious and concurrently quality-wise accountable clinical practice suffices as evidence supporting this claim. Electronic libraries are one-step towards an online status of this key health-care delivery quality control environment. Nonetheless, to date, the underlying information and knowledge management technologies have failed to be integrated into any form of pragmatic or marketable online and real-time clinical decision making tool. One of the main obstacles that needs to be overcome is the development of systems that treat both information and knowledge as clinical objects with same modelling requirements. This paper describes the development of such a system in the form of an intelligent clinical information management system: a system which at the most fundamental level of clinical decision support facilitates both the organised acquisition of clinical information and knowledge and provides a test-bed for the development and evaluation of knowledge-based decision support functions.

Dietary quality changes in response to a sugar-sweetened beverage-reduction intervention: results from the Talking Health randomized controlled clinical trial.

PubMed

Hedrick, Valisa E; Davy, Brenda M; You, Wen; Porter, Kathleen J; Estabrooks, Paul A; Zoellner, Jamie M

2017-04-01

Background: The reduction of sugar-sweetened beverage (SSB) intake may be beneficial for weight management and other related health conditions; however, to our knowledge, no data exist regarding the spontaneous changes in other dietary components or the overall dietary quality after an SSB-reduction intervention. Objectives: We explored longitudinal changes within and between an SSB-reduction intervention (SIPsmartER) and a physical activity intervention (MoveMore) with respect to spontaneous changes in 1 ) energy intake and macronutrients and micronutrients, 2 ) dietary quality [Healthy Eating Index-2010 (HEI)], and 3 ) beverage categories. Design: Participants were enrolled in a 6-mo, community-based behavioral trial and randomly assigned into either the SIPsmartER ( n = 149) intervention group or the MoveMore ( n = 143) matched-contact comparison group. Dietary intake was assessed through a mean of three 24-h dietary recalls at baseline and 6 mo. Dietary recalls were analyzed with the use of nutritional analysis software. A multilevel, mixed-effects linear regression with intention-to-treat analyses is presented. Results: SIPsmartER participants showed a significant reduction in total SSBs (mean decrease: -366 mL; P ≤ 0.001). Several spontaneous changes occurred within the SIPsmartER group and, compared with the MoveMore group, included significant HEI improvements for empty calorie, total vegetable, and total HEI scores (mean increases: 2.6, 0.3, and 2.6, respectively; all P ≤ 0.01). Additional positive changes were shown, including significant decreases in total energy intake, trans fat, added sugars, and total beverage energy (all P ≤ 0.05). Few dietary changes were noted in the MoveMore group over the 6-mo intervention. Conclusions: Intervention of the single dietary component SSB resulted in additional spontaneous and beneficial dietary changes. Interventions that target a single dietary change, such as limiting SSB intake to <240 mL/d (<8 fl oz/d), may improve the overall dietary quality health and provide motivation to make additional dietary changes. This trial was registered at clinicaltrials.gov as NCT02193009. © 2017 American Society for Nutrition.

Global health benefits of mitigating ozone pollution with methane emission controls.

PubMed

West, J Jason; Fiore, Arlene M; Horowitz, Larry W; Mauzerall, Denise L

2006-03-14

Methane (CH(4)) contributes to the growing global background concentration of tropospheric ozone (O(3)), an air pollutant associated with premature mortality. Methane and ozone are also important greenhouse gases. Reducing methane emissions therefore decreases surface ozone everywhere while slowing climate warming, but although methane mitigation has been considered to address climate change, it has not for air quality. Here we show that global decreases in surface ozone concentrations, due to methane mitigation, result in substantial and widespread decreases in premature human mortality. Reducing global anthropogenic methane emissions by 20% beginning in 2010 would decrease the average daily maximum 8-h surface ozone by approximately 1 part per billion by volume globally. By using epidemiologic ozone-mortality relationships, this ozone reduction is estimated to prevent approximately 30,000 premature all-cause mortalities globally in 2030, and approximately 370,000 between 2010 and 2030. If only cardiovascular and respiratory mortalities are considered, approximately 17,000 global mortalities can be avoided in 2030. The marginal cost-effectiveness of this 20% methane reduction is estimated to be approximately 420,000 US dollars per avoided mortality. If avoided mortalities are valued at 1 US dollars million each, the benefit is approximately 240 US dollars per tone of CH(4) ( approximately 12 US dollars per tone of CO(2) equivalent), which exceeds the marginal cost of the methane reduction. These estimated air pollution ancillary benefits of climate-motivated methane emission reductions are comparable with those estimated previously for CO(2). Methane mitigation offers a unique opportunity to improve air quality globally and can be a cost-effective component of international ozone management, bringing multiple benefits for air quality, public health, agriculture, climate, and energy.

Nitrate and phosphorus transport through subsurface drains under free and controlled drainage.

PubMed

Saadat, Samaneh; Bowling, Laura; Frankenberger, Jane; Kladivko, Eileen

2018-05-28

Controlled drainage (CD) is a structural conservation practice in which the drainage outlet is managed in order to reduce drain flow volume and nutrient loads to water bodies. The goal of this study was to evaluate the potential of CD to improve water quality for two different seasons and levels of outlet control, using ten years of data collected from an agricultural drained field in eastern Indiana with two sets of paired plots. The Rank Sum test was used to quantify the impact of CD on cumulative annual drain flow and nitrate-N and phosphorus loads. CD plots had a statistically significant (at 5% level) lower annual drain flow (eastern pair: 39%; western pair: 25%) and nitrate load (eastern pair: 43%; western pair: 26%) compared to free draining (FD) plots, while annual soluble reactive phosphorus (SRP) and total phosphorus (TP) loads were not significantly different. An ANCOVA model was used to evaluate the impact of CD on daily drain flow, nitrate-N, SRP and TP concentrations and loads during the two different periods of control. The average percent reduction of daily drain flow was 68% in the eastern pair and 58% in the western pair during controlled drainage at the higher outlet level (winter) and 64% and 58% at the lower outlet level (summer) in the eastern and western pairs, respectively. Nitrate load reduction was similar to drain flow reduction, while the effect of CD on SRP and TP loads was not significant except for the increase in SRP in one pair. These results from a decade-long field monitoring and two different statistical methods enhance our knowledge about water quality impacts of CD system and support this management practice as a reliable system for reducing nitrate loss through subsurface drains, mainly caused by flow reduction. Copyright © 2018 Elsevier Ltd. All rights reserved.

Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal.

PubMed

Naidoo, Logandran; Mahomed, Ozayr H

2016-07-26

Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. The study was conducted at the Catherine Booth Hospital (CBH) - a rural district hospital in KwaZulu-Natal, South Africa. This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators.

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review.

PubMed

Jack, Helen E; Arabadjis, Sophia D; Sun, Lucy; Sullivan, Erin E; Phillips, Russell S

2017-03-01

As the US transitions to value-based healthcare, physicians and payers are incentivized to change healthcare delivery to improve quality of care while controlling costs. By assisting with the management of common chronic conditions, community health workers (CHWs) may improve healthcare quality, but physicians and payers who are making choices about care delivery also need to understand their effects on healthcare spending. We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycINFO, Embase, and Web of Science from the inception of each database to 22 June 2015. We included US-based studies that evaluated a CHW intervention for patients with at least one chronic health condition and reported cost or healthcare utilization outcomes. We evaluated studies using tools specific to study design. Our search yielded 2,941 studies after removing duplicates. Thirty-four met inclusion and methodological criteria. Sixteen studies (47%) were randomized controlled trials (RCTs). RCTs typically had less positive outcomes than other study designs. Of the 16 RCTs, 12 reported utilization outcomes, of which 5 showed a significant reduction in one or more of ED visits, hospitalizations and/or urgent care visits. Significant reductions reported in ED visits ranged from 23%-51% and in hospitalizations ranged from 21%-50%, and the one significant reduction in urgent care visits was recorded at 60% (p < 0.05 for all). Our results suggest that CHW interventions have variable effects, but some may reduce costs and preventable utilization. These findings suggest that it is possible to achieve reductions in care utilization and cost savings by integrating CHWs into chronic care management. However, variations in cost and utilization outcomes suggest that CHWs alone do not make an intervention successful. The paucity of rigorous studies and heterogeneity of study designs limited conclusions about factors associated with reduced utilization.

Factors associated with positive outcomes in 131 patients treated with gauze-based negative pressure wound therapy.

PubMed

Dunn, Raymond; Hurd, Theresa; Chadwick, P; Cote, Julien; Cockwill, John; Mole, Trevor; Smith, Jennifer

2011-01-01

Negative Pressure Wound Therapy (NPWT) is commonly used in many surgical specialties to improve wound management and healing outcomes. This study reports the ability of gauze-based NPWT to address several treatment goals commonly defined at the onset of therapy. A prospective, multi-center, non-comparative clinical investigation was carried out using gauze-based NPWT in chronic and acute wounds. 131 patients including traumatic, post-surgical and chronic wounds were assessed. Weekly percentage reductions in wound area, depth and volume were 8.3%, 15.8% and 20.5% respectively (p < 0.001). A reduction in exudate level was observed from baseline to treatment discontinuation (p < 0.001). An increase (p = 0.007) in red granulation tissue and a decrease (p < 0.001) in non-viable tissue was observed. Baseline wound characteristics associated with slower rates of progress included chronic wound aetiologies, longer wound duration prior to NPWT and presence of diabetes as a co-morbidity. Important indicators of wounds which had improved sufficiently and no longer required NPWT included reduction in volume and exudate levels. Gauze-based NPWT can be used to address many of the treatment goals commonly defined at the onset of therapy including reduction in wound volume, management of exudate and infection status, and improvement in wound bed quality. Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Promise and problems with supply chain management approaches to health care purchasing.

PubMed

Ford, Eric W; Scanlon, Dennis P

2007-01-01

Double-digit health care inflation, coupled with widespread reports of poor care quality and deadly medical errors, has caused private sector employers to reevaluate their health benefits purchasing strategies, with a focus on supply chain management approaches. In other industries, this strategy has proven to be an effective method for simultaneously reducing costs and increasing quality. This article describes four current applications of supply chain management network methodologies to health care systems and identifies potential ways to improve purchasers' return on investment. In particular, information exchanges, purchase decision, and payment agreement components of integrated supply chains are described. First, visual depictions of the health care supply chain are developed from a purchaser's perspective. Next, five nationwide programs designed to realign incentives and rewards across the health care supply chain are described. Although several nationwide efforts are gaining traction in the marketplace, at this time, no cost reduction and quality improvement program initiative appears to systematically align the entire health care supply chain from providers to purchasers, raising doubt about the ability of supply chain management network techniques to significantly impact the health care marketplace in the short run. Current individual efforts to coordinate the health care supply chain do not act on all of the actors necessary to improve outcomes, promote safety, and control costs. Nevertheless, there are indications that several of the individual efforts are coming together. If national efforts touching on all critical elements can coordinate with purchasers, then the health care supply chain's performance may improve significantly.

The Role of Pulses in the Dietary Management of Diabetes.

PubMed

Ramdath, Dan; Renwick, Simone; Duncan, Alison M

2016-08-01

Pulses are highly nutritious foods that are included as part of Canada's Food Guide to promote healthful eating, and they have established health benefits that can contribute to the dietary management of diabetes. A review of studies that have examined the effects of pulse consumption on health outcomes, integral to the management of diabetes, provides credible evidence for improvements in glycemic control, reduction of blood lipids and regulation of body weight. Results from acute feeding trials suggest that postprandial blood glucose response is significantly attenuated by a single pulse serving of between three-quarters and 1 cup. At lower doses, pulses attenuate postprandial blood glucose response more than similar amounts of starchy foods. Long-term pulse consumption of 5 cups per week appears to result consistently in improvements in glycemic control. There is high-quality evidence that supports a role for pulse consumption in the reduction of risk for cardiovascular disease; this provides a sound rationale for the regular incorporation of pulses at about two-thirds of a cup daily in the management of hyperlipidemia in persons with type 2 diabetes. Pulse consumption can contribute to improving satiety, reducing food intake and regulating body weight, which can reduce obesity risk and, in turn, improve diabetes management. Collectively, available evidence provides very good support for a role of regular pulse consumption in the prevention and management of diabetes. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Advances in pleural disease management including updated procedural coding.

PubMed

Haas, Andrew R; Sterman, Daniel H

2014-08-01

Over 1.5 million pleural effusions occur in the United States every year as a consequence of a variety of inflammatory, infectious, and malignant conditions. Although rarely fatal in isolation, pleural effusions are often a marker of a serious underlying medical condition and contribute to significant patient morbidity, quality-of-life reduction, and mortality. Pleural effusion management centers on pleural fluid drainage to relieve symptoms and to investigate pleural fluid accumulation etiology. Many recent studies have demonstrated important advances in pleural disease management approaches for a variety of pleural fluid etiologies, including malignant pleural effusion, complicated parapneumonic effusion and empyema, and chest tube size. The last decade has seen greater implementation of real-time imaging assistance for pleural effusion management and increasing use of smaller bore percutaneous chest tubes. This article will briefly review recent pleural effusion management literature and update the latest changes in common procedural terminology billing codes as reflected in the changing landscape of imaging use and percutaneous approaches to pleural disease management.

Migraine education improves quality of life in a primary care setting.

PubMed

Smith, Timothy R; Nicholson, Robert A; Banks, James W

2010-04-01

The objective of this study was to evaluate the effectiveness of the Mercy Migraine Management Program (MMMP), an educational program for physicians and patients. The primary outcome was change in headache days from baseline at 3, 6, and 12 months. Secondary outcomes were changes in migraine-related disability and quality of life, worry about headaches, self-efficacy for managing migraines, emergency room (ER) visits for headache, and satisfaction with headache care. Despite progress in the understanding of the pathophysiology of migraine and development of effective therapeutic agents, many practitioners and patients continue to lack the knowledge and skills to effectively manage migraine. Educational efforts have been helpful in improving the quality of care and quality of life for migraine sufferers. However, little work has been performed to evaluate these changes over a longer period of time. Also, there is a paucity of published research evaluating the influence of education about migraine management on cognitive and emotional factors (for example, self-efficacy for managing headaches, worry about headaches). In this open-label, prospective study, 284 individuals with migraine (92% female, mean age = 41.6) participated in the MMMP, an educational and skills-based program. Of the 284 who participated in the program, 228 (80%) provided data about their headache frequency, headache-related disability (as measured by the Headache Impact Test-6 (HIT-6), migraine-specific quality of life (MSQ), worry about headaches, self-efficacy for managing headaches, ER visits for headaches, and satisfaction with care at 4 time points over 12 months (baseline, 3 months, 6 months, 12 months). Overall, 46% (106) of subjects reported a 50% or greater reduction in headache frequency. Over 12 months, patients reported fewer headaches and improvement on the HIT-6 and MSQ (all P < .001). The improvement in headache impact and quality of life was greater among those who had more worry about their headaches at baseline. There were also significant improvements in "worry about headaches,"self-efficacy for managing headaches," and "satisfaction with headache care." The findings demonstrate that patients participating in the MMMP reported improvements in their headache frequency as well as the cognitive and emotional aspects of headache management. This program was especially helpful among those with high amounts of worry about their headaches at the beginning of the program. The findings from this study are impetus for further research that will more clearly evaluate the effects of education and skill development on headache characteristics and the emotional and cognitive factors that influence headache.

76 FR 80362 - Agency Information Collection Activities; Submission to OMB for Review and Approval; Fuel Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-23

...In compliance with the Paperwork Reduction Act (PRA) (44 U.S.C. 3501 et seq.), this notice announces that an Information Collection Request (ICR) has been forwarded to the Office of Management and Budget (OMB) for review and approval. This is a request to renew an existing approved collection. The ICR, which is abstracted below, describes the nature of the information collection and its estimated burden and cost.

Final Environmental Assessment Addressing Aerial Application of Herbicides at Joint Base Charleston-Weapons Station Charleston, South Carolina

DTIC Science & Technology

2013-02-01

areas of JB CHS-WS. However, loblolly pine (Pinus taeda) will be planted where soil conditions are not conducive to sustain longleaf pine populations...more subject to soil erosion. Once forested areas have been planted with seedlings, further reduction of competitive vegetation through mechanical...uses. The soil qualities, growing season, and moisture supply are needed for a well-managed soil to produce a sustained high yield of crops in an

Alternative Outpatient Chemotherapy Scheduling Method to Improve Patient Service Quality and Nurse Satisfaction.

PubMed

Huang, Yu-Li; Bryce, Alan H; Culbertson, Tracy; Connor, Sarah L; Looker, Sherry A; Altman, Kristin M; Collins, James G; Stellner, Winston; McWilliams, Robert R; Moreno-Aspitia, Alvaro; Ailawadhi, Sikander; Mesa, Ruben A

2018-02-01

Optimal scheduling and calendar management in an outpatient chemotherapy unit is a complex process that is driven by a need to focus on safety while accommodating a high degree of variability. Primary constraints are infusion times, staffing resources, chair availability, and unit hours. We undertook a process to analyze our existing management models across multiple practice settings in our health care system, then developed a model to optimize safety and efficiency. The model was tested in one of the community chemotherapy units. We assessed staffing violations as measured by nurse-to-patient ratios throughout the workday and at key points during treatment. Staffing violations were tracked before and after the implementation of the new model. The new model reduced staffing violations by nearly 50% and required fewer chairs to treat the same number of patients for the selected clinic day. Actual implementation results indicated that the new model leveled the distribution of patients across the workday with an 18% reduction in maximum chair utilization and a 27% reduction in staffing violations. Subsequently, a positive impact on peak pharmacy workload reduced delays by as much as 35 minutes. Nursing staff satisfaction with the new model was positive. We conclude that the proposed optimization approach with regard to nursing resource assignment and workload balance throughout a day effectively improves patient service quality and staff satisfaction.

Impact of policy on greenhouse gas emissions and economics of biodiesel production.

PubMed

Olivetti, Elsa; Gülşen, Ece; Malça, João; Castanheira, Erica; Freire, Fausto; Dias, Luis; Kirchain, Randolph

2014-07-01

As an alternative transportation fuel to petrodiesel, biodiesel has been promoted within national energy portfolio targets across the world. Early estimations of low lifecycle greenhouse gas (GHG) emissions of biodiesel were a driver behind extensive government support in the form of financial incentives for the industry. However, studies consistently report a high degree of uncertainty in these emissions estimates, raising questions concerning the carbon benefits of biodiesel. Furthermore, the implications of feedstock blending on GHG emissions uncertainty have not been explicitly addressed despite broad practice by the industry to meet fuel quality standards and to control costs. This work investigated the impact of feedstock blending on the characteristics of biodiesel by using a chance-constrained (CC) blend optimization method. The objective of the optimization is minimization of feedstock costs subject to fuel standards and emissions constraints. Results indicate that blending can be used to manage GHG emissions uncertainty characteristics of biodiesel, and to achieve cost reductions through feedstock diversification. Simulations suggest that emissions control policies that restrict the use of certain feedstocks based on their GHG estimates overlook blending practices and benefits, increasing the cost of biodiesel. In contrast, emissions control policies which recognize the multifeedstock nature of biodiesel provide producers with feedstock selection flexibility, enabling them to manage their blend portfolios cost effectively, potentially without compromising fuel quality or emissions reductions.

Canadian Medicare: prognosis guarded.

PubMed

Naylor, C D; Fooks, C; Williams, J I

1995-08-01

Beset by unprecedented fiscal pressures, Canadian medicare has reached a crossroads. The authors review the impact of recent cuts in federal transfer payments on provincial health care programs and offer seven suggestions to policymakers trying to accommodate these reductions. (1) Go slowly: public health care spending is no longer rising and few provinces have the necessary systems in place to manage major reductions. (2) Target reductions, rewarding quality and efficiency instead of making across-the-board cuts. (3) Replace blame with praise:give health care professionals and institutions credit for their contributions. (4) Learn from the successful programs and policies already in place across the country. (5) Foster horizontal and vertical integration of services. (6) Promote physician leadership by rewarding efforts to promote the efficient use of resources. (7) Monitor the effects of cutbacks: physician groups should cooperate with government in maintaining a national "report card" on services, costs and the health status of Canadians.

A Systems Engineering Approach to Quality Assurance for Aerospace Testing

NASA Technical Reports Server (NTRS)

Shepherd, Christena C.

2015-01-01

On the surface, it appears that AS91001 has little to say about how to apply a Quality Management System (QMS) to major aerospace test programs (or even smaller ones). It also appears that there is little in the quality engineering Body of Knowledge (BOK)2 that applies to testing, unless it is nondestructive examination (NDE), or some type of lab or bench testing associated with the manufacturing process. However, if one examines: a) how the systems engineering (SE) processes are implemented throughout a test program; and b) how these SE processes can be mapped to the requirements of AS9100, a number of areas for involvement of the quality professional are revealed. What often happens is that quality assurance during a test program is limited to inspections of the test article; what could be considered a manufacturing al fresco approach. This limits the quality professional and is a disservice to the programs and projects, since there are a number of ways that quality can enhance critical processes, and support efforts to improve risk reduction, efficiency and effectiveness.

Development of a method for comprehensive water quality forecasting and its application in Miyun reservoir of Beijing, China.

PubMed

Zhang, Lei; Zou, Zhihong; Shan, Wei

2017-06-01

Water quality forecasting is an essential part of water resource management. Spatiotemporal variations of water quality and their inherent constraints make it very complex. This study explored a data-based method for short-term water quality forecasting. Prediction of water quality indicators including dissolved oxygen, chemical oxygen demand by KMnO 4 and ammonia nitrogen using support vector machine was taken as inputs of the particle swarm algorithm based optimal wavelet neural network to forecast the whole status index of water quality. Gubeikou monitoring section of Miyun reservoir in Beijing, China was taken as the study case to examine effectiveness of this approach. The experiment results also revealed that the proposed model has advantages of stability and time reduction in comparison with other data-driven models including traditional BP neural network model, wavelet neural network model and Gradient Boosting Decision Tree model. It can be used as an effective approach to perform short-term comprehensive water quality prediction. Copyright © 2016. Published by Elsevier B.V.

Impacts of soil conditioners and water table management on phosphorus loss in tile drainage from a clay loam soil.

PubMed

Zhang, T Q; Tan, C S; Zheng, Z M; Welacky, T W; Reynolds, W D

2015-03-01

Adoption of waste-derived soil conditioners and refined water management can improve soil physical quality and crop productivity of fine-textured soils. However, the impacts of these practices on water quality must be assessed to ensure environmental sustainability. We conducted a study to determine phosphorus (P) loss in tile drainage as affected by two types of soil conditioners (yard waste compost and swine manure compost) and water table management (free drainage and controlled drainage with subirrigation) in a clay loam soil under corn-soybean rotation in a 4-yr period from 1999 to 2003. Tile drainage flows were monitored and sampled on a year-round continuous basis using on-site auto-sampling systems. Water samples were analyzed for dissolved reactive P (DRP), particulate P (PP), and total P (TP). Substantially greater concentrations and losses of DRP, PP, and TP occurred with swine manure compost than with control and yard waste compost regardless of water table management. Compared with free drainage, controlled drainage with subirrigation was an effective way to reduce annual and cumulative losses of DRP, PP, and TP in tile drainage through reductions in flow volume and P concentration with control and yard waste compost but not with swine manure compost. Both DRP and TP concentrations in tile drainage were well above the water quality guideline for P, affirming that subsurface loss of P from fine-textured soils can be one critical source for freshwater eutrophication. Swine manure compost applied as a soil conditioner must be optimized by taking water quality impacts into consideration. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Specialized nursing practice for chronic disease management in the primary care setting: an evidence-based analysis.

PubMed

2013-01-01

In response to the increasing demand for better chronic disease management and improved health care efficiency in Ontario, nursing roles have expanded in the primary health care setting. To determine the effectiveness of specialized nurses who have a clinical role in patient care in optimizing chronic disease management among adults in the primary health care setting. A literature search was performed using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database. Results were limited to randomized controlled trials and systematic reviews and were divided into 2 models: Model 1 (nurse alone versus physician alone) and Model 2 (nurse and physician versus physician alone). Effectiveness was determined by comparable outcomes between groups in Model 1, or improved outcomes or efficiency in Model 2. Six studies were included. In Model 1, there were no significant differences in health resource use, disease-specific measures, quality of life, or patient satisfaction. In Model 2, there was a reduction in hospitalizations and improved management of blood pressure and lipids among patients with coronary artery disease. Among patients with diabetes, there was a reduction in hemoglobin A1c but no difference in other disease-specific measures. There was a trend toward improved process measures, including medication prescribing and clinical assessments. Results related to quality of life were inconsistent, but patient satisfaction with the nurse-physician team was improved. Overall, there were more and longer visits to the nurse, and physician workload did not change. There was heterogeneity across patient populations, and in the titles, roles, and scope of practice of the specialized nurses. Specialized nurses with an autonomous role in patient care had comparable outcomes to physicians alone (Model 1) based on moderate quality evidence, with consistent results among a subgroup analysis of patients with diabetes based on low quality evidence. Model 2 showed an overall improvement in appropriate process measures, disease-specific measures, and patient satisfaction based on low to moderate quality evidence. There was low quality evidence that nurses working under Model 2 may reduce hospitalizations for patients with coronary artery disease. The specific role of the nurse in supplementing or substituting physician care was unclear, making it difficult to determine the impact on efficiency. Nurses with additional skills, training, or scope of practice may help improve the primary care of patients with chronic diseases. This review found that specialized nurses working on their own could achieve health outcomes that were similar to those of doctors. It also found that specialized nurses who worked with doctors could reduce hospital visits and improve certain patient outcomes related to diabetes, coronary artery disease, or heart failure. Patients who had nurse-led care were more satisfied and tended to receive more tests and medications. It is unclear whether specialized nurses improve quality of life or doctor workload.

Recentralization within decentralization: County hospital autonomy under devolution in Kenya

PubMed Central

Manyara, Anthony M.; Molyneux, Sassy; Tsofa, Benjamin

2017-01-01

Background In 2013, Kenya transitioned into a devolved system of government with a central government and 47 semi-autonomous county governments. In this paper, we report early experiences of devolution in the Kenyan health sector, with a focus on public county hospitals. Specifically, we examine changes in hospital autonomy as a result of devolution, and how these have affected hospital functioning. Methods We used a qualitative case study approach to examine the level of autonomy that hospitals had over key management functions and how this had affected hospital functioning in three county hospitals in coastal Kenya. We collected data by in-depth interviews of county health managers and hospital managers in the case study hospitals (n = 21). We adopted the framework proposed by Chawla et al (1995) to examine the autonomy that hospitals had over five management domains (strategic management, finance, procurement, human resource, and administration), and how these influenced hospital functioning. Findings Devolution had resulted in a substantial reduction in the autonomy of county hospitals over the five key functions examined. This resulted in weakened hospital management and leadership, reduced community participation in hospital affairs, compromised quality of services, reduced motivation among hospital staff, non-alignment of county and hospital priorities, staff insubordination, and compromised quality of care. Conclusion Increasing the autonomy of county hospitals in Kenya will improve their functioning. County governments should develop legislation that give hospitals greater control over resources and key management functions. PMID:28771558

Water quality, hydrology, and the effects of changes in phosphorus loading to Pike Lake, Washington County, Wisconsin, with special emphasis on inlet-to-outlet short-circuiting

USGS Publications Warehouse

Rose, William J.; Robertson, Dale M.; Mergener, Elizabeth A.

2004-01-01

Simulations using water-quality models within the Wisconsin Lake Model Suite (WiLMS) indicated Pike Lake's response to 13 different phosphorus-loading scenarios. These scenarios included a base 'normal' year (2000) for which lake water quality and loading were known, six different percentage increases or decreases in phosphorus loading from controllable sources, and six different loading scenarios corresponding to specific management actions. Model simulations indicate that a 50-percent reduction in controllable loading sources would be needed to achieve a mesotrophic classification with respect to phosphorus, chlorophyll a, and Secchi depth (an index of water clarity). Model simulations indicated that short-circuiting of phosphorus from the inlet to the outlet was the main reason the water quality of the lake is good relative to the amount of loading from the Rubicon River and that changes in the percentage of inlet-to-outlet short-circuiting have a significant influence on the water quality of the lake.

Defining quality health care with outcomes assessment while achieving economic value.

PubMed

Shaw, L J; Miller, D D

2000-02-01

The effectiveness of a procedure is increasingly guided by the evaluation of patient outcomes. Outcomes data is used to develop clinical pathways of care and to define appropriate resource-use levels without sacrificing quality of care. Integration of the economic implications of medical services into an outcome-based guideline allows for the development of disease-management strategies. In cardiovascular medicine, risk reduction is associated with high cost due to the "pay-back" of new technologies and therapies. A major challenge is to define a balance between "high tech" care and cost. This paper devises an outpatient evidence-based guideline using clinical and economic outcomes data for the diagnosis of coronary disease.

Effects of 1992 farming systems on ground-water quality at the management systems evaluation area near Princeton, Minnesota

USGS Publications Warehouse

Delin, G.N.; Landon, M.K.; Lamb, J.A.; Dowdy, R.H.

1995-01-01

Results indicate that the effects of the 1992 potassium-chloride and N fertilizer applications were reduced compared to the effects of 1991 applications. The most important factors associated with these differences were lower chemical application rates and lower recharge rates during 1992 than during 1991. Some of the chloride and N fertilizer applied to the cropped areas in 1992 likely did not reach the saturated zone in 1993 due to a 60-percent reduction in recharge compared to 1991. Therefore, analysis of data from additional years will be required to fully evaluate the effects of the fanning systems on ground-water quality.

Efficient Management of Fruit Pests by Pheromone Nanogels

PubMed Central

Bhagat, Deepa; Samanta, Suman K.; Bhattacharya, Santanu

2013-01-01

Environment-friendly management of fruit flies involving pheromones is useful in reducing the undesirable pest populations responsible for decreasing the yield and the crop quality. A nanogel has been prepared from a pheromone, methyl eugenol (ME) using a low-molecular mass gelator. This was very stable at open ambient conditions and slowed down the evaporation of pheromone significantly. This enabled its easy handling and transportation without refrigeration, and reduction in the frequency of pheromone recharging in the orchard. Notably the involvement of the nano-gelled pheromone brought about an effective management of Bactrocera dorsalis, a prevalent harmful pest for a number of fruits including guava. Thus a simple, practical and low cost green chemical approach is developed that has a significant potential for crop protection, long lasting residual activity, excellent efficacy and favorable safety profiles. This makes the present invention well-suited for pest management in a variety of crops. PMID:23416455

Estimation of runoff and sediment yield in the Redrock Creek watershed using AnnAGNPS and GIS

USGS Publications Warehouse

Tsou, Ming‐shu; Zhan, X.-Y.

2004-01-01

Sediment has been identified as a significant threat to water quality and channel clogging that in turn may lead to river flooding. With the increasing awareness of the impairment from sediment to water bodies in a watershed, identifying the locations of the major sediment sources and reducing the sediment through management practices will be important for an effective watershed management. The annualized agricultural non-point source pollution (AnnAGNPS) model and newly developed GIS interface for it were applied in a small agricultural watershed, Redrock Creek watershed, Kansas, in this pilot study for exploring the effectiveness of using this model as a management tool. The calibrated model appropriately simulated monthly runoff and sediment yield through the practices in this study and potentially suggested the ways of sediment reduction through evaluating the changes of land use and field operation in the model for the purpose of watershed management.

Assessing Receiving Water Quality Impacts due to Flow Path Alteration in Residential Catchments, using the Stormwater and Wastewater Management Model

NASA Astrophysics Data System (ADS)

Wolosoff, S. E.; Duncan, J.; Endreny, T.

2001-05-01

The Croton water supply system, responsible for supplying approximately 10% of New York City's water, provides an opportunity for exploration into the impacts of significant terrestrial flow path alteration upon receiving water quality. Natural flow paths are altered during residential development in order to allow for construction at a given location, reductions in water table elevation in low lying areas and to provide drainage of increased overland flow volumes. Runoff conducted through an artificial drainage system, is prevented from being attenuated by the natural environment, thus the pollutant removal capacity inherent in most natural catchments is often limited to areas where flow paths are not altered by development. By contrasting the impacts of flow path alterations in two small catchments in the Croton system, with different densities of residential development, we can begin to identify appropriate limits to the re-routing of runoff in catchments draining into surface water supplies. The Stormwater and Wastewater Management Model (SWMM) will be used as a tool to predict the runoff quantity and quality generated from two small residential catchments and to simulate the potential benefits of changes to the existing drainage system design, which may improve water quality due to longer residence times.

Corporatization as a means of improving water quality: the experience in Victoria, Australia.

PubMed

Martin, Narelle

Factors including fragmentation, a lack of direction, poor accountability, poor water quality, and a sizable state government subsidy contributed to the rural water industry in Victoria, Australia, in 1993. In 1993 the state government set out parameters for reform to change the size, structure, performance, and culture of the water industry. The path taken was not privatization, but corporatization. Tools used included amalgamation of organizations; separating water provisions from local government; changing the composition and reporting mechanisms of the boards; establishing clear benchmarks and performance criteria; making information publicly available; and providing a commercial orientation. The outcomes of the reforms were to be a focus on water quality and effluent management. In 2001, 15 water authorities were in place. There were significant improvements in accountability, finances, and performance. The authorities provided information on performance to both the state and the public. Reductions of operating costs have been in the range of 20-35%, with savings put back into new infrastructure. Water quality has significantly improved in a number of parameters and effluent management has also improved. This paper describes the challenges faced before the reform process, the reforms initiated, and the outcomes. It argues that privatization is not the only path to improvement: Developing a corporate structure and accountability can also deliver substantial improvements.

Committed HSE management Vs TQM: Is there any difference?

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

Aitken, J.D.; McMath, C.R.; Lombardo, G.J.

1996-11-01

Safe performance of oilfield service operations at unfamiliar customer installations requires service personnel that are highly trained and motivated. When such operations are made in over sixty countries with an independent, multi-cultural work force, an additional level of difficulty in achieving an improved level of HSE (Health, Safety & Environment) performance is introduced. Recognizing these challenges, one company set out in 1989 to implement a comprehensive HSE management system suited to this environment. The system, described here, was launched with total commitment and participation of all levels of management and was designed to empower the work force rather than forcemore » them into compliance. This included a realignment of management priorities to give HSE a primary place along with other management responsibilities. One central theme of the system is a single standard applied to all HSE actions, throughout the world and at all levels of the Company. Thus, for example, all employees including all managers go through the same basic HSE training courses on a regular basis. After six years, a cultural change has taken place, along with a notable reduction in both accident frequency and severity, measured in terms of lost workdays. This reduction in lost workdays is an easily quantifiable cost saving which by far outweighs the total cost of the HSE system implementation. While the HSE management system was designed to specifically meet the needs of the company, the techniques used closely parallel those of Total Quality Management (TQM), which, in the last years, has gained momentum as a {open_quotes}new paradigm{close_quotes} in the HSE field. In this company`s experience, a common sense application of sound management to the HSE process has led to a TQM system.« less

Detecting gradual and abrupt changes in water quality time series in response to regional payment programs for watershed services in an agricultural area

NASA Astrophysics Data System (ADS)

He, Tian; Lu, Yan; Cui, Yanping; Luo, Yabo; Wang, Min; Meng, Wei; Zhang, Kaijie; Zhao, Feifei

2015-06-01

Market-based watershed protection instruments can effectively improve water quality at various catchment scales. Two payments for watershed services (PWS) programs for water quality improvement have been successively implemented in the Huai River catchment and its sub-watershed, the Shaying River catchment, in Henan Province since 2009. To detect changes in water quality in response to PWS schemes, nonparametric statistical approaches were used to analyze gradual and abrupt trends in water quality, focusing on chemical oxygen demand (COD) and ammonia-nitrogen (NH3-N) at 26 monitoring stations in the Huai River watershed during 2006-2013. The nonparametric Mann-Kendall test and the Theil-Sen estimator were used to identify trends and their magnitudes in weekly water quality observations and the Pettitt test was applied to change-point analysis of water quality time series. We found decreasing concentration trends in the weekly water quality data set in this catchment, with water quality at most stations affected by the PWS schemes. The COD and NH3-N concentrations decreased at 26 stations by an average of 0.05 mg/L wk and 0.01 mg/L wk, respectively, from 2006 to 2013. Meanwhile, the mean concentrations of COD and NH3-N decreased at the 26 stations by an average of 18.03 mg/L and 4.82 mg/L, respectively, after the abrupt change points of the time-series trends of these two pollutants. We also estimated annual reductions in COD and NH3-N for each station based on average flow observations using the Theil-Sen approach along with the resulting economic benefits from 2009 to 2010. The COD and NH3-N reductions were 14604.50 and 6213.25 t/y, respectively, in the Huai River catchment in Henan Province. The total economic benefits of reductions in these two pollutants were 769.71 million ¥ in 2009 and 2010, accounting for 0.08% and 0.06%, respectively, of the GDP in the entire Huai River watershed of Henan Province. These results provide new insights into the linkages between PWS programs and water quality improvements at regional and local scales for effective management of water resources.

[Study on the optimization of monitoring indicators of drinking water quality during health supervision].

PubMed

Ye, Bixiong; E, Xueli; Zhang, Lan

2015-01-01

To optimize non-regular drinking water quality indices (except Giardia and Cryptosporidium) of urban drinking water. Several methods including drinking water quality exceed the standard, the risk of exceeding standard, the frequency of detecting concentrations below the detection limit, water quality comprehensive index evaluation method, and attribute reduction algorithm of rough set theory were applied, redundancy factor of water quality indicators were eliminated, control factors that play a leading role in drinking water safety were found. Optimization results showed in 62 unconventional water quality monitoring indicators of urban drinking water, 42 water quality indicators could be optimized reduction by comprehensively evaluation combined with attribute reduction of rough set. Optimization of the water quality monitoring indicators and reduction of monitoring indicators and monitoring frequency could ensure the safety of drinking water quality while lowering monitoring costs and reducing monitoring pressure of the sanitation supervision departments.

Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients.

PubMed

Benditz, Achim; Greimel, Felix; Auer, Patrick; Zeman, Florian; Göttermann, Antje; Grifka, Joachim; Meissner, Winfried; von Kunow, Frederik

2016-01-01

The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking. All patients included in the study had undergone total hip arthroplasty (THA). Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project "Quality Improvement in Postoperative Pain Management" (QUIPS). A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward. From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0) on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2). Over time, the maximum pain score decreased (mean 3.0, ±2.0), whereas patient satisfaction significantly increased (mean 9.8, ±0.4; p <0.05). Among 49 anonymized hospitals, our clinic stayed on first rank in terms of lowest maximum pain and patient satisfaction over the period. Results were already acceptable at the beginning of benchmarking a standardized pain management concept. But regular benchmarking, implementation of feedback mechanisms, and staff education made the pain management concept even more successful. Multidisciplinary teamwork and flexibility in adapting processes seem to be highly important for successful pain management.

Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence.

PubMed

Bosch-Capblanch, Xavier; Marceau, Claudine

2014-12-01

To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi-component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming-up of CHW, micro-franchising or social franchising. On-site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers' basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Large, multi-faceted, iCCM programmes, with strong components of training, supervision, which included additional support of equipment and supplies, seemed to improve selected quality of care outcomes. However, current evaluation and reporting practices need to be revised in a new research agenda to address the methodological challenges of iCCM evaluations.

Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence

PubMed Central

Bosch–Capblanch, Xavier; Marceau, Claudine

2014-01-01

Aim To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Methods Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. Results The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi–component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming–up of CHW, micro–franchising or social franchising. On–site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers’ basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Conclusion Large, multi–faceted, iCCM programmes, with strong components of training, supervision, which included additional support of equipment and supplies, seemed to improve selected quality of care outcomes. However, current evaluation and reporting practices need to be revised in a new research agenda to address the methodological challenges of iCCM evaluations. PMID:25520793

Fish consumption as a driver of risk-management decisions and human health-based water quality criteria.

PubMed

Judd, Nancy; Lowney, Yvette; Anderson, Paul; Baird, Suzanne; Bay, Steven M; Breidt, Jay; Buonanduci, Michele; Dong, Zhao; Essig, Don; Garry, Michael R; Jim, Rebecca C; Kirkwood, Gemma; Moore, Shelly; Niemi, Cheryl; O'Rourke, Rory; Ruffle, Betsy; Schaider, Laurel A; Vidal-Dorsch, Doris E

2015-11-01

The use and interpretation of fish consumption surveys and interviews, the application of fish consumption rates for sediment evaluation and cleanup, and the development of human health water quality criteria (HH WQC) are complex and interrelated issues. The present article focuses on these issues using examples from the United States, although the issues may be relevant for other countries. Some key considerations include the fact that there are many types of fish consumption surveys (e.g., 24-h recall surveys, food frequency questionnaires, creel surveys), and these surveys have different advantages and limitations. Identification of target populations for protection, identification of the species and quantities of fish consumed, and determination of bioaccumulation assumptions are important factors when developing water quality and sediment screening levels and standards. Accounting for the cultural importance of fish consumption for some populations is an even more complex element. Discussions about HH WQC often focus only on the fish consumption rate and may not have broad public input. Some states are trying to change this through extensive public participation efforts and use of probabilistic approaches to derive HH WQC. Finally, there are limits to what WQC can achieve. Solutions beyond the establishment of WQC that target toxics reduction from other sources may provide the greatest improvements to water quality and reductions in human health risks in the future. © 2015 SETAC.

Financing radiology graduate medical education: today's challenges.

PubMed

Otero, Hansel J; Ondategui-Parra, Silvia; Erturk, Sukru Mehmet; Ros, Pablo R

2006-03-01

Radiology graduate medical education (GME) is exposed to huge financial challenges. First, there is a continuous increase in demand for imaging services by referring doctors and the general population, aggravating the staff shortage. Second, there has been an important decline in reimbursements. Third and probably most important is the progressive reduction of federal funds subsidizing GME. Medicare is the largest single contributor to GME. The Balanced Budget Act (BBA) of 1997 introduced reductions in Medicare payments to the major teaching hospitals calculated at $5.6 billion over the first 5 years after implementation. The BBA also brought other changes directly affecting GME. Financial changes in health care over the past decade have increased the pressure on academic institutions, which must preserve or improve the quality of training and the quality of care and manage an increased workload with fewer funds available and a narrow margin for errors. Yet the use of new technology promises to help simplify processes, decreasing workloads for residents and faculty members and increasing overall productivity, and new sources of funding have been suggested. By reviewing the financial challenges of radiologic training in today's academic centers, the authors reach the conclusion that there is still space for improving academic quality and the quality of care within current financial boundaries. But more reliable data about the specific benefits and drawbacks of having a residency program in a clinical radiology department are required.

Which offers more scope to suppress river phytoplankton blooms: reducing nutrient pollution or riparian shading?

PubMed

Hutchins, M G; Johnson, A C; Deflandre-Vlandas, A; Comber, S; Posen, P; Boorman, D

2010-10-01

River flow and quality data, including chlorophyll-a as a surrogate for river phytoplankton biomass, were collated for the River Ouse catchment in NE England, which according to established criteria is a largely unpolluted network. Against these data, a daily river quality model (QUESTOR) was setup and successfully tested. Following a review, a river quality classification scheme based on phytoplankton biomass was proposed. Based on climate change predictions the model indicated that a shift from present day oligotrophic/mesotrophic conditions to a mesotrophic/eutrophic system could occur by 2080. Management options were evaluated to mitigate against this predicted decline in quality. Reducing nutrient pollution was found to be less effective at suppressing phytoplankton growth than the less costly option of establishing riparian shading. In the Swale tributary, ongoing efforts to reduce phosphorus loads in sewage treatment works will only reduce peak (95th percentile) phytoplankton by 11%, whereas a reduction of 44% is possible if riparian tree cover is also implemented. Likewise, in the Ure, whilst reducing nitrate loads by curtailing agriculture in the headwaters may bring about a 10% reduction, riparian shading would instead reduce levels by 47%. Such modelling studies are somewhat limited by insufficient field data but offer a potentially very valuable tool to assess the most cost-effective methods of tackling effects of eutrophication. Copyright 2010 Elsevier B.V. All rights reserved.

Colostomy for Perianal Sepsis With Ecthyma Gangrenosum in Immunocompromised Children.

PubMed

Vuille-dit-Bille, Raphael N; Berger, Christoph; Meuli, Martin; Grotzer, Michael A

2016-01-01

Perianal sepsis with ecthyma gangrenosum is a severe and potentially mutilating complication in immunocompromised children. Therapies include antimicrobial treatment, incision and drainage, generous tissue debridement, and skin transplantation. We describe 3 children with acute lymphoblastic leukemia having sepsis with Pseudomonas aeruginosa in febrile neutropenia and severe perianal infections treated relatively early with a protective colostomy. Indications for colostomy were nonhealing wounds, and ceaseless pain. All patients showed a rapid reduction of pain. Complete wound healing was seen in 2 patients, and considerable pain reduction and increased quality of life were seen in a third patient during palliative care. These results suggest that a protective colostomy should be considered early in the management of immunocompromised children with ecthyma gangrenosum.

[Quality control criteria in the surgical management of advanced ovarian cancers].

PubMed

Querleu, D; Narducci, F

2009-12-01

Two concurrent policies can be proposed to improve the quality of care for ovarian cancer surgery: organization of care, audit. The two policies are not to be opposed: the efficacy of any policy must be audited, targets are more rapidly reached and more easily audited when an underlying organization is available. However, the arbitrary definition of criteria is a challenge. The interpretation of results depends on the context of each individual center. There is a definite risk of unwanted effects: competition to reach the cut-off if quantitative caseload criteria are demanded, reduction of the quality of cytoreduction if the complication rate is included, selection of patients if the rate of complete cytoreduction is chosen as a major parameter. Quality control must encompass the standard of preoperative workup, the quality of operative report, the complication rate and the oncological outcome. Although quantitative yearly caseload requirements may contribute to the quality of care, it seems more pertinent to recall the prerequisites that the surgeon must fulfil before undertaking a surgery for ovarian cancer. Knowledge of the specific features of the disease and of all the components of its medical management, skills in general surgical procedures required to complete staging and cytoreduction, and contribution to a multidisciplinary team involved in clinical research are mandatory. Even though no definitive proof is available, the available information tend to show a superiority of the standard of surgical care provided by experienced or specialized surgeons.

Reducing Lake Erie's Harmful Algal Blooms: Projection and Adoption of Management Plans

NASA Astrophysics Data System (ADS)

Martin, J.; Aloysius, N.; Howard, G.; Kalcic, M. M.; Wilson, R. S.; Scavia, D.; Roe, B.

2016-12-01

In early 2016, the United States and Canada formally agreed to reduce phosphorus inputs to Lake Erie by 40% to reduce the severity of annual Harmful Algal Blooms (HABs). These blooms have become more severe, with record events occurring in 2011 and 2015, and have compromised public safety, shut down drinking water supplies, and negatively impacted the economy of the western Lake Erie basin. Now, key questions revolve around the ability to reach the 40% reduction, required management changes, and resources to support these changes. This presentation will highlight interdisciplinary research to compare the amount and types of practices needed for this reduction to the current and projected levels of adoption. Economic resources to support these management changes are also compared with the financial support from the general public to improve Lake Erie water quality. Multiple models of the Maumee watershed identified management plans and adoption rates needed to reach the reduction targets. For example, one successful scenario estimated necessary adoption rates of 50% for subsurface application of fertilizer on row crops, 58% for cover crops, and 78% for buffer strips. Current adoption is below these levels, but future projections based on farmer surveys shows these levels are possible. Public support is necessary to generate the funding to support cost sharing and other programs aimed at increasing adoption of recommended practices. Comparing results from willingness-to-pay surveys of the general public with the estimated need for these management plans shows a gap in resources to support these levels of adoption. In general, these results show that accelerated adoption of management plans is needed compared to past adoption rates, but that these rates are possible based on likely adoption rates. Projected support from the general public indicates it will be challenging to fund these rates of adoption, especially during climate changes that may require even greater adoption. To partially address this challenge, accelerated rates of adoption may be achieved through voluntary means by increasing the perceived efficacy of the practices.

Nutrient loss with runoff from fairway turf: an evaluation of core cultivation practices and their environmental impact.

PubMed

Rice, Pamela J; Horgan, Brian P

2011-11-01

The presence of excess nutrients in surface waters can result in undesirable environmental and economic consequences, including nuisance algal blooms and eutrophication. Fertilizer use in highly managed turf systems has raised questions concerning the contribution of nutrients to surrounding surface waters. Experiments were designed to quantify phosphorus and nitrogen transport with runoff from turf plots maintained as a golf course fairway to identify which cultural practice, solid tine (ST) or hollow tine (HT) core cultivation, maximized phosphorus and nitrogen retention at the site of fertilizer application. Simulated precipitation and collection of resulting runoff were completed 26 ± 13 h following granular fertilizer application (18-3-18: N-P₂O₅-K₂O) and 63 d and 2 d following core cultivation. Runoff volumes were reduced in fairway turf plots aerated with HT relative to ST (63 d: 10%, 2 d: 55% reduction). Analysis of the runoff revealed a reduction in soluble phosphorus, ammonium nitrogen, and nitrate nitrogen losses with runoff from plots managed with HT; a 5 to 27% reduction after 63 d; and a 39 to 77% reduction at 2 d. Golf course runoff-to-surface water scenarios were used to calculate estimated environmental concentrations (EECs) of nitrogen and phosphorus in surface water receiving runoff from turf managed with ST or HT core cultivation. Surface water concentrations of phosphorus remained above the U.S. Environmental Protection Agency's water quality criteria to limit eutrophication, with the exception of concentrations associated with HT core cultivation at 2 d. Regardless of management practice (ST or HT) and time between core cultivation and runoff (63 d or 2 d), all EECs of nitrogen were below levels associated with increased algal growth. Understanding nutrient transport with runoff and identifying strategies that reduce off-site transport will increase their effectiveness at intended sites of application and minimize undesirable effects to surrounding surface water resources. Copyright © 2011 SETAC.

An information based approach to improving overhead imagery collection

NASA Astrophysics Data System (ADS)

Sourwine, Matthew J.; Hintz, Kenneth J.

2011-06-01

Recent growth in commercial imaging satellite development has resulted in a complex and diverse set of systems. To simplify this environment for both customer and vendor, an information based sensor management model was built to integrate tasking and scheduling systems. By establishing a relationship between image quality and information, tasking by NIIRS can be utilized to measure the customer's required information content. Focused on a reduction in uncertainty about a target of interest, the sensor manager finds the best sensors to complete the task given the active suite of imaging sensors' functions. This is done through determination of which satellite will meet customer information and timeliness requirements with low likelihood of interference at the highest rate of return.

Using a fuzzy DEMATEL method for analyzing the factors influencing subcontractors selection

NASA Astrophysics Data System (ADS)

Kozik, Renata

2016-06-01

Subcontracting is a long-standing practice in the construction industry. This form of project organization, if manage properly, could provide the better quality, reduction in project time and costs. Subcontractors selection is a multi-criterion problem and can be determined by many factors. Identifying the importance of each of them as well as the direction of cause-effect relations between various types of factors can improve the management process. Their values could be evaluated on the basis of the available expert opinions with the application of a fuzzy multi-stage grading scale. In this paper it is recommended to use fuzzy DEMATEL method to analyze the relationship between factors affecting subcontractors selection.

Impact of Mindfulness-based Stress Reduction (MBSR) on Depression among Elderly Residing in Residential Homes.

PubMed

Kumar, Sasi; Adiga, Kasturi Ramesh; George, Anice

2014-01-01

Old age is a period when people need physical, emotional, and psychological support. Depression is the most prevalent mental health problem among older adults and it contributes to increase in medical morbidity and mortality, reduces quality of life and elevates health care costs. Therefore early diagnosis and effective management are required to improve the quality of life of older adults suffering from depression. Intervention like Mindfulness based Stress Reduction is a powerful relaxation technique to provide quick way to get rid of depression and negative emotions by increasing mindfulness. The study was undertaken to assess the effectiveness of MBSR on depression among elderly residing in residential homes, Bangalore. In this study, quasi experimental pre-test post-test control group research design was used. There were two groups: experimental and control, each group had 30 samples selected from different residential homes by non-probability convenience sampling technique. Pre-test depression and mindfulness was assessed before the first day of intervention. Experimental group participants were provided intervention on MBSR. Assessment of post-test depression and mindfulness was done at the end of the intervention programme for both group participants. The study revealed significant reduction in depression (p < 0.001) and increase in mindfulness (p < 0.001) among elderly in the experimental group who were subjected to MBSR technique.

Watershed delineation and nitrogen source analysis for Bayou ...

EPA Pesticide Factsheets

Nutrient pollution in stormwater runoff from urbanized areas contributes to water quality degradation in streams and receiving waterbodies. Agriculture, population growth, and industrial activities are significant sources of nitrogen inputs for surface waters. Increased nitrogen loading stimulates eutrophication through algal blooms, which leads to an overall decrease in drinking water and aquatic habitat quality. Bayou Chico, a highly urbanized watershed in the Pensacola Bay system in northwest Florida, is a nutrient-impaired waterbody under management to reduce bacteria and nutrient loadings, in accordance with the Florida Department of Environmental Protection’s (FDEP) Basin Management Action Plan. Best management practices and green infrastructure (GI) throughout Bayou Chico help reduce nitrogen inputs by retaining and filtering water. GI can function as a nitrogen sink by sorption or infiltration into soils, sequestration into plant material, and denitrification through microbial processes. However, a better understanding of the efficiency of these systems is needed to better inform management practices on future nitrogen reduction. This project will address two issues relating to the presence of nitrogen in the Bayou Chico watershed: 1) the identification of specific nitrogen sources within urbanized areas, and 2) the potential rates of nitrogen removal and sequestration from GI and nitrogen transport throughout the bayou. To accomplish these goals, nitr

The role of risk-based prioritization in total quality management

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

Bennett, C.T.

1994-10-01

The climate in which government managers must make decisions grows more complex and uncertain. All stakeholders - the public, industry, and Congress - are demanding greater consciousness, responsibility, and accountability of programs and their budgets. Yet, managerial decisions have become multifaceted, involve greater risk, and operate over much longer time periods. Over the last four or five decades, as policy analysis and decisions became more complex, scientists from psychology, operations research, systems science, and economics have developed a more or less coherent process called decision analysis to aid program management. The process of decision analysis - a systems theoretic approachmore » - provides the backdrop for this paper. The Laboratory Integrated Prioritization System (LIPS) has been developed as a systems analytic and risk-based prioritization tool to aid the management of the Tri-Labs` (Lawrence Livermore, Los Alamos, and Sandia) operating resources. Preliminary analyses of the effects of LIPS has confirmed the practical benefits of decision and systems sciences - the systematic, quantitative reduction in uncertainty. To date, the use of LIPS - and, hence, its value - has been restricted to resource allocation within the Tri-Labs` operations budgets. This report extends the role of risk-based prioritization to the support of DOE Total Quality Management (TQM) programs. Furthermore, this paper will argue for the requirement to institutionalize an evolutionary, decision theoretic approach to the policy analysis of the Department of Energy`s Program Budget.« less

Is the air pollution health research community prepared to support a multipollutant air quality management framework?

PubMed

Mauderly, Joe L; Burnett, Richard T; Castillejos, Margarita; Ozkaynak, Halûk; Samet, Jonathan M; Stieb, David M; Vedal, Sverre; Wyzga, Ronald E

2010-06-01

Ambient air pollution is always encountered as a complex mixture, but past regulatory and research strategies largely focused on single pollutants, pollutant classes, and sources one-at-a-time. There is a trend toward managing air quality in a progressively "multipollutant" manner, with the idealized goal of controlling as many air contaminants as possible in an integrated manner to achieve the greatest total reduction of adverse health and environmental impacts. This commentary considers the current ability of the environmental air pollution exposure and health research communities to provide evidence to inform the development of multipollutant air quality management strategies and assess their effectiveness. The commentary is not a literature review, but a summary of key issues and information gaps, strategies for filling the gaps, and realistic expectations for progress that could be made during the next decade. The greatest need is for researchers and sponsors to address air quality health impacts from a truly multipollutant perspective, and the most limiting current information gap is knowledge of personal exposures of different subpopulations, considering activities and microenvironments. Emphasis is needed on clarifying the roles of a broader range of pollutants and their combinations in a more forward-looking manner; that is not driven by current regulatory structures. Although advances in research tools and outcome data will enhance progress, the greater need is to direct existing capabilities toward strategies aimed at placing into proper context the contributions of multiple pollutants and their combinations to the health burdens, and the relative contributions of pollutants and other factors influencing the same outcomes. The authors conclude that the research community has very limited ability to advise multipollutant air quality management and assess its effectiveness at this time, but that considerable progress can be made in a decade, even at current funding levels, if resources and incentives are shifted appropriately.

Quantification of BMPs Selection and Spatial Placement Impact on Water Quality Controlling Plans in Lower Bear River Watershed, Utah

NASA Astrophysics Data System (ADS)

Salha, A. A.; Stevens, D. K.

2016-12-01

The aim of the watershed-management program in Box Elder County, Utah set by Utah Division of Water Quality (UDEQ) is to evaluate the effectiveness and spatial placement of the implemented best-management practices (BMP) for controlling nonpoint-source contamination at watershed scale. The need to evaluate the performance of BMPs would help future policy and program decisions making as desired end results. The environmental and costs benefits of BMPs in Lower Bear River watershed have seldom been measured beyond field experiments. Yet, implemented practices have rarely been evaluated at the watershed scale where the combined effects of variable soils, climatic conditions, topography and land use/covers and management conditions may significantly change anticipated results and reductions loads. Such evaluation requires distributed watershed models that are necessary for quantifying and reproducing the movement of water, sediments and nutrients. Soil and Water Assessment Tool (SWAT) model is selected as a watershed level tool to identify contaminant nonpoint sources (critical zones) and areas of high pollution risks. Water quality concerns have been documented and are primarily attributed to high phosphorus and total suspended sediment concentrations caused by agricultural and farming practices (required load is 460 kg/day of total phosphorus based on 0.075 mg/l and an average of total suspended solids of 90 mg/l). Input data such as digital elevation model (DEM), land use/Land cover (LULC), soils, and climate data for 10 years (2000-2010) is utilized along with observed water quality at the watershed outlet (USGS) and some discrete monitoring points within the watershed. Statistical and spatial analysis of scenarios of management practices (BMP's) are not implemented (before implementation), during implementation, and after BMP's have been studied to determine whether water quality of the two main water bodies has improved as required by the LBMR watershed's TMDL and if the BMPs are cost-effectively targeting the critical zones.

Agricultural ecosystems - The world is watching

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

Madison, M.F.; Licht, L.A.

1990-02-01

Environmental degradation is displacing nuclear war as the overriding concern of the world's people. An accusing finger is rightfully pointed at agricultural practices - for degrading water, air, food, and societal quality. As reported in the popular and technical press, there is a clamor for farming technology that is both productive and ecological. We cannot survive without a productive agriculture. Yet, the eroding soil, the degrading water quality, the decrease in farm profitability, the reductions in wildlife populations, and the closing store fronts in rural America point to a need for new management approaches. The word sustainable continues to bemore » mentioned as an underlying theme for future management techniques. Soil, air, and water form a seamless whole - the thin envelope we call the biosphere. The term sustainable agriculture implies a nourishing stewardship of the biosphere when used by farmers in pursuit of their livelihood. This biosphere simultaneously produces and sustains a multitude of products, including ourselves. It is all we have to create both our present and our future.« less

Modeling drivers of phosphorus loads in Chesapeake Bay tributaries and inferences about long-term change

USGS Publications Warehouse

Ryberg, Karen R.; Blomquist, Joel; Sprague, Lori A.; Sekellick, Andrew J.; Keisman, Jennifer

2018-01-01

Causal attribution of changes in water quality often consists of correlation, qualitative reasoning, listing references to the work of others, or speculation. To better support statements of attribution for water-quality trends, structural equation modeling was used to model the causal factors of total phosphorus loads in the Chesapeake Bay watershed. By transforming, scaling, and standardizing variables, grouping similar sites, grouping some causal factors into latent variable models, and using methods that correct for assumption violations, we developed a structural equation model to show how causal factors interact to produce total phosphorus loads. Climate (in the form of annual total precipitation and the Palmer Hydrologic Drought Index) and anthropogenic inputs are the major drivers of total phosphorus load in the Chesapeake Bay watershed. Increasing runoff due to natural climate variability is offsetting purposeful management actions that are otherwise decreasing phosphorus loading; consequently, management actions may need to be reexamined to achieve target reductions in the face of climate variability.

Green innovation and sustainable industrial systems within sustainability and company improvement perspective

NASA Astrophysics Data System (ADS)

Edi Nugroho Soebandrija, Khristian

2017-12-01

This paper comprises discussion of Green Innovation and Sustainable Industrial Systems within Sustainability and Company Improvement Perspective of beverage manufacturing company (BMC). The stakeholder theory is the grand theory for the company improvement perspective in this paper. The data processing in this paper is conducted through software which are SEM-PLS with SmartPLS 2.0 and SPSS 19. The specified objective of this paper has focus on sustainability as one of 6 variables, in lieu of those 6 variables as the big picture. The reason behind this focus on sustainability is the fact that there are assorted challenges in sustainability that is ranging from economic, environment and company perspectives. Those challenges in sustainability include the sustainable service supply chain management and its involvement of society. The overall objective is to analyze relationship hypothesis of 6 variables, 4 of them (leadership, organizational learning, innovation, and performance) are based on Malcolm Baldrige’s performance excellence concept to achieve sustainability and competitive advantage through company-competitor and customer questionnaire, and its relation to Total Quality Management (TQM) and Quality Management System (QMS). In conclusion, the spearheaded of company improvement in this paper is in term of consumer satisfaction through 99.997% quality standards. These can be achieved by ambidexterity through exploitation and exploration innovation. Furthermore, in this paper, TQM enables to obtain popularity brand index achievement that is greater than 45.9%. Subsequently, ISO22000 of food security standard encompasses quality standard of ISO9000 and HACCP. Through the ambidexterity of exploitation and exploration (Non Standard Product Inspection) NOSPI machine, the company improvement generates the achievement of 75% automation, 99.997% quality control standard and 80% of waste reduction.

Seasonal Dynamics of River Corridor Exchange Across the Continental United States

NASA Astrophysics Data System (ADS)

Gomez-Velez, J. D.; Harvey, J. W.; Scott, D.; Boyer, E. W.; Schmadel, N. M.

2017-12-01

River corridors store and convey mass and energy from landscapes to the ocean, altering water quality and ecosystem functioning at the local, reach, and watershed scales. As water moves through river corridors from headwaters streams to coastal estuaries, dynamic exchange between the river channel and its adjacent riparian, floodplain, and hyporheic zones, combined with ponded waters such as lakes and reservoirs, results in the emergence of hot spots and moments for biogeochemical transformations. In this work, we used the model Networks with EXchange and Subsurface Storage (NEXSS) to estimate seasonal variations in river corridor exchange fluxes and residence times along the continental United States. Using a simple routing scheme, we translate these estimates into a cumulative measure of river corridor connectivity at the watershed scale, differentiating the contributions of hyporheic zones, floodplains, and ponded waters. We find that the relative role of these exchange subsystems changes seasonally, driven by the intra-seasonal variability of discharge. In addition, we find that seasonal variations in discharge and the biogeochemical potential of hyporheic zones are out of phase. This behavior results in a significant reduction in hyporheic water quality functions during high flows and emphasizes the potential importance of reconnecting floodplains for managing water quality during seasonal high flows. Physical parameterizations of river corridor processes are critical to model and predict water quality and to sustainably manage water resources under present and future socio-economic and climatic conditions. Parsimonious models like NEXSS can play a key role in the design, implementation, and evaluation of sustainable management practices that target both water quantity and quality at the scale of the nation. This research is a product of the John Wesley Powell Center River Corridor Working Group.

Development of an Assessment Tool for Agricultural Best Management Practice Iimplementation in the Great Lakes Restoration Initiative Priority Watersheds—Alger Creek, Tributary to Saginaw River, Michigan

USGS Publications Warehouse

Merriman, Katherine R.

2015-11-19

The Great Lakes face a number of serious challenges that cause damage to water quality, habitat, ecology, and coastal health. Excess nutrients from point and nonpoint sources have a history of causing harmful algal blooms (HABs); since the late 1990s, a resurgence of HABs have forced beach closures and resulted in water quality impairments across the Great Lakes. Studies increasingly point to phosphorus (P) runoff from agricultural lands as the cause of these HABs. In 2010, the Great Lakes Restoration Initiative (GLRI) was launched to revitalize the Great Lakes. The GLRI aims to address the challenges facing the Great Lakes and provide a framework for restoration and protection. As part of this effort, the Priority Watersheds Work Group (PWWG), cochaired by the U.S. Environmental Protection Agency (EPA) and the U.S. Department of Agriculture-Natural Resources Conservation Service (USDA–NRCS), is targeting Priority Watersheds (PWs) to reduce the amount of P reaching the Great Lakes. Within the PWs, USDA–NRCS identifies small-scale subbasins with high concentrations of agriculture for coordinated nutrient reduction efforts and enhanced monitoring and modeling. The USDA–NRCS supplies financial and/or technical assistance to producers to install or implement best management practices (BMPs) to lessen the negative effects of agriculture to water quality; additional funding is provided by the GLRI through USDA–NRCS to saturate the small-scale subbasins with BMPs. The watershed modeling component, introduced in this fact sheet, assesses the effectiveness of USDA–NRCS funded BMPs, and nutrient reductions because of GLRI or other funding programs are differentiated. Modeling scenarios consider BMPs that have already been applied and those planned to be implemented across the small-scale subbasins.

Development of an Assessment Tool for Agricultural Best Management Practice Implementation in the Great Lakes Restoration Initiative Priority Watersheds—Eagle Creek, Tributary to Maumee River, Ohio

USGS Publications Warehouse

Merriman, Katherine R.

2015-11-19

The Great Lakes face a number of serious challenges that cause damage to water quality, habitat, ecology, and coastal health. Excess nutrients from point and nonpoint sources have a history of causing harmful algal blooms (HABs); since the late 1990s, a resurgence of HABs have forced beach closures and resulted in water quality impairments across the Great Lakes. Studies increasingly point to phosphorus (P) runoff from agricultural lands as the cause of these HABs. In 2010, the Great Lakes Restoration Initiative (GLRI) was launched to revitalize the Great Lakes. The GLRI aims to address the challenges facing the Great Lakes and provide a framework for restoration and protection. As part of this effort, the Priority Watersheds Work Group (PWWG), cochaired by the U.S. Environmental Protection Agency (EPA) and the U.S. Department of Agriculture-Natural Resources Conservation Service (USDA–NRCS), is targeting Priority Watersheds (PWs) to reduce the amount of P reaching the Great Lakes. Within the PWs, USDA–NRCS identifies small-scale subbasins with high concentrations of agriculture for coordinated nutrient reduction efforts and enhanced monitoring and modeling. The USDA–NRCS supplies financial and/or technical assistance to producers to install or implement best management practices (BMPs) to lessen the negative effects of agriculture to water quality; additional funding is provided by the GLRI through USDA–NRCS to saturate the small-scale subbasins with BMPs. The watershed modeling component, introduced in this fact sheet, assesses the effectiveness of USDA–NRCS funded BMPs, and nutrient reductions because of GLRI or other funding programs are differentiated. Modeling scenarios consider BMPs that have already been applied and those planned to be implemented across the small-scale subbasins.

Development of an Assessment Tool for Agricultural Best Management Practice Implementation in the Great Lakes Restoration Initiative Priority Watersheds—Upper East River, Tributary to Green Bay, Wisconsin

USGS Publications Warehouse

Merriman, Katherine R.

2015-11-19

The Great Lakes face a number of serious challenges that cause damage to water quality, habitat, ecology, and coastal health. Excess nutrients from point and nonpoint sources have a history of causing harmful algal blooms (HABs); since the late 1990s, a resurgence of HABs have forced beach closures and resulted in water quality impairments across the Great Lakes. Studies increasingly point to phosphorus (P) runoff from agricultural lands as the cause of these HABs. In 2010, the Great Lakes Restoration Initiative (GLRI) was launched to revitalize the Great Lakes. The GLRI aims to address the challenges facing the Great Lakes and provide a framework for restoration and protection. As part of this effort, the Priority Watersheds Work Group (PWWG), cochaired by the U.S. Environmental Protection Agency (EPA) and the U.S. Department of Agriculture-Natural Resources Conservation Service (USDA–NRCS), is targeting Priority Watersheds (PWs) to reduce the amount of P reaching the Great Lakes. Within the PWs, USDA–NRCS identifies small-scale subbasins with high concentrations of agriculture for coordinated nutrient reduction efforts and enhanced monitoring and modeling. The USDA–NRCS supplies financial and/or technical assistance to producers to install or implement best management practices (BMPs) to lessen the negative effects of agriculture to water quality; additional funding is provided by the GLRI through USDA–NRCS to saturate the small-scale subbasins with BMPs. The watershed modeling component, introduced in this fact sheet, assesses the effectiveness of USDA–NRCS funded BMPs, and nutrient reductions because of GLRI or other funding programs are differentiated. Modeling scenarios consider BMPs that have already been applied and those planned to be implemented across the small-scale subbasins.

Air Quality in Mexico City: Policies Implemented for its Improvement

NASA Astrophysics Data System (ADS)

Paramo, V.

2007-12-01

Ozone and suspended particles (PM) are two pollutants in the atmosphere of Mexico City Metropolitan Area (MCMA) that still exceed the recommended Mexican health standards. The other criteria pollutants very seldom exceed their corresponding standards. In 2006, the maximum ozone concentrations were above the health standard (0.11 ppm in 1 hour) during 59 percent of the days for an average of 2.2 hours and 130 points of the Air Quality Index (Índice Metropolitano de la Calidad del Aire - IMECA). In contrast, in 1991, 98 percent of the days exceeded the ozone health standard for an average of 6.6 hours and 200 IMECA points. With regards to PM10, in 2006, 80 percent of the sampled concentrations were below the health standard of 120 µg/m3 in 24 hours. However, the annual health standard of 50 µg/m3 is still exceeded. The air quality management in the MCMA is a difficult task due to several adverse factors. The main one is the large population that increased from nearly 15 million in 1992 to more than 18 million at present. As a result, the urban area grows in the adjoined municipalities of the State of Mexico. The vehicular fleet increases also to almost 4 million and the number of industrial facilities is at present 50,000. Consequently, the fuel consumption is very high. The daily energy consumption is estimated to be 44 million liters of equivalent of gasoline. Despite the fact that the air quality has improved in recent years, the related health standards are still exceeded and therefore it is necessary to continue applying the most cost-effective actions to improve the environment quality. Some actions that have contributed most to the reduction of pollutant emissions are the following: Continuous update of the inspection and maintenance program of the vehicular fleet; substitution of the catalytic converters at the end of their useful life; self-regulation of the diesel fleet; use of alternative fuels; update the No-Driving-Day program; establishment of more stringent emission levels of the gasoline fleet; update the detention of pollutant vehicles program; partial exemption of the inspection and maintenance program for cleaner and or highly efficient vehicles; substitution of 3,000 microbuses, 40,000 taxis and 1,200 buses; commissioning of the first Bus Rapid Transit system; implementation of a program for the emissions reduction for the 300 most polluted industrial facilities; and continuous update of the air quality environmental management programs. To continue improving the air quality in the MCMA, the environmental authorities will continue the implementation of the 2002-2010 Air Quality Improvement Program. In 2007 the Green Program was started, this includes those actions that have proven to be effective reduction of pollutant emissions and incorporates new actions for the reduction of local and global pollutant emissions. The most important of these new actions are: substitution of 9,500 microbuses; renewal of all the taxis fleet; commissioning of 10 Bus Rapid Transit lines; commissioning of Line 12 of the underground system; schedules and routes limitations to the cargo fleet; increase 5 percent the number of non-motorized trips (bicycling and walking); regulation of the private public transport passenger stops; requirement of private schools to provide school transport; regulation of non-occupied taxis in circulation; modifications to the circulation of 350 critical crossing points in the city; adoption of intelligent traffic lights systems; complete substitution of the local government vehicle's fleet; implement the inspection and maintenance of the cargo fleet; introduction of low- sulfur diesel, among other measures.

Telemonitoring can assist in managing cardiovascular disease in primary care: a systematic review of systematic reviews

PubMed Central

2014-01-01

Background There has been growing interest regarding the impact of telemonitoring and its ability to reduce the increasing burden of chronic diseases, including chronic cardiovascular disease (CVD), on healthcare systems. A number of randomised trials have been undertaken internationally and synthesised into various systematic reviews to establish an evidence base for this model of care. This study sought to synthesise and critically evaluate this large body of evidence to inform clinicians, researchers and policy makers. Methods A systematic review of systematic reviews investigating the impact of telemonitoring interventions in the primary care management of CVD was conducted. Reviews were included if they explored primary care based telemonitoring in either CVD, heart failure or hypertension, were reported in the English language and were published between 2000 and 2013. Data was extracted by one reviewer and checked by a second reviewer using a standardised form. Two assessors then rated the quality of each review using the Overview Quality Assessment Questionnaire (OQAQ). Results Of the 13 included reviews, four focused on telemonitoring interventions in hypertension or CVD management and the remaining 9 reviews investigated telemonitoring in HF management. Seven reviews scored a five or above on the OQAQ evidencing good quality reviews. Findings suggest that telemonitoring can contribute to significant reductions in blood pressure, decreased all-cause and HF related hospitalisations, reduced all-cause mortality and improved quality of life. Telemonitoring was also demonstrated to reduce health care costs and appears acceptable to patients. Conclusion Telemonitoring has the potential to enhance primary care management of CVD by improving patient outcomes and reducing health costs. However, further research needs to explore the specific elements of telemonitoring interventions to determine the relative value of the various elements. Additionally, the ways in which telemonitoring care improves health outcomes needs to be further explored to understand the nature of these interventions. PMID:24606887

Disease management programmes for patients with coronary heart disease--an empirical study of German programmes.

PubMed

Gapp, Oliver; Schweikert, Bernd; Meisinger, Christa; Holle, Rolf

2008-12-01

To evaluate healthcare and outcomes of disease management programmes (DMPs) for patients with coronary heart disease (CHD) in primary care, and to assess selection of enrollment for these programmes. A cross-sectional survey of 2330 statutorily insured patients with a history of acute myocardial infarction (AMI) was performed in 2006 by the population-based KORA Myocardial Infarction Register from the region of Augsburg, Germany. Patients enrolled in DMP-CHDs receive evidence-based care, with patients not enrolled receiving standard care. To control for selection bias, a propensity score approach was used. Main factors influencing DMP participation were age (OR 0.98, 95% CI 0.96-0.99), diabetes (OR 1.56, CI 1.25-1.95) and time since last heart attack (OR 0.98, CI 0.95-0.99). Significantly more patients enrolled in DMP-CHDs stated that they received medical counselling for smoking (OR 3.77, CI 1.07-13.34), nutrition (OR 2.15, 1.69-2.74) and for physical activity (OR 2.58, 1.99-3.35). Furthermore, prescription of statins (OR 1.58, CI 1.24-2.00), antiplatelets (OR 1.96, CI 1.43-2.69) and beta-blockers (not significant) were higher in the DMP group. With respect to outcomes, we did not see relevant differences in quality of life and body mass index, and only a minor reduction in smoking. Enrollment into DMPs for CHD exhibits systematic selection effects. Participants tend to experience--at least on a short to medium term and for AMI patients--better quality of healthcare services. However, since DMP-CHDs were initiated only 2 years ago, we were unable to identify significant improvements in health outcomes. Only the reduction in smoking provides a first indication of better quality outcomes following DMP-CHD. Thus, policy-makers must provide appropriate incentives to sickness funds and physicians in order to ensure initiation and continuation of high quality DMPs.

The influence of diet and/or exercise and parental compliance on health-related quality of life in obese children.

PubMed

Yackobovitch-Gavan, Michal; Nagelberg, Nessia; Phillip, Moshe; Ashkenazi-Hoffnung, Liat; Hershkovitz, Eli; Shalitin, Shlomit

2009-06-01

Recent findings of a direct association of obesity and impaired health-related quality of life (HRQOL) in children suggest a need for early weight-management interventions that address psychosocial issues and lifestyle. Our aim was to compare the effects of exercise, diet, or diet + exercise on HRQOL in obese children. We hypothesized that HRQOL will improve as a result of the weight-loss intervention and will be correlated with the amount of weight loss achieved by each of the intervention groups. A total of 162 children aged 6 to 11 years with a body mass index (BMI) exceeding the 95th percentile were randomly allocated to a 12-week regimens of diet, exercise, or diet + exercise. Weight, height, and percent fat mass were measured, and parents completed the Pediatric Quality of Life Inventory (PedsQL) 4.0 at baseline and at the end of the intervention. The reductions in BMI were significantly greater in the diet and diet + exercise groups than in the exercise group. Pediatric Quality of Life Inventory scores improved significantly, with no differences among the groups. A greater reduction in BMI occurred in children whose parents completed the PedsQL at baseline (n = 105) than in children whose parents did not (n = 15) (-1.8 +/- 1.3 vs -1.0 +/- 1.5; P = .048) and in children whose parents completed the PedsQL at the end of the intervention (n = 73) than in children whose parents did not (n = 47) (-2.0 +/- 1.3 vs -1.3 +/- 1.3; P = .013). Weight-management programs that promote a healthy eating and physical activity can serve as an effective tool to improve the low HRQOL of obese children. Parental compliance is an important factor and may be assessed by the parents' cooperativeness in completing questionnaires.

Integrating High-Resolution Datasets to Target Mitigation Efforts for Improving Air Quality and Public Health in Urban Neighborhoods

PubMed Central

Shandas, Vivek; Voelkel, Jackson; Rao, Meenakshi; George, Linda

2016-01-01

Reducing exposure to degraded air quality is essential for building healthy cities. Although air quality and population vary at fine spatial scales, current regulatory and public health frameworks assess human exposures using county- or city-scales. We build on a spatial analysis technique, dasymetric mapping, for allocating urban populations that, together with emerging fine-scale measurements of air pollution, addresses three objectives: (1) evaluate the role of spatial scale in estimating exposure; (2) identify urban communities that are disproportionately burdened by poor air quality; and (3) estimate reduction in mobile sources of pollutants due to local tree-planting efforts using nitrogen dioxide. Our results show a maximum value of 197% difference between cadastrally-informed dasymetric system (CIDS) and standard estimations of population exposure to degraded air quality for small spatial extent analyses, and a lack of substantial difference for large spatial extent analyses. These results provide the foundation for improving policies for managing air quality, and targeting mitigation efforts to address challenges of environmental justice. PMID:27527205

The effectiveness of mindfulness-based stress reduction (MBSR) for survivors of breast cancer: study protocol for a randomized controlled trial.

PubMed

Huang, Jiayan; Shi, Lu

2016-04-22

After treatment completion, breast cancer (BC) survivors frequently experience residual symptoms of pain, fatigue, high levels of psychological stress, anxiety, depression, fear of recurrence, and metastasis. Post-treatment stress, in particular, can adversely affect health-related quality of life, which, in turn, induces onset or recurrence of chronic diseases. Effective interventions that target these psychological symptoms and their physiological consequences are needed, especially for economically disadvantaged patients. However, in China, few evidence-based intervention strategies have been established among BC survivors. This study will formally adapt, develop, and evaluate an intensive mindfulness-based stress reduction (MBSR) intervention protocol to improve mental health, quality of life, and compliance with medication among Chinese BC survivors. A randomized, waitlist-controlled clinical trial will be conducted. Based on our power calculation, 418 BC survivors will be recruited from 10 low-income communities in Shanghai. All subjects will be randomly assigned either to the MBSR program or to a waitlisted usual care regimen that will offer the MBSR program after the completion of the other trial arm (after 6 months follow-up). Our 8-week MBSR intervention program will provide systematic training to promote stress reduction by self-regulating arousal to stress. Assessments will be made at baseline, 4 weeks (in the middle of the first MBSR intervention), 8 weeks (at the end of the first MBSR intervention), 6 months, and 12 months, and will include measures of psychological symptoms (depression, anxiety, and perceived stress), quality of life, and medication adherence. The expected outcome will be the improvement in psychological symptoms, quality of life, and medication compliance in the MBSR intervention group. This study will help develop an affordable, self-care psychological intervention protocol to help Chinese BC survivors improve their quality of life, and could be helpful in further developing affordable disease management plans for patients of other chronic diseases. ChiCTR-IOR-14005390 (10/27/2014).

Improved quality of management of eclampsia patients through criteria based audit at Muhimbili National Hospital, Dar es Salaam, Tanzania. Bridging the quality gap.

PubMed

Kidanto, Hussein Lesio; Wangwe, Peter; Kilewo, Charles D; Nystrom, Lennarth; Lindmark, Gunnila

2012-11-21

Criteria-based audits (CBA) have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the use of a CBA to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es Salaam Tanzania. The prevalence of eclampsia in MNH is high (≈6%) with the majority of cases arriving after start of convulsions. In 2004-2005 the case-fatality rate in eclampsia was 5.1% of all pregnant women admitted for delivery (MNH obstetric data base). A criteria-based audit (CBA) was used to evaluate the quality of care for eclamptic mothers admitted at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania after implementation of recommendations of a previous audit. A CBA of eclampsia cases was conducted at MNH. Management practices were evaluated using evidence-based criteria for appropriate care. The Ministry of Health (MOH) guidelines, local management guidelines, the WHO manual supplemented by the WHO Reproductive Health Library, standard textbooks, the Cochrane database and reviews in peer reviewed journals were adopted. At the initial audit in 2006, 389 case notes were assessed and compared with the standards, gaps were identified, recommendations made followed by implementation. A re-audit of 88 cases was conducted in 2009 and compared with the initial audit. There was significant improvement in quality of patient management and outcome between the initial and re-audit: Review of management plan by senior staff (76% vs. 99%; P=0.001), urine for albumin test (61% vs. 99%; P=0.001), proper use of partogram to monitor labour (75% vs. 95%; P=0.003), treatment with steroids for lung maturity (2.0% vs. 24%; P=0.001), Caesarean section within 2 hours of decision (33% vs. 61%; P=0.005), full blood count (28% vs. 93%; P=0.001), serum urea and creatinine (44% vs. 86%; P=0.001), liver enzymes (4.0% vs. 86%; P=0.001), and specialist review within 2 hours of admission (25% vs. 39%; P=0.018). However, there was no significant change in terms of delivery within 24 hours of admission (69% vs. 63%; P=0.33). There was significant reduction of maternal deaths (7.7% vs. 0%; P=0.001). CBA is applicable in low resource setting and can help to improve quality of care in obstetrics including management of pre-eclampsia and eclampsia.

Water quality and coral bleaching thresholds: formalising the linkage for the inshore reefs of the Great Barrier Reef, Australia.

PubMed

Wooldridge, Scott A

2009-05-01

The threats of wide-scale coral bleaching and reef demise associated with anthropogenic climate change are widely known. Here, the additional role of poor water quality in lowering the thermal tolerance (i.e. bleaching 'resistance') of symbiotic reef corals is considered. In particular, a quantitative linkage is established between terrestrially-sourced dissolved inorganic nitrogen (DIN) loading and the upper thermal bleaching thresholds of inshore reefs on the Great Barrier Reef, Australia. Significantly, this biophysical linkage provides concrete evidence for the oft-expressed belief that improved coral reef management will increase the regional-scale survival prospects of corals reefs to global climate change. Indeed, for inshore reef areas with a high runoff exposure risk, it is shown that the potential benefit of this 'local' management imperative is equivalent to approximately 2.0-2.5 degrees C in relation to the upper thermal bleaching limit; though in this case, a potentially cost-prohibitive reduction in end-of-river DIN of >50-80% would be required. An integrated socio-economic modelling framework is outlined that will assist future efforts to understand (optimise) the alternate tradeoffs that the water quality/coral bleaching linkage presents.

Water-quality and algal conditions in the North Umpqua River basin, Oregon, 1992-95, and indications for resource management

USGS Publications Warehouse

Anderson, Chauncey W.; Carpenter, Kurt D.

1998-01-01

Water quality in the Wild and Scenic reach is dominated by water released from the hydroelectric project area during summer. Effects of the hydroelectric project include seasonal control of streamflow, water temperature, and phosphorus concentrations, and the possible release of low but ecologically important concentrations of organic nitrogen. A review of available data and literature suggests that the reservoirs can increase the interception of sediments and large organic debris, and promote their conversion into fine-grained particulate and dissolved organic matter for downstream transport. These effects could be compounded by the effects of forestry in the basin, including alteration of hydrologic cycles, changes in sediment and nutrient runoff, reductions of the transport of large woody debris, and degradation of habitat quality. It is hypothesized that, in the North Umpqua River, these processes have induced a fundamental shift in the river’s food web, from a detritus-based system to a system with a 2 higher emphasis on algal production. Confirmation of these changes and their effects on higher trophic levels are needed to properly manage the aquatic resources for all designated beneficial uses in the basin.

Community pharmacy-delivered interventions for public health priorities: a systematic review of interventions for alcohol reduction, smoking cessation and weight management, including meta-analysis for smoking cessation.

PubMed

Brown, Tamara J; Todd, Adam; O'Malley, Claire; Moore, Helen J; Husband, Andrew K; Bambra, Clare; Kasim, Adetayo; Sniehotta, Falko F; Steed, Liz; Smith, Sarah; Nield, Lucie; Summerbell, Carolyn D

2016-02-29

To systematically review the effectiveness of community pharmacy-delivered interventions for alcohol reduction, smoking cessation and weight management. Systematic review and meta-analyses. 10 electronic databases were searched from inception to May 2014. randomised and non-randomised controlled trials; controlled before/after studies, interrupted times series. any relevant intervention set in a community pharmacy, delivered by the pharmacy team. No restrictions on duration, country, age, or language. 19 studies were included: 2 alcohol reduction, 12 smoking cessation and 5 weight management. Study quality rating: 6 'strong', 4 'moderate' and 9 'weak'. 8 studies were conducted in the UK, 4 in the USA, 2 in Australia, 1 each in 5 other countries. Evidence from 2 alcohol-reduction interventions was limited. Behavioural support and/or nicotine replacement therapy are effective and cost-effective for smoking cessation: pooled OR was 2.56 (95% CI 1.45 to 4.53) for active intervention vs usual care. Pharmacy-based interventions produced similar weight loss compared with active interventions in other primary care settings; however, weight loss was not sustained longer term in a range of primary care and commercial settings compared with control. Pharmacy-based weight management interventions have similar provider costs to those delivered in other primary care settings, which are greater than those delivered by commercial organisations. Very few studies explored if and how sociodemographic or socioeconomic variables moderated intervention effects. Insufficient information was available to examine relationships between effectiveness and behaviour change strategies, implementation factors, or organisation and delivery of interventions. Community pharmacy-delivered interventions are effective for smoking cessation, and demonstrate that the pharmacy is a feasible option for weight management interventions. Given the potential reach, effectiveness and associated costs of these interventions, commissioners should consider using community pharmacies to help deliver public health services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Mercury cycling in agricultural and managed wetlands, Yolo Bypass, California: Spatial and seasonal variations in water quality

USGS Publications Warehouse

Alpers, Charles N.; Fleck, Jacob A.; Marvin-DiPasquale, Mark C.; Stricker, Craig A.; Stephenson, Mark; Taylor, Howard E.

2014-01-01

The seasonal and spatial variability of water quality, including mercury species, was evaluated in agricultural and managed, non-agricultural wetlands in the Yolo Bypass Wildlife Area, an area managed for multiple beneficial uses including bird habitat and rice farming. The study was conducted during an 11-month period (June 2007 to April 2008) that included a summer growing season and flooded conditions during winter. Methylmercury (MeHg) concentrations in surface water varied over a wide range (0.1 to 37 ng L−1 unfiltered; 0.04 to 7.3 ng L−1 filtered). Maximum MeHg values are among the highest ever recorded in wetlands. Highest MeHg concentrations in unfiltered surface water were observed in drainage from wild rice fields during harvest (September 2007), and in white rice fields with decomposing rice straw during regional flooding (February 2008). The ratio of MeHg to total mercury (MeHg/THg) increased about 20-fold in both unfiltered and filtered water during the growing season (June to August 2007) in the white and wild rice fields, and about 5-fold in fallow fields (July to August 2007), while there was little to no change in MeHg/THg in the permanent wetland. Sulfate-bearing fertilizer had no effect on Hg(II) methylation, as sulfate-reducing bacteria were not sulfate limited in these agricultural wetlands. Concentrations of MeHg in filtered and unfiltered water correlated with filtered Fe, filtered Mn, DOC, and two indicators of sulfate reduction: the SO4 2 −/Cl− ratio, and δ34S in aqueous sulfate. These relationships suggest that microbial reduction of SO4 2−, Fe(III), and possibly Mn(IV) may contribute to net Hg(II)-methylation in this setting.

Simulation of Water Quality in the Tull Creek and West Neck Creek Watersheds, Currituck Sound Basin, North Carolina and Virginia

USGS Publications Warehouse

Garcia, Ana Maria

2009-01-01

A study of the Currituck Sound was initiated in 2005 to evaluate the water chemistry of the Sound and assess the effectiveness of management strategies. As part of this study, the Soil and Water Assessment Tool (SWAT) model was used to simulate current sediment and nutrient loadings for two distinct watersheds in the Currituck Sound basin and to determine the consequences of different water-quality management scenarios. The watersheds studied were (1) Tull Creek watershed, which has extensive row-crop cultivation and artificial drainage, and (2) West Neck Creek watershed, which drains urban areas in and around Virginia Beach, Virginia. The model simulated monthly streamflows with Nash-Sutcliffe model efficiency coefficients of 0.83 and 0.76 for Tull Creek and West Neck Creek, respectively. The daily sediment concentration coefficient of determination was 0.19 for Tull Creek and 0.36 for West Neck Creek. The coefficient of determination for total nitrogen was 0.26 for both watersheds and for dissolved phosphorus was 0.4 for Tull Creek and 0.03 for West Neck Creek. The model was used to estimate current (2006-2007) sediment and nutrient yields for the two watersheds. Total suspended-solids yield was 56 percent lower in the urban watershed than in the agricultural watershed. Total nitrogen export was 45 percent lower, and total phosphorus was 43 percent lower in the urban watershed than in the agricultural watershed. A management scenario with filter strips bordering the main channels was simulated for Tull Creek. The Soil and Water Assessment Tool model estimated a total suspended-solids yield reduction of 54 percent and total nitrogen and total phosphorus reductions of 21 percent and 29 percent, respectively, for the Tull Creek watershed.

Diabetes Mellitus Management Among Patients with Limited English Proficiency: A Systematic Review and Meta-Analysis.

PubMed

Njeru, Jane W; Wieland, Mark L; Kwete, Gracia; Tan, Eugene M; Breitkopf, Carmen Radecki; Agunwamba, Amenah A; Prokop, Larry J; Murad, M Hassan

2018-04-01

Patients with limited English proficiency (LEP) and type 2 diabetes mellitus (T2DM) have several health disparities, including suboptimal patient-provider interactions, poorer glycemic control, and T2DM complications. Understanding existing interventions for improving T2DM outcomes in this population is critical for reducing disparities. We performed a systematic review of randomized controlled trials (RCTs) and observational studies examining the effectiveness of interventions in improving T2DM outcomes among patients with LEP in North America. Quality was assessed using the Cochrane risk of bias tool for RCTs and the Newcastle-Ottawa Scale for non-RCT studies. Meta-analysis was conducted using the random-effects model. Fifty-four studies, 39 of which reported sufficient data for meta-analysis of glycemic control, were included. The interventions were associated with a statistically significant reduction in hemoglobin A 1c (HbA 1c ) (weighted difference in means, -0.84% [95% CI, -0.97 to -0.71]) that was, however, very heterogeneous across studies (I 2  = 95.9%). Heterogeneity was explained by study design (lower efficacy in RCTs than non-RCTs) and by intervention length and delivery mode (greater reduction in interventions lasting <6 months or delivered face-to-face); P < 0.05 for all three covariates. The interventions were also associated in most studies with improvement in knowledge, self-efficacy in diabetes management, quality of life, blood pressure, and low-density lipoprotein cholesterol. Multiple types of interventions are available for T2DM management in patients with LEP. Multicomponent interventions delivered face-to-face seem most effective for glycemic control. More research is needed to better understand other aspects of multicomponent interventions that are critical for improving important outcomes among patients with T2DM and LEP.

Do Patients of Subspecialist Physicians Benefit from Written Asthma Action Plans?

PubMed Central

Mellins, Robert B.; Dimango, Emily; Serebrisky, Denise; Zhang, Yuan; Bye, Michael R.; Dovey, Mark E.; Nachman, Sami; Hutchinson, Vincent; Evans, David

2015-01-01

Rationale: Asthma clinical guidelines suggest written asthma action plans are essential for improving self-management and outcomes. Objectives: To assess the efficacy of written instructions in the form of a written asthma action plan provided by subspecialist physicians as part of usual asthma care during office visits. Methods: A total of 407 children and adults with persistent asthma receiving first-time care in pulmonary and allergy practices at 4 urban medical centers were randomized to receive either written instructions (n = 204) or no written instructions other than prescriptions (n = 203) from physicians. Measurements and Main Results: Using written asthma action plan forms as a vehicle for providing self-management instructions did not have a significant effect on any of the primary outcomes: (1) asthma symptom frequency, (2) emergency visits, or (3) asthma quality of life from baseline to 12-month follow-up. Both groups showed similar and significant reductions in asthma symptom frequency (daytime symptoms [P < 0.0001], nocturnal symptoms [P < 0.0001], β-agonist use [P < 0.0001]). There was also a significant reduction in emergency visits for the intervention (P < 0.0001) and control (P < 0.0006) groups. There was significant improvement in asthma quality-of-life scores for adults (P < 0.0001) and pediatric caregivers (P < 0.0001). Conclusions: Our results suggest that using a written asthma action plan form as a vehicle for providing asthma management instructions to patients with persistent asthma who are receiving subspecialty care for the first time confers no added benefit beyond subspecialty-based medical care and education for asthma. Clinical trial registered with www.clinicaltrials.gov (NCT 00149461). PMID:25867075

Study design and protocol for a culturally adapted cognitive behavioral stress and self-management intervention for localized prostate cancer: The Encuentros de Salud study.

PubMed

Penedo, Frank J; Antoni, Michael H; Moreno, Patricia I; Traeger, Lara; Perdomo, Dolores; Dahn, Jason; Miller, Gregory E; Cole, Steve; Orjuela, Julian; Pizarro, Edgar; Yanez, Betina

2018-06-14

Almost 2.8 million men in the U.S. are living with prostate cancer (PC), accounting for 40% of all male cancer survivors. Men diagnosed with prostate cancer may experience chronic and debilitating treatment side effects, including sexual and urinary dysfunction, pain and fatigue. Side effects can be stressful and can also lead to poor psychosocial functioning. Prior trials reveal that group-based cognitive behavioral stress and self-management (CBSM) is effective in reducing stress and mitigating some of these symptoms, yet little is known about the effects of culturally-translated CBSM among Spanish-speaking men with PC. This manuscript describes the rationale and study design of a multi-site, randomized controlled trial to determine whether participation in a culturally adapted cognitive behavioral stress management (C-CBSM) intervention leads to significantly greater reductions in symptom burden and improvements in health-related quality of life relative to participation in a non-culturally adapted cognitive behavioral stress management (CBSM) intervention. Participants (N = 260) will be Spanish-speaking Hispanic/Latino men randomized to the standard, non-culturally adapted CBSM intervention (e.g., cognitive behavioral strategies, stress management, and health maintenance) or the culturally adapted C-CBSM intervention (e.g., content adapted to be compatible with Hispanic/Latino cultural patterns and belief systems, meanings, values and social context) for 10 weeks. Primary outcomes (i.e., disease-specific symptom burden and health-related quality of life) will be assessed across time. We hypothesize that a culturally adapted C-CBSM intervention will be more efficacious in reducing symptom burden and improving health-related quality of life among Hispanic/Latino men when compared to a non-culturally adapted CBSM intervention. Copyright © 2017. Published by Elsevier Inc.

Work design and management in the manufacturing sector: development and validation of the Work Organisation Assessment Questionnaire.

PubMed

Griffiths, A; Cox, T; Karanika, M; Khan, S; Tomás, J M

2006-10-01

To examine the factor structure, reliability, and validity of a new context-specific questionnaire for the assessment of work and organisational factors. The Work Organisation Assessment Questionnaire (WOAQ) was developed as part of a risk assessment and risk reduction methodology for hazards inherent in the design and management of work in the manufacturing sector. Two studies were conducted. Data were collected from 524 white- and blue-collar employees from a range of manufacturing companies. Exploratory factor analysis was carried out on 28 items that described the most commonly reported failures of work design and management in companies in the manufacturing sector. Concurrent validity data were also collected. A reliability study was conducted with a further 156 employees. Principal component analysis, with varimax rotation, revealed a strong 28-item, five factor structure. The factors were named: quality of relationships with management, reward and recognition, workload, quality of relationships with colleagues, and quality of physical environment. Analyses also revealed a more general summative factor. Results indicated that the questionnaire has good internal consistency and test-retest reliability and validity. Being associated with poor employee health and changes in health related behaviour, the WOAQ factors are possible hazards. It is argued that the strength of those associations offers some estimation of risk. Feedback from the organisations involved indicated that the WOAQ was easy to use and meaningful for them as part of their risk assessment procedures. The studies reported here describe a model of the hazards to employee health and health related behaviour inherent in the design and management of work in the manufacturing sector. It offers an instrument for their assessment. The scales derived which form the WOAQ were shown to be reliable, valid, and meaningful to the user population.

40 CFR 1033.112 - Emission diagnostics for SCR systems.

Code of Federal Regulations, 2012 CFR

2012-07-01

... diagnostic system must monitor reductant quality and tank levels and alert operators to the need to refill... specified in § 1033.110 and an audible alarm. You do not need to separately monitor reductant quality if you include an exhaust NOX sensor (or other sensor) that allows you to determine inadequate reductant quality...

40 CFR 1033.112 - Emission diagnostics for SCR systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... diagnostic system must monitor reductant quality and tank levels and alert operators to the need to refill... specified in § 1033.110 and an audible alarm. You do not need to separately monitor reductant quality if you include an exhaust NOX sensor (or other sensor) that allows you to determine inadequate reductant quality...

40 CFR 1033.112 - Emission diagnostics for SCR systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... diagnostic system must monitor reductant quality and tank levels and alert operators to the need to refill... specified in § 1033.110 and an audible alarm. You do not need to separately monitor reductant quality if you include an exhaust NOX sensor (or other sensor) that allows you to determine inadequate reductant quality...

An environment-adaptive management algorithm for hearing-support devices incorporating listening situation and noise type classifiers.

PubMed

Yook, Sunhyun; Nam, Kyoung Won; Kim, Heepyung; Hong, Sung Hwa; Jang, Dong Pyo; Kim, In Young

2015-04-01

In order to provide more consistent sound intelligibility for the hearing-impaired person, regardless of environment, it is necessary to adjust the setting of the hearing-support (HS) device to accommodate various environmental circumstances. In this study, a fully automatic HS device management algorithm that can adapt to various environmental situations is proposed; it is composed of a listening-situation classifier, a noise-type classifier, an adaptive noise-reduction algorithm, and a management algorithm that can selectively turn on/off one or more of the three basic algorithms-beamforming, noise-reduction, and feedback cancellation-and can also adjust internal gains and parameters of the wide-dynamic-range compression (WDRC) and noise-reduction (NR) algorithms in accordance with variations in environmental situations. Experimental results demonstrated that the implemented algorithms can classify both listening situation and ambient noise type situations with high accuracies (92.8-96.4% and 90.9-99.4%, respectively), and the gains and parameters of the WDRC and NR algorithms were successfully adjusted according to variations in environmental situation. The average values of signal-to-noise ratio (SNR), frequency-weighted segmental SNR, Perceptual Evaluation of Speech Quality, and mean opinion test scores of 10 normal-hearing volunteers of the adaptive multiband spectral subtraction (MBSS) algorithm were improved by 1.74 dB, 2.11 dB, 0.49, and 0.68, respectively, compared to the conventional fixed-parameter MBSS algorithm. These results indicate that the proposed environment-adaptive management algorithm can be applied to HS devices to improve sound intelligibility for hearing-impaired individuals in various acoustic environments. Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

A model for managing sources of groundwater pollution

USGS Publications Warehouse

Gorelick, Steven M.

1982-01-01

The waste disposal capacity of a groundwater system can be maximized while maintaining water quality at specified locations by using a groundwater pollutant source management model that is based upon linear programing and numerical simulation. The decision variables of the management model are solute waste disposal rates at various facilities distributed over space. A concentration response matrix is used in the management model to describe transient solute transport and is developed using the U.S. Geological Survey solute transport simulation model. The management model was applied to a complex hypothetical groundwater system. Large-scale management models were formulated as dual linear programing problems to reduce numerical difficulties and computation time. Linear programing problems were solved using a numerically stable, available code. Optimal solutions to problems with successively longer management time horizons indicated that disposal schedules at some sites are relatively independent of the number of disposal periods. Optimal waste disposal schedules exhibited pulsing rather than constant disposal rates. Sensitivity analysis using parametric linear programing showed that a sharp reduction in total waste disposal potential occurs if disposal rates at any site are increased beyond their optimal values.

Improvement of the management of residual waste in areas without thermal treatment facilities: A life cycle analysis of an Italian management district

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

Di Maria, Francesco, E-mail: francesco.dimaria@unipg.it; Micale, Caterina; Morettini, Emanuela

2015-10-15

Highlights: • LCA analysis of two option for residual waste management. • Exploitation of mechanical physical sorting facility for extracting recyclable from RMSW. • Processing the mechanically sorted organic fraction in bioreactor landfill. • Sensitivity analysis demonstrate high influence for impact assessment of substitution ratio for recycle materials. - Abstract: Starting from an existing waste management district without thermal treatment facilities, two different management scenarios for residual waste were compared by life cycle assessment (LCA). The adoption of a bioreactor landfill for managing the mechanically sorted organic fraction instead of bio-stabilization led to reduction of global warming and fresh watermore » eutrophication by 50% and 10%, respectively. Extraction of recyclables from residual waste led to avoided emissions for particulate matter, acidification and resource depletion impact categories. Marginal energy and the amount of energy recovered from landfill gas marginally affected the LCA results. On the contrary the quality of the recyclables extracted can significantly modify the eco profile of the management schemes.« less

Implementing and Evaluating a Multicomponent Inpatient Diabetes Management Program: Putting Research into Practice

PubMed Central

Munoz, Miguel; Pronovost, Peter; Dintzis, Joanne; Kemmerer, Theresa; Wang, Nae-Yuh; Chang, Yi-Ting; Efird, Leigh; Berenholtz, Sean M.; Golden, Sherita Hill

2013-01-01

Background Strategies for successful implementation of hospitalwide glucose control efforts were addressed in a conceptual model for the development and implementation of an institutional inpatient glucose management program. Conceptual Model Components The Glucose Steering Committee incrementally developed and implemented hospitalwide glucose policies, coupled with targeted education and clinical decision support to facilitate policy acceptance and uptake by staff while incorporating process and outcome measures to objectively assess the effectiveness of quality improvement efforts. The model includes four components: (1) engaging staff and hospital executives in the importance of inpatient glycemic management, (2) educating staff involved in the care of patients with diabetes through structured knowledge dissemination, (3) executing evidence-based inpatient glucose management through development of policies and clinical decision aids, and (4) evaluating intervention effectiveness through assessing process measures, intermediary glucometric outcomes, and clinical and economic outcomes. An educational curriculum for nursing, provider, and pharmacist diabetes education programs and current glucometrics were also developed. Outcomes Overall the average patient-day–weighted mean blood glucose (PDWMBG) was below the currently recommended maximum of 180 mg/dL in patients with diabetes and hyperglycemia, with a significant decrease in PDWMBG of 7.8 mg/dL in patients with hyperglycemia. The program resulted in an 18.8% reduction in hypoglycemia event rates, which was sustained. Conclusion Inpatient glucose management remains an important area for patient safety, quality improvement, and clinical research, and the implementation model should guide other hospitals in their glucose management initiatives. PMID:22649859

Implementing and evaluating a multicomponent inpatient diabetes management program: putting research into practice.

PubMed

Munoz, Miguel; Pronovost, Peter; Dintzis, Joanne; Kemmerer, Theresa; Wang, Nae-Yuh; Chang, Yi-Ting; Efird, Leigh; Berenholtz, Sean M; Golden, Sherita Hill

2012-05-01

Strategies for successful implementation of hospitalwide glucose control efforts were addressed in a conceptual model for the development and implementation of an institutional inpatient glucose management program. CONCEPTUAL MODEL COMPONENTS: The Glucose Steering Committee incrementally developed and implemented hospitalwide glucose policies, coupled with targeted education and clinical decision support to facilitate policy acceptance and uptake by staffwhile incorporating process and outcome measures to objectively assess the effectiveness of quality improvement efforts. The model includes four components: (1) engaging staff and hospital executives in the importance of inpatient glycemic management, (2) educating staff involved in the care of patients with diabetes through structured knowledge dissemination, (3) executing evidence-based inpatient glucose management through development of policies and clinical decision aids, and (4) evaluating intervention effectiveness through assessing process measures, intermediary glucometric outcomes, and clinical and economic outcomes. An educational curriculum for nursing, provider, and pharmacist diabetes education programs and current glucometrics were also developed. Overall the average patient-day-weighted mean blood glucose (PDWMBG) was below the currently recommended maximum of 180 mg/dL in patients with diabetes and hyperglycemia, with a significant decrease in PDWMBG of 7.8 mg/dL in patients with hyperglycemia. The program resulted in an 18.8% reduction in hypoglycemia event rates, which was sustained. Inpatient glucose management remains an important area for patient safety, quality improvement, and clinical research, and the implementation model should guide other hospitals in their glucose management initiatives.

Environmental response of an Irish estuary to changing land management practices.

PubMed

Ní Longphuirt, Sorcha; O'Boyle, Shane; Stengel, Dagmar Brigitte

2015-07-15

Anthropogenic pressures have led to problems of nutrient over-enrichment and eutrophication in estuarine and coastal systems on a global scale. Recent improvements in farming practices, specifically a decrease in fertiliser application rates, have reduced nutrient loadings in Ireland. In line with national and European Directives, monitoring of Irish estuarine systems has been conducted for the last 30years, allowing a comparison of the effectiveness of measures undertaken to improve water quality and chemical and biological trends. The Blackwater Estuary, which drains a large agricultural catchment on the south coast of Ireland, has experienced a decrease in calculated nitrogen (N) (17%) and phosphorus (P) (20%) loads in the last decade. Monitored long-term river inputs reflect the reductions while estuarine P concentrations, chlorophyll and dissolved oxygen saturation show concurrent improvement. Consistently high N concentrations suggest a decoupling between N loads and estuarine responses. This highlights the complex interaction between N and P load reductions, and biochemical processes relating to remineralisation and primary production which can alter the effectiveness of the estuarine filter in reducing nutrient transport to the coastal zone. Effective management and reduction of both diffuse and point nutrient sources to surface waters require a consideration of the processes which may alter the effectiveness of measures in estuarine and coastal waters. Copyright © 2015. Published by Elsevier B.V.

An Air Quality Data Analysis System for Interrelating Effects, Standards and Needed Source Reductions

ERIC Educational Resources Information Center

Larsen, Ralph I.

1973-01-01

Makes recommendations for a single air quality data system (using average time) for interrelating air pollution effects, air quality standards, air quality monitoring, diffusion calculations, source-reduction calculations, and emission standards. (JR)

An evidence-based approach to case management model selection for an acute care facility: is there really a preferred model?

PubMed

Terra, Sandra M

2007-01-01

This research seeks to determine whether there is adequate evidence-based justification for selection of one acute care case management model over another. Acute Inpatient Hospital. This article presents a systematic review of published case management literature, resulting in classification specific to terms of level of evidence. This review examines the best available evidence in an effort to select an acute care case management model. Although no single case management model can be identified as preferred, it is clear that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and to form a foundation for the efficacy of hospital case management practice. Although no single case management model can be identified as preferred, this systematic review demonstrates that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and forming a foundation for the efficacy of hospital case management practice. Distinctive aspects of case management frameworks can be used to guide the development of an acute care case management model. The study illustrates: * The effectiveness of case management when there is direct patient contact by the case manager regardless of disease condition: not only does the quality of care increase but also length of stay (LOS) decreases, care is defragmented, and both patient and physician satisfaction can increase. * The preferred case management models result in measurable outcomes that can directly relate to, and demonstrate alignment with, organizational strategy. * Acute care management programs reduce cost and LOS, and improve outcomes. * An integrated case management program that includes social workers, as well as nursing, is the most effective acute care management model. * The successful case management model will recognize physicians, as well as patients, as valued customers with whom partnership can positively affect financial outcomes in terms of reduction in LOS, improvement in quality, and delivery of care.

Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries

PubMed Central

Mendel, Peter; Nunes, Francisco; Wiig, Siri; van den Bovenkamp, Hester; Karltun, Anette; Robert, Glenn; Anderson, Janet; Vincent, Charles; Fulop, Naomi

2015-01-01

Objectives Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. Methods An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals. Results How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures. Conclusions The development of hospital leaders’ skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required. PMID:26683885

Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries.

PubMed

Burnett, Susan; Mendel, Peter; Nunes, Francisco; Wiig, Siri; van den Bovenkamp, Hester; Karltun, Anette; Robert, Glenn; Anderson, Janet; Vincent, Charles; Fulop, Naomi

2016-04-01

Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies in a purposive sample of ten hospitals. How hospitals responded to the financial and quality challenges was dependent upon three factors: the coherence of demands from external institutions; managerial competence to align external demands with an overall quality improvement strategy, and managerial stability. Hospital leaders used diverse strategies and practices to manage conflicting external pressures. The development of hospital leaders' skills in translating external requirements into implementation plans with internal support is a complex, but crucial, task, if quality is to remain a priority during times of austerity. Increasing quality improvement skills within a hospital, developing a culture where quality improvement becomes embedded and linking cost reduction measures to improving care are all required. © The Author(s) 2015.

Water Quality Assessment in the Harbin Reach of the Songhuajiang River (China) Based on a Fuzzy Rough Set and an Attribute Recognition Theoretical Model

PubMed Central

An, Yan; Zou, Zhihong; Li, Ranran

2014-01-01

A large number of parameters are acquired during practical water quality monitoring. If all the parameters are used in water quality assessment, the computational complexity will definitely increase. In order to reduce the input space dimensions, a fuzzy rough set was introduced to perform attribute reduction. Then, an attribute recognition theoretical model and entropy method were combined to assess water quality in the Harbin reach of the Songhuajiang River in China. A dataset consisting of ten parameters was collected from January to October in 2012. Fuzzy rough set was applied to reduce the ten parameters to four parameters: BOD5, NH3-N, TP, and F. coli (Reduct A). Considering that DO is a usual parameter in water quality assessment, another reduct, including DO, BOD5, NH3-N, TP, TN, F, and F. coli (Reduct B), was obtained. The assessment results of Reduct B show a good consistency with those of Reduct A, and this means that DO is not always necessary to assess water quality. The results with attribute reduction are not exactly the same as those without attribute reduction, which can be attributed to the α value decided by subjective experience. The assessment results gained by the fuzzy rough set obviously reduce computational complexity, and are acceptable and reliable. The model proposed in this paper enhances the water quality assessment system. PMID:24675643

Investigating the Environmental Effects of Agriculture Practices on Natural Resources: Scientific Contributions of the U.S. Geological Survey to Enhance the Management of Agricultural Landscapes

USGS Publications Warehouse

,

2007-01-01

The U.S. Geological Survey (USGS) enhances and protects the quality of life in the United States by advancing scientific knowledge to facilitate effective management of hydrologic, biologic, and geologic resources. Results of selected USGS research and monitoring projects in agricultural landscapes are presented in this Fact Sheet. Significant environmental and social issues associated with agricultural production include changes in the hydrologic cycle; introduction of toxic chemicals, nutrients, and pathogens; reduction and alteration of wildlife habitats; and invasive species. Understanding environmental consequences of agricultural production is critical to minimize unintended environmental consequences. The preservation and enhancement of our natural resources can be achieved by measuring the success of improved management practices and by adjusting conservation policies as needed to ensure long-term protection.

Fostering the coexistence of caring philosophy and economics in today's health care system.

PubMed

Cara, Chantal M; Nyberg, Jan J; Brousseau, Sylvain

2011-01-01

For the past decade, several health care systems are undergoing continuous administrative restructuring, whose main objective is cost reduction. These changes often result in the patients' needs not being met because nurses are continuously affected by widespread budget cuts and staff downsizing. Have we reached a point, where we are setting aside our prime directive of patient well-being for the sake of finances? If so, are we at risk of forsaking our professional identity as nurses? The authors believe that caring management and economical constraints can coexist while promoting quality patient care. The purpose of this article is to show how nurse managers and administrators can facilitate caring practices while maintaining their financial responsibilities within the health care organization. This article suggests several strategies for assisting nurse managers in promoting caring in the health care environment.

Impact of fuel quality regulation and speed reductions on shipping emissions: implications for climate and air quality.

PubMed

Lack, Daniel A; Cappa, Christopher D; Langridge, Justin; Bahreini, Roya; Buffaloe, Gina; Brock, Charles; Cerully, Kate; Coffman, Derek; Hayden, Katherine; Holloway, John; Lerner, Brian; Massoli, Paola; Li, Shao-Meng; McLaren, Robert; Middlebrook, Ann M; Moore, Richard; Nenes, Athanasios; Nuaaman, Ibraheem; Onasch, Timothy B; Peischl, Jeff; Perring, Anne; Quinn, Patricia K; Ryerson, Tom; Schwartz, Joshua P; Spackman, Ryan; Wofsy, Steven C; Worsnop, Doug; Xiang, Bin; Williams, Eric

2011-10-15

Atmospheric emissions of gas and particulate matter from a large ocean-going container vessel were sampled as it slowed and switched from high-sulfur to low-sulfur fuel as it transited into regulated coastal waters of California. Reduction in emission factors (EFs) of sulfur dioxide (SO₂), particulate matter, particulate sulfate and cloud condensation nuclei were substantial (≥ 90%). EFs for particulate organic matter decreased by 70%. Black carbon (BC) EFs were reduced by 41%. When the measured emission reductions, brought about by compliance with the California fuel quality regulation and participation in the vessel speed reduction (VSR) program, are placed in a broader context, warming from reductions in the indirect effect of SO₄ would dominate any radiative changes due to the emissions changes. Within regulated waters absolute emission reductions exceed 88% for almost all measured gas and particle phase species. The analysis presented provides direct estimations of the emissions reductions that can be realized by California fuel quality regulation and VSR program, in addition to providing new information relevant to potential health and climate impact of reduced fuel sulfur content, fuel quality and vessel speed reductions.

Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients

PubMed Central

Benditz, Achim; Greimel, Felix; Auer, Patrick; Zeman, Florian; Göttermann, Antje; Grifka, Joachim; Meissner, Winfried; von Kunow, Frederik

2016-01-01

Background The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking. Methods All patients included in the study had undergone total hip arthroplasty (THA). Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project “Quality Improvement in Postoperative Pain Management” (QUIPS). A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward. Results From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0) on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2). Over time, the maximum pain score decreased (mean 3.0, ±2.0), whereas patient satisfaction significantly increased (mean 9.8, ±0.4; p<0.05). Among 49 anonymized hospitals, our clinic stayed on first rank in terms of lowest maximum pain and patient satisfaction over the period. Conclusion Results were already acceptable at the beginning of benchmarking a standardized pain management concept. But regular benchmarking, implementation of feedback mechanisms, and staff education made the pain management concept even more successful. Multidisciplinary teamwork and flexibility in adapting processes seem to be highly important for successful pain management. PMID:28031727

Reductions in cannabis use are associated with improvements in anxiety, depression, and sleep quality, but not quality of life.

PubMed

Hser, Yih-Ing; Mooney, Larissa J; Huang, David; Zhu, Yuhui; Tomko, Rachel L; McClure, Erin; Chou, Chih-Ping; Gray, Kevin M

2017-10-01

This study examined the longitudinal association between reductions in cannabis use and changes in anxiety, depression, sleep quality, and quality of life. Secondary analyses were conducted based on data from a cannabis use disorder medication trial in 302 adults (ages 18-50). Changes in symptoms of anxiety and depression, sleep quality, and quality of life were assessed in relation to changes in cannabis use during the 12-week trial of treatment. Based on the slope of individual cannabis use trajectory, the sample was classified into two groups (Cannabis Use Reduction, n=152 vs. Cannabis Use Increase, n=150) which was included as a binary covariate in subsequent modeling. Controlling for demographics (age, gender, race/ethnicity), treatment condition, and time-varying tobacco and alcohol use, separate latent growth curve models showed a significant association between the Cannabis Use Reduction group and improvement (i.e., lower values in slope) in anxiety (β=-0.09, SE=0.04; p<0.05), depression (β=-0.11, SE=0.04; p<0.01), and sleep quality (β=-0.07, SE=0.03; p<0.05) over the observation period, but not in quality of life. These results indicate a longitudinal relationship between reductions in cannabis use and improvements in anxiety, depression, and sleep quality. Clinicians treating patients with co-occurring cannabis use and problems with anxiety, depression, or sleep quality should attend to cannabis use reduction as a component of treatment. Copyright © 2017 Elsevier Inc. All rights reserved.

Translating a National Laboratory Strategic Plan into action through SLMTA in a district hospital laboratory in Botswana.

PubMed

Ntshambiwa, Keoratile; Ntabe-Jagwer, Winnie; Kefilwe, Chandapiwa; Samuel, Fredrick; Moyo, Sikhulile

2014-01-01

The Ministry of Health (MOH) of Botswana adopted Strengthening Laboratory Management Toward Accreditation (SLMTA), a structured quality improvement programme, as a key tool for the implementation of quality management systems in its public health laboratories. Coupled with focused mentorship, this programme aimed to help MOH achieve the goals of the National Laboratory Strategic Plan to provide quality and timely clinical diagnoses. This article describes the impact of implementing SLMTA in Sekgoma Memorial Hospital Laboratory (SMHL) in Serowe, Botswana. SLMTA implementation in SMHL included trainings, improvement projects, site visits and focused mentorship. To measure progress, audits using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist were conducted at baseline and exit of the programme, with scores corresponding to a zero- to five-star scale. Turnaround times, customer satisfaction, and several other health service indicators were tracked. The laboratory scored 53% (zero stars) at the baseline audit and 80% (three stars) at exit. Nearly three years later, the laboratory scored 85% (four stars) in an official audit conducted by the African Society for Laboratory Medicine. Turnaround times became shorter after SLMTA implementation, with reductions ranging 19% to 52%; overall patient satisfaction increased from 56% to 73%; and clinician satisfaction increased from 41% to 72%. Improvements in inventory management led to decreases in discarded reagents, reducing losses from US $18 000 in 2011 to $40 in 2013. The SLMTA programme contributed to enhanced performance of the laboratory, which in turn yielded potential positive impacts for patient care at the hospital.

Implementing a voluntary, nonregulatory approach to nitrogen management in Tampa Bay, FL: a public/private partnership.

PubMed

Greening, H; DeGrove, B D

2001-11-14

Participants in the Tampa Bay Estuary Program have agreed to adopt nitrogen-loading targets for Tampa Bay based on the water-quality and related light requirements of underwater seagrasses. Based on modeling results, it appears that light levels can be maintained at necessary levels by "holding the line" at existing nitrogen loadings; however, this goal may be difficult to achieve given the 20% increase in the watershed"s human population and associated 7% increase in nitrogen loading that are projected to occur over the next 20 years. To address the long-term management of nitrogen sources, a nitrogen management consortium of local electric utilities, industries, and agricultural interests, as well as local governments and regulatory agency representatives, has developed a consortium action plan to address the target load reduction needed to "hold the line" at 1992 to 1994 levels. To date, implemented and planned projects collated in the Consortium Action Plan meet and exceed the agreed-upon nitrogen-loading reduction goal. An example of the success of the private partnership aspect of this program can be seen in three phosphate fertilizer mining and manufacturing companies with facilities located on Tampa Bay. These companies are participants in the Estuary Program and the Nitrogen Management Consortium to provide support and input for a program that advocates voluntary, nonregulatory cooperation to reach environmental goals.

Spatio-temporal effects of low impact development practices

NASA Astrophysics Data System (ADS)

Gilroy, Kristin L.; McCuen, Richard H.

2009-04-01

SummaryThe increase in land development and urbanization experienced in the US and worldwide is causing environmental degradation. Traditional off-site stormwater management does not protect small streams. To mitigate the negative effects of land development, best management practices (BMPs) are being implemented into stormwater management policies for the purposes of controlling minor flooding and improving water quality. Unfortunately, the effectiveness of BMPs has not been extensively studied. The purpose of this research was to analyze the effects of both location and quantity of two types of BMPs: cisterns and bioretention pits. A spatio-temporal model of a microwatershed was developed to determine the effects of BMPs on single-family, townhome, and commercial lots. The effects of development and the BMPs on peak runoff rates and volumes were compared to pre-development conditions. The results show that cisterns alone are capable of controlling rooftop runoff for small storms. Both the spatial location and the volume of BMP storage on a microwatershed influences the effectiveness of BMPs. The volume of BMP storage is positively correlated to the percent reduction in the peak discharge rate and total runoff volume; however, location is a factor in the peak reduction and a maximum volume of effective storage for both hydrologic metrics does exist. These results provide guidelines for developing stormwater management policies that can potentially reduce pollution of first-order streams, lower the cost and maintenance requirements, enhance aesthetics, and increase safety.

Bed management team with Kanban web-based application.

PubMed

Rocha, Hermano Alexandre Lima; Santos, Ana Kelly Lima da Cruz; Alcântara, Antônia Celia de Castro; Lima, Carmen Sulinete Suliano da Costa; Rocha, Sabrina Gabriele Maia Oliveira; Cardoso, Roberto Melo; Cremonin, Jair Rodrigues

2018-05-15

To measure the effectiveness of the bed management process that uses a web-based application with Kanban methodology to reduce hospitalization time of hospitalized patients. Before-after study was performed. The study was conducted between July 2013 and July 2017, at the Unimed Regional Hospital of Fortaleza, which has 300 beds, of which 60 are in the intensive care unit (ICU). It is accredited by International Society for Quality in Healthcare. Patients hospitalized in the referred period. Bed management with an application that uses color logic to signal at which stage of high flow the patients meet, in which each patient is interpreted as a card of the classical Kanban theory. It has an automatic user signaling system for process movement, and a system for monitoring and analyzing discharge forecasts. Length of hospital stay, number of customer complaints related to bed availability. After the intervention, the hospital's overall hospital stay time was reduced from 5.6 days to 4.9 days (P = 0.001). The units with the greatest reduction were the ICUs, with reduction from 6.0 days to 2.0 (P = 0.001). The relative percentage of complaints regarding bed availability in the hospital fell from 27% to 0%. We conclude that the use of an electronic tool based on Kanban methodology and accessed via the web by a bed management team is effective in reducing patients' hospital stay time.

Waterbird habitat in California's Central Valley basins under climate, urbanization, and water management scenarios

USGS Publications Warehouse

Matchett, Elliott L.; Fleskes, Joseph

2018-01-01

California's Central Valley provides critical, but threatened habitat and food resources for migrating and wintering waterfowl, shorebirds, and other waterbirds. The Central Valley is comprised of nine basins that were defined by the Central Valley Joint Venture (CVJV) to assist in conservation planning. Basins vary in composition and extent of habitats, which primarily include croplands and wetlands that rely on water supplies shared with other competing human and environmental uses. Changes in climate, urban development, and water supply management are uncertain and could reduce future availability of water supplies supporting waterbird habitats and limit effectiveness of wetland restoration planned by the CVJV to support wintering waterbirds. We modeled 17 plausible scenarios including combinations of three climate projections, three urbanization rates, and five water supply management options to promote agricultural and urban water uses, with and without wetland restoration. Our research examines the reduction in quantity and quality of habitats during the fall migration-wintering period by basin under each scenario, and the efficacy of planned wetland restoration to compensate reductions in flooded areas of wetland habitats. Scenario combinations of projected climate, urbanization, and water supply management options reduced availability of flooded cropland and wetland habitats during fall-winter and degraded the quality of seasonal wetlands (i.e., summer-irrigation for improved forage production), though the extent and frequency of impacts varied by basin. Planned wetland restoration may substantially compensate for scenario-related effects on wetland habitats in each basin. However, results indicate that Colusa, Butte, Sutter, San Joaquin, and Tulare Basins may require additional conservation to support summer-irrigation of seasonal wetlands and winter-flooding of cropland habitats. Still further conservation may be required to provide sufficient areas of flooded seasonal and semi-permanent wetlands in San Joaquin and Tulare Basins during fall-winter. The main objective of this research is to provide decision-support for achieving waterbird conservation goals in the valley and to inform CVJV's regional conservation planning.

Eurasian beaver activity increases water storage, attenuates flow and mitigates diffuse pollution from intensively-managed grasslands.

PubMed

Puttock, Alan; Graham, Hugh A; Cunliffe, Andrew M; Elliott, Mark; Brazier, Richard E

2017-01-15

Beavers are the archetypal keystone species, which can profoundly alter ecosystem structure and function through their ecosystem engineering activity, most notably the building of dams. This can have a major impact upon water resource management, flow regimes and water quality. Previous research has predominantly focused on the activities of North American beaver (Castor canadensis) located in very different environments, to the intensive lowland agricultural landscapes of the United Kingdom and elsewhere in Europe. Two Eurasian beavers (Castor fiber) were introduced to a wooded site, situated on a first order tributary, draining from intensively managed grassland. The site was monitored to understand impacts upon water storage, flow regimes and water quality. Results indicated that beaver activity, primarily via the creation of 13 dams, has increased water storage within the site (holding ca. 1000m 3 in beaver ponds) and beavers were likely to have had a significant flow attenuation impact, as determined from peak discharges (mean 30±19% reduction), total discharges (mean 34±9% reduction) and peak rainfall to peak discharge lag times (mean 29±21% increase) during storm events. Event monitoring of water entering and leaving the site showed lower concentrations of suspended sediment, nitrogen and phosphate leaving the site (e.g. for suspended sediment; average entering site: 112±72mgl -1 , average leaving site: 39±37mgl -1 ). Combined with attenuated flows, this resulted in lower diffuse pollutant loads in water downstream. Conversely, dissolved organic carbon concentrations and loads downstream were higher. These observed changes are argued to be directly attributable to beaver activity at the site which has created a diverse wetland environment, reducing downstream hydrological connectivity. Results have important implications for beaver reintroduction programs which may provide nature based solutions to the catchment-scale water resource management issues that are faced in agricultural landscapes. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Toward a high-performance management system in health care, part 4: Using high-performance work practices to prevent central line-associated blood stream infections-a comparative case study.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer; Robbins, Julie; Garman, Andrew N

2016-01-01

Central line-associated bloodstream infections (CLABSIs) are among the most harmful health care-associated infections and a major patient safety concern. Nationally, CLABSI rates have been reduced through the implementation of evidence-based interventions; thus far, however, hospitals still differ substantially in their success implementing these practices. Prior research on high-performance work practices (HPWPs) suggests that these practices may explain some of the differences health systems experience in the success of their quality improvement efforts; however, these relationships have not yet been systematically investigated. In this study, we sought to explore the potential role HPWPs may play in explaining differences in the success of CLABSI reduction efforts involving otherwise similar organizations and approaches. To form our sample, we identified eight hospitals participating in the federally funded "On the CUSP: Stop BSI" initiative. This sample included four hospital "pairs" matched on organizational characteristics (e.g., state, size, teaching status) but having reported contrasting CLABSI reduction outcomes. We collected data through site visits as well as 194 key informant interviews, which were framed using an evidence-informed model of health care HPWPs. We found evidence that, at higher performing sites, HPWPs facilitated the adoption and consistent application of practices known to prevent CLABSIs; these HPWPs were virtually absent at lower performing sites. We present examples of management practices and illustrative quotes categorized into four HPWP subsystems: (a) staff engagement, (b) staff acquisition/development, (c) frontline empowerment, and (d) leadership alignment/development. We present the HPWP model as an organizing framework that can be applied to facilitate quality and patient safety efforts in health care. Managers and senior leaders can use these four HPWP subsystems to select, prioritize, and communicate about management practices critical to the success of their CLABSI prevention efforts.

Stress management and mind-body medicine: a randomized controlled longitudinal evaluation of students' health and effects of a behavioral group intervention at a middle-size German university (SM-MESH).

PubMed

Esch, Tobias; Sonntag, Ulrike; Esch, Sonja Maren; Thees, Stefanie

2013-01-01

Student life can be stressful. Hence, we started a regular mind-body medical stress management program in 2006. By today, more than 500 students took part and evaluations showed significant results, especially with regard to a reduction of stress warning signals. For further analysis, we now decided to run a randomized controlled longitudinal trial. Participating students at Coburg University were randomized into an intervention (n = 24) or a waitlist control group (n = 19). The intervention group completed 3 sets (pre/post/follow-up) and the control group 2 sets (pre/post) of self-administered questionnaires. The questionnaires included: SF-12 Health Survey, Perceived Stress Scale (PSS), Sense of Coherence (SOC-L9), Visual Analogue Scale (VAS) concerning stress, and the Stress Warning Signs (SWS) scale. Randomly selected participants of the intervention group were also queried in qualitative interviews. The intervention consisted of an 8 week stress management group program (mind-body medical stress reduction - MBMSR). Follow-up measures were taken after 6 months. Virtually, no drop-out occurred. Our study showed significant effects in the intervention group concerning SF-12 Mental Component Scale (p = 0.05), SF-12 Physical Component Scale (p = 0.001), VAS (in general, p = 0.001) and SWS (emotional reactions, p <0.001), underlined by qualitative results, which showed a higher quality of life. The effectiveness of an MBMSR program in a group of supposedly healthy students could be demonstrated. Findings suggest that stress management might be given importance at universities that care for the performance, the quality of life, and stress-health status of their students, acknowledging and accounting for the challenging circumstances of university life, as well as the specific needs of the modern student population. Copyright © 2013 S. Karger AG, Basel.

Leveraging lean principles in creating a comprehensive quality program: The UCLA health readmission reduction initiative.

PubMed

Afsar-Manesh, Nasim; Lonowski, Sarah; Namavar, Aram A

2017-12-01

UCLA Health embarked to transform care by integrating lean methodology in a key clinical project, Readmission Reduction Initiative (RRI). The first step focused on assembling a leadership team to articulate system-wide priorities for quality improvement. The lean principle of creating a culture of change and accountability was established by: 1) engaging stakeholders, 2) managing the process with performance accountability, and, 3) delivering patient-centered care. The RRI utilized three major lean principles: 1) A3, 2) root cause analyses, 3) value stream mapping. Baseline readmission rate at UCLA from 9/2010-12/2011 illustrated a mean of 12.1%. After the start of the RRI program, for the period of 1/2012-6/2013, the readmission rate decreased to 11.3% (p<0.05). To impact readmissions, solutions must evolve from smaller service- and location-based interventions into strategies with broader approach. As elucidated, a systematic clinical approach grounded in lean methodologies is a viable solution to this complex problem. Copyright © 2017 Elsevier Inc. All rights reserved.

Use of Weighted Regressions on Time, Discharge, and Season to Assess Effectiveness of Agricultural and Environmental Best Management Practices in California and Nevada, USA

NASA Astrophysics Data System (ADS)

Domagalski, J. L.; Schlegel, B.; Hutchins, J.

2014-12-01

Long-term data sets on stream-water quality and discharge can be used to assess whether best management practices (BMPs) are restoring beneficial uses of impaired water as required under the Clean Water Act. In this study, we evaluated a greater than 20-year record of water quality from selected streams in the Central Valley (CV) of California and Lake Tahoe (California and Nevada, USA). The CV contains a mix of agricultural and urbanized land, while the Lake Tahoe area is mostly forested, with seasonal residents and tourism. Because nutrients and fine sediments cause a reduction in water clarity that impair Lake Tahoe, BMPs were implemented in the early 1990's, to reduce nitrogen and phosphorus loads. The CV does not have a current nutrient management plan, but numerous BMPs exist to reduce pesticide loads, and it was hypothesized that these programs could also reduce nutrient levels. In the CV and Lake Tahoe areas, nutrient concentrations, loads, and trends were estimated by using the recently developed Weighted Regressions on Time, Discharge, and Season (WRTDS) model. Sufficient data were available to compare trends during a voluntary and enforcement period for seven CV sites within the lower Sacramento and San Joaquin Basins. For six of the seven sites, flow-normalized mean annual concentrations of total phosphorus and nitrate decreased at a faster rate during the enforcement period than during the earlier voluntary period. Concentration changes during similar years and ranges of flow conditions suggest that BMPs designed for pesticides also reduced nutrient loads in the CV. A trend analysis using WRTDS was completed for six streams that enter Lake Tahoe during the late 1980's through 2008. The results of the model confirm that nutrient loading is influenced strongly by season, such as by spring runoff from snowmelt. The highest nutrient concentrations in the late 1980's and early 1990's correlate with high flows, followed by statistically significant decreases in loading from most streams under different flow conditions. The results of the WRTDS model indicate a clear reduction in nutrient loading of nitrogen and phosphorus in all six streams. However, some streams show an increase in nutrient concentrations after 2000, suggesting the possible need for changes to the nutrient reduction management practices.

Educational interventions for the management of cancer-related fatigue in adults.

PubMed

Bennett, Sally; Pigott, Amanda; Beller, Elaine M; Haines, Terry; Meredith, Pamela; Delaney, Christie

2016-11-24

Cancer-related fatigue is reported as the most common and distressing symptom experienced by patients with cancer. It can exacerbate the experience of other symptoms, negatively affect mood, interfere with the ability to carry out everyday activities, and negatively impact on quality of life. Educational interventions may help people to manage this fatigue or to cope with this symptom, and reduce its overall burden. Despite the importance of education for managing cancer-related fatigue there are currently no systematic reviews examining this approach. To determine the effectiveness of educational interventions for managing cancer-related fatigue in adults. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, OTseeker and PEDro up to 1st November 2016. We also searched trials registries. We included randomised controlled trials (RCTs) of educational interventions focused on cancer-related fatigue where fatigue was a primary outcome. Studies must have aimed to evaluate the effect of educational interventions designed specifically to manage cancer-related fatigue, or to evaluate educational interventions targeting a constellation of physical symptoms or quality of life where fatigue was the primary focus. The studies could have compared educational interventions with no intervention or wait list controls, usual care or attention controls, or an alternative intervention for cancer-related fatigue in adults with any type of cancer. Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. Trial authors were contacted for additional information. A third independent person checked the data extraction. The main outcome considered in this review was cancer-related fatigue. We assessed the evidence using GRADE and created a 'Summary of Findings' table. We included 14 RCTs with 2213 participants across different cancer diagnoses. Four studies used only 'information-giving' educational strategies, whereas the remainder used mainly information-giving strategies coupled with some problem-solving, reinforcement, or support techniques. Interventions differed in delivery including: mode of delivery (face to face, web-based, audiotape, telephone); group or individual interventions; number of sessions provided (ranging from 2 to 12 sessions); and timing of intervention in relation to completion of cancer treatment (during or after completion). Most trials compared educational interventions to usual care and meta-analyses compared educational interventions to usual care or attention controls. Methodological issues that increased the risk of bias were evident including lack of blinding of outcome assessors, unclear allocation concealment in over half of the studies, and generally small sample sizes. Using the GRADE approach, we rated the quality of evidence as very low to moderate, downgraded mainly due to high risk of bias, unexplained heterogeneity, and imprecision.There was moderate quality evidence of a small reduction in fatigue intensity from a meta-analyses of eight studies (1524 participants; standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.52 to -0.04) comparing educational interventions with usual care or attention control. We found low quality evidence from twelve studies (1711 participants) that educational interventions had a small effect on general/overall fatigue (SMD -0.27, 95% CI -0.51 to -0.04) compared to usual care or attention control. There was low quality evidence from three studies (622 participants) of a moderate size effect of educational interventions for reducing fatigue distress (SMD -0.57, 95% CI -1.09 to -0.05) compared to usual care, and this could be considered clinically significant. Pooled data from four studies (439 participants) found a small reduction in fatigue interference with daily life (SMD -0.35, 95% CI -0.54 to -0.16; moderate quality evidence). No clear effects on fatigue were found related to type of cancer treatment or timing of intervention in relation to completion of cancer treatment, and there were insufficient data available to determine the effect of educational interventions on fatigue by stage of disease, tumour type or group versus individual intervention.Three studies (571 participants) provided low quality evidence for a reduction in anxiety in favour of the intervention group (mean difference (MD) -1.47, 95% CI -2.76 to -0.18) which, for some, would be considered clinically significant. Two additional studies not included in the meta-analysis also reported statistically significant improvements in anxiety in favour of the educational intervention, whereas a third study did not. Compared with usual care or attention control, educational interventions showed no significant reduction in depressive symptoms (four studies, 881 participants, SMD -0.12, 95% CI -0.47 to 0.23; very low quality evidence). Three additional trials not included in the meta-analysis found no between-group differences in the symptoms of depression. No between-group difference was evident in the capacity for activities of daily living or physical function when comparing educational interventions with usual care (4 studies, 773 participants, SMD 0.33, 95% CI -0.10 to 0.75) and the quality of evidence was low. Pooled evidence of low quality from two of three studies examining the effect of educational interventions compared to usual care found an improvement in global quality of life on a 0-100 scale (MD 11.47, 95% CI 1.29 to 21.65), which would be considered clinically significant for some.No adverse events were reported in any of the studies. Educational interventions may have a small effect on reducing fatigue intensity, fatigue's interference with daily life, and general fatigue, and could have a moderate effect on reducing fatigue distress. Educational interventions focused on fatigue may also help reduce anxiety and improve global quality of life, but it is unclear what effect they might have on capacity for activities of daily living or depressive symptoms. Additional studies undertaken in the future are likely to impact on our confidence in the conclusions.The incorporation of education for the management of fatigue as part of routine care appears reasonable. However, given the complex nature of this symptom, educational interventions on their own are unlikely to optimally reduce fatigue or help people manage its impact, and should be considered in conjunction with other interventions. Just how educational interventions are best delivered, and their content and timing to maximise outcomes, are issues that require further research.

Evaluating the effectiveness of management practices on hydrology and water quality at watershed scale with a rainfall-runoff model.

PubMed

Liu, Yaoze; Bralts, Vincent F; Engel, Bernard A

2015-04-01

The adverse influence of urban development on hydrology and water quality can be reduced by applying best management practices (BMPs) and low impact development (LID) practices. This study applied green roof, rain barrel/cistern, bioretention system, porous pavement, permeable patio, grass strip, grassed swale, wetland channel, retention pond, detention basin, and wetland basin, on Crooked Creek watershed. The model was calibrated and validated for annual runoff volume. A framework for simulating BMPs and LID practices at watershed scales was created, and the impacts of BMPs and LID practices on water quantity and water quality were evaluated with the Long-Term Hydrologic Impact Assessment-Low Impact Development 2.1 (L-THIA-LID 2.1) model for 16 scenarios. The various levels and combinations of BMPs/LID practices reduced runoff volume by 0 to 26.47%, Total Nitrogen (TN) by 0.30 to 34.20%, Total Phosphorus (TP) by 0.27 to 47.41%, Total Suspended Solids (TSS) by 0.33 to 53.59%, Lead (Pb) by 0.30 to 60.98%, Biochemical Oxygen Demand (BOD) by 0 to 26.70%, and Chemical Oxygen Demand (COD) by 0 to 27.52%. The implementation of grass strips in 25% of the watershed where this practice could be applied was the most cost-efficient scenario, with cost per unit reduction of $1m3/yr for runoff, while cost for reductions of two pollutants of concern was $445 kg/yr for Total Nitrogen (TN) and $4871 kg/yr for Total Phosphorous (TP). The scenario with very high levels of BMP and LID practice adoption (scenario 15) reduced runoff volume and pollutant loads from 26.47% to 60.98%, and provided the greatest reduction in runoff volume and pollutant loads among all scenarios. However, this scenario was not as cost-efficient as most other scenarios. The L-THIA-LID 2.1 model is a valid tool that can be applied to various locations to help identify cost effective BMP/LID practice plans at watershed scales. Copyright © 2014 Elsevier B.V. All rights reserved.

Does topical wound oxygen (TWO2) offer an improved outcome over conventional compression dressings (CCD) in the management of refractory venous ulcers (RVU)? A parallel observational comparative study.

PubMed

Tawfick, W; Sultan, S

2009-07-01

Topical wound oxygen (TWO(2)) may help wound healing in the management of refractory venous ulcers (RVU). The aim of this study was to measure the effect of TWO(2) on wound healing using the primary end-point of the proportion of ulcers healed at 12 weeks. Secondary end-points were time to full healing, percentage of reduction in ulcer size, pain reduction, recurrence rates and Quality-Adjusted Time Spent Without Symptoms of disease and Toxicity of Treatment (Q-TWiST). A parallel observational comparative study. Patients with CEAP C(6,s) RVU, assessed by duplex ultrasonography, were managed with either TWO(2) (n=46) or conventional compression dressings (CCD) (n=37) for 12 weeks or till full healing. Patients were followed up at 3 monthly intervals. At 12 weeks, 80% of TWO(2) managed ulcers were completely healed, compared to 35% of CCD ulcers (p<0.0001). Median time to full healing was 45 days in TWO(2) patients and 182 days in CCD patients (p<0.0001). The pain score threshold in TWO(2) managed patients improved from 8 to 3 by 13 days. After 12-month follow-up, 5 of the 13 healed CCD ulcers showed signs of recurrence compared to none of the 37 TWO(2) healed ulcers. TWO(2) patients experienced a significantly improved Q-TWiST. TWO(2) reduces recurrence rates, alleviates pain and improves the Q-TWiST. We believe it is a valuable tool in the armamentarium of management of RVU.

A pilot mixed-methods evaluation of MS INFoRm: a self-directed fatigue management resource for individuals with multiple sclerosis.

PubMed

Akbar, Nadine; Turpin, Karen; Petrin, Julie; Smyth, Penny; Finlayson, Marcia

2018-06-01

Fatigue management interventions for individuals with multiple sclerosis (MS) often feature structured programmes requiring repeated, in-person attendance that is not possible for all individuals. We sought to determine whether MS INFoRm, a self-directed fatigue management resource for individuals with MS, was worth further, more rigorous evaluation. Our indicators of worthiness were actual use of the resource by participants over 3 months, reductions in fatigue impact and increases in self-efficacy, and participant reports of changes in fatigue management knowledge and behaviours. This was a single-group, mixed-methods, before-after pilot study in individuals with MS reporting mild to moderate fatigue. Thirty-five participants were provided with MS INFoRm by a USB flash drive to use at home for 3 months, on their own volition. Twenty-three participants completed all standardized questionnaires, semi-structured interviews and study process measures. Participants reported actively using MS INFoRm over the 3-month study period (median total time spent using MS INFoRm=315 min) as well as significantly lower overall fatigue impact (Modified Fatigue Impact Scale: t=2.6, P=0.01), increased knowledge of MS fatigue (z=-2.8, P=0.01) and greater confidence in managing MS fatigue (z=-3.3, P=0.001). Individuals with significant reductions in fatigue impact also reported behavioural changes including tracking fatigue, better communication with others, greater awareness, improved quality of life and being more proactive. This study provides evidence that further rigorous evaluation of MS INFoRm, a self-directed resource for managing fatigue, is worth pursuing.

The experience factory: Can it make you a 5? or what is its relationship to other quality and improvement concepts?

NASA Technical Reports Server (NTRS)

Basili, Victor R.

1992-01-01

The concepts of quality improvements have permeated many businesses. It is clear that the nineties will be the quality era for software and there is a growing need to develop or adapt quality improvement approaches to the software business. Thus we must understand software as an artifact and software as a business. Since the business we are dealing with is software, we must understand the nature of software and software development. The software discipline is evolutionary and experimental; it is a laboratory science. Software is development not production. The technologies of the discipline are human based. There is a lack of models that allow us to reason about the process and the product. All software is not the same; process is a variable, goals are variable, etc. Packaged, reusable, experiences require additional resources in the form of organization, processes, people, etc. There have been a variety of organizational frameworks proposed to improve quality for various businesses. The ones discussed in this presentation include: Plan-Do-Check-Act, a quality improvement process based upon a feedback cycle for optimizing a single process model/production line; the Experience Factory/Quality Improvement Paradigm, continuous improvements through the experimentation, packaging, and reuse of experiences based upon a business's needs; Total Quality Management, a management approach to long term success through customer satisfaction based on the participation of all members of an organization; the SEI capability maturity model, a staged process improvement based upon assessment with regard to a set of key process areas until you reach a level 5 which represents a continuous process improvement; and Lean (software) Development, a principle supporting the concentration of the production on 'value added' activities and the elimination of reduction of 'not value added' activities.

41 CFR 102-80.55 - Are Federal agencies responsible for managing the execution of risk reduction projects?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Risks and Risk Reduction Strategies § 102-80.55 Are Federal agencies responsible for managing the... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Are Federal agencies responsible for managing the execution of risk reduction projects? 102-80.55 Section 102-80.55 Public...

Health economic evaluation of an infection prevention and control program: are quality and patient safety programs worth the investment?

PubMed

Raschka, Stefanie; Dempster, Linda; Bryce, Elizabeth

2013-09-01

The effect of regional consolidation of an infection prevention and control (IPC) program on reduction of selected health care-acquired infections (HAIs), the economic burden of these illnesses, and where the potential for greatest financial benefit in reducing infection rates lies was assessed. Cost-benefit analysis (in Canadian $) was used to evaluate the effectiveness of a regional IPC program in preventing incident cases of HAIs. The costs of managing these infections, as well as the operational costs of the IPC program were compared against reductions in HAI rates over a 4-year period. Benefits were calculated as cost avoided by reducing HAI cases year over year. The Health Authority spent more than $66.3 million managing 24,937 HAI cases over the 4-year evaluation period. Urinary tract infections, methicillin-resistant Staphylococcus aureus, and bacteremias incurred the greatest costs. A reduction of 4,739 HAI cases led to avoided costs of $9.1 million in 4 years; the IPC program budget was $6.7 million during this period. Regionalization of the IPC program with standardized policies, procedures, and initiatives led to a 19% reduction in selected HAIs over 4 years and a cost avoidance of at least $9 million. This was particularly evident in years 3 and 4 of the program when $7.2 million (79% of the total) savings were realized. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Evaluating changes in water quality with respect to nonpoint source nutrient management strategies in the Chesapeake Bay Watershed

NASA Astrophysics Data System (ADS)

Keisman, J.; Sekellick, A.; Blomquist, J.; Devereux, O. H.; Hively, W. D.; Johnston, M.; Moyer, D.; Sweeney, J.

2014-12-01

Chesapeake Bay is a eutrophic ecosystem with periodic hypoxia and anoxia, algal blooms, diminished submerged aquatic vegetation, and degraded stocks of marine life. Knowledge of the effectiveness of actions taken across the watershed to reduce nitrogen (N) and phosphorus (P) loads to the bay (i.e. "best management practices" or BMPs) is essential to its restoration. While nutrient inputs from point sources (e.g. wastewater treatment plants and other industrial and municipal operations) are tracked, inputs from nonpoint sources, including atmospheric deposition, farms, lawns, septic systems, and stormwater, are difficult to measure. Estimating reductions in nonpoint source inputs attributable to BMPs requires compilation and comparison of data on water quality, climate, land use, point source discharges, and BMP implementation. To explore the relation of changes in nonpoint source inputs and BMP implementation to changes in water quality, a subset of small watersheds (those containing at least 10 years of water quality monitoring data) within the Chesapeake Watershed were selected for study. For these watersheds, data were compiled on geomorphology, demographics, land use, point source discharges, atmospheric deposition, and agricultural practices such as livestock populations, crop acres, and manure and fertilizer application. In addition, data on BMP implementation for 1985-2012 were provided by the Environmental Protection Agency Chesapeake Bay Program Office (CBPO) and the U.S. Department of Agriculture. A spatially referenced nonlinear regression model (SPARROW) provided estimates attributing N and P loads associated with receiving waters to different nutrient sources. A recently developed multiple regression technique ("Weighted Regressions on Time, Discharge and Season" or WRTDS) provided an enhanced understanding of long-term trends in N and P loads and concentrations. A suite of deterministic models developed by the CBPO was used to estimate expected nutrient load reductions attributable to BMPs. Further quantification of the relation of land-based nutrient sources and BMPs to water quality in the bay and its tributaries must account for inconsistency in BMP data over time and uncertainty regarding BMP locations and effectiveness.

The potential impact of accountable care organizations with respect to cost and quality with special attention to imaging.

PubMed

Mukherji, Suresh K

2014-04-01

An accountable care organization is a form of a managed care organization in which a group of networked health care providers, which may include hospitals, group practices, networks of practices, hospital-provider partnerships, or joint ventures, are accountable for the health care of a defined group of patients. Initial results of the institutions participating in CMS's Physician Group Demonstration Project did not demonstrate a substantial reduction in imaging that could be directly attributed to the accountable care organization model. However, the initial results suggest that incentive-based methodology appears to be successful for increasing compliance for measuring quality metrics. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

A comparison of alternative strategies for cost-effective water quality management in lakes.

PubMed

Kramer, Daniel Boyd; Polasky, Stephen; Starfield, Anthony; Palik, Brian; Westphal, Lynne; Snyder, Stephanie; Jakes, Pamela; Hudson, Rachel; Gustafson, Eric

2006-09-01

Roughly 45% of the assessed lakes in the United States are impaired for one or more reasons. Eutrophication due to excess phosphorus loading is common in many impaired lakes. Various strategies are available to lake residents for addressing declining lake water quality, including septic system upgrades and establishing riparian buffers. This study examines 25 lakes to determine whether septic upgrades or riparian buffers are a more cost-effective strategy to meet a phosphorus reduction target. We find that riparian buffers are the more cost-effective strategy in every case but one. Large transaction costs associated with the negotiation and monitoring of riparian buffers, however, may be prohibiting lake residents from implementing the most cost-effective strategy.

Virtual reality and medicine--from the cockpit to the operating room: are we there yet?

PubMed

Saied, Nahel

2005-01-01

Teaching medicine to medical students, physicians in training and nurses is a challenging task that has remained unchanged for decades. The airline industry has achieved a great deal of safety and quality in a technically challenging environment. Many believe that their outstanding achievement is due to team training and crew resource management using simulators and dedicated training programs. Many experts in the medical profession believe that adopting the same strategies in teaching medical students and trainees could achieve significant reductions in medical errors and improve the quality of patient care. This article explores the role of teaching medicine using virtual reality in a multitude of medical specialties and outlines the use of simulation training at Saint Louis University.

A Comparison of Alternative Strategies for Cost-Effective Water Quality Management in Lakes

NASA Astrophysics Data System (ADS)

Kramer, Daniel Boyd; Polasky, Stephen; Starfield, Anthony; Palik, Brian; Westphal, Lynne; Snyder, Stephanie; Jakes, Pamela; Hudson, Rachel; Gustafson, Eric

2006-09-01

Roughly 45% of the assessed lakes in the United States are impaired for one or more reasons. Eutrophication due to excess phosphorus loading is common in many impaired lakes. Various strategies are available to lake residents for addressing declining lake water quality, including septic system upgrades and establishing riparian buffers. This study examines 25 lakes to determine whether septic upgrades or riparian buffers are a more cost-effective strategy to meet a phosphorus reduction target. We find that riparian buffers are the more cost-effective strategy in every case but one. Large transaction costs associated with the negotiation and monitoring of riparian buffers, however, may be prohibiting lake residents from implementing the most cost-effective strategy.

The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD) in primary care

PubMed Central

de Lusignan, Simon; Gallagher, Hugh; Chan, Tom; Thomas, Nicki; van Vlymen, Jeremy; Nation, Michael; Jain, Neerja; Tahir, Aumran; du Bois, Elizabeth; Crinson, Iain; Hague, Nigel; Reid, Fiona; Harris, Kevin

2009-01-01

Background Chronic kidney disease (CKD) is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP) control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression Design Cluster randomised controlled trial (CRT) Methods This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices) powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small group of practices (n = 4) will take part in an in-depth process evaluation. We will use time series data to examine the natural history of CKD in the community. Finally, we will conduct an economic evaluation based on a comparison of the cost effectiveness of each intervention. Clinical Trials Registration ISRCTN56023731. ClinicalTrials.gov identifier. PMID:19602233

In-situ sequential laser transfer and laser reduction of graphene oxide films

NASA Astrophysics Data System (ADS)

Papazoglou, S.; Petridis, C.; Kymakis, E.; Kennou, S.; Raptis, Y. S.; Chatzandroulis, S.; Zergioti, I.

2018-04-01

Achieving high quality transfer of graphene on selected substrates is a priority in device fabrication, especially where drop-on-demand applications are involved. In this work, we report an in-situ, fast, simple, and one step process that resulted in the reduction, transfer, and fabrication of reduced graphene oxide-based humidity sensors, using picosecond laser pulses. By tuning the laser illumination parameters, we managed to implement the sequential printing and reduction of graphene oxide flakes. The overall process lasted only a few seconds compared to a few hours that our group has previously published. DC current measurements, X-Ray Photoelectron Spectroscopy, X-Ray Diffraction, and Raman Spectroscopy were employed in order to assess the efficiency of our approach. To demonstrate the applicability and the potential of the technique, laser printed reduced graphene oxide humidity sensors with a limit of detection of 1700 ppm are presented. The results demonstrated in this work provide a selective, rapid, and low-cost approach for sequential transfer and photochemical reduction of graphene oxide micro-patterns onto various substrates for flexible electronics and sensor applications.

Specialized Community-Based Care: An Evidence-Based Analysis

PubMed Central

2012-01-01

Background Specialized community-based care (SCBC) refers to services that manage chronic illness through formalized links between primary and specialized care. Objectives The objectives of this evidence-based analysis (EBA) were as follows: to summarize the literature on SCBC, also known as intermediate care to synthesize the evidence from previous Medical Advisory Secretariat (now Health Quality Ontario) EBAs on SCBC for heart failure, diabetes, chronic obstructive pulmonary disease (COPD), and chronic wounds to examine the role of SCBC in family practice Results Part 1: Systematic Review of Intermediate Care Seven systematic reviews on intermediate care since 2008 were identified. The literature base is complex and difficult to define. There is evidence to suggest that intermediate care is effective in improving outcomes; however, the effective interventions are still uncertain. Part 2: Synthesis of Evidence in Intermediate Care Mortality • Heart failure Significant reduction in patients receiving SCBC • COPD Nonsignificant reduction in patients receiving SCBC Hospitalization • Heart failure Nonsignificant reduction in patients receiving SCBC • COPD Significant reduction in patients receiving SCBC Emergency Department Visits • Heart failure Nonsignificant reduction in patients receiving SCBC • COPD Significant reduction in patients receiving SCBC Disease-Specific Patient Outcomes • COPD Nonsignificant improvement in lung function in patients receiving SCBC • Diabetes Significant reduction in hemoglobin A1c (HbA1c) and systolic blood pressure in patients receiving SCBC • Chronic wounds Significant increase in the proportion of healed wounds in patients receiving SCBC Quality of Life • Heart failure Trend toward improvement in patients receiving SCBC • COPD Significant improvement in patients receiving SCBC Part 3: Intermediate Care in Family Practice—Evidence-Based Analysis Five randomized controlled trials were identified comparing SCBC to usual care in family practice. Inclusion criteria were 1) the presence of multiple chronic conditions, and 2) interventions that included 2 or more health care professions. The GRADE quality of the evidence was assessed as low for all outcomes due to the inconsistency and indirectness of the results. Limitations This review did not look at disease-specific studies on intermediate care in family practice. Conclusions Specialized community-based care effectively improves outcomes in patients with heart failure, COPD, and diabetes. The effectiveness of SCBC in family practice is unclear. PMID:23226812

Application of Autonomous Smart Inverter Volt-VAR Function for Voltage Reduction Energy Savings and Power Quality in Electric Distribution Systems: Preprint

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

Ding, Fei; Nagarajan, Adarsh; Baggu, Murali

This paper evaluated the impact of smart inverter Volt-VAR function on voltage reduction energy saving and power quality in electric power distribution systems. A methodology to implement the voltage reduction optimization was developed by controlling the substation LTC and capacitor banks, and having smart inverters participate through their autonomous Volt-VAR control. In addition, a power quality scoring methodology was proposed and utilized to quantify the effect on power distribution system power quality. All of these methodologies were applied to a utility distribution system model to evaluate the voltage reduction energy saving and power quality under various PV penetrations and smartmore » inverter densities.« less

A review on the fermentation of foods and the residues of pesticides-biotransformation of pesticides and effects on fermentation and food quality.

PubMed

Regueiro, Jorge; López-Fernández, Olalla; Rial-Otero, Raquel; Cancho-Grande, Beatriz; Simal-Gándara, Jesús

2015-01-01

Residues of pesticides in food are influenced by processing such as fermentation. Reviewing the extensive literature showed that in most cases, this step leads to large reductions in original residue levels in the fermented food, with the formation of new pesticide by-products. The behavior of residues in fermentation can be rationalized in terms of the physical-chemical properties of the pesticide and the nature of the process. In addition, the presence of pesticides decrease the growth rate of fermentative microbiota (yeasts and bacterias), which provokes stuck and sluggish fermentations. These changes have in consequence repercussions on several aspects of food sensory quality (physical-chemical properties, polyphenolic content, and aromatic profile) of fermented food. The main aim of this review is to deal with all these topics to propose challenging needs in science-based quality management of pesticides residues in food.

Quality tracing in meat supply chains

PubMed Central

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

2014-01-01

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

Quality tracing in meat supply chains.

PubMed

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

2014-06-13

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

Perceived Parent-Child Relations, Conduct Problems, and Clinical Improvement Following the Treatment of Oppositional Defiant Disorder.

PubMed

Booker, Jordan A; Ollendick, Thomas H; Dunsmore, Julie C; Greene, Ross W

2016-05-01

Our objective in this study was to examine the moderating influence of parent-child relationship quality (as viewed by the child) on associations between conduct problems and treatment responses for children with oppositional defiant disorder (ODD). To date, few studies have considered children's perceptions of relationship quality with parents in clinical contexts even though extant studies show the importance of this factor in children's behavioral adjustment in non-clinical settings. In this study, 123 children (ages 7 - 14 years, 61.8% male, 83.7% white) who fulfilled DSM-IV criteria for ODD received one of two psychosocial treatments: Parent Management Training or Collaborative & Proactive Solutions. In an earlier study, both treatments were found to be effective and equivalent in treatment outcomes (Ollendick et al., in press). In the current study, pre-treatment maternal reports of conduct problems and pre-treatment child reports of relations with parents were used to predict outcomes in ODD symptoms and their severity following treatment. Elevated reports of children's conduct problems were associated with attenuated reductions in both ODD symptoms and their severity. Perceived relationship quality with parents moderated the ties between conduct problems and outcomes in ODD severity but not the number of symptoms. Mother reports of elevated conduct problems predicted attenuated treatment response only when children viewed relationship quality with their parents as poorer. When children viewed the relationship as higher quality, they did not show an attenuated treatment response, regardless of reported conduct problems. The current findings underscore the importance of children's perspectives in treatment response and reductions in externalizing child behaviors.

Optimizing pain care delivery in outpatient facilities: experience in NCI, Cairo, Egypt.

PubMed

Hameed, Khaled Abdel

2011-04-01

As a result of increasing waiting lists of patients attending National Cancer Institute of Cairo, we are faced to provide high-quality pain care service through our outpatient pain clinic. The program description presented here shows the capacity of a 24 hours/7 days outpatient cancer pain management service to provide rapidly accessible, high-quality care to patients with complex pain and palliative care symptom burdens. In addition, this model avoids inpatient hospital admissions. Pain clinics of cancer are committed to helping patients and families identify and implement the treatments necessary to achieve optimum functional ability and the best possible quality of life. These clinics also help to communicate and work with the family physician, surgeon, and other physicians associated with patient treatment. Cancer pain is complex in its causes, and affects all parts of the body. It involves the tissues, body systems , and the mind. Being multidimensional, it is never adequately addressed with unidimensional treatment. Pain management must extend beyond physical approaches to include the psychological, social, and even spiritual aspects of the patient. Effective integrated treatment fosters self awareness and teaches appropriate and effective self care. With time, complex issues are managed, pain is reduced, and the patient moves toward peak physical and psychological functioning. These goals can be achieved by providing the highest quality pain management services. Patients attending the clinic get treated medically for their physical ailments. Their emotional and psychological problems also need to be attended with an atmosphere of love and care. The mission of the highest quality service is to obtain customer satisfaction with reduction of cost in a multidisciplinary (or better interdisciplinary) approach. This can be reached by proper identification of the customers either internal or external, assessing their needs, and implementing plans for their satisfaction. In addition, monitoring the improvement of such plans is an integral part of the quality process. Importantly, the facility provides comprehensive care with professionals available 24 hours/7 days. On-call teams assigned to manage pain and other treatment modalities comprises of staff supervised by the primary cancer clinicians; this arrangement facilitates reaching this goal. This study will illustrate our experience through 25 years, trying to provide the highest care of patients with cancer pain on an outpatient basis.

Short Term Advantages of a Public-Private Partnership for Tuberculosis in Guinea Bissau: Reduction of Mortality and Increased Diagnostic Capacity

PubMed Central

Vieira, Fina; Sanha, Mamadu Saliu; Riccardi, Fabio; Colombatti, Raffaella

2014-01-01

Background Tuberculosis (TB) is widespread in Africa, but weak health systems in developing countries, often display poor quality of care with delays in case identification, irrational therapy and drug shortage, clinical mismanagement, unnecessary expenditures for patients, reduced adherence and increased mortality. Public-private partnership has demonstrated to increase TB case detection, but less is known about its effects on quality of care, mortality and costs for hospitalized TB patients. Methods Clinical outcomes and costs for TB patients at the TB National Reference Center of Bissau, in Guinea Bissau, West Africa, were determined during the first 5 months of the public-private management and compared to the ones of previous years when the hospitals was under direct Government’s management. Results 215 (2009–2010) and 194 (2012–2013) patients were admitted, respectively. Improvement (p<0.05) was observed in mortality reduction (21% vs 6%), cause of death determination (50% vs 85%), treatment abandonment (15 vs 1). Direct costs for patients during TB diagnostic pathway and inpatient care were significantly reduced, 475 vs. 0 USD. Conclusions Public-private partnerships displays significant short term benefits in National TB reference centers, even in post-conflict countries. Further studies could aid in determining the overall long term benefits of this type of cooperation, and the specific characteristic of TB and concomitant hematologic and infectious diseases in TB admitted patients. PMID:25045457

Ultra-Efficient Engine Technology (UEET) Program

NASA Technical Reports Server (NTRS)

Manthey, Lori A.

2001-01-01

The Ultra-Efficient Engine Technology (UEET) Program includes seven key projects that work with industry to develop and hand off revolutionary propulsion technologies that will enable future-generation vehicles over a wide range of flight speeds. A new program office, the Ultra-Efficient Engine Technology (UEET) Program Office, was formed at the NASA Glenn Research Center to manage an important National propulsion program for NASA. The Glenn-managed UEET Program, which began on October 1, 1999, includes participation from three other NASA centers (Ames, Goddard, and Langley), as well as five engine companies (GE Aircraft Engines, Pratt & Whitney, Honeywell, Allison/Rolls Royce, and Williams International) and two airplane manufacturers (the Boeing Company and Lockheed Martin Corporation). This 6-year, nearly $300 million program will address local air-quality concerns by developing technologies to significantly reduce nitrogen oxide (NOx) emissions. In addition, it will provide critical propulsion technologies to dramatically increase performance as measured in fuel burn reduction that will enable reductions of carbon dioxide (CO2) emissions. This is necessary to address the potential climate impact of long-term aviation growth.

Gonorrhea prevention and clinical care in the private sector: lessons learned and priorities for quality improvement.

PubMed

Tao, Guoyu; Irwin, Kathleen L

2006-11-01

We reviewed literature on gonorrhea prevention and clinical care in the private sector, the setting where most gonorrhea cases in the United States are now diagnosed. Although most private-sector health settings had a low prevalence of gonorrhea (0.1-2.5%), some private emergency departments and specialty clinics that serve a large number of high-risk or infected patients had prevalences ranged from 1.7% to 11.0%. Studies of diverse settings and populations suggest that, in general, diagnostic testing of symptomatic patients (69-83%), appropriate treatment (61-100%), and case reporting (64-94%) are delivered more commonly than risk assessment for asymptomatic patients (15-28%), routine screening of pregnant women (31-77%), risk-reduction counseling (35-78%), and sex partner management (0-82%). To sustain the recent declines in gonorrhea incidence in the United States, private-sector providers and health systems must continue to offer gonorrhea prevention and clinical services and consider implementing interventions to improve delivery of risk assessment, risk-reduction counseling, and partner management services.

ICARUSS, the Integrated Care for the Reduction of Secondary Stroke trial: rationale and design of a randomized controlled trial of a multimodal intervention to prevent recurrent stroke in patients with a recent cerebrovascular event, ACTRN = 12611000264987.

PubMed

Joubert, J; Davis, S M; Hankey, G J; Levi, C; Olver, J; Gonzales, G; Donnan, G A

2015-07-01

The majority of strokes, both ischaemic and haemorrhagic, are attributable to a relatively small number of risk factors which are readily manageable in primary care setting. Implementation of best-practice recommendations for risk factor management is calculated to reduce stroke recurrence by around 80%. However, risk factor management in stroke survivors has generally been poor at primary care level. A model of care that supports long-term effective risk factor management is needed. To determine whether the model of Integrated Care for the Reduction of Recurrent Stroke (ICARUSS) will, through promotion of implementation of best-practice recommendations for risk factor management reduce the combined incidence of stroke, myocardial infarction and vascular death in patients with recent stroke or transient ischaemic attack (TIA) of the brain or eye. A prospective, Australian, multicentre, randomized controlled trial. Academic stroke units in Melbourne, Perth and the John Hunter Hospital, New South Wales. 1000 stroke survivors recruited as from March 2007 with a recent (<3 months) stroke (ischaemic or haemorrhagic) or a TIA (brain or eye). Randomization and data collection are performed by means of a central computer generated telephone system (IVRS). Exposure to the ICARUSS model of integrated care or usual care. The composite of stroke, MI or death from any vascular cause, whichever occurs first. Risk factor management in the community, depression, quality of life, disability and dementia. With 1000 patients followed up for a median of one-year, with a recurrence rate of 7-10% per year in patients exposed to usual care, the study will have at least 80% power to detect a significant reduction in primary end-points The ICARUSS study aims to recruit and follow up patients between 2007 and 2013 and demonstrate the effectiveness of exposure to the ICARUSS model in stroke survivors to reduce recurrent stroke or vascular events and promote the implementation of best practice risk factor management at primary care level. © 2015 World Stroke Organization.

Postpartum diet quality in Australian women following a gestational diabetes pregnancy.

PubMed

Morrison, M K; Koh, D; Lowe, J M; Miller, Y D; Marshall, A L; Colyvas, K; Collins, C E

2012-10-01

To describe the diet quality of a national sample of Australian women with a recent history of gestational diabetes mellitus (GDM) and determine factors associated with adherence to national dietary recommendations. A postpartum lifestyle survey with 1499 Australian women diagnosed with GDM ≤3 years previously. Diet quality was measured using the Australian recommended food score (ARFS) and weighted by demographic and diabetes management characteristics. Multinominal logistic regression analysis was used to determine the association between diet quality and demographic characteristics, health seeking behaviours and diabetes-related risk factors. Mean (±s.d.) ARFS was 30.9±8.1 from a possible maximum score of 74. Subscale component scores demonstrated that the nuts/legumes, grains and fruits were the most poorly scored. Factors associated with being in the highest compared with the lowest ARFS quintile included age (odds ratio (OR) 5-year increase=1.40; 95% (confidence interval) CI:1.16-1.68), tertiary education (OR=2.19; 95% CI:1.52-3.17), speaking only English (OR=1.92; 95% CI:1.19-3.08), being sufficiently physically active (OR=2.11; 95% CI:1.46-3.05), returning for postpartum blood glucose testing (OR=1.75; 95% CI:1.23-2.50) and receiving risk reduction advice from a health professional (OR=1.80; 95% CI:1.24-2.60). Despite an increased risk of type 2 diabetes, women in this study had an overall poor diet quality as measured by the ARFS. Women with GDM should be targeted for interventions aimed at achieving a postpartum diet consistent with the guidelines for chronic disease prevention. Encouraging women to return for follow-up and providing risk reduction advice may be positive initial steps to improve diet quality, but additional strategies need to be identified.

Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study.

PubMed

Linzer, Mark; Poplau, Sara; Brown, Roger; Grossman, Ellie; Varkey, Anita; Yale, Steven; Williams, Eric S; Hicks, Lanis; Wallock, Jill; Kohnhorst, Diane; Barbouche, Michael

2017-01-01

While primary care work conditions are associated with adverse clinician outcomes, little is known about the effect of work condition interventions on quality or safety. A cluster randomized controlled trial of 34 clinics in the upper Midwest and New York City. Primary care clinicians and their diabetic and hypertensive patients. Quality improvement projects to improve communication between providers, workflow design, and chronic disease management. Intervention clinics received brief summaries of their clinician and patient outcome data at baseline. We measured work conditions and clinician and patient outcomes both at baseline and 6-12 months post-intervention. Multilevel regression analyses assessed the impact of work condition changes on outcomes. Subgroup analyses assessed impact by intervention category. There were no significant differences in error reduction (19 % vs. 11 %, OR of improvement 1.84, 95 % CI 0.70, 4.82, p = 0.21) or quality of care improvement (19 % improved vs. 44 %, OR 0.62, 95 % CI 0.58, 1.21, p = 0.42) between intervention and control clinics. The conceptual model linking work conditions, provider outcomes, and error reduction showed significant relationships between work conditions and provider outcomes (p ≤ 0.001) and a trend toward a reduced error rate in providers with lower burnout (OR 1.44, 95 % CI 0.94, 2.23, p = 0.09). Few quality metrics, short time span, fewer clinicians recruited than anticipated. Work-life interventions improving clinician satisfaction and well-being do not necessarily reduce errors or improve quality. Longer, more focused interventions may be needed to produce meaningful improvements in patient care. ClinicalTrials.gov # NCT02542995.

Agroforestry buffers for nonpoint source pollution reductions from agricultural watersheds.

PubMed

Udawatta, Ranjith P; Garrett, Harold E; Kallenbach, Robert

2011-01-01

Despite increased attention and demand for the adoption of agroforestry practices throughout the world, rigorous long-term scientific studies confirming environmental benefits from the use of agroforestry practices are limited. The objective was to examine nonpoint-source pollution (NPSP) reduction as influenced by agroforestry buffers in watersheds under grazing and row crop management. The grazing study consists of six watersheds in the Central Mississippi Valley wooded slopes and the row crop study site consists of three watersheds in a paired watershed design in Central Claypan areas. Runoff water samples were analyzed for sediment, total nitrogen (TN), and total phosphorus (TP) for the 2004 to 2008 period. Results indicate that agroforestry and grass buffers on grazed and row crop management sites significantly reduce runoff, sediment, TN, and TP losses to streams. Buffers in association with grazing and row crop management reduced runoff by 49 and 19%, respectively, during the study period as compared with respective control treatments. Average sediment loss for grazing and row crop management systems was 13.8 and 17.9 kg ha yr, respectively. On average, grass and agroforestry buffers reduced sediment, TN, and TP losses by 32, 42, and 46% compared with the control treatments. Buffers were more effective in the grazing management practice than row crop management practice. These differences could in part be attributed to the differences in soils, management, and landscape features. Results from this study strongly indicate that agroforestry and grass buffers can be designed to improve water quality while minimizing the amount of land taken out of production. American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America.

Network-based production quality control

NASA Astrophysics Data System (ADS)

Kwon, Yongjin; Tseng, Bill; Chiou, Richard

2007-09-01

This study investigates the feasibility of remote quality control using a host of advanced automation equipment with Internet accessibility. Recent emphasis on product quality and reduction of waste stems from the dynamic, globalized and customer-driven market, which brings opportunities and threats to companies, depending on the response speed and production strategies. The current trends in industry also include a wide spread of distributed manufacturing systems, where design, production, and management facilities are geographically dispersed. This situation mandates not only the accessibility to remotely located production equipment for monitoring and control, but efficient means of responding to changing environment to counter process variations and diverse customer demands. To compete under such an environment, companies are striving to achieve 100%, sensor-based, automated inspection for zero-defect manufacturing. In this study, the Internet-based quality control scheme is referred to as "E-Quality for Manufacturing" or "EQM" for short. By its definition, EQM refers to a holistic approach to design and to embed efficient quality control functions in the context of network integrated manufacturing systems. Such system let designers located far away from the production facility to monitor, control and adjust the quality inspection processes as production design evolves.

Association of Calf Muscle Pump Stimulation With Sleep Quality in Adults.

PubMed

Baniak, Lynn M; Pierce, Carolyn S; McLeod, Kenneth J; Chasens, Eileen R

2016-12-01

Prevention of lower extremity fluid pooling (LEFP) is associated with improved sleep quality. Physical activity and compression stockings are non-invasive methods used to manage LEFP, but both are associated with low adherence. Calf muscle pump (CMP) stimulation is an alternative and more convenient approach. Convenience sampling was used to recruit 11 participants between ages 45 and 65 with poor sleep quality. A within-person single-group pre-test-post-test design was used to evaluate changes in sleep quality, daytime sleepiness, and functional outcomes sensitive to impaired sleep as measured by the Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire, and Epworth Sleepiness Scale after 4 weeks of CMP stimulation. Statistical analysis included effect size (ES) calculations. After daily use of CMP stimulation, participants demonstrated improvement in overall sleep quality (ES = -.97) and a large reduction in daily disturbance from poor sleep (ES = -1.25). Moderate improvements were observed in daytime sleepiness (ES = -.53) and functional outcomes sensitive to sleepiness (ES = .49). Although causality could not be determined with this study design, these results support further research to determine whether CMP stimulation can improve sleep quality. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

The vital role of manufacturing quality in the reliability of PV modules

NASA Astrophysics Data System (ADS)

Rusch, Peter

2014-10-01

The influence of manufacturing quality on the reliability of PV modules coming out of today's factories has been, and is still, under estimated among investors and buyers. The main reason is perception. Contrary to popular belief, PV modules are not a commodity. Module quality does differ among module brands. Certification alone does not guarantee the quality or reliability of a module. Cost reductions in manufacturing have unequivocally affected module quality. And the use of new, cheaper materials has had a measureable impact on module reliability. The need for meaningful manufacturing quality standards has been understood by the leading technical institutions and important industry players. The fact that most leading PV panel manufacturers have been certified according to ISO 9001 has led to some level of improvement and higher effectiveness. The new ISO 9001 PV QMS standards will be a major step in providing a tool to assess PV manufacturers' quality management systems. The current lack of sufficient standards has still got a negative influence on the quality of modules being installed today. Today every manufacturer builds their modules in their own way with little standardization or adherence to quality processes and methods, which are commonplace in other manufacturing industries. Although photovoltaic technology is to a great extent mature, the way modules are being produced has changed significantly over the past few years and it continues to change at a rapid pace. Investors, financiers and lenders stand the most to gain from PV systems over the long-term, but also the most to lose. Investors, developers, EPC, O&M and solar asset management companies must all manage manufacturing quality more proactively or they will face unexpected risks and failures down the road. Manufacturing quality deserves more transparency and attention, as it is a major driver of module performance and reliability. This paper will explain the benefits of good manufacturing quality and the dangers in poor manufacturing quality. The paper also explains why buyers and long-term investors need to pay close attention to the day-to-day manufacturing quality of module manufacturers. We demonstrate how these quality risks can be assessed and mitigated by independent diligence, professional contracting and smart quality assurance processes that can be easily built into any module procurement process. We highlight the steps to ensure that every module used in a PV system is built to quality standards that support the long-term reliability of a PV system.

A GIS-based groundwater travel time model to evaluate stream nitrate concentration reductions from land use change

USGS Publications Warehouse

Schilling, K.E.; Wolter, C.F.

2007-01-01

Excessive nitrate-nitrogen (nitrate) loss from agricultural watersheds is an environmental concern. A common conservation practice to improve stream water quality is to retire vulnerable row croplands to grass. In this paper, a groundwater travel time model based on a geographic information system (GIS) analysis of readily available soil and topographic variables was used to evaluate the time needed to observe stream nitrate concentration reductions from conversion of row crop land to native prairie in Walnut Creek watershed, Iowa. Average linear groundwater velocity in 5-m cells was estimated by overlaying GIS layers of soil permeability, land slope (surrogates for hydraulic conductivity and gradient, respectively) and porosity. Cells were summed backwards from the stream network to watershed divide to develop a travel time distribution map. Results suggested that groundwater from half of the land planted in prairie has reached the stream network during the 10 years of ongoing water quality monitoring. The mean travel time for the watershed was estimated to be 10.1 years, consistent with results from a simple analytical model. The proportion of land in the watershed and subbasins with prairie groundwater reaching the stream (10-22%) was similar to the measured reduction of stream nitrate (11-36%). Results provide encouragement that additional nitrate reductions in Walnut Creek are probable in the future as reduced nitrate groundwater from distal locations discharges to the stream network in the coming years. The high spatial resolution of the model (5-m cells) and its simplicity may make it potentially applicable for land managers interested in communicating lag time issues to the public, particularly related to nitrate concentration reductions over time. ?? 2007 Springer-Verlag.

Themes in the literature related to cardiovascular disease risk reduction.

PubMed

Cohen, Shannon Munro; Kataoka-Yahiro, Merle

2009-01-01

This article aimed to identify themes in the literature related to patient-healthcare provider beliefs, barriers to adherence, and interventions pertaining to cardiovascular disease risk reduction. Twenty quantitative and qualitative primary research studies including 2 meta-analyses published between 1995 and 2008 were analyzed for themes and practice implications to synthesize existing research on cardiovascular disease risk reduction. Databases searched included EBSCO, CINAHL, MEDLINE, ScienceDirect, HealthSource, and PsychLit using the search terms patient- provider adherence, adherence and shared decision making, adherence and decision support, patient- provider goal setting, and cardiovascular disease risk reduction. The emergent themes found in this literature review included (1) complex medication regimens; (2) risk perception, quality of life, and competing priorities; (3) motivation for change; (4) provider clinical inertia; and (5) goal setting, feedback, and reminders. Studies reporting the highest rates of adherence to cardiovascular disease risk reduction recommendations incorporated patient-provider goal setting and decision support, self-management techniques, and personalized printed communication. Goal setting in cardiovascular disease risk reduction is a relatively unexplored area and is an important component of shared decision making and adherence to cardiovascular disease health recommendations. The following review will address the 5 themes identified in more detail and provide a basis for improved clinical practice.

Can image enhancement allow radiation dose to be reduced whilst maintaining the perceived diagnostic image quality required for coronary angiography?

PubMed Central

Joshi, Anuja; Gislason-Lee, Amber J; Keeble, Claire; Sivananthan, Uduvil M

2017-01-01

Objective: The aim of this research was to quantify the reduction in radiation dose facilitated by image processing alone for percutaneous coronary intervention (PCI) patient angiograms, without reducing the perceived image quality required to confidently make a diagnosis. Methods: Incremental amounts of image noise were added to five PCI angiograms, simulating the angiogram as having been acquired at corresponding lower dose levels (10–89% dose reduction). 16 observers with relevant experience scored the image quality of these angiograms in 3 states—with no image processing and with 2 different modern image processing algorithms applied. These algorithms are used on state-of-the-art and previous generation cardiac interventional X-ray systems. Ordinal regression allowing for random effects and the delta method were used to quantify the dose reduction possible by the processing algorithms, for equivalent image quality scores. Results: Observers rated the quality of the images processed with the state-of-the-art and previous generation image processing with a 24.9% and 15.6% dose reduction, respectively, as equivalent in quality to the unenhanced images. The dose reduction facilitated by the state-of-the-art image processing relative to previous generation processing was 10.3%. Conclusion: Results demonstrate that statistically significant dose reduction can be facilitated with no loss in perceived image quality using modern image enhancement; the most recent processing algorithm was more effective in preserving image quality at lower doses. Advances in knowledge: Image enhancement was shown to maintain perceived image quality in coronary angiography at a reduced level of radiation dose using computer software to produce synthetic images from real angiograms simulating a reduction in dose. PMID:28124572

Using QMRAcatch - a stochastic hydrological water quality and infection risk model - to identify sustainable management options for long term drinking water resource planning

NASA Astrophysics Data System (ADS)

Derx, J.; Demeter, K.; Schijven, J. F.; Sommer, R.; Zoufal-Hruza, C. M.; Kromp, H.; Farnleitner, A.; Blaschke, A. P.

2017-12-01

River water resources in urban environments play a critical role in sustaining human health and ecosystem services, as they are used for drinking water production, bathing and irrigation. In this study the hydrological water quality model QMRAcatch was used combined with measured concentrations of human enterovirus and human-associated genetic fecal markers. The study area is located at a river/floodplain area along the Danube which is used for drinking water production by river bank filtration and further disinfection. QMRAcatch was previously developed to support long term planning of water resources in accordance with a public infection protection target (Schijven et al., 2015). Derx et al. 2016 previously used QMRAcatch for evaluating the microbiological quality and required virus-reduction targets at the study area for the current and robust future "crisis" scenarios, i.e. for the complete failure of wastewater treatment plants and infection outbreaks. In contrast, the aim of this study was to elaborate future scenarios based on projected climate and population changes in collaboration with urban water managers. The identified scenarios until 2050 include increased wastewater discharge rates due to the projected urban population growth and more frequent storm and overflow events of urban sewer systems following forecasted changes in climate and hydrology. Based on the simulation results for the developed scenarios sustainable requirements of the drinking water treatment system for virus reductions were re-evaluated to achieve the health risk target. The model outcomes are used to guide practical and scientifically sound management options for long term water resource planning. This paper was supported by FWF (Vienna Doctoral Program on Water Resource Systems W1219-N22) and the GWRS project (Vienna Water) as part of the "(New) Danube-Lower Lobau Network Project" funded by the Government of Austria and Vienna, and the European Agricultural Fund for Rural Development (LE 07-13). ReferencesDerx, J. et al. (2016) QMRAcatch: Human-Associated Fecal Pollution and Infection Risk Modeling for a River/Floodplain Environment. J Env Qual 45(4), 1205-1214 Schijven, J., et al. (2015) QMRAcatch: Microbial Quality Simulation of Water Resources including Infection Risk Assessment. J Env Qual 44(5), 1491-1502

Comprehensive long-term management program for asthma: effect on outcomes in adult African-Americans.

PubMed

Kelso, T M; Abou-Shala, N; Heilker, G M; Arheart, K L; Portner, T S; Self, T H

1996-06-01

To determine if a comprehensive long-term management program, emphasizing inhaled corticosteroids and patient education, would improve outcomes in adult African-American asthmatics a nonrandomized control trial with a 2-year intervention was performed in a university-based clinic. Inclusion criteria consisted of (> or = 5) emergency department (ED) visits or hospitalizations (> or = 2) during the previous 2 years. Intervention patients were volunteers; a comparable control group was identified via chart review at hospitals within the same area and time period as the intervention patients. Individualized doses of beclomethasone with a spacer, inhaled albuterol "as needed," and crisis prednisone were the primary therapies. Environmental control, peak flow monitoring, and a partnership with the patient were emphasized. Detailed patient education was an integral part of management. Control patients received usual care from local physicians. ED visits and hospitalizations for 2 years before and 2 years during the intervention period were compared. Quality of life (QOL) measurements were made at baseline and every 6 months in the intervention group. Study group (n = 21) had a significant reduction in ED visits (2.3 +/- 0.2 pre-intervention versus 0.6 +/- 0.2 post-intervention; P = 0.0001). Control group (n = 18) did not have a significant change in ED visits during the 2-year post-intervention period (2.6 +/- 0.2 pre-intervention versus 2.0 +/- 0.2 post-intervention; P = 0.11). Both groups had significant reductions in hospitalizations, but the study group had a greater reduction. Sixty-two percent of study patients had complete elimination of ED visits and hospitalizations, whereas no control patients had total elimination of the need for institutional acute care. QOL in the study patients revealed significant improvements for most parameters. A comprehensive long-term management program emphasizing inhaled corticosteroids combined with other state-of-the-art management, including intensive patient education, improves outcomes in adult African-American asthmatics.

Specialized Nursing Practice for Chronic Disease Management in the Primary Care Setting

PubMed Central

2013-01-01

Background In response to the increasing demand for better chronic disease management and improved health care efficiency in Ontario, nursing roles have expanded in the primary health care setting. Objectives To determine the effectiveness of specialized nurses who have a clinical role in patient care in optimizing chronic disease management among adults in the primary health care setting. Data Sources and Review Methods A literature search was performed using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database. Results were limited to randomized controlled trials and systematic reviews and were divided into 2 models: Model 1 (nurse alone versus physician alone) and Model 2 (nurse and physician versus physician alone). Effectiveness was determined by comparable outcomes between groups in Model 1, or improved outcomes or efficiency in Model 2. Results Six studies were included. In Model 1, there were no significant differences in health resource use, disease-specific measures, quality of life, or patient satisfaction. In Model 2, there was a reduction in hospitalizations and improved management of blood pressure and lipids among patients with coronary artery disease. Among patients with diabetes, there was a reduction in hemoglobin A1c but no difference in other disease-specific measures. There was a trend toward improved process measures, including medication prescribing and clinical assessments. Results related to quality of life were inconsistent, but patient satisfaction with the nurse-physician team was improved. Overall, there were more and longer visits to the nurse, and physician workload did not change. Limitations There was heterogeneity across patient populations, and in the titles, roles, and scope of practice of the specialized nurses. Conclusions Specialized nurses with an autonomous role in patient care had comparable outcomes to physicians alone (Model 1) based on moderate quality evidence, with consistent results among a subgroup analysis of patients with diabetes based on low quality evidence. Model 2 showed an overall improvement in appropriate process measures, disease-specific measures, and patient satisfaction based on low to moderate quality evidence. There was low quality evidence that nurses working under Model 2 may reduce hospitalizations for patients with coronary artery disease. The specific role of the nurse in supplementing or substituting physician care was unclear, making it difficult to determine the impact on efficiency. Plain Language Summary Nurses with additional skills, training, or scope of practice may help improve the primary care of patients with chronic diseases. This review found that specialized nurses working on their own could achieve health outcomes that were similar to those of doctors. It also found that specialized nurses who worked with doctors could reduce hospital visits and improve certain patient outcomes related to diabetes, coronary artery disease, or heart failure. Patients who had nurse-led care were more satisfied and tended to receive more tests and medications. It is unclear whether specialized nurses improve quality of life or doctor workload. PMID:24194798

The sources, impact and management of car park runoff pollution: a review.

PubMed

Revitt, D Michael; Lundy, Lian; Coulon, Frédéric; Fairley, Martin

2014-12-15

Traffic emissions contribute significantly to the build-up of diffuse pollution loads on urban surfaces with their subsequent mobilisation and direct discharge posing problems for receiving water quality. This review focuses on the impact and mitigation of solids, metals, nutrients and organic pollutants in the runoff deriving from car parks. Variabilities in the discharged pollutant levels and in the potentials for pollutant mitigation complicate an impact assessment of car park runoff. The different available stormwater best management practices and proprietary devices are reported to be capable of reductions of between 20% and almost 100% for both suspended solids and a range of metals. This review contributes to prioritising the treatment options which can achieve the appropriate pollutant reductions whilst conforming to the site requirements of a typical car park. By applying different treatment scenarios to the runoff from a hypothetical car park, it is shown that optimal performance, in terms of ecological benefits for the receiving water, can be achieved using a treatment train incorporating permeable paving and bioretention systems. The review identifies existing research gaps and emphasises the pertinent management practices as well as design issues which are relevant to the mitigation of car park pollution. Copyright © 2014 Elsevier Ltd. All rights reserved.

Systematic review on the cost-effectiveness of self-management education programme for type 2 diabetes mellitus.

PubMed

Lian, J X; McGhee, S M; Chau, J; Wong, Carlos K H; Lam, Cindy L K; Wong, William C W

2017-05-01

A review of cost-effectiveness studies on self-management education programmes for Type 2 diabetes mellitus. Cochrane, PubMed and PsycINFO databases were searched for papers published from January 2003 through September 2015. Further hand searching using the reference lists of included papers was carried out. In total, 777 papers were identified and 12 papers were finally included. We found eight programmes whose effectiveness analyses were based on randomised controlled trials and whose costs were comprehensively estimated from the stated perspective. Among these eight, four studies showed a cost per unit reduction in clinical risk factors (HbA1c or BMI) of US$491 to US$7723 or cost per glycaemic symptom day avoided of US$39. In three studies the cost per QALY gained, as estimated from a life-time model, was less than US$50,000. However, one study found the programme was not cost-effective despite a gain in QALYs at the one-year follow up. A small number of cost-effectiveness studies were identified with only eight of sufficiently good quality. The cost of a self-management education programme achieving reduction in clinical risk factors seems to be modest and is likely to be cost-effective in the long-term. Copyright © 2017 Elsevier B.V. All rights reserved.

Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland.

PubMed

Carney, Marie

2010-07-01

The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study's aim. Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.

Performance evaluation of vinasse treatment plant integrated with physico-chemical methods.

PubMed

Ojha, Sanjay Kumar; Mishra, Snehasish; Kumar, Satish; Mohanty, Shakti Shankar; Sarkar, Biplab; Singh, Monika; Chaudhury, Gautam Roy

2015-11-01

With an objective to assess environmental management criteria of a vinasse treatment plant (VTP) and to evaluate the critical environmental parameters, a study was undertaken in a multi-product (packaged apple juice, distillery, brewery, packaged drinking water) brewery-cum-distillery unit. The facility with a volumetric loading rate of 11-15 kg COD m(-3).day, 3.6-4.5 h hydraulic retention time and 20 g l(-1) VSS had a scientifically managed technically sound effluent treatment system. While the water quality parameters were found within the acceptable limits, there was 99.07% reduction in BOD, from 43140.0 to 398.0 mg l(-1) and 98.61% reduction in COD from 98003.0 to 1357.0 mg l(-1). There was appreciable improvement in mixed liquor suspended solids (MLSS), mixed liquorvolatile suspended solids (MLVSS) and sludge volume index (SVI). A striking feature was the integrated aerobic-anaerobic highly efficient Up-flow Anaerobic Sludge Blanket (UASB) treatment for biodegradation and energy production that reduced energy and space needs, producing utilisable end-products and net savings on the operational cost. The end-point waste management included terminal products such as fertile sludge, cattle feed supplement, recyclable water and biogas. Vast lagoons with combined aerobic-anaerobic approaches, biogasification unit, sludge recovery, remediated irrigable water were the notable attributes.

[Periods for growth and quality improvement of fish in context of animal welfare compliant management of commercial fish ponds--a literature review].

PubMed

Pietrock, Michael; Brämick, Uwe

2016-01-01

In Germany, management of commercial fish ponds requires consideration of animal welfare legislation. In particular, it is forbidden to immediately catch fish that have recently been stocked into put-and-take fishponds. Rather, after stocking is completed, a short-term fishing ban period needs to be adhered to that allows the fishes the opportunity to grow and/or significantly improve in overall quality. The duration of the fishing ban varies considerably among German federal states. A literature review, therefore, was undertaken to identify the amount of time required by adult fish to reach changes in various parameters of quality (proximate composition, fillet colour, odour/taste, stress response), and growth.The literature search revealed that some of the selected parameters (odour/taste, stress response) can change within 24 hours, potentially resulting in improved fish flesh quality. With a time span of about four weeks, feeding-induced changes in proximate composition took the longest among the parameters tested to realize significant changes in fish flesh quality. Transportation-related reductions in body mass are overcome and succeeded by net growth within one to two weeks depending on food availability. Maintaining the fish under species-specific conditions and providing the optimal environment to meet their physiological demands, however, are critical prerequisites for growth and quality improvement. In conclusion there is science-based justification for fishing ban periods ranging from 24 hours to four weeks. Final determination of its duration, therefore, remains a careful balancing of values.

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

Osmanlioglu, Ahmet Erdal

Pre-treatment of radioactive waste is the first step in waste management program that occurs after waste generation from various applications in Turkey. Pre-treatment and characterization practices are carried out in Radioactive Waste Management Unit (RWMU) at Cekmece Nuclear Research and Training Center (CNRTC) in Istanbul. This facility has been assigned to take all low-level radioactive wastes generated by nuclear applications in Turkey. The wastes are generated from research and nuclear applications mainly in medicine, biology, agriculture, quality control in metal processing and construction industries. These wastes are classified as low- level radioactive wastes. Pre-treatment practices cover several steps. In thismore » paper, main steps of pre-treatment and characterization are presented. Basically these are; collection, segregation, chemical adjustment, size reduction and decontamination operations. (author)« less

The Synergy of Class Size Reduction and Classroom Quality

ERIC Educational Resources Information Center

Graue, Elizabeth; Rauscher, Erica; Sherfinski, Melissa

2009-01-01

A contextual approach to understanding class size reduction includes attention to both educational inputs and processes. Based on our study of a class size reduction program in Wisconsin we explore the following question: How do class size reduction and classroom quality interact to produce learning opportunities in early elementary classrooms? To…

Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review.

PubMed

Brignardello-Petersen, Romina; Guyatt, Gordon H; Buchbinder, Rachelle; Poolman, Rudolf W; Schandelmaier, Stefan; Chang, Yaping; Sadeghirad, Behnam; Evaniew, Nathan; Vandvik, Per O

2017-05-11

To determine the effects and complications of arthroscopic surgery compared with conservative management strategies in patients with degenerative knee disease. Systematic review. Pain, function, adverse events. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar and Open Grey up to August 2016. For effects, randomised clinical trials (RCTs) comparing arthroscopic surgery with a conservative management strategy (including sham surgery) in patients with degenerative knee disease. For complications, RCTs and observational studies. Two reviewers independently extracted data and assessed risk of bias for patient-important outcomes. A parallel guideline committee ( BMJ Rapid Recommendations) provided input on the design and interpretation of the systematic review, including selection of patient-important outcomes. We used the GRADE approach to rate the certainty (quality) of the evidence. We included 13 RCTs and 12 observational studies. With respect to pain, the review identified high-certainty evidence that knee arthroscopy results in a very small reduction in pain up to 3 months (mean difference =5.4 on a 100-point scale, 95% CI 2.0 to 8.8) and very small or no pain reduction up to 2 years (mean difference =3.1, 95% CI -0.2 to 6.4) when compared with conservative management. With respect to function, the review identified moderate-certainty evidence that knee arthroscopy results in a very small improvement in the short term (mean difference =4.9 on a 100-point scale, 95% CI 1.5 to 8.4) and very small or no improved function up to 2 years (mean difference =3.2, 95% CI -0.5 to 6.8). Alternative presentations of magnitude of effect, and associated sensitivity analyses, were consistent with the findings of the primary analysis. Low-quality evidence suggested a very low probability of serious complications after knee arthroscopy. Over the long term, patients who undergo knee arthroscopy versus those who receive conservative management strategies do not have important benefits in pain or function. PROSPERO CRD42016046242. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review

PubMed Central

Brignardello-Petersen, Romina; Guyatt, Gordon H; Buchbinder, Rachelle; Poolman, Rudolf W; Chang, Yaping; Sadeghirad, Behnam; Evaniew, Nathan; Vandvik, Per O

2017-01-01

Objective To determine the effects and complications of arthroscopic surgery compared with conservative management strategies in patients with degenerative knee disease. Design Systematic review. Main outcome measures Pain, function, adverse events. Data sources MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar and Open Grey up to August 2016. Eligibility criteria For effects, randomised clinical trials (RCTs) comparing arthroscopic surgery with a conservative management strategy (including sham surgery) in patients with degenerative knee disease. For complications, RCTs and observational studies. Review methods Two reviewers independently extracted data and assessed risk of bias for patient-important outcomes. A parallel guideline committee (BMJ Rapid Recommendations) provided input on the design and interpretation of the systematic review, including selection of patient-important outcomes. We used the GRADE approach to rate the certainty (quality) of the evidence. Results We included 13 RCTs and 12 observational studies. With respect to pain, the review identified high-certainty evidence that knee arthroscopy results in a very small reduction in pain up to 3 months (mean difference =5.4 on a 100-point scale, 95% CI 2.0 to 8.8) and very small or no pain reduction up to 2 years (mean difference =3.1, 95% CI −0.2 to 6.4) when compared with conservative management. With respect to function, the review identified moderate-certainty evidence that knee arthroscopy results in a very small improvement in the short term (mean difference =4.9 on a 100-point scale, 95% CI 1.5 to 8.4) and very small or no improved function up to 2 years (mean difference =3.2, 95% CI −0.5 to 6.8). Alternative presentations of magnitude of effect, and associated sensitivity analyses, were consistent with the findings of the primary analysis. Low-quality evidence suggested a very low probability of serious complications after knee arthroscopy. Conclusions Over the long term, patients who undergo knee arthroscopy versus those who receive conservative management strategies do not have important benefits in pain or function. Trial registration number PROSPERO CRD42016046242. PMID:28495819

Methodology For Reduction Of Sampling On The Visual Inspection Of Developed And Etched Wafers

NASA Astrophysics Data System (ADS)

van de Ven, Jamie S.; Khorasani, Fred

1989-07-01

There is a lot of inspection in the manufacturing of semiconductor devices. Generally, the more important a manufacturing step, the higher is the level of inspection. In some cases 100% of the wafers are inspected after certain steps. Inspection is a non-value added and expensive activity. It requires an army of "inspectors," often times expensive equipment and becomes a "bottle neck" when the level of inspection is high. Although inspection helps identify quality problems, it hurts productivity. The new management, quality and productivity philosophies recommend against over inspection. [Point #3 in Dr. Deming's 14 Points for Management (1)] 100% inspection is quite unnecessary . Often the nature of a process allows us to reduce inspection drastically and still maintain a high level of confidence in quality. In section 2, we discuss such situations and show that some elementary probability theory allows us to determine sample sizes and measure the chances of catching a bad "lot" and accepting a good lot. In section 3, we provide an example and application of the theory, and make a few comments on money and time saved because of this work. Finally, in section 4, we draw some conclusions about the new quality and productivity philosophies and how applied statisticians and engineers should study every situation individually and avoid blindly using methods and tables given in books.

Managerial implications of corporate board involvement and perceived market competition for quality improvement in nursing homes.

PubMed

Weech-Maldonado, R; Zinn, J S; Brannon, D

1999-01-01

This study examines the relationships among corporate board involvement, total quality management (TQM) adoption, perceived market competition, and the perceived effect of quality improvement (QI) activities for a sample of nursing homes in Pennsylvania. The findings of this study have several implications for healthcare managers interested in maximizing the effectiveness of QI efforts. Board involvement in quality improvement was an important predictor of QI outcomes in the areas of finance, resident care, and human resources. However, TQM adoption had a positive effect on human resources outcomes only. These findings suggest that board involvement in any organized form of QI may be more important than the adoption of a formal TQM program in the nursing home industry. TQM's emphasis on employee empowerment may account for its positive influence on human resources. Perceived competition was associated with better financial outcomes. Low-cost leadership can be a key to survival in more competitive markets, requiring a focus on efficiency and productivity issues in QI efforts. By focusing on process improvement, the facilities may achieve cost reductions that can result in an improved financial position. Facilities perceived to be in more competitive environments were also more likely to adopt TQM. This is consistent with the assertion by resource-dependence theorists that organizations facing competition for resources must be responsive to the needs of resource-providing constituencies.

Variable infiltration and river flooding resulting in changing groundwater quality - A case study from Central Europe

NASA Astrophysics Data System (ADS)

Miotliński, Konrad; Postma, Dieke; Kowalczyk, Andrzej

2012-01-01

SummaryThe changes in groundwater quality occurring in a buried valley aquifer following a reduction in groundwater exploitation and enhanced infiltration due to extensive flooding of the Odra River in 1997 were investigated. Long-time series data for the chemical composition of groundwater in a large well field for drinking water supply indicated the deterioration of groundwater quality in the wells capturing water from the flooded area, which had been intensively cultivated since the 1960s. Infiltration of flooded river water into the aquifer is suggested by an elevated chloride concentration, although salt flushing from the rewatered unsaturated zone due to the enhanced recharge event is much more feasible. Concomitantly with chloride increases in the concentrations of sulphate, ferrous iron, manganese, and nickel imply the oxidation of pyrite (FeS 2) which is abundant in the aquifer. The proton production resulting from pyrite oxidation is buffered by the dissolution of calcite, while the Ca:SO 4 stoichiometry of the groundwater indicates that pyrite oxidation coupled with nitrate reduction is the dominant process occurring in the aquifer. The pyritic origin of SO42- is confirmed by the sulphur isotopic composition. The resultant Fe 2+ increase induces Mn-oxide dissolution and the mobilisation of Ni 2+ previously adsorbed to Mn-oxide surfaces. The study has a major implication for groundwater quality prediction studies where there are considerable variations in water level associated with groundwater management and climate change issues.

COPD: Health Care Utilisation Patterns with Different Disease Management Interventions.

PubMed

Luk, Edwin K; Hutchinson, Anastasia F; Tacey, Mark; Irving, Louis; Khan, Fary

2017-08-01

The management of COPD is a significant and costly issue worldwide, with acute healthcare utilisation consisting of admissions and outpatient attendances being a major contributor to the cost. Pulmonary rehabilitation (PR) and integrated disease management (IDM) are often offered. Whilst there is strong evidence of physical and quality of life outcomes following IDM and PR, few studies have looked into healthcare utilisation. The aims of this study were to confirm whether IDM and PR reduce acute healthcare utilisation and to identify factors which contribute to acute health care utilisation or increased mortality. This was a retrospective cohort study of patients with COPD who were referred to IDM over a 10-year period. Patients were also offered an 8-week PR program. Data collected were matched with the hospital dataset to obtain information on inpatient, ED and outpatient attendances. 517 patients were enrolled to IDM. 315 (61%) also commenced PR and 220 (43%) completed PR. Patients who were referred to PR were younger and had less comorbidities (p < 0.001). Both groups (IDM only and IDM + PR referred) had reductions in healthcare utilisation but the IDM-only group had greater reductions. A survival benefit (HR 0.68, 95% CI 0.50-0.92) was seen in those who were PR completers compared to patients who received IDM only. Patients with COPD who successfully complete PR in addition to participating in IDM have improved survival. IDM alone was effective in the reduction of healthcare utilisation; however, the addition of PR did not reduce healthcare usage further.

The antecedents, attributes and consequences of trust among nurses and nurse managers: a concept analysis.

PubMed

McCabe, T J; Sambrook, Sally

2014-05-01

Although trust has been investigated in the health context, limited research explores nurse and nurse manager perceptions of trust. To explore the concept of trust amongst nurses and nurse managers at individual, interpersonal and organisational levels. Our paper reports the findings from an interpretivist study conducted within the British National Health Service, involving thirty-nine semi-structured interviews with nurses and nurse managers. Large acute and small community organisation within the British National Health Service. 28 nurses and 11 nurse managers working within an Acute and a Community sector organisation - 20 and 19 in each organisation. Participants were selected through a process of purposive sampling, reflecting variations in terms of age, grade, ward and tenure. We utilise a concept analysis framework in exploring the antecedents, attributes and consequences of trust amongst nurses and nurse managers at individual, interpersonal and organisational levels. Key findings suggest that trust is formed within the immediate ward environment, and is significantly influenced by the role of line manager. Other positively influencing factors include professionalism and commitment to the nursing profession. These form the basis for the teamwork, delegation, support, open communication systems, confidentiality and discretion essential to delivering quality patient care. Negatively influencing factors include new management concepts, practices and styles overseen by managers recruited from the private sector. New management concepts were associated with reductions in the number of qualified nurses and increasing numbers of untrained nursing staff, reduced direct patient contact, less opportunities for professional training and development and deteriorating terms and conditions of employment. Our findings offer insight for managers, nurses and human resource practitioners to help build high trust relationships in a health care context. Of particular import is the need for managers to communicate more effectively organisational and financial constraints, in a manner that does not 'alienate' nurses and nurse managers, by highlighting their value and acknowledging their role in delivering high quality patient care. Copyright © 2013 Elsevier Ltd. All rights reserved.

Evaluation of the Multi-Chambered Treatment Train, a retrofit water-quality management device

USGS Publications Warehouse

Corsi, Steven R.; Greb, Steven R.; Bannerman, Roger T.; Pitt, Robert E.

1999-01-01

This paper presents the results of an evaluation of the benefits and efficiencies of a device called the Multi-Chambered Treatment Train (MCTT), which was installed below the pavement surface at a municipal maintenance garage and parking facility in Milwaukee, Wisconsin. Flow-weighted water samples were collected at the inlet and outlet of the device during 15 storms, and the efficiency of the device was based on reductions in the loads of 68 chemical constituents and organic compounds. High reduction efficiencies were achieved for all particulate-associated constituents, including total suspended solids (98 percent), total phosphorus (88 percent), and total recoverable zinc (91 percent). Reduction rates for dissolved fractions of the constituents were substantial, but somewhat lower (dissolved solids, 13 percent; dissolved phosphorus, 78 percent; dissolved zinc, 68 percent). The total dissolved solids load, which originated from road salt storage, was more than four times the total suspended solids load. No appreciable difference was detected between particle-size distributions in inflow and outflow samples.

Assessing and addressing the re-eutrophication of Lake Erie: central basin hypoxia

USGS Publications Warehouse

Scavia, Donald; Allan, J. David; Arend, Kristin K.; Bartell, Steven; Beletsky, Dmitry; Bosch, Nate S.; Brandt, Stephen B.; Briland, Ruth D.; Daloğlu, Irem; DePinto, Joseph V.; Dolan, David M.; Evans, Mary Anne; Farmer, Troy M.; Goto, Daisuke; Han, Haejin; Höök, Tomas O.; Knight, Roger; Ludsin, Stuart A.; Mason, Doran; Michalak, Anna M.; Richards, R. Peter; Roberts, James J.; Rucinski, Daniel K.; Rutherford, Edward; Schwab, David J.; Sesterhenn, Timothy M.; Zhang, Hongyan; Zhou, Yuntao

2014-01-01

Relieving phosphorus loading is a key management tool for controlling Lake Erie eutrophication. During the 1960s and 1970s, increased phosphorus inputs degraded water quality and reduced central basin hypolimnetic oxygen levels which, in turn, eliminated thermal habitat vital to cold-water organisms and contributed to the extirpation of important benthic macroinvertebrate prey species for fishes. In response to load reductions initiated in 1972, Lake Erie responded quickly with reduced water-column phosphorus concentrations, phytoplankton biomass, and bottom-water hypoxia (dissolved oxygen 2) requires cutting total phosphorus loads by 46% from the 2003–2011 average or reducing dissolved reactive phosphorus loads by 78% from the 2005–2011 average. Reductions to these levels are also protective of fish habitat. We provide potential approaches for achieving those new loading targets, and suggest that recent load reduction recommendations focused on western basin cyanobacteria blooms may not be sufficient to reduce central basin hypoxia to 2000 km2.

Realization of process improvement at a diagnostic radiology department with aid of simulation modeling.

PubMed

Oh, Hong-Choon; Toh, Hong-Guan; Giap Cheong, Eddy Seng

2011-11-01

Using the classical process improvement framework of Plan-Do-Study-Act (PDSA), the diagnostic radiology department of a tertiary hospital identified several patient cycle time reduction strategies. Experimentation of these strategies (which included procurement of new machines, hiring of new staff, redesign of queue system, etc.) through pilot scale implementation was impractical because it might incur substantial expenditure or be operationally disruptive. With this in mind, simulation modeling was used to test these strategies via performance of "what if" analyses. Using the output generated by the simulation model, the team was able to identify a cost-free cycle time reduction strategy, which subsequently led to a reduction of patient cycle time and achievement of a management-defined performance target. As healthcare professionals work continually to improve healthcare operational efficiency in response to rising healthcare costs and patient expectation, simulation modeling offers an effective scientific framework that can complement established process improvement framework like PDSA to realize healthcare process enhancement. © 2011 National Association for Healthcare Quality.

Strategies for net cost reductions with the expanded role and expertise of anesthesiologists in the perioperative surgical home.

PubMed

Dexter, Franklin; Wachtel, Ruth E

2014-05-01

The Perioperative Surgical Home is a model adopted by the American Society of Anesthesiologists to increase quality and patient safety and to decrease costs. This Special Article is about the latter topic. Using narrative review, we show that there are two principal opportunities for net cost reduction. One opportunity is to reduce unnecessary interventions that do not have potential to benefit patients (e.g., preoperative laboratory studies in healthy patients undergoing low-risk surgery and use of substantial fresh gas flows with volatile anesthetics). The other opportunity is to optimize staff scheduling, case scheduling, and staff assignment. These two are the same as the principal ways that a positive return on investment can be achieved from use of an anesthesia information management system. Three other opportunities are much less likely to achieve as large (if any) net cost reduction among all patients but may at some hospitals. These are to reduce cancellations, operating room times, and/or hospital postoperative lengths of stay.