Fit for purpose quality management system for military forensic exploitation.

PubMed

Wilson, Lauren Elizabeth; Gahan, Michelle Elizabeth; Robertson, James; Lennard, Chris

2018-03-01

In a previous publication we described a systems approach to forensic science applied in the military domain. The forensic science 'system of systems' describes forensic science as a sub-system in the larger criminal justice, law enforcement, intelligence, and military systems, with quality management being an important supporting system. Quality management systems help to ensure that organisations achieve their objective and continually improve their capability. Components of forensic science quality management systems can include standardisation of processes, accreditation of facilities to national/international standards, and certification of personnel. A fit for purpose quality management system should be balanced to allow organisations to meet objectives, provide continuous improvement; mitigate risk; and impart a positive quality culture. Considerable attention over the last decades has been given to the need for forensic science quality management systems to meet criminal justice and law enforcement objectives. More recently, the need for the forensic quality management systems to meet forensic intelligence objectives has been considered. This paper, for the first time, discusses the need for a fit for purpose quality management system for military forensic exploitation. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

Quality Rating and Improvement Systems and Children's Cognitive Development

ERIC Educational Resources Information Center

Jeon, Lieny; Buettner, Cynthia K.

2015-01-01

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

Implementation of quality improvement techniques for management and technical processes in the ACRV project

NASA Technical Reports Server (NTRS)

Raiman, Laura B.

1992-01-01

Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

Implementation of quality improvement techniques for management and technical processes in the ACRV project

NASA Astrophysics Data System (ADS)

Raiman, Laura B.

1992-12-01

Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

They Lift My Spirit Up: Stakeholders' Perspectives on Support Teams for African Americans Facing Serious Illness

ERIC Educational Resources Information Center

Jackson, LeRon C.; Hanson, Laura C.; Hayes, Michelle; Green, Melissa; Peacock, Stacie; Corbie-Smith, Giselle

2014-01-01

Background: Active social and spiritual support for persons with cancer and other serious illnesses has been shown to improve psychological adjustment to illness and quality of life. Objective: To evaluate a community-based support team intervention within the African American community using stakeholder interviews. Methods: Support team members…

NACA documents database project

NASA Technical Reports Server (NTRS)

Smith, Ruth S.

1991-01-01

The plan to get all the National Advisory Committee on Aeronautics (NACA) collection online, with quality records, led to the NACA Documents Data base Project. The project has a two fold purpose: (1) to develop the definitive bibliography of NACA produced and/or held documents; and (2) to make that bibliography and the associated documents available to the aerospace community. This study supports the first objective by providing an analysis of the NACA collection and its bibliographic records, and supports the second objective by defining the NACA archive and recommending methodologies for meeting the project objectives.

Clinical Decision Support System to Enhance Quality Control of Spirometry Using Information and Communication Technologies

PubMed Central

2014-01-01

Background We recently demonstrated that quality of spirometry in primary care could markedly improve with remote offline support from specialized professionals. It is hypothesized that implementation of automatic online assessment of quality of spirometry using information and communication technologies may significantly enhance the potential for extensive deployment of a high quality spirometry program in integrated care settings. Objective The objective of the study was to elaborate and validate a Clinical Decision Support System (CDSS) for automatic online quality assessment of spirometry. Methods The CDSS was done through a three step process including: (1) identification of optimal sampling frequency; (2) iterations to build-up an initial version using the 24 standard spirometry curves recommended by the American Thoracic Society; and (3) iterations to refine the CDSS using 270 curves from 90 patients. In each of these steps the results were checked against one expert. Finally, 778 spirometry curves from 291 patients were analyzed for validation purposes. Results The CDSS generated appropriate online classification and certification in 685/778 (88.1%) of spirometry testing, with 96% sensitivity and 95% specificity. Conclusions Consequently, only 93/778 (11.9%) of spirometry testing required offline remote classification by an expert, indicating a potential positive role of the CDSS in the deployment of a high quality spirometry program in an integrated care setting. PMID:25600957

Work-Family Conflict, Family-Supportive Supervisor Behaviors (FSSB), and Sleep Outcomes

PubMed Central

Crain, Tori L.; Hammer, Leslie B.; Bodner, Todd; Kossek, Ellen Ernst; Moen, Phyllis; Lilienthal, Richard; Buxton, Orfeu M.

2014-01-01

Although critical to health and well-being, relatively little research has been conducted in the organizational literature on linkages between the work-family interface and sleep. Drawing on Conservation of Resources theory, we use a sample of 623 information technology workers to examine the relationships between work-family conflict, family-supportive supervisor behaviors (FSSB), and sleep quality and quantity. Validated wrist actigraphy methods were used to collect objective sleep quality and quantity data over a one week period of time, and survey methods were used to collect information on self-reported work-family conflict, FSSB, and sleep quality and quantity. Results demonstrated that the combination of predictors (i.e., work-to-family conflict, family-to-work conflict, FSSB) was significantly related to both objective and self-report measures of sleep quantity and quality. Future research should further examine the work-family interface to sleep link and make use of interventions targeting the work-family interface as a means for improving sleep health. PMID:24730425

Positive Social Support, Negative Social Exchanges, and Suicidal Behavior in College Students

ERIC Educational Resources Information Center

Hirsch, Jameson K.; Barton, Alison L.

2011-01-01

Objective: Risk for suicide is often higher among college students, compared to same-age noncollegiate peers, and may be exacerbated by quality of social support and interactions. The authors examined the independent contributions of positive social support and negative social exchanges to suicide ideation and attempts in college students.…

Stress associated with hospitalization in patients with COPD: the role of social support and health related quality of life

PubMed Central

2012-01-01

Background The objective of this study was to determine stress levels during hospitalization in patients with Chronic Obstructive Pulmonary Disease (COPD). We wanted to relate stress to previous level of quality of life and patients’ Social Support. Methods 80 patients (70.43; SD = 8.13 years old) with COPD were assessed by means of: Hospital Stress Rating Scale, Nottingham Health Profile, St. George’s Respiratory Questionnaire and Social Support Scale. Results COPD patients’ stress levels are lower than expected independently from the severity or number of previous hospitalizations. Linear regression analysis shows the predictive value of Quality of Life and Social Support on stress level during hospitalization (p < 0.0001). Conclusion HRQOL and social support can be associated with stress during hospitalization. PMID:23227860

Urban airshed modeling of air quality impacts of alternative transportation fuel use in Los Angeles and Atlanta

DOT National Transportation Integrated Search

1997-12-01

This report documents a photochemical modeling study of the potential impacts on air quality of future emissions from alternative fuel vehicles (AFVs). The main objective of the National Renewable Energy Laboratory (NREL) in supporting this study is ...

Asperger Syndrome in Males over Two Decades: Quality of Life in Relation to Diagnostic Stability and Psychiatric Comorbidity

ERIC Educational Resources Information Center

Helles, Adam; Gillberg, I. Carina; Gillberg, Christopher; Billstedt, Eva

2017-01-01

This study examined objective quality of life (work, academic success, living situation, relationships, support system) and subjective quality of life (Sense of Coherence and Short-Form Health Survey-36) in an adult sample of males (n = 50, mean age: 30 years) with Asperger syndrome diagnosed in childhood and followed prospectively over two…

I Am Aware of My Inconsistencies but Can Tolerate Them: The Effect of High Quality Listening on Speakers' Attitude Ambivalence.

PubMed

Itzchakov, Guy; Kluger, Avraham N; Castro, Dotan R

2017-01-01

We examined how listeners characterized by empathy and a non-judgmental approach affect speakers' attitude structure. We hypothesized that high quality listening decreases speakers' social anxiety, which in turn reduces defensive processing. This reduction in defensive processing was hypothesized to result in an awareness of contradictions (increased objective-attitude ambivalence), and decreased attitude extremity. Moreover, we hypothesized that experiencing high quality listening would enable speakers to tolerate contradictory responses, such that listening would attenuate the association between objective- and subjective-attitude ambivalence. We obtained consistent support for our hypotheses across four laboratory experiments that manipulated listening experience in different ways on a range of attitude topics. The effects of listening on objective-attitude ambivalence were stronger for higher dispositional social anxiety and initial objective-attitude ambivalence (Study 4). Overall, the results suggest that speakers' attitude structure can be changed by a heretofore unexplored interpersonal variable: merely providing high quality listening.

Targeted support and telecare in staffed housing for people with intellectual disabilities: impact on staffing levels and objective lifestyle indicators.

PubMed

Perry, Jonathan; Firth, Caroline; Puppa, Michael; Wilson, Rick; Felce, David

2012-01-01

Increased provision of out-of-family residential support is required because of demographic changes within the intellectual disabilities population. Residential support now has to be provided in a climate requiring both financial constraint and high quality service outcomes. The aim was to evaluate the quality of life consequences of living with less intensive staff support, resulting from the introduction of more targeted staff allocation coupled with telecare. The study comprised 91 participants who lived in 33 settings. The targeted support/telecare intervention was implemented at staggered intervals in 25 of these settings (63 participants). Data on a range of participant and setting descriptors, quality of care, and a range of objective lifestyle indicators were collected at four points in time over 2 years. Impact of the intervention was evaluated using within-group comparisons over time. Comparison between pre- and post-intervention showed that staffing levels were significantly reduced by 23%, whereas they were constant in the absence of intervention. One health indicator improved in the absence of intervention and another improved following intervention. There were no significant changes in any other lifestyle indicators (safety, money, social and community activity, independence or choice). A combination of targeted support and telecare had no adverse short-term affect on participants' quality of life, but reduced staff input so it seems that they have a role to play in the strategic development of out-of-family placements for adults with intellectual disabilities. Further research is needed to explore in more detail how efficiency is achieved in practice. © 2011 Blackwell Publishing Ltd.

Evaluation of impact of social support and care on HIV-positive and AIDS individuals' quality of life: a nonrandomised community trial.

PubMed

Li, Xing-Ming; Yuan, Xiao-Qing; Wang, Jun-Jie; Zhang, Wan-Ying; Zhou, Yang; Liu, Gu-Ning

2017-02-01

Our study was conducted to further investigate the model of social support and care for People Living with HIV/AIDS(PLHA), to explore their role in People Living with AIDS's quality of life (QOL) as reference for improving nursing policies for AIDS. Social support and care are the most important factors impacting the QOL of People Living with HIV/AIDS, but most studies conducted upon the influence of social support and QOL of People Living with HIV/AIDS are mainly based on cross-sectional design. Our study was a nonrandomised controlled community intervention study. The participants diagnosed as People Living with HIV/AIDS at Beijing You An Hospital received a comprehensive social support care from December 2013 to December 2014. To evaluate the impact of social support and care model on People Living with HIV/AIDS, our study analysed the different dimension scores of social support scale and quality of life before and after the intervention. Correlation between the net benefit value of social support and that of QOL from various dimensions were analysed. There were significant differences in the score of objective support and usage of support (all p = 0·02) for social support. Net values of objective support score and usage of support were 0·25 and 0·19, respectively, after intervention. There were significant differences in physiological function, role physical, general health, vitality, social function, mental health, health transition and total score of quality of life (all p < 0·05). The canonical correlation analysis of net values of social support and QOL indicated that the first and second canonical correlation were statistically significant, with correlation coefficients of 0·53 (p = 0·00) and 0·21 (p = 0·04). Social support and care intervention model can effectively improve perceived subjective feeling on social support and QOL condition for People Living with HIV/AIDS. And strategies to improve social support and care intervention programmes are strongly encouraged. The method is simple and cost-effective and could be a way to improve the quality of life condition for People Living with HIV/AIDS. © 2016 John Wiley & Sons Ltd.

The correlation between quality of life and social support in female nurses.

PubMed

Sun, Ning; Lv, Dong-Mei; Man, Jing; Wang, Xiao-Yu; Cheng, Qin; Fang, Hong-Li; Fu, Zhen; Liu, Shuang; Wu, Qun-Hong

2017-04-01

To investigate the relationship between quality of life and social support in female nurses. Nurses play an important role in providing care and managing patients' health in hospitals. However, limited studies have shown an association between quality of life and social support in female nurses in China. Questionnaire survey. To investigate 320 full-time female nurses in different departments at four comprehensive hospitals in Harbin with a cross-sectional correlational design using questionnaires. A demographic data questionnaire, menopause-specific quality of life questionnaire and social support scale were used. The scores on the physical (36·93 ± 17·65) and psychological (17·57 ± 9·45) subscales were higher than those of the vasomotor (4·88 ± 3·48) and sexual (4·53 ± 3·23) subscales of quality of life. The average score of objective support (25·12 ± 4·32) was higher than those of subjective support (9·80 ± 3·04) and utilisation of social support (7·80 ± 1·97). A significant association between quality of life and social support was found (p < 0·01). Social support influenced quality of life. Social support as a buffer for pressure can influence individual stress perception, help individuals cope with pressure and reduce the negative impact of stress on mental and physical health, thus improving different aspects of health. Enhancing social support in an active environment would allow female nurses to enjoy a better quality of life in their clinical practice. © 2016 John Wiley & Sons Ltd.

Burden, quality of life, and social support in caregivers of patients undergoing radiotherapy for head and neck cancer: A pilot study

PubMed Central

Nightingale, Chandylen L; Curbow, Barbara A; Wingard, John R; Pereira, Deidre B; Carnaby, Giselle D

2017-01-01

Objective The purpose of this pilot study was to (1) obtain preliminary data on changes in burden and quality of life in head and neck cancer caregivers during and shortly following patient radiotherapy, (2) assess the relationship between perceived social support and burden as well as perceived social support and quality of life in caregivers during radiotherapy, and (3) identify preferences for sources of support among caregivers during radiotherapy. Methods Caregivers completed burden and quality of life instruments at the start of patient radiotherapy (T1), 5 weeks into radiotherapy (T2), and 1 month post-radiotherapy (T3) and instruments for perceived social support and support preferences at T2 only. Results Caregivers showed a trend toward increased burden and worsened quality of life for the majority of subscales at T2 or T3 than at T1. Caregivers reported significantly lower esteem and significantly greater disruption at T2 than at T1 and significantly worse health at T3 than at T2. Higher perceived social support was typically associated with lower burden and higher quality of life at T2. Spouses/partners were the most commonly preferred source of support. Discussion These pilot findings suggest that caregivers experience psychosocial impairments during and shortly after patient radiotherapy, but more research using larger samples is warranted. PMID:27068111

SHERPA: an image segmentation and outline feature extraction tool for diatoms and other objects

PubMed Central

2014-01-01

Background Light microscopic analysis of diatom frustules is widely used both in basic and applied research, notably taxonomy, morphometrics, water quality monitoring and paleo-environmental studies. In these applications, usually large numbers of frustules need to be identified and/or measured. Although there is a need for automation in these applications, and image processing and analysis methods supporting these tasks have previously been developed, they did not become widespread in diatom analysis. While methodological reports for a wide variety of methods for image segmentation, diatom identification and feature extraction are available, no single implementation combining a subset of these into a readily applicable workflow accessible to diatomists exists. Results The newly developed tool SHERPA offers a versatile image processing workflow focused on the identification and measurement of object outlines, handling all steps from image segmentation over object identification to feature extraction, and providing interactive functions for reviewing and revising results. Special attention was given to ease of use, applicability to a broad range of data and problems, and supporting high throughput analyses with minimal manual intervention. Conclusions Tested with several diatom datasets from different sources and of various compositions, SHERPA proved its ability to successfully analyze large amounts of diatom micrographs depicting a broad range of species. SHERPA is unique in combining the following features: application of multiple segmentation methods and selection of the one giving the best result for each individual object; identification of shapes of interest based on outline matching against a template library; quality scoring and ranking of resulting outlines supporting quick quality checking; extraction of a wide range of outline shape descriptors widely used in diatom studies and elsewhere; minimizing the need for, but enabling manual quality control and corrections. Although primarily developed for analyzing images of diatom valves originating from automated microscopy, SHERPA can also be useful for other object detection, segmentation and outline-based identification problems. PMID:24964954

SHERPA: an image segmentation and outline feature extraction tool for diatoms and other objects.

PubMed

Kloster, Michael; Kauer, Gerhard; Beszteri, Bánk

2014-06-25

Light microscopic analysis of diatom frustules is widely used both in basic and applied research, notably taxonomy, morphometrics, water quality monitoring and paleo-environmental studies. In these applications, usually large numbers of frustules need to be identified and/or measured. Although there is a need for automation in these applications, and image processing and analysis methods supporting these tasks have previously been developed, they did not become widespread in diatom analysis. While methodological reports for a wide variety of methods for image segmentation, diatom identification and feature extraction are available, no single implementation combining a subset of these into a readily applicable workflow accessible to diatomists exists. The newly developed tool SHERPA offers a versatile image processing workflow focused on the identification and measurement of object outlines, handling all steps from image segmentation over object identification to feature extraction, and providing interactive functions for reviewing and revising results. Special attention was given to ease of use, applicability to a broad range of data and problems, and supporting high throughput analyses with minimal manual intervention. Tested with several diatom datasets from different sources and of various compositions, SHERPA proved its ability to successfully analyze large amounts of diatom micrographs depicting a broad range of species. SHERPA is unique in combining the following features: application of multiple segmentation methods and selection of the one giving the best result for each individual object; identification of shapes of interest based on outline matching against a template library; quality scoring and ranking of resulting outlines supporting quick quality checking; extraction of a wide range of outline shape descriptors widely used in diatom studies and elsewhere; minimizing the need for, but enabling manual quality control and corrections. Although primarily developed for analyzing images of diatom valves originating from automated microscopy, SHERPA can also be useful for other object detection, segmentation and outline-based identification problems.

Unemployment and health: the quality of social support among residents in the Trent region of England.

PubMed Central

Roberts, H; Pearson, J C; Madeley, R J; Hanford, S; Magowan, R

1997-01-01

OBJECTIVE: To examine the quality of social support among unemployed residents in Trent, England. DESIGN: Secondary analysis of data generated by those of working age drawn from a postal lifestyle survey of the adult population of Trent region. SUBJECTS AND SETTING: Subjects were 6987 individuals (males 16-64 years and females 16-59 years of age), of whom 9.9% (689/6987) were unemployed. MAIN OUTCOME MEASURES: Responses about the quality of social support obtained from three key questions. RESULTS: Generally, the unemployed reported poorer quality of social support than employed persons (p < 0.0001) on all three key elements examined: 31% v 17% respectively had no practical support; 19% v 10% had no help with solving problems, and 21% v 10% had no emotional support. Only 57% of the unemployed had all three of these elements compared with 75% of the employed. Unemployment and lack of social support had independent and deleterious effects on perceptions of general health and mental health. Relationships remained after allowing for the possible confounding effects of age, gender, and household composition. CONCLUSIONS: There is a relationship between unemployment and poorer quality of social support which may help to explain some of the increased morbidity and mortality experienced by this group, especially that related to mental health. PMID:9135787

Psychiatric Residents' Views of Quality of Psychotherapy Training and Psychotherapy Competencies: A Multisite Survey

ERIC Educational Resources Information Center

Calabrese, Christina; Sciolla, Andres; Zisook, Sidney; Bitner, Robin; Tuttle, Jeffrey; Dunn, Laura B.

2010-01-01

Objective: Few studies of residents' attitudes toward psychotherapy training exist. The authors examined residents' perceptions of the quality of their training, support for training, their own competence levels, and associations between self-perceived competence and perceptions of the training environment. Methods: An anonymous, web-based…

Factorial validity of the Delta Healthy Eating Attitudes Scale related to diet quality

USDA-ARS?s Scientific Manuscript database

The objective of this study was to establish factorial validity of decisional balance (DB), self-efficacy (SE) and social support (SS) psychosocial constructs and convergent validity related to diet quality. A sample (N=319) of predominantly African American women from the Mississippi Communities fo...

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

Holladay, S.K.; Anderson, H.M.; Benson, S.B.

Quality assurance (QA) objectives for Phase 2 were that (1) scientific data generated would withstand scientific and legal scrutiny; (2) data would be gathered using appropriate procedures for sample collection, sample handling and security, chain of custody, laboratory analyses, and data reporting; (3) data would be of known precision and accuracy; and (4) data would meet data quality objectives defined in the Phase 2 Sampling and Analysis Plan. A review of the QA systems and quality control (QC) data associated with the Phase 2 investigation is presented to evaluate whether the data were of sufficient quality to satisfy Phase 2more » objectives. The data quality indicators of precision, accuracy, representativeness, comparability, completeness, and sensitivity were evaluated to determine any limitations associated with the data. Data were flagged with qualifiers that were associated with appropriate reason codes and documentation relating the qualifiers to the reviewer of the data. These qualifiers were then consolidated into an overall final qualifier to represent the quality of the data to the end user. In summary, reproducible, precise, and accurate measurements consistent with CRRI objectives and the limitations of the sampling and analytical procedures used were obtained for the data collected in support of the Phase 2 Remedial Investigation.« less

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

PubMed

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

2015-11-01

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

Leading quality through the development of a multi-year corporate quality plan: sharing The Ottawa Hospital experience.

PubMed

Hunter, Linda; Myles, Joanne; Worthington, James R; Lebrun, Monique

2011-01-01

This article discusses the background and process for developing a multi-year corporate quality plan. The Ottawa Hospital's goal is to be a top 10% performer in quality and patient safety in North America. In order to create long-term measurable and sustainable changes in the quality of patient care, The Ottawa Hospital embarked on the development of a three-year strategic corporate quality plan. This was accomplished by engaging the organization at all levels and defining quality frameworks, aligning with internal and external expectations, prioritizing strategic goals, articulating performance measurements and reporting to stakeholders while maintaining a transparent communication process. The plan was developed through an iterative process that engaged a broad base of health professionals, physicians, support staff, administration and senior management. A literature review of quality frameworks was undertaken, a Quality Plan Working Group was established, 25 key stakeholder interviews were conducted and 48 clinical and support staff consultations were held. The intent was to gather information on current quality initiatives and challenges encountered and to prioritize corporate goals and then create the quality plan. Goals were created and then prioritized through an affinity exercise. Action plans were developed for each goal and included objectives, tasks and activities, performance measures (structure, process and outcome), accountabilities and timelines. This collaborative methodology resulted in the development of a three-year quality plan. Six corporate goals were outlined by the tenets of the quality framework for The Ottawa Hospital: access to care, appropriate care (effective and efficient), safe care and satisfaction with care. Each of the six corporate goals identified objectives and supporting action plans with accountabilities outlining what would be accomplished in years one, two and three. The three-year quality plan was approved by senior management and the board in April 2009. This process has supported The Ottawa Hospital's journey of excellence through the creation of a quality plan that will enable long-term measurable and sustainable changes in the quality of patient care. It also engaged healthcare providers who aim to achieve more measured quality patient care, engaged practitioners through collaboration resulting in both alignment of goals and outcomes and allowed for greater commitment by those responsible for achieving quality goals.

Basic Education and Policy Support (BEPS) Activity.

ERIC Educational Resources Information Center

Creative Associates International, Inc., Washington, DC.

The Basic Education and Policy Support (BEPS) Activity is a multi-year, worldwide, indefinite quantity contract by which the U.S. Agency for International Development (USAID) Global Bureau Center for Human Capacity (G/HCD) can work to achieve four objectives: (1) improve the quality, efficiency, access, and equity of education, particularly basic…

The Learning Thermometer: Closing the Loop between Teaching, Learning, Wellbeing and Support in Universities

ERIC Educational Resources Information Center

Stallman, Helen M.; King, Sharron

2016-01-01

The increasing awareness and impact of mental health problems in university students in addition to a need for objective measures of teaching quality provide the impetus for a new approach to supporting students. There is a need for more effective tools that integrate the institutional silos of teaching, learning, support, and wellbeing to help…

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

USDA-ARS?s Scientific Manuscript database

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

Using Formative Student Feedback: A Continuous Quality Improvement Approach for Online Course Development

ERIC Educational Resources Information Center

Bloxham, Kristy Taylor

2010-01-01

The objective of this study was to examine the use of frequent, anonymous student course surveys as a tool in supporting continuous quality improvement (CQI) principles in online instruction. The study used a qualitative, multiple-case design involving four separate online courses. Analysis methods included pattern matching/explanation building,…

Factors Influencing the Quality of EHR Performance: An Exploratory Qualitative Study

ERIC Educational Resources Information Center

Rhodes, Harry B.

2016-01-01

A significant amount of evidence existed in support of the positive effect on the quality of healthcare that resulted from transitioning to electronic health information systems, equally compelling evidence suggests that the development process for electronic health information systems falls short of achieving its potential. The objective of this…

Environmental stressors afflicting tailwater stream reaches across the United States

USGS Publications Warehouse

Miranda, Leandro E.; Krogman, R. M.

2014-01-01

The tailwater is the reach of a stream immediately below an impoundment that is hydrologically, physicochemically and biologically altered by the presence and operation of a dam. The overall goal of this study was to gain a nationwide awareness of the issues afflicting tailwater reaches in the United States. Specific objectives included the following: (i) estimate the percentage of reservoirs that support tailwater reaches with environmental conditions suitable for fish assemblages throughout the year, (ii) identify and quantify major sources of environmental stress in those tailwaters that do support fish assemblages and (iii) identify environmental features of tailwater reaches that determine prevalence of key fish taxa. Data were collected through an online survey of fishery managers. Relative to objective 1, 42% of the 1306 reservoirs included in this study had tailwater reaches with sufficient flow to support a fish assemblage throughout the year. The surface area of the reservoir and catchment most strongly delineated reservoirs maintaining tailwater reaches with or without sufficient flow to support a fish assemblage throughout the year. Relative to objective 2, major sources of environmental stress generally reflected flow variables, followed by water quality variables. Relative to objective 3, zoogeography was the primary factor discriminating fish taxa in tailwaters, followed by a wide range of flow and water quality variables. Results for objectives 1–3 varied greatly among nine geographic regions distributed throughout the continental United States. Our results provide a large-scale view of the effects of reservoirs on tailwater reaches and may help guide research and management needs.

A review of couple-centred interventions in dementia: Exploring the what and why - Part A.

PubMed

Bielsten, Therése; Hellström, Ingrid

2017-01-01

Introduction Symptoms of dementia bring about challenges to couples' relationships. Relationship-focused support has been highlighted to be of significant importance for sustained relationship quality and to reduce the negative impact of dementia on the dyadic relationship. This review aimed to explore the 'what' and 'why' of interventions aimed at couples where one partner has a diagnosis of dementia and in which the couple jointly participate. Method Searches were performed in Academic Search Premier, CINAHL, PsycINFO, PubMed, Scopus and Web of Science from January 2000 to August 2017. Results Six studies were included. Objectives for the person with dementia was related to cognitive function and for the care partner the objectives were related to well-being. The majority of the outcomes were mirrored by the objectives and focused on cognitive function for people with dementia and depression and relationship quality for care partners. Our findings indicate that people with dementia should be included in the assessment of the relationship in order to gain an overall picture of relationship dynamics and to increase tailored support in couple-centred interventions. Conclusions The findings of this review indicate that joint interventions for people with dementia and care partners are lacking a genuine dyadic approach where both partners' views of their relationship are valued. In order to identify targets for support and to use the appropriate outcome measures, the quality of the relationship should be recognised and taken into account. Moreover, there is a lack of a salutogenic approach in couple-centred interventions in which couples' strengths and resources can be identified and supported.

Data Quality Objectives Supporting the Environmental Soil Monitoring Program for the Idaho National Laboratory Site

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

Haney, Thomas Jay

This document describes the process used to develop data quality objectives for the Idaho National Laboratory (INL) Environmental Soil Monitoring Program in accordance with U.S. Environmental Protection Agency guidance. This document also develops and presents the logic that was used to determine the specific number of soil monitoring locations at the INL Site, at locations bordering the INL Site, and at locations in the surrounding regional area. The monitoring location logic follows the guidance from the U.S. Department of Energy for environmental surveillance of its facilities.

Depression and anxiety mediate perceived social support to predict health-related quality of life in pregnant women living with HIV.

PubMed

Xiaowen, Wang; Guangping, Guo; Ling, Zhou; Jiarui, Zheng; Xiumin, Liang; Zhaoqin, Li; Hongzhuan, Luo; Yuyan, Yang; Liyuan, Yang; Lin, Lu

2018-04-01

Pregnant women living with HIV represent one of the most high-priority groups for HIV treatment and health assessment. Although social support has been shown to be a protective factor for improved health-related quality of life (HRQoL), and depression and anxiety have been identified as two major causes of psychological distress among people living with HIV, it is still unclear how social support, anxiety, and depression interact to influence HRQoL. The objective of our study was to demonstrate the nature of predictors, direct effects and mediator effects among social support, anxiety, depression symptoms and HRQoL in pregnant women living with HIV. We investigated a total of 101 pregnant women living with HIV in Yunnan province in China from April 2016 to June 2016. All participants completed the Social Support Rating Scale (SSRS), the Chinese version of the Hospital Anxiety and Depression Scales (HADS) and Quality of Life instruments (EuroQoL Five Dimensions Questionnaire, EQ-5D). The relationships between the variables were examined by Pearson's or Spearman's correlation analysis. Predictor effects were tested using separate multiple regressions, controlling for demographic variables and HIV diagnosis variables. Direct and mediation effects of social support on HRQoL were tested using a structural equation model (SEM). Anxiety and depression symptoms were negatively correlated with subjective social support, support utilization, social support and HRQoL. Social support significantly predicted better HRQoL, and anxiety and depression symptoms significantly predicted poorer HRQoL. Anxiety and depression symptoms partially mediated the associations between social support and HRQoL. Anxiety and depression symptoms completely mediated the associations of objective support and support utilization with HRQoL. Interventions to improve HRQoL in pregnant women living with HIV must consider the mediation effect of anxiety and depression symptoms on the association between social support and HRQoL. Social support interventions are valid only when anxiety and depression symptoms are managed effectively.

Implementation of the Secondary 3 Program of Project P.A.T.H.S.: observations based on the co-walker scheme.

PubMed

Shek, Daniel T L; Ma, Cecilia M S

2012-01-17

The present study was conducted to explore the implementation quality of the Secondary 3 Program of the Tier 1 Program of Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) in the third year of the Full Implementation Phase. Classroom observations of 182 units in 129 schools were conducted. Results showed that the overall level of program adherence was 73.9%. Thirteen aspects concerning program delivery were significantly correlated. Multiple regression analyses revealed that overall implementation quality was significantly predicted by student participation and involvement, strategies to enhance student motivation, use of positive and supportive feedback, degree of achievement of the objectives, and lesson preparation. Success of implementation was significantly predicted by student participation and involvement, classroom control, use of positive and supportive feedback, opportunity for reflection, degree of achievement of the objectives and time management. The present findings generally suggest that the implementation quality of Project P.A.T.H.S. was high.

A Study of Family Support, Friendship, and Psychological Well-Being among Older Women in Hong Kong

ERIC Educational Resources Information Center

Siu, Oi-Ling; Phillips, David R.

2002-01-01

The "dual-channel" hypothesis (Lawton, 1996), which suggests the dual-antecedent pattern for positive and negative aspects of psychological well-being, was tested by examining the differential relationships between objective and subjective measures of family support (family contact, family quality, perceived importance of family) and…

An improved NAS-RIF algorithm for image restoration

NASA Astrophysics Data System (ADS)

Gao, Weizhe; Zou, Jianhua; Xu, Rong; Liu, Changhai; Li, Hengnian

2016-10-01

Space optical images are inevitably degraded by atmospheric turbulence, error of the optical system and motion. In order to get the true image, a novel nonnegativity and support constants recursive inverse filtering (NAS-RIF) algorithm is proposed to restore the degraded image. Firstly the image noise is weaken by Contourlet denoising algorithm. Secondly, the reliable object support region estimation is used to accelerate the algorithm convergence. We introduce the optimal threshold segmentation technology to improve the object support region. Finally, an object construction limit and the logarithm function are added to enhance algorithm stability. Experimental results demonstrate that, the proposed algorithm can increase the PSNR, and improve the quality of the restored images. The convergence speed of the proposed algorithm is faster than that of the original NAS-RIF algorithm.

Young Adults’ Provision of Support to Middle-Aged Parents

PubMed Central

Birditt, Kira S.; Zarit, Steven H.; Fingerman, Karen L.

2015-01-01

Objectives. Middle-aged adults often provide support to aging parents, but researchers know little about support that young adults provide middle-aged parents. This study examined support that young adults provide parents and explanations for that support from both offspring’s and parents’ perspectives. Method. Young adults (n = 515, mean age = 22.34) and their parents (n = 364, mean age = 50.09) from the Family Exchanges Study reported support that offspring provide parents. Participants also reported parental personal problems, parental disability status, relationship quality, and support that parents provide offspring. Results. Offspring provided parents with emotional support and listening more often than other forms of support. Offspring reported providing more frequent support than parents reported receiving. We examined factors associated with support using multilevel models. Both offspring and parents reported more frequent support provided to parents when they had higher quality relationships and when parents gave more frequent support to offspring. Offspring (but not parents) reported providing more frequent support to parents when parents were disabled. Discussion. Findings are consistent with solidarity theory, which suggests that high-quality relationships may explain support. The concept of self-enhancement and generativity in middle-aged parents may explain the intergenerational differences in the association between parental disability and support. PMID:24162441

Postharvest color and texture retention in organic Chinese red raspberry and sea-buckthorn fruit during modified atmosphere storage

USDA-ARS?s Scientific Manuscript database

Color and texture are among the key quality attributes for small fruit. Postharvest approaches such as modified atmosphere packaging (MAP) along with cold chain management have been shown to support retention of fruit quality during handling and distribution. The objective of this study was to inves...

Fathers in Turkey: Paternity Characteristics, Gender Role, Communication Skills

ERIC Educational Resources Information Center

ünüvar, Perihan

2017-01-01

Objective of this study is to examine the correlation the quality of paternity, gender roles and communication skills of fathers. The scores in the scale of supporting developmental tasks were used in order to determine the quality of paternity. The other data collection tools were the BEM sex role inventory and the communication skills inventory.…

Toward High Quality Family Day Care for Infants and Toddlers. Final Report.

ERIC Educational Resources Information Center

Rauch, Marian D.; Crowell, Doris C.

Reported were the results of a project which established a cluster of family day care homes in Hawaii in which caregivers were selected, trained, and provided with supportive services and salaries. The primary objective of the program was to provide a replicable, high quality program for preschool children that would maximize social, emotional,…

Developing a Learning Object Metadata Application Profile Based on LOM Suitable for the Australian Higher Education Context

ERIC Educational Resources Information Center

Agostinho, Shirley; Bennett, Sue; Lockyer, Lori; Harper, Barry

2004-01-01

This paper reports recent work in developing of structures and processes that support university teachers and instructional designers incorporating learning objects into higher education focused learning designs. The aim of the project is to develop a framework to guide the design and implementation of high quality learning experiences. This…

Compatibility Grab Sampling and Analysis Plan for FY 2000

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

SASAKI, L.M.

1999-12-29

This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for grab samples obtained to address waste compatibility. It is written in accordance with requirements identified in Data Quality Objectives for Tank Farms Waste Compatibility Program (Mulkey et al. 1999) and Tank Farm Waste Transfer Compatibility Program (Fowler 1999). In addition to analyses to support Compatibility, the Waste Feed Delivery program has requested that tank samples obtained for Compatibility also be analyzed to confirm the high-level waste and/or low-activity waste envelope(s) for the tank waste (Baldwin 1999). The analytical requirements tomore » confirm waste envelopes are identified in Data Quality Objectives for TWRS Privatization Phase I: Confirm Tank T is an Appropriate Feed Source for Low-Activity Waste Feed Batch X (Nguyen 1999a) and Data Quality Objectives for RPP Privatization Phase I: Confirm Tank T is an Appropriate Feed Source for High-Level Waste Feed Batch X (Nguyen 1999b).« less

A decision-support system for the analysis of clinical practice patterns.

PubMed

Balas, E A; Li, Z R; Mitchell, J A; Spencer, D C; Brent, E; Ewigman, B G

1994-01-01

Several studies documented substantial variation in medical practice patterns, but physicians often do not have adequate information on the cumulative clinical and financial effects of their decisions. The purpose of developing an expert system for the analysis of clinical practice patterns was to assist providers in analyzing and improving the process and outcome of patient care. The developed QFES (Quality Feedback Expert System) helps users in the definition and evaluation of measurable quality improvement objectives. Based on objectives and actual clinical data, several measures can be calculated (utilization of procedures, annualized cost effect of using a particular procedure, and expected utilization based on peer-comparison and case-mix adjustment). The quality management rules help to detect important discrepancies among members of the selected provider group and compare performance with objectives. The system incorporates a variety of data and knowledge bases: (i) clinical data on actual practice patterns, (ii) frames of quality parameters derived from clinical practice guidelines, and (iii) rules of quality management for data analysis. An analysis of practice patterns of 12 family physicians in the management of urinary tract infections illustrates the use of the system.

40 CFR 255.10 - Criteria for identifying regions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... volume of waste to support the goals and objectives of the State plan, including materials or energy... designated in accordance with the Safe Drinking Water Act, and with air quality planning agencies designated...

40 CFR 255.10 - Criteria for identifying regions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... volume of waste to support the goals and objectives of the State plan, including materials or energy... designated in accordance with the Safe Drinking Water Act, and with air quality planning agencies designated...

40 CFR 255.10 - Criteria for identifying regions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... volume of waste to support the goals and objectives of the State plan, including materials or energy... designated in accordance with the Safe Drinking Water Act, and with air quality planning agencies designated...

Flight Tests of a Ministick Controller in an F/A-18 Airplane

NASA Technical Reports Server (NTRS)

Stoliker, Patrick C.; Carter, John

2003-01-01

In March of 1999, five pilots performed flight tests to evaluate the handling qualities of an F/A-18 research airplane equipped with a small-displacement center stick (ministick) controller that had been developed for the JAS 39 Gripen airplane (a fighter/attack/ reconnaissance airplane used by the Swedish air force). For these tests, the ministick was installed in the aft cockpit (see figure) and production support flight control computers (PSFCCs) were used as interfaces between the controller hardware and the standard F/A-18 flight-control laws. The primary objective of the flight tests was to assess any changes in handling qualities of the F/A-18 airplane attributable to the mechanical characteristics of the ministick. The secondary objective was to demonstrate the capability of the PSFCCs to support flight-test experiments.

Capacity and readiness for quality improvement among home and community-based service providers.

PubMed

Abrahamson, Kathleen; Myers, Jaclyn; Arling, Greg; Davila, Heather; Mueller, Christine; Abery, Brian; Cai, Yun

2016-01-01

The objective of this study was to explore home and community-based service (HCBS) providers' perspectives of organizational readiness for quality improvement (QI). Data were obtained from a survey of participants (N = 56) in a state-sponsored HCBS QI initiative. Quality improvement challenges included lack of time and resources, staff apprehension or resistance, resistance from consumers and families, and project sustainability. Support from leadership was viewed as an important factor in participating organizations' decision to engage in QI. Internal resources available to support QI varied widely between participating organizations, with differences observed between smaller and larger agencies, as well as between provider types and populations served.

Toward a multi-objective decision support framework to support regulations of unconventional oil and gas development

NASA Astrophysics Data System (ADS)

Alongi, M.; Howard, C.; Kasprzyk, J. R.; Ryan, J. N.

2015-12-01

Unconventional oil and gas development (UOGD) using hydraulic fracturing and horizontal drilling has recently fostered an unprecedented acceleration in energy development. Regulations seek to protect environmental quality of areas surrounding UOGD, while maintaining economic benefits. One such regulation is a setback distance, which dictates the minimum proximity between an oil and gas well and an object such as a residential or commercial building, property line, or water source. In general, most setback regulations have been strongly politically motivated without a clear scientific basis for understanding the relationship between the setback distance and various performance outcomes. This presentation discusses a new decision support framework for setback regulations, as part of a large NSF-funded sustainability research network (SRN) on UOGD. The goal of the decision support framework is to integrate a wide array of scientific information from the SRN into a coherent framework that can help inform policy regarding UOGD. The decision support framework employs multiobjective evolutionary algorithm (MOEA) optimization coupled with simulation models of air quality and other performance-based outcomes on UOGD. The result of the MOEA optimization runs are quantitative tradeoff curves among different objectives. For example, one such curve could demonstrate air pollution concentrations versus estimates of energy development profits, for different levels of setback distance. Our results will also inform policy-relevant discussions surrounding UOGD such as comparing single- and multi-well pads, as well as regulations on the density of well development over a spatial area.

Data Quality Objectives Supporting Radiological Air Emissions Monitoring for the Marine Sciences Laboratory, Sequim Site

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

Barnett, J. Matthew; Meier, Kirsten M.; Snyder, Sandra F.

2012-12-27

This document of Data Quality Objectives (DQOs) was prepared based on the U.S. Environmental Protection Agency (EPA) Guidance on Systematic Planning Using the Data Quality Objectives Process, EPA, QA/G4, 2/2006 (EPA 2006), as well as several other published DQOs. The intent of this report is to determine the necessary steps required to ensure that radioactive emissions to the air from the Marine Sciences Laboratory (MSL) headquartered at the Pacific Northwest National Laboratory’s Sequim Marine Research Operations (Sequim Site) on Washington State’s Olympic Peninsula are managed in accordance with regulatory requirements and best practices. The Sequim Site was transitioned in Octobermore » 2012 from private operation under Battelle Memorial Institute to an exclusive use contract with the U.S. Department of Energy, Office of Science, Pacific Northwest Site Office.« less

The Perception of Preservice Mathematics Teachers on the Role of Scaffolding in Achieving Quality Mathematics Classroom Instruction

ERIC Educational Resources Information Center

Bature, Iliya Joseph; Jibrin, Adamu Gagdi

2015-01-01

This paper was designed to investigate the perceptions of four preservice mathematics teachers on the role of scaffolding in supporting and assisting them achieves quality classroom teaching. A collaborative approach to teaching through a community of practice was used to obtain data for the three research objectives that were postulated. Two…

Prosthetic outcome, patient complaints, and nutritional effects on elderly patients with magnet-retained, implant-supported overdentures--a 1-year report.

PubMed

Khoo, Huan Ding; Chai, John; Chow, Tak Wah

2013-01-01

To study the changes in treatment outcomes of complete dentures and magnet-retained, implant-supported overdentures in a group of elderly patients. In this nonrandomized trial, 43 edentulous patients (14 men and 29 women) were fitted with complete dentures followed by implant-supported mandibular overdenture in a sequential model. Treatment outcomes used for analysis included objective assessment of denture quality (Woelfel's index), patient satisfaction, nutritional status, body mass index (BMI), and serum albumin level. The McNemar test was used to determine if significant differences in the Woelfel's index and nutritional status existed at different treatment phases. Repeated measures ANOVA and multiple pairwise comparison tests were used to analyze patient satisfaction. BMI status and serum albumin level at different treatment phases were analyzed with one-way ANOVA and Tukey post hoc test. At the 1-year follow-up, significant improvements were recorded for the objective assessment of denture quality and patient complaints (P < .05). No subject was found to be malnourished at pretreatment and in subsequent treatment phases. BMI and serum albumin level were not significantly different at different treatment phases (P > .05) CONCLUSIONS: The present study demonstrated that in elderly patients with stable health and nutritional status, complete dentures made in a university clinic brought about overall improvement in denture quality and reduction in denture complaint score. Insertion of mandibular implant-supported overdentures further improved the mandibular denture quality and reduced the mandibular denture complaint score. In this group of patients, no improvement in BMI, serum albumin value, and nutritional status were documented.

Social support and responsiveness in online patient communities: impact on service quality perceptions.

PubMed

Nambisan, Priya; Gustafson, David H; Hawkins, Robert; Pingree, Suzanne

2016-02-01

Hospitals frequently evaluate their service quality based on the care and services provided to patients by their clinical and non-clinical staff.(1,2) However, such evaluations do not take into consideration the many interactions that patients have in online patient communities with the health-care organization (HCO) as well as with peer patients. Patients' interactions in these online communities could impact their perceptions regarding the HCO's service quality. The objective of this pilot study was to evaluate the impact of social support and responsiveness that patients experience in an HCO's online community on patients' perceptions regarding the HCO's service quality. The study data are collected from CHESS, a health-care programme (Comprehensive Health Enhancement Support System) run by the Centre for Health Enhancement System Studies at the University of Wisconsin-Madison. Findings show that the social support and the responsiveness received from peer patients in the online patient communities will impact patients' perceptions regarding the service quality of the HCO even when the organizational members themselves do not participate in the online discussions. The results indicate that interactions in such HCO-provided online patient communities should not be ignored as they could translate into patients' perceptions regarding HCOs' service quality. Ways to improve responsiveness and social support in an HCO's online patient community are discussed. © 2014 John Wiley & Sons Ltd.

Quality of life and social support in patients with multiple sclerosis.

PubMed

Rosiak, Katarzyna; Zagożdżon, Paweł

2017-10-29

Quality of life and needforsocial support in persons diagnosed with multiple sclerosis (MS) are to a large extent determined by the degree of their disability. The aim of the study was to analyze an association between specific forms of MS, subjectively perceived quality of life and social support. The study included subjects with established diagnosis of MS, treated at rehabilitation centers, hospitals and in a home setting, as well as the members of patient organizations. After being informed about objectives of the study, type of included tasks and way to complete them, each participant was handed out a set of questionnaires: Berlin Social Support Scales (Łuszczyńska, Kowalska, Schwarzer, Schulz), Quality of Life Questionnaire (WHOQOLBREF), as well as a survey developed specifically for the purposes of this project. The results were subjected to statistical analysis with STATA 12 package. The study included a total of 110 persons (67 women and 43 men). Quality of life overall, as well in physical, psychological, social relationships and environmental health domains, turned out to be particularly important in patients with primary-progressive MS. Irrespective of MS type, social support overall did not play a significant role on univariate analysis. However, subgroup analysis according to sex demonstrated that men with MS received social support four times less often than women. Quality of life in individuals with primary-progressive MS is significantly lower than in patients presenting with other types of this disease. Men with MS are more likely to present with worse scores for social support overall. They are less likely both to acknowledge the need for support and to realize the availability of support they actually need.

[Quality of life and adherence to nebulised antibiotic therapy using a new device in non-cystic fibrosis bronchiectasis].

PubMed

Gulini, Martina; Prados, Concepción; Pérez, Amparo; Romero, David; Feliz, Darwin; Gómez Carrera, Luis; Cabanillas, Juan José; Barbero, Javier; Alvarez-Sala, Rodolfo

2012-01-01

Analysis of psychological variables, quality of life, depression and anxiety, subjective perception of compliance, level of satisfaction with the electronic device, and objective verification) in order to study the therapeutic adherence, in non-cystic fibrosis bronchiectasis (NCFB) colonized by Pseudomonas aeruginosa. A cross-sectional descriptive study was conducted on 22 NCFB stable patients colonised by Pseudomonas aeruginosa (two groups of 11 subjects: GROUP 1, Pari-LC plus nebuliser device, and GROUP 2, with the I- neb device), both containing sodium colistemethate. Different variables, were obtained, such as, self-perceived health (St George questionnaire), state of mind (HADS scale), and subjective perception of therapeutic compliance and objective verification by using the device software. There were no significant differences in questionnaire results. The therapeutic support in GROUP 2, could be proved objectively (up to 60%) using specific software, and the excellent tolerability using a specific questionnaire created for the study. These types of aerosol devices demonstrate a high level of therapeutic support, that can be measured objectively and is different from what the patients subjectively indicates. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Help With “Strings Attached”: Offspring Perceptions That Middle-Aged Parents Offer Conflicted Support

PubMed Central

2013-01-01

Objectives. Middle-aged adults often provide beneficial support to grown children. Yet, in some relationships, grown children may feel beholden or intruded upon when they receive parental help. The purpose of this study was to examine such conflicted support in relationships between middle-aged parents and young adults. Methods. Middle-aged parents (aged 40–60, n = 399) and their grown children (n = 592) participated. Parents rated perceptions of providing support and relationship quality with each child. Grown children indicated whether their mothers and fathers provided conflicted support and rated their perceptions of parental support, relationship quality, and other factors. Results. Multilevel models revealed that offspring’s perceptions of conflicted support were associated with (a) parents’ evaluations about providing support (e.g., greater stress and beliefs that grown children should be autonomous), (b) poorer quality relationships, and (c) offspring having more problems. Discussion. Findings suggest that perceptions of conflicted support are embedded in a larger constellation of relationship problems and underlying distress for parents and children. These patterns may reflect lifelong difficulties in the tie or that arise in adulthood. Researchers might seek to understand how dyads experiencing such conflicted support differ from more normative relationships characterized by warmth and well-received support. PMID:23707999

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

PubMed

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

2016-10-18

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

Quality of Life and Unmet Need in People with Psychosis in the London Borough of Haringey, UK

PubMed Central

Lambri, Maria; Chakraborty, Apu; Leavey, Gerard; King, Michael

2012-01-01

Objectives. Deinstitutionalization of long-term psychiatric patients produced various community-based residential care facilities. However, inner-city areas have many patients with severe mental illness (SMI) as well as deprivation, unemployment, and crime. This makes meeting their community needs complex. We undertook a needs assessment of service provision and consonance between service users' evaluation of need and by care workers. Design. Cross-sectional study with random sample of SMI service users in four housing settings: rehabilitation units; high-supported; medium-supported; low-supported housing. Setting. London Borough of Haringey. Outcome Measures. 110 SMI service users and 110 keyworkers were interviewed, using Camberwell Assessment of Need; SF-36; Lancashire Quality-of-Life profile; demographic and clinical information. Results. People in “low-support” and “high-support” housing had similar symptom scores, though low support had significantly lower quality of life. Quality of life was positively predicted by self-reported mental-health score and negatively predicted by unmet-need score in whole sample and in medium-support residents. Residents' and care-workers' assessments of need differed considerably. Conclusions. Although patients' housing needs were broadly met, those in low-supported housing fared least well. Attendance to self-reported mental health and unmet social needs to quality of life underpins planning of residential services for those with SMI. Social and personal needs of people in supported housing may be underestimated and overlooked; service providers need to prioritise these if concept of “recovery” is to advance. PMID:23213300

The Italian Dementia National Plan. Commentary.

PubMed

Di Fiandra, Teresa; Canevelli, Marco; Di Pucchio, Alessandra; Vanacore, Nicola

2015-01-01

The Italian Dementia National Plan was formulated in October 2014 by the Italian Ministry of Health in close cooperation with the regions, the National Institute of Health and the three major national associations of patients and carers. The main purpose of this strategy was to provide directive indications for promoting and improving interventions in the dementia field, not limiting to specialist and therapeutic actions, but particularly focusing on the support of patients and families throughout the pathways of care. Four main objectives are indicated: 1) promote health- and social-care interventions and policies; 2) create/strengthen the integrated network of services for dementia based on an integrated approach; 3) implement strategies for promoting appropriateness and quality of care; and 4) improve the quality of life of persons with dementia and their families by supporting empowerment and stigma reduction. These objectives and the pertaining actions are described in the present paper.

Social support network, mental health and quality of life: a cross-sectional study in primary care.

PubMed

Portugal, Flávia Batista; Campos, Mônica Rodrigues; Correia, Celina Ragoni; Gonçalves, Daniel Almeida; Ballester, Dinarte; Tófoli, Luis Fernando; Mari, Jair de Jesus; Gask, Linda; Dowrick, Christopher; Bower, Peter; Fortes, Sandra

2016-12-22

The objective of this study was to identify the association between emotional distress and social support networks with quality of life in primary care patients. This was a cross-sectional study involving 1,466 patients in the cities of São Paulo and Rio de Janeiro, Brazil, in 2009/2010. The General Health Questionnaire, the Hospital Anxiety and Depression Scale and the brief version of the World Health Organization Quality of Life Instrument were used. The Social Support Network Index classified patients with the highest and lowest index as socially integrated or isolated. A bivariate analysis and four multiple linear regressions were conducted for each quality of life outcome. The means scores for the physical, psychological, social relations, and environment domains were, respectively, 64.7; 64.2; 68.5 and 49.1. In the multivariate analysis, the psychological domain was negatively associated with isolation, whereas the social relations and environment domains were positively associated with integration. Integration and isolation proved to be important factors for those in emotional distress as they minimize or maximize negative effects on quality of life.

Types of social supports predicting health-related quality of life among adult patients with CHD in the Institut Jantung Negara (National Heart Institute), Malaysia.

PubMed

Tye, Sue K; Kandavello, Geetha; Gan, Kah L

2017-01-01

The objectives of this study were to examine which types of social supports - emotional/informational support, tangible support, affectionate support, and positive interactions - are the predictors of health-related quality of life (HRQoL) in adult patients with CHD and to assess the influence of demographic variables and clinical factors on these variables. In total, 205 adult patients with CHD from the National Heart Institute, Malaysia, were recruited. Patients were first screened by cardiology consultants to ensure they fit the inclusion criteria before filling in questionnaires, which were medical outcome studies - social support survey and AQoL-8D. Results/conclusions All social supports and their subscales were found to have mild-to-moderate significant relationships with physical dimension, psychological dimension, and overall HRQoL; however, only positive interaction, marital status, and types of diagnosis were reported as predictors of HRQoL. Surprisingly, with regard to the physical dimension of quality of life, social supports were not significant predictors, but educational level, marital status, and types of diagnosis were significant predictors. Positive interaction, affectionate support, marital status, and types of diagnosis were again found to be predictors in the aspects of the psychological dimension of quality of life. In conclusion, positive interaction and affectionate support, which include elements of fun, relaxation, love, and care, should be included in the care of adult patients with CHD.

Health System Decision Makers' Feedback on Summaries and Tools Supporting the Use of Systematic Reviews: A Qualitative Study

ERIC Educational Resources Information Center

Ellen, Moriah E.; Lavis, John N.; Wilson, Michael G.; Grimshaw, Jeremy; Haynes, R. Brian; Ouimet, Mathieu; Raina, Parminder; Gruen, Russell

2014-01-01

Health system managers and policy makers need timely access to high quality, policy-relevant systematic reviews. Our objectives were to obtain managers' and policy makers' feedback about user-friendly summaries of systematic reviews and about tools related to supporting or assessing their use. Our interviews identified that participants prefer key…

Software Engineering Guidebook

NASA Technical Reports Server (NTRS)

Connell, John; Wenneson, Greg

1993-01-01

The Software Engineering Guidebook describes SEPG (Software Engineering Process Group) supported processes and techniques for engineering quality software in NASA environments. Three process models are supported: structured, object-oriented, and evolutionary rapid-prototyping. The guidebook covers software life-cycles, engineering, assurance, and configuration management. The guidebook is written for managers and engineers who manage, develop, enhance, and/or maintain software under the Computer Software Services Contract.

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

Law, B E

Research involves analysis and field direction of AmeriFlux operations, and the PI provides scientific leadership of the AmeriFlux network. Activities include the coordination and quality assurance of measurements across AmeriFlux network sites, synthesis of results across the network, organizing and supporting the annual Science Team Meeting, and communicating AmeriFlux results to the scientific community and other users. Objectives of measurement research include (i) coordination of flux and biometric measurement protocols (ii) timely data delivery to the Carbon Dioxide Information and Analysis Center (CDIAC); and (iii) assurance of data quality of flux and ecosystem measurements contributed by AmeriFlux sites. Objectives ofmore » integration and synthesis activities include (i) integration of site data into network-wide synthesis products; and (ii) participation in the analysis, modeling and interpretation of network data products. Communications objectives include (i) organizing an annual meeting of AmeriFlux investigators for reporting annual flux measurements and exchanging scientific information on ecosystem carbon budgets; (ii) developing focused topics for analysis and publication; and (iii) developing data reporting protocols in support of AmeriFlux network goals.« less

Structured Task versus Free Play: The Influence of Social Context on Parenting Quality, Toddlers' Engagement with Parents and Play Behaviors, and Parent-Toddler Language Use

ERIC Educational Resources Information Center

Kwon, Kyong-Ah; Bingham, Gary; Lewsader, Joellen; Jeon, Hyun-Joo; Elicker, James

2013-01-01

Background: Little empirical research examines relations among the quality of both mothers' and fathers' social emotional and linguistic support of toddlers across multiple parent-child interaction contexts. Objective: The current study investigated the influence of parent gender (mother vs. father) and activity setting (structured task vs. free…

The RCP Information Laboratory (iLab): breaking the cycle of poor data quality.

PubMed

Croft, Giles P; Williams, John G

2005-01-01

A review of data quality in the NHS by the Audit Commission cited a lack of clinician involvement in the validation and use of centrally held activity data as one of the key issues to resolve. The perception that hospital episode statistics cannot support the needs of the individual clinician results in mistrust and disinterest. This in turn leads to under-development of such data from a clinical perspective, and the cycle continues. The RCP Information Laboratory (iLab) aims to address this problem by accessing, analysing and presenting information from these central repositories concerning the activity of visiting individual consultant physicians. With support from iLab staff--an information analyst and a clinician--local data quality issues are highlighted and local solutions sought. The information obtained can be used as an objective measure of activity to support the processes of appraisal and revalidation.

The Health Quality and Safety Commission: making good health care better.

PubMed

Shuker, Carl; Bohm, Gillian; Bramley, Dale; Frost, Shelley; Galler, David; Hamblin, Richard; Henderson, Robert; Jansen, Peter; Martin, Geraint; Orsborn, Karen; Penny, Anthea; Wilson, Janice; Merry, Alan F

2015-01-30

New Zealand has one of the best value health care systems in the world, but as a proportion of GDP our spending on health care has increased every year since 1999. Further, there are issues of quality and safety in our system we must address, including rates of adverse events. The Health Quality and Safety Commission was formed in 2010 as a crown agent to influence, encourage, guide and support improvement in health care practice in New Zealand. The New Zealand Triple Aim has been defined as: improved quality, safety and experience of care; improved health and equity for all populations; and best value for public health system resources. The Commission is pursuing the Triple Aim via two fundamental objectives: doing the right thing by providing care supported by the best evidence available, focused on what matters to each individual patient, and doing the right thing right, first time, by making sure health care is safe and of the highest quality possible. Improvement efforts must be supported by robust but economical measurements. New Zealand has a strong culture of quality, so the Commission's role is to work with our colleagues to make good health care better.

Quality Assurance Specifications for Planetary Protection Assays

NASA Astrophysics Data System (ADS)

Baker, Amy

As the European Space Agency planetary protection (PP) activities move forward to support the ExoMars and other planetary missions, it will become necessary to increase staffing of labo-ratories that provide analyses for these programs. Standardization of procedures, a comprehen-sive quality assurance program, and unilateral training of personnel will be necessary to ensure that the planetary protection goals and schedules are met. The PP Quality Assurance/Quality Control (QAQC) program is designed to regulate and monitor procedures performed by labora-tory personnel to ensure that all work meets data quality objectives through the assembly and launch process. Because personnel time is at a premium and sampling schedules are often de-pendent on engineering schedules, it is necessary to have flexible staffing to support all sampling requirements. The most productive approach to having a competent and flexible work force is to establish well defined laboratory procedures and training programs that clearly address the needs of the program and the work force. The quality assurance specification for planetary protection assays has to ensure that labora-tories and associated personnel can demonstrate the competence to perform assays according to the applicable standard AD4. Detailed subjects included in the presentation are as follows: • field and laboratory control criteria • data reporting • personnel training requirements and certification • laboratory audit criteria. Based upon RD2 for primary and secondary validation and RD3 for data quality objectives, the QAQC will provide traceable quality assurance safeguards by providing structured laboratory requirements for guidelines and oversight including training and technical updates, standardized documentation, standardized QA/QC checks, data review and data archiving.

Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care.

PubMed

Stockdale, Susan E; Zuchowski, Jessica; Rubenstein, Lisa V; Sapir, Negar; Yano, Elizabeth M; Altman, Lisa; Fickel, Jacqueline J; McDougall, Skye; Dresselhaus, Timothy; Hamilton, Alison B

Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation. Our evaluation objectives were to (a) assess design element implementation, (b) describe implementation barriers and facilitators, and (c) assess successful quality improvement project completion and spread. We analyzed administrative records and conducted interviews with 85 organizational leaders. We developed and applied criteria for assessing design element implementation using hybrid deductive/inductive analytic techniques. All quality councils implemented interdisciplinary leadership and a structured quality improvement process, and all but one completed at least one quality improvement project and a toolkit for spreading improvements. Quality councils were perceived as most effective when service line leaders had well-functioning interdisciplinary communication. Matching positions within leadership hierarchies with appropriate supportive roles facilitated frontline quality improvement efforts. Two key resources were (a) a dedicated internal facilitator with project management, data collection, and presentation skills and (b) support for preparing customized data reports for identifying and addressing practice level quality issues. Overall, quality councils successfully cultivated interdisciplinary, multilevel primary care quality improvement leadership with accountability mechanisms and generated frontline innovations suitable for spread. Practice level performance data and quality improvement project management support were critical. In order to successfully facilitate systematic, sustainable primary care quality improvement, regional and executive health care system leaders should engage interdisciplinary practice level leadership in a priority-setting process that encourages frontline innovation and establish local structures such as quality councils to coordinate quality improvement initiatives, ensure accountability, and promote spread of best practices.

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

PubMed Central

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

2016-01-01

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

Experimental results supporting the determination of service quality objectives for DBS systems

NASA Technical Reports Server (NTRS)

Chouinard, G.; Whyte, W. A., Jr.; Goldberg, A. A.; Jones, B. L.

1985-01-01

A summary of the results of a joint United States and Canadian program on subjective measurements of the picture degradation caused by noise and interference on an NTSC encoded color television signal is given in this paper. The effects of system noise, cochannel and adjacent channel interference, and both single entry and aggregate as well as a combination of these types of interference were subjectively evaluated by expert and nonexpert viewers under reference conditions. These results were used to develop the rationale used at RARC '83 to establish the service quality objective for planning the DBS service for the American continents.

Experimental manipulation of psychosocial exposure and questionnaire sensitivity in a simulated manufacturing setting.

PubMed

Ikuma, Laura H; Babski-Reeves, Kari; Nussbaum, Maury A

2009-05-01

The objectives of this study were to determine the efficacy of experimental manipulations of psychosocial exposures and to evaluate the sensitivity of a psychosocial questionnaire by determining the factors perceived. A 50-item questionnaire was developed from the job content questionnaire (JCQ) and the quality of worklife survey (QWL). The experiment involved simulated work at different physical and psychosocial levels. Forty-eight participants were exposed to two levels of one psychosocial manipulation (job control, job demands, social support, or time pressure). Significantly different questionnaire responses supported the effectiveness of psychosocial manipulations. Exploratory factor analysis revealed five factors: skill discretion and decision authority, stress level and supervisor support, physical demands, quality of coworker support, and decision-making support. These results suggest that psychosocial factors can be manipulated experimentally, and that questionnaires can distinguish perceptions of these factors. These questionnaires may be used to assess perceptions of psychosocial factors in experimental settings.

Interventions to Modify Health Care Provider Adherence to Asthma Guidelines: A Systematic Review

PubMed Central

Okelo, Sande O.; Butz, Arlene M.; Sharma, Ritu; Diette, Gregory B.; Pitts, Samantha I.; King, Tracy M.; Linn, Shauna T.; Reuben, Manisha; Chelladurai, Yohalakshmi

2013-01-01

BACKGROUND AND OBJECTIVE: Health care provider adherence to asthma guidelines is poor. The objective of this study was to assess the effect of interventions to improve health care providers’ adherence to asthma guidelines on health care process and clinical outcomes. METHODS: Data sources included Medline, Embase, Cochrane CENTRAL Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Center, PsycINFO, and Research and Development Resource Base in Continuing Medical Education up to July 2012. Paired investigators independently assessed study eligibility. Investigators abstracted data sequentially and independently graded the evidence. RESULTS: Sixty-eight eligible studies were classified by intervention: decision support, organizational change, feedback and audit, clinical pharmacy support, education only, quality improvement/pay-for-performance, multicomponent, and information only. Half were randomized trials (n = 35). There was moderate evidence for increased prescriptions of controller medications for decision support, feedback and audit, and clinical pharmacy support and low-grade evidence for organizational change and multicomponent interventions. Moderate evidence supports the use of decision support and clinical pharmacy interventions to increase provision of patient self-education/asthma action plans. Moderate evidence supports use of decision support tools to reduce emergency department visits, and low-grade evidence suggests there is no benefit for this outcome with organizational change, education only, and quality improvement/pay-for-performance. CONCLUSIONS: Decision support tools, feedback and audit, and clinical pharmacy support were most likely to improve provider adherence to asthma guidelines, as measured through health care process outcomes. There is a need to evaluate health care provider-targeted interventions with standardized outcomes. PMID:23979092

The Air Quality Model Evaluation International Initiative ...

EPA Pesticide Factsheets

This presentation provides an overview of the Air Quality Model Evaluation International Initiative (AQMEII). It contains a synopsis of the three phases of AQMEII, including objectives, logistics, and timelines. It also provides a number of examples of analyses conducted through AQMEII with a particular focus on past and future analyses of deposition. The National Exposure Research Laboratory (NERL) Computational Exposure Division (CED) develops and evaluates data, decision-support tools, and models to be applied to media-specific or receptor-specific problem areas. CED uses modeling-based approaches to characterize exposures, evaluate fate and transport, and support environmental diagnostics/forensics with input from multiple data sources. It also develops media- and receptor-specific models, process models, and decision support tools for use both within and outside of EPA.

Not planning a sustainable transport system

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

Finnveden, Göran, E-mail: goran.finnveden@abe.kth.se; Åkerman, Jonas

2014-04-01

The overall objective of the Swedish transport policy is to ensure the economically efficient and sustainable provision of transport services for people and business throughout the country. More specifically, the transport sector shall, among other things, contribute to the achievement of environmental quality objectives in which the development of the transport system plays an important role in the achievement of the objectives. The aim of this study is to analyse if current transport planning supports this policy. This is done by analysing two recent cases: the National Infrastructure Plan 2010–2021, and the planning of Bypass Stockholm, a major road investment.more » Our results show that the plans are in conflict with several of the environmental quality objectives. Another interesting aspect of the planning processes is that the long-term climate goals are not included in the planning processes, neither as a clear goal nor as factor that will influence future transport systems. In this way, the long-term sustainability aspects are not present in the planning. We conclude that the two cases do not contribute to a sustainable transport system. Thus, several changes must be made in the processes, including putting up clear targets for emissions. Also, the methodology for the environmental assessments needs to be further developed and discussed. - Highlights: • Two cases are studied to analyse if current planning supports a sustainable transport system. • Results show that the plans are in conflict with several of the environmental quality objectives. • Long-term climate goals are not included in the planning processes. • Current practices do not contribute to a sustainable planning processes. • Methodology and process for environmental assessments must be further developed and discussed.« less

Subjective audio quality evaluation of embedded-optimization-based distortion precompensation algorithms.

PubMed

Defraene, Bruno; van Waterschoot, Toon; Diehl, Moritz; Moonen, Marc

2016-07-01

Subjective audio quality evaluation experiments have been conducted to assess the performance of embedded-optimization-based precompensation algorithms for mitigating perceptible linear and nonlinear distortion in audio signals. It is concluded with statistical significance that the perceived audio quality is improved by applying an embedded-optimization-based precompensation algorithm, both in case (i) nonlinear distortion and (ii) a combination of linear and nonlinear distortion is present. Moreover, a significant positive correlation is reported between the collected subjective and objective PEAQ audio quality scores, supporting the validity of using PEAQ to predict the impact of linear and nonlinear distortion on the perceived audio quality.

Is the evidence supporting dental procedures strong? A survey of Cochrane systematic reviews in oral health.

PubMed

Faggion, Clovis Mariano

2012-09-01

Every day a large number and variety of dental procedures are performed in clinical dental practice. There is, however, no information on the overall quality of evidence supporting these procedures. The objective of this study was to assess whether several common dental procedures are based on sound evidence. All Cochrane systematic reviews (CSR) published in dentistry were surveyed. The authors' conclusions about the quality of evidence supporting a specific clinical treatment were used as the measure of outcome. The evidence was considered adequate if the authors did not clearly state the evidence was weak in the conclusions while also suggesting some evidence of the effectiveness of the therapy. Of 120 CSRs assessed, in only 26 (22.0% of the reviews) was the quality of evidence regarded as adequate for supporting clinical decisions, although some methodological limitations were identified in the full text of these reviews. Moreover, the authors of most reviews reported weak or unavailable evidence. On the basis of CSRs, the overall quality of evidence can be regarded as low or nonexistent for most of the dental procedures assessed. The information reported may guide future research. Copyright © 2012 Elsevier Inc. All rights reserved.

Comparison of Objective and Subjective Life Balance Between Women With and Without a Personality Disorder.

PubMed

Larivière, Nadine; Denis, Catherine; Payeur, Amélie; Ferron, Amélie; Levesque, Stéphanie; Rivard, Guillaume

2016-12-01

Life balance is associated to health, well-being and quality of life and is a target of psychiatric rehabilitation interventions. However, little is known about this life dimension in women living with personality disorders. The purpose of this descriptive-correlational study was to compare and explore relationships between subjective life balance, objective time use, quality of life and perceived stress in women without a mental health disorder (n = 43) and women with a personality disorder (clusters B and C) (n = 30), aged between 18 and 50 years old. The variables were measured with the Life Balance Inventory (subjective life balance), the Occupational Questionnaire (objective time use), the Depression Anxiety Stress Scale (perceived stress) and the Quality of Life Index (satisfaction and importance with life domains). The analyses showed that women with a personality disorder spend significantly less time in work but more time in daily tasks and leisure. Subjective life balance, quality of life and perceived stress were significantly lower in women with a personality disorder (p < 0.05). In women with a personality disorder, subjective life balance was explained by quality of life (R 2  = 27.5 %). In women without a mental illness, subjective life balance was explained by quality of life and motherhood (R 2  = 36.1 %). To support the recovery of women with personality disorders and their quality of life, it is important to address objective and subjective time use to enable accomplishment of a variety of meaningful activities.

Improving Quality Using Architecture Fault Analysis with Confidence Arguments

DTIC Science & Technology

2015-03-01

the same time, T text, diagram, and table-based requirements documentation and the use of Microsoft Word and Dynamic Object - Oriented Requirements...Lamsweerde 2003] Van Lamsweerde, Axel & Letier, Emmanuel. “From Object Orientation to Goal Orientation : A Paradigm Shift for Requirements Engineering,” 4–8...Introduction 1 Approach , Concepts, and Notations 5 2.1 Requirement Specification and Architecture Design 5 2.2 AADL Concepts Supporting Architecture

A decision support tool for setting population objectives for priority landbirds in the Central Hardwoods and West Gulf Coastal Plain/Quachitas Bird Conservation Regions

Treesearch

D. Todd Jones-Farrand; John M. Tirpak; Frank R. Thompson; Daniel J. Twedt; Charles K. Baxter; Jane A. Fitzgerald; William B. Uihlein

2009-01-01

Setting and achieving population objectives for priority landbirds must be informed by, 1) the quantity, quality, and spatial confi guration of available habitat, 2) an explicit linkage between habitat condition and population response, and 3) expected future habitat conditions. Based on this philosophy, the Central Hardwoods and Lower Mississippi Valley Joint Ventures...

Reliability and utility of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII) for auditing and quality development in services for adults with intellectual disability and challenging behaviour.

PubMed

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

2013-08-01

Having an objective means of evaluating the quality of behaviour support plans (BSPs) could assist service providers and statutory authorities to monitor and improve the quality of support provided to people with intellectual disability (ID) who exhibit challenging behaviour. The Behaviour Support Plan Quality Evaluation Guide II (BSP-QEII) was developed to monitor and assess BSPs prepared by teachers to support children with disability in the school system. This study investigated the application of the BSP-QEII to the assessment of BSPs for adults with ID in community support services. The inter-rater reliability of the BSP-QEII was assessed. The utility of the BPS-QEII was then investigated with reference to a time series study of matched pairs of BSPs, developed for the same clients over a period of approximately 3 years. Differences in plan quality measured across a number of service and systemic variables were also investigated. The BSP-QEII was found to have good inter-rater reliability and good utility for audit purposes. It was able to discriminate changes in plan quality over time. Differences in plan quality were also evident across different service types, where specialist staff had or had not been involved, and in some instances where a statutory format for the plan had or had not been used. There were no differences between plans developed by government and community sector agencies, nor were there any regional differences across the jurisdiction. The BSP-QEII could usefully be adopted as an audit tool for measuring the quality of BSPs for adults with ID. In addition to being used for research and administrative auditing, the principles underpinning the BSP-QEII could also be useful to guide policy and educational activities for staff in community based services for adults with ID. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.

3D Reasoning from Blocks to Stability.

PubMed

Zhaoyin Jia; Gallagher, Andrew C; Saxena, Ashutosh; Chen, Tsuhan

2015-05-01

Objects occupy physical space and obey physical laws. To truly understand a scene, we must reason about the space that objects in it occupy, and how each objects is supported stably by each other. In other words, we seek to understand which objects would, if moved, cause other objects to fall. This 3D volumetric reasoning is important for many scene understanding tasks, ranging from segmentation of objects to perception of a rich 3D, physically well-founded, interpretations of the scene. In this paper, we propose a new algorithm to parse a single RGB-D image with 3D block units while jointly reasoning about the segments, volumes, supporting relationships, and object stability. Our algorithm is based on the intuition that a good 3D representation of the scene is one that fits the depth data well, and is a stable, self-supporting arrangement of objects (i.e., one that does not topple). We design an energy function for representing the quality of the block representation based on these properties. Our algorithm fits 3D blocks to the depth values corresponding to image segments, and iteratively optimizes the energy function. Our proposed algorithm is the first to consider stability of objects in complex arrangements for reasoning about the underlying structure of the scene. Experimental results show that our stability-reasoning framework improves RGB-D segmentation and scene volumetric representation.

The relationship of maternal work characteristics to childcare type and quality in rural communities

PubMed Central

De Marco, Allison; Crouter, Ann C.; Vernon-Feagans, Lynne

2010-01-01

Drawing on data from the Family Life Project collected in North Carolina and Pennsylvania, this paper examines the relationship between maternal work characteristics and childcare type and quality in rural communities. Research is limited on the childcare experiences of rural families. Rural areas have less access to formal childcare and families often commute long distances for work, restricting childcare options. Employed mothers using childcare were selected (n = 441). Logistic and OLS regression was used to examine which characteristics, including workplace support, objective occupational measures, hours, wage, and shift, predicted care type and quality. Results indicated that most families were using informal care. Those with more hazardous work conditions and working night shifts were less likely to use centers. Higher quality care was related to more workplace support, center use, and higher wages. Implications for social policy and practice are discussed. PMID:20664710

Training quality job interviews with adults with developmental disabilities.

PubMed

Mozingo, D; Ackley, G B; Bailey, J S

1994-01-01

Supported work models of vocational integration have increased the employability of individuals with developmental disabilities. Interview questions most frequently used and corresponding responses considered most beneficial to job applicants were derived from an empirical analysis of the "hiring community" and served as a basis for the development of the verbal job interview skills training package evaluated in this research. Dependent measures were objective, behavioral indices of the quality of job interview responses. One-to-one training by a direct training staff, job coach, and a trained behavior analyst resulted in improved responding by all subjects as indicated in a multiple baseline design across interview questions. Improved quality in responding to questions generalized to variations in interview questions, to a novel interviewer, and in an in vivo interview situation. Finally, global measures of social validity support the value of the quality-of-response training.

Onboard experiment data support facility. Task 2 report: Definition of onboard processing requirements

NASA Technical Reports Server (NTRS)

1976-01-01

The onboard experiment data support facility (OEDSF) will provide data processing support to various experiment payloads on board the space shuttle. The OEDSF study will define the conceptual design and generate specifications for an OEDSF which will meet the following objectives: (1) provide a cost-effective approach to end-to-end processing requirements, (2) service multiple disciplines (3) satisfy user needs, (4) reduce the amount and improve the quality of data collected, stored and processed, and (5) embody growth capacity.

Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda

PubMed Central

Opio, Alex; Calnan, Jacqueline; Njeuhmeli, Emmanuel

2015-01-01

Background Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality. Methods and Findings Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the “good” range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring “good” rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events. Conclusion Public sector providers can be engaged to address the quality of VMMC using a continuous quality improvement approach. PMID:26207986

Embedding systematic quality assessments in supportive supervision at primary healthcare level: application of an electronic Tool to Improve Quality of Healthcare in Tanzania.

PubMed

Mboya, Dominick; Mshana, Christopher; Kessy, Flora; Alba, Sandra; Lengeler, Christian; Renggli, Sabine; Vander Plaetse, Bart; Mohamed, Mohamed A; Schulze, Alexander

2016-10-13

Assessing quality of health services, for example through supportive supervision, is essential for strengthening healthcare delivery. Most systematic health facility assessment mechanisms, however, are not suitable for routine supervision. The objective of this study is to describe a quality assessment methodology using an electronic format that can be embedded in supervision activities and conducted by council health staff. An electronic Tool to Improve Quality of Healthcare (e-TIQH) was developed to assess the quality of primary healthcare provision. The e-TIQH contains six sub-tools, each covering one quality dimension: infrastructure and equipment of the facility, its management and administration, job expectations, clinical skills of the staff, staff motivation and client satisfaction. As part of supportive supervision, council health staff conduct quality assessments in all primary healthcare facilities in a given council, including observation of clinical consultations and exit interviews with clients. Using a hand-held device, assessors enter data and view results in real time through automated data analysis, permitting immediate feedback to health workers. Based on the results, quality gaps and potential measures to address them are jointly discussed and actions plans developed. For illustrative purposes, preliminary findings from e-TIQH application are presented from eight councils of Tanzania for the period 2011-2013, with a quality score <75 % classed as 'unsatisfactory'. Staff motivation (<50 % in all councils) and job expectations (≤50 %) scored lowest of all quality dimensions at baseline. Clinical practice was unsatisfactory in six councils, with more mixed results for availability of infrastructure and equipment, and for administration and management. In contrast, client satisfaction scored surprisingly high. Over time, each council showed a significant overall increase of 3-7 % in mean score, with the most pronounced improvements in staff motivation and job expectations. Given its comprehensiveness, convenient handling and automated statistical reports, e-TIQH enables council health staff to conduct systematic quality assessments. Therefore e-TIQH may not only contribute to objectively identifying quality gaps, but also to more evidence-based supervision. E-TIQH also provides important information for resource planning. Institutional and financial challenges for implementing e-TIQH on a broader scale need to be addressed.

Tank 241-AY-101 Privatization Push Mode Core Sampling and Analysis Plan

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

TEMPLETON, A.M.

2000-01-12

This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for samples obtained from tank 241-AY-101. The purpose of this sampling event is to obtain information about the characteristics of the contents of 241-AY-101 required to satisfy Data Quality Objectives For RPP Privatization Phase I: Confirm Tank T Is An Appropriate Feed Source For High-Level Waste Feed Batch X(HLW DQO) (Nguyen 1999a), Data Quality Objectives For TWRS Privatization Phase I : Confirm Tank T Is An Appropriate Feed Source For Low-Activity Waste Feed Batch X (LAW DQO) (Nguyen 1999b), Low Activitymore » Waste and High-Level Waste Feed Data Quality Objectives (L and H DQO) (Patello et al. 1999), and Characterization Data Needs for Development, Design, and Operation of Retrieval Equipment Developed through the Data Quality Objective Process (Equipment DQO) (Bloom 1996). Special instructions regarding support to the LAW and HLW DQOs are provided by Baldwin (1999). Push mode core samples will be obtained from risers 15G and 150 to provide sufficient material for the chemical analyses and tests required to satisfy these data quality objectives. The 222-S Laboratory will extrude core samples; composite the liquids and solids; perform chemical analyses on composite and segment samples; archive half-segment samples; and provide subsamples to the Process Chemistry Laboratory. The Process Chemistry Laboratory will prepare test plans and perform process tests to evaluate the behavior of the 241-AY-101 waste undergoing the retrieval and treatment scenarios defined in the applicable DQOs. Requirements for analyses of samples originating in the process tests will be documented in the corresponding test plans and are not within the scope of this SAP.« less

Tank 241-AY-101 Privatization Push Mode Core Sampling and Analysis Plan

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

TEMPLETON, A.M.

2000-05-19

This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for samples obtained from tank 241-AY-101. The purpose of this sampling event is to obtain information about the characteristics of the contents of 241-AY-101 required to satisfy ''Data Quality Objectives For RPP Privatization Phase I: Confirm Tank T Is An Appropriate Feed Source For High-Level Waste Feed Batch X(HLW DQO)' (Nguyen 1999a), ''Data Quality Objectives For TWRS Privatization Phase I: Confirm Tank T Is An Appropriate Feed Source For Low-Activity Waste Feed Butch X (LAW DQO) (Nguyen 1999b)'', ''Low Activity Wastemore » and High-Level Waste Feed Data Quality Objectives (L&H DQO)'' (Patello et al. 1999), and ''Characterization Data Needs for Development, Design, and Operation of Retrieval Equipment Developed through the Data Quality Objective Process (Equipment DQO)'' (Bloom 1996). Special instructions regarding support to the LAW and HLW DQOs are provided by Baldwin (1999). Push mode core samples will be obtained from risers 15G and 150 to provide sufficient material for the chemical analyses and tests required to satisfy these data quality objectives. The 222-S Laboratory will extrude core samples; composite the liquids and solids; perform chemical analyses on composite and segment samples; archive half-segment samples; and provide sub-samples to the Process Chemistry Laboratory. The Process Chemistry Laboratory will prepare test plans and perform process tests to evaluate the behavior of the 241-AY-101 waste undergoing the retrieval and treatment scenarios defined in the applicable DQOs. Requirements for analyses of samples originating in the process tests will be documented in the corresponding test plans and are not within the scope of this SAP.« less

A non-linear optimization programming model for air quality planning including co-benefits for GHG emissions.

PubMed

Turrini, Enrico; Carnevale, Claudio; Finzi, Giovanna; Volta, Marialuisa

2018-04-15

This paper introduces the MAQ (Multi-dimensional Air Quality) model aimed at defining cost-effective air quality plans at different scales (urban to national) and assessing the co-benefits for GHG emissions. The model implements and solves a non-linear multi-objective, multi-pollutant decision problem where the decision variables are the application levels of emission abatement measures allowing the reduction of energy consumption, end-of pipe technologies and fuel switch options. The objectives of the decision problem are the minimization of tropospheric secondary pollution exposure and of internal costs. The model assesses CO 2 equivalent emissions in order to support decision makers in the selection of win-win policies. The methodology is tested on Lombardy region, a heavily polluted area in northern Italy. Copyright © 2017 Elsevier B.V. All rights reserved.

The Nexus between Instructional Supervision, Supervisors' and Teachers': The Practical Paradox and Its Effect on Quality Education a Case of Woliat Zone Administration Elementary and Secondary Schools (1-8)

ERIC Educational Resources Information Center

Dea, Mulatu

2016-01-01

Even though the new instructional supervision practices materialized in the schools level, teachers were not properly supported well, so that the students achievements was decreasing in national exams than before as the regional grade report documents revealed and quality is deteriorating from time to times. Hence, the main objective of this study…

Creating Quality Improvement Culture in Public Health Agencies

PubMed Central

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

2014-01-01

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

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

PubMed Central

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

2000-01-01

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

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

PubMed

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

2000-01-01

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

[Suspension of Respiratory Support in Patients with Amyotrophic Lateral Sclerosis].

PubMed

Silberberg, Agustín A; Robetto, Josefina; Achával, Mora

2018-01-01

Decision making in advanced Amyotrophic Lateral Sclerosis (ALS) patients keeps on being a controversial issue. The aim of this work is to discuss ethical implications of withdrawing respiratory support treatment in patients with ALS. Through a bibliographic search on Pubmed database (2010-2016) we investigated whether or not the use of Non-Invasive Ventilation (NIV) and Mechanical Ventilation (MV) would increase survival and quality of life. We included 38 review articles. From these papers, results and ethical implications of initiating and mainly withdrawing respiratory support were analyzed. Survival time increased with NIV and with MV. Quality of life, above all according to physiological criteria, improved with NIV but regarding MV it remained controversial. Implementation and future withdrawal of MV seemed open to medical and ethical discussion. From a perspective of the intrinsic dignity of every human being, whatever its quality of life was, and knowing that no effective therapies for the underlying disease are available, the decision to remove MV in a patient with advanced ALS requires: knowledge of the will of the patient and, above all, evaluating whether this respiratory support measure is becoming objectively disproportionate.

Power Extension Package (PEP) system definition extension, orbital service module systems analysis study. Volume 10: PEP project plan

NASA Technical Reports Server (NTRS)

1979-01-01

Contents: project plan summary; project and mission objectives; related studies and technology support activities; technical summary; management; procurement approach; project definition items and schedule; resources; management review; controlled items; and safety, reliability, and quality assurance.

Effective Schools. What Makes a Public School Work Well?

ERIC Educational Resources Information Center

Our Children, 1998

1998-01-01

Most effective schools share a number of key characteristics, including clear-cut goals and objectives, adequate funding and financial management, quality academic programs, valid assessment programs, parent and family involvement, teacher and staff development, high expectations for students, community involvement, comprehensive support services,…

Prediction of pork loin quality using online computer vision system and artificial intelligence model.

PubMed

Sun, Xin; Young, Jennifer; Liu, Jeng-Hung; Newman, David

2018-06-01

The objective of this project was to develop a computer vision system (CVS) for objective measurement of pork loin under industry speed requirement. Color images of pork loin samples were acquired using a CVS. Subjective color and marbling scores were determined according to the National Pork Board standards by a trained evaluator. Instrument color measurement and crude fat percentage were used as control measurements. Image features (18 color features; 1 marbling feature; 88 texture features) were extracted from whole pork loin color images. Artificial intelligence prediction model (support vector machine) was established for pork color and marbling quality grades. The results showed that CVS with support vector machine modeling reached the highest prediction accuracy of 92.5% for measured pork color score and 75.0% for measured pork marbling score. This research shows that the proposed artificial intelligence prediction model with CVS can provide an effective tool for predicting color and marbling in the pork industry at online speeds. Copyright © 2018 Elsevier Ltd. All rights reserved.

Clinical characteristics and objective living conditions in relation to quality of life among community-based individuals of schizophrenia in Hong Kong.

PubMed

Yeung, Frederick Ka Ching; Chan, Sunny Ho Wan

2006-11-01

Quality of life (QOL) has gained importance as an outcome measure for people with schizophrenia living in the community following deinstitutionalization. This study aims at exploring the effects of clinical characteristics and objective living conditions on QOL. In this study, 201 community-based individuals with schizophrenia were recruited from five different types of objective living conditions comprising long stay care home, halfway house, supported hostel/housing, living with family, and living alone. Clinical characteristics including cognitive abilities, symptom levels, and community/social functioning were assessed by the Allen Cognitive Level Screen, the Scales for the Assessment of Negative Symptoms and Positive Symptoms, and the Chinese version of the Multnomah Community Ability Scale respectively. The outcome measure of QOL was measured by the Chinese version of the WHO Quality of Life Measure. Analysis of covariance showed significant differences in community/social functioning, cognitive abilities, and negative symptoms; but not in QOL under different objective living conditions. Further simultaneous multiple regressions found out that community/social functioning was the robust significant predictor of QOL. Yet caution should be noted in making the conclusion with the objective living condition of long stay care home, as it provides a protective element for the perseverance of QOL.

A framework for assessing Health Economic Evaluation (HEE) quality appraisal instruments.

PubMed

Langer, Astrid

2012-08-16

Health economic evaluations support the health care decision-making process by providing information on costs and consequences of health interventions. The quality of such studies is assessed by health economic evaluation (HEE) quality appraisal instruments. At present, there is no instrument for measuring and improving the quality of such HEE quality appraisal instruments. Therefore, the objectives of this study are to establish a framework for assessing the quality of HEE quality appraisal instruments to support and improve their quality, and to apply this framework to those HEE quality appraisal instruments which have been subject to more scrutiny than others, in order to test the framework and to demonstrate the shortcomings of existing HEE quality appraisal instruments. To develop the quality assessment framework for HEE quality appraisal instruments, the experiences of using appraisal tools for clinical guidelines are used. Based on a deductive iterative process, clinical guideline appraisal instruments identified through literature search are reviewed, consolidated, and adapted to produce the final quality assessment framework for HEE quality appraisal instruments. The final quality assessment framework for HEE quality appraisal instruments consists of 36 items organized within 7 dimensions, each of which captures a specific domain of quality. Applying the quality assessment framework to four existing HEE quality appraisal instruments, it is found that these four quality appraisal instruments are of variable quality. The framework described in this study should be regarded as a starting point for appraising the quality of HEE quality appraisal instruments. This framework can be used by HEE quality appraisal instrument producers to support and improve the quality and acceptance of existing and future HEE quality appraisal instruments. By applying this framework, users of HEE quality appraisal instruments can become aware of methodological deficiencies inherent in existing HEE quality appraisal instruments. These shortcomings of existing HEE quality appraisal instruments are illustrated by the pilot test.

A framework for assessing Health Economic Evaluation (HEE) quality appraisal instruments

PubMed Central

2012-01-01

Background Health economic evaluations support the health care decision-making process by providing information on costs and consequences of health interventions. The quality of such studies is assessed by health economic evaluation (HEE) quality appraisal instruments. At present, there is no instrument for measuring and improving the quality of such HEE quality appraisal instruments. Therefore, the objectives of this study are to establish a framework for assessing the quality of HEE quality appraisal instruments to support and improve their quality, and to apply this framework to those HEE quality appraisal instruments which have been subject to more scrutiny than others, in order to test the framework and to demonstrate the shortcomings of existing HEE quality appraisal instruments. Methods To develop the quality assessment framework for HEE quality appraisal instruments, the experiences of using appraisal tools for clinical guidelines are used. Based on a deductive iterative process, clinical guideline appraisal instruments identified through literature search are reviewed, consolidated, and adapted to produce the final quality assessment framework for HEE quality appraisal instruments. Results The final quality assessment framework for HEE quality appraisal instruments consists of 36 items organized within 7 dimensions, each of which captures a specific domain of quality. Applying the quality assessment framework to four existing HEE quality appraisal instruments, it is found that these four quality appraisal instruments are of variable quality. Conclusions The framework described in this study should be regarded as a starting point for appraising the quality of HEE quality appraisal instruments. This framework can be used by HEE quality appraisal instrument producers to support and improve the quality and acceptance of existing and future HEE quality appraisal instruments. By applying this framework, users of HEE quality appraisal instruments can become aware of methodological deficiencies inherent in existing HEE quality appraisal instruments. These shortcomings of existing HEE quality appraisal instruments are illustrated by the pilot test. PMID:22894708

Total quality in acute care hospitals: guidelines for hospital managers.

PubMed

Holthof, B

1991-08-01

Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements.

Implementing and using quality measures for children's health care: perspectives on the state of the practice.

PubMed

Shaller, Dale

2004-01-01

The objective of this study was to identify issues, obstacles, and priorities related to implementing and using child health care quality measures from the perspectives of 4 groups: 1) funders of quality-measurement development and implementation; 2) developers of quality measures; 3) users of quality measures (including Medicaid and the State Children's Health Insurance Program, employer coalitions, and consumer groups); and 4) health plans and providers (in their role as both subjects and users of quality measures). A series of semistructured interviews was conducted with approximately 40 opinion leaders drawn from these 4 groups. The interviews were conducted by telephone between September and December of 2001. Major topic areas covered in the interviews were similar across the groups. Topic areas included 1) strategic vision and/or objectives for funding, developing, or using quality measures for children's health care; 2) a brief summary of the specific quality measures funded, developed, or used; 3) issues and challenges facing funders and developers of measures; 4) major successes achieved; 5) obstacles to implementation and use of measures; and 6) priority needs for future funding. Leaders from all 4 groups acknowledge the importance of developing a robust set of quality measures that can serve multiple objectives and multiple audiences. Standardization of measures is viewed as a critical feature related to all objectives. An assessment of specific quality measures funded, developed, or used by strategic objective shows a high correlation between the uses intended by funders and developers and the actual applications of the various users. The most commonly cited measures across all groups are the Consumer Assessment of Health Plans Survey and Health Plan Employer Data and Information Set, followed by the Child and Adolescent Health Measurement Initiative and special topic studies to support quality-improvement applications (eg, asthma, diabetes, etc). The major issues and challenges cited in common among funders and developers are 1) the lack of trained capacity in the field to conduct needed research and development, and 2) the difficulty in generating sustained interest and support among funders because of the complexity of quality-measurement issues, competing funding priorities in the face of limited funds available to allocate, and the lack of clear and compelling evidence that quality measurement and improvement actually result in better outcomes for children. The 3 most common successes cited across all 4 groups are 1) the growing consensus and collaboration among diverse stakeholder groups involved in measurement development and implementation; 2) the increasing collection and use of specific measures; and 3) early documentation of tangible results in terms of improved quality of care. Specific measurement tools cited as successes by funders and developers include the Medicaid Health Plan Employer Data and Information Set, Consumer Assessment of Health Plans Survey, the Child and Adolescent Health Measurement Initiative, and Rand QA Tools. The most important obstacle reported across all groups is the lack of a strong and compelling "business case" that clearly demonstrates the benefits of quality measurement relative to the costs of implementation. Strongly related to this barrier is the cost of implementing and using measures without a sustainable source of financing as well as the absence of strong public awareness and political support for children's health care quality measurement. Another major barrier cited is the lack of coordination among funders, which prevents the field from developing a unified approach to addressing the numerous technical, political, and administrative issues also cited at length by the leaders interviewed. The 5 top needs for future funding identified across all 4 groups follow directly from the major obstacles that they reported: 1) develop the business case for children's health care quality measurement and improvement based on rigorous cost-bigorous cost-benefit analysis and documentation of quantifiable successes; 2) develop new measures to fill the gaps in critical areas (including adolescent health care, behavioral health, and chronic conditions) that can be applied at the hospital and ambulatory care provider levels; 3) invest in building needed research capacity, a trained pool of users of quality measures, and the capacity among providers to understand and use quality-improvement methods and tools; 4) invest in developing an information infrastructure that will support the efficient collection and use of measures for multiple purposes, including clinical practice, quality measurement, and quality improvement; and 5) develop increased public awareness and support for quality measurement based on improved strategies for communicating with consumers, purchasers, providers, and policy makers. Several implications are suggested by these perspectives for the future direction of quality measurement in children's health care. First, to meet the funding needs identified, many funders must improve coordination to reduce the noise and fragmentation generated by numerous competing or redundant activities. Improved coordination among funders will help assure maximum impact and the efficient use of scarce resources. Second, the importance attached to standardization of measures by both users and developers may conflict at times with the need for innovation and flexibility. Child health quality leaders will need to manage this tension between standardization and innovation to maintain an appropriate balance between the benefits of both. Finally, many of the obstacles identified are not unique to children's health care. Child health quality leaders will need to determine to what extent their efforts to overcome these obstacles can be successfully undertaken independently as opposed to in concert with groups concerned about other populations and sectors in the health care system.

SU-E-T-97: An Analysis of Knowledge Based Planning for Stereotactic Body Radiation Therapy of the Spine

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

Foy, J; Marsh, R; Owen, D

2015-06-15

Purpose: Creating high quality SBRT treatment plans for the spine is often tedious and time consuming. In addition, the quality of treatment plans can vary greatly between treatment facilities due to inconsistencies in planning methods. This study investigates the performance of knowledge-based planning (KBP) for spine SBRT. Methods: Treatment plans were created for 28 spine SBRT patients. Each case was planned to meet strict dose objectives and guidelines. After physician and physicist approval, the plans were added to a custom model in a KBP system (RapidPlan, Varian Eclipse v13.5). The model was then trained to be able to predict estimatedmore » DVHs and provide starting objective functions for future patients based on both generated and manual objectives. To validate the model, ten additional spine SBRT cases were planned manually as well as using the model objectives. Plans were compared based on planning time and quality (ability to meet the plan objectives, including dose metrics and conformity). Results: The average dose to the spinal cord and the cord PRV differed between the validation and control plans by <0.25% demonstrating iso-toxicity. Six out of 10 validation plans met all dose objectives without the need for modifications, and overall, target dose coverage was increased by about 4.8%. If the validation plans did not meet the dose requirements initially, only 1–2 iterations of modifying the planning parameters were required before an acceptable plan was achieved. While manually created plans usually required 30 minutes to 3 hours to create, KBP can be used to create similar quality plans in 15–20 minutes. Conclusion: KBP for spinal tumors has shown to greatly decrease the amount of time required to achieve high quality treatment plans with minimal human intervention and could feasibly be used to standardize plan quality between institutions. Supported by Varian Medical Systems.« less

Local environmental quality positively predicts breastfeeding in the UK's Millennium Cohort Study.

PubMed

Brown, Laura J; Sear, Rebecca

2017-01-01

Background and Objectives: Breastfeeding is an important form of parental investment with clear health benefits. Despite this, rates remain low in the UK; understanding variation can therefore help improve interventions. Life history theory suggests that environmental quality may pattern maternal investment, including breastfeeding. We analyse a nationally representative dataset to test two predictions: (i) higher local environmental quality predicts higher likelihood of breastfeeding initiation and longer duration; (ii) higher socioeconomic status (SES) provides a buffer against the adverse influences of low local environmental quality. Methodology: We ran factor analysis on a wide range of local-level environmental variables. Two summary measures of local environmental quality were generated by this analysis-one 'objective' (based on an independent assessor's neighbourhood scores) and one 'subjective' (based on respondent's scores). We used mixed-effects regression techniques to test our hypotheses. Results: Higher objective, but not subjective, local environmental quality predicts higher likelihood of starting and maintaining breastfeeding over and above individual SES and area-level measures of environmental quality. Higher individual SES is protective, with women from high-income households having relatively high breastfeeding initiation rates and those with high status jobs being more likely to maintain breastfeeding, even in poor environmental conditions. Conclusions and Implications: Environmental quality is often vaguely measured; here we present a thorough investigation of environmental quality at the local level, controlling for individual- and area-level measures. Our findings support a shift in focus away from individual factors and towards altering the landscape of women's decision making contexts when considering behaviours relevant to public health.

Quality of Life in a Vitiligo Support Group.

PubMed

Zabetian, Saba; Jacobson, Gordon; Lim, Henry W; Eide, Melody J; Huggins, Richard H

2017-04-01

BACKGROUND: No study has examined the impact of vitiligo support group membership on vitiligo patient quality of life (QoL).

OBJECTIVE: We sought to examine the QoL impact of vitiligo support groups by comparing QoL and associated patient characteristics between vitiligo patients who are and are not members of a vitiligo support group.

METHODS: Members of a Henry Ford Hospital-sponsored, Southeast Michigan Vitiligo Support Group were compared to non-member vitiligo patients recruited from a previous study cohort.17 Eligible patients were asked to complete the Dermatology Life Quality Index (DLQI) and a study-specific questionnaire designed to collect relevant patient characteristics.

RESULTS: The mean DLQI scores for the support group members and non-members were similar (7.1 ± 5.4 and 6.0 ± 6.5, respectively; P-value 0.2), despite the support group members reporting more severe overall disease and increased disease severity in exposed portions of the body. The African-American: Caucasian ratio and the prevalence of unemployment were both significantly higher among the support group participants. Small sample size may have limited the study's ability to demonstrate the differences between the support group participants and the controls.

CONCLUSIONS: The similar QoL despite an increased prevalence of poorer QoL indicators among the support group participants suggests a protective effect of support group membership.

J Drugs Dermatol. 2017;16(4):344-350.

[Evaluation of the quality of life in people with Autistic Spectrum Disorder].

PubMed

Cuesta Gómez, José L; Casado Muñoz, Raquel; Lezcano Barbero, Fernando

2010-01-01

The search for quality of life and the trend towards continual improvement has today become a true reference which guides most social organizations. The bodies which offer support to persons with Autistic Spectrum Disorder (referred to hereon as ASD) have not gone untouched by the influence of this concept of quality. The serious difficulties which are associated with this disorder affect the main areas of one ??s personal development: socialisation, communication, comprehension, and adaptation to ones environment, and they require that organizations promote integral networks of resources which guarantee a lifetime of quality services and support. The difficulties of assessing quality of life in persons with ASD from the subjective perspective, make it especially necessary to find valid indicators that help us to favour certain conditions in the ASD person ??s environment. This identified need is justification for the objective put forward: to design an instrument capable of being used to assess the quality of life of persons with ASD, made up of a Guide of Indicators, which organizations and programmes can then use to promote favourable conditions.

Quality and Certification of Electronic Health Records

PubMed Central

Hoerbst, A.; Ammenwerth, E.

2010-01-01

Background Numerous projects, initiatives, and programs are dedicated to the development of Electronic Health Records (EHR) worldwide. Increasingly more of these plans have recently been brought from a scientific environment to real life applications. In this context, quality is a crucial factor with regard to the acceptance and utility of Electronic Health Records. However, the dissemination of the existing quality approaches is often rather limited. Objectives The present paper aims at the description and comparison of the current major quality certification approaches to EHRs. Methods A literature analysis was carried out in order to identify the relevant publications with regard to EHR quality certification. PubMed, ACM Digital Library, IEEExplore, CiteSeer, and Google (Scholar) were used to collect relevant sources. The documents that were obtained were analyzed using techniques of qualitative content analysis. Results The analysis discusses and compares the quality approaches of CCHIT, EuroRec, IHE, openEHR, and EN13606. These approaches differ with regard to their focus, support of service-oriented EHRs, process of (re-)certification and testing, number of systems certified and tested, supporting organizations, and regional relevance. Discussion The analyzed approaches show differences with regard to their structure and processes. System vendors can exploit these approaches in order to improve and certify their information systems. Health care organizations can use these approaches to support selection processes or to assess the quality of their own information systems. PMID:23616834

Asynchronous Object Storage with QoS for Scientific and Commercial Big Data

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

Brim, Michael J; Dillow, David A; Oral, H Sarp

2013-01-01

This paper presents our design for an asynchronous object storage system intended for use in scientific and commercial big data workloads. Use cases from the target workload do- mains are used to motivate the key abstractions used in the application programming interface (API). The architecture of the Scalable Object Store (SOS), a prototype object stor- age system that supports the API s facilities, is presented. The SOS serves as a vehicle for future research into scalable and resilient big data object storage. We briefly review our research into providing efficient storage servers capable of providing quality of service (QoS) contractsmore » relevant for big data use cases.« less

Caring for Carers of People with Dementia: A Protocol for Harnessing Innovation Through Deploying Leading Edge Technologies to Enable Virtual Support Groups and Services.

PubMed

Parkinson, Lynne; Banbury, Annie; Livingstone, Anne; Gordon, Steven; Ray, Biplob; Byrne, Louise; Nancarrow, Susan; Doran, Chris; McAllister, Margaret; Petersen, Carrie; Pedell, Sonja; Wood, Denise

2018-01-01

In rural Australia, knowledge and utilisation of support by informal carers is lacking. During the caregiving period, socioemotional support from family and friends plays an important role in sustaining caregiving activities. Post-care, these social networks facilitate adjustment to role change and dealing with grief. Developing and improving access to peer support to enable carers to effectively cope with the challenges of caring may positively influence their caring experience. The primary objective of this project is to examine the response of isolated rural carers for older people with dementia to a videoconference (VC) based peer support and information program. Will participation in the program improve self-efficacy, quality of life, and mental health? Secondary objectives are to develop a VC based peer support program for isolated rural carers for older people with dementia, using a co-design approach; and to assess the feasibility of VC technology for enhancing social support to family caregivers in their homes. This project will collaboratively co-design and evaluate a facilitated VC peer support and information program to carers of people with dementia within rural areas. Carers will be recruited through community health and care providers. Program development will use an information sharing approach to facilitate social interaction. A focus of the project is to use off-the-shelf technology which will be more accessible than specialised bespoke solutions that are currently popular in this area of research. A mixed methods repeated measures randomized wait list design will be used to evaluate the project. The primary outcomes are self-efficacy, quality of life, and mental health. Secondary outcomes are perceived social support and user satisfaction with the technology, and intention to continue VC interaction.

Professional medical writing support and the quality of randomised controlled trial reporting: a cross-sectional study

PubMed Central

Gattrell, William T; Hopewell, Sally; Young, Kate; Farrow, Paul; White, Richard; Winchester, Christopher C

2016-01-01

Objectives Authors may choose to work with professional medical writers when writing up their research for publication. We examined the relationship between medical writing support and the quality and timeliness of reporting of the results of randomised controlled trials (RCTs). Design Cross-sectional study. Study sample Primary reports of RCTs published in BioMed Central journals from 2000 to 16 July 2014, subdivided into those with medical writing support (n=110) and those without medical writing support (n=123). Main outcome measures Proportion of items that were completely reported from a predefined subset of the Consolidated Standards of Reporting Trials (CONSORT) checklist (12 items known to be commonly poorly reported), overall acceptance time (from manuscript submission to editorial acceptance) and quality of written English as assessed by peer reviewers. The effect of funding source and publication year was examined. Results The number of articles that completely reported at least 50% of the CONSORT items assessed was higher for those with declared medical writing support (39.1% (43/110 articles); 95% CI 29.9% to 48.9%) than for those without (21.1% (26/123 articles); 95% CI 14.3% to 29.4%). Articles with declared medical writing support were more likely than articles without such support to have acceptable written English (81.1% (43/53 articles); 95% CI 67.6% to 90.1% vs 47.9% (23/48 articles); 95% CI 33.5% to 62.7%). The median time of overall acceptance was longer for articles with declared medical writing support than for those without (167 days (IQR 114.5–231 days) vs 136 days (IQR 77–193 days)). Conclusions In this sample of open-access journals, declared professional medical writing support was associated with more complete reporting of clinical trial results and higher quality of written English. Medical writing support may play an important role in raising the quality of clinical trial reporting. PMID:26899254

Ensuring quality: a key consideration in scaling-up HIV-related point-of-care testing programs

PubMed Central

Fonjungo, Peter N.; Osmanov, Saladin; Kuritsky, Joel; Ndihokubwayo, Jean Bosco; Bachanas, Pam; Peeling, Rosanna W.; Timperi, Ralph; Fine, Glenn; Stevens, Wendy; Habiyambere, Vincent; Nkengasong, John N.

2016-01-01

Objective: The objective of the WHO/US President's Emergency Plan for AIDS Relief consultation was to discuss innovative strategies, offer guidance, and develop a comprehensive policy framework for implementing quality-assured HIV-related point-of-care testing (POCT). Methods: The consultation was attended by representatives from international agencies (WHO, UNICEF, UNITAID, Clinton Health Access Initiative), United States Agency for International Development, Centers for Disease Control and Prevention/President's Emergency Plan for AIDS Relief Cooperative Agreement Partners, and experts from more than 25 countries, including policy makers, clinicians, laboratory experts, and program implementers. Main outcomes: There was strong consensus among all participants that ensuring access to quality of POCT represents one of the key challenges for the success of HIV prevention, treatment, and care programs. The following four strategies were recommended: implement a newly proposed concept of a sustainable quality assurance cycle that includes careful planning; definition of goals and targets; timely implementation; continuous monitoring; improvements and adjustments, where necessary; and a detailed evaluation; the importance of supporting a cadre of workers [e.g. volunteer quality corps (Q-Corps)] with the role to ensure that the quality assurance cycle is followed and sustained; implementation of the new strategy should be seen as a step-wise process, supported by development of appropriate policies and tools; and joint partnership under the leadership of the ministries of health to ensure sustainability of implementing novel approaches. Conclusion: The outcomes of this consultation have been well received by program implementers in the field. The recommendations also laid the groundwork for developing key policy and quality documents for the implementation of HIV-related POCT. PMID:26807969

75 FR 60471 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

... support for working families and improving the quality of child care to promote healthy development... child care programs authorized under the Child Care and Development Block Grant (CCDBG) Act and section...; identifies and implements operational planning objectives and initiatives related to child care; provides...

Framework for Healthful Living Education.

ERIC Educational Resources Information Center

North Carolina State Dept. of Public Instruction, Raleigh.

The Healthful Living Education program promotes behaviors that contribute to a healthful lifestyle and improved quality of life for all students. The Framework for Healthy Living Education supports and reinforces the goals and objectives of its three major components: health education, physical education, and alcohol and other drugs. When the…

DATA QUALITY OBJECTIVE SUMMARY REPORT FOR THE 105 K EAST ION EXCHANGE COLUMN MONOLITH

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

JOCHEN, R.M.

2007-08-02

The 105-K East (KE) Basin Ion Exchange Column (IXC) cells, lead caves, and the surrounding vault are to be removed as necessary components in implementing ''Hanford Federal Facility Agreement and Consent Order'' (Ecology et al. 2003) milestone M-034-32 (Complete Removal of the K East Basin Structure). The IXCs consist of six units located in the KE Basin, three in operating positions in cells and three stored in a lead cave. Methods to remove the IXCs from the KE Basin were evaluated in KBC-28343, ''Disposal of K East Basin Ion Exchange Column Evaluation''. The method selected for removal was grouting themore » six IXCs into a single monolith for disposal at the Environmental Restoration Disposal Facility (ERDF). Grout will be added to the IXC cells, IXC lead caves containing spent IXCs, and in the spaces between the lead cave walls and metal skin, to immobilize the contaminants, provide self-shielding, minimize void space, and provide a structurally stable waste form. The waste to be offered for disposal is the encapsulated monolith defined by the exterior surfaces of the vault and the lower surface of the underlying slab. This document presents summary of the data quality objective (DQO) process establishing the decisions and data required to support decision-making activities for the disposition of the IXC monolith. The DQO process is completed in accordance with the seven-step planning process described in EPA QA/G-4, ''Guidance for the Data Quality Objectives Process'', which is used to clarify and study objectives; define the appropriate type, quantity, and quality of data; and support defensible decision-making. The DQO process involves the following steps: (1) state the problem; (2) identify the decision; (3) identify the inputs to the decision; (4) define the boundaries of the study; (5) develop a decision rule (DR); (6) specify tolerable limits on decision errors; and (7) optimize the design for obtaining data.« less

Familiarity with and advocacy of Healthy People 2010 goals by Mississippi Chiropractic Association members.

PubMed

Leach, Robert A; Cossman, Ronald E; Yates, Joyce M

2011-01-01

The purpose of this study was to determine the familiarity with and stated advocacy of Healthy People 2010 objectives by member doctors of the Mississippi Chiropractic Association. Peer experts established face validity of a questionnaire regarding the Leading Health Indicators. This survey was distributed to 157 Mississippi Chiropractic Association members in 2009 during a conference and a follow-up by postal mail. Most doctors of chiropractic in the sample (n = 68, or 43% response) consider themselves wellness-oriented health care providers. Forty-two percent had read, 29% had not read, and another 29% were unsure whether they had read the Healthy People 2010 national objectives. Almost half (44%) strongly or somewhat agreed that their office practice reflects support for the Healthy People 2010 objective. In contrast, 27% disagree and 29% were unsure if their practice reflects the Healthy People 2010 objectives. There were differences between support and practice behaviors for some of the objectives. Chiropractors who have read the objectives tend to be more supportive of the national goals. Doctors of chiropractic in this sample are supportive of most Leading Health Indicators, and the majority reports that they incorporate these public health goals into their practices. Familiarity with reading the Health People objectives seems to be related to reported practice behaviors. There is a need to improve the percentage of practicing doctors of chiropractic who are familiar with Healthy People objectives. Future health education initiatives may assist doctors of chiropractic in further incorporating public health objectives into their practice behaviors and improving quality health care. Copyright © 2011 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Quantitative Prediction of Beef Quality Using Visible and NIR Spectroscopy with Large Data Samples Under Industry Conditions

NASA Astrophysics Data System (ADS)

Qiao, T.; Ren, J.; Craigie, C.; Zabalza, J.; Maltin, Ch.; Marshall, S.

2015-03-01

It is well known that the eating quality of beef has a significant influence on the repurchase behavior of consumers. There are several key factors that affect the perception of quality, including color, tenderness, juiciness, and flavor. To support consumer repurchase choices, there is a need for an objective measurement of quality that could be applied to meat prior to its sale. Objective approaches such as offered by spectral technologies may be useful, but the analytical algorithms used remain to be optimized. For visible and near infrared (VISNIR) spectroscopy, Partial Least Squares Regression (PLSR) is a widely used technique for meat related quality modeling and prediction. In this paper, a Support Vector Machine (SVM) based machine learning approach is presented to predict beef eating quality traits. Although SVM has been successfully used in various disciplines, it has not been applied extensively to the analysis of meat quality parameters. To this end, the performance of PLSR and SVM as tools for the analysis of meat tenderness is evaluated, using a large dataset acquired under industrial conditions. The spectral dataset was collected using VISNIR spectroscopy with the wavelength ranging from 350 to 1800 nm on 234 beef M. longissimus thoracis steaks from heifers, steers, and young bulls. As the dimensionality with the VISNIR data is very high (over 1600 spectral bands), the Principal Component Analysis (PCA) technique was applied for feature extraction and data reduction. The extracted principal components (less than 100) were then used for data modeling and prediction. The prediction results showed that SVM has a greater potential to predict beef eating quality than PLSR, especially for the prediction of tenderness. The infl uence of animal gender on beef quality prediction was also investigated, and it was found that beef quality traits were predicted most accurately in beef from young bulls.

[Systematic review and meta-analysis on the effect of implant supported overdentures on the oral health related quality of life of edentulous patients].

PubMed

Zhang, S S; Zhang, Y; Di, P; Lin, Y

2017-05-09

Objective: To evaluate the effect of implant related treatment on the oral health related quality of life (OHRQoL) of edentulous patients. Methods: The CNKI, Wanfang database and Medline, EMBASE, Cochrane Library databases that include randomized clinical trials comparing implant supported overdentures with conventional complete denture for edentulous patients were retrived. Nine studies involving 769 cases were included and meta-analysis was conducted. Results: The standardized mean difference (SMD) of oral health impact profile (OHIP) score was 1.63 (95% CI: 1.25-2.02) and improved after implant related treatment, which was significantly better than the conventional complete denture (0.87, 95% CI: 0.54-1.20). Conclusions: Implant supported overdentures improved patient's OHRQoL and showed better performance compared to the overdentures complete dentures.

An Electronic Nursing Patient Care Plan Helps in Clinical Decision Support.

PubMed

Wong, C M; Wu, S Y; Ting, W H; Ho, K H; Tong, L H; Cheung, N T

2015-01-01

Information technology can help to improve health care delivery. The utilisation of informatics principle enhances the quality of nursing practices through improved communication, documentation and efficiency. The Nursing Profession constitutes 34% of the total workforce in the Hong Kong Hospital Authority (HA) and includes 21,000 nurses in 2012. To enhance the quality of care and patient safety in both hospitals and community care setting, it is essential that an integrated electronic decision support system for nurses is designed to track documentation and support care or service including observations, decisions, actions and outcomes throughout the care process at each point-of-care. The Patient Care Plan project was set up to achieve these objectives. The Project adheres to strict documentation information architecture to ensure data sharing is freely available. Preliminary results showed very promising improvement in clinical care.

Water Quality Assessment for Deep-water Channel area of Guangzhou Port based on the Comprehensive Water Quality Identification Index Method

NASA Astrophysics Data System (ADS)

Chen, Yi

2018-03-01

The comprehensive water quality identification index method is able to assess the general water quality situation comprehensively and represent the water quality classification; water environment functional zone achieves pollution level and standard objectively and systematically. This paper selects 3 representative zones along deep-water channel of Guangzhou port and applies comprehensive water quality identification index method to calculate sea water quality monitoring data for different selected zones from year 2006 to 2014, in order to investigate the temporal variation of water quality along deep-water channel of Guangzhou port. The comprehensive water quality level from north to south presents an increased trend, and the water quality of the three zones in 2014 is much better than in 2006. This paper puts forward environmental protection measurements and suggestions for Pearl River Estuary, provides data support and theoretical basis for studied sea area pollution prevention and control.

The Genius of Shakespeare: A Case History in Content Analysis.

ERIC Educational Resources Information Center

Derks, Peter

Shakespeare's genius as a creative playwright can be judged both subjectively and objectively. Cognitive psychology uses specific behavioral measures to assess performance. A product is marked by latency, quantity, and quality. When college students engage in tests of originality, these measures support many theories of creativity. A similar…

Program Evaluation for USAID/Guinea Basic Education Program Portfolio

ERIC Educational Resources Information Center

Midling, Michael; Filion, Louise; David-Gnahoui, Emmanuel M.; Gassama-Mbaye, Mbarou; Diallo, Amadou Tidjane; Diallo, Abdoul Karim

2006-01-01

In support of its strategic objective of a quality basic education provided to a larger percentage of Guinean children with an emphasis on girls and rural children, the United States Agency for International Development established the following intermediate results: (1) Improved sectoral strategic planning, management, and decision-making in…

[Self-help groups--a fashion trend or objective requirement?].

PubMed

Horvat, M; Gospocić, G; Gospocić, S

1989-01-01

The role and the significance of the self-help groups in the modern medicine are described. The authors propose that the medical profession should actively support the formation and the activity of such groups with the aim to improve the quality of life of many groups of patients.

The impact of handwriting difficulties on compositional quality in children with developmental coordination disorder

PubMed Central

Barnett, Anna L; Wilmut, Kate; Plumb, Mandy S

2016-01-01

Introduction There is substantial evidence to support the relationship between transcription skills (handwriting and spelling) and compositional quality. For children with developmental coordination disorder, handwriting can be particularly challenging. While recent research has aimed to investigate their handwriting difficulties in more detail, the impact of transcription on their compositional quality has not previously been examined. The aim of this exploratory study was to examine compositional quality in children with developmental coordination disorder and to ascertain whether their transcription skills influence writing quality. Method Twenty-eight children with developmental coordination disorder participated in the study, with 28 typically developing age and gender matched controls. The children completed the ‘free-writing’ task from the detailed assessment of speed of handwriting tool, which was evaluated for compositional quality using the Wechsler objective language dimensions. Results The children with developmental coordination disorder performed significantly below their typically developing peers on five of the six Wechsler objective language dimensions items. They also had a higher percentage of misspelled words. Regression analyses indicated that the number of words produced per minute and the percentage of misspelled words explained 55% of the variance for compositional quality. Conclusion The handwriting difficulties so commonly reported in children with developmental coordination disorder have wider repercussions for the quality of written composition. PMID:27807392

The Utility of the OMI HCHO/NO2 in Air Quality Decision-Making Activities

NASA Technical Reports Server (NTRS)

Duncan, Bryan

2010-01-01

I will discuss a novel and practical application of the OMI HCHU and NO2 data products to the "weight of evidence" in the air quality decision-making process (e.g., State Implementation Plan (SIP)) for a city, region, or state to demonstrate that it is making progress toward attainment of the National Ambient Air Quality Standard (NAAQS) for ozone. Any trend, or lack thereof, in the observed OMI HCHO/NO2 may support that an emission control strategy implemented to reduce ozone is or is not occurring for a metropolitan area. In addition, the observed OMI HCHO/NO2 may be used to define new emission control strategies as the photochemical environments of urban areas evolve over time. I will demonstrate the utility of the OMI HCHO/NO2 over the U.S. for air quality applications with support from simulations with both a regional model and a photochemical box model. These results support mission planning of an OMI-like instrument for the proposed GEO-CAPE satellite that has as one of its objectives to study air quality from space. However, I'm attending the meeting as the Aura Deputy Project Scientist, so I don't technically need to present anything to justify the travel.

Chemical analyses of coal, coal-associated rocks and coal combustion products collected for the National Coal Quality Inventory

USGS Publications Warehouse

Hatch, Joseph R.; Bullock, John H.; Finkelman, Robert B.

2006-01-01

In 1999, the USGS initiated the National Coal Quality Inventory (NaCQI) project to address a need for quality information on coals that will be mined during the next 20-30 years. At the time this project was initiated, the publicly available USGS coal quality data was based on samples primarily collected and analyzed between 1973 and 1985. The primary objective of NaCQI was to create a database containing comprehensive, accurate and accessible chemical information on the quality of mined and prepared United States coals and their combustion byproducts. This objective was to be accomplished through maintaining the existing publicly available coal quality database, expanding the database through the acquisition of new samples from priority areas, and analysis of the samples using updated coal analytical chemistry procedures. Priorities for sampling include those areas where future sources of compliance coal are federally owned. This project was a cooperative effort between the U.S. Geological Survey (USGS), State geological surveys, universities, coal burning utilities, and the coal mining industry. Funding support came from the Electric Power Research Institute (EPRI) and the U.S. Department of Energy (DOE).

Measuring, managing and maximizing performance of mineral processing plants

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

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

1995-12-31

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

A Systematic Process for Developing High Quality SaaS Cloud Services

NASA Astrophysics Data System (ADS)

La, Hyun Jung; Kim, Soo Dong

Software-as-a-Service (SaaS) is a type of cloud service which provides software functionality through Internet. Its benefits are well received in academia and industry. To fully utilize the benefits, there should be effective methodologies to support the development of SaaS services which provide high reusability and applicability. Conventional approaches such as object-oriented methods do not effectively support SaaS-specific engineering activities such as modeling common features, variability, and designing quality services. In this paper, we present a systematic process for developing high quality SaaS and highlight the essentiality of commonality and variability (C&V) modeling to maximize the reusability. We first define criteria for designing the process model and provide a theoretical foundation for SaaS; its meta-model and C&V model. We clarify the notion of commonality and variability in SaaS, and propose a SaaS development process which is accompanied with engineering instructions. Using the proposed process, SaaS services with high quality can be effectively developed.

Biomechanics-based active control of bedding support properties and its influence on sleep.

PubMed

Van Deun, D; Verhaert, V; Willemen, T; Wuyts, J; Verbraecken, J; Exadaktylos, V; Haex, B; Vander Sloten, J

2012-01-01

Proper body support plays an import role in the recuperation of our body during sleep. Therefore, this study uses an automatically adapting bedding system that optimises spinal alignment throughout the night by altering the stiffness of eight comfort zones. The aim is to investigate the influence of such a dynamic sleep environment on objective and subjective sleep parameters. The bedding system contains 165 sensors that measure mattress indentation. It also includes eight actuators that control the comfort zones. Based on the measured mattress indentation, body movements and posture changes are detected. Control of spinal alignment is established by fitting personalized human models in the measured indentation. A total of 11 normal sleepers participated in this study. Sleep experiments were performed in a sleep laboratory where subjects slept three nights: a first night for adaptation, a reference night and an active support night (in counterbalanced order). Polysomnographic measurements were recorded during the nights, combined with questionnaires aiming at assessing subjective information. Subjective information on sleep quality, daytime quality and perceived number of awakenings shows significant improvements during the active support (ACS) night. Objective results showed a trend towards increased slow wave sleep. On the other hand, it was noticed that % N1-sleep was significantly increased during ACS night, while % N2-sleep was significantly decreased. No prolonged N1 periods were found during or immediately after steering.

Work addiction and quality of life: a study with physicians

PubMed Central

de Azevedo, Walter Fernandes; Mathias, Lígia Andrade da Silva Telles

2017-01-01

ABSTRACT Objective To evaluate the quality of life of physicians and investigate to what extent it is affected by work addiction. Methods This is an exploratory, descriptive and cross-sectional study, conducted with 1,110 physicians. For data collection, we used a questionnaire with sociodemographic information, the World Health Organization Quality of Life BREF, and the Work Addiction Scale. Results Most physicians presented high quality of life. Female participants presented lower quality of life in the domains psychologic, environment and general (p<0.05). Quality of life was negatively correlated with the number of shifts (p<0.005). The higher the addiction to work, the lower the quality of life. Conclusion The research allowed understanding the implications of work addiction in the quality of life. Further studies are required to support the development of strategies that improve health conditions and quality of life of medical professionals. PMID:28767908

Manufacturing Credibility: The National Energy Management Institute and the Tobacco Institute's Strategy for Indoor Air Quality

PubMed Central

Balbach, Edith D.

2011-01-01

Objectives. We studied tobacco industry efforts during the 1980s and 1990s to promote the National Energy Management Institute (NEMI), a nonprofit organization, as an authority on indoor air quality as part of the industry's strategy to oppose smoke-free worksite policies. Methods. We analyzed tobacco industry documents, conducted literature searches in Lexis–Nexis for background and historical literature, and reviewed relevant public health and policy literature. Results. The tobacco industry provided more than US $6 million to NEMI to establish it as an authority on indoor air quality and to work with it to undermine support for smoke-free air policies by promoting ventilation as a solution to indoor air quality problems. Tobacco industry support for NEMI was not publicly disclosed. Conclusions. NEMI was a valuable ally for the tobacco industry through NEMI's ties to organized labor, its technical background, and its status as a third-party actor. NEMI also helped the industry to portray ventilation to improve overall indoor air quality and smoke-free worksites as an either–or choice; in fact, both can improve worker health. PMID:21233427

[The seventieth anniversary of Medicina (Buenos Aires)].

PubMed

Kantor, Isabel N; Kotsias, Basilio A

2010-01-01

The historical trajectory of Medicina (Buenos Aires) and the current challenges accompanying its seventieth birthday are briefly described. The initial objectives at its foundation were to contribute to the advance of medicine, and support both clinical and experimental research in Argentina. These objectives continue to be valid. The editorial presence of the journal continues to be necessary. It is published following the international quality standards, the peer review system, and it is indexed in the main international data bases for scientific journals.

Influence of Social Support on Health-Related Quality of Life in New-Generation Migrant Workers in Eastern China.

PubMed

Xing, Haiyan; Yu, Wei; Chen, Sanmei; Zhang, Dengke; Tan, Rongmei

2013-08-01

The World Health Organization Quality of Life-BREF (WHOQOL-BREF) has generally been used for patients, few studies in migrants who move from rural to urban within one country. Many studies asserted that social isolation presents a risk to individual health. Poor social networks are associated with worse QOL. This study examined health-related quality of life (HRQOL) and social support in new-generation migrant workers and compared it with urban workers. Nine hundred thirty new-generation migrant workers and 939 urban controls completed the WHOQOL-BREF questionnaire and Social Support Rating Scale (SSRS) by stratified sampling in 2011. Spearman's correlation was performed to clarify the relationship between social support and HRQOL in migrants. Multiple linear regression analyses were used to identify the variables that were associated with HRQOL. The general health, psychological health, and environmental scores of QOL in new-generation migrant workers were lower than in urban workers. New-generation migrants had poorer social support compared with urban controls with regard to general support, objective support, and support utilization. A positive correlation was found between social support and HRQOL. Workers with a higher level of education achieved better psychological, environmental, and general scores than workers with a primary education. Physical, social, environmental, and general health was also closely connected with the age factor. Physical health scores were higher in males than in females. These data suggest that new-generation migrant workers have significant impairment in HRQOL and receive less social support. HRQOL may be affected by social support, education, age, and gender.

Social participation, willingness and quality of life: A population-based study among older adults in rural areas of China.

PubMed

He, Qian; Cui, Yanjie; Liang, Ling; Zhong, Qi; Li, Jie; Li, Yuancheng; Lv, Xiaofeng; Huang, Fen

2017-10-01

The present study aimed to reflect the current situation of social participation in rural areas of China, willingness to participate in social activities, association between health-related quality of life and social participation, and factors related to social participation. A total of 2644 rural adults aged 60 years and older were randomly selected and surveyed with a self-rating questionnaire. We used the unified definition of social participation in our study. The Medical Outcomes Study Short-Form Health Survey was used to measure health-related quality of life. The overall engagement of social activities was 26%. Those who participated in social activities were more likely to have high scores of health-related quality of life. Older men with a high educational level (OR 1.59, 95% CI 1.01-2.29) living alone or with a spouse (OR 1.51, 95% CI 1.08-2.12), high objective social support (OR 1.08, 95% CI 1.00-1.17) and high support utilization (OR 1.13, 95% CI 1.07-1.21) were inclined to engage in social participation. Older women with high individual income (OR 1.74, 95% CI 1.25-2.43), single marital status (OR 1.53, 95% CI 1.11-2.10), normal weight (OR 1.92, 95% CI 1.10-3.34), overweight (OR 2.28, 95% CI 1.24-4.19), living alone or with a spouse (OR 1.55, 95% CI 1.20-2.00), objective social support (OR 1.11, 95% CI 1.04-1.18) and subjective social support (OR 1.15, 95% CI 1.10-1.20) were more willing to engage in social participation. Engagement in social activities is relatively low in rural areas, and associations of willingness and health-related quality of life with social participation were found. Policy-makers and government workers should make appropriate types of encouragement policies around social participation for older adults in rural areas. Geriatr Gerontol Int 2017; 17: 1593-1602. © 2016 Japan Geriatrics Society.

Feasibility of Extracting Key Elements from ClinicalTrials.gov to Support Clinicians' Patient Care Decisions.

PubMed

Kim, Heejun; Bian, Jiantao; Mostafa, Javed; Jonnalagadda, Siddhartha; Del Fiol, Guilherme

2016-01-01

Motivation: Clinicians need up-to-date evidence from high quality clinical trials to support clinical decisions. However, applying evidence from the primary literature requires significant effort. Objective: To examine the feasibility of automatically extracting key clinical trial information from ClinicalTrials.gov. Methods: We assessed the coverage of ClinicalTrials.gov for high quality clinical studies that are indexed in PubMed. Using 140 random ClinicalTrials.gov records, we developed and tested rules for the automatic extraction of key information. Results: The rate of high quality clinical trial registration in ClinicalTrials.gov increased from 0.2% in 2005 to 17% in 2015. Trials reporting results increased from 3% in 2005 to 19% in 2015. The accuracy of the automatic extraction algorithm for 10 trial attributes was 90% on average. Future research is needed to improve the algorithm accuracy and to design information displays to optimally present trial information to clinicians.

The Missing Link: Improving Quality With a Chronic Disease Management Intervention for the Primary Care Office

PubMed Central

Zweifler, John

2007-01-01

Bold steps are necessary to improve quality of care for patients with chronic diseases and increase satisfaction of both primary care physicians and patients. Office-based chronic disease management (CDM) workers can achieve these objectives by offering self-management support, maintaining disease registries, and monitoring compliance from the point of care. CDM workers can provide the missing link by connecting patients, primary care physicans, and CDM services sponsored by health plans or in the community. CDM workers should be supported financially by Medicare, Medicaid, and commercial health plans through reimbursements to physicians for units of service, analogous to California’s Comprehensive Perinatal Services Program. Care provided by CDM workers should be standardized, and training requirements should be sufficiently flexible to ensure wide dissemination. CDM workers can potentially improve quality while reducing costs for preventable hospitalizations and emergency department visits, but evaluation at multiple levels is recommended. PMID:17893388

[Relationship between perceived emotional intelligence and professional quality of life with the achievement of occupational objectives in the costa del sol primary health care district].

PubMed

Macías Fernández, Antonio José; Gutiérrez-Castañeda, Carlos; Carmona González, Francisco Jesús; Crespillo Vílchez, Daniel

2016-05-01

To examine the relationship between "Quality of Professional Life" and "Perceived Emotional Intelligence" and the relationship of both of these with the level of achievement of occupational objectives in the Costa del Sol Primary Health Care District. Multicentre descriptive cross-sectional observational study. The Costa del Sol Primary Health Care District in the province of Málaga. Sample of Employees of all categories in fixed and contracted employment in the Management Units of the Costa del Sol District. (N=303). Respondents 247 (81.5%) The data collected was that of the percentage of achievement of objectives in 2010 and the socio-demographic data of the participants, using ad hoc designed self-report questionnaires. The TMMS -24 questionnaire was used to measure the "Perceived Emotional Intelligence", with the following dimensions: Perception, comprehension, and emotional control, and the CVP-35 measuring: management support, work demands, and intrinsic motivation. Significant correlationas were observed between Quality of Professional Life and Emotional Intelligence in the Regulation (p<.01) and Comprehension categories (p<0.05). There were also significant correlations between the profession and the type of contract in the achievement of objectives (p<.005), and quality of professional life and type of contract (p<.05). The perceived quality of professional life is related to perception and regulation dimensions of Emotional Intelligence. Knowledge of emotion management methods should be promoted by management organisations for all employees. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Modelling health care processes for eliciting user requirements: a way to link a quality paradigm and clinical information system design.

PubMed

Staccini, P; Joubert, M; Quaranta, J F; Fieschi, D; Fieschi, M

2000-01-01

Hospital information systems have to support quality improvement objectives. The design issues of health care information system can be classified into three categories: 1) time-oriented and event-labelled storage of patient data; 2) contextual support of decision-making; 3) capabilities for modular upgrading. The elicitation of the requirements has to meet users' needs in relation to both the quality (efficacy, safety) and the monitoring of all health care activities (traceability). Information analysts need methods to conceptualize clinical information systems that provide actors with individual benefits and guide behavioural changes. A methodology is proposed to elicit and structure users' requirements using a process-oriented analysis, and it is applied to the field of blood transfusion. An object-oriented data model of a process has been defined in order to identify its main components: activity, sub-process, resources, constrains, guidelines, parameters and indicators. Although some aspects of activity, such as "where", "what else", and "why" are poorly represented by the data model alone, this method of requirement elicitation fits the dynamic of data input for the process to be traced. A hierarchical representation of hospital activities has to be found for this approach to be generalised within the organisation, for the processes to be interrelated, and for their characteristics to be shared.

Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance

PubMed Central

Campbell, S; Sheaff, R; Sibbald, B; Marshall, M; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M

2002-01-01

Objectives: To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Design: Qualitative case studies using semi-structured interviews and documentation review. Setting: Twelve purposively sampled PCG/Ts in England. Participants: Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Main outcome measures: Participants' perceptions of the role of clinical governance in PCG/Ts. Results: PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). Conclusion: PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance. PMID:12078380

Resolving future fire management conflicts using multicriteria decision making.

PubMed

Driscoll, Don A; Bode, Michael; Bradstock, Ross A; Keith, David A; Penman, Trent D; Price, Owen F

2016-02-01

Management strategies to reduce the risks to human life and property from wildfire commonly involve burning native vegetation. However, planned burning can conflict with other societal objectives such as human health and biodiversity conservation. These conflicts are likely to intensify as fire regimes change under future climates and as growing human populations encroach farther into fire-prone ecosystems. Decisions about managing fire risks are therefore complex and warrant more sophisticated approaches than are typically used. We applied a multicriteria decision making approach (MCDA) with the potential to improve fire management outcomes to the case of a highly populated, biodiverse, and flammable wildland-urban interface. We considered the effects of 22 planned burning options on 8 objectives: house protection, maximizing water quality, minimizing carbon emissions and impacts on human health, and minimizing declines of 5 distinct species types. The MCDA identified a small number of management options (burning forest adjacent to houses) that performed well for most objectives, but not for one species type (arboreal mammal) or for water quality. Although MCDA made the conflict between objectives explicit, resolution of the problem depended on the weighting assigned to each objective. Additive weighting of criteria traded off the arboreal mammal and water quality objectives for other objectives. Multiplicative weighting identified scenarios that avoided poor outcomes for any objective, which is important for avoiding potentially irreversible biodiversity losses. To distinguish reliably among management options, future work should focus on reducing uncertainty in outcomes across a range of objectives. Considering management actions that have more predictable outcomes than landscape fuel management will be important. We found that, where data were adequate, an MCDA can support decision making in the complex and often conflicted area of fire management. © 2015 Society for Conservation Biology.

The impact of the board's strategy-setting role on board-management relations and hospital performance.

PubMed

Büchner, Vera Antonia; Schreyögg, Jonas; Schultz, Carsten

2014-01-01

The appropriate governance of hospitals largely depends on effective cooperation between governing boards and hospital management. Governing boards play an important role in strategy-setting as part of their support for hospital management. However, in certain situations, this active strategic role may also generate discord within this relationship. The objective of this study is to investigate the impact of the roles, attributes, and processes of governing boards on hospital performance. We examine the impact of the governing board's strategy-setting role on board-management collaboration quality and on financial performance while also analyzing the interaction effects of board diversity and board activity level. The data are derived from a survey that was sent simultaneously to German hospitals and their associated governing board, combined with objective performance information from annual financial statements and quality reports. We use a structural equation modeling approach to test the model. The results indicate that different board characteristics have a significant impact on hospital performance (R = .37). The strategy-setting role and board-management collaboration quality have a positive effect on hospital performance, whereas the impact of strategy-setting on collaboration quality is negative. We find that the positive effect of strategy-setting on performance increases with decreasing board diversity. When board members have more homogeneous backgrounds and exhibit higher board activity levels, the negative effect of the strategy-setting on collaboration quality also increases. Active strategy-setting by a governing board may generally improve hospital performance. Diverse members of governing boards should be involved in strategy-setting for hospitals. However, high board-management collaboration quality may be compromised if managerial autonomy is too highly restricted. Consequently, hospitals should support board-management collaboration about empowered contrasting board roles.

Reuse Metrics for Object Oriented Software

NASA Technical Reports Server (NTRS)

Bieman, James M.

1998-01-01

One way to increase the quality of software products and the productivity of software development is to reuse existing software components when building new software systems. In order to monitor improvements in reuse, the level of reuse must be measured. In this NASA supported project we (1) derived a suite of metrics which quantify reuse attributes for object oriented, object based, and procedural software, (2) designed prototype tools to take these measurements in Ada, C++, Java, and C software, (3) evaluated the reuse in available software, (4) analyzed the relationship between coupling, cohesion, inheritance, and reuse, (5) collected object oriented software systems for our empirical analyses, and (6) developed quantitative criteria and methods for restructuring software to improve reusability.

Quality assurance and accreditation.

PubMed

1997-01-01

In 1996, the Joint Commission International (JCI), which is a partnership between the Joint Commission on Accreditation of Healthcare Organizations and Quality Healthcare Resources, Inc., became one of the contractors of the Quality Assurance Project (QAP). JCI recognizes the link between accreditation and quality, and uses a collaborative approach to help a country develop national quality standards that will improve patient care, satisfy patient-centered objectives, and serve the interest of all affected parties. The implementation of good standards provides support for the good performance of professionals, introduces new ideas for improvement, enhances the quality of patient care, reduces costs, increases efficiency, strengthens public confidence, improves management, and enhances the involvement of the medical staff. Such good standards are objective and measurable; achievable with current resources; adaptable to different institutions and cultures; and demonstrate autonomy, flexibility, and creativity. The QAP offers the opportunity to approach accreditation through research efforts, training programs, and regulatory processes. QAP work in the area of accreditation has been targeted for Zambia, where the goal is to provide equal access to cost-effective, quality health care; Jordan, where a consensus process for the development of standards, guidelines, and policies has been initiated; and Ecuador, where JCI has been asked to help plan an approach to the evaluation and monitoring of the health care delivery system.

National Quality Measures for Child Mental Health Care: Background, Progress, and Next Steps

PubMed Central

Murphy, J. Michael; Scholle, Sarah Hudson; Hoagwood, Kimberly Eaton; Sachdeva, Ramesh C.; Mangione-Smith, Rita; Woods, Donna; Kamin, Hayley S.; Jellinek, Michael

2013-01-01

OBJECTIVE: To review recent health policies related to measuring child health care quality, the selection processes of national child health quality measures, the nationally recommended quality measures for child mental health care and their evidence strength, the progress made toward developing new measures, and early lessons learned from these national efforts. METHODS: Methods used included description of the selection process of child health care quality measures from 2 independent national initiatives, the recommended quality measures for child mental health care, and the strength of scientific evidence supporting them. RESULTS: Of the child health quality measures recommended or endorsed during these national initiatives, only 9 unique measures were related to child mental health. CONCLUSIONS: The development of new child mental health quality measures poses methodologic challenges that will require a paradigm shift to align research with its accelerated pace. PMID:23457148

[Impact of Emotion Regulation and Emotional Arousal on Quality of Life and Adherence of Couples after Kidney Transplantation].

PubMed

Peters, Luisa; Franke, Laura; Tkachenko, Daria; Schiffer, Mario; Zimmermann, Tanja

2018-05-01

Nonadherence to immunosuppressive medication increases the risk of graft failure. Maladaptive emotion regulation strategies (ERS) seem to be a risk factor for nonadherence, whereas for patients in relationships spousal support appears as a protective resource. Emotional arousal, objectively measured by the fundamental frequency (f 0 ) during spousal supportive communication is associated with supportive behavior. This study examined the relationship between beliefs about immunosuppressive medication, quality of life, ERS, emotions and emotional arousal, assessed during social support interactions of both spouses of N=50 couples after kidney transplantation. Maladaptive ERS of the transplant recipient were associated with lower mental quality of life of the partner, marginally higher own negative affect and lower beliefs about medication. Maladaptive ERS of the partner showed negative correlations with own mental quality of life. Regarding f 0 , gender differences were found. Higher f 0 of the male transplant recipient were associated with more maladaptive ERS of the female partner. Marginally significate correlations were found with lower own beliefs about medication. Higher f 0 of the wife of the male transplant recipient showed correlations with lower own positive affect, more negative affect of the male patient and lower beliefs about medication. Higher f 0 of female transplant recipients were associated with lower own maladaptive ERS and lower maladaptive ERS of the husband. The findings support the relevance of early interventions focusing on identifying and modifying maladaptive ERS for both the patient and partner. © Georg Thieme Verlag KG Stuttgart · New York.

Support and Social Contact as a Decisive Meta-Variable in Morbidity and Social Welfare of the Older Person.

PubMed

Rondon Garcia, Luis Miguel; Aguirre Arizala, Blanca Aranzazu; Garcia Garcia, Francisco Jose; Gallego, Carmen Castillo

2017-01-01

Bacground: This article tackles social support as a meta-variable that is reinforced by a set of social variables, which correlate and act as predictors of social welfare and life quality of the older person. The objective of the study is to know how social support, networks and social contacts can influence the health of the elderly person, especially if these are interrelated factors. The population studied are individuals from both sexes living in Toledo (Spanish people) and who were 65 years of age or over. Several scales were applied to assess the frequency of and the degree of satisfaction with perceived social support received from different sources in relation to social support. The co relational analysis showed significant positive associations between scores and measures of and social support, social relations, contact and social networks. We conclude that the support in general is very good, over 90% of people from the sample have someone who would help if needed. Social and health factors are interrelated with social support. Social contact can also be considered as a life quality estimate. He progressive loss of contact over the years is a social factor that affects the quality of life. The meta-analysis we find that social support and the emotional factor, along with social interactions, have powerful effects on preventing morbidity and mortality, which are important social indicators. We conclude that social support based on positive social interactions provides an optimal state of health in the older person. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Probiotics

PubMed Central

Reid, Gregor; Hammond, Jo-Anne

2005-01-01

OBJECTIVE To define the term probiotics, to indicate how to identify products that have been proven beneficial, and to assess the quality of evidence regarding probiotics. QUALITY OF EVIDENCE A few level I studies support the effectiveness of specific probiotics for certain diagnoses. For most so-called probiotics, however, weak or no evidence supports their effectiveness. MAIN MESSAGE Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. Level I evidence supports use of VSL#3 for maintaining remission of inflammatory colitis. Probiotics for treating vaginal infections, Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, have level I evidence of effectiveness, but are not available in Canada. Specific probiotics taken for certain indications improve health and have few side effects. CONCLUSION Limited but good evidence supports the role of certain probiotics in medical practice. Because consumer pressure will undoubtedly stimulate further interest in probiotics, family doctors need to be informed about them so they can advise their patients appropriately. PMID:16353831

Perceived Social Support from Friends and Parents for Eating Behavior and Diet Quality among Low-income, Urban, Minority Youth

PubMed Central

Steeves, Elizabeth Anderson; Jones-Smith, Jessica; Hopkins, Laura; Gittelsohn, Joel

2016-01-01

Objective Evidence of associations between social support and dietary intake among adolescents is mixed. This study examines relationships between social support for healthy and unhealthy eating from friends and parents, and associations with diet quality. Design Cross-sectional analysis of survey data. Setting Baltimore, MD. Participants 296 youth ages 9-15 years, 53% female, 91% African American, participating in the B’More Healthy Communities for Kids study. Main Outcome Measure(s) Primary dependent variable: Diet quality measured using Healthy Eating Index 2010 overall score, calculated from the Block Kids Food Frequency Questionnaire. Independent variables: Social support from parents and friends for healthy eating (4 questions analyzed as a scale) and unhealthy eating (3 questions analyzed individually), age, gender, race, and household income, reported via questionnaire. Analysis Adjusted multiple linear regressions. Alpha, p<0.05. Results Friend and parent support for healthy eating did not have statistically significant relationships with overall HEI scores. Youth who reported their parents offering high fat foods or sweets more frequently had lower overall HEI scores (β=−1.65; SE=0.52; 95% CI: −2.66 to −0.63). Conclusions and Implications These results are novel and demonstrate the need for additional studies examining support for unhealthy eating. These preliminary findings may be relevant to researchers as they develop family-based nutrition interventions. PMID:26865358

Predictors of Well-Being in the Lives of Student Service Members and Veterans

ERIC Educational Resources Information Center

Williston, Sarah Krill; Roemer, Lizabeth

2017-01-01

Objective: The current study examined predictors of well-being, including quality of life and academic engagement, in a sample of student service members and veteran college students. Methods: Eighty-seven student service members/veterans (SSM/V) completed an online survey containing questions about post-deployment social support, emotion…

Considerations for the Use of the Observation Experience to Aid in Early Socialization and Retention of Athletic Training Students

ERIC Educational Resources Information Center

Mazerolle, Stephanie M.; Dodge, Thomas

2014-01-01

Context: Retention of quality students in athletic training programs (ATPs) is important. Many factors contribute to retention of students, including their motivation level, peer support, positive interactions with instructors, clinical integration, and mentorship. Objective: Highlight the use of the observation period for preparatory athletic…

The Evolution of University-Based Knowledge Transfer Structures. The EUIMA Collaborative Research Project Papers

ERIC Educational Resources Information Center

Trueman, Stephen; Borrell-Damian, Lidia; Smith, John H.

2014-01-01

The modernisation process of universities has historically highlighted the necessity of providing support structures to facilitate contacts and relationships between research groups and the outside environment, with the objective of increasing the quantity and improving the quality of collaborative research activity. The first steps in this…

An Implementation of Interactive Objects on the Web.

ERIC Educational Resources Information Center

Fritze, Paul

With the release of ShockWave, MacroMedia Director animations can now be incorporated directly into Web pages to provide high quality animation and interactivity, to support, for example, tutorial style questions and instantaneous feedback. This paper looks at the application of this technique in the translation of a traditional computer-based…

And Then a Miracle Occurs! Ensuring the Successful Implementation of Enterpisewide EPSS and E-Learning from Day One.

ERIC Educational Resources Information Center

Stone, Deborah L.; Villachica, Steven W.

2003-01-01

Provides suggestions to ensure the success of electronic performance support systems (EPSS) and electronic learning, including creating hybrid solutions; aligning EPSS with business objectives and performance requirements; change management efforts; and rapid application development to lower costs, shrink schedules, and improve quality.…

Chapter 6. Landscape Analysis for Habitat Monitoring

Treesearch

Samuel A. Cushman; Kevin McGarigal; Kevin S. McKelvey; Christina D. Vojta; Claudia M. Regan

2013-01-01

The primary objective of this chapter is to describe standardized methods for measur¬ing and monitoring attributes of landscape pattern in support of habitat monitoring. This chapter describes the process of monitoring categorical landscape maps in which either selected habitat attributes or different classes of habitat quality are represented as different patch types...

Using Reading Times and Eye-Movements to Measure Cognitive Engagement

ERIC Educational Resources Information Center

Miller, Brian W.

2015-01-01

Self-paced reading and eye-tracking can be used to measure microlevel student engagement during science instruction. These methods imply a definition of engagement as the quantity and quality of mental resources directed at an object and the emotions and behaviors entailed. This definition is theoretically supported by models of reading…

Structure of the Social Support Network of Patients with Severe and Persistent Psychiatric Disorders in Follow-Ups to Primary Health Care.

PubMed

de Souza, Jacqueline; de Almeida, Letícia Yamawaka; Moll, Marciana Fernandes; Silva, Lucas Duarte; Ventura, Carla Aparecida Arena

2016-02-01

The objective of this study is to analyze the characteristics of social support networks of patients with psychiatric disorders at follow-up to primary care. This is a cross-sectional qualitative research study. Forty-five interviews were held with patients and their supporters. The results showed small and dense networks, with a strong emphasis on the bonds with formal supporters and a scant network of informal supporters. It is recommended to develop strategies to improve social support networks and use this as an outcome indicator related to social integration of these patients and to the quality of services involved with outpatient healthcare. Copyright © 2015 Elsevier Inc. All rights reserved.

A two-metric proposal to specify the color-rendering properties of light sources for retail lighting

NASA Astrophysics Data System (ADS)

Freyssinier, Jean Paul; Rea, Mark

2010-08-01

Lighting plays an important role in supporting retail operations, from attracting customers, to enabling the evaluation of merchandise, to facilitating the completion of the sale. Lighting also contributes to the identity, comfort, and visual quality of a retail store. With the increasing availability and quality of white LEDs, retail lighting specifiers are now considering LED lighting in stores. The color rendering of light sources is a key factor in supporting retail lighting goals and thus influences a light source's acceptance by users and specifiers. However, there is limited information on what consumers' color preferences are, and metrics used to describe the color properties of light sources often are equivocal and fail to predict preference. The color rendering of light sources is described in the industry solely by the color rendering index (CRI), which is only indirectly related to human perception. CRI is intended to characterize the appearance of objects illuminated by the source and is increasingly being challenged because new sources are being developed with increasingly exotic spectral power distributions. This paper discusses how CRI might be augmented to better use it in support of the design objectives for retail merchandising. The proposed guidelines include the use of gamut area index as a complementary metric to CRI for assuring good color rendering.

Proceedings of the Annual Conference on Ada (Trademark) Technology (2nd) Held at Hampton, Virginia on March 27, 28, 1984.

DTIC Science & Technology

1984-03-01

evaluation of powerful support environments are essential if we are to maximize Lanauage Definition the productivity of programmers. CENVTACS provided...quality Policy and Objectives Ada support environment which includes a rich set of powerful tools (in addition to a compiler) The DOD has established Ada...to be easy to learn and easy to use. It will be powerful , efficient, and The MAPSE Command Language (MCL) friendly. This paper describes how these

[Evaluation of organization of the military medical support in the peace time].

PubMed

Korshever, N G

2001-09-01

The work is devoted to investigation of some theoretical and practical aspects of organizational diagnosis of troops medical support during the peace-time. The analysis of literature, the materials obtained during the practical training of the students of Saratov Military Medical Institute, the expert questioning of the teaching stuff (14 persons) allowed to characterize the difficulties in diagnosis of different objects as well as the qualities necessary for the diagnostician. It also permitted to determine the functions, methods, classification and stages of organizational diagnosis, to substantiate the requirements necessary for evaluation of troops medical support.

Work engagement as a key driver of quality of care: a study with midwives.

PubMed

Freeney, Yseult; Fellenz, Martin R

2013-01-01

Against a backdrop of increased work intensification within maternity hospitals, the purpose of this paper is to examine the role of work engagement in the quality of care delivered to patients and in general health of the midwives delivering care, as reported by midwives and nurses. Quantitative questionnaires consisting of standardised measures were distributed to midwives in two large maternity hospitals. These questionnaires assessed levels of work engagement, supervisor and colleague support, general health and quality of care. Structural equation modelling analysis revealed a best-fit model that demonstrated work engagement to be a significant partial mediator between organisational and supervisor support and quality of care, and as a significant predictor of self-reported general health. Together, supervisor support, social support and organisational resources, mediated by work engagement, explained 38 per cent of the variance in quality of care at the unit level and 23 per cent of variance in general health among midwives (chi2(67) = 113; p < 0.01, CFI = 0.961, RMSEA = 0.06). The study is limited in that it uses self-report measures of quality of care and lacks objective indicators of patient outcomes. The cross-sectional design also does not allow for causal inferences to be drawn from the data. This study provides evidence for the links between individual levels of work engagement and both health and self-reports of unit level quality of care. The results support the importance of health services organisations and managers deploying organisational resources to foster employee work engagement. The results also highlight the significant role of the immediate nurse manager and suggest training and development for such roles is a valuable investment. These results are the first to link work engagement and performance in health care contexts and point to the value of work engagement for both unit performance and for individual employee well-being in health organisations.

Developing an ANSI standard for image quality tools for the testing of active millimeter wave imaging systems

NASA Astrophysics Data System (ADS)

Barber, Jeffrey; Greca, Joseph; Yam, Kevin; Weatherall, James C.; Smith, Peter R.; Smith, Barry T.

2017-05-01

In 2016, the millimeter wave (MMW) imaging community initiated the formation of a standard for millimeter wave image quality metrics. This new standard, American National Standards Institute (ANSI) N42.59, will apply to active MMW systems for security screening of humans. The Electromagnetic Signatures of Explosives Laboratory at the Transportation Security Laboratory is supporting the ANSI standards process via the creation of initial prototypes for round-robin testing with MMW imaging system manufacturers and experts. Results obtained for these prototypes will be used to inform the community and lead to consensus objective standards amongst stakeholders. Images collected with laboratory systems are presented along with results of preliminary image analysis. Future directions for object design, data collection and image processing are discussed.

Do Personality Problems Improve During Psychodynamic Supportive-Expressive Psychotherapy? Secondary Outcome Results From a Randomized Controlled Trial for Psychiatric Outpatients with Personality Disorders

PubMed Central

Vinnars, Bo; Thormählen, Barbro; Gallop, Robert; Norén, Kristina; Barber, Jacques P.

2009-01-01

Studies involving patients with personality disorders (PD) have not focused on improvement of core aspects of the PD. This paper examines changes in quality of object relations, interpersonal problems, psychological mindedness, and personality traits in a sample of 156 patients with DSM-IV PD diagnoses being randomized to either manualized or non manualized dynamic psychotherapy. Effect sizes adjusted for symptomatic change and reliable change indices were calculated. We found that both treatments were equally effective at reducing personality pathology. Only in neuroticism did the non manualized group do better during the follow-up period. The largest improvement was found in quality of object relations. For the remaining variables only small and clinically insignificant magnitudes of change were found. PMID:20161588

Evaluation of NASA Data Products for RPO Applications

NASA Technical Reports Server (NTRS)

Frisbie, Troy; Knowlton, Kelly; Andrews, Jane

2005-01-01

This presentation summarizes preliminary investigations at SSC by NASA's ASD in Air Quality including decision support tools, partner plans, working groups, and committees. An overview of follow-on short-term and long-term objectives is also provided. A table of potential NASA sensors for use with air quality applications is included, along with specifications for MODIS 04 and 06 products. This presentation was originally given by Rich Piorot of the Vermont Department of Environmental Conservation - Air Quality as part of a round-table discussion during "Exploring Collaborative Opportunities in Air Quality Monitoring, Modelling and Communication Workshop" in Boulder, CO, on March 21-22, 2005; verbal consent for this presentation to be provided to Mr. Piorot was given by the NASA SSC ASD Air Quality Program Manager on March 14, 2005.

Case studies evaluating the quality of synthetic environments

NASA Astrophysics Data System (ADS)

Deisinger, Joachim; Blach, Roland; Simon, Andreas

1999-03-01

Multi wall stereo projection systems (MWSP) are an emerging display paradigm, promising a new quality in 3D-real-time interactions. Not much is known about the ergonomics of these systems. In this paper some basics of perception and approaches to improve the visual quality will be discussed and results of four experiments will be presented in order to obtain a better understanding of user interactions with existing projection technology. Due to the limited number of participants the experiments are considered as case-studies only. The first task was the estimation of absolute geometrical dimensions of simple objects. The second task was grabbing simple objects of different sizes. In order to classify MWSP, these tasks were compared to other display devices and compared to physical reality. We conducted two further experiments to compare different viewing devices for virtual reality (VR) like Head Mounted Displays (HMD), monitor, and the MWSP. For all of those experiments quantitative data was collected as a measure of interaction quality. The last two tests were supported by pre- and post questionnaires to obtain subjective judgement of the displays as well.

Implementation of Consolidated HIS: Improving Quality and Efficiency of Healthcare

PubMed Central

Choi, Jinwook; Seo, Jeong-Wook; Chung, Chun Kee; Kim, Kyung-Hwan; Kim, Ju Han; Kim, Jong Hyo; Chie, Eui Kyu; Cho, Hyun-Jai; Goo, Jin Mo; Lee, Hyuk-Joon; Wee, Won Ryang; Nam, Sang Mo; Lim, Mi-Sun; Kim, Young-Ah; Yang, Seung Hoon; Jo, Eun Mi; Hwang, Min-A; Kim, Wan Suk; Lee, Eun Hye; Choi, Su Hi

2010-01-01

Objectives Adoption of hospital information systems offers distinctive advantages in healthcare delivery. First, implementation of consolidated hospital information system in Seoul National University Hospital led to significant improvements in quality of healthcare and efficiency of hospital management. Methods The hospital information system in Seoul National University Hospital consists of component applications: clinical information systems, clinical research support systems, administrative information systems, management information systems, education support systems, and referral systems that operate to generate utmost performance when delivering healthcare services. Results Clinical information systems, which consist of such applications as electronic medical records, picture archiving and communication systems, primarily support clinical activities. Clinical research support system provides valuable resources supporting various aspects of clinical activities, ranging from management of clinical laboratory tests to establishing care-giving procedures. Conclusions Seoul National University Hospital strives to move its hospital information system to a whole new level, which enables customized healthcare service and fulfills individual requirements. The current information strategy is being formulated as an initial step of development, promoting the establishment of next-generation hospital information system. PMID:21818449

Nightmares affect the experience of sleep quality but not sleep architecture: an ambulatory polysomnographic study.

PubMed

Paul, Franc; Schredl, Michael; Alpers, Georg W

2015-01-01

Nightmares and bad dreams are common in people with emotional disturbances. For example, nightmares are a core symptom in posttraumatic stress disorder and about 50% of borderline personality disorder patients suffer from frequent nightmares. Independent of mental disorders, nightmares are often associated with sleep problems such as prolonged sleep latencies, poorer sleep quality, and daytime sleepiness. It has not been well documented whether this is reflected in objectively quantifiable physiological indices of sleep quality. Questionnaires regarding subjective sleep quality and ambulatory polysomnographic recordings of objective sleep parameters were collected during three consecutive nights in 17 individuals with frequent nightmares (NM) and 17 healthy control participants (HC). NM participants reported worse sleep quality, more waking problems and more severe insomnia compared to HC group. However, sleep measures obtained by ambulatory polysomnographic recordings revealed no group differences in (a) overall sleep architecture, (b) sleep cycle duration as well as REM density and REM duration in each cycle and (c) sleep architecture when only nights with nightmares were analyzed. Our findings support the observation that nightmares result in significant impairment which is independent from disturbed sleep architecture. Thus, these specific problems require specific attention and appropriate treatment.

Spectrum analysis on quality requirements consideration in software design documents.

PubMed

Kaiya, Haruhiko; Umemura, Masahiro; Ogata, Shinpei; Kaijiri, Kenji

2013-12-01

Software quality requirements defined in the requirements analysis stage should be implemented in the final products, such as source codes and system deployment. To guarantee this meta-requirement, quality requirements should be considered in the intermediate stages, such as the design stage or the architectural definition stage. We propose a novel method for checking whether quality requirements are considered in the design stage. In this method, a technique called "spectrum analysis for quality requirements" is applied not only to requirements specifications but also to design documents. The technique enables us to derive the spectrum of a document, and quality requirements considerations in the document are numerically represented in the spectrum. We can thus objectively identify whether the considerations of quality requirements in a requirements document are adapted to its design document. To validate the method, we applied it to commercial software systems with the help of a supporting tool, and we confirmed that the method worked well.

Innovating to enhance clinical data management using non-commercial and open source solutions across a multi-center network supporting inpatient pediatric care and research in Kenya

PubMed Central

Tuti, Timothy; Bitok, Michael; Paton, Chris; Makone, Boniface; Malla, Lucas; Muinga, Naomi; Gathara, David; English, Mike

2016-01-01

Objective To share approaches and innovations adopted to deliver a relatively inexpensive clinical data management (CDM) framework within a low-income setting that aims to deliver quality pediatric data useful for supporting research, strengthening the information culture and informing improvement efforts in local clinical practice. Materials and methods The authors implemented a CDM framework to support a Clinical Information Network (CIN) using Research Electronic Data Capture (REDCap), a noncommercial software solution designed for rapid development and deployment of electronic data capture tools. It was used for collection of standardized data from case records of multiple hospitals’ pediatric wards. R, an open-source statistical language, was used for data quality enhancement, analysis, and report generation for the hospitals. Results In the first year of CIN, the authors have developed innovative solutions to support the implementation of a secure, rapid pediatric data collection system spanning 14 hospital sites with stringent data quality checks. Data have been collated on over 37 000 admission episodes, with considerable improvement in clinical documentation of admissions observed. Using meta-programming techniques in R, coupled with branching logic, randomization, data lookup, and Application Programming Interface (API) features offered by REDCap, CDM tasks were configured and automated to ensure quality data was delivered for clinical improvement and research use. Conclusion A low-cost clinically focused but geographically dispersed quality CDM (Clinical Data Management) in a long-term, multi-site, and real world context can be achieved and sustained and challenges can be overcome through thoughtful design and implementation of open-source tools for handling data and supporting research. PMID:26063746

Multiscale visual quality assessment for cluster analysis with self-organizing maps

NASA Astrophysics Data System (ADS)

Bernard, Jürgen; von Landesberger, Tatiana; Bremm, Sebastian; Schreck, Tobias

2011-01-01

Cluster analysis is an important data mining technique for analyzing large amounts of data, reducing many objects to a limited number of clusters. Cluster visualization techniques aim at supporting the user in better understanding the characteristics and relationships among the found clusters. While promising approaches to visual cluster analysis already exist, these usually fall short of incorporating the quality of the obtained clustering results. However, due to the nature of the clustering process, quality plays an important aspect, as for most practical data sets, typically many different clusterings are possible. Being aware of clustering quality is important to judge the expressiveness of a given cluster visualization, or to adjust the clustering process with refined parameters, among others. In this work, we present an encompassing suite of visual tools for quality assessment of an important visual cluster algorithm, namely, the Self-Organizing Map (SOM) technique. We define, measure, and visualize the notion of SOM cluster quality along a hierarchy of cluster abstractions. The quality abstractions range from simple scalar-valued quality scores up to the structural comparison of a given SOM clustering with output of additional supportive clustering methods. The suite of methods allows the user to assess the SOM quality on the appropriate abstraction level, and arrive at improved clustering results. We implement our tools in an integrated system, apply it on experimental data sets, and show its applicability.

The effectiveness and cost-effectiveness of clinical nurse specialists in outpatient roles: a systematic review.

PubMed

Kilpatrick, Kelley; Kaasalainen, Sharon; Donald, Faith; Reid, Kim; Carter, Nancy; Bryant-Lukosius, Denise; Martin-Misener, Ruth; Harbman, Patricia; Marshall, Deborah Anne; Charbonneau-Smith, Renee; DiCenso, Alba

2014-12-01

Increasing numbers of clinical nurse specialists (CNSs) are working in outpatient settings. The objective of this paper is to describe a systematic review of randomized controlled trials (RCTs) evaluating the cost-effectiveness of CNSs delivering outpatient care in alternative or complementary provider roles. We searched CINAHL, MEDLINE, EMBASE and seven other electronic databases, 1980 to July 2012 and hand-searched bibliographies and key journals. RCTs that evaluated formally trained CNSs and health system outcomes were included. Study quality was assessed using the Cochrane risk of bias tool and the Quality of Health Economic Studies instrument. We used the Grading of Recommendations Assessment, Development and Evaluation to assess quality of evidence for individual outcomes. Eleven RCTs, four evaluating alternative provider (n = 683 participants) and seven evaluating complementary provider roles (n = 1464 participants), were identified. Results of the alternative provider RCTs (low-to-moderate quality evidence) were fairly consistent across study populations with similar patient outcomes to usual care, some evidence of reduced resource use and costs, and two economic analyses (one fair and one high quality) favouring CNS care. Results of the complementary provider RCTs (low-to-moderate quality evidence) were also fairly consistent across study populations with similar or improved patient outcomes and mostly similar health system outcomes when compared with usual care; however, the economic analyses were weak. Low-to-moderate quality evidence supports the effectiveness and two fair-to-high quality economic analyses support the cost-effectiveness of outpatient alternative provider CNSs. Low-to-moderate quality evidence supports the effectiveness of outpatient complementary provider CNSs; however, robust economic evaluations are needed to address cost-effectiveness. © 2014 John Wiley & Sons, Ltd.

Significant improvement of the quality of bystander first aid using an expert system with a mobile multimedia device.

PubMed

Ertl, Lorenz; Christ, Frank

2007-08-01

Better quality bystander first-aid could improve outcome rates for emergency victims significantly. In this case-control study, we hypothesised that expert knowledge presented step-by-step to untrained helpers using a personal digital assistant (PDA), would improve the quality of bystanders basic life support. We confronted 101 lay-helpers with two standard emergency situations. (1) An unconscious trauma victim with severe bleeding. (2) Cardiopulmonary resuscitation (CPR). Performance was assessed using an Objective Structured Clinical Examination (OSCE). One group was supported by a PDA providing visual and audio instructions, whereas the control group acted only with their current knowledge. The expert system was programmed in HTML-code and displayed on the PDA's Internet browser. The maximum score obtainable was 24 points corresponding to optimal treatment. The control group without the PDA reached 14.8+/-3.5 (mean value+/-standard deviation), whereas the PDA supported group scored significantly higher (21.9+/-2.7, p<0.01). The difference in performance was measurable in all criteria tested and particularly notable in the items: placing in recovery position, airway management and quality of CPR. The PDA based expert system increased the performance of untrained helpers supplying emergency care significantly. Since Internet compatible mobile devices have become widely available, a significant quality improvement in bystander first-aid seems possible.

Introducing quality management into primary health care services in Uganda.

PubMed Central

Omaswa, F.; Burnham, G.; Baingana, G.; Mwebesa, H.; Morrow, R.

1997-01-01

In 1994, a national quality assurance programme was established in Uganda to strengthen district-level management of primary health care services. Within 18 months both objective and subjective improvements in the quality of services had been observed. In the examples documented here, there was a major reduction in maternal mortality among pregnant women referred to Jinja District Hospital, a reduction in waiting times and increased patient satisfaction at Masaka District Hospital, and a marked reduction in reported cases of measles in Arua District. Beyond these quantitative improvements, increased morale of district health team members, improved satisfaction among patients, and greater involvement of local government in the decisions of district health committees have been observed. At the central level, the increased coordination of activities has led to new guidelines for financial management and the procurement of supplies. District quality management workshops followed up by regular support visits from the Ministry of Health headquarters have led to a greater understanding by central staff of the issues faced at the district level. The quality assurance programme has also fostered improved coordination among national disease-control programmes. Difficulties encountered at the central level have included delays in carrying out district support visits and the failure to provide appropriate support. At the district level, some health teams tackled problems over which they had little control or which were overly complex; others lacked the management capacity for problem solving. PMID:9185368

SU-D-BRB-02: Combining a Commercial Autoplanning Engine with Database Dose Predictions to Further Improve Plan Quality

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

Robertson, SP; Moore, JA; Hui, X

Purpose: Database dose predictions and a commercial autoplanning engine both improve treatment plan quality in different but complimentary ways. The combination of these planning techniques is hypothesized to further improve plan quality. Methods: Four treatment plans were generated for each of 10 head and neck (HN) and 10 prostate cancer patients, including Plan-A: traditional IMRT optimization using clinically relevant default objectives; Plan-B: traditional IMRT optimization using database dose predictions; Plan-C: autoplanning using default objectives; and Plan-D: autoplanning using database dose predictions. One optimization was used for each planning method. Dose distributions were normalized to 95% of the planning target volumemore » (prostate: 8000 cGy; HN: 7000 cGy). Objectives used in plan optimization and analysis were the larynx (25%, 50%, 90%), left and right parotid glands (50%, 85%), spinal cord (0%, 50%), rectum and bladder (0%, 20%, 50%, 80%), and left and right femoral heads (0%, 70%). Results: All objectives except larynx 25% and 50% resulted in statistically significant differences between plans (Friedman’s χ{sup 2} ≥ 11.2; p ≤ 0.011). Maximum dose to the rectum (Plans A-D: 8328, 8395, 8489, 8537 cGy) and bladder (Plans A-D: 8403, 8448, 8527, 8569 cGy) were significantly increased. All other significant differences reflected a decrease in dose. Plans B-D were significantly different from Plan-A for 3, 17, and 19 objectives, respectively. Plans C-D were also significantly different from Plan-B for 8 and 13 objectives, respectively. In one case (cord 50%), Plan-D provided significantly lower dose than plan C (p = 0.003). Conclusion: Combining database dose predictions with a commercial autoplanning engine resulted in significant plan quality differences for the greatest number of objectives. This translated to plan quality improvements in most cases, although special care may be needed for maximum dose constraints. Further evaluation is warranted in a larger cohort across HN, prostate, and other treatment sites. This work is supported by Philips Radiation Oncology Systems.« less

Orienting health care information systems toward quality: how Group Health Cooperative of Puget Sound did it.

PubMed

Goverman, I L

1994-11-01

Group Health Cooperative of Puget Sound (GHC), a large staff-model health maintenance organization based in Seattle, is redesigning its information systems to provide the systems and information needed to support its quality agenda. Long-range planning for GHC's information resources was done in three phases. In assessment, interviews, surveys, and a benchmarking effort identified strengths and weaknesses of the existing information systems. We concluded that we needed to improve clinical care and patient management systems and enhance health plan applications. In direction setting, we developed six objectives (for example, approach information systems in a way that is consistent with quality improvement principles). Detailed planning was used to define projects, timing, and resource allocations. Some of the most important efforts in the resulting five-year plan include the development of (1) a computerized patient record; (2) a provider-based clinical workstation for access to patient information, order entry, results reporting, guidelines, and reminders; (3) a comprehensive set of patient management and service quality systems; (4) reengineered structures, policies, and processes within the health plan, supported by a complete set of integrated information systems; (5) a standardized, high-capacity communications network to provide linkages both within GHC and among its business partners; and (6) a revised oversight structure for information services, which forms partnerships with users. A quality focus ensured that each project not only produced its own benefits but also supported the larger organizational goals associated with "total" quality.

The quality of health care in prison: results of a year's programme of semistructured inspections.

PubMed Central

Reed, J.; Lyne, M.

1997-01-01

OBJECTIVES: To assess, as part of wider inspections by HM Inspectorate of Prisons, the extent and quality of health care in prisons in England and Wales. DESIGN: Inspections based on a set of "expectations" derived mainly from existing healthcare quality standards published by the prison service and existing ethical guidelines; questionnaire survey of prisoners. SUBJECTS: 19 prisons in England and Wales, 1996-7. MAIN OUTCOME MEASURES: Appraisals of needs assessment and the commissioning and delivery of health care against the inspectorate's expectations. RESULTS: The quality of health care varied greatly. A few prisons provided health care broadly equivalent to NHS care, but in many the health care was of low quality, some doctors were not adequately trained to do the work they faced, and some care failed to meet proper ethical standards. Little professional support was available to healthcare staff. CONCLUSIONS: The current policy for improving health care in prisons is not likely to achieve its objectives and is potentially wasteful. The prison service needs to recognise that expertise in the commissioning and delivery of health care is overwhelming based in the NHS. The current review of the provision of health care in prisons offers an opportunity to ensure that prisoners are not excluded from high quality health care. PMID:9418090

Measuring, managing and maximizing refinery performance

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

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

1996-01-01

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

Relationship between sleep and pain in adolescents with juvenile primary fibromyalgia syndrome.

PubMed

Olsen, Margaret N; Sherry, David D; Boyne, Kathleen; McCue, Rebecca; Gallagher, Paul R; Brooks, Lee J

2013-04-01

To investigate sleep quality in adolescents with juvenile primary fibromyalgia syndrome (JPFS) and determine whether sleep abnormalities, including alpha-delta sleep (ADS), correlate with pain intensity. We hypothesized that successful treatment for pain with exercise therapy would reduce ADS and improve sleep quality. Single-center preintervention and postintervention (mean = 5.7 ± 1.0 weeks; range = 4.0-7.3 weeks) observational study. Ten female adolescents (mean age = 16.2 ± 0.65 SD yr) who met criteria for JPFS and completed treatment. Multidisciplinary pain treatment, including intensive exercise therapy. Pain and disability were measured by a pain visual analog scale (VAS) and the functional disability inventory. Subjective sleep measures included a sleep VAS, an energy VAS, and the School Sleep Habits Survey. Objective sleep measures included actigraphy, polysomnography (PSG), and the Multiple Sleep Latency Test. Baseline PSG was compared with that of healthy age- and sex-matched control patients. At baseline, patients had poorer sleep efficiency, more arousals/awakenings, and more ADS (70.3% of total slow wave sleep [SWS] versus 21.9% SWS, P = 0.002) than controls. ADS was unrelated to pain, disability, or subjective sleep difficulty. After treatment, pain decreased (P = 0.000) and subjective sleep quality improved (P = 0.008). Objective sleep quality, including the amount of ADS, did not change. Although perceived sleep quality improved in adolescents with JPFS after treatment, objective measures did not. Our findings do not suggest exercise therapy for pain improves sleep by reducing ADS, nor do they support causal relationships between ADS and chronic pain or subjective sleep quality.

[Sibling relations between individuation and attachment: attempt at a conceptualization].

PubMed

Seiffge-Krenke, I

2001-01-01

Although sibling relationships can be considered as one of the most durable and intensive relationships, not much research in developmental psychology and family research has been done on this issue. The strong focus on parents, more specifically on mothers, stood in the way of adequate conceptualization and understanding of the function and contribution of siblings to individual development and family interaction. In this contribution a conceptualization of sibling relationships is presented. Siblings as objects of aggressive and sexual feelings as well as the function of siblings in the family system, for example, as parentification and negative identity is emphasized. In addition, the different qualities of sibling relationships, for example, envy, rivalry, similarity, and difference, are emphasized. The function of siblings as love objects is stressed, and the role of siblings as support as well as teaching object is illustrated. Finally, it is emphasized that, similar to relationships between parents and child, the quality of sibling relationships changed over time and leads, for example, to a detachment between sibling relationships during adolescence.

The management service company's expectation of the customer.

PubMed

Kuykendall, R D

1992-02-01

The one constant factor in health care today is change. Choose your management support company carefully, expect high quality results, and communicate both positive and negative feedback immediately. This formula will give you excellent results as well as a long-term productive partnership in which cost, risk, and the end objectives can be balanced for maximum benefit.

Professional Development Needs for Educators Working with Children with Autism Spectrum Disorders in Inclusive School Environments

ERIC Educational Resources Information Center

Corkum, Penny; Bryson, Susan E.; Smith, Isabel M.; Giffen, Cynthia; Hume, Kym; Power, Ann

2014-01-01

The primary objective of this mixed methods study was to identify educators' professional development needs to determine how best to support them in providing quality programming for children with Autism Spectrum Disorders (ASD) within an inclusive educational system. Information was collected through focus groups with key school board informants…

Crane Cell Testing Support of Nasa/goddard Space Flight Center: an Update

NASA Technical Reports Server (NTRS)

Strawn, Mike; David, Jerry; Rao, Gopalakrishna M.

2001-01-01

The objective of this paper is to verify the quality and reliability of aerospace battery cells and batteries for NASA flight programs, disseminate the data - to develop a plan for in-orbit battery management - to design a cell/battery for future NASA spacecraft and establish a cell test data base for rechargeable cell/batteries.

Pathways to Change: Improving the Quality of Education in Developing Countries. World Bank Discussion Papers 53.

ERIC Educational Resources Information Center

Verspoor, Adriaan

A review of 21 educational change programs supported by 42 World Bank-assisted projects found that the most successful programs have a different profile than the less successful programs. The former aimed at comprehensive change, encompassing a wide range of objectives including administrative and management training and the provision of…

Characterizing the Breadth and Depth of Volunteer Water Monitoring Programs in the United States.

PubMed

Stepenuck, Kristine F; Genskow, Kenneth D

2018-01-01

A survey of 345 volunteer water monitoring programs in the United States was conducted to document their characteristics, and perceived level of support for data to inform natural resource management or policy decisions. The response rate of 86% provided information from 46 states. Programs represented a range of ages, budgets, objectives, scopes, and level of quality assurance, which influenced data uses and perceived support by sponsoring agency administrators and external decision makers. Most programs focused on rivers, streams, and lakes. Programs had not made substantial progress to develop EPA or state-approved quality assurance plans since 1998, with only 48% reporting such plans. Program coordinators reported feeling slightly more support for data to be used for management as compared to policy decisions. Programs with smaller budgets may be at particular risk of being perceived to lack credibility due to failure to develop quality assurance plans. Over half of programs identified as collaborative, in that volunteers assisted scientists in program design, data analysis and/or dissemination of results. Just under a third were contributory, in which volunteers primarily collected data in a scientist-defined program. Recommendations to improve perceived data credibility, and to augment limited budgets include developing quality assurance plans and gaining agency approval, and developing partnerships with other organizations conducting monitoring in the area to share resources and knowledge. Funding agencies should support development of quality assurance plans to help ensure data credibility. Service providers can aid in plan development by providing training to program staff over time to address high staff turnover rates.

Characterizing the Breadth and Depth of Volunteer Water Monitoring Programs in the United States

NASA Astrophysics Data System (ADS)

Stepenuck, Kristine F.; Genskow, Kenneth D.

2018-01-01

A survey of 345 volunteer water monitoring programs in the United States was conducted to document their characteristics, and perceived level of support for data to inform natural resource management or policy decisions. The response rate of 86% provided information from 46 states. Programs represented a range of ages, budgets, objectives, scopes, and level of quality assurance, which influenced data uses and perceived support by sponsoring agency administrators and external decision makers. Most programs focused on rivers, streams, and lakes. Programs had not made substantial progress to develop EPA or state-approved quality assurance plans since 1998, with only 48% reporting such plans. Program coordinators reported feeling slightly more support for data to be used for management as compared to policy decisions. Programs with smaller budgets may be at particular risk of being perceived to lack credibility due to failure to develop quality assurance plans. Over half of programs identified as collaborative, in that volunteers assisted scientists in program design, data analysis and/or dissemination of results. Just under a third were contributory, in which volunteers primarily collected data in a scientist-defined program. Recommendations to improve perceived data credibility, and to augment limited budgets include developing quality assurance plans and gaining agency approval, and developing partnerships with other organizations conducting monitoring in the area to share resources and knowledge. Funding agencies should support development of quality assurance plans to help ensure data credibility. Service providers can aid in plan development by providing training to program staff over time to address high staff turnover rates.

Health-Related Quality of Life in Bereaved HIV-Positive Adults: Relationships between HIV Symptoms, Grief, Social Support, and Axis II Indication

PubMed Central

Hansen, Nathan B.; Vaughan, Ellen L.; Cavanaugh, Courtenay E.; Connell, Christian M.; Sikkema, Kathleen J.

2008-01-01

Objective This study evaluated a model of the impact of borderline and antisocial personality disorder indications on HIV symptoms and health-related quality of life (HRQoL) in AIDS-bereaved adults, accounting for grief severity, social support and years since HIV diagnosis. Design Structural Equation modeling was used to test the proposed model in a sample of 268 HIV-seropositive adults enrolled in an intervention for coping with AIDS-related bereavement. Main Outcome Measures Functional Assessment of HIV Infection, HIV symptoms. Results The proposed model demonstrated excellent fit with study data and all hypothesized paths were supported. Personality disorder indication was directly related to HIV symptoms and HRQoL, and indirectly related through both social support and grief severity. Social support was negatively related to HIV symptoms and positively related to HRQoL, while grief severity was positively related to HIV symptoms and negatively related to HRQoL. Finally, HIV symptoms had a direct negative relationship with HRQoL. Conclusion Personality disorders have a direct negative effect on HIV symptoms and HRQoL, and indirect effects through grief severity and social support. PMID:19290717

Public emergency department: the psychosocial impact on the physical domain of quality of life of nursing professionals

PubMed Central

Kogien, Moisés; Cedaro, José Juliano

2014-01-01

Objectives to determine the psychosocial factors of work related to harm caused in the physical domain of the quality of life of nursing professionals working in a public emergency department. Method cross-sectional, descriptive study addressing 189 nursing professionals. The Job Stress Scale and the short version of an instrument from the World Health Organization to assess quality of life were used to collect data. Robert Karasek's Demand-Control Model was the reference for the analysis of the psychosocial configuration. The risk for damage was computed with a confidence interval of 95%. Results In regard to the psychosocial environment, the largest proportion of workers reported low psychological demands (66.1%) and low social support (52.4%), while 60.9% of the professionals experienced work situations with a greater potential for harm: high demand job (22.8%) and passive work (38.1%). Conclusions low intellectual discernment, low social support and experiencing a high demand job or a passive job were the main risk factors for damage in the physical domain of quality of life. PMID:24553703

BRIEF REPORT: Nutrition and Weight Loss Information in a Popular Diet Book: Is It Fact, Fiction, or Something in Between?

PubMed Central

Goff, Sarah L; Foody, Joanne M; Inzucchi, Silvio; Katz, David; Mayne, Susan T; Krumholz, Harlan M

2006-01-01

BACKGROUND/OBJECTIVE Diet books dominate the New York Times Advice Best Seller list and consumers cite such books as an important source of nutrition information. However, the scientific support for nutrition claims presented as fact (nutrition facts) in diet books is not known. DESIGN/MEASUREMENTS We assessed the quality of nutrition facts in the best-selling South Beach Diet using support in peer-reviewed literature as a measure of quality. We performed structured literature searches on nutrition facts located in the books' text, and then assigned each fact to 1 of 4 categories (1) fact supported, (2) fact not supported, (3) fact both supported and not supported, and (4) no related papers. A panel of expert reviewers adjudicated the findings. RESULTS Forty-two nutrition facts were included. Fourteen (33%) facts were supported, 7 (17%) were not supported, 18 (43%) were both supported and not supported, and 3 (7%) had no related papers, including the fact that the diet had been “scientifically studied and proven effective.” CONCLUSIONS Consumers obtain nutrition information from diet books. We found that over 67% of nutrition facts in a best-seller diet book may not be supported in the peer-reviewed literature. These findings have important implications for educating consumers about nutrition information sources. PMID:16808780

Distributed sensor architecture for intelligent control that supports quality of control and quality of service.

PubMed

Poza-Lujan, Jose-Luis; Posadas-Yagüe, Juan-Luis; Simó-Ten, José-Enrique; Simarro, Raúl; Benet, Ginés

2015-02-25

This paper is part of a study of intelligent architectures for distributed control and communications systems. The study focuses on optimizing control systems by evaluating the performance of middleware through quality of service (QoS) parameters and the optimization of control using Quality of Control (QoC) parameters. The main aim of this work is to study, design, develop, and evaluate a distributed control architecture based on the Data-Distribution Service for Real-Time Systems (DDS) communication standard as proposed by the Object Management Group (OMG). As a result of the study, an architecture called Frame-Sensor-Adapter to Control (FSACtrl) has been developed. FSACtrl provides a model to implement an intelligent distributed Event-Based Control (EBC) system with support to measure QoS and QoC parameters. The novelty consists of using, simultaneously, the measured QoS and QoC parameters to make decisions about the control action with a new method called Event Based Quality Integral Cycle. To validate the architecture, the first five Braitenberg vehicles have been implemented using the FSACtrl architecture. The experimental outcomes, demonstrate the convenience of using jointly QoS and QoC parameters in distributed control systems.

Distributed Sensor Architecture for Intelligent Control that Supports Quality of Control and Quality of Service

PubMed Central

Poza-Lujan, Jose-Luis; Posadas-Yagüe, Juan-Luis; Simó-Ten, José-Enrique; Simarro, Raúl; Benet, Ginés

2015-01-01

This paper is part of a study of intelligent architectures for distributed control and communications systems. The study focuses on optimizing control systems by evaluating the performance of middleware through quality of service (QoS) parameters and the optimization of control using Quality of Control (QoC) parameters. The main aim of this work is to study, design, develop, and evaluate a distributed control architecture based on the Data-Distribution Service for Real-Time Systems (DDS) communication standard as proposed by the Object Management Group (OMG). As a result of the study, an architecture called Frame-Sensor-Adapter to Control (FSACtrl) has been developed. FSACtrl provides a model to implement an intelligent distributed Event-Based Control (EBC) system with support to measure QoS and QoC parameters. The novelty consists of using, simultaneously, the measured QoS and QoC parameters to make decisions about the control action with a new method called Event Based Quality Integral Cycle. To validate the architecture, the first five Braitenberg vehicles have been implemented using the FSACtrl architecture. The experimental outcomes, demonstrate the convenience of using jointly QoS and QoC parameters in distributed control systems. PMID:25723145

SME Worker Affective (SWA) index based on environmental ergonomics

NASA Astrophysics Data System (ADS)

Ushada, M.; Kusuma Aji, G.; Okayama, T.; Khidir, M.

2018-04-01

Small-Medium sized (SME) is a focal type of Indonesian industry which contributes to national emerging economies. Indonesian goverment has developed employee social security system (BPJS Ketenagakerjaan) to support worker quality of life. However, there were limited research which could assist BPJS Ketenagakerjaan in evaluating worker quality of life. Worker quality of life could be categorized as the highest worker needs or affective states. SME Worker Affective (SWA) index is being concerned as a basic tool to make balance between worker performance and quality of life in workstation of SMEs. The research objectives are: 1) To optimize the environmental ergonomics in SMEs; 2) To quantify SME Worker Affective (SWA) index based on optimized environmental ergonomics. The research advantage is to support Indonesian goverment in monitoring SMEs good practices to its worker quality of life. Simulated annealing optimized the heart rate and environmental ergonomics parameters. SWA index was determined based on comparison between optimized heart rate and environmental ergonomics parameters. SWA index were quantified for 380 data of worker. The evaluation indicated 51.3% worker in affective and 48.7% in non-affective condition. Research results indicated that stakeholders of SMEs should put more attention on environmental ergonomics and worker affective.

Marital Quality and Negative Experienced Well-Being: An Assessment of Actor and Partner Effects Among Older Married Persons

PubMed Central

Cornman, Jennifer C.; Freedman, Vicki A.

2016-01-01

Objectives. We evaluate (a) associations between marital quality (emotional support, strain, and overall appraisal) and three negative aspects of experienced well-being (frustration, sadness, and worry) among older husbands and wives and (b) the relative importance of own versus spouse’s marital quality assessments for understanding experienced well-being in later life. Method. Data are from the 2009 Disability and Use of Time daily diary supplement to the Panel Study of Income Dynamics (N = 722). We estimate actor–partner interdependence models, using seemingly unrelated regression. Results. Own reports of marital strain are associated with own frustration, sadness, and worry among wives and are associated with frustration only among husbands. Own reports of marital support are associated with negative emotion among husbands only: higher levels of marital support are associated with less worry. Results from partner effects analyses also are mixed. Husbands’ reports of marital strain are associated with wives’ elevated frustration levels, whereas wives’ reports of greater marital support are associated with their husbands’ higher frustration levels. Discussion. One’s own and spouse’s marital appraisals play a complex role in shaping negative emotions among older adults. Findings suggest that frustration is a particularly complex emotion and a promising area for further study among older married couples. PMID:26329115

How women perceive abortion care: A study focusing on healthy women and those with mental and posttraumatic stress.

PubMed

Wallin Lundell, Inger; Öhman, Susanne Georgsson; Sundström Poromaa, Inger; Högberg, Ulf; Sydsjö, Gunilla; Skoog Svanberg, Agneta

2015-06-01

Objectives To identify perceived deficiencies in the quality of abortion care among healthy women and those with mental stress. Methods This multi-centre cohort study included six obstetrics and gynaecology departments in Sweden. Posttraumatic stress (PTSD/PTSS) was assessed using the Screen Questionnaire-Posttraumatic Stress Disorder; anxiety and depressive symptoms, using the Hospital Anxiety Depression Scale; and abortion quality perceptions, using a modified version of the Quality from the Patient's Perspective questionnaire. Pain during medical abortion was assessed in a subsample using a visual analogue scale. Results Overall, 16% of the participants assessed the abortion care as being deficient, and 22% experienced intense pain during medical abortion. Women with PTSD/PTSS more often perceived the abortion care as deficient overall and differed from healthy women in reports of deficiencies in support, respectful treatment, opportunities for privacy and rest, and availability of support from a significant person during the procedure. There was a marginally significant difference between PTSD/PTSS and the comparison group for insufficient pain alleviation. Conclusions Women with PTSD/PTSS perceived abortion care to be deficient more often than did healthy women. These women do require extra support, relatively simple efforts to provide adequate pain alleviation, support and privacy during abortion may improve abortion care.

Telemedicine-based system for quality management and peer review in radiology.

PubMed

Morozov, Sergey; Guseva, Ekaterina; Ledikhova, Natalya; Vladzymyrskyy, Anton; Safronov, Dmitry

2018-06-01

Quality assurance is the key component of modern radiology. A telemedicine-based quality assurance system helps to overcome the "scoring" approach and makes the quality control more accessible and objective. A concept for quality assurance in radiology is developed. Its realization is a set of strategies, actions, and tools. The latter is based on telemedicine-based peer review of 23,199 computed tomography (CT) and magnetic resonance imaging (MRI) images. The conception of the system for quality management in radiology represents a chain of actions: "discrepancies evaluation - routine support - quality improvement activity - discrepancies evaluation". It is realized by an audit methodology, telemedicine, elearning, and other technologies. After a year of systemic telemedicine-based peer reviews, the authors have estimated that clinically significant discrepancies were detected in 6% of all cases, while clinically insignificant ones were found in 19% of cases. Most often, problems appear in musculoskeletal records; 80% of the examinations have diagnostic or technical imperfections. The presence of routine telemedicine support and personalized elearning allowed improving the diagnostics quality. The level of discrepancies has decreased significantly (p < 0.05). The telemedicine-based peer review system allows improving radiology departments' network effectiveness. • "Scoring" approach to radiologists' performance assessment must be changed. • Telemedicine peer review and personalized elearning significantly decrease the number of discrepancies. • Teleradiology allows linking all primary-level hospitals to a common peer review network.

Young Adults With Type 1 Diabetes: Romantic Relationships and Implications for Well-Being

PubMed Central

2017-01-01

Objective. The study goal was to examine whether young adults with type 1 diabetes involve romantic partners in their illness, and, if so, how their involvement is related to relationship quality and psychological well-being. Methods. A total of 68 people (mean age 25.5 years, [SD 3.7 years]) with type 1 diabetes (mean diabetes duration 6 years, [SD 6.7]) involved in a romantic relationship (mean relationship duration 25 months, [SD 27 months]) completed phone interviews. Communal coping (shared illness appraisal and collaborative problem-solving), partner supportive and unsupportive behavior, relationship quality, and psychological well-being were assessed with standardized measures. The study was partly descriptive in identifying the extent of communal coping and specific supportive and unsupportive behaviors and partly correlational in connecting communal coping and supportive or unsupportive behaviors to relationship quality and psychological well-being. Results. Descriptive findings showed that partners were somewhat involved in diabetes, but communal coping was less common compared to other chronically ill populations. The most common partner supportive behaviors were emotional and instrumental support. The most common partner unsupportive behavior was worry about diabetes. Correlational results showed that communal coping was related to greater partner emotional and instrumental support, but also to greater partner overprotective and controlling behaviors (P <0.01 for all). Communal coping was unrelated to relationship quality or psychological distress. Partner overinvolvement in diabetes management had a mixed relation to outcomes, whereas partner underinvolvement was uniformly related to poor outcomes. Conclusion. People with type 1 diabetes may benefit from increased partner involvement in illness. This could be facilitated by health care professionals. PMID:28588377

Validity evidence as a key marker of quality of technical skill assessment in OTL-HNS.

PubMed

Labbé, Mathilde; Young, Meredith; Nguyen, Lily H P

2018-01-13

Quality monitoring of assessment practices should be a priority in all residency programs. Validity evidence is one of the main hallmarks of assessment quality and should be collected to support the interpretation and use of assessment data. Our objective was to identify, synthesize, and present the validity evidence reported supporting different technical skill assessment tools in otolaryngology-head and neck surgery (OTL-HNS). We performed a secondary analysis of data generated through a systematic review of all published tools for assessing technical skills in OTL-HNS (n = 16). For each tool, we coded validity evidence according to the five types of evidence described by the American Educational Research Association's interpretation of Messick's validity framework. Descriptive statistical analyses were conducted. All 16 tools included in our analysis were supported by internal structure and relationship to variables validity evidence. Eleven articles presented evidence supporting content. Response process was discussed only in one article, and no study reported on evidence exploring consequences. We present the validity evidence reported for 16 rater-based tools that could be used for work-based assessment of OTL-HNS residents in the operating room. The articles included in our review were consistently deficient in evidence for response process and consequences. Rater-based assessment tools that support high-stakes decisions that impact the learner and programs should include several sources of validity evidence. Thus, use of any assessment should be done with careful consideration of the context-specific validity evidence supporting score interpretation, and we encourage deliberate continual assessment quality-monitoring. NA. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

Data Quality Objectives for Tank Farms Waste Compatibility Program

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

BANNING, D.L.

1999-07-02

There are 177 waste storage tanks containing over 210,000 m{sup 3} (55 million gal) of mixed waste at the Hanford Site. The River Protection Project (RPP) has adopted the data quality objective (DQO) process used by the U.S. Environmental Protection Agency (EPA) (EPA 1994a) and implemented by RPP internal procedure (Banning 1999a) to identify the information and data needed to address safety issues. This DQO document is based on several documents that provide the technical basis for inputs and decision/action levels used to develop the decision rules that evaluate the transfer of wastes. A number of these documents are presentlymore » in the process of being revised. This document will need to be revised if there are changes to the technical criteria in these supporting documents. This DQO process supports various documents, such as sampling and analysis plans and double-shell tank (DST) waste analysis plans. This document identifies the type, quality, and quantity of data needed to determine whether transfer of supernatant can be performed safely. The requirements in this document are designed to prevent the mixing of incompatible waste as defined in Washington Administrative Code (WAC) 173-303-040. Waste transfers which meet the requirements contained in this document and the Double-Shell Tank Waste Analysis Plan (Mulkey 1998) are considered to be compatible, and prevent the mixing of incompatible waste.« less

Needs Assessment for the Use of NASA Remote Sensing Data in the Development and Implementation of Estuarine and Coastal Water Quality Standards

NASA Technical Reports Server (NTRS)

Spiering, Bruce; Underwood, Lauren; Ellis, Chris; Lehrter, John; Hagy, Jim; Schaeffer, Blake

2010-01-01

The goals of the project are to provide information from satellite remote sensing to support numeric nutrient criteria development and to determine data processing methods and data quality requirements to support nutrient criteria development and implementation. The approach is to identify water quality indicators that are used by decision makers to assess water quality and that are related to optical properties of the water; to develop remotely sensed data products based on algorithms relating remote sensing imagery to field-based observations of indicator values; to develop methods to assess estuarine water quality, including trends, spatial and temporal variability, and seasonality; and to develop tools to assist in the development and implementation of estuarine and coastal nutrient criteria. Additional slides present process, criteria development, typical data sources and analyses for criteria process, the power of remote sensing data for the process, examples from Pensacola Bay, spatial and temporal variability, pixel matchups, remote sensing validation, remote sensing in coastal waters, requirements for remotely sensed data products, and needs assessment. An additional presentation examines group engagement and information collection. Topics include needs assessment purpose and objectives, understanding water quality decision making, determining information requirements, and next steps.

Project Quality Assurance Plan for research and development services provided by Oak Ridge National Laboratory in support of the Westinghouse Materials Company of Ohio Operable Unit 1 Stabilization Development and Treatability Studies Program

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

Gilliam, T.M.

1991-05-01

This Project Quality Assurance Plan (PQAP) sets forth the quality assurance (QA) requirements that are applied to those elements of the Westinghouse Materials Company of Ohio (WMCO) Operable Unit 1 support at Oak Ridge National Laboratory (ORNL) project that involve research and development (R D) performed at ORNL. This is in compliance with the applicable criteria of 10 CFR Part 50, Appendix B, ANSI/ASME NQA-1, as specified by Department of Energy (DOE) Oak Ridge Operations (ORO) Order 5700.6B. For this application, NQA-1 is the core QA Program requirements document. QA policy, normally found in the requirements document, is contained herein.more » The requirements of this PQAP apply to project activities that affect the quality and reliability/credibility of research, development, and investigative data and documentation. These activities include the functions of attaining quality objectives and assuring that an appropriate QA program scope is established. The scope of activities affecting quality includes organization; personnel training and qualifications; design control; procurement; material handling and storage; operating procedures; testing, surveillance, and auditing; R D investigative activities and documentation; deficiencies; corrective actions; and QA record keeping. 12 figs.« less

The emergence of family medicine in Kyrgyzstan.

PubMed

Hardison, Charles; Fonken, Paul; Chew, Tom; Smith, Barton

2007-10-01

In post-Soviet Central Asia, Kyrgyzstan has emerged as the leader in family medicine reform. This paper examines the factors that have allowed family medicine to become the foundation of primary care and the rationale for retraining specialists in primary care. Critical elements of successful family medicine reform have included national policy, international cooperation, training programs, support structures, and quality measures. The national policy has contributed to an environment that has allowed many international organizations to participate in the process of reforming the health care system. The 9-year training process was a momentous nationwide development task that was supported by various structures, organizations, and events and included the implementation of quality measures. Various reports, studies, and evaluations support the positive impact family medicine has had on patient satisfaction, physician attitude, and scope of practice. Further, one study indicates improved health outcomes in terms of decreased years of potential life lost. The national policy of reform that is in favor of family medicine, and international donor agencies-supported training, produced the following results: a group of family medicine teachers, 98% (2,691) of the country's primary care doctors retrained in family medicine, and there were 372 family medicine resident graduates. To ensure quality, objective structured clinical exams were implemented in all levels of training. It will take many more years to fully establish family medicine in the medical culture of Kyrgyzstan and reap its full benefits, but already it is contributing toward improvements in the quality of patient care.

Navigating change: how outreach facilitators can help clinicians improve patient outcomes.

PubMed

Laferriere, Dianne; Liddy, Clare; Nash, Kate; Hogg, William

2012-01-01

The objective of this study was to describe outreach facilitation as an effective method of assisting and supporting primary care practices to improve processes and delivery of care. We spent 4 years working with 83 practices in Eastern Ontario, Canada, on the Improved Delivery of Cardiovascular Care through the Outreach Facilitation program. Primary care practices, even if highly motivated, face multiple challenges when providing quality patient care. Outreach facilitation can be an effective method of assisting and supporting practices to make the changes necessary to improve processes and delivery of care. Multiple jurisdictions use outreach facilitation for system redesign, improved efficiencies, and advanced access. The development and implementation of quality improvement programs using practice facilitation can be challenging. Our research team has learned valuable lessons in developing tools, finding resources, and assisting practices to reach their quality improvement goals. These lessons can lead to improved experiences for the practices and overall improved outcomes for the patients they serve.

Feasibility of Extracting Key Elements from ClinicalTrials.gov to Support Clinicians’ Patient Care Decisions

PubMed Central

Kim, Heejun; Bian, Jiantao; Mostafa, Javed; Jonnalagadda, Siddhartha; Del Fiol, Guilherme

2016-01-01

Motivation: Clinicians need up-to-date evidence from high quality clinical trials to support clinical decisions. However, applying evidence from the primary literature requires significant effort. Objective: To examine the feasibility of automatically extracting key clinical trial information from ClinicalTrials.gov. Methods: We assessed the coverage of ClinicalTrials.gov for high quality clinical studies that are indexed in PubMed. Using 140 random ClinicalTrials.gov records, we developed and tested rules for the automatic extraction of key information. Results: The rate of high quality clinical trial registration in ClinicalTrials.gov increased from 0.2% in 2005 to 17% in 2015. Trials reporting results increased from 3% in 2005 to 19% in 2015. The accuracy of the automatic extraction algorithm for 10 trial attributes was 90% on average. Future research is needed to improve the algorithm accuracy and to design information displays to optimally present trial information to clinicians. PMID:28269867

Sources of social support associated with health and quality of life: a cross-sectional study among Canadian and Latin American older adults

PubMed Central

Bélanger, Emmanuelle; Ahmed, Tamer; Vafaei, Afshin; Curcio, Carmen Lucia; Phillips, Susan P; Zunzunegui, Maria Victoria

2016-01-01

Objectives To examine whether the association between emotional support and indicators of health and quality of life differs between Canadian and Latin American older adults. Design Cross-sectional analysis of the International Mobility in Aging Study (IMIAS). Social support from friends, family members, children and partner was measured with a previously validated social network and support scale (IMIAS-SNSS). Low social support was defined as ranking in the lowest site-specific quartile. Prevalence ratios (PR) of good health, depression and good quality of life were estimated with Poisson regression models, adjusting for age, gender, education, income and disability in activities of daily living. Setting Kingston and Saint-Hyacinthe in Canada, Manizales in Colombia and Natal in Brazil. Participants 1600 community-dwelling adults aged 65–74 years, n=400 at each site. Outcome measures Likert scale question on self-rated health, Center for Epidemiological Studies Depression Scale and 10-point analogical quality-of-life (QoL) scale. Results Relationships between social support and study outcomes differed between Canadian and Latin American older adults. Among Canadians, those without a partner had a lower prevalence of good health (PR=0.90; 95% CI 0.82 to 0.98), and those with high support from friends had a higher prevalence of good health (PR=1.09; 95% CI 1.01 to 1.18). Among Latin Americans, depression was lower among those with high levels of support from family (PR=0.63; 95% CI 0.48 to 0.83), children (PR=0.60; 95% CI 0.45 to 0.80) and partner (PR=0.57; 95% CI 0.31 to 0.77); good QoL was associated with high levels of support from children (PR=1.54; 95% CI 1.20 to 1.99) and partner (PR=1.31; 95% CI 1.03 to 1.67). Conclusions Among older adults, different sources of support were relevant to health across societies. Support from friends and having a partner were related to good health in Canada, whereas in Latin America, support from family, children and partner were associated with less depression and better QoL. PMID:27354077

Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses

PubMed Central

Krömker, Dörthe; Meguerditchian, Ari N; Tamblyn, Robyn

2016-01-01

Background Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. Objective The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Methods Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Results Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than others. Integration of content control improved quality of decision making (SMD 0.59 vs 0.23 for knowledge; SMD 0.39 vs 0.29 for decisional conflict). In contrast, tailoring reduced quality of decision making (SMD 0.40 vs 0.71 for knowledge; SMD 0.25 vs 0.52 for decisional conflict). Similarly, patient narratives also reduced quality of decision making (SMD 0.43 vs 0.65 for knowledge; SMD 0.17 vs 0.46 for decisional conflict). Results were varied for different types of explicit values clarification, feedback, and social support. Conclusions Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making. However, this is an emerging field with limited evidence to guide use. The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids, in an effort to facilitate reporting of these features and to promote integration of such features into decision aids. The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids. Further research can focus on clarifying independent contributions of specific features through experimental designs and refining the designs of features to improve effectiveness. PMID:26813512

Associations between Stress and Quality of Life: Differences between Owners Keeping a Living Dog or Losing a Dog by Euthanasia

PubMed Central

Tzivian, Lilian

2015-01-01

Objectives The loss of a pet may be stressful to the owner. The main objectives of this study were to compare the levels of stress and to explore the correlates of QOL of healthy adults who currently own or who have just lost their dog. Methods The study sample contained 110 current, and 103 bereaved dog owners, all females, who lost their dogs due to euthanasia. QOL was assessed with the WHOQOL-BREF questionnaire and divided into four major domains–Physical, Psychological, Relationship, and Environmental. Demographic variables, stress, health behaviors, and social support from family, friends, and significant other were included in multivariate analysis. Results Stress levels were significantly higher in bereaved owners. QOL in three of the four domains (Physical, Psychological, and Relationship) of current owners were significantly better than among bereaved owners. Stress was significantly associated with these three domains of QOL. Quality of life was found to be positively associated with social support. Age was related directly only to current owners’ QOL. Conclusions The results suggest that a loss of a dog is associated with stress for the bereaved owner and reduced physical, psychological, and relationship QOL. Lack of social support in the case of death of a companion animal has a strong effect on owners’ grief reactions. PMID:25826295

Canadian Association of Gastroenterology consensus guidelines on safety and quality indicators in endoscopy

PubMed Central

Armstrong, David; Barkun, Alan; Bridges, Ron; Carter, Rose; de Gara, Chris; Dubé, Catherine; Enns, Robert; Hollingworth, Roger; MacIntosh, Donald; Borgaonkar, Mark; Forget, Sylviane; Leontiadis, Grigorios; Meddings, Jonathan; Cotton, Peter; Kuipers, Ernst J; Valori, Roland

2012-01-01

BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy. OBJECTIVE: To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery. METHODS: A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants. RESULTS: Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified. DISCUSSION: The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services. CONCLUSIONS: The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy. PMID:22308578

The cost-effectiveness of supported employment for adults with autism in the United Kingdom

PubMed Central

Megnin-Viggars, Odette; Cheema, Nadir; Howlin, Patricia; Baron-Cohen, Simon; Pilling, Stephen

2014-01-01

Adults with autism face high rates of unemployment. Supported employment enables individuals with autism to secure and maintain a paid job in a regular work environment. The objective of this study was to assess the cost-effectiveness of supported employment compared with standard care (day services) for adults with autism in the United Kingdom. Thus, a decision-analytic economic model was developed, which used outcome data from the only trial that has evaluated supported employment for adults with autism in the United Kingdom. The main analysis considered intervention costs, while cost-savings associated with changes in accommodation status and National Health Service and personal social service resource use were examined in secondary analyses. Two outcome measures were used: the number of weeks in employment and the quality-adjusted life year. Supported employment resulted in better outcomes compared with standard care, at an extra cost of £18 per additional week in employment or £5600 per quality-adjusted life year. In secondary analyses that incorporated potential cost-savings, supported employment dominated standard care (i.e. it produced better outcomes at a lower total cost). The analysis suggests that supported employment schemes for adults with autism in the United Kingdom are cost-effective compared with standard care. Further research needs to confirm these findings. PMID:24126866

Objectively Assessed Exercise Behavior in Chinese Patients with Early-Stage Cancer: A Predictor of Perceived Benefits, Communication with Doctors, Medical Coping Modes, Depression and Quality of Life.

PubMed

Liu, Zhunzhun; Zhang, Lanfeng; Shi, Songsong; Xia, Wenkai

2017-01-01

This study sought to identify factors associated with objectively assessed exercise behavior in Chinese patients with early-stage cancer. Three hundred and fifty one cancer patients were recruited from the Affiliated Jiangyin Hospital of Southeast University Medical College and the Nantong Tumor Hospital. One-way ANOVA, Pearson Chi-square tests and regression analysis were employed to identify the correlations between physical exercise and the measured factors. The results showed that occupation type (χ2 = 14.065; p = 0.029), monthly individual monthly income level (χ2 = 24.795; p = 0.003), BMI (χ2 = 15.709; p = 0.015) and diagnosis (χ2 = 42.442; p < 0.000) were significantly correlated with the subjects self-reported exercise with different frequency per week. Differences in the frequency of exercise were associated with different degrees of reported Benefit Finding (BF) (F = 24.651; p < 0.000), communication with doctors (F = 15.285; p < 0.000), medical coping modes (F = 45.912; p < 0.000), social support (F = 2.938; p = 0.030), depression (F = 6.017; p < 0.000), and quality of life (F = 12.288; p < 0.000). Multiple regression analysis showed that 1.6%-6.4% of the variance in five variables, excluding social support and optimism could be explained by exercise. Our results indicated that benefit finding, medical coping modes, communication with doctors, social support, depression and quality of life were significantly correlated with exercise. The variance in several psychosocial factors (benefit finding, medical coping modes, the communication with doctors, depression and quality of life) could be explained by exercise. Psychosocial factors should be addressed and examined over time when evaluating the effect of physical exercise that is prescribed as a clinically relevant treatment.

How do aggregated patient-reported outcome measures data stimulate health care improvement? A realist synthesis

PubMed Central

Dalkin, Sonia; Gibbons, Elizabeth; Wright, Judy; Valderas, Jose Maria; Meads, David; Black, Nick

2017-01-01

Objectives Internationally, there has been considerable debate about the role of data in supporting quality improvement in health care. Our objective was to understand how, why and in what circumstances the feedback of aggregated patient-reported outcome measures data improved patient care. Methods We conducted a realist synthesis. We identified three main programme theories underlying the use of patient-reported outcome measures as a quality improvement strategy and expressed them as nine ‘if then’ propositions. We identified international evidence to test these propositions through searches of electronic databases and citation tracking, and supplemented our synthesis with evidence from similar forms of performance data. We synthesized this evidence through comparing the mechanisms and impact of patient-reported outcome measures and other performance data on quality improvement in different contexts. Results Three programme theories were identified: supporting patient choice, improving accountability and enabling providers to compare their performance with others. Relevant contextual factors were extent of public disclosure, use of financial incentives, perceived credibility of the data and the practicality of the results. Available evidence suggests that patients or their agents rarely use any published performance data when selecting a provider. The perceived motivation behind public reporting is an important determinant of how providers respond. When clinicians perceived that performance indicators were not credible but were incentivized to collect them, gaming or manipulation of data occurred. Outcome data do not provide information on the cause of poor care: providers needed to integrate and interpret patient-reported outcome measures and other outcome data in the context of other data. Lack of timeliness of performance data constrains their impact. Conclusions Although there is only limited research evidence to support some widely held theories of how aggregated patient-reported outcome measures data stimulate quality improvement, several lessons emerge from interventions sharing the same programme theories to help guide the increasing use of these measures. PMID:29260592

The environment of professional practice and Burnout in nurses in primary healthcare

PubMed Central

Lorenz, Vera Regina; Guirardello, Edinêis de Brito

2014-01-01

OBJECTIVES: to assess how nurses perceive autonomy, control over the environment, the professional relationship between nurses and physicians and the organizational support and correlate them with burnout, satisfaction at work, quality of work and the intention to quit work in primary healthcare. METHOD: cross-sectional and correlation study, using a sample of 198 nurses. The tools used were the Nursing Work Index Revised, Maslach Burnout Inventory and a form to characterize the nurses. To analyze the data, descriptive statistics were applied and Spearman's correlation coefficient was used. RESULTS: the nurses assessed that the environment is partially favorable for: autonomy, professional relationship and organizational support and that the control over this environment is limited. Significant correlations were evidenced between the Nursing Work Index Revised, Maslach Burnout Inventory and the variables: satisfaction at work, quality of care and the intent to quit the job. CONCLUSION: the nurses' perceptions regarding the environment of practice are correlated with burnout, satisfaction at work, quality of care and the intent to quit the job. This study provides support for the restructuring of work processes in the primary health care environment and for communication among the health service management, human resources and occupational health areas. PMID:25517928

A Conceptual Analytics Model for an Outcome-Driven Quality Management Framework as Part of Professional Healthcare Education

PubMed Central

Loe, Alan; Barman, Linda; O'Donoghue, John; Zary, Nabil

2015-01-01

Background Preparing the future health care professional workforce in a changing world is a significant undertaking. Educators and other decision makers look to evidence-based knowledge to improve quality of education. Analytics, the use of data to generate insights and support decisions, have been applied successfully across numerous application domains. Health care professional education is one area where great potential is yet to be realized. Previous research of Academic and Learning analytics has mainly focused on technical issues. The focus of this study relates to its practical implementation in the setting of health care education. Objective The aim of this study is to create a conceptual model for a deeper understanding of the synthesizing process, and transforming data into information to support educators’ decision making. Methods A deductive case study approach was applied to develop the conceptual model. Results The analytics loop works both in theory and in practice. The conceptual model encompasses the underlying data, the quality indicators, and decision support for educators. Conclusions The model illustrates how a theory can be applied to a traditional data-driven analytics approach, and alongside the context- or need-driven analytics approach. PMID:27731840

Clarifying Objectives and Results of Equivalent System Mass Analyses for Advanced Life Support

NASA Technical Reports Server (NTRS)

Levri, Julie A.; Drysdale, Alan E.

2003-01-01

This paper discusses some of the analytical decisions that an investigator must make during the course of a life support system trade study. Equivalent System Mass (ESM) is often applied to evaluate trade study options in the Advanced Life Support (ALS) Program. ESM can be used to identify which of several options that meet all requirements are most likely to have lowest cost. It can also be used to identify which of the many interacting parts of a life support system have the greatest impact and sensitivity to assumptions. This paper summarizes recommendations made in the newly developed ALS ESM Guidelines Document and expands on some of the issues relating to trade studies that involve ESM. In particular, the following three points are expounded: 1) The importance of objectives: Analysis objectives drive the approach to any trade study, including identification of assumptions, selection of characteristics to compare in the analysis, and the most appropriate techniques for reflecting those characteristics. 2) The importance of results inferprefafion: The accuracy desired in the results depends upon the analysis objectives, whereas the realized accuracy is determined by the data quality and degree of detail in analysis methods. 3) The importance of analysis documentation: Documentation of assumptions and data modifications is critical for effective peer evaluation of any trade study. ESM results are analysis-specific and should always be reported in context, rather than as solitary values. For this reason, results reporting should be done with adequate rigor to allow for verification by other researchers.

Similarities amid the difference: caregiving burden and adaptation outcomes in dyads of parents and their children with and without cerebral palsy.

PubMed

Carona, C; Crespo, C; Canavarro, M C

2013-03-01

This study had two main objectives: first, to examine the direct and indirect effects, via social support, of caregiving burden on the adaptation outcomes of children/adolescents with cerebral palsy and their parents; and second, to assess the invariance of such models in clinical vs. healthy subsamples. Participants were 210 dyads of children/adolescents and one of their parents (total N=420), divided in 93 dyads of children/adolescents with cerebral palsy and 117 dyads of children/adolescents with no medical diagnosis. Data on caregiving burden, social support and adaptation outcomes were obtained through self-report questionnaires. Caregiving burden was linked to parents and their children's psychological maladjustment and quality of life both directly (except for children's quality of life) and indirectly through social support. Findings were invariant across clinical and healthy subsamples. Caregiving burden may influence adaptation outcomes of children/adolescents with CP and their parents both directly and via their social support perceptions. These patterns are similar to those observed in typically developing children/adolescents. Copyright © 2012 Elsevier Ltd. All rights reserved.

Current State of Inclusion of Children with Special Needs in Child Care Programmes in One Canadian Province

ERIC Educational Resources Information Center

Wiart, Lesley; Kehler, Heather; Rempel, Gwen; Tough, Suzanne

2014-01-01

Background: Access to quality child care is an important support for families with children with disabilities. The objectives of this study were to determine: (1) the current state of inclusion of children with special needs in child care programmes, and (2) the presence of child care staff practices and programme characteristics that support…

Supporting Self-Improvement in Teaching, Literacy, Language and Numeracy. Tools for Staff Development. Module 4: Teaching and Learning Approaches

ERIC Educational Resources Information Center

Basic Skills Agency, 2007

2007-01-01

This module provides teachers with practical tools to improve the quality of teaching and learning activities and enable learners to achieve their objectives in literacy, language and numeracy. Unit 1 explores approaches that are particularly appropriate to adult learners, developing thinking skills and involving them in decision making and…

Resilience Factors Associated with Adaptation in Families with Deaf or Hard of Hearing Children

ERIC Educational Resources Information Center

Ahlert, Ingrid A.; Greeff, Abraham P.

2012-01-01

The study objective was to identify and explore resilience qualities that help protect and support families facing the adversity associated with having a child with hearing loss. The Resiliency Model of Family Stress, Adjustment, and Adaptation (M. A. McCubbin & H. I. McCubbin, 1993, 1996) provided the study's theoretical framework. The 54…

APPLICATION OF DATA QUALITY OBJECTIVES AND MEASUREMENT QUALITY OBJECTIVES TO RESEARCH PROJECTS

EPA Science Inventory

The paper assists systematic planning for research projects. It presents planning concepts in terms that have some utility for researchers. For example, measurement quality objectives are more familiar to researchers than data quality objectives because these quality criteria are...

Mid-life occupational grade and quality of life following retirement: a 16-year follow-up of the French GAZEL study

PubMed Central

Platts, Loretta G.; Webb, Elizabeth; Zins, Marie; Goldberg, Marcel; Netuveli, Gopalakrishnan

2015-01-01

Objectives: This article aims to contribute to the literature on life course influences upon quality of life by examining pathways linking social position in middle age to quality of life following retirement in French men and women. Method: Data are from the GAZEL cohort study of employees at the French national gas and electricity company. A finely grained measure of occupational grade in 1989 was obtained from company records. Annual self-completion questionnaires provided information on quality of life in 2005, measured with the CASP-19 scale, and on participants’ recent circumstances 2002–2005: mental health, physical functioning, wealth, social status, neighbourhood characteristics, social support and social participation. Path analysis using full information maximum likelihood estimation was performed on 11,293 retired participants. Results: Higher occupational grade in 1989 was associated, in a graded relationship, with better quality of life 16 years later. This association was accounted for by individuals’ more recent circumstances, particularly their social status, mental health, physical functioning and wealth. Conclusion: The graded relationship between occupational grade in mid-life and quality of life after labour market exit was largely accounted for by more recent socio-economic circumstances and state of health. The results support a pathway model for the development of social disparities in quality of life, in which earlier social position shapes individual circumstances in later life. PMID:25220504

Processing Technology Selection for Municipal Sewage Treatment Based on a Multi-Objective Decision Model under Uncertainty.

PubMed

Chen, Xudong; Xu, Zhongwen; Yao, Liming; Ma, Ning

2018-03-05

This study considers the two factors of environmental protection and economic benefits to address municipal sewage treatment. Based on considerations regarding the sewage treatment plant construction site, processing technology, capital investment, operation costs, water pollutant emissions, water quality and other indicators, we establish a general multi-objective decision model for optimizing municipal sewage treatment plant construction. Using the construction of a sewage treatment plant in a suburb of Chengdu as an example, this paper tests the general model of multi-objective decision-making for the sewage treatment plant construction by implementing a genetic algorithm. The results show the applicability and effectiveness of the multi-objective decision model for the sewage treatment plant. This paper provides decision and technical support for the optimization of municipal sewage treatment.

Image Quality Improvement in Adaptive Optics Scanning Laser Ophthalmoscopy Assisted Capillary Visualization Using B-spline-based Elastic Image Registration

PubMed Central

Uji, Akihito; Ooto, Sotaro; Hangai, Masanori; Arichika, Shigeta; Yoshimura, Nagahisa

2013-01-01

Purpose To investigate the effect of B-spline-based elastic image registration on adaptive optics scanning laser ophthalmoscopy (AO-SLO)-assisted capillary visualization. Methods AO-SLO videos were acquired from parafoveal areas in the eyes of healthy subjects and patients with various diseases. After nonlinear image registration, the image quality of capillary images constructed from AO-SLO videos using motion contrast enhancement was compared before and after B-spline-based elastic (nonlinear) image registration performed using ImageJ. For objective comparison of image quality, contrast-to-noise ratios (CNRS) for vessel images were calculated. For subjective comparison, experienced ophthalmologists ranked images on a 5-point scale. Results All AO-SLO videos were successfully stabilized by elastic image registration. CNR was significantly higher in capillary images stabilized by elastic image registration than in those stabilized without registration. The average ratio of CNR in images with elastic image registration to CNR in images without elastic image registration was 2.10 ± 1.73, with no significant difference in the ratio between patients and healthy subjects. Improvement of image quality was also supported by expert comparison. Conclusions Use of B-spline-based elastic image registration in AO-SLO-assisted capillary visualization was effective for enhancing image quality both objectively and subjectively. PMID:24265796

Microbiological monitoring for the US Geological Survey National Water-Quality Assessment Program

USGS Publications Warehouse

Francy, Donna S.; Myers, Donna N.; Helsel, Dennis R.

2000-01-01

Data to characterize the microbiological quality of the Nation?s fresh, marine, and estuarine waters are usually collected for local purposes, most often to judge compliance with standards for protection of public health in swimmable or drinkable waters. Methods and procedures vary with the objectives and practices of the parties collecting data and are continuously being developed or modified. Therefore, it is difficult to provide a nationally consistent picture of the microbial quality of the Nation?s waters. Study objectives and guidelines for a national microbiological monitoring program are outlined in this report, using the framework of the U.S. Geological Survey (USGS) National Water-Quality Assessment (NAWQA) program. A national program is designed to provide long-term data on the presence of microbiological pathogens and indicators in ground water and surface water to support effective water policy and management. Three major groups of waterborne pathogens affect the public health acceptability of waters in the United States?bacteria, protozoa, and viruses. Microbiological monitoring in NAWQA would be designed to assess the occurrence, distribution, and trends of pathogenic organisms and indicators in surface waters and ground waters; relate the patterns discerned to factors that help explain them; and improve our understanding of the processes that control microbiological water quality.

The Ocean Surface Topography Sentinel-6/Jason-CS Mission

NASA Astrophysics Data System (ADS)

Giulicchi, L.; Cullen, R.; Donlon, C.; Vuilleumier@esa int, P.

2016-12-01

The Sentinel-6/Jason-CS mission consists of two identical satellites flying in sequence and designed to provide operational measurements of sea surface height significant wave high and wind speed to support operational oceanography and climate monitoring. The mission will be the latest in a series of ocean surface topography missions that will span nearly three decades. They follow the altimeters on- board TOPEX/Poseidon through to Jason-3 (launched in January 2016). Jason-CS will continue to fulfil objectives of the reference series whilst introducing a major enhancement in capability providing the operational and science oceanographic community with the state of the art in terms of spacecraft, measurement instrumentation design thus securing optimal operational and science data return. As a secondary objective the mission will also include Radio Occultation user services. Each satellite will be launched sequentially into the Jason orbit (up to 66 latitude) respectively in 2020 and 2025. The principle payload instrument is a high precision Ku/C band radar altimeter with retrieval of geophysical parameters (surface elevation, wind speed and SWH) from the altimeter data require supporting measurements: a DORIS receiver for Precise Orbit Determination; The Climate Quality Advanced Microwave Radiometer (AMR-C) for high stability path delay correction. Orbit tracking data are also provided by GPS & LRA. An additional GPS receiver will be dedicated to radio-occultation measurements. The programme is a part of the European Community Copernicus initiative, whose objective is to support Europe's goals regarding sustainable development and global governance of the environment by providing timely and quality data, information, services and knowledge. The Sentinel-6/Jason-CS in particular is a cooperative mission with contributions from NASA, NOAA, EUMETSAT, ESA, CNES and the European Union.

Physics and Novel Schemes of Laser Radiation Pressure Acceleration for Quasi-monoenergetic Proton Generation

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

Liu, Chuan S.; Shao, Xi

2016-06-14

The main objective of our work is to provide theoretical basis and modeling support for the design and experimental setup of compact laser proton accelerator to produce high quality proton beams tunable with energy from 50 to 250 MeV using short pulse sub-petawatt laser. We performed theoretical and computational studies of energy scaling and Raleigh--Taylor instability development in laser radiation pressure acceleration (RPA) and developed novel RPA-based schemes to remedy/suppress instabilities for high-quality quasimonoenergetic proton beam generation as we proposed. During the project period, we published nine peer-reviewed journal papers and made twenty conference presentations including six invited talks onmore » our work. The project supported one graduate student who received his PhD degree in physics in 2013 and supported two post-doctoral associates. We also mentored three high school students and one undergraduate student of physics major by inspiring their interests and having them involved in the project.« less

Associations of objective and subjective sleep disturbance with cognitive function in older men with comorbid depression and insomnia.

PubMed

Biddle, Daniel J; Naismith, Sharon L; Griffiths, Kathleen M; Christensen, Helen; Hickie, Ian B; Glozier, Nicholas S

2017-06-01

To examine whether poor objective and subjective sleep quality are differentially associated with cognitive function. Cross-sectional. Participants were recruited from primary and secondary care, and directly from the community, in Sydney, Australia. The sample consisted of 74 men 50years and older (mean [SD], 58.4 [6.2] years), with comorbid depression and above-threshold insomnia symptoms, participating in a trial of online cognitive behavioral therapy for insomnia. Insomnia severity and depression severity were assessed via self-report. Objective sleep efficiency and duration were measured using actigraphy. Objective cognitive function was measured using 3 subtests of a computerized neuropsychological battery. Poor objective sleep efficiency was associated with slower reaction time (r=-0.249, P=.033) and poorer executive functioning (odds ratio, 4.14; 95% confidence interval, 1.35-12.69), but not memory. These associations remained after adjusting for age, education, depression severity, cardiovascular risk, and medication. Subjective sleep quality was not related to cognitive function. Among older men with depression and insomnia, objectively measured poor sleep efficiency may be associated with worse cognitive function, independent of depression severity. Objective poor sleep may be underpinned by neurobiological correlates distinct from those underlying subjective poor sleep and depression, and represent a potentially effective modifiable mechanism in interventions to improve cognitive functioning in this population. This supports the use of objective measures of sleep in diagnostic assessments and care. Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Hospital nurses' wellbeing at work: a theoretical model.

PubMed

Utriainen, Kati; Ala-Mursula, Leena; Kyngäs, Helvi

2015-09-01

To develop a theoretical model of hospital nurses' wellbeing at work. The concept of wellbeing at work is presented without an exact definition and without considering different contents. A model was developed in a deductive manner and empirical data collected from nurses (n = 233) working in a university hospital. Explorative factor analysis was used. The main concepts were: patients' experience of high-quality care; assistance and support among nurses; nurses' togetherness and cooperation; fluent practical organisation of work; challenging and meaningful work; freedom to express diverse feelings in the work community; well-conducted everyday nursing; status related to the work itself; fair and supportive leadership; opportunities for professional development; fluent communication with other professionals; and being together with other nurses in an informal way. Themes included: collegial relationships; enhancing high-quality patient care; supportive and fair leadership; challenging, meaningful and well organised work; and opportunities for professional development. Object-dependent wellbeing was supported. Managers should focus on strengthening the positive aspect of wellbeing at work, focusing on providing fluently organised work practices, fair and supportive leadership and togetherness while allowing nurses to implement their own ideas and promote the experience of meaningfulness. © 2014 John Wiley & Sons Ltd.

Space transfer vehicle concepts and requirements, volume 2, book 1

NASA Technical Reports Server (NTRS)

1991-01-01

The objective of the systems engineering task was to develop and implement an approach that would generate the required study products as defined by program directives. This product list included a set of system and subsystem requirements, a complete set of optimized trade studies and analyses resulting in a recommended system configuration, and the definition of an integrated system/technology and advanced development growth path. A primary ingredient in the approach was the TQM philosophy stressing job quality from the inception. Included throughout the Systems Engineering, Programmatics, Concepts, Flight Design, and Technology sections are data supporting the original objectives as well as supplemental information resulting from program activities. The primary result of the analyses and studies was the recommendation of a single propulsion stage Lunar Transportation System (LTS) configuration that supports several different operations scenarios with minor element changes. This concept has the potential to support two additional scenarios with complex element changes. The space based LTS concept consists of three primary configurations--Piloted, Reusable Cargo, and Expendable Cargo.

The Pharmacological Management of Oppositional Behaviour, Conduct Problems, and Aggression in Children and Adolescents With Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A Systematic Review and Meta-Analysis. Part 2: Antipsychotics and Traditional Mood Stabilizers

PubMed Central

Pringsheim, Tamara; Hirsch, Lauren; Gardner, David; Gorman, Daniel A

2015-01-01

Objective: Attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are among the most common psychiatric diagnoses in childhood. Aggression and conduct problems are a major source of disability and a risk factor for poor long-term outcomes. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) of antipsychotics, lithium, and anticonvulsants for aggression and conduct problems in youth with ADHD, ODD, and CD. Each medication was given an overall quality of evidence rating based on the Grading of Recommendations Assessment, Development and Evaluation approach. Results: Eleven RCTs of antipsychotics and 7 RCTs of lithium and anticonvulsants were included. There is moderate-quality evidence that risperidone has a moderate-to-large effect on conduct problems and aggression in youth with subaverage IQ and ODD, CD, or disruptive behaviour disorder not otherwise specified, with and without ADHD, and high-quality evidence that risperidone has a moderate effect on disruptive and aggressive behaviour in youth with average IQ and ODD or CD, with and without ADHD. Evidence supporting the use of haloperidol, thioridazine, quetiapine, and lithium in aggressive youth with CD is of low or very-low quality, and evidence supporting the use of divalproex in aggressive youth with ODD or CD is of low quality. There is very-low-quality evidence that carbamazepine is no different from placebo for the management of aggression in youth with CD. Conclusion: With the exception of risperidone, the evidence to support the use of antipsychotics and mood stabilizers is of low quality. PMID:25886656

Improving the quality of hospital care for children by supportive supervision: a cluster randomized trial, Kyrgyzstan

PubMed Central

Shukurova, Venera; Davletbaeva, Marina; Monolbaev, Kubanychbek; Kulichenko, Tatiana; Akoev, Yuri; Bakradze, Maya; Margieva, Tea; Mityushino, Ilya; Namazova-Baranova, Leyla; Boronbayeva, Elnura; Kuttumuratova, Aigul; Weber, Martin Willy; Tamburlini, Giorgio

2017-01-01

Abstract Objective To determine whether periodic supportive supervision after a training course improved the quality of paediatric hospital care in Kyrgyzstan, where inappropriate care was common but in-hospital postnatal mortality was low. Methods In a cluster, randomized, parallel-group trial, 10 public hospitals were allocated to a 4-day World Health Organization (WHO) course on hospital care for children followed by periodic supportive supervision by paediatricians for 1 year, while 10 hospitals had no intervention. We assessed prospectively 10 key indicators of inappropriate paediatric case management, as indicated by WHO guidelines. The primary indicator was the combination of the three indicators: unnecessary hospitalization, increased iatrogenic risk and unnecessary painful procedures. An independent team evaluated the overall quality of care. Findings We prospectively reviewed the medical records of 4626 hospitalized children aged 2 to 60 months. In the intervention hospitals, the mean proportion of the primary indicator decreased from 46.9% (95% confidence interval, CI: 24.2 to 68.9) at baseline to 6.8% (95% CI: 1.1 to 12.1) at 1 year, but was unchanged in the control group (45.5%, 95% CI: 25.2 to 67.9, to 64.7%, 95% CI: 43.3 to 86.1). At 1 year, the risk ratio for the primary indicator in the intervention versus the control group was 0.09 (95% CI: 0.06 to 0.13). The proportions of the other nine indicators also decreased in the intervention group (P < 0.0001 for all). Overall quality of care improved significantly in intervention hospitals. Conclusion Periodic supportive supervision for 1 year after a training course improved both adherence to WHO guidelines on hospital care for children and the overall quality of paediatric care. PMID:28603306

Assessment of quality of life of parents of children with osteogenesis imperfecta.

PubMed

Szczepaniak-Kubat, Anna; Kurnatowska, Olga; Jakubowska-Pietkiewicz, Elzbieta; Chlebna-Sokół, Danuta

2012-01-01

The aim of the work was an objective assessment of the quality of life of parents of children with osteogenesis imperfecta (OI) and of its determinant factors. The survey answers of 25 parents were analyzed and contained demographic parameters, socioeconomic status information, quality of life of responses and type of support they have been receiving. In order to assess the effects of this children's disease on the quality of life of the parents, families were divided into two groups depending on the OI severity: group M--mild (type I and IV OI), group S--severe (type III OI). The objective of the work was carried out based on the WHOQOL-BREF quality of life questionnaire and measures of family status: education degree based on the International Standard Classification of Education (ISCED), a subjective assessment of the family's wealth (Perceived Family Wealth, PFW), and the family's financial resources (Family Affluence Scale, FAS). 56% of respondents assessed their global quality of life (Quality of Life, QL) as good, whereas 8% answered poor. Perception of general health status was similar. Life domains assessed in the WHOQOL-BREF questionnaire received the following mean values on a scale from 4 to 20 points: physical--12.2 +/- 1.2, psychological--15.04 +/- 2.2, environmental--13.32 +/- 2, social relationships--14.28 +/- 1.5. In the severe OI group, the environmental domain was assessed as worse than in the mild OI group and this assessment was statistically significant, despite the fact that the group of families with severe cases of OI received more support from the appropriate institutions. Indicators of socioeconomic status did not affect the respondents' assessment of their global quality of life. In the tested group of families, the child's disease did not affect either the global quality of life assessment or health of the respondents or their quality of life in terms of physical and mental status and social relationships. The parents of children with severe OI assessed the life domain associated with the environment they live in as worse than the parents of children with mild OI. The global quality of life assessment of the respondents did not depend on the family's socioeconomic status and on the help they have been receiving with regard to care for the child.

Object relations predicts borderline personality disorder symptoms beyond emotional dysregulation, negative affect, and impulsivity.

PubMed

Huprich, Steven K; Nelson, Sharon M; Paggeot, Amy; Lengu, Ketrin; Albright, Jeremy

2017-01-01

Many studies have determined that the traits of emotional dysregulation, negative affect, and impulsivity are the strongest predictors of borderline personality disorder (BPD). Although psychodynamic, empirically supported BPD treatments (i.e., transference-focused, mentalization based) focus upon changing the internal representations of self and other, no studies have simultaneously evaluated the contribution of object relations in relation to these traits in predicting BPD symptoms. This study sought to determine the combined effects of emotional dysregulation, negative affect, impulsivity, and object relations in the prediction of BPD through the use of mediation modeling in 4 a priori hypothesized relationships among these variables. One hundred sixty-nine psychiatric outpatients and 171 undergraduate students were evaluated with self-reported trait and object relations measures and were administered 2 semistructured diagnostic interviews for BPD. Although all trait and object relations measures were correlated with BPD symptoms, the best fitting model was one in which object relations partially mediated the relationship of negative affect and impulsivity with BPD symptoms. Direct effects of the traits were also observed in mediation. Self-reported object relational quality had more of an effect on the prediction of BPD than previously recognized within a trait-framework, thus further supporting the model explicated in psychodynamic and relationally based treatments for BPD. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Earnings Quality Measures and Excess Returns

PubMed Central

Perotti, Pietro; Wagenhofer, Alfred

2014-01-01

This paper examines how commonly used earnings quality measures fulfill a key objective of financial reporting, i.e., improving decision usefulness for investors. We propose a stock-price-based measure for assessing the quality of earnings quality measures. We predict that firms with higher earnings quality will be less mispriced than other firms. Mispricing is measured by the difference of the mean absolute excess returns of portfolios formed on high and low values of a measure. We examine persistence, predictability, two measures of smoothness, abnormal accruals, accruals quality, earnings response coefficient and value relevance. For a large sample of US non-financial firms over the period 1988–2007, we show that all measures except for smoothness are negatively associated with absolute excess returns, suggesting that smoothness is generally a favorable attribute of earnings. Accruals measures generate the largest spread in absolute excess returns, followed by smoothness and market-based measures. These results lend support to the widespread use of accruals measures as overall measures of earnings quality in the literature. PMID:26300582

Earnings Quality Measures and Excess Returns.

PubMed

Perotti, Pietro; Wagenhofer, Alfred

2014-06-01

This paper examines how commonly used earnings quality measures fulfill a key objective of financial reporting, i.e., improving decision usefulness for investors. We propose a stock-price-based measure for assessing the quality of earnings quality measures. We predict that firms with higher earnings quality will be less mispriced than other firms. Mispricing is measured by the difference of the mean absolute excess returns of portfolios formed on high and low values of a measure. We examine persistence, predictability, two measures of smoothness, abnormal accruals, accruals quality, earnings response coefficient and value relevance. For a large sample of US non-financial firms over the period 1988-2007, we show that all measures except for smoothness are negatively associated with absolute excess returns, suggesting that smoothness is generally a favorable attribute of earnings. Accruals measures generate the largest spread in absolute excess returns, followed by smoothness and market-based measures. These results lend support to the widespread use of accruals measures as overall measures of earnings quality in the literature.

Development and Examination of a Family Triadic Measure to Examine Quality of Life Family Congruence in Nursing Home Residents and Two Family Members.

PubMed

Aalgaard Kelly, Gina

2015-01-01

Objective: The overall purpose of this study was to propose and test a conceptual model and apply family analyses methods to understand quality of life family congruence in the nursing home setting. Method: Secondary data for this study were from a larger study, titled Measurement, Indicators and Improvement of the Quality of Life (QOL) in Nursing Homes . Research literature, family systems theory and human ecological assumptions, fostered the conceptual model empirically testing quality of life family congruence. Results: The study results supported a model examining nursing home residents and two family members on quality of life family congruence. Specifically, family intergenerational dynamic factors, resident personal and social-psychological factors, and nursing home family input factors were examined to identify differences in quality of life family congruence among triad families. Discussion: Formal family involvement and resident cognitive functioning were found as the two most influential factors to quality of life family congruence (QOLFC).

Development and Examination of a Family Triadic Measure to Examine Quality of Life Family Congruence in Nursing Home Residents and Two Family Members

PubMed Central

Aalgaard Kelly, Gina

2015-01-01

Objective: The overall purpose of this study was to propose and test a conceptual model and apply family analyses methods to understand quality of life family congruence in the nursing home setting. Method: Secondary data for this study were from a larger study, titled Measurement, Indicators and Improvement of the Quality of Life (QOL) in Nursing Homes. Research literature, family systems theory and human ecological assumptions, fostered the conceptual model empirically testing quality of life family congruence. Results: The study results supported a model examining nursing home residents and two family members on quality of life family congruence. Specifically, family intergenerational dynamic factors, resident personal and social-psychological factors, and nursing home family input factors were examined to identify differences in quality of life family congruence among triad families. Discussion: Formal family involvement and resident cognitive functioning were found as the two most influential factors to quality of life family congruence (QOLFC). PMID:28138474

The Computerized Medical Record as a Tool for Clinical Governance in Australian Primary Care

PubMed Central

Phillips, Christine; Hall, Sally; Travaglia, Joanne

2013-01-01

Background Computerized medical records (CMR) are used in most Australian general practices. Although CMRs have the capacity to amalgamate and provide data to the clinician about their standard of care, there is little research on the way in which they may be used to support clinical governance: the process of ensuring quality and accountability that incorporates the obligation that patients are treated according to best evidence. Objective The objective of this study was to explore the capability, capacity, and acceptability of CMRs to support clinical governance. Methods We conducted a realist review of the role of seven CMR systems in implementing clinical governance, developing a four-level maturity model for the CMR. We took Australian primary care as the context, CMR to be the mechanism, and looked at outcomes for individual patients, localities, and for the population in terms of known evidence-based surrogates or true outcome measures. Results The lack of standardization of CMRs makes national and international benchmarking challenging. The use of the CMR was largely at level two of our maturity model, indicating a relatively simple system in which most of the process takes place outside of the CMR, and which has little capacity to support benchmarking, practice comparisons, and population-level activities. Although national standards for coding and projects for record access are proposed, they are not operationalized. Conclusions The current CMR systems can support clinical governance activities; however, unless the standardization and data quality issues are addressed, it will not be possible for current systems to work at higher levels. PMID:23939340

Vision for a worldwide fluvial-sediment information network

USGS Publications Warehouse

Gray, J.R.; Osterkamp, W.R.

2007-01-01

The WoFSIN is described in the ensuing sections in stand-alone fashion, followed by a section that describes the complementary aspects of the WoFSIN and the International Sediment Initiative. Thus, our first objective is to describe the fundamental components of a WoFSIN. Our second objective is to identify overlap or gaps between the WoFSIN and ISI concepts that might be useful in refining the ISI’s ability to meet its global mission to develop decision support for sediment management at the global scale more fully, cost-effectively, and (or) with enhanced quality.

Local environmental quality positively predicts breastfeeding in the UK’s Millennium Cohort Study

PubMed Central

Sear, Rebecca

2017-01-01

ABSTRACT Background and Objectives: Breastfeeding is an important form of parental investment with clear health benefits. Despite this, rates remain low in the UK; understanding variation can therefore help improve interventions. Life history theory suggests that environmental quality may pattern maternal investment, including breastfeeding. We analyse a nationally representative dataset to test two predictions: (i) higher local environmental quality predicts higher likelihood of breastfeeding initiation and longer duration; (ii) higher socioeconomic status (SES) provides a buffer against the adverse influences of low local environmental quality. Methodology: We ran factor analysis on a wide range of local-level environmental variables. Two summary measures of local environmental quality were generated by this analysis—one ‘objective’ (based on an independent assessor’s neighbourhood scores) and one ‘subjective’ (based on respondent’s scores). We used mixed-effects regression techniques to test our hypotheses. Results: Higher objective, but not subjective, local environmental quality predicts higher likelihood of starting and maintaining breastfeeding over and above individual SES and area-level measures of environmental quality. Higher individual SES is protective, with women from high-income households having relatively high breastfeeding initiation rates and those with high status jobs being more likely to maintain breastfeeding, even in poor environmental conditions. Conclusions and Implications: Environmental quality is often vaguely measured; here we present a thorough investigation of environmental quality at the local level, controlling for individual- and area-level measures. Our findings support a shift in focus away from individual factors and towards altering the landscape of women’s decision making contexts when considering behaviours relevant to public health. PMID:29354262

Effects of social support and stressful life events on health-related quality of life in coronary artery disease patients.

PubMed

Staniute, Margarita; Brozaitiene, Julija; Bunevicius, Robertas

2013-01-01

The objective of this study was to examine the effects of social support and stressful life events on health-related quality of life (HRQoL) in coronary artery disease (CAD) patients. Five hundred sixty consecutive patients with CAD attending cardiac rehabilitation program were invited to participate in the study. Data on stressful life events, perceived social support, and HRQoL were collected from the self-administered questionnaires, Social Readjustment Rating Scale, Multidimensional Scale of Perceived Social Support, and 36-Item Short Form Medical Outcome Questionnaire, respectively. In male patients, multivariate linear regression analyses revealed that physical domains of the HRQoL, specifically physical functioning, were associated with clinical aspects of the CAD, such as New York Heart Association class and angina pectoris class, and psychological domains of the HRQoL such as mental health, energy/vitality, and social functioning were associated with social characteristics such as stressful life events and perceived social support. In women, both physical and psychological domains of the HRQoL were associated only with social characteristics, especially with perceived social support. Perceived social support and stressful life events have independent significant effects on the HRQoL in CAD patients, especially in female patients. When planning cardiac rehabilitation programs, special attention should be paid to patients who experience high levels of stress and have low social support.

The New York City Operations Support Tool: Supporting Water Supply Operations for Millions in an Era of Changing Patterns in Hydrological Extreme Events

NASA Astrophysics Data System (ADS)

Matonse, A. H.; Porter, J. H.; Frei, A.

2015-12-01

Providing an average 1.1 billion gallons (~ 4.2 x 106 cubic meters) of drinking water per day to approximately nine million people in New York City (NYC) and four upstate counties, the NYC water supply is among the world's largest unfiltered systems. In addition to providing a reliable water supply in terms of water quantity and quality, the city has to fulfill other flow objectives to serve downstream communities. At times, such as during extreme hydrological events, water quality issues may restrict water usage for parts of the system. To support a risk-based water supply decision making process NYC has developed the Operations Support Tool (OST). OST combines a water supply systems model with reservoir water quality models, near real time data ingestion, data base management and an ensemble hydrological forecast. A number of reports have addressed the frequency and intensities of extreme hydrological events across the continental US. In the northeastern US studies have indicated an increase in the frequency of extremely large precipitation and streamflow events during the most recent decades. During this presentation we describe OST and, using case studies we demonstrate how this tool has been useful to support operational decisions. We also want to motivate a discussion about how undergoing changes in patterns of hydrological extreme events elevate the challenge faced by water supply managers and the role of the scientific community to integrate nonstationarity approaches in hydrologic forecast and modeling.

Introduction of a quality improvement program in a children's hospital in Tehran: design, implementation, evaluation and lessons learned.

PubMed

Mohammadi, S Mehrdad; Mohammadi, S Farzad; Hedges, Jerris R; Zohrabi, Morteza; Ameli, Omid

2007-08-01

Reports addressing continuous quality improvement (CQI) methods in developing countries are scant and there are questions about the applicability of quality improvement methods in such settings. The structure and output of a formal quality improvement program implemented in a teaching hospital affiliated with the Tehran University of Medical Sciences is presented. OBJECTIVE METHOD: During a nine-month period, a multi-stage quality improvement program was implemented. It comprised: (i) training workshops; (ii) a steering committee; (iii) weekly consultation and facilitation of improvement projects; and (iv) a day-long demonstration and recognition meeting. Four cycles of workshops were held in which 132 employees were trained in the basics of CQI. Thirty improvement projects were initiated. Twenty-five of the projects were completed. In an evaluation survey more than 70% of respondents assessed a 'positive impact' on organizational culture, work efficiency and quality of services. More than 90% believed that the changes were sustained, and more than 60% reported that they have implemented additional improvement projects. Our quality improvement package supported rapid implementation of multiple projects. The underlying 'change structure' comprised the improvement teams, top management and the university's quality improvement office; it integrated project management, support and facilitation functions by the respective participant. Organization-wide change was more limited than anticipated. To institutionalize the program and ensure sustainability, a local structure for change should be organized, management coaching should be sustained, local facilitators should be developed, incentives should be established and physician involvement should be emphasized.

Assessing the impact of continuous quality improvement/total quality management: concept versus implementation.

PubMed Central

Shortell, S M; O'Brien, J L; Carman, J M; Foster, R W; Hughes, E F; Boerstler, H; O'Connor, E J

1995-01-01

OBJECTIVE: This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. DATA SOURCES AND STUDY SETTING: Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. STUDY DESIGN: The study involved cross-sectional examination of the named relationships. DATA COLLECTION/EXTRACTION METHODS: Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. PRINCIPAL FINDINGS: A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. CONCLUSIONS: What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard. PMID:7782222

A Multifaceted Intervention to Improve Health Worker Adherence to Integrated Management of Childhood Illness Guidelines in Benin

PubMed Central

Onikpo, Faustin; Lama, Marcel; Osterholt, Dawn M.; Rowe, Samantha Y.; Deming, Michael S.

2009-01-01

Objectives. We evaluated an intervention to support health workers after training in Integrated Management of Childhood Illness (IMCI), a strategy that can improve outcomes for children in developing countries by encouraging workers' use of evidence-based guidelines for managing the leading causes of child mortality. Methods. We conducted a randomized trial in Benin. We administered a survey in 1999 to assess health care quality before IMCI training. Health workers then received training plus either study supports (job aids, nonfinancial incentives, and supervision of workers and supervisors) or usual supports. Follow-up surveys conducted in 2001 to 2004 assessed recommended treatment, recommended or adequate treatment, and an index of overall guideline adherence. Results. We analyzed 1244 consultations. Performance improved in both intervention and control groups, with no significant differences between groups. However, training proceeded slowly, and low-quality care from health workers without IMCI training diluted intervention effects. Per-protocol analyses revealed that workers with IMCI training plus study supports provided better care than did those with training plus usual supports (27.3 percentage-point difference for recommended treatment; P < .05), and both groups outperformed untrained workers. Conclusions. IMCI training was useful but insufficient. Relatively inexpensive supports can lead to additional improvements. PMID:19299681

DATA QUALITY OBJECTIVES AND MEASUREMENT QUALITY OBJECTIVES FOR RESEARCH PROJECTS

EPA Science Inventory

The paper provides assistance with systematic planning using measurement quality objectives to those working on research projects. These performance criteria are more familiar to researchers than data quality objectives because they are more closely associated with the measuremen...

Moving base simulation of an integrated flight and propulsion control system for an ejector-augmentor STOVL aircraft in hover

NASA Technical Reports Server (NTRS)

Mcneill, Walter, E.; Chung, William W.; Stortz, Michael W.

1995-01-01

A piloted motion simulator evaluation, using the NASA Ames Vertical Motion Simulator, was conducted in support of a NASA Lewis Contractual study of the integration of flight and propulsion systems of a STOVL aircraft. Objectives of the study were to validate the Design Methods for Integrated Control Systems (DMICS) concept, to evaluate the handling qualities, and to assess control power usage. The E-7D ejector-augmentor STOVL fighter design served as the basis for the simulation. Handling-qualities ratings were obtained during precision hover and shipboard landing tasks. Handling-qualities ratings for these tasks ranged from satisfactory to adequate. Further improvement of the design process to fully validate the DMICS concept appears to be warranted.

Quality of online information to support patient decision-making in breast cancer surgery.

PubMed

Bruce, Jordan G; Tucholka, Jennifer L; Steffens, Nicole M; Neuman, Heather B

2015-11-01

Breast cancer patients commonly use the internet as an information resource. Our objective was to evaluate the quality of online information available to support patients facing a decision for breast surgery. Breast cancer surgery-related queries were performed (Google and Bing), and reviewed for content pertinent to breast cancer surgery. The DISCERN instrument was used to evaluate websites' structural components that influence publication reliability and ability of information to support treatment decision-making. Scores of 4/5 were considered "good." 45 unique websites were identified. Websites satisfied a median 5/9 content questions. Commonly omitted topics included: having a choice between breast conservation and mastectomy (67%) and potential for 2nd surgery to obtain negative margins after breast conservation (60%). Websites had a median DISCERN score of 2.9 (range 2.0-4.5). Websites achieved higher scores on structural criteria (median 3.6 [2.1-4.7]), with 24% rated as "good." Scores on supporting decision-making questions were lower (2.6 [1.3-4.4]), with only 7% scoring "good." Although numerous breast cancer-related websites exist, most do a poor job providing women with essential information necessary to actively participate in decision-making for breast cancer surgery. Providing easily- accessible, high-quality online information has the potential to significantly improve patients' experiences with decision-making. © 2015 Wiley Periodicals, Inc.

What's love got to do with it: Relationship functioning and mental and physical quality of life among pregnant adolescent couples.

PubMed

Kershaw, Trace; Murphy, Alexandrea; Divney, Anna; Magriples, Urania; Niccolai, Linda; Gordon, Derrick

2013-12-01

The study objective was to describe relationship adjustment and its association with mental and physical quality of life for young couples expecting a baby. 296 young pregnant couples recruited from urban obstetric clinics reported on relationship strengths (e.g., equity, romantic love, and attractiveness), relationship risks (e.g., attachment, intimate partner violence), external family support, relationship adjustment, and mental and physical quality of life. Using the Actor Partner Interdependence Model we assessed both actor and partner effects of relationship variables on relationship adjustment and quality of life. Sixty-one percent of couples had at least one member with moderate or severe relationship distress. Lower attachment avoidance, lower attachment anxiety, higher relationship equity, lack of intimate partner violence, feelings of love, perceived partner attractiveness, and family support of the relationship related to better relationship adjustment. Associations were fairly consistent across gender. Better relationship adjustment related to more positive mental and physical quality of life for both young women and men. Our results highlight the potential importance of strong relationships on the well-being of expecting parents. Our results suggest that secure attachments, equitable relationships, feelings of love, and a lack of violence may be particularly important in having strong relationships and improved mental and physical health during pregnancy.

What’s Love Got to Do with It: Relationship Functioning and Mental and Physical Quality of Life Among Pregnant Adolescent Couples

PubMed Central

Murphy, Alexandrea; Divney, Anna; Magriples, Urania; Niccolai, Linda; Gordon, Derrick

2014-01-01

The study objective was to describe relationship adjustment and its association with mental and physical quality of life for young couples expecting a baby. 296 young pregnant couples recruited from urban obstetric clinics reported on relationship strengths (e.g., equity, romantic love, and attractiveness), relationship risks (e.g., attachment, intimate partner violence), external family support, relationship adjustment, and mental and physical quality of life. Using the Actor Partner Interdependence Model we assessed both actor and partner effects of relationship variables on relationship adjustment and quality of life. Sixty-one percent of couples had at least one member with moderate or severe relationship distress. Lower attachment avoidance, lower attachment anxiety, higher relationship equity, lack of intimate partner violence, feelings of love, perceived partner attractiveness, and family support of the relationship related to better relationship adjustment. Associations were fairly consistent across gender. Better relationship adjustment related to more positive mental and physical quality of life for both young women and men. Our results highlight the potential importance of strong relationships on the well-being of expecting parents. Our results suggest that secure attachments, equitable relationships, feelings of love, and a lack of violence may be particularly important in having strong relationships and improved mental and physical health during pregnancy. PMID:24091562

A Configurational Approach to the Relationship between High-Performance Work Practices and Frontline Health Care Worker Outcomes

PubMed Central

Chuang, Emmeline; Dill, Janette; Morgan, Jennifer Craft; Konrad, Thomas R

2012-01-01

Objective To identify high-performance work practices (HPWP) associated with high frontline health care worker (FLW) job satisfaction and perceived quality of care. Methods Cross-sectional survey data from 661 FLWs in 13 large health care employers were collected between 2007 and 2008 and analyzed using both regression and fuzzy-set qualitative comparative analysis. Principal Findings Supervisor support and team-based work practices were identified as necessary for high job satisfaction and high quality of care but not sufficient to achieve these outcomes unless implemented in tandem with other HPWP. Several configurations of HPWP were associated with either high job satisfaction or high quality of care. However, only one configuration of HPWP was sufficient for both: the combination of supervisor support, performance-based incentives, team-based work, and flexible work. These findings were consistent even after controlling for FLW demographics and employer type. Additional research is needed to clarify whether HPWP have differential effects on quality of care in direct care versus administrative workers. Conclusions High-performance work practices that integrate FLWs in health care teams and provide FLWs with opportunities for participative decision making can positively influence job satisfaction and perceived quality of care, but only when implemented as bundles of complementary policies and practices. PMID:22224858

Knowledge Representation and Care Planning for Population Health Management.

PubMed

Merahn, Steven

2015-01-01

The traditional organizing principles of medical knowledge may be insufficient to allow for problem representations that are relevant to solution development in emerging models of care such as population health management. Operational classification and central management of clinical and quality objectives and associated strategies will allow for productive innovation in care design and better support goal-directed collaboration among patients and their health resource communities.

Quality versus Quantity: The Use of Observation by Early Childhood Educators in Improving the Performance of Children Enrolled in Preschool Programs in Ghana

ERIC Educational Resources Information Center

Tackie-Ofosu, Vivian; Bentum, Kwesi

2013-01-01

In the current study, the authors explored how early childhood educators used observation to support children in the learning environment. The objectives set were to find out the observation methods teachers used, ascertain their understanding of child observation, find out activities children undertook, and how teachers documented what children…

Management Systems, Patient Quality Improvement, Resource Availability, and Substance Abuse Treatment Quality

PubMed Central

Fields, Dail; Roman, Paul M; Blum, Terry C

2012-01-01

Objective To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment. Data Sources/Study Setting Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS). Study Design The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance. Data Collection Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007–2008. Principal Findings Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient. Conclusions Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present. PMID:22098342

Developing a multidisciplinary robotic surgery quality assessment program.

PubMed

Gonsenhauser, Iahn; Abaza, Ronney; Mekhjian, Hagop; Moffatt-Bruce, Susan D

2012-01-01

The objective of this study was to test the feasibility of a novel quality-improvement (QI) program designed to incorporate multiple robotic surgical sub-specialties in one health care system. A robotic surgery quality assessment program was developed by The Ohio State University College of Medicine (OSUMC) in conjunction with The Ohio State University Medical Center Quality Improvement and Operations Department. A retrospective review of cases was performed using data interrogated from the OSUMC Information Warehouse from January 2007 through August 2009. Robotic surgery cases (n=2200) were assessed for operative times, length of stay (LOS), conversions, returns to surgery, readmissions and cancellations as potential quality indicators. An actionable and reproducible framework for the quality measurement and assessment of a multidisciplinary and interdepartmental robotic surgery program was successfully completed demonstrating areas for improvement opportunities. This report supports that standard quality indicators can be applied to multiple specialties within a health care system to develop a useful quality tracking and assessment tool in the highly specialized area of robotic surgery. © 2012 National Association for Healthcare Quality.

The Effect of Social Integration on Outcomes after Major Lower Extremity Amputation

PubMed Central

Hawkins, Alexander T.; Pallangyo, Anthony J.; Herman, Ayesiga M.; Schaumeier, Maria J.; Smith, Ann D.; Hevelone, Nathanael D.; Crandell, David M.; Nguyen, Louis

2016-01-01

Objective Major lower extremity amputation is a common procedure that results in a profound change in a patient's life. We sought to determine the association between social support and outcomes after amputation. We hypothesized that patients with greater social support will have better post amputation outcomes. Methods From November 2011 to May 2013, we conducted a cross-sectional, observational, multicenter study. Social integration was measured by the social integration subset of the Short Form (Craig Handicap Assessment and Reporting Technique (CHART). Systemic social support was assessed by comparing a US and Tanzanian population. Walking function was measured using the 6MWT and quality of life (QoL) was measured using the EQ-5D. Results 102 major lower extremity amputees were recruited. 63 patients were enrolled in the US with a mean age of 58.0. Forty-two (67%) were male. Patients with low social integration were more likely to be unable to ambulate (no walk 39% vs. slow walk 23% vs. fast walk 10%; P=.01) and those with high social integration were more likely to be fast walkers (no walk 10% vs. slow walk 59% vs. fast walk 74%; P=.01). This relationship persisted in a multivariable analysis. Increasing social integration scores were also positively associated with increasing quality of life scores in a multivariable analysis (β .002; SE .0008; P = .02). In comparing the US population with the Tanzanian cohort (39 subjects), there were no significant differences between functional or quality of life outcomes in the systemic social support analysis. Conclusions In the US population, increased social integration is associated with both improved function and quality of life outcomes among major lower extremity amputees. Systemic social support, as measured by comparing the US population with a Tanzanian population, was not associated with improved function or quality of life outcomes. In the US, steps should be taken to identify and aid amputees with poor social integration. PMID:26474508

Traditional food: a better compatibility with industry requirements.

PubMed

Cotillon, Christophe; Guyot, Anne-Clothilde; Rossi, Daniel; Notarfonso, Maurizio

2013-11-01

The objective of this article is to summarise the main results of the TRUEFOOD Integrated project, which is supported by the European Commission in the European Framework Program 6 (FP6). This project started in 2006 and ended in 2010. TRUEFOOD aimed to improve quality and safety and introduce innovation into Traditional European Food production systems through research, demonstration, dissemination and training activities. It focuses on increasing value to both consumers and producers and on supporting the development of realistic business plans for all components of the food chain, using a farm-to-fork approach. © 2013 Society of Chemical Industry.

Unmet Supportive Care Needs in U.S. Dialysis Centers and Lack of Knowledge of Available Resources to Address Them.

PubMed

Culp, Stacey; Lupu, Dale; Arenella, Cheryl; Armistead, Nancy; Moss, Alvin H

2016-04-01

Because of high symptom burden, numerous comorbidities, and shortened life expectancy, dialysis patients are increasingly recognized as appropriate candidates for early and continuous supportive care. The objectives of this study were to describe dialysis professionals' perceptions of the adequacy of supportive care in dialysis centers, barriers to providing it, suggestions for improving it, and familiarity with the existing evidence-based resources for supportive care of dialysis patients. The Coalition for Supportive Care of Kidney Patients conducted an online survey of dialysis professionals and administrators solicited through the 18 End-Stage Renal Disease Networks and the Renal Physicians Association. Only 4.5% of 487 respondents believed their dialysis centers were presently providing high-quality supportive care. They identified bereavement support, spiritual support, and end-of-life care discussions as the top three unmet needs. They reported that lack of a predictive algorithm for prognosis was the top barrier, and "guidelines to help with decision-making in seriously ill patients" was the top priority to improve supportive care. A majority of respondents were unaware that an evidence-based validated prognostic model and a clinical practice guideline to help with decision-making were already available. Dialysis professionals report significant unmet supportive care needs and barriers in their centers with only a small minority rating themselves as competently providing supportive care. There is an urgent need for education of dialysis professionals about available supportive care resources to provide quality supportive care to dialysis patients. Copyright © 2016. Published by Elsevier Inc.

Supervising community health workers in low-income countries – a review of impact and implementation issues

PubMed Central

Hill, Zelee; Dumbaugh, Mari; Benton, Lorna; Källander, Karin; Strachan, Daniel; Asbroek, Augustinus ten; Tibenderana, James; Kirkwood, Betty; Meek, Sylvia

2014-01-01

Background Community health workers (CHWs) are an increasingly important component of health systems and programs. Despite the recognized role of supervision in ensuring CHWs are effective, supervision is often weak and under-supported. Little is known about what constitutes adequate supervision and how different supervision strategies influence performance, motivation, and retention. Objective To determine the impact of supervision strategies used in low- and middle-income countries and discuss implementation and feasibility issues with a focus on CHWs. Design A search of peer-reviewed, English language articles evaluating health provider supervision strategies was conducted through November 2013. Included articles evaluated the impact of supervision in low- or middle-income countries using a controlled, pre-/post- or observational design. Implementation and feasibility literature included both peer-reviewed and gray literature. Results A total of 22 impact papers were identified. Papers were from a range of low- and middle-income countries addressing the supervision of a variety of health care providers. We classified interventions as testing supervision frequency, the supportive/facilitative supervision package, supervision mode (peer, group, and community), tools (self-assessment and checklists), focus (quality assurance/problem solving), and training. Outcomes included coverage, performance, and perception of quality but were not uniform across studies. Evidence suggests that improving supervision quality has a greater impact than increasing frequency of supervision alone. Supportive supervision packages, community monitoring, and quality improvement/problem-solving approaches show the most promise; however, evaluation of all strategies was weak. Conclusion Few supervision strategies have been rigorously tested and data on CHW supervision is particularly sparse. This review highlights the diversity of supervision approaches that policy makers have to choose from and, while choices should be context specific, our findings suggest that high-quality supervision that focuses on supportive approaches, community monitoring, and/or quality assurance/problem solving may be most effective. PMID:24815075

Water quality monitoring strategies - A review and future perspectives.

PubMed

Behmel, S; Damour, M; Ludwig, R; Rodriguez, M J

2016-11-15

The reliable assessment of water quality through water quality monitoring programs (WQMPs) is crucial in order for decision-makers to understand, interpret and use this information in support of their management activities aiming at protecting the resource. The challenge of water quality monitoring has been widely addressed in the literature since the 1940s. However, there is still no generally accepted, holistic and practical strategy to support all phases of WQMPs. The purpose of this paper is to report on the use cases a watershed manager has to address to plan or optimize a WQMP from the challenge of identifying monitoring objectives; selecting sampling sites and water quality parameters; identifying sampling frequencies; considering logistics and resources to the implementation of actions based on information acquired through the WQMP. An inventory and critique of the information, approaches and tools placed at the disposal of watershed managers was proposed to evaluate how the existing information could be integrated in a holistic, user-friendly and evolvable solution. Given the differences in regulatory requirements, water quality standards, geographical and geological differences, land-use variations, and other site specificities, a one-in-all solution is not possible. However, we advance that an intelligent decision support system (IDSS) based on expert knowledge that integrates existing approaches and past research can guide a watershed manager through the process according to his/her site-specific requirements. It is also necessary to tap into local knowledge and to identify the knowledge needs of all the stakeholders through participative approaches based on geographical information systems and adaptive survey-based questionnaires. We believe that future research should focus on developing such participative approaches and further investigate the benefits of IDSS's that can be updated quickly and make it possible for a watershed manager to obtain a timely, holistic view and support for every aspect of planning and optimizing a WQMP. Copyright © 2016 Elsevier B.V. All rights reserved.

Religious Coping and Quality of LifefAmong Individuals Living With Schizophrenia

PubMed Central

Nolan, Jennifer A.; McEvoy, Joseph P.; Koenig, Harold G.; Hooten, Elizabeth G.; Whetten, Kathryn; Pieper, Carl F.

2013-01-01

Objective This study investigated the relationship between positive and negative religious coping and quality of life among outpatients with schizophrenia. Methods Interviews were conducted with 63 adults in the southeastern United States. Religious coping was measured by the 14-item RCOPE and quality of life by the World Health Organization Quality of Life–BREF. Data were examined via descriptive bivariate statistics and controlled analyses. Results Most participants reported participation in private religious or spiritual activities (91%) and participation in public religious services or activities (68%). Positive religious coping was related to the quality-of-life facet of psychological health (r=.28, p=.03). Negative religious coping and quality of life were inversely related (r=−.30, p=.02). Positive religious coping was associated with psychological health in the reduced univariate general linear model (B=.72, p=.03, adjusted R2=.08). Conclusions Greater awareness of the importance of religion in this population may improve cultural competence in treatment and community support. PMID:23032680

Building quality into medical product software design.

PubMed

Mallory, S R

1993-01-01

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

Peer support preferences among African-American breast cancer survivors and caregivers.

PubMed

Haynes-Maslow, Lindsey; Allicock, Marlyn; Johnson, La-Shell

2017-05-01

Breast cancer mortality rates continue to improve due to advances in cancer control and treatment. However, gains in breast cancer survival rates vary by race. Psychosocial support systems can lead to improved health outcomes among cancer survivors. This study was a part of a larger study exploring the challenges that both African-American cancer survivors and caregivers face across the cancer continuum. The objective of this paper was to explore African-American breast cancer survivors' and caregivers' preferences regarding characteristics and qualities of Peer Connect guides to inform the development of a peer support program. Forty-one African-American cancer survivors and caregivers participated in five focus groups lasting approximately 90 min. Participants were asked about what qualities or characteristics they would prefer in a peer support guide to make them feel comfortable talking with them. Focus group transcripts were analyzed using thematic content analysis, an iterative coding process. Themes were identified based on the research team's integrated and unified final codes. Twenty-two cancer survivors, 19 caregivers, and 3 individuals who were both survivors and caregivers participated in the focus groups. Participants discussed five preferences for peer support guides: (1) competency, (2) gender, (3) age, (4) cancer role status, and (5) relationship to participant. This study highlights cancer survivors' and caregivers' perceptions of characteristics needed for peer support providers that in turn can influence whether and how they participate in cancer support programs.

Identifying high quality medical education websites in Otolaryngology: a guide for medical students and residents.

PubMed

Yang, Nathan; Hosseini, Sarah; Mascarella, Marco A; Young, Meredith; Posel, Nancy; Fung, Kevin; Nguyen, Lily H P

2017-05-25

Learners often utilize online resources to supplement formalized curricula, and to appropriately support learning, these resources should be of high quality. Thus, the objectives of this study are to develop and provide validity evidence supporting an assessment tool designed to assess the quality of educational websites in Otolaryngology- Head & Neck Surgery (ORL-HNS), and identify those that could support effective web-based learning. METHODS: After a literature review, the Modified Education in Otolaryngology Website (MEOW) assessment tool was designed by a panel of experts based on a previously validated website assessment tool. A search strategy using a Google-based search engine was used subsequently to identify websites. Those that were free of charge and in English were included. Websites were coded for whether their content targeted medical students or residents. Using the MEOW assessment tool, two independent raters scored the websites. Inter-rater and intra-rater reliability were evaluated, and scores were compared to recommendations from a content expert. The MEOW assessment tool included a total of 20 items divided in 8 categories related to authorship, frequency of revision, content accuracy, interactivity, visual presentation, navigability, speed and recommended hyperlinks. A total of 43 out of 334 websites identified by the search met inclusion criteria. The scores generated by our tool appeared to differentiate higher quality websites from lower quality ones: websites that the expert "would recommend" scored 38.4 (out of 56; CI [34.4-42.4]) and "would not recommend" 27.0 (CI [23.2-30.9]). Inter-rater and intra-rater intraclass correlation coefficient were greater than 0.7. Using the MEOW assessment tool, high quality ORL-HNS educational websites were identified.

Internet Interventions for Long-Term Conditions: Patient and Caregiver Quality Criteria

PubMed Central

Murray, Elizabeth; Stevenson, Fiona; Gore, Charles; Nazareth, Irwin

2006-01-01

Background Interactive health communication applications (IHCAs) that combine high-quality health information with interactive components, such as self-assessment tools, behavior change support, peer support, or decision support, are likely to benefit people with long-term conditions. IHCAs are now largely Web-based and are becoming known as "Internet interventions." Although there are numerous professionally generated criteria to assess health-related websites, to date there has been scant exploration of patient-generated assessment criteria even though patients and professionals use different criteria for assessing the quality of traditional sources of health information. Objective We aimed to determine patients' and caregivers' requirements of IHCAs for long-term conditions as well as their criteria for assessing the quality of different programs. Methods This was a qualitative study with focus groups. Patients and caregivers managing long-term conditions used three (predominantly Web-based) IHCAs relevant to their condition and subsequently discussed the strengths and weaknesses of the different IHCAs in focus groups. Participants in any one focus group all shared the same long-term condition and viewed the same three IHCAs. Patient and caregiver criteria for IHCAs emerged from the data. Results There were 40 patients and caregivers who participated in 10 focus groups. Participants welcomed the potential of Internet interventions but felt that many were not achieving their full potential. Participants generated detailed and specific quality criteria relating to information content, presentation, interactivity, and trustworthiness, which can be used by developers and purchasers of Internet interventions. Conclusions The user-generated quality criteria reported in this paper should help developers and purchasers provide Internet interventions that better meet user needs. PMID:16954123

Health-related quality of life in Asian patients with breast cancer: a systematic review

PubMed Central

Gernaat, Sofie A M; Hartman, Mikael

2018-01-01

Objective To summarise the evidence on determinants of health-related quality of life (HRQL) in Asian patients with breast cancer. Design Systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and registered with PROSPERO (CRD42015032468). Methods According to the PRISMA guidelines, databases of MEDLINE (PubMed), Embase and PsycINFO were systematically searched using the following terms and synonyms: breast cancer, quality of life and Asia. Articles reporting on HRQL using EORTC-QLQ-C30, EORTC-QLQ-BR23, FACT-G and FACT-B questionnaires in Asian patients with breast cancer were eligible for inclusion. The methodological quality of each article was assessed using the quality assessment scale for cross-sectional studies or the Newcastle-Ottawa Quality Assessment Scale for cohort studies. Results Fifty-seven articles were selected for this qualitative synthesis, of which 43 (75%) were cross-sectional and 14 (25%) were longitudinal studies. Over 75 different determinants of HRQL were studied with either the EORTC or FACT questionnaires. Patients with comorbidities, treated with chemotherapy, with less social support and with more unmet needs have poorer HRQL. HRQL improves over time. Discordant results in studies were found in the association of age, marital status, household income, type of surgery, radiotherapy and hormone therapy and unmet sexuality needs with poor global health status or overall well-being. Conclusions In Asia, patients with breast cancer, in particular those with other comorbidities and those treated with chemotherapy, with less social support and with more unmet needs, have poorer HRQL. Appropriate social support and meeting the needs of patients may improve patients’ HRQL. PMID:29678980

Development and Psychometric Evaluation of a Health-Related Quality of Life Instrument for Individuals with Adult-Onset Hearing Loss

PubMed Central

Stika, Carren J.; Hays, Ron D.

2016-01-01

Objective Self-reports of “hearing handicap” are available, but a comprehensive measure of health-related quality of life (HRQOL) for individuals with adult-onset hearing loss (AOHL) does not exist. Our objective was to develop and evaluate a multidimensional HRQOL instrument for individuals with AOHL. Design The Impact of Hearing Loss Inventory Tool (IHEAR-IT) was developed using results of focus groups, a literature review, Advisory Expert Panel input, and cognitive interviews. Study Sample The 73-item field-test instrument was completed by 409 adults (22-91 years old) with varying degrees of AOHL and from different areas of the US. Results Multitrait scaling analysis supported four multi-item scales and five individual items. Internal consistency reliabilities ranged from 0.93 to 0.96 for the scales. Construct validity was supported by correlations between the IHEAR-IT scales and scores on the 36-Item Short Form Health Survey, Version 2.0 (SF-36v2) Mental Composite Summary (r’s = 0.32 – 0.64) and the Hearing Handicap Inventory for the Elderly/Adults (HHIE/HHIA) (r’s > −0.70). Conclusions The field test provide initial support for the reliability and construct validity of the IHEAR-IT for evaluating HRQOL of individuals with AOHL. Further research is needed to evaluate the responsiveness to change of the IHEAR-IT scales and identify items for a short-form. PMID:27104754

[Interaction between clinical and research towards venture business].

PubMed

Sumida, Iori

2014-01-01

The author as a medical physicist has supported multiple institutions where the advanced radiation therapies as well as the conventional radiation therapy have been performed. Since the advanced radiation treatment techniques have spread rapidly, the quality assurance (QA) has been more important and complex that results in the increase of QA items. In order to maintain the quality of radiation therapy as accurate as possible, the efficient and objective approach for performing QA should be important. Author has developed some QA software which has solved those approaches based on the experiment. In this paper the background in multiple institutions as a view point of radiation treatment situation is presented and what author contributes to those institutions by a medical physics support is shown, finally it is considered that how the developed software has spread in Japan and used for many institutions via venture business.

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.

[Medical indications for acupuncture: Systematic review].

PubMed

Muñoz-Ortego, Juan; Solans-Domènech, Maite; Carrion, Carme

2016-09-16

Acupuncture is a medical procedure with a very wide range of indications according to the WHO. However the indications require robust scientific evidence to support them. We have conducted a systematic review (2010-2015) in order to define in which pathologies acupuncture can be an effective strategy, STRICTA criteria that aim to set up acupuncture clinical trials standard criteria were defined in 2010. Only systematic reviews and meta-analyses of good or very good methodological quality according to SIGN criteria were selected. Its main objective was to evaluate the effectiveness of acupuncture in the management of any disease. Most of the final 31 selected reviews focus on chronic pain-related diseases, mainly in the disciplines of Neurology, Orthopaedics and Rheumatology. Current evidence supports the use of acupuncture in the treatment of headaches, migraines, back pain, cervical pain and osteoarthritis. The remaining pathologies still require further good quality studies. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Evaluation of a newly developed media-supported 4-step approach for basic life support training

PubMed Central

2012-01-01

Objective The quality of external chest compressions (ECC) is of primary importance within basic life support (BLS). Recent guidelines delineate the so-called 4“-step approach” for teaching practical skills within resuscitation training guided by a certified instructor. The objective of this study was to evaluate whether a “media-supported 4-step approach” for BLS training leads to equal practical performance compared to the standard 4-step approach. Materials and methods After baseline testing, 220 laypersons were either trained using the widely accepted method for resuscitation training (4-step approach) or using a newly created “media-supported 4-step approach”, both of equal duration. In this approach, steps 1 and 2 were ensured via a standardised self-produced podcast, which included all of the information regarding the BLS algorithm and resuscitation skills. Participants were tested on manikins in the same mock cardiac arrest single-rescuer scenario prior to intervention, after one week and after six months with respect to ECC-performance, and participants were surveyed about the approach. Results Participants (age 23 ± 11, 69% female) reached comparable practical ECC performances in both groups, with no statistical difference. Even after six months, there was no difference detected in the quality of the initial assessment algorithm or delay concerning initiation of CPR. Overall, at least 99% of the intervention group (n = 99; mean 1.5 ± 0.8; 6-point Likert scale: 1 = completely agree, 6 = completely disagree) agreed that the video provided an adequate introduction to BLS skills. Conclusions The “media-supported 4-step approach” leads to comparable practical ECC-performance compared to standard teaching, even with respect to retention of skills. Therefore, this approach could be useful in special educational settings where, for example, instructors’ resources are sparse or large-group sessions have to be prepared. PMID:22647148

[Clinical trial data management and quality metrics system].

PubMed

Chen, Zhao-hua; Huang, Qin; Deng, Ya-zhong; Zhang, Yue; Xu, Yu; Yu, Hao; Liu, Zong-fan

2015-11-01

Data quality management system is essential to ensure accurate, complete, consistent, and reliable data collection in clinical research. This paper is devoted to various choices of data quality metrics. They are categorized by study status, e.g. study start up, conduct, and close-out. In each category, metrics for different purposes are listed according to ALCOA+ principles such us completeness, accuracy, timeliness, traceability, etc. Some general quality metrics frequently used are also introduced. This paper contains detail information as much as possible to each metric by providing definition, purpose, evaluation, referenced benchmark, and recommended targets in favor of real practice. It is important that sponsors and data management service providers establish a robust integrated clinical trial data quality management system to ensure sustainable high quality of clinical trial deliverables. It will also support enterprise level of data evaluation and bench marking the quality of data across projects, sponsors, data management service providers by using objective metrics from the real clinical trials. We hope this will be a significant input to accelerate the improvement of clinical trial data quality in the industry.

Understanding the Role of the Professional Practice Environment on Quality of Care in Magnet® and Non-Magnet Hospitals

PubMed Central

Stimpfel, Amy Witkoski; Rosen, Jennifer E.; McHugh, Matthew D.

2017-01-01

OBJECTIVE The aim of this study was to explore the relationship between Magnet Recognition® and nurse-reported quality of care. BACKGROUND Magnet® hospitals are recognized for nursing excellence and quality patient outcomes; however, few studies have explored contributing factors for these superior outcomes. METHODS This was a secondary analysis of linked nurse survey data, hospital administrative data, and a listing of American Nurses Credentialing Center Magnet hospitals. Multivariate regressions were modeled before and after propensity score matching to assess the relationship between Magnet status and quality of care. A mediation model assessed the indirect effect of the professional practice environment on quality of care. RESULTS Nurse-reported quality of care was significantly associated with Magnet Recognition after matching. The professional practice environment mediates the relationship between Magnet status and quality of care. CONCLUSION A prominent feature of Magnet hospitals, a professional practice environment that is supportive of nursing, plays a role in explaining why Magnet hospitals have better nurse-reported quality of care. PMID:26426138

Understanding the Role of the Professional Practice Environment on Quality of Care in Magnet® and Non-Magnet Hospitals

PubMed Central

Stimpfel, Amy Witkoski; Rosen, Jennifer E.; McHugh, Matthew D.

2014-01-01

OBJECTIVE The aim of this study was to explore the relationship between Magnet Recognition® and nurse-reported quality of care. BACKGROUND Magnet® hospitals are recognized for nursing excellence and quality patient outcomes; however, few studies have explored contributing factors for these superior outcomes. METHODS This was a secondary analysis of linked nurse survey data, hospital administrative data, and a listing of American Nurses Credentialing Center Magnet hospitals. Multivariate regressions were modeled before and after propensity score matching to assess the relationship between Magnet status and quality of care. A mediation model assessed the indirect effect of the professional practice environment on quality of care. RESULTS Nurse-reported quality of care was significantly associated with Magnet Recognition after matching. The professional practice environment mediates the relationship between Magnet status and quality of care. CONCLUSION A prominent feature of Magnet hospitals, a professional practice environment that is supportive of nursing, plays a role in explaining why Magnet hospitals have better nurse-reported quality of care. PMID:24316613

Sleep, Dietary, and Exercise Behavioral Clusters among Truck Drivers with Obesity: Implications for Interventions

PubMed Central

Olson, Ryan; Thompson, Sharon V.; Wipfli, Brad; Hanson, Ginger; Elliot, Diane L.; Anger, W. Kent; Bodner, Todd; Hammer, Leslie B.; Hohn, Elliot; Perrin, Nancy A.

2015-01-01

Objective Our objectives were to describe a sample of truck drivers, identify clusters of drivers with similar patterns in behaviors affecting energy balance (sleep, diet, and exercise), and test for cluster differences in health and psychosocial factors. Methods Participants’ (n=452, BMI M=37.2, 86.4% male) self-reported behaviors were dichotomized prior to hierarchical cluster analysis, which identified groups with similar behavior co-variation. Cluster differences were tested with generalized estimating equations. Results Five behavioral clusters were identified that differed significantly in age, smoking status, diabetes prevalence, lost work days, stress, and social support, but not in BMI. Cluster 2, characterized by the best sleep quality, had significantly lower lost workdays and stress than other clusters. Conclusions Weight management interventions for drivers should explicitly address sleep, and may be maximally effective after establishing socially supportive work environments that reduce stress exposures. PMID:26949883

Recommendations resulting from the SPDS Community-Wide Workshop

NASA Technical Reports Server (NTRS)

1993-01-01

The Data Systems Panel identified three critical functionalities of a Space Physics Data System (SPDS): the delivery of self-documenting data, the existence of a matrix of translators between various standard formats (IDFS, CDF, netCDF, HDF, TENNIS, UCLA flat file, and FITS), and a network-based capability for browsing and examining inventory records for the system's data holdings. The recommendations resulting from the workshop include the philosophy, funding, and objectives of a SPDS. Access to quality data is seen as the most important objective by the Policy Panel, with curation and information about the data being integral parts of any accessible data set. The Data Issues Panel concluded that the SPDS can supply encouragement, guidelines, and ultimately provide a mechanism for financial support for data archiving, restoration, and curation. The Software Panel of the SPDS focused on defining the requirements and priorities for SPDS to support common data analysis and data visualization tools and packages.

Grape colour phenotyping: development of a method based on the reflectance spectrum.

PubMed

Rustioni, Laura; Basilico, Roberto; Fiori, Simone; Leoni, Alessandra; Maghradze, David; Failla, Osvaldo

2013-01-01

The colour of fruit is an important quality factor for cultivar classification and phenotyping techniques. Besides the subjective visual evaluation, new instruments and techniques can be used. This work aims at developping an objective, fast, easy and non-destructive method as a useful support for evaluating grapes' colour under different cultural and environmental conditions, as well as for breeding process and germplasm evaluation, supporting the plant characterization and the biodiversity preservation. Colours of 120 grape varieties were studied using reflectance spectra. The classification was realized using cluster and discriminant analysis. Reflectance of the whole berries surface was also compared with absorption properties of single skin extracts. A phenotyping method based on the reflectance spectra was developed, producing reliable colour classifications. A cultivar-independent index for pigment content evaluation has also been obtained. This work allowed the classification of the berry colour using an objective method. Copyright © 2013 John Wiley & Sons, Ltd.

GeoViQua: quality-aware geospatial data discovery and evaluation

NASA Astrophysics Data System (ADS)

Bigagli, L.; Papeschi, F.; Mazzetti, P.; Nativi, S.

2012-04-01

GeoViQua (QUAlity aware VIsualization for the Global Earth Observation System of Systems) is a recently started FP7 project aiming at complementing the Global Earth Observation System of Systems (GEOSS) with rigorous data quality specifications and quality-aware capabilities, in order to improve reliability in scientific studies and policy decision-making. GeoViQua main scientific and technical objective is to enhance the GEOSS Common Infrastructure (GCI) providing the user community with innovative quality-aware search and evaluation tools, which will be integrated in the GEO-Portal, as well as made available to other end-user interfaces. To this end, GeoViQua will promote the extension of the current standard metadata for geographic information with accurate and expressive quality indicators, also contributing to the definition of a quality label (GEOLabel). GeoViQua proposed solutions will be assessed in several pilot case studies covering the whole Earth Observation chain, from remote sensing acquisition to data processing, to applications in the main GEOSS Societal Benefit Areas. This work presents the preliminary results of GeoViQua Work Package 4 "Enhanced geo-search tools" (WP4), started in January 2012. Its major anticipated technical innovations are search and evaluation tools that communicate and exploit data quality information from the GCI. In particular, GeoViQua will investigate a graphical search interface featuring a coherent and meaningful aggregation of statistics and metadata summaries (e.g. in the form of tables, charts), thus enabling end users to leverage quality constraints for data discovery and evaluation. Preparatory work on WP4 requirements indicated that users need the "best" data for their purpose, implying a high degree of subjectivity in judgment. This suggests that the GeoViQua system should exploit a combination of provider-generated metadata (objective indicators such as summary statistics), system-generated metadata (contextual/tracking information such as provenance of data and metadata), and user-generated metadata (informal user comments, usage information, rating, etc.). Moreover, metadata should include sufficiently complete access information, to allow rich data visualization and propagation. The following main enabling components are currently identified within WP4: - Quality-aware access services, e.g. a quality-aware extension of the OGC Sensor Observation Service (SOS-Q) specification, to support quality constraints for sensor data publishing and access; - Quality-aware discovery services, namely a quality-aware extension of the OGC Catalog Service for the Web (CSW-Q), to cope with quality constrained search; - Quality-augmentation broker (GeoViQua Broker), to support the linking and combination of the existing GCI metadata with GeoViQua- and user-generated metadata required to support the users in selecting the "best" data for their intended use. We are currently developing prototypes of the above quality-enabled geo-search components, that will be assessed in a sensor-based pilot case study in the next months. In particular, the GeoViQua Broker will be integrated with the EuroGEOSS Broker, to implement CSW-Q and federate (either via distribution or harvesting schemes) quality-aware data sources, GeoViQua will constitute a valuable test-bed for advancing the current best practices and standards in geospatial quality representation and exploitation. The research leading to these results has received funding from the European Community's Seventh Framework Programme (FP7/2007-2013) under Grant Agreement n° 265178.

Characteristics of health care organizations associated with learning and development: lessons from a pilot study.

PubMed

Nyström, Monica

2009-01-01

Characteristics of health care organizations associated with an ability to learn from experiences and to develop and manage change were explored in this study. Understanding of these characteristics is necessary to identify factors influencing success in learning from the past and achieving future health care quality objectives. A literature review of the quality improvement, strategic organizational development and change management, organizational learning, and microsystems fields identified 20 organizational characteristics, grouped under (a) organizational systems, (b) key actors, and (c) change management processes. Qualitative methods, using interviews, focus group reports, and archival records, were applied to find associations between identified characteristics and 6 Swedish health care units externally evaluated as delivering high-quality care. Strong support for a characteristic was defined as units having more than 4 sources describing the characteristic as an important success factor. Eighteen characteristics had strong support from at least 2 units. The strongest evidence was found for the following: (i) key actors have long-term commitment, provide support, and make sense of ambiguous situations; (ii) organizational systems encourage employee commitment, participation, and involvement; and (iii) change management processes are employed systematically. Based on the results, a new model of "characteristics associated with learning and development in health care organizations" is proposed.

Establishment and outcomes of a model primary care pharmacy service system.

PubMed

Carmichael, Jannet M; Alvarez, Autumn; Chaput, Ryan; DiMaggio, Jennifer; Magallon, Heather; Mambourg, Scott

2004-03-01

The establishment and outcomes of a model primary care pharmacy service system are described. A primary care pharmacy practice model was established at a government health care facility in March 1996. The original objective was to establish a primary pharmacy practice model that would demonstrate improved patient outcomes and maximize the pharmacist's contributions to drug therapy. Since its inception, many improvements have been realized and supported by advanced computer and automated systems, expanded disease state management practices, and unique practitioner and administrative support. Many outcomes studies have been performed on the pharmacist-initiated and -managed clinics, leading to improved patient care and conveying the quality-conscious and cost-effective role pharmacists can play as independent practitioners in this environment. These activities demonstrate cutting-edge leadership in health-system pharmacy. Redesign has been used to improve consistent access to a medication expert and has significantly improved the quality of patient care while easing physicians' workload without increasing health care costs. A system using pharmacists as independent practitioners to promote primary care has achieved high-quality and cost-effective patient care.

Web Services and Handle Infrastructure - WDCC's Contributions to International Projects

NASA Astrophysics Data System (ADS)

Föll, G.; Weigelt, T.; Kindermann, S.; Lautenschlager, M.; Toussaint, F.

2012-04-01

Climate science demands on data management are growing rapidly as climate models grow in the precision with which they depict spatial structures and in the completeness with which they describe a vast range of physical processes. The ExArch project is exploring the challenges of developing a software management infrastructure which will scale to the multi-exabyte archives of climate data which are likely to be crucial to major policy decisions in by the end of the decade. The ExArch approach to future integration of exascale climate archives is based on one hand on a distributed web service architecture providing data analysis and quality control functionality across archvies. On the other hand a consistent persistent identifier infrastructure is deployed to support distributed data management and data replication. Distributed data analysis functionality is based on the CDO climate data operators' package. The CDO-Tool is used for processing of the archived data and metadata. CDO is a collection of command line Operators to manipulate and analyse Climate and forecast model Data. A range of formats is supported and over 500 operators are provided. CDO presently is designed to work in a scripting environment with local files. ExArch will extend the tool to support efficient usage in an exascale archive with distributed data and computational resources by providing flexible scheduling capabilities. Quality control will become increasingly important in an exascale computing context. Researchers will be dealing with millions of data files from multiple sources and will need to know whether the files satisfy a range of basic quality criterea. Hence ExArch will provide a flexible and extensible quality control system. The data will be held at more than 30 computing centres and data archives around the world, but for users it will appear as a single archive due to a standardized ExArch Web Processing Service. Data infrastructures such as the one built by ExArch can greatly benefit from assigning persistent identifiers (PIDs) to the main entities, such as data and metadata records. A PID should then not only consist of a globally unique identifier, but also support built-in facilities to relate PIDs to each other, to build multi-hierarchical virtual collections and to enable attaching basic metadata directly to PIDs. With such a toolset, PIDs can support crucial data management tasks. For example, data replication performed in ExArch can be supported through PIDs as they can help to establish durable links between identical copies. By linking derivative data objects together, their provenance can be traced with a level of detail and reliability currently unavailable in the Earth system modelling domain. Regarding data transfers, virtual collections of PIDs may be used to package data prior to transmission. If the PID of such a collection is used as the primary key in data transfers, safety of transfer and traceability of data objects across repositories increases. End-users can benefit from PIDs as well since they make data discovery independent from particular storage sites and enable user-friendly communication about primary research objects. A generic PID system can in fact be a fundamental building block for scientific e-infrastructures across projects and domains.

Evaluation of training programme uptake in an attempt to reduce obstetric anal sphincter injuries: the SUPPORT programme.

PubMed

Rahman, Nadia; Vinayakarao, Latha; Pathak, Sangeeta; Minden, Dawn; Melson, Louise; Vitue, Ella; Pradhan, A

2017-03-01

The objective was to assess the feedback from a quality improvement training programme to reduce obstetric anal sphincter injuries (OASIS). Training sessions were organised that included evidence-based information on OASIS risk factors and training on models to measure perineal body length (PBL), perform episiotomies with standard and 60° fixed angle scissors (EPISCISSORS-60®), and measure post-delivery episiotomy suture angles with protractor transparencies. Feedback forms using a Likert scale (1-4) were completed and analysed. The setting was an evidence-based quality improvement programme (Strategy for Using Practical aids for Prevention of OASIS, Recording episiotomies and clinician Training [SUPPORT]) at two National Health Service (NHS) Hospitals in the UK. The participants were midwives and doctors attending the SUPPORT training programme RESULTS: All of the participants (100 %) would recommend the training programme to a friend or colleague. 92 % felt that the training session improved their knowledge of the impact of PBL and perineal distension and their knowledge of the relationship between episiotomy angle and OASIS "a lot" or "somewhat". Based on this feedback, we recommend the addition of the knowledge content of the SUPPORT programme to other centres providing perineal assessment and repair courses.

[An individualized life project: from theory to practice].

PubMed

Lombard, Marie; Léchenet, Martine; Dupuis, Justine; Milleret, Marianne; Weyrich, Alain; Jasmin, Jaon

2012-01-01

A life project defines the conditions of personalised treatment and support. The main objective is to consider the human being from an ethical perspective, to respect an individual's dignity and rights despite the dependency, as well as to provide a decent quality of life for the user. It mobilises all the caregivers, refocusing their actions on the resident, in accordance with his or her wishes and those of the family.

Analyzing the Critical Supply Chain For Unmanned Aircraft Systems

DTIC Science & Technology

2017-03-23

with a decision support tool that facilitates interdiction strategy planning. Overall, the different models developed in the study provide modeling...allow adaptation to different levels of fidelity of the supply chain, based on the user’s mission objectives and available data. A House of Quality...priorities are unknown or incorrect. 1.7 Implications The models presented in this research can be utilized from two different perspectives of

Identifying best practice principles of audit in health care.

PubMed

Patel, S

Audit is recognised as a crucial component of improving the quality of patient care. Examples include giving patients safe, reliable and dignified care, enhancing their experiences and satisfaction by encouraging them to self-direct their recovery, and reducing the length of stay in hospital, readmission rates and delayed discharge. This article describes clinical audit, the stages involved in the process and the support required to achieve strategic objectives.

El Poder de Cambiar: La Experiencia del Proyecto Costa Atlantica de Colombia (The Power To Change: The Experience of the Atlantic Coast Project in Columbia, 1977-1989).

ERIC Educational Resources Information Center

Chetley, Andrew

In 1977, the Bernard van Leer Foundation began supporting a project in Colombia that had the objective of improving the quality of early childhood care and education in a small village. The Costa Atlantica project offered an approach to development that was based on community organization, social management, participation, cooperation, popular…

An object-relational model for structured representation of medical knowledge.

PubMed

Koch, S; Risch, T; Schneider, W; Wagner, I V

2006-07-01

Domain specific knowledge is often not static but continuously evolving. This is especially true for the medical domain. Furthermore, the lack of standardized structures for presenting knowledge makes it difficult or often impossible to assess new knowledge in the context of existing knowledge. Possibilities to compare knowledge easily and directly are often not given. It is therefore of utmost importance to create a model that allows for comparability, consistency and quality assurance of medical knowledge in specific work situations. For this purpose, we have designed on object-relational model based on structured knowledge elements that are dynamically reusable by different multi-media-based tools for case-based documentation, disease course simulation, and decision support. With this model, high-level components, such as patient case reports or simulations of the course of a disease, and low-level components (e.g., diagnoses, symptoms or treatments) as well as the relationships between these components are modeled. The resulting schema has been implemented in AMOS II, on object-relational multi-database system supporting different views with regard to search and analysis depending on different work situations.

The Need to Objectively Measure Physical Activity During Pregnancy: Considerations for Clinical Research and Public Health Impact.

PubMed

Guérin, Eva; Ferraro, Zachary M; Adamo, Kristi B; Prud'homme, Denis

2018-05-01

Engaging in recommended levels of physical activity during pregnancy can provide a host of physical and mental health benefits for the expecting mother and her child. However, methodological issues related to physical activity measurement have plagued many studies examining the effects of physical activity during this important life stage. Burgeoning support exists for the more widespread use of objective methods, and accelerometers specifically, for an accurate appraisal of maternal physical activity. In this commentary, we highlight discrepancies between activity estimates obtained via self-report and objective measures and describe the implications of erroneous measurement when making clinical recommendations and in conducting future physical activity and pregnancy research. Most importantly, we aim to foster academic discussion and propose a call to action requiring a paradigm shift where we acknowledge the shortcomings of self-report and move toward an empirically driven approach for physical activity measurement. Results from more high-quality research studies will help support public health messaging and facilitate trust among health care providers, clinical researchers, and expecting mothers regarding the health benefits of physical activity recommendations.

Development of comprehensive remediation standards at San Francisco International Airport

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

Grosso, A.; Lawler, M.; Meek, S.

1995-12-31

An ongoing expansion at the San Francisco International Airport (Airport) will result in a 35 percent increase in both terminal square footage and passenger handling capability. Facility relocation and construction are set to begin in October, 1995. Appropriate cleanup of contaminated soil and groundwater must be completed prior to this activity. Remedial goals for this major industrial facility must be protective of both human health and the environment. A risk-based strategy for the development of recommended cleanup objectives has been developed with the support of state regulatory agencies. This strategy includes Remediation Management Zones (RMZs), distinct regions at the Airportmore » with different remedial goals based on the associated risk to water quality, human health, and the environment. The RMZs and the final cleanup objectives for the Airport will be finalized by mid-1995, and will be used to govern future cleanup efforts at the site. This presentation will describe the history of the project, the determination of human health and ecological buffer zones, and the integration of these two concepts to produce cleanup objectives fully supported by the state regulatory authority.« less

Social Support of Patients with Type 2 Diabetes in Marginalized Contexts in Mexico and Its Relation to Compliance with Treatment: A Sociocultural Approach

PubMed Central

Juárez-Ramírez, Clara; Théodore, Florence L.; Villalobos, Aremis; Jiménez-Corona, Aida; Lerin, Sergio; Nigenda, Gustavo; Lewis, Sarah

2015-01-01

Objective This study aimed to describe the ways social support works in the daily life of patients with type 2 diabetes living in conditions of social and economic marginality, in order to understand how that support relates to treatment compliance. Methods Sequential mixed methods research was used. The sample of patients was obtained from primary health care units and selected considering regional representativeness, and levels of morbidity and mortality for type 2 diabetes. Results Results point to the nuclear family as the main source of support. Regardless of the area of residence, four main dimensions of support were identified: economic support, help with treatment compliance, emotional support, and material aid. Conclusions We conclude that the support network assists the patient in different ways and helps cope with the disease, but in conditions of social and economic marginality, does not guarantee the quality of attention nor enable the self-management of treatment. PMID:26545122

Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice

PubMed Central

Coughlin, Mary; Gibbins, Sharyn; Hoath, Steven

2009-01-01

Title Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. Aim This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units. Background Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America’s Joint Commission’s concept of ‘core measures’ for evaluating and accrediting healthcare organizations. This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model. Data sources Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. Discussion Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads. Conclusion Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes. PMID:19686402

Hydrogen Fuel Quality

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

Rockward, Tommy

2012-07-16

For the past 6 years, open discussions and/or meetings have been held and are still on-going with OEM, Hydrogen Suppliers, other test facilities from the North America Team and International collaborators regarding experimental results, fuel clean-up cost, modeling, and analytical techniques to help determine levels of constituents for the development of an international standard for hydrogen fuel quality (ISO TC197 WG-12). Significant progress has been made. The process for the fuel standard is entering final stages as a result of the technical accomplishments. The objectives are to: (1) Determine the allowable levels of hydrogen fuel contaminants in support of themore » development of science-based international standards for hydrogen fuel quality (ISO TC197 WG-12); and (2) Validate the ASTM test method for determining low levels of non-hydrogen constituents.« less

Modeling Study of the Marano and Grado Lagoon (Italy) to Support the Regional Water Protection Plan) TO SUPPORT THE REGIONAL WATER PROTECTION PLAN

NASA Astrophysics Data System (ADS)

Scroccaro, Isabella; Mattassi, Giorgio

2014-05-01

The Water Framework Directive 2000/60/EC (WFD) contemplates the classification of water bodies and establishes the quality objectives of water bodies to achieve a good status within 2015. Further, the Italian law which takes in the WFD with Decree n. 152/2006, allows to identify some water bodies as heavily modified (HMWB). The Regional Administration, involved in the setting up of the Water Protection Plan, according with the above mentioned decree and directive, has to establish specific programs to maintain or conform water quality to the requested quality objectives, also for heavily modified water bodies that have to reach the ecological potential. In the north-eastern part of Italy, in the Friuli Venezia Giulia Region, the Marano and Grado Lagoon is the most complex transitional ecosystem in which four water bodies have been temporarily classified as heavily modified. They are identified as FM1, FM2, FM3 and FM4. In particular, FM2 - "Paludo della Carogna" and FM3 - "Barbana" water bodies seem to be characterized by some confinement since they are delimited by a bridge, called "Ponte Belvedere". The preliminary evaluation of the quality status of FM2 and FM3 water bodies is conditioned by the value of one of the quality criteria: the macrophytes. In fact, macrophytes are represented by very few species in these two water bodies. In a preliminary way the overall judgement of FM2 and FM3 water bodies has been indicated by the experts as scarse. This means that a specific programme of measures has to be proposed to improve the quality status of these water bodies in order to reach the ecological potential. In this context modeling may be used as a scientific and technical tool to support the evaluation on FM2 and FM3 water bodies and the effectiveness of specific measures for the achievement of the quality objectives. Numerical simulations of the Marano and Grado lagoon were performed for hydrodynamic circulation, temperature and salinity behavior with the SHYFEM model, a shallow water finite element model developed at ISMAR-CNR in Venice (Ferrarin et al., 2010) and experimental data were used to calibrate the numerical model. In this study the effectiveness of some proposed measures is investigated with the SHYFEM model, trying to solve the problem of the scarse quality evaluation of FM2 and FM3 in the eastern part of the Marano and Grado lagoon. The proposals are: Modification of the bridge "Ponte Belvedere": the bridge, which divides FM2 and FM3 from the western part of the lagoon, has some openings which are not very large. The proposal is to enlarge these openings on the dam to assess if this action might improve the circulation and consequently the water quality. Excavation of a new channel on the bottom of the lagoon: besides the openings on the dam, it is also possible to hypothetically excavate one or more channels; these are preferential ways for the water to pass in and arrive to the areas in which the circulation has to be increased. This proposal seems to be efficient, with good effects on the inner circulation of the eastern lagoon.

222-S Laboratory Quality Assurance Plan. Revision 1

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

Meznarich, H.K.

1995-07-31

This Quality Assurance Plan provides,quality assurance (QA) guidance, regulatory QA requirements (e.g., 10 CFR 830.120), and quality control (QC) specifications for analytical service. This document follows the U.S Department of Energy (DOE) issued Hanford Analytical Services Quality Assurance Plan (HASQAP). In addition, this document meets the objectives of the Quality Assurance Program provided in the WHC-CM-4-2, Section 2.1. Quality assurance elements required in the Guidelines and Specifications for Preparing Quality Assurance Program Plans (QAMS-004) and Interim Guidelines and Specifications for Preparing Quality Assurance Project Plans (QAMS-005) from the US Environmental Protection Agency (EPA) are covered throughout this document. A qualitymore » assurance index is provided in the Appendix A. This document also provides and/or identifies the procedural information that governs laboratory operations. The personnel of the 222-S Laboratory and the Standards Laboratory including managers, analysts, QA/QC staff, auditors, and support staff shall use this document as guidance and instructions for their operational and quality assurance activities. Other organizations that conduct activities described in this document for the 222-S Laboratory shall follow this QA/QC document.« less

Effect of Computer Support on Younger Women with Breast Cancer

PubMed Central

Gustafson, David H; Hawkins, Robert; Pingree, Suzanne; McTavish, Fiona; Arora, Neeraj K; Mendenhall, John; Cella, David F; Serlin, Ronald C; Apantaku, Funmi M; Stewart, James; Salner, Andrew

2001-01-01

OBJECTIVE Assess impact of a computer-based patient support system on quality of life in younger women with breast cancer, with particular emphasis on assisting the underserved. DESIGN Randomized controlled trial conducted between 1995 and 1998. SETTING Five sites: two teaching hospitals (Madison, Wis, and Chicago, Ill), two nonteaching hospitals (Chicago), and a cancer resource center (Indianapolis, Ill). The latter three sites treat many underserved patients. PARTICIPANTS Newly diagnosed breast cancer patients (N = 246) under age 60. INTERVENTIONS Experimental group received Comprehensive Health Enhancement Support System (CHESS), a home-based computer system providing information, decision-making, and emotional support. MEASUREMENTS AND MAIN RESULTS Pretest and two post-test surveys (at two- and five-month follow-up) measured aspects of participation in care, social/information support, and quality of life. At two-month follow-up, the CHESS group was significantly more competent at seeking information, more comfortable participating in care, and had greater confidence in doctor(s). At five-month follow-up, the CHESS group had significantly better social support and also greater information competence. In addition, experimental assignment interacted with several indicators of medical underservice (race, education, and lack of insurance), such that CHESS benefits were greater for the disadvantaged than the advantaged group. CONCLUSIONS Computer-based patient support systems such as CHESS may benefit patients by providing information and social support, and increasing their participation in health care. These benefits may be largest for currently underserved populations. PMID:11520380

NURSE-LED INTERVENTION TO IMPROVE SURROGATE DECISION MAKING FOR PATIENTS WITH ADVANCED CRITICAL ILLNESS

PubMed Central

White, Douglas B.; Cua, Sarah Martin; Walk, Roberta; Pollice, Laura; Weissfeld, Lisa; Hong, Seoyeon; Landefeld, C. Seth; Arnold, Robert M.

2013-01-01

Background Problems persist with surrogate decision making in intensive care units, leading to distress for surrogates and treatment that may not reflect patients’ values. Objectives To assess the feasibility, acceptability, and perceived effectiveness of a multifaceted, nurse-led intervention to improve surrogate decision making in intensive care units. Study Design A single-center, single-arm, interventional study in which 35 surrogates and 15 physicians received the Four Supports Intervention, which involved incorporating a family support specialist into the intensive care team. That specialist maintained a longitudinal relationship with surrogates and provided emotional support, communication support, decision support, and anticipatory grief support. A mixed-methods approach was used to evaluate the intervention. Results The intervention was implemented successfully in all 15 patients, with a high level of completion of each component of the intervention. The family support specialist devoted a mean of 48 (SD 36) minutes per day to each clinician-patient-family triad. All participants reported that they would recommend the intervention to others. At least 90% of physicians and surrogates reported that the intervention (1) improved the quality and timeliness of communication, (2) facilitated discussion of the patient’s values and treatment preferences, and (3) improved the patient-centeredness of care. Conclusions The Four Supports Intervention is feasible, acceptable, and was perceived by physicians and surrogates to improve the quality of decision making and the patient-centeredness of care. A randomized trial is warranted to determine whether the intervention improves patient, family, and health system outcomes. PMID:23117903

An Analytical Model / Emotional Intelligence Quotient and QOL in Mothers with Infants in Japan.

PubMed

Ohashi, Junko; Katsura, Toshiki; Hoshino, Akiko; Usui, Kanae

2013-01-01

The purpose of this study was to examine the relationship between the emotional intelligence quotient and health-related quality of life using structural equation modeling. A self-administered questionnaire survey was conducted among 1,911 mothers who visited the Health Center for an infant medical examination. A hypothetical model was constructed using variables of the emotional intelligence quotient, social support, coping, parenting stress, and perceived health competence. There were a total of 1,104 valid responses (57.8%). Significant standardized estimates were obtained, confirming the goodness of fit issues with the model. The emotional intelligence quotient had a strong impact on physical and psychological quality of life, and showed the greatest association with coping. This study differed from previous studies in that, due to the inclusion of social support and explanatory variables in coping, an increase in coping strategies was more highly associated with emotional intelligence quotient levels than with social support. An enhanced emotional intelligence quotient should be considered a primary objective to promote the health of mothers with infant children.

Relationships between self-reported sleep quality components and cognitive functioning in breast cancer survivors up to 10 years following chemotherapy.

PubMed

Henneghan, Ashley M; Carter, Patricia; Stuifbergan, Alexa; Parmelee, Brennan; Kesler, Shelli

2018-04-23

Links have been made between aspects of sleep quality and cognitive function in breast cancer survivors (BCS), but findings are heterogeneous. The objective of this study is to examine relationships between specific sleep quality components (latency, duration, efficiency, daytime sleepiness, sleep disturbance, use of sleep aids) and cognitive impairment (performance and perceived), and determine which sleep quality components are the most significant contributors to cognitive impairments in BCS 6 months to 10 years post chemotherapy. Women 21 to 65 years old with a history of non-metastatic breast cancer following chemotherapy completion were recruited. Data collection included surveys to evaluate sleep quality and perceived cognitive impairments, and neuropsychological testing to evaluate verbal fluency and memory. Descriptive statistics, bivariate correlations, and hierarchical multiple regression were calculated. 90 women (mean age 49) completed data collection. Moderate significant correlations were found between daytime dysfunction, sleep efficiency, sleep latency, and sleep disturbance and perceived cognitive impairment (Rs = -0.37 to -0.49, Ps<.00049), but not objective cognitive performance of verbal fluency, memory or attention. After accounting for individual and clinical characteristics, the strongest predictors of perceived cognitive impairments were daytime dysfunction, sleep efficiency, and sleep disturbance. Findings support links between sleep quality and perceived cognitive impairments in BCS and suggest specific components of sleep quality (daytime dysfunction, sleep efficiency, and sleep disturbance) are associated with perceived cognitive functioning in this population. Findings can assist clinicians in guiding survivors to manage sleep and cognitive problems and aid in the design of interventional research. This article is protected by copyright. All rights reserved.

Prevalence of xerostomia and hyposalivation and their association with quality of life in elderly patients in dependence on dental status and prosthetic rehabilitation: a pilot study.

PubMed

Hahnel, Sebastian; Schwarz, Simone; Zeman, Florian; Schäfer, Lina; Behr, Michael

2014-06-01

The aims of this pilot study were to investigate the prevalence of xerostomia and hyposalivation and their impact on quality of life in a cohort of elderly patients including dental status and the character of potential prosthetic restorations as independent variables. Patients aged 60 years or older without any objective or subjective need for prosthodontic treatment taking part in a regular recall programme were included in the trial. Quality of life was assessed using the German version of the GOHAI; prevalence and severity of xerostomia was investigated using the shortened version of the Xerostomia Inventory (XI). Stimulated salivary flow rate was determined using a sialometric approach. Dental status and the character of prosthetic restorations (no/fixed restorations and removable but tooth-supported dentures vs. gum-supported dentures) were assessed in a clinical examination by experienced dentists specialized in prosthodontic treatment. A total of 68 patients were included in the trial; a prevalence of xerostomia of 16% and a prevalence of hyposalivation of 31% were identified. The quality of life in the study cohort decreased significantly as a function of xerostomia severity but not salivary flow; moreover, a significant impact of the number of teeth/implants in the upper jaw and the presence of gum-supported dentures in both jaws on GOHAI scores could be identified. Within the limitations of a pilot study, the results support the assumption that the quality of life in elderly patients is particularly related to their subjective perception of xerostomia. A decline in salivary flow, the dental status and the character of prosthetic restorations appear to play a subordinate role for the quality of life in elderly patients. The quality of life in elderly patients may be severely diminished due to an increased subjective perception of dry mouth. Dental treatment should focus on alleviating xerostomia, whereas the impact of dental status and prosthetic restoration appear to be subordinate. Copyright © 2014 Elsevier Ltd. All rights reserved.

Technology Infusion Challenges from a Decision Support Perspective

NASA Technical Reports Server (NTRS)

Adumitroaie, V.; Weisbin, C. R.

2009-01-01

In a restricted science budget environment and increasingly numerous required technology developments, the technology investment decisions within NASA are objectively more and more difficult to make such that the end results are satisfying the technical objectives and all the organizational constraints. Under these conditions it is rationally desirable to build an investment portfolio, which has the highest possible technology infusion rate. Arguably the path to infusion is subject to many influencing factors, but here only the challenges associated with the very initial stages are addressed: defining the needs and the subsequent investment decision-support process. It is conceivable that decision consistency and possibly its quality suffer when the decision-making process has limited or no traceability. This paper presents a structured decision-support framework aiming to provide traceable, auditable, infusion- driven recommendations towards a selection process in which these recommendations are used as reference points in further discussions among stakeholders. In this framework addressing well-defined requirements, different measures of success can be defined based on traceability to specific selection criteria. As a direct result, even by using simplified decision models the likelihood of infusion can be probed and consequently improved.

Statistical procedures for determination and verification of minimum reporting levels for drinking water methods.

PubMed

Winslow, Stephen D; Pepich, Barry V; Martin, John J; Hallberg, George R; Munch, David J; Frebis, Christopher P; Hedrick, Elizabeth J; Krop, Richard A

2006-01-01

The United States Environmental Protection Agency's Office of Ground Water and Drinking Water has developed a single-laboratory quantitation procedure: the lowest concentration minimum reporting level (LCMRL). The LCMRL is the lowest true concentration for which future recovery is predicted to fall, with high confidence (99%), between 50% and 150%. The procedure takes into account precision and accuracy. Multiple concentration replicates are processed through the entire analytical method and the data are plotted as measured sample concentration (y-axis) versus true concentration (x-axis). If the data support an assumption of constant variance over the concentration range, an ordinary least-squares regression line is drawn; otherwise, a variance-weighted least-squares regression is used. Prediction interval lines of 99% confidence are drawn about the regression. At the points where the prediction interval lines intersect with data quality objective lines of 50% and 150% recovery, lines are dropped to the x-axis. The higher of the two values is the LCMRL. The LCMRL procedure is flexible because the data quality objectives (50-150%) and the prediction interval confidence (99%) can be varied to suit program needs. The LCMRL determination is performed during method development only. A simpler procedure for verification of data quality objectives at a given minimum reporting level (MRL) is also presented. The verification procedure requires a single set of seven samples taken through the entire method procedure. If the calculated prediction interval is contained within data quality recovery limits (50-150%), the laboratory performance at the MRL is verified.

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care

PubMed Central

Percival, Nikki; O’Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

PubMed

Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers.

Using a State Birth Registry as a Quality Improvement Tool.

PubMed

Lannon, Carole; Kaplan, Heather C; Friar, Kelly; Fuller, Sandra; Ford, Susan; White, Beth; Besl, John; Paulson, John; Marcotte, Michael; Krew, Michael; Bailit, Jennifer; Iams, Jay

2017-08-01

Background  Birth registry data are universally collected, generating large administrative datasets. However, these data are typically not used for quality improvement (QI) initiatives in perinatal medicine because the quality and timeliness of the information is uncertain. Objective  We sought to identify and address causes of inaccuracy in recording birth registry information so that birth registry data could support statewide obstetrical quality initiatives in Ohio. Study Design  The Ohio Perinatal Quality Collaborative and the Ohio Department of Health Vital Statistics used QI techniques in 15 medium-sized maternity hospitals to identify and remove systemic sources of inaccuracy in birth registry data. The primary outcome was the rate of scheduled deliveries without medical indication between 37 0/7 and 38 6/7 weeks at participating hospitals from birth registry data. Results  Inaccurate birth registry data most commonly resulted from limited communication between clinical and medical record staff. The rate of scheduled births between 37 0/7 and 38 6/7 weeks' gestation without a documented medical indication as recorded in the birth registry declined by 35%. Conclusion  A QI initiative aimed at increasing the accuracy of birth registry information demonstrated the utility of these data for surveillance of perinatal outcomes and has led to ongoing efforts to support birth registrars in submitting accurate data. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Associations Between Parental SES and Children's Health-Related Quality of Life: The Role of Objective and Subjective Social Status.

PubMed

Kim, Kay W; Wallander, Jan L; Peskin, Melissa; Cuccaro, Paula; Elliott, Marc N; Schuster, Mark A

2018-06-01

We examined (1) the relationship that parental objective social status (OSS) and subjective social status (SSS) have with children's health-related quality of life (HRQOL), (2) whether SSS mediates the association between OSS and HRQOL, and (3) whether these associations differ among Black, Latino, and White children. Data came from 4,824 Black, Latino, and White 5th graders in the Healthy PassagesTM study. OSS was measured as parent educational attainment and net equivalent household income. SSS was measured by parent rating of community and national standing on the MacArthur Scale of Subjective Social Status. Child HRQOL was measured with child report on the Pediatric Quality of Life Inventory (PedsQL) physical and psychosocial scales. Structural equation modeling path analysis was conducted using Mplus version 7.4. The data supported the hypothesized measurement and structural models. Whereas parental OSS was positively related to psychosocial HRQOL for all three racial/ethnic groups and to physical HRQOL for Latino children, parental SSS was not related to either for any of the racial/ethnic groups. Therefore, mediation by SSS was not supported for any group. OSS was confirmed to have stronger association with children's HRQOL than parental SSS. This is in contrast to some research on adults, raising the questions of how best to assess SSS relevant to children and at what point in development SSS may influence children's health and well-being. The persistent relationship found between parental OSS and child health suggests that efforts to improve low socioeconomic resources in families may contribute to improve children's health.

Efficacy of a short cognitive training program in patients with multiple sclerosis

PubMed Central

Pérez-Martín, María Yaiza; González-Platas, Montserrat; Eguía-del Río, Pablo; Croissier-Elías, Cristina; Jiménez Sosa, Alejandro

2017-01-01

Background Cognitive impairment is a common feature in multiple sclerosis (MS) and may have a substantial impact on quality of life. Evidence about the effectiveness of neuropsychological rehabilitation is still limited, but current data suggest that computer-assisted cognitive training improves cognitive performance. Objective The objective of this study was to evaluate the efficacy of combined computer-assisted training supported by home-based neuropsychological training to improve attention, processing speed, memory and executive functions during 3 consecutive months. Methods In this randomized controlled study blinded for the evaluators, 62 MS patients with clinically stable disease and mild-to-moderate levels of cognitive impairment were randomized to receive a computer-assisted neuropsychological training program (n=30) or no intervention (control group [CG]; n=32). The cognitive assessment included the Brief Repeatable Battery of Neuropsychological Test. Other secondary measures included subjective cognitive impairment, anxiety and depression, fatigue and quality of life measures. Results The treatment group (TG) showed significant improvements in measures of verbal memory, working memory and phonetic fluency after intervention, and repeated measures analysis of covariance revealed a positive effect in most of the functions. The control group (CG) did not show changes. The TG showed a significant reduction in anxiety symptoms and significant improvement in quality of life. There were no improvements in fatigue levels and depressive symptoms. Conclusion Cognitive intervention with a computer-assisted training supported by home training between face-to-face sessions is a useful tool to treat patients with MS and improve functions such as verbal memory, working memory and phonetic fluency. PMID:28223806

Clinical governance and external audit.

PubMed

Glazebrook, S G; Buchanan, J G

2001-01-01

This paper describes a model of clinical governance that was developed at South Auckland Health during the period 1995 to 2000. Clinical quality and safety are core objectives. A multidisciplinary Clinical Board is responsible for the development and publicising of sound clinical policies together with monitoring the effects of their implementation on quality and safety. The Clinical Board has several committees, including an organization-wide Continuous Quality Improvement Committee to enhance the explicit nature of the quality system in terms of structure, staff awareness and involvement, and to develop the internal audit system. The second stream stems from the Chief Medical Officer and clinical directors in a clinical management sense. The Audit Committee of the Board of Directors covers both clinical and financial audit. The reporting lines back to that committee are described and the role of the external auditor of clinical standards is explained. The aim has been to create a supportive culture where quality initiatives and innovation can flourish, and where the emphasis is not on censure but improvement.

Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses.

PubMed

Syrowatka, Ania; Krömker, Dörthe; Meguerditchian, Ari N; Tamblyn, Robyn

2016-01-26

Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than others. Integration of content control improved quality of decision making (SMD 0.59 vs 0.23 for knowledge; SMD 0.39 vs 0.29 for decisional conflict). In contrast, tailoring reduced quality of decision making (SMD 0.40 vs 0.71 for knowledge; SMD 0.25 vs 0.52 for decisional conflict). Similarly, patient narratives also reduced quality of decision making (SMD 0.43 vs 0.65 for knowledge; SMD 0.17 vs 0.46 for decisional conflict). Results were varied for different types of explicit values clarification, feedback, and social support. Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making. However, this is an emerging field with limited evidence to guide use. The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids, in an effort to facilitate reporting of these features and to promote integration of such features into decision aids. The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids. Further research can focus on clarifying independent contributions of specific features through experimental designs and refining the designs of features to improve effectiveness.

Source Water Management for Disinfection By-Product Control using New York City's Operations Support Tool and On-Line Monitoring

NASA Astrophysics Data System (ADS)

Weiss, W. J.; Becker, W.; Schindler, S.

2012-12-01

The United States Environmental Protection Agency's 2006 Stage 2 Disinfectant / Disinfection Byproduct Rule (DBPR) for finished drinking waters is intended to reduce overall DBP levels by limiting the levels of total trihalomethanes (TTHM) and five of the haloacetic acids (HAA5). Under Stage 2, maximum contaminant levels (MCLs), 80 μg/L for TTHM and 60 μg/L for HAA5, are based on a locational running annual average for individual sites instead of as the system-wide quarterly running annual average of the Stage 1 DBPR. This means compliance will have to be met at sampling locations of peak TTHM and HAA5 concentrations rather than an average across the entire system. Compliance monitoring under the Stage 2 DBPR began on April 1, 2012. The New York City (NYC) Department of Environmental Protection (DEP) began evaluating potential impacts of the Stage 2 DBPR on NYC's unfiltered water supply in 2002 by monitoring TTHM and HAA5 levels at various locations throughout the distribution system. Initial monitoring indicated that HAA5 levels could be of concern in the future, with the potential to intermittently violate the Stage 2 DBPR at specific locations, particularly those with high water age. Because of the uncertainty regarding the long-term prospect for compliance, DEP evaluated alternatives to ensure compliance, including operational changes (reducing chlorine dose, changing flow configurations to minimize water age, altering pH, altering source water withdrawals); changing the residual disinfectant from free chlorine to chloramines; and engineered treatment alternatives. This paper will discuss the potential for using DEP's Operations Support Tool (OST) and enhanced reservoir monitoring to support optimization of source water withdrawals to minimize finished water DBP levels. The OST is a state-of-the-art decision support system (DSS) to provide computational and predictive support for water supply operations and planning. It incorporates a water supply system simulation model (OASIS, HydroLogics, Inc.), reservoir water quality models, a near real-time monitoring network, and hydrologic forecasts to provide analytical support for both long-term planning and near-term operations. The OST helps managers and operators balance multiple objectives, including water supply reliability, water quality, and environmental and community release objectives. This paper will describe the results of initial testing to evaluate the potential to reduce DBP levels by managing source water withdrawals to minimize the transport of natural organic matter (NOM) precursors from upper reservoirs. Operating rules were developed that take advantage of selective withdrawal capabilities at some upstate reservoirs and the inherent flexibility of the overall water supply system, seeking to minimize DBPs within the larger framework of water supply, water quality, environmental, and regulatory objectives. The results demonstrated that there is substantial flexibility within the system to manage DBP levels, in some cases providing the potential for reductions of DBP precursors of nearly 10%. Additional research is underway that seeks to better understand the sources of natural organic matter in the NYC watershed to provide guidance for on-line monitoring to be used with the OST to support real-time operation support for DBP control.

Stratospheric Intrusion Catalog: A 10-year Compilation of Events Identified By Using an Objective Feature Tracking Model With NASA's MERRA-2 Reanalysis

NASA Astrophysics Data System (ADS)

Knowland, K. E.; Ott, L. E.; Duncan, B. N.; Wargan, K.; Hodges, K.

2017-12-01

Stratospheric intrusions - the introduction of ozone-rich stratospheric air into the troposphere - have been linked with surface ozone air quality exceedances, especially at the high elevations in the western USA in springtime. However, the impact of stratospheric intrusions in the remaining seasons and over the rest of the USA is less clear. A new approach to the study of stratospheric intrusions uses NASA's Goddard Earth Observing System Model (GEOS) model and assimilation products with an objective feature tracking algorithm to investigate the atmospheric dynamics that generate stratospheric intrusions and the different mechanisms through which stratospheric intrusions may influence tropospheric chemistry and surface air quality seasonally over both the western and the eastern USA. A catalog of stratospheric intrusions identified in the MERRA-2 reanalysis was produced for the period 2005-2014 and validated against surface ozone observations (focusing on those which exceed the national air quality standard) and a recent data set of stratospheric intrusion-influenced air quality exceedance flags from the US Environmental Protection Agency (EPA). Considering not all ozone exceedances have been flagged by the EPA, a collection of stratospheric intrusions can support air quality agencies for more rapid identification of the impact of stratospheric air on surface ozone and demonstrates that future operational analyses may aid in forecasting such events. An analysis of the spatiotemporal variability of stratospheric intrusions over the continental US was performed, and while the spring over the western USA does exhibit the largest number of stratospheric intrusions affecting the lower troposphere, the number of intrusions in the remaining seasons and over the eastern USA is sizable. By focusing on the major modes of variability that influence weather in the USA, such as the Pacific North American (PNA) teleconnection index, predicative meteorological patterns associated with stratospheric intrusions and their regional effects on tropospheric ozone were identified. Improved understanding of the connections between large-scale climate variability and local-scale dynamically-driven air quality events may support improved seasonal prediction of such events.

South Asia transboundary water quality monitoring workshop summary report.

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

Betsill, Jeffrey David; Littlefield, Adriane C.; Luetters, Frederick O.

2003-04-01

The Cooperative Monitoring Center (CMC) promotes collaborations among scientists and researchers in several regions as a means of achieving common regional security objectives. To promote cooperation in South Asia on environmental research, an international working group made up of participants from Bangladesh, India, Nepal, Pakistan, and the United States convened in Kathmandu, Nepal, from February 17-23,2002. The workshop was held to further develop the South Asia Transboundary Water Quality Monitoring (SATWQM) project. The project is sponsored in part by the CMC located at Sandia National Laboratories in Albuquerque, New Mexico through funding provided by the US. Department of State, Regionalmore » Environmental Affairs Office, American Embassy, Kathmandu, Nepal, and the National Nuclear Security Administration's (NNSA) Office of Nonproliferation and National Security. This report summarizes the SATWQM project, the workshop objectives, process and results. The long-term interests of the participants are to develop systems for sharing regional environmental information as a means of building confidence and improving relations among South Asian countries. The more immediate interests of the group are focused on activities that foster regional sharing of water quality data in the Ganges and Indus River basins. Issues of concern to the SATWQM network participants include studying the impacts from untreated sewage and industrial effluents, agricultural run-off, salinity increases in fresh waters, the siltation and shifting of river channels, and the environmental degradation of critical habitats such as wetlands, protected forests, and endangered aquatic species conservation areas. The workshop focused on five objectives: (1) a deepened understanding of the partner organizations involved; (2) garnering the support of additional regional and national government and non-government organizations in South Asia involved in river water quality monitoring; (3) identification of sites within the region at which water quality data are to be collected; (4) instituting a data and information collection and sharing process; and, (5) training of partners in the use of water quality monitoring equipment.« less

(abstract) Formal Inspection Technology Transfer Program

NASA Technical Reports Server (NTRS)

Welz, Linda A.; Kelly, John C.

1993-01-01

A Formal Inspection Technology Transfer Program, based on the inspection process developed by Michael Fagan at IBM, has been developed at JPL. The goal of this program is to support organizations wishing to use Formal Inspections to improve the quality of software and system level engineering products. The Technology Transfer Program provides start-up materials and assistance to help organizations establish their own Formal Inspection program. The course materials and certified instructors associated with the Technology Transfer Program have proven to be effective in classes taught at other NASA centers as well as at JPL. Formal Inspections (NASA tailored Fagan Inspections) are a set of technical reviews whose objective is to increase quality and reduce the cost of software development by detecting and correcting errors early. A primary feature of inspections is the removal of engineering errors before they amplify into larger and more costly problems downstream in the development process. Note that the word 'inspection' is used differently in software than in a manufacturing context. A Formal Inspection is a front-end quality enhancement technique, rather than a task conducted just prior to product shipment for the purpose of sorting defective systems (manufacturing usage). Formal Inspections are supporting and in agreement with the 'total quality' approach being adopted by many NASA centers.

Cost-effectiveness of supported employment adapted for people with affective disorders.

PubMed

Saha, Sanjib; Bejerholm, Ulrika; Gerdtham, Ulf-G; Jarl, Johan

2018-04-01

The individual enabling and support (IES) model was effective in gaining competitive employment for people with affective disorders compared with traditional vocational rehabilitation (TVR) services in a randomized controlled trial in a Swedish setting. The object of this study is to perform a cost-effectiveness analysis of IES comparing to TVR. We considered the costs of intervention and productivity gain due to increased competitive employment. We estimated quality of life using EuroQol 5 Dimension (EQ-5D) and Manchester Short Assessment of Quality of Life (MANSA) scale. EQ-5D was translated into quality-adjusted life-years (QALY), using the UK, Danish, and Swedish tariffs. We performed the analysis from a societal perspective with a one-year timeframe. The cost of IES was €7247 lower per person per year (2014 prices) compared to TVR. There were no significant differences in QALY improvement within or between groups. However, quality of life measured by the MANSA scale significantly improved over the study period in IES. Besides the small sample size, details on the intervention costs for both IES and TVR group were unavailable and had to be obtained from external sources. Implementation of IES for people with affective disorders is most likely cost-saving and is potentially even dominating TVR, although a larger trial is required to establish this.

CORAL REEF BIOLOGICAL CRITERIA: USING THE CLEAN ...

EPA Pesticide Factsheets

Coral reefs are declining at unprecedented rates worldwide due to multiple interactive stressors including climate change and land-based sources of pollution. The Clean Water Act (CWA) can be a powerful legal instrument for protecting water resources, including the biological inhabitants of coral reefs. The objective of the CWA is to restore and maintain the chemical, physical and biological integrity of water resources. Coral reef protection and restoration under the Clean Water Act begins with water quality standards - provisions of state or Federal law that consist of a designated use(s) for the waters of the United States and water quality criteria sufficient to protect the uses. Aquatic life use is the designated use that is measured by biological criteria (biocriteria). Biocriteria are expectations set by a jurisdiction for the quality and quantity of living aquatic resources in a defined waterbody. Biocriteria are an important addition to existing management tools for coral reef ecosystems. The Technical Support Document “Coral Reef Biological Criteria: Using the Clean Water Act to Protect a National Treasure” will provide a framework to aid States and Territories in their development, adoption, and implementation of coral reef biocriteria in their respective water quality standards. The Technical Support Document “Coral Reef Biological Criteria: Using the Clean Water Act to Protect a National Treasure” will provide a framework for coral re

The use of engineered biomaterial Bone Plexur M® in benign epiphyseal tumors: our experience at 20 months of follow-up.

PubMed

Zoccali, C; Anelli, V; Chichierchia, G; Erba, F; Biagini, R

2014-01-01

The objective is to reconstruct the subchondral bone after curettage of benign tumors located in the epiphysis, a relevant topic in oncological orthopedics. Several bones substituted are commercially available, yet none of these are suitably moldable to repair or be placed in the bone defect; although autologous bone for little defects and homologous for bigger defects are still considered the standard in reconstruction, we verify the ability to adapt and support articular cartilage through the application of Plexur M (Registered Trademark), a newly engineered biomaterial bone. In the present study, we enrolled the first ten consecutive cases referred to our department, where patients were affected by a benign epiphyseal tumor destroying the subchondral bone through to the articular cartilage. Every patient underwent curettage of the disease, apposition of a newly engineered biomaterial bone and filling with homologous morselized bone. The quality of reconstruction was evaluated by two surgeons and by a radiologist based on the achievement of surgical objectives and comparing pre and postoperative imaging. In seven out of eight cases of lesions located in the lower limbs the quality of reconstruction was considered good, restoring an adequate support to the articular cartilage. The quality of the remaining case was considered poor probably due to the extent of the spread of the disease, which destroyed the entire proximal tibial epiphysis. In the two cases where the disease was located in the upper limbs, the Plexur M application restored support to the articular cartilage sufficiently well. However, in the case of a giant cell tumor of the distal radial epiphysis there was a slight reabsorption of the morselized homologous bone. Our series suggest that Plexur M should be considered a valid option for orthopedic surgeons in restoring adequate mechanical support to the articular cartilage; nevertheless, considering its high cost, its use might be reserved to selected cases until further studies can verify the integration process, the effects on the survival of the articular cartilage and on the prevention of premature osteoarthritis.

HIV-related behaviors, social support and health-related quality of life among men who have sex with men and women (MSMW): a cross-sectional study in Chongqing, China.

PubMed

Chen, Jiang-Peng; Han, Ming-Ming; Liao, Zi-Jun; Dai, Zhen-Zhen; Liu, Liang; Chen, Hua; Wen, Xiao-Yan; Hu, Shan; Que, Ping; Wen, Wen; Peng, Bin

2015-01-01

Health-related quality of life (HRQOL) has become commonly used both as a concept and as a field of research. However, little is known about the HRQOL of men who have sex with men and women (MSMW). The aim of this study was to examine HIV-related behaviors, social support, and HRQOL status and explore its predictors among MSMW. An anonymous cross-sectional study was conducted by snowball sampling method in 2013. A total of 563 Chinese MSM completed a structured questionnaire. The HRQOL and social support were measured with the Chinese version of the World Health Organization Quality of Life Scale (WHOQOL-BRFE) and the Social Support Rating Scale (SSRS), respectively. Of the 563 MSM analyzed, 77 (13.68%) were MSMW who had a higher proportion of in-marriage and preference for an insertive role as compared with the men who have sex with men only (MSMO) (P<0.05). As high as 70.13% of MSMW had no regular sex partners and 72.73% of MSMW reported engaging in unprotected anal sex in the last six months. 36.36% had tested for HIV, while only 12.99% had accepted HIV voluntary counseling and testing (VCT) services. The scores of objective support and subjective support in MSMW were significantly higher than that of MSMO (P<0.05). No statistically significant difference was found in scores of all the four domains of the HRQOL between MSMW and MSMO. When comparing the HRQOL scores of MSMW with the Chinese general population reference group, the scores of MSMW were significantly lower in physical health domain. In a multivariate regression model, age, monthly income, sexual role, VCT acceptability, subjective support were associated with variability in HRQOL. To improve the HRQOL among MSMW, more attention needs to be paid to those with low social support, low-income, the old and those prefer a receptive role during anal sex populations.

Appreciative Inquiry for quality improvement in primary care practices.

PubMed

Ruhe, Mary C; Bobiak, Sarah N; Litaker, David; Carter, Caroline A; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen J; Weyer, Sharon M; Werner, James J; Fry, Ronald E; Stange, Kurt C

2011-01-01

To test the effect of an Appreciative Inquiry (AI) quality improvement strategy on clinical quality management and practice development outcomes. Appreciative inquiry enables the discovery of shared motivations, envisioning a transformed future, and learning around the implementation of a change process. Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical-record review assessed change in PSD rates. Ethnographic field notes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. The PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives, and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited 1 or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective.

Appreciative Inquiry for Quality Improvement in Primary Care Practices

PubMed Central

Ruhe, Mary C.; Bobiak, Sarah N.; Litaker, David; Carter, Caroline A.; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen; Weyer, Sharon M.; Werner, James J.; Fry, Ronald E.; Stange, Kurt C.

2014-01-01

Purpose To test the effect of an Appreciative Inquiry (AI) quality improvement strategy, on clinical quality management and practice development outcomes. AI enables discovery of shared motivations, envisioning a transformed future, and learning around implementation of a change process. Methods Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical record review assessed change in PSD rates. Ethnographic fieldnotes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. Results PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited one or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. Conclusions An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective. PMID:21192206

Caring for late preterm infants: public health nurses' experiences.

PubMed

Currie, Genevieve; Dosani, Aliyah; Premji, Shahirose S; Reilly, Sandra M; Lodha, Abhay K; Young, Marilyn

2018-01-01

Public health nurses (PHNs) care for and support late preterm infants (LPIs) and their families when they go home from the hospital. PHNs require evidence-informed guidelines to ensure appropriate and consistent care. The objective of this research study is to capture the lived experience of PHNs caring for LPIs in the community as a first step to improving the quality of care for LPIs and support for their parents. To meet our objectives we chose a descriptive phenomenology approach as a method of inquiry. We conducted semi-structured interviews with PHNs ( n  = 10) to understand PHN perceptions of caring for LPIs and challenges in meeting the needs of families within the community. Interpretative thematic analysis revealed PHN perceptions of caring for LPIs and challenges in meeting the needs of families within the community. Four themes emerged from the data. First, PHNs expressed challenges with meeting the physiological needs of LPIs and gave voice to the resulting strain this causes for parents. Second, nurses conveyed that parents require more anticipatory guidance about the special demands associated with feeding LPIs. Third, PHNs relayed that parents sometimes receive inconsistent advice from different providers. Lastly, PHNs acknowledged that due to lack of resources, families sometimes did not receive the full scope of evidence informed care required by fragile, immature infants. The care of LPIs by PHNs would benefit from more research about the needs of these infants and their families. Efforts to improve quality of care should focus on: evidence-informed guidelines, consistent care pathways, coordination of follow up care and financial resources, to provide physical, emotional, informational support that families require once they leave the hospital. More research on meeting the challenges of caring for LPIs and their families would provide direction for the competencies PHNs require to improve the quality of care in the community.

Socioeconomic status and quality of life among Chinese American breast cancer survivors: The mediating roles of social support and social constraints.

PubMed

You, Jin; Wang, Carol; Yeung, Nelson Chun Yiu; Lu, Qian

2018-03-30

Literature has well noted ethnic/racial disparities in cancer survival and cancer care. However, socioeconomic disparities in psychosocial adjustment to breast cancer have garnered little attention. This study addresses the research gap by investigating the associations between socioeconomic indicators (ie, education, annual personal, and household income) and quality of life (QOL) and the mediating roles of social support and social constraints (objective and subjective conditions that constrain individuals from disclosing cancer concerns) in these associations among Chinese American breast cancer survivors (CABCS). Ninety-six CABCS completed questionnaires assessing these variables. After controlling for stage of cancer, annual personal and household income had indirect effects on QOL through social support, and education showed indirect effect on QOL through social support and social constraints. Subscale analyses indicated that controlling for years of immigration, annual personal and household income showed indirect effect on functional well-being through social support. When controlling for stage of cancer and income, education showed indirect effects on physical well-being through social support and social constraints and showed both direct and indirect effects on breast cancer concerns through social constraints. This study suggested that socioeconomic indicators, education, and income could be associated with different aspects of QOL through unique interpersonal mechanisms among CABCS. Our findings implied that increasing social support and reducing social constraints when implementing psychosocial interventions for CABCS may help to address the SES-related health disparities. Copyright © 2018 John Wiley & Sons, Ltd.

Data Quality Objectives Process for Designation of K Basins Debris

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

WESTCOTT, J.L.

2000-05-22

The U.S. Department of Energy has developed a schedule and approach for the removal of spent fuels, sludge, and debris from the K East (KE) and K West (KW) Basins, located in the 100 Area at the Hanford Site. The project that is the subject of this data quality objective (DQO) process is focused on the removal of debris from the K Basins and onsite disposal of the debris at the Environmental Restoration Disposal Facility (ERDF). This material previously has been dispositioned at the Hanford Low-Level Burial Grounds (LLBGs) or Central Waste Complex (CWC). The goal of this DQO processmore » and the resulting Sampling and Analysis Plan (SAP) is to provide the strategy for characterizing and designating the K-Basin debris to determine if it meets the Environmental Restoration Disposal Facility Waste Acceptance Criteria (WAC), Revision 3 (BHI 1998). A critical part of the DQO process is to agree on regulatory and WAC interpretation, to support preparation of the DQO workbook and SAP.« less

Preliminary remediation goals for use at the US Department of Energy Oak Ridge Operations Office. Revision 1

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

NONE

1996-05-01

This technical memorandum presents Preliminary Remediation Goals (PRGs) for use in human health risk assessment efforts under the United States Department of Energy, Oak Ridge Operations Office Environmental Restoration (ER) Division. This document provides the ER Division with standardized PRGs which are integral to the Remedial Investigation/Feasibility Study process. They are used during project scooping (Data Quality Objectives development), in screening level risk assessments to support early action or No Further Investigation decisions, and in the baselines risk assessment where they are employed in the selection of chemicals of potential concern. The primary objective of this document is to standardizemore » these values and eliminate any duplication of effort by providing PRGs to all contractors involved in risk activities. In addition, by managing the assumptions and systems used in PRG derivation, the ER Risk Assessment Program will be able to control the level of quality assurance associated with these risk-based guideline values.« less

Getting the most out of your practice--the Practice Health Atlas and business modelling opportunities.

PubMed

Del Fante, Peter; Allan, Don; Babidge, Elizabeth

2006-01-01

The Practice Health Atlas (PHA) is a decision support tool for general practice, designed by the Adelaide Western Division of General Practice (AWDGP). This article describes the features of the PHA and its potential role in enhancing health care. In developing the PHA, the AWDGP utilises a range of software tools and consults with a practice to understand its clinical data management approach. The PHA comprises three sections: epidemiology, business and clinical modelling systems, access to services. The objectives include developing a professional culture around quality health data and synthesis of aggregated de-identified general practice data at both practice and divisional level (and beyond) to assist with local health needs assessment, planning, and funding. Evaluation occurs through group feedback sessions and from the general practitioners and staff. It has demonstrated its potential to fulfill the objectives in outcome areas such as data quality and management, team based care, pro-active practice population health care, and business systems development, thereby contributing to improved patient health outcomes.

The students’ mathematical argumentation in geometry

NASA Astrophysics Data System (ADS)

Sukirwan; Darhim; Herman, T.; Prahmana, R. C. I.

2017-12-01

The main objective of this research is to analyze the student's mathematical argumentation when dealing with geometry. The method is used qualitative method with grounded theory to know how the students provide an explanation or an answer against claims so that the quality of the vernacular students will be drawn up with clear from how students compose a series of arguments. The results showed that there were still many students basically experiencing constraints in argumentation, but the quality of the reasoning appears to be a variation of the argument appeared, include: inductive, algebra, visual and perceptual. In addition, the starting point of the students composes a series of arguments generally starts from claims that arise in a matter. Proof of claim further builds upon the relationship between the characteristics of data with mathematical objects that appear in the acquired mathematical knowledge from previous students. Relationship spelled out in a series of statements and reasons which support the claims through the fourth argument.

Assessing Weight-Related Quality of Life in Adolescents

PubMed Central

Kolotkin, Ronette L.; Zeller, Meg; Modi, Avani C.; Samsa, Gregory P.; Quinlan, Nicole Polanichka; Yanovski, Jack A.; Bell, Stephen K.; Maahs, David M.; de Serna, Daniela Gonzales; Roehrig, Helmut R.

2008-01-01

Objective The development of a new weight-related measure to assess quality of life in adolescents [Impact of Weight on Quality of Life (IWQOL)-Kids] is described. Research Methods and Procedures Using a literature search, clinical experience, and consultation with pediatric clinicians, 73 items were developed, pilot tested, and administered to 642 participants, 11 to 19 years old, recruited from weight loss programs/studies and community samples (mean z-BMI, 1.5; range, –1.2 to 3.4; mean age, 14.0; 60% female; 56% white). Participants completed the 73 items and the Pediatric Quality of Life Inventory and were weighed and measured. Results Four factors (27 items) were identified (physical comfort, body esteem, social life, and family relations), accounting for 71% of the variance. The IWQOL-Kids demonstrated excellent psychometric properties. Internal consistency coefficients ranged from 0.88 to 0.95 for scales and equaled 0.96 for total score. Convergent validity was demonstrated with strong correlations between IWQOL-Kids total score and the Pediatric Quality of Life Inventory (r = 0.76, p < 0.0001). Significant differences were found across BMI groups and between clinical and community samples, supporting the sensitivity of this measure. Participants in a weight loss camp demonstrated improved IWQOL-Kids scores, suggesting responsiveness of the IWQOL-Kids to weight loss/social support intervention. Discussion The present study provides preliminary evidence regarding the psychometric properties of the IWQOL-Kids, a weight-related quality of life measure for adolescents. Given the rise of obesity in youth, the development of a reliable and valid weight-related measure of quality of life is timely. PMID:16648616

Support needs for medication use and the suitability of eHealth technologies to address these needs: a focus group study of older patients with rheumatoid arthritis

PubMed Central

Mathijssen, Elke GE; Vriezekolk, Johanna E; Eijsbouts, Agnes MM; van den Hoogen, Frank HJ; van den Bemt, Bart JF

2018-01-01

Objective The objectives of this study were to explore the needs of patients with rheumatoid arthritis (RA) regarding support for medication use and to gain insight into their perspective on the suitability of eHealth technologies to address these needs. Methods Three focus groups were conducted with 28 patients with RA. Audio recordings made during the focus groups were transcribed verbatim. Two researchers independently performed an inductive, thematic analysis on the data (ie, the transcripts and field notes). Results The following three themes that described support needs of patients with RA for medication use were identified in the data: 1) informational support; 2) practical support; and 3) emotional support. Informational support reflected the provision of information and facts, including advice, suggestions, and feedback from health care providers. Practical support included the reinforcement of practical skills as well as the provision of medication aids and pharmacy services. Emotional support reflected a trusted patient–health care provider relationship, characterized by good communication. Although potential advantages of eHealth technologies to address the patients’ support needs were recognized, concerns over matters such as personal interaction with health care providers, privacy and data security, and the quality and reliability of online information were prevalent. Conclusion Patients with RA have informational, practical, and emotional support needs for medication use. Informational support seems to be most important. From the patients’ perspective, eHealth technologies may have the potential to address these needs. However, these technologies are regarded as a complement to, rather than a replacement of, current practices. PMID:29563778

Perceptual video quality assessment in H.264 video coding standard using objective modeling.

PubMed

Karthikeyan, Ramasamy; Sainarayanan, Gopalakrishnan; Deepa, Subramaniam Nachimuthu

2014-01-01

Since usage of digital video is wide spread nowadays, quality considerations have become essential, and industry demand for video quality measurement is rising. This proposal provides a method of perceptual quality assessment in H.264 standard encoder using objective modeling. For this purpose, quality impairments are calculated and a model is developed to compute the perceptual video quality metric based on no reference method. Because of the shuttle difference between the original video and the encoded video the quality of the encoded picture gets degraded, this quality difference is introduced by the encoding process like Intra and Inter prediction. The proposed model takes into account of the artifacts introduced by these spatial and temporal activities in the hybrid block based coding methods and an objective modeling of these artifacts into subjective quality estimation is proposed. The proposed model calculates the objective quality metric using subjective impairments; blockiness, blur and jerkiness compared to the existing bitrate only calculation defined in the ITU G 1070 model. The accuracy of the proposed perceptual video quality metrics is compared against popular full reference objective methods as defined by VQEG.

Adding Remote Sensing Data Products to the Nutrient Management Decision Support Toolbox

NASA Technical Reports Server (NTRS)

Lehrter, John; Schaeffer, Blake; Hagy, Jim; Spiering, Bruce; Blonski, Slawek; Underwood, Lauren; Ellis, Chris

2011-01-01

Some of the primary issues that manifest from nutrient enrichment and eutrophication (Figure 1) may be observed from satellites. For example, remotely sensed estimates of chlorophyll a (chla), total suspended solids (TSS), and light attenuation (Kd) or water clarity, which are often associated with elevated nutrient inputs, are data products collected daily and globally for coastal systems from satellites such as NASA s MODIS (Figure 2). The objective of this project is to inform water quality decision making activities using remotely sensed water quality data. In particular, we seek to inform the development of numeric nutrient criteria. In this poster we demonstrate an approach for developing nutrient criteria based on remotely sensed chla.

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

An importance-performance analysis of hospital information system attributes: A nurses' perspective.

PubMed

Cohen, Jason F; Coleman, Emma; Kangethe, Matheri J

2016-02-01

Health workers have numerous concerns about hospital IS (HIS) usage. Addressing these concerns requires understanding the system attributes most important to their satisfaction and productivity. Following a recent HIS implementation, our objective was to identify priorities for managerial intervention based on user evaluations of the performance of the HIS attributes as well as the relative importance of these attributes to user satisfaction and productivity outcomes. We collected data along a set of attributes representing system quality, data quality, information quality, and service quality from 154 nurse users. Their quantitative responses were analysed using the partial least squares approach followed by an importance-performance analysis. Qualitative responses were analysed using thematic analysis to triangulate and supplement the quantitative findings. Two system quality attributes (responsiveness and ease of learning), one information quality attribute (detail), one service quality attribute (sufficient support), and three data quality attributes (records complete, accurate and never missing) were identified as high priorities for intervention. Our application of importance-performance analysis is unique in HIS evaluation and we have illustrated its utility for identifying those system attributes for which underperformance is not acceptable to users and therefore should be high priorities for intervention. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Information quantity and quality affect the realistic accuracy of personality judgment.

PubMed

Letzring, Tera D; Wells, Shannon M; Funder, David C

2006-07-01

Triads of unacquainted college students interacted in 1 of 5 experimental conditions that manipulated information quantity (amount of information) and information quality (relevance of information to personality), and they then made judgments of each others' personalities. To determine accuracy, the authors compared the ratings of each judge to a broad-based accuracy criterion composed of personality ratings from 3 types of knowledgeable informants (the self, real-life acquaintances, and clinician-interviewers). Results supported the hypothesis that information quantity and quality would be positively related to objective knowledge about the targets and realistic accuracy. Interjudge consensus and self-other agreement followed a similar pattern. These findings are consistent with expectations based on models of the process of accurate judgment (D. C. Funder, 1995, 1999) and consensus (D. A. Kenny, 1994). Copyright 2006 APA, all rights reserved.

Assessment of economic and water quality impacts of land use change using a simple bioeconomic model.

PubMed

Bhattarai, Gandhi; Srivastava, Puneet; Marzen, Luke; Hite, Diane; Hatch, Upton

2008-07-01

The objective of this study is to assess the economic and water quality impact of land use change in a small watershed in the Wiregrass region of Alabama. The study compares changes in water quality and revenue from agricultural and timber production due to changes in land use between years 1992 and 2001. The study was completed in two stages. In the first stage, a biophysical model was used to estimate the effect of land use change on nitrogen and phosphorus runoff and sediment deposition in the main channel; in the second stage, farm enterprise budgeting tools were used to estimate the economic returns for the changes in land use condition. Both biophysical and economic results are discussed, and a case for complex optimization to develop a decision support system is presented.

Socially Interactive and Passive Technologies Enhance Friendship Quality: An Investigation of the Mediating Roles of Online and Offline Self-Disclosure.

PubMed

Desjarlais, Malinda; Joseph, Jessica J

2017-05-01

Previous studies indicate that characteristics of social-based technologies (STs) stimulate the sharing of intimate information online, which in turn enhances the quality of friendships. In addition, intimate online self-disclosure has been positively associated with offline self-disclosure. One objective of the current study was to combine the literature and test a model which postulates that STs use stimulates online self-disclosure which facilitates offline self-disclosure and, thereby, enhances the quality of close friendships. A second objective of this study was to examine if the aforementioned model applies to two categories of STs, including socially interactive technologies (SITs; e.g., instant messaging) and socially passive technologies (SPTs; e.g., reading posts on social networking sites). An online survey was conducted with 212 young adults between 18 and 25 years of age. The proposed indirect positive effects of SITs and SPTs use on the quality of friendships were supported. The positive effect of SITs use on the quality of friendships was explained entirely by the young adults' disclosure of personal information when using SITs which facilitated intimate self-disclosure during face-to-face interactions. Although there was not a direct effect of SPTs use on the quality of friendships, SPTs use was positively related to SPTs self-disclosure, which had a positive effect on offline self-disclosure. The current study enhances our understanding regarding the positive effects associated with the use of STs among close friends and identifies the contribution of online self-disclosure for offline interactions.

Not all are desired: providers' views on interpreters' emotional support for patients.

PubMed

Hsieh, Elaine; Hong, Soo Jung

2010-11-01

This study examines (a) providers' expectations and concerns for interpreters' emotional support, and (b) the complexity and dilemma for interpreters to offer emotional support in health care settings. We recruited 39 providers from 5 specialties to participate in in-depth interviews or focus groups. Grounded theory was used for data analysis to identify providers' expectations and concerns for interpreters' emotional support. From the providers' perspective, interpreters' emotional support: (a) is embodied through their physical presence, (b) is to be both a human being but also a professional, (c) represents the extension of the providers' care, and (d) imposes potential risks to quality of care. Emotional support in bilingual health care is accomplished through the alliance of providers and interpreters, complementing each other to support patients' emotional needs. Interpreters should be vigilant about how their emotional support may impact the provider-patient relationship and the providers' therapeutic objectives. Interpreters should be aware that providers also rely on them to provide emotional support, which highlights the importance of giving medical talk and rapport-building talk equal attention in medical encounters. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Introduction to a Special Issue of the Journal of Immunological Methods: Building global resource programs to support HIV/AIDS clinical trial studies.

PubMed

Sanchez, Ana M; Denny, Thomas N; O'Gorman, Maurice

2014-07-01

This Special Issue of the Journal of Immunological Methods includes 16 manuscripts describing quality assurance activities related to virologic and immunologic monitoring of six global laboratory resource programs that support international HIV/AIDS clinical trial studies: Collaboration for AIDS Vaccine Discovery (CAVD); Center for HIV/AIDS Vaccine Immunology (CHAVI); External Quality Assurance Program Oversight Laboratory (EQAPOL); HIV Vaccine Trial Network (HVTN); International AIDS Vaccine Initiative (IAVI); and Immunology Quality Assessment (IQA). The reports from these programs address the many components required to develop comprehensive quality control activities and subsequent quality assurance programs for immune monitoring in global clinical trials including: all aspects of processing, storing, and quality assessment of PBMC preparations used ubiquitously in HIV clinical trials, the development and optimization of assays for CD8 HIV responses and HIV neutralization, a comprehensive global HIV virus repository, and reports on the development and execution of novel external proficiency testing programs for immunophenotyping, intracellular cytokine staining, ELISPOT and luminex based cytokine measurements. In addition, there are articles describing the implementation of Good Clinical Laboratory Practices (GCLP) in a large quality assurance laboratory, the development of statistical methods specific for external proficiency testing assessment, a discussion on the ability to set objective thresholds for measuring rare events by flow cytometry, and finally, a manuscript which addresses a framework for the structured reporting of T cell immune function based assays. It is anticipated that this series of manuscripts covering a wide range of quality assurance activities associated with the conduct of global clinical trials will provide a resource for individuals and programs involved in improving the harmonization, standardization, accuracy, and sensitivity of virologic and immunologic testing. Copyright © 2014 Elsevier B.V. All rights reserved.

Psychosocial work environment and prediction of quality of care indicators in one Canadian health center.

PubMed

Paquet, Maxime; Courcy, François; Lavoie-Tremblay, Mélanie; Gagnon, Serge; Maillet, Stéphanie

2013-05-01

Few studies link organizational variables and outcomes to quality indicators. This approach would expose operant mechanisms by which work environment characteristics and organizational outcomes affect clinical effectiveness, safety, and quality indicators. What are the predominant psychosocial variables in the explanation of organizational outcomes and quality indicators (in this case, medication errors and length of stay)? The primary objective of this study was to link the fields of evidence-based practice to the field of decision making, by providing an effective model of intervention to improve safety and quality. The study involved healthcare workers (n = 243) from 13 different care units of a university affiliated health center in Canada. Data regarding the psychosocial work environment (10 work climate scales, effort/reward imbalance, and social support) was linked to organizational outcomes (absenteeism, turnover, overtime), to the nurse/patient ratio and quality indicators (medication errors and length of stay) using path analyses. The models produced in this study revealed a contribution of some psychosocial factors to quality indicators, through an indirect effect of personnel- or human resources-related variables, more precisely: turnover, absenteeism, overtime, and nurse/patient ratio. Four perceptions of work environment appear to play an important part in the indirect effect on both medication errors and length of stay: apparent social support from supervisors, appreciation of the workload demands, pride in being part of one's work team, and effort/reward balance. This study reveals the importance of employee perceptions of the work environment as an indirect predictor of quality of care. Working to improve these perceptions is a good investment for loyalty and attendance. In general, better personnel conditions lead to fewer medication errors and shorter length of stay. © Sigma Theta Tau International.

Service offerings and interfaces for the ACTS network of earth stations

NASA Technical Reports Server (NTRS)

Coney, T. A.; Dobyns, T. R.; Chitre, D. M.; Lindstrom, R.

1988-01-01

The NASA Advanced Communications Technology Satellite (ACTS) will use a network of about 20 earth stations to operate as a Mode 1 network. This network will support two ACTS program objectives: to verify the technical performance of ACTS Mode 1 operation in GEO and to demonstrate the types and quality of services that can be provided by an ACTS Mode 1 communications system. The terrestrial interface design is a critical element in assuring that these network earth stations will meet the objectives. In this paper, the applicable terrestrial interface design requirements, the resulting interface specifications, and the associated terrestrial input/output hardware are discussed. A functional block diagram of a network earth station is shown.

Planetary and Primitive Object Strength Measurement and Sampling Apparatus

NASA Technical Reports Server (NTRS)

Ahrens, Thomas J.

1995-01-01

Support is requested for continuation of a program of dynamic impact (harpoon) coring of planetary, comet, or asteroid surface materials. We have previously demonstrated that good quality cores are obtainable for planetary materials with compressive strengths less than 200 MPa. Since the dynamics of penetration are observable on a Discovery class spacecraft, which images the sampling operation, these data can be used with a model developed under this project, to measure in-situ strength and frictional strength of the crust of the object. During the last year we have developed a detailed analytic model of penetrator mechanics. Progress is reported for the solid penetrators experiments, the CIT penetrator model, and the impact spall sampling apparatus.

DRIFTER Web App Development Support

NASA Technical Reports Server (NTRS)

Davis, Derrick D.; Armstrong, Curtis D.

2015-01-01

During my 2015 internship at Stennis Space Center (SSC) I supported the development of a web based tool to enable user interaction with a low-cost environmental monitoring buoy called the DRIFTER. DRIFTERs are designed by SSC's Applied Science and Technology Projects branch and are used to measure parameters such as water temperature and salinity. Data collected by the buoys help verify measurements by NASA satellites, which contributes to NASA's mission to advance understanding of the Earth by developing technologies to improve the quality of life on or home planet. My main objective during this internship was to support the development of the DRIFTER by writing web-based software that allows the public to view and access data collected by the buoys. In addition, this software would enable DRIFTER owners to configure and control the devices.

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.

An Adaptation of Family-Based Behavioral Pediatric Obesity Treatment for a Primary Care Setting: Group Health Family Wellness Program Pilot

PubMed Central

Riggs, Karin R; Lozano, Paula; Mohelnitzky, Amy; Rudnick, Sarah; Richards, Julie

2014-01-01

Objective: To assess the feasibility and acceptability of family-based group pediatric obesity treatment in a primary care setting, to obtain an estimate of its effectiveness, and to describe participating parents’ experiences of social support for healthy lifestyle changes. Methods: We adapted an evidence-based intervention to a group format and completed six 12- to 16-week groups over 3 years. We assessed program attendance and completion, changes in child and parent body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and changes in child quality of life in a single-arm before-and-after trial. Qualitative interviews explored social support for implementing healthy lifestyle changes. Results: Thirty-eight parent-child pairs enrolled (28% of the 134 pairs invited). Of those, 24 (63%) completed the program and another 6 (16%) attended at least 4 sessions but did not complete the program. Children who completed the program achieved a mean change in BMI Z-scores (Z-BMI) of −0.1 (0.1) (p < 0.001) and significant improvement in parent-reported child quality of life (mean change = 8.5; p = 0.002). Mean BMI of parents changed by −0.9 (p = 0.003). Parents reported receiving a wide range of social support for healthy lifestyle changes and placed importance on the absence or presence of support. Conclusions: A pilot group program for family-based treatment of pediatric obesity is feasible and acceptable in a primary care setting. Change in child and parent BMI outcomes and child quality of life among completers were promising despite the pilot’s low intensity. Parent experiences with lack of social support suggest possible ways to improve retention and adherence. PMID:24937148

Effectiveness of a nurse-supported self-management programme for dual sensory impaired older adults in long-term care: a cluster randomised controlled trial

PubMed Central

Roets-Merken, Lieve M; Zuidema, Sytse U; Vernooij-Dassen, Myrra J F J; Teerenstra, Steven; Hermsen, Pieter G J M; Kempen, Gertrudis I J M; Graff, Maud J L

2018-01-01

Objective To evaluate the effectiveness of a nurse-supported self-management programme to improve social participation of dual sensory impaired older adults in long-term care homes. Design Cluster randomised controlled trial. Setting Thirty long-term care homes across the Netherlands. Participants Long-term care homes were randomised into intervention clusters (n=17) and control clusters (n=13), involving 89 dual sensory impaired older adults and 56 licensed practical nurses. Intervention Nurse-supported self-management programme. Measurements Effectiveness was evaluated by the primary outcome social participation using a participation scale adapted for visually impaired older adults distinguishing four domains: instrumental activities of daily living, social-cultural activities, high-physical-demand and low-physical-demand leisure activities. A questionnaire assessing hearing-related participation problems was added as supportive outcome. Secondary outcomes were autonomy, control, mood and quality of life and nurses’ job satisfaction. For effectiveness analyses, linear mixed models were used. Sampling and intervention quality were analysed using descriptive statistics. Results Self-management did not affect all four domains of social participation; however. the domain ‘instrumental activities of daily living’ had a significant effect in favour of the intervention group (P=0.04; 95% CI 0.12 to 8.5). Sampling and intervention quality was adequate. Conclusions A nurse-supported self-management programme was effective in empowering the dual sensory impaired older adults to address the domain ‘instrumental activities of daily living’, but no differences were found in addressing the other three participation domains. Self-management showed to be beneficial for managing practical problems, but not for those problems requiring behavioural adaptations of other persons. Trial registration number NCT01217502; Results. PMID:29371264

Quality of life: a key variable to consider in the evaluation of adjustment in parents of children with autism spectrum disorders and in the development of relevant support and assistance programmes.

PubMed

Cappe, Emilie; Wolff, Marion; Bobet, René; Adrien, Jean-Louis

2011-10-01

Our primary objective was to identify cognitive and behavioural profiles that affect adjustment, in order to make relevant recommendations about support and assistance for parents of autistic children. One hundred and sixty French parents completed a battery of questionnaires and self-report measures developed or adapted to assess (1) the child and family situations; (2) perceived stress; (3) perceived social support; (4) perceived control; (5) coping strategies; and (6) quality of life. The psychometric properties of the instruments we used proved to be adequate. Our results support the pre-existing data and our findings may prove to be of interest to clinicians. Our primary finding was that emotion-focused coping strategies seem to be less effective. Parents who employed emotion-focused strategies were more stressed and more disturbed in most parts of their life. They also experienced more guilt and reported more false beliefs about PDD. Our data underscore the need for psychoeducation programmes for parents, focused on handling stress and emotions, modifying false beliefs and solving the daily problems that arise from PDD. We propose a 5-axis intervention model for parents of children with PDD, based on cognitive-behavioural therapies and on a stress management programme.

The benefits of prayer on mood and well-being of breast cancer survivors

PubMed Central

Aviv, Caryn; Yoo, Grace; Ewing, Cheryl; Au, Alfred

2012-01-01

Objectives Prayer is becoming more widely acknowledged as a way to cope with cancer. The goal of this study was to compare differences in use of prayer between breast cancer survivors from different ethnic groups and examine how use of prayer is related to mood and quality of life. Methods This study used a mixed methods design. One hundred and seventy-five breast cancer survivors participated in a longitudinal study of survivorship. Women completed in-depth qualitative interviews and a battery of measures including quality of life, spirituality, social support, and mood. Results Eighty-one percent of the women prayed. There were no significant differences between the groups for any of the psychological, social support, or quality of life variables with the exception of higher benefit finding and spiritual well-being among those who prayed. The data did show that women who prayed were able to find more positive contributions from their cancer experience than women who did not pray. The interviews showed that those who prayed tended to be African American or Asian, Catholic or Protestant. The prayers were for petitioning, comfort, or praise. Some of the women stated that they had difficulty praying for themselves. Conclusions While there seems to be few differences in terms of standardized measures of quality of life, social support, and mood between those who prayed and those who did not, the interviews showed that certain ethnic minority groups seem to find more comfort in prayer, felt closer to God, and felt more compassion and forgiveness than Caucasian women. PMID:18633651

A Systematic Review of Vocational Interventions for Young Adults With Autism Spectrum Disorders

PubMed Central

McPheeters, Melissa L.; Sathe, Nila A.; Dove, Dwayne; Veenstra-VanderWeele, Jeremy; Warren, Zachary

2012-01-01

BACKGROUND AND OBJECTIVE: Many individuals with autism spectrum disorders (ASDs) are approaching adolescence and young adulthood; interventions to assist these individuals with vocational skills are not well understood. This study systematically reviewed evidence regarding vocational interventions for individuals with ASD between the ages of 13 and 30 years. METHODS: The Medline, PsycINFO, and ERIC databases (1980–December 2011) and reference lists of included articles were searched. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes, and assigned overall quality and strength of evidence ratings based on predetermined criteria. RESULTS: Five studies were identified; all were of poor quality and all focused on on-the-job supports as the employment/vocational intervention. Short-term studies reported that supported employment was associated with improvements in quality of life (1 study), ASD symptoms (1 study), and cognitive functioning (1 study). Three studies reported that interventions increased rates of employment for young adults with ASD. CONCLUSIONS: Few studies have been conducted to assess vocational interventions for adolescents and young adults with ASD. As such, there is very little evidence available for specific vocational treatment approaches as individuals transition to adulthood. All studies of vocational approaches were of poor quality, which may reflect the recent emergence of this area of research. Individual studies suggest that vocational programs may increase employment success for some; however, our ability to understand the overall benefit of supported employment programs is limited given the existing research. PMID:22926170

Improved Specimen-Referral System and Increased Access to Quality Laboratory Services in Ethiopia: The Role of the Public-Private Partnership

PubMed Central

Kebede, Yenew; Fonjungo, Peter N.; Tibesso, Gudeta; Shrivastava, Ritu; Nkengasong, John N.; Kenyon, Thomas; Kebede, Amha; Gadde, Renuka; Ayana, Gonfa

2016-01-01

Background. Nonstandardized specimen-transport logistics, lack of laboratory personnel to transport specimens, lack of standard specimen containers, and long turnaround time (TAT) hindered access to quality laboratory services. The objective of the Becton, Dickinson, and Company (BD)–US President's Emergency Plan for AIDS Relief (PEPFAR) Public-Private Partnership (PPP) was to support country-specific programs to develop integrated laboratory systems, services, and quality improvement strategies, with an emphasis on strengthening the specimen-referral system (SRS). Methods. In 2007, through the Centers for Disease Control and Prevention (CDC), the Ethiopian Public Health Institute (EPHI) joined with the BD-PEPFAR PPP to strengthen laboratory systems. A joint planning and assessment committee identified gaps in the SRS for prioritization and intervention and piloted the system in Addis Ababa and Amhara Region. Results. The PPP established standardized, streamlined specimen logistics, using the Ethiopian Postal Service Enterprise to support a laboratory network in which 554 facilities referred specimens to 160 laboratories. The PPP supported procuring 400 standard specimen containers and the training of 586 laboratory personnel and 81 postal workers. The average TAT was reduced from 7 days (range, 2–14 days) to 2 days (range, 1–3 days) in Addis Ababa and from 10 days (range, 6–21 days) to 5 days (range, 2–6 days) in Amhara Region. Conclusions. This study highlights the feasibility and untapped potential of PPPs to strengthen laboratory systems. This planned and structured approach to improving specimen referral enhanced access to quality laboratory services. PMID:27025700

Quality of life in adults with facial port-wine stains

PubMed Central

Hagen, Solveig L.; Grey, Katherine R.; Korta, Dorota Z.; Kelly, Kristen M.

2018-01-01

Background Facial port-wine stains (PWS) are considered by some an aesthetic skin problem, yet impact on quality of life (QoL) has not been objectively documented. Objective We sought to (1) characterize the effect of PWS on QoL in adults, (2) to identify the clinical and demographic factors that affect QoL, and (3) to compare our results with QoL studies in other skin conditions. Methods In total, 244 adults with facial PWS completed an online QoL survey, which included the Skindex-29 instrument. Results QoL in adults with facial PWS was diminished, especially from an emotional perspective. Variables associated with reduced QoL in all Skindex-29 subdomains included comorbid depression, limited facial mobility, and presence of other skin conditions. Persons with hypertrophy had more emotional and symptomatic impairment. The composite dermatologic-specific QoL scores were similar to those of cutaneous T-cell lymphoma, rosacea, alopecia, and vitiligo. Limitations Selection bias was a potential limitation, as participants were primarily recruited from patient support groups. Conclusion Our analysis demonstrates that the presence of a facial PWS has a significant negative impact on QoL. Dermatologists caring for patients with PWS should inquire about QoL, provide appropriate support and resources, and consider QoL when discussing treatment options and obtaining authorization for these procedures. PMID:27955934

Smartphone Apps for Cardiopulmonary Resuscitation Training and Real Incident Support: A Mixed-Methods Evaluation Study

PubMed Central

Felzen, Marc; Rossaint, Rolf; Tabuenca, Bernardo; Specht, Marcus; Skorning, Max

2014-01-01

Background No systematic evaluation of smartphone/mobile apps for resuscitation training and real incident support is available to date. To provide medical, usability, and additional quality criteria for the development of apps, we conducted a mixed-methods sequential evaluation combining the perspective of medical experts and end-users. Objective The study aims to assess the quality of current mobile apps for cardiopulmonary resuscitation (CPR) training and real incident support from expert as well as end-user perspective. Methods Two independent medical experts evaluated the medical content of CPR apps from the Google Play store and the Apple App store. The evaluation was based on pre-defined minimum medical content requirements according to current Basic Life Support (BLS) guidelines. In a second phase, non-medical end-users tested usability and appeal of the apps that had at least met the minimum requirements. Usability was assessed with the System Usability Scale (SUS); appeal was measured with the self-developed ReactionDeck toolkit. Results Out of 61 apps, 46 were included in the experts’ evaluation. A consolidated list of 13 apps resulted for the following layperson evaluation. The interrater reliability was substantial (kappa=.61). Layperson end-users (n=14) had a high interrater reliability (intraclass correlation 1 [ICC1]=.83, P<.001, 95% CI 0.75-0.882 and ICC2=.79, P<.001, 95% CI 0.695-0.869). Their evaluation resulted in a list of 5 recommendable apps. Conclusions Although several apps for resuscitation training and real incident support are available, very few are designed according to current BLS guidelines and offer an acceptable level of usability and hedonic quality for laypersons. The results of this study are intended to optimize the development of CPR mobile apps. The app ranking supports the informed selection of mobile apps for training situations and CPR campaigns as well as for real incident support. PMID:24647361

Interim Basis for PCB Sampling and Analyses

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

BANNING, D.L.

2001-01-18

This document was developed as an interim basis for sampling and analysis of polychlorinated biphenyls (PCBs) and will be used until a formal data quality objective (DQO) document is prepared and approved. On August 31, 2000, the Framework Agreement for Management of Polychlorinated Biphenyls (PCBs) in Hanford Tank Waste was signed by the US. Department of Energy (DOE), the Environmental Protection Agency (EPA), and the Washington State Department of Ecology (Ecology) (Ecology et al. 2000). This agreement outlines the management of double shell tank (DST) waste as Toxic Substance Control Act (TSCA) PCB remediation waste based on a risk-based disposalmore » approval option per Title 40 of the Code of Federal Regulations 761.61 (c). The agreement calls for ''Quantification of PCBs in DSTs, single shell tanks (SSTs), and incoming waste to ensure that the vitrification plant and other ancillary facilities PCB waste acceptance limits and the requirements of the anticipated risk-based disposal approval are met.'' Waste samples will be analyzed for PCBs to satisfy this requirement. This document describes the DQO process undertaken to assure appropriate data will be collected to support management of PCBs and is presented in a DQO format. The DQO process was implemented in accordance with the U.S. Environmental Protection Agency EPA QAlG4, Guidance for the Data Quality Objectives Process (EPA 1994) and the Data Quality Objectives for Sampling and Analyses, HNF-IP-0842, Rev. 1 A, Vol. IV, Section 4.16 (Banning 1999).« less

Interim Basis for PCB Sampling and Analyses

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

BANNING, D.L.

2001-03-20

This document was developed as an interim basis for sampling and analysis of polychlorinated biphenyls (PCBs) and will be used until a formal data quality objective (DQO) document is prepared and approved. On August 31, 2000, the Framework Agreement for Management of Polychlorinated Biphenyls (PCBs) in Hanford Tank Waste was signed by the U.S. Department of Energy (DOE), the Environmental Protection Agency (EPA), and the Washington State Department of Ecology (Ecology) (Ecology et al. 2000). This agreement outlines the management of double shell tank (DST) waste as Toxic Substance Control Act (TSCA) PCB remediation waste based on a risk-based disposalmore » approval option per Title 40 of the Code of Federal Regulations 761.61 (c). The agreement calls for ''Quantification of PCBs in DSTs, single shell tanks (SSTs), and incoming waste to ensure that the vitrification plant and other ancillary facilities PCB waste acceptance limits and the requirements of the anticipated risk-based disposal approval are met.'' Waste samples will be analyzed for PCBs to satisfy this requirement. This document describes the DQO process undertaken to assure appropriate data will be collected to support management of PCBs and is presented in a DQO format. The DQO process was implemented in accordance with the U.S. Environmental Protection Agency EPA QA/G4, Guidance for the Data Quality Objectives Process (EPA 1994) and the Data Quality Objectives for Sampling and Analyses, HNF-IP-0842, Rev. 1A, Vol. IV, Section 4.16 (Banning 1999).« less

The advanced along track scanning radiometer (aatsr) on esa's envisat satellite - an early assessment

NASA Astrophysics Data System (ADS)

Llewellyn-Jones, D.; Mutlow, C.; Smith, D.; Edwards, M.

The AATSR sensor is an imaging radiometer designed to measure top-of-the- atmosphere brightness temperature in seven thermal infrared, reflected infrared and visible wavelength channels. The main objective of the AATSR mission is to generate fields of global sea-surface temperature to the high levels of accuracy required for the monitoring and detection of climate change, and to support a broad range of associated research into the marine, terrestrial, cryospheric and atmospheric environments. An essential component of this objective is maintain continuity with the high-quality data-sets already collected form the two predecessor sensors, ATSR1 and 2 on ESA's ERS-1 and -2 satellites respectively. Following the successful launch of ENVISAT on March 1 2002, the AATSR sensor was activated and systematically brought up to full operating configuration in accordance with the agreed Switch-On and Data Acquisition Plan (SODAP). The early images form AATSR are of a quality that is consistent with its objective of effective data continuity. Since the instrument has been returning data, a programme of quality assessment has been taking place. This has included a systematic assessment of instrumental aspects such as signal-to-noise performance and image stability as well as the initial observations in the AATSR validation programme. In this programme, AATSR data-products are compared with correlative observations from other sources, which include, sea-borne radiometers, meteorological analysis fields and data from other satellites. This paper reports early results from some of the activities.

Barriers to health-care and psychological distress among mothers living with HIV in Quebec (Canada).

PubMed

Blais, Martin; Fernet, Mylène; Proulx-Boucher, Karène; Lebouché, Bertrand; Rodrigue, Carl; Lapointe, Normand; Otis, Joanne; Samson, Johanne

2015-01-01

Health-care providers play a major role in providing good quality care and in preventing psychological distress among mothers living with HIV (MLHIV). The objectives of this study are to explore the impact of health-care services and satisfaction with care providers on psychological distress in MLHIV. One hundred MLHIV were recruited from community and clinical settings in the province of Quebec (Canada). Prevalence estimation of clinical psychological distress and univariate and multivariable logistic regression models were performed to predict clinical psychological distress. Forty-five percent of the participants reported clinical psychological distress. In the multivariable regression, the following variables were significantly associated with psychological distress while controlling for sociodemographic variables: resilience, quality of communication with the care providers, resources, and HIV disclosure concerns. The multivariate results support the key role of personal, structural, and medical resources in understanding psychological distress among MLHIV. Interventions that can support the psychological health of MLHIV are discussed.

Mental and social health in disasters: the Sphere standards and post-tsunami psychosocial interventions in Asia.

PubMed

Henderson, Silja E K; Elsass, Peter; Berliner, Peter

2016-07-01

The primary objective of this paper is to examine and inform the mental health and psychosocial support standards of the 2011 edition of the Sphere Project's Humanitarian Charter and Minimum Standards in Humanitarian Response. This is done through a qualitative analysis of internal evaluation documents, reflecting four long-term humanitarian psychosocial programmes in different countries in post-tsunami Asia. The analysis yielded three overall conclusions. First, the Sphere standards on mental health and psychosocial support generally are highly relevant to long-term psychosocial interventions after disasters such as the Indian Ocean tsunami of 26 December 2004, and their application in such settings may improve the quality of the response. Second, some of the standards in the current Sphere handbook may lack sufficient guidance to ensure the quality of humanitarian response required. Third, the long-term intervention approach poses specific challenges to programming, a problem that could be addressed by including additional guidance in the publication. © 2016 The Author(s). Disasters © Overseas Development Institute, 2016.

Care provider order entry (CPOE): a perspective on factors leading to success or to failure.

PubMed

Ozdas, A; Miller, R A

2007-01-01

Authors provide a perspective on factors leading to successful care provider order entry (CPOE) implementations. Viewpoint of authors supported by background literature review. Authors review both benefits and challenges related to CPOE implementation using three guiding principles: (1) a clinical approach to clinical systems, which claims that CPOE implementation is analogous to a "good" clinician delivering care to a patient; (2) a commitment to quality, which advocates that no compromises should be made in implementing system functionality and clinical system content - the highest objective for CPOE implementation is to provide better quality of care and increased safety for patients; (3) a commitment to fairness, as evidenced by respect for individuals and support of local autonomy, which advocates for minimizing disruptions to clinician-users' workflows, and adequate local control over CPOE system design and evolution, including clinical content management. Past experiences with CPOE implementation can inform future installation attempts. Sociocultural factors dominate in determining the success of implementation, and should govern technical factors.

[Social support status and related influential factors of patients with acute coronary syndrome].

PubMed

Lei, S; Ding, R J; Wang, L; Xia, K; Zhang, L J; Yao, D K; Hu, D Y

2017-05-24

Objectives: To investigate the social support status, related influential factors and the impact on one year outcome in patients with acute coronary syndrome (ACS), our data might be helpful to provide basis for making new treatment strategy aimed at improving social support for patients with ACS. Methods: From January 2013 to June 2014, a total of 778 hospitalized patients with ACS were enrolled in the study. All patients completed enhancing recovery in coronary heart disease patients social support inventory(ESSI), general anxiety disorder scale(GAD-7), patient health questionnaire(PHQ-9), short-form 12 health survey questionnaire(SF-12), sleep questionnaire and demographic questionnaire within 7 days after admission and at 6 months and one year post discharge. Multiple linear regressions were performed to analyze factors that influenced the social support. Results: The total score of social support was 17.08±3.61, 17.72±3.04, and 17.76±3.05 respectively in patients with ACS at baseline, 6 months and 12 months after discharge. Patients had a higher point of social support at 6 months ( t =-2.69, P <0.01) and 12 months ( t =-2.86, P <0.01) after discharge than at baseline. Multiple regression analysis for baseline data identified five significant predictors of low social support status: workers or farmers ( t =2.82, P <0.01), low family monthly income ( t =2.42, P <0.05), anxiety ( t =-3.66, P <0.01), depression ( t =-3.22, P <0.01) and low quality of life ( t =4.38, P <0.01). Conclusions: Social support of patients with ACS is lower in China, and there are significant relationships between low social support and occupation, economic status, anxiety, depression, quality of life of ACS patients.

Identifying and classifying quality-of-life tools for assessing pressure ulcers after spinal cord injury

PubMed Central

Hitzig, Sander L.; Balioussis, Christina; Nussbaum, Ethne; McGillivray, Colleen F.; Catharine Craven, B.; Noreau, Luc

2013-01-01

Context Although pressure ulcers may negatively influence quality of life (QoL) post-spinal cord injury (SCI), our understanding of how to assess their impact is confounded by conceptual and measurement issues. To ensure that descriptions of pressure ulcer impact are appropriately characterized, measures should be selected according to the domains that they evaluate and the population and pathologies for which they are designed. Objective To conduct a systematic literature review to identify and classify outcome measures used to assess the impact of pressure ulcers on QoL after SCI. Methods Electronic databases (Medline/PubMed, CINAHL, and PsycInfo) were searched for studies published between 1975 and 2011. Identified outcome measures were classified as being either subjective or objective using a QoL model. Results Fourteen studies were identified. The majority of tools identified in these studies did not have psychometric evidence supporting their use in the SCI population with the exception of two objective measures, the Short-Form 36 and the Craig Handicap Assessment and Reporting Technique, and two subjective measures, the Life Situation Questionnaire-Revised and the Ferrans and Powers Quality of Life Index SCI-Version. Conclusion Many QoL outcome tools showed promise in being sensitive to the presence of pressure ulcers, but few of them have been validated for use with SCI. Prospective studies should employ more rigorous methods for collecting data on pressure ulcer severity and location to improve the quality of findings with regard to their impact on QoL. The Cardiff Wound Impact Schedule is a potential tool for assessing impact of pressure ulcers-post SCI. PMID:24090238

Female sexual function mediates the effects of medication adherence on quality of life in people with epilepsy.

PubMed

Lin, Chung-Ying; Burri, Andrea; Fridlund, Bengt; Pakpour, Amir H

2017-02-01

The purpose of this study was to understand the mediating effects of female sexual functioning in the association between medication adherence and quality of life (QoL) in Iranian women with epilepsy (WWE). Women's sexual functioning was measured using Female Sexual Function Index; QoL using Quality of Life in Epilepsy; epilepsy severity using Liverpool Seizure Severity Scale; subjective medication adherence using Medication Adherence Report Scale; and objective medication adherence using serum level for antiepileptic drugs in 567 WWE. Medication adherence was measured at baseline, while women's sexual functioning, QoL, and epilepsy severity were measured at the 6-month follow-up. Structural equation modeling and regression models were conducted to examine the mediating role of women's sexual functioning. The mediating effects of sexual functioning in the relationship between medication adherence (including subjective and objective measures) and QoL were supported in the total score of Female Sexual Function Index (coefficient=0.415, SE=0.117, p<0.001 for subjective medication adherence; coefficient=1.980, SE=0.446, p<0.001 for objective medication adherence). Seizure severity was significantly associated with QoL but only when objective medication adherence was measured (coefficient=-0.094, SE=0.036, p=0.009). Our results extended the importance of medication adherence from symptom reduction to the beneficial effects of women's sexual functioning and QoL. Health care providers should be aware of these additional benefits of medication adherence and use these arguments to encourage female patients to take their medication, which can eventually increase their sexual satisfaction and overall QoL. Copyright © 2016 Elsevier Inc. All rights reserved.

Shifting attention from objective risk factors to patients' self-assessed health resources: a clinical model for general practice.

PubMed

Hollnagel, H; Malterud, K

1995-12-01

The study was designed to present and apply theoretical and empirical knowledge for the construction of a clinical model intended to shift the attention of the general practitioner from objective risk factors to self-assessed health resources in male and female patients. Review, discussion and analysis of selected theoretical models about personal health resources involving assessing existing theories according to their emphasis concerning self-assessed vs. doctor-assessed health resources, specific health resources vs. life and coping in general, abstract vs. clinically applicable theory, gender perspective explicitly included or not. Relevant theoretical models on health and coping (salutogenesis, coping and social support, control/demand, locus of control, health belief model, quality of life), and the perspective of the underprivileged Other (critical theory, feminist standpoint theory, the patient-centred clinical method) were presented and assessed. Components from Antonovsky's salutogenetic perspective and McWhinney's patient-centred clinical method, supported by gender perspectives, were integrated to a clinical model which is presented. General practitioners are recommended to shift their attention from objective risk factors to self-assessed health resources by means of the clinical model. The relevance and feasibility of the model should be explored in empirical research.

Measuring Software Product Quality: The ISO 25000 Series and CMMI

DTIC Science & Technology

2004-06-14

performance objectives” covers objectives and requirements for product quality, service quality , and process performance. Process performance objectives...such that product quality, service quality , and process performance attributes are measurable and controlled throughout the project (internal and

What is the quality of the maternal near-miss case reviews in WHO European Region? Cross-sectional study in Armenia, Georgia, Latvia, Republic of Moldova and Uzbekistan

PubMed Central

Bacci, Alberta; Hodorogea, Stelian; Khachatryan, Henrik; Babojonova, Shohida; Irsa, Signe; Jansone, Maira; Dondiuc, Iurie; Matarazde, George; Lazdane, Gunta; Lazzerini, Marzia

2018-01-01

Objectives The maternal near-miss case review (NMCR) cycle is a type of clinical audit aiming at improving quality of maternal healthcare by discussing near-miss cases. In several countries this approach has been introduced and supported by WHO and partners since 2004, but information on the quality of its implementation is missing. This study aimed at evaluating the quality of the NMCR implementation in selected countries within WHO European Region. Design Cross-sectional study. Settings Twenty-three maternity units in Armenia, Georgia, Latvia, Moldova and Uzbekistan. Assessment tools A predefined checklist including 50 items, according to WHO methodology. Quality in the NMCR implementation was defined by summary scores ranging from 0 (totally inappropriate) to 3 (appropriate). Results Quality of the NMCR implementation was heterogeneous among different countries, and within the same country. Overall, the first part of the audit cycle (from case identification to case analysis) was fairly well performed (mean score 2.00, 95% CI 1.94 to 2.06), with the exception of the ‘inclusion of users’ views’ (mean score 0.66, 95% CI 0.11 to 1.22), while the second part (developing recommendations, implementing them and ensuring quality) was poorly performed (mean score 0.66, 95% CI 0.11 to 1.22). Each country had at least one champion facility, where quality of the NMCR cycle was acceptable. Quality of the implementation was not associated with its duration. Gaps in implementation were of technical, organisational and attitudinal nature. Conclusions Ensuring quality in the NMCR may be difficult but achievable. The high heterogeneity in results within the same country suggests that quality of the NMCR implementation depends, to a large extent, from hospital factors, including staff’s commitment, managerial support and local coordination. Efforts should be put in preventing and mitigating common barriers that hamper successful NMCR implementation. PMID:29654004

Improving Water Management Decision Support Tools Using NASA Satellite and Modeling Data

NASA Astrophysics Data System (ADS)

Toll, D. L.; Arsenault, K.; Nigro, J.; Pinheiro, A.; Engman, E. T.; Triggs, J.; Cosgrove, B.; Alonge, C.; Boyle, D.; Allen, R.; Townsend, P.; Ni-Meister, W.

2006-05-01

One of twelve Applications of National priority within NASA's Applied Science Program, the Water Management Program Element addresses concerns and decision making related to water availability, water forecast and water quality. The goal of the Water Management Program Element is to encourage water management organizations to use NASA Earth science data, models products, technology and other capabilities in their decision support tools for problem solving. The Water Management Program Element partners with Federal agencies, academia, private firms, and may include international organizations. This paper further describes the Water Management Program with the objective of informing the applications community of the potential opportunities for using NASA science products for problem solving. We will illustrate some ongoing and application Water Management projects evaluating and benchmarking NASA data with partnering federal agencies and their decision support tools: 1) Environmental Protection Agency for water quality; 2) Bureau of Reclamation for water supply, demand and forecast; and 3) NOAA National Weather Service for improved weather prediction. Examples of the types of NASA contributions to the these agency decision support tools include: 1) satellite observations within models assist to estimate water storage, i.e., snow water equivalent, soil moisture, aquifer volumes, or reservoir storages; 2) model derived products, i.e., evapotranspiration, precipitation, runoff, ground water recharge, and other 4-dimensional data assimilation products; 3) improve water quality, assessments by using improved inputs from NASA models (precipitation, evaporation) and satellite observations (e.g., temperature, turbidity, land cover) to nonpoint source models; and 4) water (i.e., precipitation) and temperature predictions from days to decades over local, regional and global scales.

Including quality attributes in efficiency measures consistent with net benefit: creating incentives for evidence based medicine in practice.

PubMed

Eckermann, Simon; Coelli, Tim

2013-01-01

Evidence based medicine supports net benefit maximising therapies and strategies in processes of health technology assessment (HTA) for reimbursement and subsidy decisions internationally. However, translation of evidence based medicine to practice is impeded by efficiency measures such as cost per case-mix adjusted separation in hospitals, which ignore health effects of care. In this paper we identify a correspondence method that allows quality variables under control of providers to be incorporated in efficiency measures consistent with maximising net benefit. Including effects framed from a disutility bearing (utility reducing) perspective (e.g. mortality, morbidity or reduction in life years) as inputs and minimising quality inclusive costs on the cost-disutility plane is shown to enable efficiency measures consistent with maximising net benefit under a one to one correspondence. The method combines advantages of radial properties with an appropriate objective of maximising net benefit to overcome problems of inappropriate objectives implicit with alternative methods, whether specifying quality variables with utility bearing output (e.g. survival, reduction in morbidity or life years), hyperbolic or exogenous variables. This correspondence approach is illustrated in undertaking efficiency comparison at a clinical activity level for 45 Australian hospitals allowing for their costs and mortality rates per admission. Explicit coverage and comparability conditions of the underlying correspondence method are also shown to provide a robust framework for preventing cost-shifting and cream-skimming incentives, with appropriate qualification of analysis and support for data linkage and risk adjustment where these conditions are not satisfied. Comparison on the cost-disutility plane has previously been shown to have distinct advantages in comparing multiple strategies in HTA, which this paper naturally extends to a robust method and framework for comparing efficiency of health care providers in practice. Consequently, the proposed approach provides a missing link between HTA and practice, to allow active incentives for evidence based net benefit maximisation in practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

Multi Objective Optimization of Yarn Quality and Fibre Quality Using Evolutionary Algorithm

NASA Astrophysics Data System (ADS)

Ghosh, Anindya; Das, Subhasis; Banerjee, Debamalya

2013-03-01

The quality and cost of resulting yarn play a significant role to determine its end application. The challenging task of any spinner lies in producing a good quality yarn with added cost benefit. The present work does a multi-objective optimization on two objectives, viz. maximization of cotton yarn strength and minimization of raw material quality. The first objective function has been formulated based on the artificial neural network input-output relation between cotton fibre properties and yarn strength. The second objective function is formulated with the well known regression equation of spinning consistency index. It is obvious that these two objectives are conflicting in nature i.e. not a single combination of cotton fibre parameters does exist which produce maximum yarn strength and minimum cotton fibre quality simultaneously. Therefore, it has several optimal solutions from which a trade-off is needed depending upon the requirement of user. In this work, the optimal solutions are obtained with an elitist multi-objective evolutionary algorithm based on Non-dominated Sorting Genetic Algorithm II (NSGA-II). These optimum solutions may lead to the efficient exploitation of raw materials to produce better quality yarns at low costs.

The Relationships among Satisfaction with Social Support, Quality of Life, and Survival 5 to 10 Years after Heart Transplantation

PubMed Central

White-Williams, Connie; Grady, Kathleen L.; Myers, Susan; Naftel, David C.; Wang, Edward; Bourge, Robert; Rybarczyk, Bruce

2012-01-01

Background Despite the fact that social support has been found to be important to cardiovascular health, there is a paucity of information regarding the relationship between social support and outcomes long-term after heart transplantation (HT). Objectives Thus, the purposes of our retrospective analyses of a prospective, longitudinal study were to examine (1) the relationship between satisfaction with social support and post HT health-related quality of life (HRQOL) and survival, and (2) whether two types of social support (emotional and tangible) were predictors of survival and HRQOL. Methods Data were collected from 555 HT patients over a 5-year period (78% male, 88% white, mean age=53.8 years at time of transplant) at 4 U.S. medical centers using the following instruments: Social Support Index, QOL Index, HT Stressor Scale, Jalowiec Coping Scale, and medical records review. Statistical analyses included t-tests, correlations, Kaplan-Meier survival actuarials, and linear and multivariable regression. Results Patients were very satisfied with overall social support from 5 to 10 years after HT (0=very satisfied, 1=very dissatisfied) which was stable across time (p = 0.74). Satisfaction with emotional social support (p = 0.53) and tangible social support (p = 0.61) also remained stable over time. When stratified into low, medium and high levels of satisfaction, satisfaction with social support was not related to survival (p = 0.24). At 5 years, overall satisfaction with social support was a predictor of HRQOL ( r2=.59, p<.0001), and satisfaction with emotional social support was a predictor of HRQOL at 10 years post HT ( r2=.66, p<.0001). Conclusions Patients were very satisfied over time with emotional and tangible social support. While social support explained QOL outcomes, it did not predict survival. Knowledge of relationships among social support, stress, and outcomes may assist clinicians to address social support needs and resources long-term after HT. PMID:22580630

A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

PubMed Central

Doyle, Cathal; Lennox, Laura; Bell, Derek

2013-01-01

Objective To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. Design Systematic review. Setting A wide range of settings within primary and secondary care including hospitals and primary care centres. Participants A wide range of demographic groups and age groups. Primary and secondary outcome measures A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. Results This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. Conclusions The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness. PMID:23293244

Standards for reporting randomized controlled trials in medical informatics: a systematic review of CONSORT adherence in RCTs on clinical decision support

PubMed Central

Berntsen, G; Lassen, K; Bellika, J G; Wootton, R; Lindsetmo, R O

2011-01-01

Introduction The Consolidated Standards for Reporting Trials (CONSORT) were published to standardize reporting and improve the quality of clinical trials. The objective of this study is to assess CONSORT adherence in randomized clinical trials (RCT) of disease specific clinical decision support (CDS). Methods A systematic search was conducted of the Medline, EMBASE, and Cochrane databases. RCTs on CDS were assessed against CONSORT guidelines and the Jadad score. Result 32 of 3784 papers identified in the primary search were included in the final review. 181 702 patients and 7315 physicians participated in the selected trials. Most trials were performed in primary care (22), including 897 general practitioner offices. RCTs assessing CDS for asthma (4), diabetes (4), and hyperlipidemia (3) were the most common. Thirteen CDS systems (40%) were implemented in electronic medical records, and 14 (43%) provided automatic alerts. CONSORT and Jadad scores were generally low; the mean CONSORT score was 30.75 (95% CI 27.0 to 34.5), median score 32, range 21–38. Fourteen trials (43%) did not clearly define the study objective, and 11 studies (34%) did not include a sample size calculation. Outcome measures were adequately identified and defined in 23 (71%) trials; adverse events or side effects were not reported in 20 trials (62%). Thirteen trials (40%) were of superior quality according to the Jadad score (≥3 points). Six trials (18%) reported on long-term implementation of CDS. Conclusion The overall quality of reporting RCTs was low. There is a need to develop standards for reporting RCTs in medical informatics. PMID:21803926

Practice and payment preferences of newly practising family physicians in British Columbia

PubMed Central

Brcic, Vanessa; McGregor, Margaret J.; Kaczorowski, Janusz; Dharamsi, Shafik; Verma, Serena

2012-01-01

Abstract Objective To examine the remuneration model preferences of newly practising family physicians. Design Mixed-methods study comprising a cross-sectional, Web-based survey, as well as qualitative content analysis of answers to open-ended questions. Setting British Columbia. Participants University of British Columbia family practice residents who graduated between 2000 and 2009. Main outcome measures Preferred remuneration models of newly practising physicians. Results The survey response rate was 31% (133 of 430). Of respondents, 71% (93 of 132) preferred non–fee-for-service practice models and 86% (110 of 132) identified the payment model as very or somewhat important in their choice of future practice. Three principal themes were identified from content analysis of respondents’ open-ended comments: frustrations with fee-for-service billing, which encompassed issues related to aggravations with “the business side of things” and was seen as impeding “the freedom to focus on medicine”; quality of patient care, which embraced the importance of a payment model that supported “comprehensive patient care” and “quality rather than quantity”; and freedom to choose, which supported the plurality of practice preferences among providers who strived to provide quality care for patients, “whatever model you happen to be working in.” Conclusion Newly practising physicians in British Columbia preferred alternatives to fee-for-service payment models, which were perceived as contributing to fewer frustrations with billing systems, improved quality of work life, and better quality of patient care. PMID:22586205

Assessing the conceptual clarity and evidence base of quality criteria/standards developed for evaluating decision aids

PubMed Central

McDonald, Heather; Charles, Cathy; Gafni, Amiram

2011-01-01

Abstract Context  Promoting patient participation in treatment decision making is of increasing interest to researchers, clinicians and policy makers. Decision aids (DAs) are advocated as one way to help achieve this goal. Despite their proliferation, there has been little agreement on criteria or standards for evaluating these tools. To fill this gap, an international collaboration of researchers and others interested in the development, content and quality of DAs have worked over the past several years to develop a checklist and, based on this checklist, an instrument for determining whether any given DA meets a defined set of quality criteria. Objective/Methods  In this paper, we offer a framework for assessing the conceptual clarity and evidence base used to support the development of quality criteria/standards for evaluating DAs. We then apply this framework to assess the conceptual clarity and evidence base underlying the International Patient Decision Aids Standards (IPDAS) checklist criteria for one of the checklist domains: how best to present in DAs probability information to patients on treatment benefits and risks. Conclusion  We found that some of the central concepts underlying the presenting probabilities domain were not defined. We also found gaps in the empirical evidence and theoretical support for this domain and criteria within this domain. Finally, we offer suggestions for steps that should be undertaken for further development and refinement of quality standards for DAs in the future. PMID:22050440

Automated Assessment of Cognitive Health Using Smart Home Technologies

PubMed Central

Dawadi, Prafulla N.; Cook, Diane J.; Schmitter-Edgecombe, Maureen; Parsey, Carolyn

2014-01-01

BACKGROUND The goal of this work is to develop intelligent systems to monitor the well being of individuals in their home environments. OBJECTIVE This paper introduces a machine learning-based method to automatically predict activity quality in smart homes and automatically assess cognitive health based on activity quality. METHODS This paper describes an automated framework to extract set of features from smart home sensors data that reflects the activity performance or ability of an individual to complete an activity which can be input to machine learning algorithms. Output from learning algorithms including principal component analysis, support vector machine, and logistic regression algorithms are used to quantify activity quality for a complex set of smart home activities and predict cognitive health of participants. RESULTS Smart home activity data was gathered from volunteer participants (n=263) who performed a complex set of activities in our smart home testbed. We compare our automated activity quality prediction and cognitive health prediction with direct observation scores and health assessment obtained from neuropsychologists. With all samples included, we obtained statistically significant correlation (r=0.54) between direct observation scores and predicted activity quality. Similarly, using a support vector machine classifier, we obtained reasonable classification accuracy (area under the ROC curve = 0.80, g-mean = 0.73) in classifying participants into two different cognitive classes, dementia and cognitive healthy. CONCLUSIONS The results suggest that it is possible to automatically quantify the task quality of smart home activities and perform limited assessment of the cognitive health of individual if smart home activities are properly chosen and learning algorithms are appropriately trained. PMID:23949177

[Quality development within interdisciplinary transgender healthcare : Results and implications of a participatory research project].

PubMed

Nieder, Timo O; Köhler, Andreas; Eyssel, Jana; Briken, Peer

2017-09-01

Both internationally and nationally, the objective has been set to offer specialized, coordinated, and interdisciplinary treatment to individuals with rare clinical needs, such as trans individuals (e. g., transsexual, transgender). The Interdisciplinary Transgender Health Care Center Hamburg (ITHCCH) is the first and only center in Germany to integrate all disciplines relevant to trans healthcare (THC).The research project seeks to generate valid information to support quality development and assure high-quality treatment at the ITHCCH. This was done by (a) investigating needs and concerns of trans individuals regarding interdisciplinary THC, and (b) analyzing attitudes and interests of key stakeholders.Using a participatory approach involving a work group (representatives of trans support groups and local THC professionals), researchers developed an online survey focusing on trans individuals' needs and concerns. Data from N = 415 trans-identified participants were analyzed using quantitative and qualitative methods. In addition, a short survey was used to record key stakeholders' attitudes and interests towards the ITHCCH.Healthcare offers accessed by trans individuals as part of transition related treatment vary in focus and number. For example, take-up numbers of genital surgery differ between binary and non-binary trans individuals. Crucial aspects impacting on THC quality are structural characteristics, communication/social aspects, individuality, and professionalism/quality.To ensure successful, high-quality interdisciplinary THC, feedback from (potential) patients and stakeholders is crucial. In addition, both structural development and optimizing individuality and flexibility throughout the treatment process are key. This poses a considerable challenge to the sector of THC provision.

Finding High Quality Young Star Candidates in Ceph C using X-ray, Optical, and IR data

NASA Astrophysics Data System (ADS)

Orr, Laura; Rebull, Luisa M.; Johnson, Milton; Miller, Alexandra; Aragon Orozco, Anthony; Bakhaj, Benjamin; Bakshian, Jacquelyn; Chiffelle, Elizabeth; DeLint, Arie; Gerber, Stefan; Mader, Jared; Marengo, Amelia; McAdams, Jesse; Montufar, Cassandra; Orr, Quinton; San Emeterio, Lis; Stern, Eliyah; Weisserman, Drew

2017-01-01

We looked for new candidate young stars within the star forming region of Ceph OB3, more specifically in a region of this molecular cloud called Ceph C. While this region lies in the galactic plane and is included in several large surveys, Ceph C has not been well studied in the past and few young stellar objects (YSOs) have been identified there. The YSOVAR team (Rebull et al. 2014) has time-series monitoring data of this region, and in order to understand the diversity of the light curves, it is crucial to understand which objects in the field of view are likely YSOs, and which are foreground/background objects. The goal of our study is to identify candidate YSO sources as well as support the greater understanding of the variety, evolution, and variability of young stars. Our search for young stars includes data in X-ray, optical, and IR. Data points used are from Chandra, SDSS, IPHAS, 2MASS, Spitzer IRAC and MIPS, and WISE, giving us data over many orders of magnitude, 0.001 to 25 microns (0.36 to 25 microns without the X-rays). The catalogs were merged across all available wavelengths. Each source was inspected in all available images to insure good matches and quality of data across wavelengths and to eliminate poor candidates, those with contamination or confusion, and non-YSO objects. Spectral energy distributions (SEDs) for each candidate YSO were constructed and compared to images for greater assessment and reliable YSO identification. Color-color and color-magnitude diagrams have been created for the sources in this region and are used in conjunction with images, SEDs, X-ray, IR excess, and variability properties to identify candidate YSOs. Support provided for this work by the NASA/IPAC Teacher Archive Research Program (NITARP), which receives funding from the NASA ADP program.

Desired Precision in Multi-Objective Optimization: Epsilon Archiving or Rounding Objectives?

NASA Astrophysics Data System (ADS)

Asadzadeh, M.; Sahraei, S.

2016-12-01

Multi-objective optimization (MO) aids in supporting the decision making process in water resources engineering and design problems. One of the main goals of solving a MO problem is to archive a set of solutions that is well-distributed across a wide range of all the design objectives. Modern MO algorithms use the epsilon dominance concept to define a mesh with pre-defined grid-cell size (often called epsilon) in the objective space and archive at most one solution at each grid-cell. Epsilon can be set to the desired precision level of each objective function to make sure that the difference between each pair of archived solutions is meaningful. This epsilon archiving process is computationally expensive in problems that have quick-to-evaluate objective functions. This research explores the applicability of a similar but computationally more efficient approach to respect the desired precision level of all objectives in the solution archiving process. In this alternative approach each objective function is rounded to the desired precision level before comparing any new solution to the set of archived solutions that already have rounded objective function values. This alternative solution archiving approach is compared to the epsilon archiving approach in terms of efficiency and quality of archived solutions for solving mathematical test problems and hydrologic model calibration problems.

Improving Pediatric Basic Life Support Performance Through Blended Learning With Web-Based Virtual Patients: Randomized Controlled Trial.

PubMed

Lehmann, Ronny; Thiessen, Christiane; Frick, Barbara; Bosse, Hans Martin; Nikendei, Christoph; Hoffmann, Georg Friedrich; Tönshoff, Burkhard; Huwendiek, Sören

2015-07-02

E-learning and blended learning approaches gain more and more popularity in emergency medicine curricula. So far, little data is available on the impact of such approaches on procedural learning and skill acquisition and their comparison with traditional approaches. This study investigated the impact of a blended learning approach, including Web-based virtual patients (VPs) and standard pediatric basic life support (PBLS) training, on procedural knowledge, objective performance, and self-assessment. A total of 57 medical students were randomly assigned to an intervention group (n=30) and a control group (n=27). Both groups received paper handouts in preparation of simulation-based PBLS training. The intervention group additionally completed two Web-based VPs with embedded video clips. Measurements were taken at randomization (t0), after the preparation period (t1), and after hands-on training (t2). Clinical decision-making skills and procedural knowledge were assessed at t0 and t1. PBLS performance was scored regarding adherence to the correct algorithm, conformance to temporal demands, and the quality of procedural steps at t1 and t2. Participants' self-assessments were recorded in all three measurements. Procedural knowledge of the intervention group was significantly superior to that of the control group at t1. At t2, the intervention group showed significantly better adherence to the algorithm and temporal demands, and better procedural quality of PBLS in objective measures than did the control group. These aspects differed between the groups even at t1 (after VPs, prior to practical training). Self-assessments differed significantly only at t1 in favor of the intervention group. Training with VPs combined with hands-on training improves PBLS performance as judged by objective measures.

Adverse Effects of Induced Hot Flashes on Objectively Recorded and Subjectively Reported Sleep: Results of a Gonadotropin-Releasing Hormone Agonist Experimental Protocol

PubMed Central

Joffe, Hadine; White, David P.; Crawford, Sybil L.; McCurnin, Kristin E.; Economou, Nicole; Connors, Stephanie; Hall, Janet E.

2013-01-01

Objectives The impact of hot flashes on sleep is of great clinical interest, but results are inconsistent, especially when both hot flashes and sleep are measured objectively. Using objective and subjective measurements, we examined the impact of hot flashes on sleep by inducing hot flashes with a gonadotropin-releasing hormone agonist (GnRHa). Methods The GnRHa leuprolide was administered to 20 healthy premenopausal volunteers without hot flashes or sleep disturbances. Induced hot flashes were assessed objectively (skin-conductance monitor) and subjectively (daily diary) during one-month follow-up. Changes from baseline in objective (actigraphy) and subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI]) were compared between women who did and did not develop objective hot flashes, and, in parallel analyses, subjective hot flashes. Results New-onset hot flashes were recorded in 14 (70%) and reported by 14 (70%) women (80% concordance). Estradiol was universally suppressed. Objective sleep efficiency worsened in women with objective hot flashes and improved in women without objective hot flashes (median decrease 2.6%, increase 4.2%, p=0.005). Subjective sleep quality worsened more in those with than without subjective hot flashes (median increase PSQI 2.5 vs. 1.0, p=0.03). Objective hot flashes were not associated with subjective sleep quality, nor were subjective symptoms linked to objective sleep measures. Conclusions This experimental model of induced hot flashes demonstrates a causal relationship between hot flashes and poor sleep quality. Objective hot flashes result in worse objective sleep efficiency, while subjective hot flashes worsen perceived sleep quality. PMID:23481119

A no-reference video quality assessment metric based on ROI

NASA Astrophysics Data System (ADS)

Jia, Lixiu; Zhong, Xuefei; Tu, Yan; Niu, Wenjuan

2015-01-01

A no reference video quality assessment metric based on the region of interest (ROI) was proposed in this paper. In the metric, objective video quality was evaluated by integrating the quality of two compressed artifacts, i.e. blurring distortion and blocking distortion. The Gaussian kernel function was used to extract the human density maps of the H.264 coding videos from the subjective eye tracking data. An objective bottom-up ROI extraction model based on magnitude discrepancy of discrete wavelet transform between two consecutive frames, center weighted color opponent model, luminance contrast model and frequency saliency model based on spectral residual was built. Then only the objective saliency maps were used to compute the objective blurring and blocking quality. The results indicate that the objective ROI extraction metric has a higher the area under the curve (AUC) value. Comparing with the conventional video quality assessment metrics which measured all the video quality frames, the metric proposed in this paper not only decreased the computation complexity, but improved the correlation between subjective mean opinion score (MOS) and objective scores.

Developing the protocol for the evaluation of the health foundation's 'engaging with quality initiative' – an emergent approach

PubMed Central

Soper, Bryony; Buxton, Martin; Hanney, Stephen; Oortwijn, Wija; Scoggins, Amanda; Steel, Nick; Ling, Tom

2008-01-01

In 2004 a UK charity, The Health Foundation, established the 'Engaging with Quality Initiative' to explore and evaluate the benefits of engaging clinicians in quality improvement in healthcare. Eight projects run by professional bodies or specialist societies were commissioned in various areas of acute care. A developmental approach to the initiative was adopted, accompanied by a two level evaluation: eight project self-evaluations and a related external evaluation. This paper describes how the protocol for the external evaluation was developed. The challenges faced included large variation between and within the projects (in approach, scope and context, and in understanding of quality improvement), the need to support the project teams in their self-evaluations while retaining a necessary objectivity, and the difficulty of evaluating the moving target created by the developmental approach adopted in the initiative. An initial period to develop the evaluation protocol proved invaluable in helping us to explore these issues. PMID:18973650

Identification of innovative potential quality markers in rocket and melon fresh-cut produce.

PubMed

Cavaiuolo, Marina; Cocetta, Giacomo; Bulgari, Roberta; Spinardi, Anna; Ferrante, Antonio

2015-12-01

Ready-to-eat fresh cut produce are exposed to pre- and postharvest abiotic stresses during the production chain. Our work aimed to identify stress responsive genes as new molecular markers of quality that can be widely applied to leaves and fruits and easily determined at any stage of the production chain. Stress responsive genes associated with quality losses were isolated in rocket and melon fresh-cut produce and their expression levels analyzed by quantitative real time PCR (qRT-PCR) at different time points after harvest at 20 °C and 4 °C. qRT-PCR results were supported by correlation analysis with physiological and biochemical determinations evaluated at the same conditions such as chlorophyll a fluorescence indices, total, reducing sugars, sucrose, ethylene, ascorbic acid, lipid peroxidation and reactive oxygen species. In both species the putative molecular markers increased their expression soon after harvest suggesting a possible use as novel and objective quality markers of fresh-cut produces. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Identification of special quality eggs with NIR spectroscopy technology based on symbol entropy feature extraction method].

PubMed

Zhao, Yong; Hong, Wen-Xue

2011-11-01

Fast, nondestructive and accurate identification of special quality eggs is an urgent problem. The present paper proposed a new feature extraction method based on symbol entropy to identify near infrared spectroscopy of special quality eggs. The authors selected normal eggs, free range eggs, selenium-enriched eggs and zinc-enriched eggs as research objects and measured the near-infrared diffuse reflectance spectra in the range of 12 000-4 000 cm(-1). Raw spectra were symbolically represented with aggregation approximation algorithm and symbolic entropy was extracted as feature vector. An error-correcting output codes multiclass support vector machine classifier was designed to identify the spectrum. Symbolic entropy feature is robust when parameter changed and the highest recognition rate reaches up to 100%. The results show that the identification method of special quality eggs using near-infrared is feasible and the symbol entropy can be used as a new feature extraction method of near-infrared spectra.

Fourier transform near-infrared spectroscopy application for sea salt quality evaluation.

PubMed

Galvis-Sánchez, Andrea C; Lopes, João Almeida; Delgadillo, Ivonne; Rangel, António O S S

2011-10-26

Near-infrared (NIR) spectroscopy in diffuse reflectance mode was explored with the objective of discriminating sea salts according to their quality type (traditional salt vs "flower of salt") and geographical origin (Atlantic vs Mediterranean). Sea salts were also analyzed in terms of Ca(2+), Mg(2+), K(+), alkalinity, and sulfate concentrations to support spectroscopic results. High concentrations of Mg(2+) and K(+) characterized Atlantic samples, while a high Ca(2+) content was observed in traditional sea salts. A partial least-squares discriminant analysis model considering the 8500-7500 cm(-1) region permitted the discrimination of salts by quality types. The regions 4650-4350 and 5900-5500 cm(-1) allowed salts classification according to their geographical origin. It was possible to classify correctly 85.3 and 94.8% of the analyzed samples according to the salt type and to the geographical origin, respectively. These results demonstrated that NIR spectroscopy is a suitable and very efficient tool for sea salt quality evaluation.

Stress and Negative Relationship Quality among Older Couples: Implications for Blood Pressure

PubMed Central

Newton, Nicky J.; Cranford, James A.; Ryan, Lindsay H.

2016-01-01

Objectives: The cardiovascular system may represent a significant pathway by which marriage and stress influence health, but research has focused on married individuals cross-sectionally. This study examined associations among chronic stress, negative spousal relationship quality, and systolic blood pressure over time among middle-aged and older husbands and wives. Method: Participants were from the nationally representative longitudinal Health and Retirement Study. A total of 1,356 (N = 2,712) married and cohabitating couples completed psychosocial and biomeasure assessments in waves 2006 and 2010. Analyses examined whether Wave 1 (2006) relationship quality and stress were associated with changes in blood pressure over time. Results: The effects of stress and negative relationship quality were dyadic and varied by gender. Husbands had increased blood pressure when wives reported greater stress, and this link was exacerbated by negative spousal relationship quality. Negative relationship quality predicted increased blood pressure when both members of the couple reported negative quality relations. Discussion: Findings support the dyadic biopsychosocial model of marriage and health indicating: (a) stress and relationship quality directly effect the cardiovascular system, (b) relationship quality moderates the effect of stress, and (c) the dyad rather than only the individual should be considered when examining marriage and health. PMID:25852106

Managerial attitude to the implementation of quality management systems in Lithuanian support treatment and nursing hospitals.

PubMed

Buciuniene, Ilona; Malciankina, Sonata; Lydeka, Zigmas; Kazlauskaite, Ruta

2006-09-20

The regulations of the Quality Management System (QMS) implementation in health care organizations were approved by the Lithuanian Ministry of Health in 1998. Following the above regulations, general managers of health care organizations had to initiate the QMS implementation in hospitals. As no research on the QMS implementation has been carried out in Lithuanian support treatment and nursing hospitals since, the objective of this study is to assess its current stage from a managerial perspective. A questionnaire survey of general managers of Lithuanian support treatment and nursing hospitals was carried out in the period of January through March 2005. Majority of the items included in the questionnaire were measured on a seven-point Likert scale. During the survey, a total of 72 questionnaires was distributed, out of which 58 filled-in ones were returned (response rate 80.6 per cent; standard sampling error 0.029 at 95 per cent level of confidence). Quality Management Systems were found operating in 39.7 per cent of support treatment and nursing hospitals and currently under implementation in 46.6 per cent of hospitals (13.7% still do not have it). The mean of the respondents' perceived QMS significance is 5.8 (on a seven-point scale). The most critical issues related to the QMS implementation include procedure development (5.5), lack of financial resources (5.4) and information (5.1), and development of work guidelines (4.6), while improved responsibility and power sharing (5.2), better service quality (5.1) and higher patient satisfaction (5.1) were perceived by the respondents as the key QMS benefits. The level of satisfaction with the QMS among the management of the surveyed hospitals is mediocre (3.6). However it was found to be higher among respondents who were more competent in quality management, were familiar with ISO 9000 standards, and had higher numbers of employees trained in quality management. QMSs are perceived to be successfully running in one third of the Lithuanian support treatment and nursing hospitals. Its current implementation stage is dependent on the hospital size - the bigger the hospital the more success it meets in the QMS implementation. As to critical Quality Management (QM) issues, hospitals tend to encounter such major problems as lack of financial resources, information and training, as well as difficulties in procedure development. On the other hand, the key factors that assist to the success of the QMS implementation comprise managerial awareness of the QMS significance and the existence of employee training systems and audit groups in hospitals.

Care quality following intrauterine death in Spanish hospitals: results from an online survey.

PubMed

Cassidy, Paul Richard

2018-01-10

The objective of the study was to evaluate practices in Spanish hospitals after intrauterine death in terms of medical/ technical care and bereavement support care. A cross-sectional descriptive study using an online self-completion questionnaire. The population was defined as women who had experienced an intrauterine fetal death between sixteen weeks and birth, either through spontaneous late miscarriage/stillbirth or termination of pregnancy for medical reasons. Respondents were recruited through an online advertisement on a stillbirth charity website and social media. The analysis used Pearson's chi-squared (p ≤ 0.05) test of independence to cross-analyse for associations between objective measures of care quality and independent variables. Responses from 796 women were analysed. Half of the women (52.9%) had postmortem contact with their baby. 30.4% left the hospital with a least one linking object or a photograph. In 35.8% of cases parents weren't given any option to recover the body/remains. 22.9% of births ≥26 weeks gestation were by caesarean, with a significant (p < 0.001) difference between public hospitals (16.8%) and private hospitals (41.5%). 29.3% of respondents were not accompanied during the delivery. 48.0% of respondents recalled being administered sedatives at least once during the hospital stay. The autopsy rate in stillbirth cases (≥ 20 weeks) was 70.5% and 44.4% in cases of termination of pregnancy (all gestational ages). Consistent significant (p < 0.05) differences in care practices were found based on gestational age and type of hospital (public or private), but not to other variables related to socio-demographics, pregnancy history or details of the loss/death. Intrauterine deaths at earlier gestational ages received poorer quality care. Supportive healthcare following intrauterine death is important to women's experiences in the hospital and beneficial to the grief process. Many care practices that are standard in other high-income countries are not routine in Spanish hospitals. Providing such care is a relatively new phenomenon in the Spanish health system, the results provide a quality benchmark and identify a number of areas where hospitals could make improvements to care practices that should have important psychosocial benefits for women and their families.

The effects on anxiety and quality of life of breast cancer patients following completion of the first cycle of chemotherapy

PubMed Central

Charalambous, Andreas; Kaite, Charis P; Charalambous, Melanie; Tistsi, Theologia; Kouta, Christiana

2017-01-01

Objectives: Breast cancer patients as part of their treatment need to undergo various forms of chemotherapy. This is considered as a burdensome experience for many patients often leading to significant levels of anxiety. The aim of the study was to explore the anxiety levels and any correlations to the quality of life of women with breast cancer that were undergoing chemotherapy. Methods: This was a cross-sectional study utilizing an explanatory sequential design. Data were collected from 355 women with breast cancer with the Self Anxiety Scale, the EORTC QLQ-C30, the EORTC QLQ-BR23 and sociodemographic questionnaires. Further insight to patients’ experiences was given through 12 in-depth interviews. Results: Anxiety scores ranged between 24 and 75 (45.7 ± 10.11), with 44% reporting serious or/and intense anxiety. The results revealed statistically significant differences on patients’ anxiety levels depending on their source of support. Overall, patients’ global health-related quality of life was found to be low to average 55.91 ± 17.94. The results showed low emotional functioning (49.30 ± 29.12), low role functions (56.34 ± 27.50) and low sexual functioning (24.93 ± 20.75). Patients also reported experiencing problems with fatigue (49.04 ± 29.12), insomnia (44.32 ± 32.97), hair loss (48.25 ± 38.32) and arm symptoms (36.53 ± 23.71). Patients being solely supported by the family experienced higher anxiety levels (p < 0.001) and lower quality of life (p < 0.001). There was a statistically significant negative correlation between anxiety and quality of life (r = −0.623, p < 0.001). Statistically significant differences were also found in relation to demographics, anxiety and quality of life. The interviews provided further evidence on the impact of anxiety on patients’ lives. Conclusion: The time following the completion of the first cycle of chemotherapy is associated with anxiety and lower quality of life levels in breast cancer patients. Healthcare providers should consider the supportive healthcare needs from the beginning of chemotherapy in patients to optimize their conventional and supportive healthcare outcomes. PMID:28694967

The influence of familiar characters and other appealing images on young children's preference for low-quality objects.

PubMed

Danovitch, Judith H; Mills, Candice M

2017-09-01

This study examines the factors underlying young children's preference for products bearing a familiar character's image. Three-year-olds (N = 92) chose between low-quality objects with images on or near the objects and high-quality objects without images. Children showed stronger preferences for damaged objects bearing images of a preferred familiar character than for objects bearing images of a preferred colour star, and they showed weak preferences for damaged objects with the character near, but not on, the object. The results suggest that children's preference for low-quality products bearing character images is driven by prior exposure to characters, and not only by the act of identifying a favourite. Statement of contribution What is already known on this subject? Children are exposed to characters in the media and on products such as clothing and school supplies. Products featuring familiar characters appeal to preschool children, even if they are of low quality. What does this study add? Three-year-olds prefer damaged objects with an image of a favourite character over plain undamaged objects. Children's preference is not solely a function of having identified a favourite image or of attentional cues. © 2017 The British Psychological Society.

Portrait of trauma care in Quebec's rural emergency departments and identification of priority intervention needs to improve the quality of care: a study protocol

PubMed Central

Fleet, Richard; Tounkara, Fatoumata Korika; Ouimet, Mathieu; Dupuis, Gilles; Poitras, Julien; Tanguay, Alain; Fortin, Jean Paul; Trottier, Jean-Guy; Ouellet, Jean; Lortie, Gilles; Plant, Jeff; Morris, Judy; Chauny, Jean Marc; Lauzier, François; Légaré, France

2016-01-01

Introduction Trauma remains the primary cause of death in individuals under 40 years of age in Canada. In Quebec, the Trauma Care Continuum (TCC) has been demonstrated to be effective in decreasing the mortality rate among trauma victims. Although rural citizens are at greater risk for trauma and trauma death, no empirical data concerning the effectiveness of the TCC for the rural population in Quebec are available. The emergency departments (EDs) are important safety nets for rural citizens. However, our data indicate that access to diagnostic support services, such as intensive care units and CT is limited in rural areas. The objectives are to (1) draw a portrait of trauma services in rural EDs; (2) explore geographical variations in trauma care in Quebec; (3) identify adaptable factors that could reduce variation; and (4) establish consensus solutions for improving the quality of care. Methods and analysis The study will take place from November 2015 to November 2018. A mixed methodology (qualitative and quantitative) will be used. We will include data (2009–2013) from all trauma victims treated in the 26 rural EDs and tertiary/secondary care centres in Quebec. To meet objectives 1 and 2, data will be gathered from the Ministry's Database of the Quebec Trauma Registry Information System. For objectives 3 and 4, the project will use the Delphi method to develop consensus solutions for improving the quality of trauma care in rural areas. Data will be analysed using a Poisson regression to compare mortality rate during hospital stay or death on ED arrival (objectives 1 and 2). Average scores and 95% CI will be calculated for the Delphi questionnaire (objectives 3 and 4). Ethics and dissemination This protocol has been approved by CSSS Alphonse-Desjardins research ethics committee (Project MP-HDL-2016-003). The results will be published in peer-reviewed journals. PMID:27098826

Euthanasia and physician-assisted suicide in amyotrophic lateral sclerosis: a prospective study.

PubMed

Maessen, Maud; Veldink, Jan H; Onwuteaka-Philipsen, Bregje D; Hendricks, Henk T; Schelhaas, Helenius J; Grupstra, Hepke F; van der Wal, Gerrit; van den Berg, Leonard H

2014-10-01

The objective of this study is to determine if quality of care, symptoms of depression, disease characteristics and quality of life of patients with amyotrophic lateral sclerosis (ALS) are related to requesting euthanasia or physician-assisted suicide (EAS) and dying due to EAS. Therefore, 102 ALS patients filled out structured questionnaires every 3 months until death and the results were correlated with EAS. Thirty-one percent of the patients requested EAS, 69% of whom eventually died as a result of EAS (22% of all patients). Ten percent died during continuous deep sedation; only one of them had explicitly requested death to be hastened. Of the patients who requested EAS, 86% considered the health care to be good or excellent, 16% felt depressed, 45% experienced loss of dignity and 42% feared choking. These percentages do not differ from the number of patients who did not explicitly request EAS. The frequency of consultations of professional caregivers and availability of appliances was similar in both groups. Our findings do not support continuous deep sedation being used as a substitute for EAS. In this prospective study, no evidence was found for a relation between EAS and the quality and quantity of care received, quality of life and symptoms of depression in patients with ALS. Our study does not support the notion that unmet palliative care needs are related to EAS.

Real-time quality assurance testing using photonic techniques: Application to iodine water system

NASA Technical Reports Server (NTRS)

Arendale, W. F.; Hatcher, Richard; Garlington, Yadilett; Harwell, Jack; Everett, Tracey

1990-01-01

A feasibility study of the use of inspection systems incorporating photonic sensors and multivariate analyses to provide an instrumentation system that in real-time assures quality and that the system in control has been conducted. A system is in control when the near future of the product quality is predictable. Off-line chemical analyses can be used for a chemical process when slow kinetics allows time to take a sample to the laboratory and the system provides a recovery mechanism that returns the system to statistical control without intervention of the operator. The objective for this study has been the implementation of do-it-right-the-first-time and just-in-time philosophies. The Environment Control and Life Support Systems (ECLSS) water reclamation system that adds iodine for biocidal control is an ideal candidate for the study and implementation of do-it-right-the-first-time technologies.

Urban airshed modeling of air quality impacts of alternative transportation fuel use in Los Angeles and Atlanta

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

NONE

1997-12-01

The main objective of NREL in supporting this study is to determine the relative air quality impact of the use of compressed natural gas (CNG) as an alternative transportation fuel when compared to low Reid vapor pressure (RVP) gasoline and reformulated gasoline (RFG). A table lists the criteria, air toxic, and greenhouse gas pollutants for which emissions were estimated for the alternative fuel scenarios. Air quality impacts were then estimated by performing photochemical modeling of the alternative fuel scenarios using the Urban Airshed Model Version 6.21 and the Carbon Bond Mechanism Version IV (CBM-IV) (Geary et al., 1988) Using thismore » model, the authors examined the formation and transport of ozone under alternative fuel strategies for motor vehicle transportation sources for the year 2007. Photochemical modeling was performed for modeling domains in Los Angeles, California, and Atlanta, Georgia.« less

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

PubMed

Macé, C; Nikiema, J-B

2016-11-01

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

What happens to quality in integrated homecare? A 15-year follow-up study

PubMed Central

Paljärvi, Soili; Rissanen, Sari; Sinkkonen, Sirkka; Paljärvi, Leo

2011-01-01

Objectives To explore the impact of structural integration on homecare quality. Methods A case study in an organisation comprising a before–after comparison with baseline and four follow-up measurements during 1994–2009, using interviews with clients (n=66–84) and postal inquiries to relatives (n=73–78) and staff (n=68–136). Results Despite the organisational reform involving extensive mergers of health and social care organisations and cuts in staff and service provision, homecare quality remained at almost the same level throughout the 15-year follow-up. According to the clients, it even slightly improved in some homecare areas. Conclusions The results show that despite the structural integration and cuts in staff and service provision, the quality of homecare remained at a good level. Assuming that the potential confounders did have inhibiting effects, the results suggest that structural integration had a positive impact on homecare quality. To obtain firmer evidence to support this tentative conclusion, further research with a randomised comparison design is needed. PMID:21949487

Methods to characterize environmental settings of stream and groundwater sampling sites for National Water-Quality Assessment

USGS Publications Warehouse

Nakagaki, Naomi; Hitt, Kerie J.; Price, Curtis V.; Falcone, James A.

2012-01-01

Characterization of natural and anthropogenic features that define the environmental settings of sampling sites for streams and groundwater, including drainage basins and groundwater study areas, is an essential component of water-quality and ecological investigations being conducted as part of the U.S. Geological Survey's National Water-Quality Assessment program. Quantitative characterization of environmental settings, combined with physical, chemical, and biological data collected at sampling sites, contributes to understanding the status of, and influences on, water-quality and ecological conditions. To support studies for the National Water-Quality Assessment program, a geographic information system (GIS) was used to develop a standard set of methods to consistently characterize the sites, drainage basins, and groundwater study areas across the nation. This report describes three methods used for characterization-simple overlay, area-weighted areal interpolation, and land-cover-weighted areal interpolation-and their appropriate applications to geographic analyses that have different objectives and data constraints. In addition, this document records the GIS thematic datasets that are used for the Program's national design and data analyses.

Developing evidence-based physical therapy clinical practice guidelines.

PubMed

Kaplan, Sandra L; Coulter, Colleen; Fetters, Linda

2013-01-01

Recommended strategies for developing evidence-based clinical practice guidelines (CPGs) are provided. The intent is that future CPGs developed with the support of the Section on Pediatrics of the American Physical Therapy Association would consistently follow similar developmental processes to yield consistent quality and presentation. Steps in the process of developing CPGs are outlined and resources are provided to assist CPG developers in carrying out their task. These recommended processes may also be useful to CPG developers representing organizations with similar structures, objectives, and resources.

Advanced Wireless Integrated Navy Network - AWINN

DTIC Science & Technology

2005-06-30

de Sousa, GRA (5/15/05-6/30/05) George C. Hadjichristofi, GRA (4/1/05-5/14/05) Unghee Lee, GRA (33% for 4/1/05-5/14/05, 100% for 5/15/05-6/30/05...and initial implementation of test bed conversion to support Internet Protocol version 6 (IPv6). In this section, we also report on accomplishments in...below. 2.1.2 Task Activities for the Period Subtask 2. la Policy-based Quality of Service Task Obiective: The objectives of this subtask are to

PowerGuard® manufacturing innovation and expansion

NASA Astrophysics Data System (ADS)

Dinwoodie, Thomas; Kleiner, Tim; O'Brien, Colleen; Quiroz, Maurice

1999-03-01

PowerLight Corporation, with support from the DOE's PVMaT program, has undertaken a comprehensive agenda to automate the manufacture of its PowerGuard PV roof tile system. The advanced manufacturing will lead to substantially reduced costs, quality improvements, and increased production capacity. Over the three years of the PVMaT contract, system costs are expected to fall 2.65/Wp, with annual production capability increasing from 5 to 16 MW. PowerLight is on schedule with meeting its objectives under this program.

Implementation of EcoAIM (trademark) - A Multi-Objective Decision Support Tool for Ecosystem Services at Department of Defense Installations

DTIC Science & Technology

2014-09-26

neotropical birds , as well as its high-quality habitat for resident birds in the Chesapeake Bay watershed, such as bald eagles and several species of...Duelli and Obrist 2003). Several papers have developed methods that relate measurable habitat features at various spatial scales to species richness ...advised to first establish a baseline in which a species adheres to patterns of ideal habitat selection (Johnson 2007). In the case of the APG bird

Use of Social Support during Communication about Sickle Cell Carrier Status

PubMed Central

Bradford, Lisa; Roedl, Sara J.; Christopher, Stephanie A.; Farrell, Michael H.

2012-01-01

Objective To examine the use of social support behaviors by primary care providers during delivery of positive newborn screening results for Sickle Cell Anemia carrier status. Methods Transcripts from 125 primary care providers who conveyed Sickle Cell Anemia carrier status to standardized parents were content analyzed using categories derived from Cutrona and Suhr’s social support taxonomy. Frequencies and cross-tabulation matrices were calculated to study providers’ social support utilization. Results Results showed most primary care providers (80%) incorporate social support behaviors into delivery of Sickle Cell Anemia carrier results and most frequently employed social network (61.6%) and informational support (38.4%) behaviors. Providers used tangible aid (8%), esteem (1.6%), and emotional support (9.6%) behaviors less frequently. Conclusion Cutrona and Suhr’s taxonomy may be a useful tool for assessing supportive communication during the delivery of Sickle Cell Anemia carrier status and could be incorporated into population scale assessments of communication quality assurance. Practice Implications Primary care providers may need training in how to adapt supportive behaviors to parents’ needs during communication of Sickle Cell Anemia carrier status. They also may benefit from specific training about how to use esteem and emotional support. PMID:22658247

Changes in Church-Based Social Support Relationships During Older Adulthood

PubMed Central

2013-01-01

Objectives. To track the course of age-related changes in emotional and tangible support given and received by older adults in the context of their religious congregations. Method. Hierarchical linear modeling was applied to data from a national sample of 1,192 White and African American older adults who attended church regularly, and they were interviewed up to four times over a period of seven years. Results. Changes were found in six measures of support. Participants increased in terms of the amount of emotional support that they both gave and received, whereas decreased in the amount of tangible support they gave and received. Satisfaction increased with age for both emotional and tangible support. There were large race-related differences, with African Americans being more engaged in support relationships of all types. Religious factors, including frequency of attendance, commitment, and the congregational cohesiveness were strong predictors of between-person differences. Discussion. This study is the first to demonstrate within-person change in church-based support relationships during the course of older adulthood. Patterns of increasing quantity and quality of emotional ties, but decreasing tangible support, partially contrast with previous findings regarding secular support networks but are consistent with the socioemotional selectivity perspective. PMID:23149429

Integrated Primary Care Teams (IPCT) pilot project in Quebec: a protocol paper

PubMed Central

Contandriopoulos, Damien; Duhoux, Arnaud; Roy, Bernard; Amar, Maxime; Bonin, Jean-Pierre; Borges Da Silva, Roxane; Brault, Isabelle; Dallaire, Clémence; Dubois, Carl-Ardy; Girard, Francine; Jean, Emmanuelle; Larue, Caroline; Lessard, Lily; Mathieu, Luc; Pépin, Jacinthe; Cockenpot, Aurore

2015-01-01

Introduction The overall aim of this project is to help develop knowledge about primary care delivery models likely to improve the accessibility, quality and efficiency of care. Operationally, this objective will be achieved through supporting and evaluating 8 primary care team pilot sites that rely on an expanded nursing role within a more intensive team-based, interdisciplinary setting. Methods and analysis The first research component is aimed at supporting the development and implementation of the pilot projects, and is divided into 2 parts. The first part is a logical analysis based on interpreting available scientific data to understand the causal processes by which the objectives of the intervention being studied may be achieved. The second part is a developmental evaluation to support teams in the field in a participatory manner and thereby learn from experience. Operationally, the developmental evaluation phase mainly involves semistructured interviews. The second component of the project design focuses on evaluating pilot project results and assessing their costs. This component is in turn made up of 2 parts. Part 1 is a pre-and-post survey of patients receiving the intervention care to analyse their care experience. In part 2, each patient enrolled in part 1 (around 4000 patients) will be matched with 2 patients followed within a traditional primary care model, so that a comparative analysis of the accessibility, quality and efficiency of the intervention can be performed. The cohorts formed in this way will be followed longitudinally for 4 years. Ethics and dissemination The project, as well as all consent forms and research tools, have been accepted by 2 health sciences research ethics committees. The procedures used will conform to best practices regarding the anonymity of patients. PMID:26700294

A Preliminary Investigation of the Utility of the "Behavior Support Plan Quality Evaluation Guide II" for Use in Australia

ERIC Educational Resources Information Center

Webber, Lynne S.; McVilly, Keith R.; Fester, Tarryn; Zazelis, Telly

2011-01-01

Background: The quality of behaviour support plans (BSPs) can be an important influence on the quality of the support provided to people with disability who show challenging behaviours. The Behavior Support Plan Quality Evaluation Guide II (BSP-QE II) is one tool that may be useful in assessing the quality of behaviour support plans. It has…

Relationships between Death Anxiety and Quality of Life in Iranian Patients with Cancer

PubMed Central

Soleimani, Mohammad A.; Lehto, Rebecca H.; Negarandeh, Reza; Bahrami, Nasim; Nia, Hamid Sharif

2016-01-01

Objective: The purpose of the study was to examine relationships between death anxiety and quality of life (QOL) parameters of patients with cancer in the Iranian sociocultural context. Methods: A descriptive, correlational methodology was used. The sample included 330 patients. Demographics, health information, religious behaviors, death anxiety, and QOL data were collected. Results: Overall death anxiety levels were moderate with satisfactory overall QOL. Death anxiety was predictive of lowered QOL. Female patients had lower QOL and higher death anxiety compared to men Conclusions: Findings support that higher death anxiety negatively impacts QOL in an Iranian sample with cancer. Alleviation of existential concerns in vulnerable patients may palliate mental health distress associated with facing cancer and its challenging treatments. PMID:27981157

Crane Cell Testing Support of NASA/Goddard Space Flight Center: An Update

NASA Technical Reports Server (NTRS)

Strawn, Mike; David, Jerry; Rao, Gopalakrishna M.

2001-01-01

The objectives presented in this viewgraph presentation include: 1) Verify the quality and reliability of aerospace battery cells and batteries for NASA flight programs; 2) Disseminate the data to develop a plan for in-orbit battery management and to design a cell/battery for future NASA spacecraft; and 3) Establish a cell test data base for rechargeable cell/batteries. In summary: quality EPT Ni-H2, EPT Super NiCd and SAFT NiCd cells have been demonstrated for aerospace applications; the data has been provided to NASA Centers and other agencies for their use and application; developed plan and used in NASA in-orbit battery management. Database on rechargeable cell/batteries is now available for customer use.

Computing quality scores and uncertainty for approximate pattern matching in geospatial semantic graphs

DOE PAGES

Stracuzzi, David John; Brost, Randolph C.; Phillips, Cynthia A.; ...

2015-09-26

Geospatial semantic graphs provide a robust foundation for representing and analyzing remote sensor data. In particular, they support a variety of pattern search operations that capture the spatial and temporal relationships among the objects and events in the data. However, in the presence of large data corpora, even a carefully constructed search query may return a large number of unintended matches. This work considers the problem of calculating a quality score for each match to the query, given that the underlying data are uncertain. As a result, we present a preliminary evaluation of three methods for determining both match qualitymore » scores and associated uncertainty bounds, illustrated in the context of an example based on overhead imagery data.« less

A proposed framework on hybrid feature selection techniques for handling high dimensional educational data

NASA Astrophysics Data System (ADS)

Shahiri, Amirah Mohamed; Husain, Wahidah; Rashid, Nur'Aini Abd

2017-10-01

Huge amounts of data in educational datasets may cause the problem in producing quality data. Recently, data mining approach are increasingly used by educational data mining researchers for analyzing the data patterns. However, many research studies have concentrated on selecting suitable learning algorithms instead of performing feature selection process. As a result, these data has problem with computational complexity and spend longer computational time for classification. The main objective of this research is to provide an overview of feature selection techniques that have been used to analyze the most significant features. Then, this research will propose a framework to improve the quality of students' dataset. The proposed framework uses filter and wrapper based technique to support prediction process in future study.

Modelling health care processes for eliciting user requirements: a way to link a quality paradigm and clinical information system design.

PubMed

Staccini, P; Joubert, M; Quaranta, J F; Fieschi, D; Fieschi, M

2001-12-01

Healthcare institutions are looking at ways to increase their efficiency by reducing costs while providing care services with a high level of safety. Thus, hospital information systems have to support quality improvement objectives. The elicitation of the requirements has to meet users' needs in relation to both the quality (efficacy, safety) and the monitoring of all health care activities (traceability). Information analysts need methods to conceptualise clinical information systems that provide actors with individual benefits and guide behavioural changes. A methodology is proposed to elicit and structure users' requirements using a process-oriented analysis, and it is applied to the blood transfusion process. An object-oriented data model of a process has been defined in order to organise the data dictionary. Although some aspects of activity, such as 'where', 'what else', and 'why' are poorly represented by the data model alone, this method of requirement elicitation fits the dynamic of data input for the process to be traced. A hierarchical representation of hospital activities has to be found for the processes to be interrelated, and for their characteristics to be shared, in order to avoid data redundancy and to fit the gathering of data with the provision of care.

AmO 2 Analysis for Analytical Method Testing and Assessment: Analysis Support for AmO 2 Production

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

Kuhn, Kevin John; Bland, Galey Jean; Fulwyler, James Brent

Americium oxide samples will be measured for various analytes to support AmO 2 production. The key analytes that are currently requested by the Am production customer at LANL include total Am content, Am isotopics, Pu assay, Pu isotopics, and trace element content including 237Np content. Multiple analytical methods will be utilized depending on the sensitivity, accuracy and precision needs of the Am matrix. Traceability to the National Institute of Standards and Technology (NIST) will be achieved, where applicable, by running NIST traceable quality control materials. This given that there are no suitable AmO 2 reference materials currently available for requestedmore » analytes. The primary objective is to demonstrate the suitability of actinide analytical chemistry methods to support AmO 2 production operations.« less

Fusing modeling techniques to support domain analysis for reuse opportunities identification

NASA Technical Reports Server (NTRS)

Hall, Susan Main; Mcguire, Eileen

1993-01-01

Functional modeling techniques or object-oriented graphical representations, which are more useful to someone trying to understand the general design or high level requirements of a system? For a recent domain analysis effort, the answer was a fusion of popular modeling techniques of both types. By using both functional and object-oriented techniques, the analysts involved were able to lean on their experience in function oriented software development, while taking advantage of the descriptive power available in object oriented models. In addition, a base of familiar modeling methods permitted the group of mostly new domain analysts to learn the details of the domain analysis process while producing a quality product. This paper describes the background of this project and then provides a high level definition of domain analysis. The majority of this paper focuses on the modeling method developed and utilized during this analysis effort.

[Quality and objectifiability of training and advanced training in urology].

PubMed

Müller, S C; Strunk, T; Alken, P

2012-08-01

The attraction to study medicine has not changed, however we are facing a lack of trainees especially in surgical subspecialties like urology. Possible explanations are a 70% proportion of female students and different views on the work-life balance in the future. A high burden of theory and unrealistic multiple choice examinations support those who can learn but there are no objective and reproducible criteria to recognize the competence of a good physician early in the career. This problem continues during residency, especially in surgical subspecialities. The different medical boards in Germany responsible for the training programs have no concepts. Many attempts in other countries to objectively measure surgical skills have so far been ignored. If we do not want to lose our traditionally high competence in medicine we should join those who attempt to improve teaching and to use methods for selecting suitable candidates for surgery as soon and as objectively as possible.

The associations between organizational culture, organizational structure and quality management in European hospitals

PubMed Central

Wagner, C.; Mannion, R.; Hammer, A.; Groene, O.; Arah, O.A.; Dersarkissian, M.; Suñol, R.

2014-01-01

Objective To better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals. Design A multi-method, multi-level, cross-sectional observational study. Setting and participants As part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospitals in 7 countries (France, Poland, Turkey, Portugal, Spain, Germany and Czech Republic) participated in a comprehensive questionnaire survey and a one-day on-site surveyor audit. Respondents for this study (n = 158) included professional quality managers and hospital trustees. Main outcome measures Extent of implementation of quality management systems, extent of compliance with existing management procedures and implementation of clinical quality activities. Results Among participating hospitals, 33% had a clan culture as their dominant culture type, 26% an open and developmental culture type, 16% a hierarchical culture type and 25% a rational culture type. The culture type had no statistically significant association with the outcome measures. Some structural characteristics were associated with the development of quality management systems. Conclusion The type of OC was not associated with the development of quality management in hospitals. Other factors (not culture type) are associated with the development of quality management. An OS that uses fewer protocols is associated with a less developed quality management system, whereas an OS which supports innovation in care is associated with a more developed quality management system. PMID:24671119

Quality of Individualised Education Programme Goals and Objectives for Preschool Children with Disabilities

ERIC Educational Resources Information Center

Rakap, Salih

2015-01-01

Individualised education programmes (IEPs) are the road maps for individualising services for children with disabilities, specifically through the development of high-quality child goals/objectives. High-quality IEP goals/objectives that are developed based on a comprehensive assessment of child functioning and directly connected to intervention…

Broadened population-level frequency tuning in the auditory cortex of tinnitus patients.

PubMed

Sekiya, Kenichi; Takahashi, Mariko; Murakami, Shingo; Kakigi, Ryusuke; Okamoto, Hidehiko

2017-03-01

Tinnitus is a phantom auditory perception without an external sound source and is one of the most common public health concerns that impair the quality of life of many individuals. However, its neural mechanisms remain unclear. We herein examined population-level frequency tuning in the auditory cortex of unilateral tinnitus patients with similar hearing levels in both ears using magnetoencephalography. We compared auditory-evoked neural activities elicited by a stimulation to the tinnitus and nontinnitus ears. Objective magnetoencephalographic data suggested that population-level frequency tuning corresponding to the tinnitus ear was significantly broader than that corresponding to the nontinnitus ear in the human auditory cortex. The results obtained support the hypothesis that pathological alterations in inhibitory neural networks play an important role in the perception of subjective tinnitus. NEW & NOTEWORTHY Although subjective tinnitus is one of the most common public health concerns that impair the quality of life of many individuals, no standard treatment or objective diagnostic method currently exists. We herein revealed that population-level frequency tuning was significantly broader in the tinnitus ear than in the nontinnitus ear. The results of the present study provide an insight into the development of an objective diagnostic method for subjective tinnitus. Copyright © 2017 the American Physiological Society.

The systems engineering upgrade intiative at NASA's Jet Propulsion Laboratory

NASA Technical Reports Server (NTRS)

Jones, Ross M.

2005-01-01

JPL is implementing an initiative to significantly upgrade our systems engineering capabilities. This Systems Engineering Upgrade Initiative [SUI] has been authorized by the highest level technical management body of JPL and is sponsored with internal funds. The SUI objective is to upgrade system engineering at JPL to a level that is world class, professional and efficient compared to the FY04/05 baseline. JPL system engineering, along with the other engineering disciplines, is intended to support optimum designs; controlled and efficient implementations; and high quality, reliable, cost effective products. SUI technical activities are categorized into those dealing with people, process and tools. The purpose of this paper is to describe the rationale, objectives/plans and current status of the JPL SUI.

Engineering design of a high-temperature superconductor current lead

NASA Astrophysics Data System (ADS)

Niemann, R. C.; Cha, Y. S.; Hull, J. R.; Daugherty, M. A.; Buckles, W. E.

As part of the US Department of Energy's Superconductivity Pilot Center Program, Argonne National Laboratory and Superconductivity, Inc., are developing high-temperature superconductor (HTS) current leads suitable for application to superconducting magnetic energy storage systems. The principal objective of the development program is to design, construct, and evaluate the performance of HTS current leads suitable for near-term applications. Supporting objectives are to (1) develop performance criteria; (2) develop a detailed design; (3) analyze performance; (4) gain manufacturing experience in the areas of materials and components procurement, fabrication and assembly, quality assurance, and cost; (5) measure performance of critical components and the overall assembly; (6) identify design uncertainties and develop a program for their study; and (7) develop application-acceptance criteria.

What Factors Influence States' Capacity to Report Children's Health Care Quality Measures? A Multiple-Case Study.

PubMed

Christensen, Anna L; Petersen, Dana M; Burton, Rachel A; Forsberg, Vanessa C; Devers, Kelly J

2017-01-01

Objectives The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services' (CMS) core set of children's health care quality measures (Child Core Set). Methods We conducted a multiple-case study of four high-performing states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program: Illinois, Maine, Pennsylvania, and Oregon. Cases were purposively selected for their diverse measurement approaches and used data from 2010 to 2015, including 154 interviews, semiannual grant progress reports, and annual public reports on Child Core Set measures. We followed Yin's multiple-case study methodology to describe how and why each state increased the number of measures reported to CMS. Results All four states increased the number of Child Core Set measures reported to CMS during the grant period. Each took a different approach to reporting, depending on the available technical, organizational, and behavioral inputs in the state. Reporting capacity was influenced by a state's Medicaid data availability, ability to link to other state data systems, past experience with quality measurement, staff time and technical expertise, and demand for the measures. These factors were enhanced by CHIPRA Quality Demonstration grant funding and other federal capacity building activities, as hypothesized in our conceptual framework. These and other states have made progress reporting the Child Core Set since 2010. Conclusion With financial support and investment in state data systems and organizational factors, states can overcome challenges to reporting most of the Child Core Set measures.

Quality evaluation of value sets from cancer study common data elements using the UMLS semantic groups

PubMed Central

Solbrig, Harold R; Chute, Christopher G

2012-01-01

Objective The objective of this study is to develop an approach to evaluate the quality of terminological annotations on the value set (ie, enumerated value domain) components of the common data elements (CDEs) in the context of clinical research using both unified medical language system (UMLS) semantic types and groups. Materials and methods The CDEs of the National Cancer Institute (NCI) Cancer Data Standards Repository, the NCI Thesaurus (NCIt) concepts and the UMLS semantic network were integrated using a semantic web-based framework for a SPARQL-enabled evaluation. First, the set of CDE-permissible values with corresponding meanings in external controlled terminologies were isolated. The corresponding value meanings were then evaluated against their NCI- or UMLS-generated semantic network mapping to determine whether all of the meanings fell within the same semantic group. Results Of the enumerated CDEs in the Cancer Data Standards Repository, 3093 (26.2%) had elements drawn from more than one UMLS semantic group. A random sample (n=100) of this set of elements indicated that 17% of them were likely to have been misclassified. Discussion The use of existing semantic web tools can support a high-throughput mechanism for evaluating the quality of large CDE collections. This study demonstrates that the involvement of multiple semantic groups in an enumerated value domain of a CDE is an effective anchor to trigger an auditing point for quality evaluation activities. Conclusion This approach produces a useful quality assurance mechanism for a clinical study CDE repository. PMID:22511016

CPAP Treatment Supported by Telemedicine Does Not Improve Blood Pressure in High Cardiovascular Risk OSA Patients: A Randomized, Controlled Trial

PubMed Central

Mendelson, Monique; Vivodtzev, Isabelle; Tamisier, Renaud; Laplaud, David; Dias-Domingos, Sonia; Baguet, Jean-Philippe; Moreau, Laurent; Koltes, Christian; Chavez, Léonidas; De Lamberterie, Gilles; Herengt, Frédéric; Levy, Patrick; Flore, Patrice; Pépin, Jean-Louis

2014-01-01

Study Objectives: Obstructive sleep apnea (OSA) has been associated with hypertension, which is one of the intermediary mechanisms leading to increased cardiovascular morbidity. This study aimed at evaluating the effects of a combination of continuous positive airway pressure (CPAP) and telemedicine support on blood pressure (BP) reduction in high cardiovascular risk OSA patients. Design: A multi-center randomized controlled trial that compared standard CPAP care and CPAP care and a telemedicine intervention. Setting: Sleep clinics in France. Patients or Participants: 107 adult (18-65 years old) OSA patients (AHI > 15 events/h) with a high cardiovascular risk (cardiovascular SCORE > 5% or secondary prevention). Interventions: Patients were randomized to either standard care CPAP (n = 53) or CPAP and telemedicine (n = 54). Patients assigned to telemedicine were equipped with a smartphone for uploading BP measurements, CPAP adherence, sleepiness, and quality of life data; in return, they received pictograms containing health-related messages. Measurements: The main outcome was home self-measured BP and secondary outcomes were cardiovascular risk evolution, objective physical activity, CPAP adherence, sleepiness and quality of life. Results: Self-measured BP did not improve in either group (telemedicine or standard care). Patients in primary prevention showed greater BP reduction with CPAP treatment than those in secondary prevention. Conclusions: CPAP treatment supported by telemedicine alone did not improve blood pressure and cardiovascular risk in high cardiovascular risk OSA patients. This study emphasizes the need for diet and physical activity training programs in addition to CPAP when aiming at decreasing cardiometabolic risk factors in these patients. Clinical Trials Registration: ClinicalTrials.gov identifier: NCT01226641. Citation: Mendelson M, Vivodtzev I, Tamisier R, Laplaud D, Dias-Domingos S, Baguet JP, Moreau L, Koltes C, Chavez L, De Lamberterie G, Herengt F, Levy P, Flore P, Pépin JL. CPAP treatment supported by telemedicine does not improve blood pressure in high cardiovascular risk OSA patients: a randomized, controlled trial. SLEEP 2014;37(11):1863-1870. PMID:25364081

Testing the Feasibility and Usability of a Novel Smartphone-Based Self-Management Support System for Dialysis Patients: A Pilot Study

PubMed Central

Fujiu, Katsuhito; Hanafusa, Norio; Nishi, Takahiro; Tomita, Hyoe; Kobayashi, Haruka; Fujita, Hideo; Kadowaki, Takashi; Nangaku, Masaomi; Ohe, Kazuhiko

2017-01-01

Background Diet and fluid restrictions that need continuous self-management are among the most difficult aspects of dialysis treatment. Smartphone applications may be useful for supporting self-management. Objective Our objective is to investigate the feasibility and usability of a novel smartphone-based self-management support system for dialysis patients. Methods We developed the Self-Management and Recording System for Dialysis (SMART-D), which supports self-monitoring of three mortality-related factors that can be modified by lifestyle: interdialytic weight gain and predialysis serum potassium and phosphorus concentrations. Data is displayed graphically, with all data evaluated automatically to determine whether they achieve the values suggested by the Japanese Society for Dialysis Therapy guidelines. In a pilot study, 9 dialysis patients used SMART-D system for 2 weeks. A total of 7 of them completed questionnaires rating their assessment of SMART-D’s usability and their satisfaction with the system. In addition, the Kidney Disease Quality of Life scale was compared before and after the study period. Results All 9 participants were able to use SMART-D with no major problems. Completion rates for body weight, pre- and postdialysis weight, and serum potassium and phosphorus concentrations were, respectively, 89% (SD 23), 95% (SD 7), and 78% (SD 44). Of the 7 participants who completed the usability survey, all were motivated by the sense of security derived from using the system, and 6 of the 7 (86%) reported that using SMART-D helped improve their lifestyle and self-management. Conclusions Using SMART-D was feasible, and the system was well regarded by patients. Further study with larger scale cohorts and longer study and follow-up periods is needed to evaluate the effects of SMART-D on clinical outcomes and quality of life. PMID:28428168

Developing translational research infrastructure and capabilities associated with cancer clinical trials.

PubMed

Hall, Jacqueline A; Brown, Robert

2013-09-27

The integration of molecular information in clinical decision making is becoming a reality. These changes are shaping the way clinical research is conducted, and as reality sets in, the challenges in conducting, managing and organising multi-disciplinary research become apparent. Clinical trials provide a platform to conduct translational research (TR) within the context of high quality clinical data accrual. Integrating TR objectives in trials allows the execution of pivotal studies that provide clinical evidence for biomarker-driven treatment strategies, targeting early drug development trials to a homogeneous and well defined patient population, supports the development of companion diagnostics and provides an opportunity for deepening our understanding of cancer biology and mechanisms of drug action. To achieve these goals within a clinical trial, developing translational research infrastructure and capabilities (TRIC) plays a critical catalytic role for translating preclinical data into successful clinical research and development. TRIC represents a technical platform, dedicated resources and access to expertise promoting high quality standards, logistical and operational support and unified streamlined procedures under an appropriate governance framework. TRIC promotes integration of multiple disciplines including biobanking, laboratory analysis, molecular data, informatics, statistical analysis and dissemination of results which are all required for successful TR projects and scientific progress. Such a supporting infrastructure is absolutely essential in order to promote high quality robust research, avoid duplication and coordinate resources. Lack of such infrastructure, we would argue, is one reason for the limited effect of TR in clinical practice beyond clinical trials.

Patient and caregiver perspectives on decision support for symptom and quality of life management during cancer treatment: Implications for eHealth.

PubMed

Cooley, Mary E; Nayak, Manan M; Abrahm, Janet L; Braun, Ilana M; Rabin, Michael S; Brzozowski, Jane; Lathan, Christopher; Berry, Donna L

2017-08-01

Adequate symptom and quality-of-life (SQL) management is a priority during cancer treatment. eHealth is a timely way to enhance patient-engagement, facilitate communication, and improve health outcomes. The objectives of this study were to describe patient and caregivers' perspectives for providing, processing, and managing SQL data to enhance communication and identify desired components for decision support. Data were collected from 64 participants through questionnaires and focus groups. Analysis was conducted using NVivo. Open and axial coding was completed, grouping commonalities and large constructs into nodes to identify and synthesize themes. Face-to-face meetings with clinicians were the prime time to communicate, and patients strove to understand treatment options and the effect on SQL by bringing caregivers to their visits, taking notes, tracking symptoms, and creating portable health records. Patients/caregivers struggled to self-manage their symptoms and were uncertain when to contact clinicians when experiencing uncontrolled symptoms. Most participants identified eHealth solutions for decision support. However, 38% of participants (n = 24) rarely used computers and identified non-eHealth options for decision support. Core components for both eHealth and non-eHealth systems were access to (1) cancer information, (2) medical records, (3) peer support, and (4) improved support and understanding on when to contact clinicians. Patients were faced with an overwhelming amount of information and relied on their caregivers to help navigate the complexities of cancer care and self-manage SQL. Health technologies can provide informational support; however, decision support needs to span multiple venues to avoid increasing disparities caused by a digital divide. Copyright © 2017 John Wiley & Sons, Ltd.

Improving Multi-Objective Management of Water Quality Tipping Points: Revisiting the Classical Shallow Lake Problem

NASA Astrophysics Data System (ADS)

Quinn, J. D.; Reed, P. M.; Keller, K.

2015-12-01

Recent multi-objective extensions of the classical shallow lake problem are useful for exploring the conceptual and computational challenges that emerge when managing irreversible water quality tipping points. Building on this work, we explore a four objective version of the lake problem where a hypothetical town derives economic benefits from polluting a nearby lake, but at the risk of irreversibly tipping the lake into a permanently polluted state. The trophic state of the lake exhibits non-linear threshold dynamics; below some critical phosphorus (P) threshold it is healthy and oligotrophic, but above this threshold it is irreversibly eutrophic. The town must decide how much P to discharge each year, a decision complicated by uncertainty in the natural P inflow to the lake. The shallow lake problem provides a conceptually rich set of dynamics, low computational demands, and a high level of mathematical difficulty. These properties maximize its value for benchmarking the relative merits and limitations of emerging decision support frameworks, such as Direct Policy Search (DPS). Here, we explore the use of DPS as a formal means of developing robust environmental pollution control rules that effectively account for deeply uncertain system states and conflicting objectives. The DPS reformulation of the shallow lake problem shows promise in formalizing pollution control triggers and signposts, while dramatically reducing the computational complexity of the multi-objective pollution control problem. More broadly, the insights from the DPS variant of the shallow lake problem formulated in this study bridge emerging work related to socio-ecological systems management, tipping points, robust decision making, and robust control.

Quality and Content of Individualized Habilitation Plan Objectives in Residential Settings.

ERIC Educational Resources Information Center

Stancliffe, Roger J.; Hayden, Mary F.; Lakin, K. Charlie

2000-01-01

The quality, number, and content of residential Individualized Habilitation Plans (IHP) objectives were evaluated for 155 adult institution and community residents. Over 90 percent of objectives were functional and age appropriate. Community residents had significantly more IHP objectives and also had objectives from a wider variety of content…

Improved Specimen-Referral System and Increased Access to Quality Laboratory Services in Ethiopia: The Role of the Public-Private Partnership.

PubMed

Kebede, Yenew; Fonjungo, Peter N; Tibesso, Gudeta; Shrivastava, Ritu; Nkengasong, John N; Kenyon, Thomas; Kebede, Amha; Gadde, Renuka; Ayana, Gonfa

2016-04-15

Nonstandardized specimen-transport logistics, lack of laboratory personnel to transport specimens, lack of standard specimen containers, and long turnaround time (TAT) hindered access to quality laboratory services. The objective of the Becton, Dickinson, and Company (BD)-US President's Emergency Plan for AIDS Relief (PEPFAR) Public-Private Partnership (PPP) was to support country-specific programs to develop integrated laboratory systems, services, and quality improvement strategies, with an emphasis on strengthening the specimen-referral system (SRS). In 2007, through the Centers for Disease Control and Prevention (CDC), the Ethiopian Public Health Institute (EPHI) joined with the BD-PEPFAR PPP to strengthen laboratory systems. A joint planning and assessment committee identified gaps in the SRS for prioritization and intervention and piloted the system in Addis Ababa and Amhara Region. The PPP established standardized, streamlined specimen logistics, using the Ethiopian Postal Service Enterprise to support a laboratory network in which 554 facilities referred specimens to 160 laboratories. The PPP supported procuring 400 standard specimen containers and the training of 586 laboratory personnel and 81 postal workers. The average TAT was reduced from 7 days (range, 2-14 days) to 2 days (range, 1-3 days) in Addis Ababa and from 10 days (range, 6-21 days) to 5 days (range, 2-6 days) in Amhara Region. This study highlights the feasibility and untapped potential of PPPs to strengthen laboratory systems. This planned and structured approach to improving specimen referral enhanced access to quality laboratory services. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Quality of Life among Immigrant Latina Breast Cancer Survivors: Realities of Culture and Enhancing Cancer Care

PubMed Central

Lopez-Class, Maria; Perret-Gentil, Monique; Kreling, Barbara; Caicedo, Larisa; Mandelblatt, Jeanne; Graves, Kristi D.

2012-01-01

Objectives Breast cancer is the most common cancer among Latinas. This study examined social, cultural, and health care system factors that impact quality of life and survivorship experiences of Latina immigrant breast cancer survivors. Design We interviewed Latina breast cancer survivors (n=19) and, based on the interview findings, conducted two focus groups (n=9). Research staff translated transcripts from Spanish into English. Two trained raters reviewed the content and identified themes. Thematic content analysis was used to categorize and organize data. Results Participants were largely mono-lingual in Spanish, predominantly from Central and South America and most (68%) had lived in the U.S. for 10 or more years. All women were diagnosed and treated in the U.S. and were an average of 3.1 years from diagnosis. Women’s survivorship experiences appeared to be shaped by cultural beliefs and experiences as immigrants such as secrecy/shame about a breast cancer diagnosis, feelings of isolation, importance of family support (familism), challenges with developing social relationships in the U.S. (less personalismo), and, for some, their partner’s difficulty with showing emotional support (machismo). Navigating the U.S. medical system and language barriers were additional challenges in participants’ health care interactions. Conclusion Latina breast cancer survivors adhere to certain cultural values and face unique issues as immigrants, potentially influencing overall quality of life and doctor-patient communication. Efforts to improve Latina immigrant breast cancer survivors’ quality of life could include increased assessment of psychosocial functioning and referral to social support services, culturally-sensitive navigation programs and consistent use of appropriately trained interpreters. PMID:21706194

SU-E-T-216: TPS QC Supporting Program by a Third-Party Evaluation Agency in Japan.

PubMed

Fukata, K; Minemura, T; Kurokawa, C; Miyagishi, T; Itami, J

2012-06-01

To equalize the quality of radiation therapy in Japan by supporting quality control of radiation treatment planning system. Center for Cancer Control and Information Service in National Cancer Center supports the QA-QC of the cancer core hospitals in Japan as a third-party evaluation agency. Recently, a program for assessing the quality of treatment planning system (TPS) began as a part of our QA-QC supporting activities. In this program, a questionnaire about TPS was sent to 45 prefectural cancer core hospitals in Japan. The object of this questionnaire is to assess the proper commissioning, implement and applications of TPSs. The contents of the questionnaire are as follows; 1) calculate MUs which deliver 1000 cGy to the point of SSD = 100 cm, 10 cm depth with field sizes ranging from 5×5 to 30 × 30 cm 2 , and obtain doses at several depths for the calculated MUs, 2) calculate MUs which deliver 1000 cGy to the point of SSD = 100 cm, 10 cm depth for wedge fields whose angles are from 15 to 60 degrees, and obtain doses at several depths with the MUs, 3) calculate MU which deliver 1000 cGy to the point of STD = 100 cm, 10 cm depth with 10×10 cm 2 field size and obtain doses at several depths with the MU. In this program, 179 beam data from 44 facilities were collected. Data were compared in terms of dose per MU, output factor, wedge factor and TMR. It was found that 90% of the data agreed within 2%. The quality of the treatment planning system was investigated through the questionnaire including the information of essential beam data. We compared 179 beam data in TPSs sent from 44 facilities and 90% of the data showed good agreement. © 2012 American Association of Physicists in Medicine.

Delivery should happen soon and my pain will be reduced: understanding women's perception of good delivery care in India.

PubMed

Bhattacharyya, Sanghita; Srivastava, Aradhana; Avan, Bilal Iqbal

2013-11-22

Understanding a woman's perspective and her needs during childbirth and addressing them as part of quality-improvement programmes can make delivery care safe, affordable, and respectful. It has been pointed out that the patient's judgement on the quality and goodness of care is indispensible to improving the management of healthcare systems. The objective of the study is to understand the aspects of care that women consider important during childbirth. Individual in-depth interviews (IDIs) and focus-group discussions (FGDs) with women who recently delivered were the techniques used. Seventeen IDIs and four FGDs were conducted in Jharkhand state in east India between January and March 2012. Women who had normal deliveries with live births at home and in primary health centres were included. To minimise recall bias, interviews were conducted within 42 days of childbirth. Using the transcripts of interviews, the data were analysed thematically. Aspects of care most commonly cited by women to be important were: availability of health providers and appropriate medical care (primarily drugs) in case of complications; emotional support; privacy; clean place after delivery; availability of transport to reach the institution; monetary incentives that exceed expenses; and prompt care. Other factors included kind interpersonal behaviour, cognitive support, faith in the provider's competence, and overall cleanliness of the facility and delivery room. Respondents belonging to low socio-economic strata with basic literacy levels might not understand appropriate clinical aspects of care, but they want care that is affordable and accessible, along with privacy and emotional support during delivery. The study highlighted that healthcare quality-improvement programmes in India need to include non-clinical aspects of care as women want to be treated humanely during delivery--they desire respectful treatment, privacy, and emotional support. Further research into maternal satisfaction could be made more policy relevant by assessing the relative strength of various factors in influencing maternal satisfaction; this could help in prioritising appropriate interventions for improved quality of care (QoC).

Identification of Important Parameter from Leachate Solid Waste Landfill on Water Quality, Case Study of Pesanggrahan River

NASA Astrophysics Data System (ADS)

Yanidar, R.; Hartono, D. M.; Moersidik, S. S.

2018-03-01

Cipayung Landfill takes waste generation from Depok City approximately ± 750 tons/day of solid waste. The south and west boundaries of the landfill is Pesanggarahan River which 200m faraway. The objectives of this study are to indicate an important parameter which greatly affects the water quality of Pesanggrahan River and purpose the dynamic model for improving our understanding of the dynamic behavior that captures the interactions and feedbacks important parameter in river in order to identify and assess the effects of the treated leachate from final solid waste disposal activity as it responds to changes over time in the river. The high concentrations of BOD and COD are not the only cause significantly affect the quality of the pesanggrahan water, it also because the river has been contaminated in the upstream area. It need the water quality model to support the effectiveness calculation of activities for preventing a selected the pollutant sources the model should be developed for simulating and predicting the trend of water quality performance in Pesanggrahan River which can potentially be used by policy makers in strategic management to sustain river water quality as raw drinking water.

Objective quality assessment for multiexposure multifocus image fusion.

PubMed

Hassen, Rania; Wang, Zhou; Salama, Magdy M A

2015-09-01

There has been a growing interest in image fusion technologies, but how to objectively evaluate the quality of fused images has not been fully understood. Here, we propose a method for objective quality assessment of multiexposure multifocus image fusion based on the evaluation of three key factors of fused image quality: 1) contrast preservation; 2) sharpness; and 3) structure preservation. Subjective experiments are conducted to create an image fusion database, based on which, performance evaluation shows that the proposed fusion quality index correlates well with subjective scores, and gives a significant improvement over the existing fusion quality measures.

Defining Information Quality Into Health Websites: A Conceptual Framework of Health Website Information Quality for Educated Young Adults

PubMed Central

LeRouge, Cynthia; Smith, K Jody; De Leo, Gianluca

2017-01-01

Background Today’s health care environment encourages health care consumers to take an active role in managing their health. As digital natives, young educated adults do much of their health information management through the Internet and consider it a valid source of health advice. However, the quality of information on health websites is highly variable and dynamic. Little is known about the understandings and perceptions that young educated adults have garnered on the quality of information on health websites used for health care–related purposes. Objective To fill this gap, the aim of this study was to develop a conceptual framework of health website information quality with quality dimensions (ie, criteria) and associated quality drivers (ie, attributes) specified in the context of young educated adults’ use of health websites for health care–related purposes. This aim was achieved by (1) identifying information quality dimensions of health websites from the perspective of young educated adults; (2) identifying the importance ratings of these quality dimensions; and (3) constructing a framework of health website information quality with quality dimensions and associated drivers specified in the context of young educated adults’ use of health websites for health care–related purposes. Methods The study employed both qualitative and quantitative methods. Methods included semistructured group interviews and an individual quality assessment exercise grounded in visiting various websites and responding to Likert scale questions regarding the importance ratings of information quality dimensions and open-ended questions with specifying website quality drivers. Study participants included junior and senior undergraduate and graduate students in business, allied health, and public health majors. Qualitative, open-coding procedures were used to develop the conceptual framework reflecting the participants’ means of assessing information quality on health websites. Results Five dimensions of information quality for health websites were identified: Completeness of information, Understandability of information, Relevance of information, Depth of information, and Accuracy of information. Completeness of information and Understandability of information were rated as the two most important quality dimensions by the study participants. Results indicated that these five information quality dimensions for health websites were supported by the following main driver themes: Content, Design, Links, Consumer resources, Search functionality, Supporting references, User focus, Content FAQ, Open access, Policy statements, and Site performance. Conclusions This study contributes to the literature by developing a health website information quality conceptual framework with quality dimensions and associated drivers specified for a young educated adult population. The detailed quality drivers supporting the corresponding quality dimensions provide a rich picture of young educated adults’ perceptions on health website information quality. This framework can be used to guide the development of health websites, as well as the foundation for a means to evaluate health information from existing health websites with young educated adults as the target audience. PMID:28986336

The navigation toolkit

NASA Technical Reports Server (NTRS)

Rich, William F.; Strom, Stephen W.

1994-01-01

This report summarizes the experience of the authors in managing, designing, and implementing an object-oriented applications framework for orbital navigation analysis for the Flight Design and Dynamics Department of the Rockwell Space Operations Company in Houston, in support of the Mission Operations Directorate of NASA's Johnson Space Center. The 8 person year project spanned 1.5 years and produced 30,000 lines of C++ code, replacing 150,000 lines of Fortran/C. We believe that our experience is important because it represents a 'second project' experience and generated real production-quality code - it was not a pilot. The project successfully demonstrated the use of 'continuous development' or rapid prototyping techniques. Use of formal methods and executable models contributed to the quality of the code. Keys to the success of the project were a strong architectural vision and highly skilled workers. This report focuses on process and methodology, and not on a detailed design description of the product. But the true importance of the object-oriented paradigm is its liberation of the developer to focus on the problem rather than the means used to solve the problem.

An audit of the quality of online immunisation information available to Australian parents.

PubMed

Wiley, K E; Steffens, M; Berry, N; Leask, J

2017-01-13

The Internet is increasingly a source of health information for parents, who use the Internet alongside health care providers for immunisation information. Concerns have been raised about the reliability of online immunisation information, however to date there has been no audit of the quality or quantity of what is available to Australian parents. The objective of this study was to address this gap by simulating a general online search for immunisation information, and assessing the quality and quantity of the web sites returned by the search. We used Google trends to identify the most common immunisation search terms used in Australia. The ten most common terms were entered into five search engines and the first ten non-commercial results from each search collated. A quality assessment tool was developed using the World Health Organization Global Advisory Committee on Vaccine Safety (GACVS) criteria for assessing the quality of vaccine safety web sites, and used to assess and score the quality of the sites. Seven hundred web pages were identified, of which 514 were duplicates, leaving 186 pages from 115 web sites which were audited. Forty sites did not include human immunisation information, or presented personal opinion about individuals, and were not scored. Of the 75 sites quality scored, 65 (87%) were supportive of immunisation, while 10 (13%) were not supportive. The overall mean quality score was 57/100 (range 14/100 to 92/100). When stratified by pro and anti-vaccination stance, the average quality score for pro-vaccine sites was 61/100, while the average score for anti-vaccine sites was 30/100. Pro-vaccine information could be divided into three content groups: generalist overview with little detail; well-articulated and understandable detail; and lengthy and highly technical explanations. The main area found to be lacking in pro-vaccine sites was lack of transparent authorship. Our findings suggest a need for information which is easily found, transparently authored, well-referenced, and written in a way that is easily understood.

Longitudinal Relations Between Observed Parenting Behaviors and Dietary Quality of Meals From Ages 2 to 5

PubMed Central

Montaño, Zorash; Smith, Justin D.; Dishion, Thomas J.; Shaw, Daniel S.; Wilson, Melvin N.

2015-01-01

Objectives Parents influence a child’s diet by modeling food choices, selecting the food they will make available, and controlling the child’s intake. Few studies have examined the covariation between parent’s behavior management practices and their guidance and support for a young child’s nutritional environment in early childhood. We hypothesized that parents’ positive behavior support (PBS), characterized as skillful behavior management and proactive structuring of children’s activities, would predict dietary quality over the course of early childhood (age 2 to 5 years), a critical period for the development of a dietary lifestyle through the lifespan. Methods Participants included 731 culturally diverse, low-income families in a randomized, controlled trial of the Family Check-Up. Families participated in a yearly home visit videotaped assessment when children were 2 to 5 years. PBS and dietary quality of meals parents served to their children were assessed by coding videotapes of structured parent–child interactions, including a meal preparation task. A cross-lagged panel model was used to evaluate the longitudinal relation between PBS and the dietary quality of meals served during the meal preparation task. Results Analyses revealed that PBS repeatedly predicted meals’ dietary quality the following year: age 2–3 (β = .30), age 3–4 (β = 0.14), age 4–5 (β = 0.37). Dietary quality significantly predicted PBS 1 year later: age 3–4 (β = 0.16), age 4–5 (β = 0.14). As expected, the relative strength of the relationship from PBS to dietary quality was significantly stronger than the reverse, from dietary quality to PBS. Conclusions Positive behavior management and proactive parenting practices are an important foundation for establishing a healthy nutritional environment for young children. These findings suggest that family-centered prevention interventions for pediatric obesity may benefit from targeting PBS in service of promoting better dietary quality. PMID:25555539

Perceptions of Quality for Graduate Athletic Training Education

PubMed Central

Seegmiller, Jeff G

2006-01-01

Context: Accreditation is generally considered the primary mechanism for quality assurance in higher education, but disagreement often exists between accrediting agencies and the perceptions of professionals who feel the accrediting body has failed to meet its quality control function. For accreditation to have value, it must be a meaningful indicator of quality and be viewed as such. Objective: To identify the predominant contributors to quality for postcertification graduate education as perceived by athletic training educators and to compare results among respondents with different education levels, academic ranks, tenure classifications, and program affiliations. Design: Non-experimental descriptive survey. Setting: 2003 National Athletic Trainers' Association Educators' Conference. Patients or Other Participant(s): Of a convenience sample of 353 athletic training educators, 194 (55%) submitted usable questionnaires. Males accounted for 115 (59%) respondents and females for 79 (41%). Of the 14 National Athletic Trainers' Association-accredited postcertification graduate education programs, 12 were represented. Main Outcome Measure(s): Quantitative data for closed-ended questionnaire items were analyzed using descriptive statistics and measures of central tendency, with composite mean scores for each item used for comparisons. Qualitative data were coded according to major themes and analyzed. Results: Support for accreditation at the postcertification graduate education level was moderate (mean = 3.08 ± 0.811 on a 4-point scale). Subjects with doctoral degrees (n = 88) indicated that research contributed significantly more to quality (mean = 3.38 ± 0.636) than did those with master's degrees (n = 106, mean = 2.97 ± 0.786). Respondents with master's degrees stated that clinical education was a greater contributor to quality (mean = 3.76 ± 0.491) than did those with doctoral degrees (3.44 ± 0.663). Conclusions: The educators showed agreement for most quality indicators. The greatest contributors to program quality were program curriculum; adequate faculty, staff, and administrative support; evaluation; clinical education; and research. PMID:17273467

Occupational Noise and Ischemic Heart Disease: A Systematic Review

PubMed Central

Dzhambov, Angel M; Dimitrova, Donka D

2016-01-01

Noise exposure might be a risk factor for ischemic heart disease (IHD). Unlike residential exposure, however, evidence for occupational noise is limited. Given that high-quality quantitative synthesis of existing data is highly warranted for occupational safety and policy, we aimed at conducting a systematic review and meta-analysis of the risks of IHD morbidity and mortality because of occupational noise exposure. We carried out a systematic search in MEDLINE, EMBASE, and on the Internet since April 2, 2015, in English, Spanish, Russian, and Bulgarian. A quality-scoring checklist was developed a priori to assess different sources of methodological bias. A qualitative data synthesis was performed. Conservative assumptions were applied when appropriate. A meta-analysis was not feasible because of unresolvable methodological discrepancies between the studies. On the basis of five studies, there was some evidence to suggest higher risk of IHD among workers exposed to objectively assessed noise >75–80 dB for <20 years (supported by one high, one moderate, and one low quality study, opposed by one high and one moderate quality study). Three moderate and two low quality studies out of six found self-rated exposure to be associated with higher risk of IHD, and only one moderate quality study found no effect. Out of four studies, a higher mortality risk was suggested by one moderate quality study relying on self-rated exposure and one of high-quality study using objective exposure. Sensitivity analyses showed that at higher exposures and in some vulnerable subgroups, such as women, the adverse effects were considerably stronger. Despite methodological discrepancies and limitations of the included studies, occupational noise appeared to be a risk factor for IHD morbidity. Results suggested higher risk for IHD mortality only among vulnerable subgroups. Workers exposed to high occupational noise should be considered at higher overall risk of IHD. PMID:27569404

Consensus Recommendations for Systematic Evaluation of Drug-Drug Interaction Evidence for Clinical Decision Support

PubMed Central

Scheife, Richard T.; Hines, Lisa E.; Boyce, Richard D.; Chung, Sophie P.; Momper, Jeremiah; Sommer, Christine D.; Abernethy, Darrell R.; Horn, John; Sklar, Stephen J.; Wong, Samantha K.; Jones, Gretchen; Brown, Mary; Grizzle, Amy J.; Comes, Susan; Wilkins, Tricia Lee; Borst, Clarissa; Wittie, Michael A.; Rich, Alissa; Malone, Daniel C.

2015-01-01

Background Healthcare organizations, compendia, and drug knowledgebase vendors use varying methods to evaluate and synthesize evidence on drug-drug interactions (DDIs). This situation has a negative effect on electronic prescribing and medication information systems that warn clinicians of potentially harmful medication combinations. Objective To provide recommendations for systematic evaluation of evidence from the scientific literature, drug product labeling, and regulatory documents with respect to DDIs for clinical decision support. Methods A conference series was conducted to develop a structured process to improve the quality of DDI alerting systems. Three expert workgroups were assembled to address the goals of the conference. The Evidence Workgroup consisted of 15 individuals with expertise in pharmacology, drug information, biomedical informatics, and clinical decision support. Workgroup members met via webinar from January 2013 to February 2014. Two in-person meetings were conducted in May and September 2013 to reach consensus on recommendations. Results We developed expert-consensus answers to three key questions: 1) What is the best approach to evaluate DDI evidence?; 2) What evidence is required for a DDI to be applicable to an entire class of drugs?; and 3) How should a structured evaluation process be vetted and validated? Conclusion Evidence-based decision support for DDIs requires consistent application of transparent and systematic methods to evaluate the evidence. Drug information systems that implement these recommendations should be able to provide higher quality information about DDIs in drug compendia and clinical decision support tools. PMID:25556085

Is the Moderating Effect of Social Support on New Korean Mothers' Psychological Distress Contingent on Levels of Marital Quality?

PubMed

Park, Ki Tae

2018-03-01

This study examines how levels of marital quality change the effect of social support on postpartum psychological distress among new Korean mothers using the Panel Study on Korean Children (N = 1585). In accord with findings from previous studies, this study shows that low marital quality negatively affects new mothers' mental health, but that social support alleviates psychological distress independent of marital quality. The main finding of this research is that the moderating effect of social support is contingent on levels of marital quality. Aggregated social support moderates the effects of marital quality on new mothers' mental health only when the level of marital quality is low. Furthermore, each dimension of social support (emotional, informational, and instrumental) only has a moderating effect when marital quality is low. The findings highlight the fact that the moderating effect of social support varies with the individual context and so customized social support that fits individual needs matters for the mental health of new mothers.

[Correlation between social support and quality of life in patients with breast cancer at different periods of treatment].

PubMed

Yang, L; Song, W P; Chen, Z L; Wang, Y; Chen, Y Y; Hua, Y H; Chen, M; Zou, W B

2017-03-23

Objective: To analyze the differences between the social support for breast cancer patients and healthy female, and to explore the correlation between social support and quality of life (QOL) in the patients. Methods: From January 2013 to December 2014, 101 patients with operable breast cancer treated at Xinyu City People's Hospital were recruited as the experimental group. They completed questionnaires in the preoperative, postoperative chemoradiotherapy and rehabilitation periods, respectively.101 healthy female volunteers recruited from the community were included as control group, whose age and level of education were matched with those of the experimental group.The general questionnaire including basic information, disease conditions and other projects, perceived social support scale (PSSS), quality of life of breast cancer patients (FACT-B) were applied to evaluate the general situation, social support and QOL of the subjects. The differences in PSSS scores between the experimental and control groups were compared. The correlation between PSSS score and FACT-B score in the experimental group was analyzed. SPSS 18.0 software was used for statistical analysis. Results: The general situations of the experimental and control groups were comparable (all P >0.05). The rates of the total social support score ≥50 in the experimental and control groups were not significantly different (93.6% vs. 94.7%, P =0.067). Compared with that of the control group (23.2±4.8), the scores of family support in the experimental group in preoperative, postoperative chemoradiotherapy and rehabilitation periods were statistically higher (25.6±3.2, 24.2±4.2 and 24.0±3.4, respectively, P =0.034). The social support scores of patients with different demographic characteristics were different. Among the demographic characteristics, years of education and place of residence had the largest impact. The scores of social support in patients with longer education years and living in the urban area were higher than those with shorter education years and living in the rural areas ( P <0.001). The scores of QOL among preoperative, postoperative chemoradiotherapy and rehabilitation periods in the experimental group were significantly different (all P <0.05). The patients gained the highest score of QOL in the preoperative period (110.7±5.1) and the lowest in the postoperative chemoradiotherapy period (95.3±18.1). The QOL of patients in the experimental group in preoperative, postoperative chemoradiotherapy and rehabilitation periods were all positively correlated with the overall social support (all P <0.01). Conclusions: The QOL of breast cancer patients at different periods of treatment is positively correlated with the social support. The quality of life can be enhanced by improving the social support for the patients.

Quality-Assurance Data for Routine Water Analyses by the U.S. Geological Survey Laboratory in Troy, New York-July 1997 through June 1999

USGS Publications Warehouse

Lincoln, Tricia A.; Horan-Ross, Debra A.; McHale, Michael R.; Lawrence, Gregory B.

2006-01-01

The laboratory for analysis of low-ionic-strength water at the U.S. Geological Survey (USGS) Water Science Center in Troy, N.Y., analyzes samples collected by USGS projects throughout the Northeast. The laboratory's quality-assurance program is based on internal and interlaboratory quality-assurance samples and quality-control procedures that were developed to ensure proper sample collection, processing, and analysis. The quality-assurance/quality-control data for the time period addressed in this report were stored in the laboratory's SAS data-management system, which provides efficient review, compilation, and plotting of data. This report presents and discusses results of quality-assurance and quality- control samples analyzed from July 1997 through June 1999. Results for the quality-control samples for 18 analytical procedures were evaluated for bias and precision. Control charts indicate that data for eight of the analytical procedures were occasionally biased for either high-concentration and (or) low-concentration samples but were within control limits; these procedures were: acid-neutralizing capacity, total monomeric aluminum, total aluminum, ammonium, calcium, chloride, specific conductance, and sulfate. The data from the potassium and sodium analytical procedures are insufficient for evaluation. Results from the filter-blank and analytical-blank analyses indicate that the procedures for 11 of 13 analytes were within control limits, although the concentrations for blanks were occasionally outside the control limits. Blank analysis results for chloride showed that 22 percent of blanks did not meet data-quality objectives and results for dissolved organic carbon showed that 31 percent of the blanks did not meet data-quality objectives. Sampling and analysis precision are evaluated herein in terms of the coefficient of variation obtained for triplicate samples in the procedures for 14 of the 18 analytes. At least 90 percent of the samples met data-quality objectives for all analytes except total aluminum (70 percent of samples met objectives) and potassium (83 percent of samples met objectives). Results of the USGS interlaboratory Standard Reference Sample (SRS) Project indicated good data quality for most constituents over the time period. The P-sample (low-ionic-strength constituents) analysis had good ratings in two of these studies and a satisfactory rating in the third. The results of the T-sample (trace constituents) analysis indicated high data quality with good ratings in all three studies. The N-sample (nutrient constituents) studies had one each of excellent, good, and satisfactory ratings. Results of Environment Canada's National Water Research Institute (NWRI) program indicated that at least 80 percent of the samples met data-quality objectives for 9 of the 13 analytes; the exceptions were dissolved organic carbon, ammonium, chloride, and specific conductance. Data-quality objectives were not met for dissolved organic carbon in two NWRI studies, but all of the samples were within control limits for the last study. Data-quality objectives were not met in 41 percent of samples analyzed for ammonium, 25 percent of samples analyzed for chloride, and 30 percent of samples analyzed for specific conductance. Results from blind reference-sample analyses indicated that data-quality objectives were met by at least 84 percent of the samples analyzed for calcium, chloride, magnesium, pH, and potassium. Data-quality objectives were met by 73 percent of those analyzed for sulfate. The data-quality objective was not met for sodium. The data are insufficient for evaluation of the specific conductance results.

Long-term outcomes of internet-based self-management support in adults with asthma: randomized controlled trial.

PubMed

van Gaalen, Johanna L; Beerthuizen, Thijs; van der Meer, Victor; van Reisen, Patricia; Redelijkheid, Geertje W; Snoeck-Stroband, Jiska B; Sont, Jacob K

2013-09-12

Long-term asthma management falls short of the goals set by international guidelines. The Internet is proposed as an attractive medium to support guided self-management in asthma. Recently, in a multicenter, pragmatic randomized controlled parallel trial with a follow-up period of 1 year, patients were allocated Internet-based self-management (IBSM) support (Internet group [IG]) or usual care (UC) alone. IBSM support was automatically terminated after 12 months of follow-up. In this study, IBSM support has been demonstrated to improve asthma-related quality of life, asthma control, lung function, and the number of symptom-free days as compared to UC. IBSM support was based on known key components for effective self-management and included weekly asthma control monitoring and treatment advice, online and group education, and communication (both online and offline) with a respiratory nurse. The objective of the study was to assess the long-term effects of providing patients 1 year of IBSM support as compared to UC alone. Two hundred adults with physician-diagnosed asthma (3 or more months of inhaled corticosteroids prescribed in the past year) from 37 general practices and 1 academic outpatient department who previously participated were invited by letter for additional follow-up at 1.5 years after finishing the study. The Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ) were completed by 107 participants (60 UC participants and 47 IG participants). A minimal clinical important difference in both questionnaires is 0.5 on a 7-point scale. At 30 months after baseline, a sustained and significant difference in terms of asthma-related quality of life of 0.29 (95% CI 0.01-0.57) and asthma control of -0.33 (95% CI -0.61 to -0.05) was found in favor of the IBSM group. No such differences were found for inhaled corticosteroid dosage or for lung function, measured as forced expiratory volume in 1 second. Improvements in asthma-related quality of life and asthma control were sustained in patients who received IBSM support for 1 year, even up to 1.5 years after terminating support. Future research should be focused on implementation of IBSM on a wider scale within routine asthma care. International Standard Randomized Controlled Trial Number (ISRCTN): 79864465; http://www.controlled-trials.com/ISRCTN79864465 (Archived by WebCite at http://www.webcitation.org/6J4VHhPk4).

The effect of recognizability on figure-ground processing: does it affect parsing or only figure selection?

PubMed

Navon, David

2011-03-01

Though figure-ground assignment has been shown to be probably affected by recognizability, it appears sensible that object recognition must follow at least the earlier process of figure-ground segregation. To examine whether or not rudimentary object recognition could, counterintuitively, start even before the completion of the stage of parsing in which figure-ground segregation is done, participants were asked to respond, in a go/no-go fashion, whenever any out of 16 alternative connected patterns (that constituted familiar stimuli in the upright orientation) appeared. The white figure of the to-be-attended stimulus-target or foil-could be segregated from the white ambient ground only by means of a frame surrounding it. Such a frame was absent until the onset of target display. Then, to manipulate organizational quality, the greyness of the frame was either gradually increased from zero (in Experiment 1) or changed abruptly to a stationary level whose greyness was varied between trials (in Experiments 2 and 3). Stimulus recognizability was manipulated by orientation angle. In all three experiments the effect of recognizability was found to be considerably larger when organizational quality was minimal due to an extremely faint frame. This result is argued to be incompatible with any version of a serial thesis suggesting that processing aimed at object recognition starts only with a good enough level of organizational quality. The experiments rather provide some support to the claim, termed here "early interaction hypothesis", positing interaction between early recognition processing and preassignment parsing processes.

Life quality assessment among patients with atopic eczema.

PubMed

Holm, E A; Wulf, H C; Stegmann, H; Jemec, G B E

2006-04-01

Quantification of quality of life (QoL) related to disease severity is important in patients with atopic eczema (AE), because the assessment provides additional information to the traditional objective clinical scoring systems. To measure health-related QoL (HRQoL) in patients with AE; to analyse discriminant, divergent and convergent validity by examining the association between various QoL methods; and to examine the association between disease severity assessed by an objective Severity Scoring of Atopic Dermatitis (SCORAD) and QoL. HRQoL was assessed at two visits at a 6-monthly interval in 101 patients with AE and 30 controls with one dermatology-specific questionnaire [Dermatology Life Quality Index (DLQI) or Children's DLQI (CDLQI)], one generic instrument (SF-36) and three visual analogue scales (VASs) of severity and pruritus. Objective SCORAD was used to measure disease severity. Patients with AE had significantly lower QoL than healthy controls and the general population. DLQI /CDLQI, pruritus, and patient and investigator overall assessment of eczema severity were significantly (P < 0.0001) and positively correlated with SCORAD, while the generic questionnaire showed only poor correlation. A gender difference was found for the mental component score of SF-36 (P = 0.019). AE has an impact on HRQoL. Patients' mental health, social functioning and role emotional functioning seem to be more affected than physical functioning. A simple VAS score of patients' assessment of disease severity showed the highest and most significant correlations with most of the HRQoL methods used. There is evidence to support the ability of patients with AE to make an accurate determination of their disease severity and QoL.

Measuring and modelling the quality of 40 post-disaster mental health and psychosocial support programmes.

PubMed

Dückers, Michel L A; Thormar, Sigridur B; Juen, Barbara; Ajdukovic, Dean; Newlove-Eriksson, Lindy; Olff, Miranda

2018-01-01

Disasters can have an enormous impact on the health and well-being of those affected. Internationally, governments and service providers are often challenged to address complex psychosocial problems. Ideally, the potentially broad range of support activities include a coherent, high-quality mental health and psychosocial support (MHPSS) programme. We present a theory-driven quantitative analysis of the quality of 40 MHPSS programmes, mostly implemented in European disaster settings. The objective is to measure quality domains recognized as relevant in the literature and to empirically test associations. During the EU project "Operationalizing Psychosocial Support in Crisis" (OPSIC) an evaluation survey was designed and developed for this purpose and completed by 40 MHPSS programme coordinators involved in different mass emergencies and disasters. We analysed the survey data in two steps. Firstly, we used the data to operationalize quality domains of a MHPSS programme, tested constructs and assessed their internal consistency reliability. A total of 26 out of 44 survey items clustered into three of the four domains identified within the theoretical framework: "planning and delivery system" (Cronbach's alpha 0.82); "general evaluation criteria" (Cronbach's alpha 0.82); and "essential psychosocial principles" (Cronbach's alpha 0.75). "Measures and interventions applied", theoretically a potential fourth domain, could not be confirmed to empirically cluster together. Secondly, several models with associations between domains and measures and interventions were tested and compared. The model with the best fit suggests that in MHPSS programmes with a higher planning and delivery systems score, a larger number of measures and interventions from evidence-informed guidelines are applied. In such programmes, coordinators are more positive about general evaluation criteria and the realization of essential psychosocial principles. Moreover, the analyses showed that some measures and interventions are more likely to be applied in programmes with more evolved planning and delivery systems, yet for most measures and interventions the likelihood of being applied is not linked to planning and delivery system status, nor to coordinator perceptions concerning psychosocial principles and evaluation criteria. Further research is necessary to validate and expand the findings and to learn more about success factors and obstacles for MHPSS programme implementation.

Real-Time Internet Connections: Implications for Surgical Decision Making in Laparoscopy

PubMed Central

Broderick, Timothy J.; Harnett, Brett M.; Doarn, Charles R.; Rodas, Edgar B.; Merrell, Ronald C.

2001-01-01

Objective To determine whether a low-bandwidth Internet connection can provide adequate image quality to support remote real-time surgical consultation. Summary Background Data Telemedicine has been used to support care at a distance through the use of expensive equipment and broadband communication links. In the past, the operating room has been an isolated environment that has been relatively inaccessible for real-time consultation. Recent technological advances have permitted videoconferencing over low-bandwidth, inexpensive Internet connections. If these connections are shown to provide adequate video quality for surgical applications, low-bandwidth telemedicine will open the operating room environment to remote real-time surgical consultation. Methods Surgeons performing a laparoscopic cholecystectomy in Ecuador or the Dominican Republic shared real-time laparoscopic images with a panel of surgeons at the parent university through a dial-up Internet account. The connection permitted video and audio teleconferencing to support real-time consultation as well as the transmission of real-time images and store-and-forward images for observation by the consultant panel. A total of six live consultations were analyzed. In addition, paired local and remote images were “grabbed” from the video feed during these laparoscopic cholecystectomies. Nine of these paired images were then placed into a Web-based tool designed to evaluate the effect of transmission on image quality. Results The authors showed for the first time the ability to identify critical anatomic structures in laparoscopy over a low-bandwidth connection via the Internet. The consultant panel of surgeons correctly remotely identified biliary and arterial anatomy during six laparoscopic cholecystectomies. Within the Web-based questionnaire, 15 surgeons could not blindly distinguish the quality of local and remote laparoscopic images. Conclusions Low-bandwidth, Internet-based telemedicine is inexpensive, effective, and almost ubiquitous. Use of these inexpensive, portable technologies will allow sharing of surgical procedures and decisions regardless of location. Internet telemedicine consistently supported real-time intraoperative consultation in laparoscopic surgery. The implications are broad with respect to quality improvement and diffusion of knowledge as well as for basic consultation. PMID:11505061

Social participation and quality-of-life of patients with traumatic brain injury living in the community: A mixed methods study.

PubMed

Takada, Kaoruko; Sashika, Hironobu; Wakabayashi, Hidetaka; Hirayasu, Yoshio

2016-01-01

To investigate the quality-of-life (QoL) and social participation of patients with traumatic brain injury (TBI) living in the community in Japan. A mixed-methods study of 29 post-TBI patients and 12 family members was conducted. Objective scales were used to evaluate QoL (Short Form Health Survey SF-36), depression (Zung Self-rating Depression Scale) and psychosocial function (Sydney Psychosocial Reintegration Scale, 2 nd edition). Subjective views of changes in social functioning, participation and suitability of family support were obtained by a semi-structured interview. Participants were classified into 'change' and 'no-change' groups for social participation and between-group comparisons of QoL and determinant factors of QoL were evaluated. The SF-36 social role component was significantly associated with the suitability of family support, followed by their understanding. However, QoL was not significantly associated with changes in social participation. Social participation was particularly influenced by the absence of rehabilitation support for low-skill labourers and housewives, whether they lost their employment or not. Advances in rehabilitation services are required, particularly to meet the specific needs of housewives and low-skill labourers. Families should receive sufficient education and short- and long-term strategies for providing suitable support to patients and their families should be implemented.

The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation

PubMed Central

O'Brien, Rosaleen; Fitzpatrick, Bridie; Higgins, Maria; Guthrie, Bruce; Watt, Graham; Wyke, Sally

2016-01-01

Objectives To develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas. Methods Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients. Results Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients. Discussion We have co-designed and optimised an augmented primary care intervention involving a whole-system approach to enhance quality of life in multimorbid patients living in the deprived areas. CARE Plus will next be tested in a phase 2 cluster randomised controlled trial. PMID:27068113

Collaborative Workshops for Assessment and Creation of Multi-Objective Decision Support for Multiple Sectors

NASA Astrophysics Data System (ADS)

Kasprzyk, J. R.; Smith, R.; Raseman, W. J.; DeRousseau, M. A.; Dilling, L.; Ozekin, K.; Summers, R. S.; Balaji, R.; Livneh, B.; Rosario-Ortiz, F.; Sprain, L.; Srubar, W. V., III

2017-12-01

This presentation will report on three projects that used interactive workshops with stakeholders to develop problem formulations for Multi-Objective Evolutionary Algorithm (MOEA)-based decision support in diverse fields - water resources planning, water quality engineering under climate extremes, and sustainable materials design. When combined with a simulation model of a system, MOEAs use intelligent search techniques to provide new plans or designs. This approach is gaining increasing prominence in design and planning for environmental sustainability. To use this technique, a problem formulation - objectives and constraints (quantitative measures of performance) and decision variables (actions that can be modified to improve the system) - must be identified. Although critically important for MOEA effectiveness, the problem formulations are not always developed with stakeholders' interests in mind. To ameliorate this issue, project workshops were organized to improve the tool's relevance as well as collaboratively build problem formulations that can be used in applications. There were interesting differences among the projects, which altered the findings of each workshop. Attendees ranged from a group of water managers on the Front Range of Colorado, to water utility representatives from across the country, to a set of designers, academics, and trade groups. The extent to which the workshop participants were already familiar with simulation tools contributed to their willingness to accept the solutions that were generated using the tool. Moreover, in some instances, brainstorming new objectives to include within the MOEA expanded the scope of the problem formulation, relative to the initial conception of the researchers. Through describing results across a diversity of projects, the goal of this presentation is to report on how our approach may inform future decision support collaboration with a variety of stakeholders and sectors.

The Controlled Ecological Life Support System Antarctic Analog Project: Prototype Crop Production and Water Treatment System Performance

NASA Technical Reports Server (NTRS)

Bubenheim, David L.; Flynn, Michael T.; Bates, Maynard; Schlick, Greg; Kliss, Mark (Technical Monitor)

1997-01-01

The Controlled Ecological Life Support System (CELSS) Antarctic Analog Project (CAAP), is a joint endeavor between the National Science Foundation, Office of Polar Programs (NSF-OPP) and the NASA. The fundamental objective is to develop, deploy, and operate a testbed of advanced life support technologies at the Amundsen-Scott South Pole Station that enable the objectives of both the NSF and NASA. The functions of food production, water purification, and waste treatment, recycle and reduction provided by CAAP will improve the quality of life for the South Pole inhabitants, reduce logistics dependence, enhance safety and minimize environmental impacts associated with human presence on the polar plateau. Because of the analogous technical, scientific, and mission features with Planetary missions such as a mission to Mars, CAAP provides NASA with a method for validating technologies and overall approaches to supporting humans. Prototype systems for sewage treatment, water recycle and crop production are being evaluated at Ames Research Center. The product water from sewage treatment using a Wiped-Film Rotating Disk is suitable for input to the crop production system. The crop production system has provided an enhanced level of performance compared with projected performance for plant-based life support: an approximate 50% increase in productivity per unit area, more than a 65% decrease in power for plant lighting, and more than a 75% decrease in the total power requirement to produce an equivalent mass of edible biomass.

Design, implementation, use, and preliminary evaluation of SEBASTIAN, a standards-based Web service for clinical decision support.

PubMed

Kawamoto, Kensaku; Lobach, David F

2005-01-01

Despite their demonstrated ability to improve care quality, clinical decision support systems are not widely used. In part, this limited use is due to the difficulty of sharing medical knowledge in a machine-executable format. To address this problem, we developed a decision support Web service known as SEBASTIAN. In SEBASTIAN, individual knowledge modules define the data requirements for assessing a patient, the conclusions that can be drawn using that data, and instructions on how to generate those conclusions. Using standards-based XML messages transmitted over HTTP, client decision support applications provide patient data to SEBASTIAN and receive patient-specific assessments and recommendations. SEBASTIAN has been used to implement four distinct decision support systems; an architectural overview is provided for one of these systems. Preliminary assessments indicate that SEBASTIAN fulfills all original design objectives, including the re-use of executable medical knowledge across diverse applications and care settings, the straightforward authoring of knowledge modules, and use of the framework to implement decision support applications with significant clinical utility.

Effectiveness of befriending interventions: a systematic review and meta-analysis

PubMed Central

Siette, Joyce; Cassidy, Megan; Priebe, Stefan

2017-01-01

Objective Befriending is an emotional supportive relationship in which one-to-one companionship is provided on a regular basis by a volunteer. It is commonly and increasingly offered by the voluntary sector for individuals with distressing physical and mental conditions. However, the effectiveness of this intervention on health outcomes is largely unknown. We aim to conduct a systematic review of the benefits of befriending. Design Systematic review. Methods A systematic search of electronic databases was conducted to identify randomised controlled trials and quasi-experimental trials of befriending for a range of physical and mental health indications including depression, anxiety, mental illness, cancer, physical illness and dementia. Main outcomes included patient-relevant and disease-specific outcomes, such as depression, loneliness, quality of life, self-esteem, social support and well-being. Results A total of 14 trials (2411 participants) were included; 7 were judged at low risk of bias. Most trials showed improvement in symptoms associated with befriending but these associations did not reach statistical significance in all trials. Befriending was significantly associated with better patient-reported outcomes across primary measures (standardised mean difference 0.18 (95% CI, −0.002 to 0.36, I2=26%, seven trials)). However, there was no significant benefit on single outcomes, including depression, quality of life, loneliness ratings, self-esteem measures, social support structures and well-being. Conclusions There was moderate quality evidence to support the use of befriending for the treatment of individuals with different physical and mental health conditions. This evidence refers to an overall improvement benefit in patient-reported primary outcomes, although with a rather small effect size. The current evidence base does not allow for firm conclusions on more specific outcomes. Future trials should hypothesise a model for the precise effects of befriending and use specified inclusion and outcome criteria. PMID:28446525

A Person-Centered, Registry-Based Learning Health System for Palliative Care: A Path to Coproducing Better Outcomes, Experience, Value, and Science

PubMed Central

Kamal, Arif H.; Kirkland, Kathryn B.; Meier, Diane E.; Nelson, Eugene C.; Pantilat, Steven Z.

2018-01-01

Abstract Background: Palliative care offers an approach to the care of people with serious illness that focuses on quality of life and aligning care with individual and family goals, and values in the context of what is medically achievable. Objective: Measurement of the impact of palliative care is critical for determining what works for which patients in what settings, to learn, improve care, and ensure access to high value care for people with serious illness. Methods: A learning health system that includes patients and families partnering with clinicians and care teams, is directly linked to a registry to support networks for improvement and research, and offers an ideal framework for measuring what matters to a range of stakeholders interested in improving care for this population. Measurements: Measurement focuses on the individual patient and family experience as the fundamental outcome of interest around which all care delivery is organized. Results: We describe an approach to codesigning and implementing a palliative care registry that functions as a learning health system, by combining patient and family inputs and clinical data to support person-centered care, quality improvement, accountability, transparency, and scientific research. Discussion: The potential for a palliative care learning health system that, by design, brings together enriched information environments to support coproduction of healthcare and facilitated peer networks to support patients and families, collaborative clinician networks to support palliative care program improvement, and collaboratories to support research and the application of research to benefit individual patients is immense. PMID:29091509

DMD-based multi-object spectrograph on Galileo telescope

NASA Astrophysics Data System (ADS)

Zamkotsian, Frederic; Spano, Paolo; Lanzoni, Patrick; Bon, William; Riva, Marco; Nicastro, Luciano; Molinari, Emilio; Di Marcantonio, Paolo; Zerbi, Filippo; Valenziano, Luca

2013-03-01

Next-generation infrared astronomical instrumentation for ground-based and space telescopes could be based on MOEMS programmable slit masks for multi-object spectroscopy (MOS). This astronomical technique is used extensively to investigate the formation and evolution of galaxies. We propose to develop a 2048x1080 DMD-based MOS instrument to be mounted on the Galileo telescope and called BATMAN. A two-arm instrument has been designed for providing in parallel imaging and spectroscopic capabilities. The two arms with F/4 on the DMD are mounted on a common bench, and an upper bench supports the detectors thanks to two independent hexapods. Very good optical quality on the DMD and the detectors will be reached. ROBIN, a BATMAN demonstrator, has been designed, realized and integrated. It permits to determine the instrument integration procedure, including optics and mechanics integration, alignment procedure and optical quality. First images have been obtained and measured. A DMD pattern manager has been developed in order to generate any slit mask according to the list of objects to be observed; spectra have been generated and measured. Observation strategies will be studied and demonstrated for the scientific optimization strategy over the whole FOV. BATMAN on the sky is of prime importance for characterizing the actual performance of this new family of MOS instruments, as well as investigating the operational procedures on astronomical objects. This instrument will be placed on the Telescopio Nazionale Galileo at the beginning of next year, in 2014.

WE-AB-209-07: Explicit and Convex Optimization of Plan Quality Metrics in Intensity-Modulated Radiation Therapy Treatment Planning

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

Engberg, L; KTH Royal Institute of Technology, Stockholm; Eriksson, K

Purpose: To formulate objective functions of a multicriteria fluence map optimization model that correlate well with plan quality metrics, and to solve this multicriteria model by convex approximation. Methods: In this study, objectives of a multicriteria model are formulated to explicitly either minimize or maximize a dose-at-volume measure. Given the widespread agreement that dose-at-volume levels play important roles in plan quality assessment, these objectives correlate well with plan quality metrics. This is in contrast to the conventional objectives, which are to maximize clinical goal achievement by relating to deviations from given dose-at-volume thresholds: while balancing the new objectives means explicitlymore » balancing dose-at-volume levels, balancing the conventional objectives effectively means balancing deviations. Constituted by the inherently non-convex dose-at-volume measure, the new objectives are approximated by the convex mean-tail-dose measure (CVaR measure), yielding a convex approximation of the multicriteria model. Results: Advantages of using the convex approximation are investigated through juxtaposition with the conventional objectives in a computational study of two patient cases. Clinical goals of each case respectively point out three ROI dose-at-volume measures to be considered for plan quality assessment. This is translated in the convex approximation into minimizing three mean-tail-dose measures. Evaluations of the three ROI dose-at-volume measures on Pareto optimal plans are used to represent plan quality of the Pareto sets. Besides providing increased accuracy in terms of feasibility of solutions, the convex approximation generates Pareto sets with overall improved plan quality. In one case, the Pareto set generated by the convex approximation entirely dominates that generated with the conventional objectives. Conclusion: The initial computational study indicates that the convex approximation outperforms the conventional objectives in aspects of accuracy and plan quality.« less

Experiences with Acquiring Highly Redundant Spatial Data to Support Driverless Vehicle Technologies

NASA Astrophysics Data System (ADS)

Koppanyi, Z.; Toth, C. K.

2018-05-01

As vehicle technology is moving towards higher autonomy, the demand for highly accurate geospatial data is rapidly increasing, as accurate maps have a huge potential of increasing safety. In particular, high definition 3D maps, including road topography and infrastructure, as well as city models along the transportation corridors represent the necessary support for driverless vehicles. In this effort, a vehicle equipped with high-, medium- and low-resolution active and passive cameras acquired data in a typical traffic environment, represented here by the OSU campus, where GPS/GNSS data are available along with other navigation sensor data streams. The data streams can be used for two purposes. First, high-definition 3D maps can be created by integrating all the sensory data, and Data Analytics/Big Data methods can be tested for automatic object space reconstruction. Second, the data streams can support algorithmic research for driverless vehicle technologies, including object avoidance, navigation/positioning, detecting pedestrians and bicyclists, etc. Crucial cross-performance analyses on map database resolution and accuracy with respect to sensor performance metrics to achieve economic solution for accurate driverless vehicle positioning can be derived. These, in turn, could provide essential information on optimizing the choice of geospatial map databases and sensors' quality to support driverless vehicle technologies. The paper reviews the data acquisition and primary data processing challenges and performance results.

On pictures and stuff: image quality and material appearance

NASA Astrophysics Data System (ADS)

Ferwerda, James A.

2014-02-01

Realistic images are a puzzle because they serve as visual representations of objects while also being objects themselves. When we look at an image we are able to perceive both the properties of the image and the properties of the objects represented by the image. Research on image quality has typically focused improving image properties (resolution, dynamic range, frame rate, etc.) while ignoring the issue of whether images are serving their role as visual representations. In this paper we describe a series of experiments that investigate how well images of different quality convey information about the properties of the objects they represent. In the experiments we focus on the effects that two image properties (contrast and sharpness) have on the ability of images to represent the gloss of depicted objects. We found that different experimental methods produced differing results. Specifically, when the stimulus images were presented using simultaneous pair comparison, observers were influenced by the surface properties of the images and conflated changes in image contrast and sharpness with changes in object gloss. On the other hand, when the stimulus images were presented sequentially, observers were able to disregard the image plane properties and more accurately match the gloss of the objects represented by the different quality images. These findings suggest that in understanding image quality it is useful to distinguish between quality of the imaging medium and the quality of the visual information represented by that medium.

A method for the evaluation of image quality according to the recognition effectiveness of objects in the optical remote sensing image using machine learning algorithm.

PubMed

Yuan, Tao; Zheng, Xinqi; Hu, Xuan; Zhou, Wei; Wang, Wei

2014-01-01

Objective and effective image quality assessment (IQA) is directly related to the application of optical remote sensing images (ORSI). In this study, a new IQA method of standardizing the target object recognition rate (ORR) is presented to reflect quality. First, several quality degradation treatments with high-resolution ORSIs are implemented to model the ORSIs obtained in different imaging conditions; then, a machine learning algorithm is adopted for recognition experiments on a chosen target object to obtain ORRs; finally, a comparison with commonly used IQA indicators was performed to reveal their applicability and limitations. The results showed that the ORR of the original ORSI was calculated to be up to 81.95%, whereas the ORR ratios of the quality-degraded images to the original images were 65.52%, 64.58%, 71.21%, and 73.11%. The results show that these data can more accurately reflect the advantages and disadvantages of different images in object identification and information extraction when compared with conventional digital image assessment indexes. By recognizing the difference in image quality from the application effect perspective, using a machine learning algorithm to extract regional gray scale features of typical objects in the image for analysis, and quantitatively assessing quality of ORSI according to the difference, this method provides a new approach for objective ORSI assessment.

Challenges in managing elderly people with diabetes in primary care settings in Norway

PubMed Central

2013-01-01

Abstract Objective To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings. Design Focus-group interviews. Subjects and setting Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years. Results Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines. Conclusion Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging. PMID:24205973

Continuous support for women during childbirth.

PubMed

Bohren, Meghan A; Hofmeyr, G Justus; Sakala, Carol; Fukuzawa, Rieko K; Cuthbert, Anna

2017-07-06

Historically, women have generally been attended and supported by other women during labour. However, in hospitals worldwide, continuous support during labour has often become the exception rather than the routine. The primary objective was to assess the effects, on women and their babies, of continuous, one-to-one intrapartum support compared with usual care, in any setting. Secondary objectives were to determine whether the effects of continuous support are influenced by:1. Routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement and ability to cope with labour, including: policies about the presence of support people of the woman's own choosing; epidural analgesia; and continuous electronic fetal monitoring.2. The provider's relationship to the woman and to the facility: staff member of the facility (and thus has additional loyalties or responsibilities); not a staff member and not part of the woman's social network (present solely for the purpose of providing continuous support, e.g. a doula); or a person chosen by the woman from family members and friends;3. Timing of onset (early or later in labour);4. Model of support (support provided only around the time of childbirth or extended to include support during the antenatal and postpartum periods);5. Country income level (high-income compared to low- and middle-income). We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (1 June 2017) and reference lists of retrieved studies. All published and unpublished randomised controlled trials, cluster-randomised trials comparing continuous support during labour with usual care. Quasi-randomised and cross-over designs were not eligible for inclusion. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We sought additional information from the trial authors. The quality of the evidence was assessed using the GRADE approach. We included a total of 27 trials, and 26 trials involving 15,858 women provided usable outcome data for analysis. These trials were conducted in 17 different countries: 13 trials were conducted in high-income settings; 13 trials in middle-income settings; and no studies in low-income settings. Women allocated to continuous support were more likely to have a spontaneous vaginal birth (average RR 1.08, 95% confidence interval (CI) 1.04 to 1.12; 21 trials, 14,369 women; low-quality evidence) and less likely to report negative ratings of or feelings about their childbirth experience (average RR 0.69, 95% CI 0.59 to 0.79; 11 trials, 11,133 women; low-quality evidence) and to use any intrapartum analgesia (average RR 0.90, 95% CI 0.84 to 0.96; 15 trials, 12,433 women). In addition, their labours were shorter (MD -0.69 hours, 95% CI -1.04 to -0.34; 13 trials, 5429 women; low-quality evidence), they were less likely to have a caesarean birth (average RR 0.75, 95% CI 0.64 to 0.88; 24 trials, 15,347 women; low-quality evidence) or instrumental vaginal birth (RR 0.90, 95% CI 0.85 to 0.96; 19 trials, 14,118 women), regional analgesia (average RR 0.93, 95% CI 0.88 to 0.99; 9 trials, 11,444 women), or a baby with a low five-minute Apgar score (RR 0.62, 95% CI 0.46 to 0.85; 14 trials, 12,615 women). Data from two trials for postpartum depression were not combined due to differences in women, hospitals and care providers included; both trials found fewer women developed depressive symptomatology if they had been supported in birth, although this may have been a chance result in one of the studies (low-quality evidence). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, such as admission to special care nursery (average RR 0.97, 95% CI 0.76 to 1.25; 7 trials, 8897 women; low-quality evidence), and exclusive or any breastfeeding at any time point (average RR 1.05, 95% CI 0.96 to 1.16; 4 trials, 5584 women; low-quality evidence).Subgroup analyses suggested that continuous support was most effective at reducing caesarean birth, when the provider was present in a doula role, and in settings in which epidural analgesia was not routinely available. Continuous labour support in settings where women were not permitted to have companions of their choosing with them in labour, was associated with greater likelihood of spontaneous vaginal birth and lower likelihood of a caesarean birth. Subgroup analysis of trials conducted in high-income compared with trials in middle-income countries suggests that continuous labour support offers similar benefits to women and babies for most outcomes, with the exception of caesarean birth, where studies from middle-income countries showed a larger reduction in caesarean birth. No conclusions could be drawn about low-income settings, electronic fetal monitoring, the timing of onset of continuous support or model of support.Risk of bias varied in included studies: no study clearly blinded women and personnel; only one study sufficiently blinded outcome assessors. All other domains were of varying degrees of risk of bias. The quality of evidence was downgraded for lack of blinding in studies and other limitations in study designs, inconsistency, or imprecision of effect estimates. Continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score and negative feelings about childbirth experiences. We found no evidence of harms of continuous labour support. Subgroup analyses should be interpreted with caution, and considered as exploratory and hypothesis-generating, but evidence suggests continuous support with certain provider characteristics, in settings where epidural analgesia was not routinely available, in settings where women were not permitted to have companions of their choosing in labour, and in middle-income country settings, may have a favourable impact on outcomes such as caesarean birth. Future research on continuous support during labour could focus on longer-term outcomes (breastfeeding, mother-infant interactions, postpartum depression, self-esteem, difficulty mothering) and include more woman-centred outcomes in low-income settings.

Developing future clinical leaders for quality improvement: experience from a London children's hospital.

PubMed

Runnacles, Jane; Moult, Beki; Lachman, Peter

2013-11-01

Medical training does not necessarily prepare graduates for the real world of healthcare in which continual improvement is required. Doctors in postgraduate training (DrPGT) rarely have the opportunity to develop skills to implement changes where they work. Paradoxically they are often best placed to identify safety and quality concerns and can innovate across organisational boundaries. In order to address this, educational programmes require a supportive educational environment and should include experiential learning on a safety and quality project, alongside teaching of quality improvement (QI) knowledge and systems theory. Enabling Doctors in Quality Improvement and Patient Safety (EQuIP) has been designed for DrPGT at a London children's hospital. The aim is to prepare trainees for the future of continual improvement to ensure safe and effective services are developed through effective clinical microsystems. This paper describes the rationale and design of EQuIP with evaluation built in the evolving programme. EQuIP supports DrPGTs through a QI project within their department, aligned to the Great Ormond Street NHS Foundation Trust's objectives. This changes the way DrPGTs view healthcare as they become quality champions for their department. A three-level approach to the programme is described. The innovation involves a peer-designed programme while being work-based, delivering organisational strategies. Results of the preprogramme and postprogramme evaluations demonstrate an improvement in knowledge, skills and attitudes. Benefits to both the DrPGTs and the organisation are emphasised and key factors to achieve success and barriers identified by the participants. The design and evaluation of EQuIP may inform similar educational programmes in other organisations. This capacity building is crucial to ensure that future clinical leaders have the skills and motivation to improve the effectiveness of clinical microsystems.

Mobile Phone Interventions for Sleep Disorders and Sleep Quality: Systematic Review

PubMed Central

Shin, Jong Cheol; Kim, Julia

2017-01-01

Background Although mobile health technologies have been developed for interventions to improve sleep disorders and sleep quality, evidence of their effectiveness remains limited. Objective A systematic literature review was performed to determine the effectiveness of mobile technology interventions for improving sleep disorders and sleep quality. Methods Four electronic databases (EBSCOhost, PubMed/Medline, Scopus, and Web of Science) were searched for articles on mobile technology and sleep interventions published between January 1983 and December 2016. Studies were eligible for inclusion if they met the following criteria: (1) written in English, (2) adequate details on study design, (3) focus on sleep intervention research, (4) sleep index measurement outcome provided, and (5) publication in peer-reviewed journals. Results An initial sample of 2679 English-language papers were retrieved from five electronic databases. After screening and review, 16 eligible studies were evaluated to examine the impact of mobile phone interventions on sleep disorders and sleep quality. These included one case study, three pre-post studies, and 12 randomized controlled trials. The studies were categorized as (1) conventional mobile phone support and (2) utilizing mobile phone apps. Based on the results of sleep outcome measurements, 88% (14/16) studies showed that mobile phone interventions have the capability to attenuate sleep disorders and to enhance sleep quality, regardless of intervention type. In addition, mobile phone intervention methods (either alternatively or as an auxiliary) provide better sleep solutions in comparison with other recognized treatments (eg, cognitive behavioral therapy for insomnia). Conclusions We found evidence to support the use of mobile phone interventions to address sleep disorders and to improve sleep quality. Our findings suggest that mobile phone technologies can be effective for future sleep intervention research. PMID:28882808

The Utility of the OMI HCHO and NO2 Data Products in Air Quality Decision- Making Activities

NASA Technical Reports Server (NTRS)

Duncan, Bryan N.

2010-01-01

We will present three related air quality applications of the OMI HCHO (formaldehyde) and NO2 (nitrogen dioxide) data products, which we us to support mission planning of an OMI-like instrument for the proposed GEO-CAPE satellite that has as one of its objectives to study air quality from space. First, we will discuss a novel and practical application of the data products to the "weight of evidence" in the air quality decision-making process (e.g., State Implementation Plan (SIP)) for a city, region, or state to demonstrate that it is making progress toward attainment of the National Ambient Air Quality Standard (NAAQS) for ozone. Any trend, or lack thereof, in the observed OMI HCHO/NO2, which we use as an air quality indicator, may support that an emission control strategy implemented to reduce ozone is or is not occurring for a metropolitan area. Second, we will discuss how we use variations in the OMI HCHO product as a proxy for variability in the biogenic hydrocarbon, isoprene, which is an important player for the formation of high levels of ozone and the dominant source of HCHO in the eastern U.S. Third, we will discuss the variability of NO2 in the U.S. as indicated by the OMI NO2 product. In addition, we will show the impact of the 2005 hurricanes on pollutant emissions, including those associated with the intensive oil extraction and refining activities, in the Gulf of Mexico region using the OMI NO2 product. The variability of HCHO and NO2 as indicated by OMI helps us to understand changes in the OMI HCHO/NO2 and the implications for ozone formation.

Telescience testbed: operational support functions for biomedical experiments.

PubMed

Yamashita, M; Watanabe, S; Shoji, T; Clarke, A H; Suzuki, H; Yanagihara, D

1992-07-01

A telescience testbed was conducted to study the methodology of space biomedicine with simulated constraints imposed on space experiments. An experimental subject selected for this testbedding was an elaborate surgery of animals and electrophysiological measurements conducted by an operator onboard. The standing potential in the ampulla of the pigeon's semicircular canal was measured during gravitational and caloric stimulation. A principal investigator, isolated from the operation site, participated in the experiment interactively by telecommunication links. Reliability analysis was applied to the whole layers of experimentation, including design of experimental objectives and operational procedures. Engineering and technological aspects of telescience are discussed in terms of reliability to assure quality of science. Feasibility of robotics was examined for supportive functions to reduce the workload of the onboard operator.

A snapshot of the lives of women with polycystic ovary syndrome: A photovoice investigation.

PubMed

Williams, Sophie; Sheffield, David; Knibb, Rebecca C

2016-06-01

Polycystic ovary syndrome affects 6  percent of women. Symptoms include hirsutism, acne, and infertility. This research explores the impact of polycystic ovary syndrome on women's lives using photovoice. Nine participants photographed objects related to their quality of life and made diary entries explaining each photograph. Three themes emerged from thematic analysis of the diaries: control (of symptoms and polycystic ovary syndrome controlling their lives), perception (of self, others, and their situation), and support (from relationships, health care systems, and education). These findings illuminate positive aspects of living with polycystic ovary syndrome and the role pets and social networking sites play in providing support for women with polycystic ovary syndrome. © The Author(s) 2014.

Collaboration for Land, Air, Sea, and Space Vehicles: Developing the Common Ground in Vehicle Dynamics, System Identification, Control, and Handling Qualities (La collaboration dans le domaine des vehicules terrestres, aeriens, maritimes et spatiaux: L’etablissement d’une approche commune de la dynamique des vehicules, l’identification des systemes, et les qualite’s de controle et de pilotage)

DTIC Science & Technology

2002-11-01

slots in the side of the tail boom, which, by coupling with the predominately downward flow induced by the main rotor , produces “Coanda Effect ” and thus...conduct and promote cooperative research and information exchange. The objective is to support the development and effective use of national defence...decision makers. The RTO performs its mission with the support of an extensive network of national experts. It also ensures effective coordination with

An Analysis of Context-Aware Data Models for Smart Cities: Towards Fiware and Etsi Cim Emerging Data Model

NASA Astrophysics Data System (ADS)

Jara, A. J.; Bocchi, Y.; Fernandez, D.; Molina, G.; Gomez, A.

2017-09-01

Smart Cities requires the support of context-aware and enriched semantic descriptions to support a scalable and cross-domain development of smart applications. For example, nowadays general purpose sensors such as crowd monitoring (counting people in an area), environmental information (pollution, air quality, temperature, humidity, noise) etc. can be used in multiple solutions with different objectives. For that reason, a data model that offers advanced capabilities for the description of context is required. This paper presents an overview of the available technologies for this purpose and how it is being addressed by the Open and Agile Smart Cities principles and FIWARE platform through the data models defined by the ETSI ISG Context Information Management (ETSI CIM).

Midwest Nuclear Science and Engineering Consortium

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

Dr. Wynn Volkert; Dr. Arvind Kumar; Dr. Bryan Becker

2010-12-08

The objective of the Midwest Nuclear Science and Engineering Consortium (MNSEC) is to enhance the scope, quality and integration of educational and research capabilities of nuclear sciences and engineering (NS/E) programs at partner schools in support of the U.S. nuclear industry (including DOE laboratories). With INIE support, MNSEC had a productive seven years and made impressive progress in achieving these goals. Since the past three years have been no-cost-extension periods, limited -- but notable -- progress has been made in FY10. Existing programs continue to be strengthened and broadened at Consortium partner institutions. The enthusiasm generated by the academic, state,more » federal, and industrial communities for the MNSEC activities is reflected in the significant leveraging that has occurred for our programs.« less

Identifying clinical and support-service resources and network practices for cancer patients and survivors in southern Puerto Rico

PubMed Central

Castro, Eida M.; Jiménez, Julio C.; Quinn, Gwendolyn; García, Myra; Colón, Yesenia; Ramos, Axel; Brandon, Thomas; Simmons, Vani; Gwede, Clement; Vadaparampil, Susan; Nazario, Cruz María

2015-01-01

Objective The objectives of this study were to identify cancer-related health care services and to explore the presence of inter-organizational interactions among clinical and support oncology services in southern Puerto Rico. Methods From January through July of 2010, a survey was completed by 54 health care organizations offering clinical, supportive, or both services to cancer patients/survivors (CPS) in southern PR. Survey data were compiled and descriptive analyses performed using the software Statistical Package for a Social Science (SPSS), version 18.0. Results The distribution of the primary services provided by the participating organizations was the following: 26 had clinical services, 16 had support services, and 12 offered a combination of clinical and support services. Only 24% of the surveyed organizations offered their services exclusively to patients diagnosed with cancer. In terms of referral practices, 61% of the responses were for medical specialists, 43% were for mental health services, and 37% were referrals for primary care services. The most common reason for interacting (n = 27) was to provide a given patient both an referral and information. Conclusion Findings suggest gaps in both the availability of oncology services and the delivery of integrated health care. Lack of communication among clinical and support organizations (for cancer patients, specifically) could negatively impact the quality of the services that they offer. Further network analysis studies are needed to confirm these gaps. Until systemic, structural changes occur, more efforts are needed to facilitate communication and collaboration among these kinds of organization. PMID:25249352

Wageningen UR Unmanned Aerial Remote Sensing Facility - Overview of activities

NASA Astrophysics Data System (ADS)

Bartholomeus, Harm; Keesstra, Saskia; Kooistra, Lammert; Suomalainen, Juha; Mucher, Sander; Kramer, Henk; Franke, Jappe

2016-04-01

To support environmental management there is an increasing need for timely, accurate and detailed information on our land. Unmanned Aerial Systems (UAS) are increasingly used to monitor agricultural crop development, habitat quality or urban heat efficiency. An important reason is that UAS technology is maturing quickly while the flexible capabilities of UAS fill a gap between satellite based and ground based geo-sensing systems. In 2012, different groups within Wageningen University and Research Centre have established an Unmanned Airborne Remote Sensing Facility. The objective of this facility is threefold: a) To develop innovation in the field of remote sensing science by providing a platform for dedicated and high-quality experiments; b) To support high quality UAS services by providing calibration facilities and disseminating processing procedures to the UAS user community; and c) To promote and test the use of UAS in a broad range of application fields like habitat monitoring, precision agriculture and land degradation assessment. The facility is hosted by the Laboratory of Geo-Information Science and Remote Sensing (GRS) and the Department of Soil Physics and Land Management (SLM) of Wageningen University together with the team Earth Informatics (EI) of Alterra. The added value of the Unmanned Aerial Remote Sensing Facility is that compared to for example satellite based remote sensing more dedicated science experiments can be prepared. This includes for example higher frequent observations in time (e.g., diurnal observations), observations of an object under different observation angles for characterization of BRDF and flexibility in use of camera's and sensors types. In this way, laboratory type of set ups can be tested in a field situation and effects of up-scaling can be tested. In the last years we developed and implemented different camera systems (e.g. a hyperspectral pushbroom system, and multispectral frame cameras) which we operated in projects all around the world, while new camera systems are being planned such as LiDAR and a full frame hyperspectral camera. In the presentation we will give an overview of our activities, ranging from erosion studies, decision support for precision agriculture, determining leaf biochemistry and canopy structure in tropical forests to the mapping of coastal zones.

The Huaihe Basin Water Resource and Water Quality Management Platform Implemented with a Spatio-Temporal Data Model

NASA Astrophysics Data System (ADS)

Liu, Y.; Zhang, W.; Yan, C.

2012-07-01

Presently, planning and assessment in maintenance, renewal and decision-making for watershed hydrology, water resource management and water quality assessment are evolving toward complex, spatially explicit regional environmental assessments. These problems have to be addressed with object-oriented spatio-temporal data models that can restore, manage, query and visualize various historic and updated basic information concerning with watershed hydrology, water resource management and water quality as well as compute and evaluate the watershed environmental conditions so as to provide online forecasting to police-makers and relevant authorities for supporting decision-making. The extensive data requirements and the difficult task of building input parameter files, however, has long been an obstacle to use of such complex models timely and effectively by resource managers. Success depends on an integrated approach that brings together scientific, education and training advances made across many individual disciplines and modified to fit the needs of the individuals and groups who must write, implement, evaluate, and adjust their watershed management plans. The centre for Hydro-science Research, Nanjing University, in cooperation with the relevant watershed management authorities, has developed a WebGIS management platform to facilitate this complex process. Improve the management of watersheds over the Huaihe basin through the development, promotion and use of a web-based, user-friendly, geospatial watershed management data and decision support system (WMDDSS) involved many difficulties for the development of this complicated System. In terms of the spatial and temporal characteristics of historic and currently available information on meteorological, hydrological, geographical, environmental and other relevant disciplines, we designed an object-oriented spatiotemporal data model that combines spatial, attribute and temporal information to implement the management system. Using this system, we can update, query and analyze environmental information as well as manage historical data, and a visualization tool was provided to help the user interpret results so as to provide scientific support for decision-making. The utility of the system has been demonstrated its values by being used in watershed management and environmental assessments.

The contribution of schools to supporting the well being of children affected by HIV in eastern Zimbabwe

PubMed Central

Pufall, Erica L.; Gregson, Simon; Eaton, Jeffrey W.; Masoka, Tidings; Mpandaguta, Edith; Andersen, Louise; Skovdal, Morten; Nyamukapa, Constance; Campbell, Catherine

2016-01-01

Objectives Schools are often cited as a source of support for orphans and children affected by HIV/AIDS in populations experiencing generalized HIV epidemics and severe poverty. Here we investigate the success of schools at including and supporting the well being of vulnerable children in rural Zimbabwe. Design Data from a cross-sectional household survey of 4577 children (aged 6–17 years), conducted between 2009 and 2011, were linked to data on the characteristics of 28 primary schools and 18 secondary schools from a parallel monitoring and evaluation facility survey. Methods We construct two measures of school quality (one general and one HIV-specific) and use multivariable regression to test whether these were associated with improved educational outcomes and well being for vulnerable children. Results School quality was not associated with primary or secondary school attendance, but was associated with children’s being in the correct grade for age [adjusted odds ratio 2.0, 95% confidence interval (CI) 1.2–3.5, P = 0.01]. General and HIV-specific school quality had significant positive effects on well being in the primary school-age children (coefficient 5.1, 95% CI 2.4–7.7, P < 0.01 and coefficient 3.0, 95% CI 0.4–5.6, P = 0.02, respectively), but not in the secondary school-age children (P > 0.2). There was no evidence that school quality provided an additional benefit to the well being of vulnerable children. Community HIV prevalence was negatively associated with well being in the secondary school-age children (coefficient −0.7, 95% CI −1.3 to −0.1, P = 0.03). Conclusions General and HIV-specific school quality may enhance the well being of primary school-age children in eastern Zimbabwe. Local community context also plays an important role in child well being. PMID:24991911

A PROMIS Measure of Neuropathic Pain Quality

PubMed Central

Askew, Robert L.; Cook, Karon F.; Keefe, Francis J.; Nowinski, Cindy J; Cella, David; Revicki, Dennis A.; DeWitt, Esi M. Morgan; Michaud, Kaleb; Trence, Dace L.; Amtmann, Dagmar

2016-01-01

Objectives Neuropathic pain is a consequence of many chronic conditions. This study aimed to develop a unidimensional neuropathic pain scale whose scores represent levels of neuropathic pain and distinguish between individuals with neuropathic and non-neuropathic pain conditions. Methods A candidate item pool of 42 pain quality descriptors was administered to participants with osteoarthritis, rheumatoid arthritis, diabetic neuropathy, and cancer chemotherapy-induced peripheral neuropathy. A subset of pain quality descriptors (items) that best distinguished between participants with and those without neuropathic pain conditions were identified. Dimensionality of pain descriptors was evaluated in a development sample and cross-validated in a hold-out sample. Item responses were calibrated using an item response theory model, and scores were generated on a T-score metric. Neuropathic pain scale scores were evaluated in terms of reliability, validity, and the ability to distinguish between participants with and without conditions typically associated with neuropathic pain. Results Of the 42 initial items, 5 were identified for the Patient Reported Outcome Measurement Information System (PROMIS) Neuropathic Pain Quality scale (PROMIS-PQ-Neuro). The IRT-generated T-scores exhibited good discriminatory ability based on receiver operator characteristic analysis. Score thresholds were identified that optimize sensitivity and specificity. Construct, criterion, and discriminant validity, and reliability of scale scores were supported. Conclusions The 5-item PROMIS PQ-Neuro is a short and practical measure that can be used to identify patients more likely to have neuropathic pain and to distinguish levels of neuropathic pain. The data collected will support future research that targets other unidimensional pain quality domains (e.g., nociceptive pain). PMID:27565279

The quality of life of farmers with chronic obstructive pulmonary disease (COPD).

PubMed

Milanowska, Joanna; Mackiewicz, Barbara; Węgorowski, Paweł; Milanowski, Janusz; Milanowski, Piotr; Makara-Studzińska, Marta

2017-06-09

Introduction and objective. COPD is a medical state characterized by chronically poor airflow, and typically worsens over time. Farmers have an increased risk of COPD because of being exposed to ammonia, hydrogen sulfide, inorganic dust, and organic dust. The quality of life of the ill depends on biomedical as well as psychosocial factors, the impact of which has not been a frequent subject of studies among COPD patients. The aim of the study was to indicate the factors that have negative and positive influence on the quality of life of farmers suffering from COPD. Materials and method. The study was conducted among 84 farmers treated for COPD in the Department of Pneumology, Oncology and Allergology of the Medical University in Lublin, Poland. The differences between the farmers concerned: severity of the disease, level of education and income, frequency of smoking tobacco and drinking alcohol, kinds of support they receive from their families, and the level of depression and anxiety experienced by the patients. Results. The study revealed that most patients suffered from depressive and anxiety disorders, and the level of depression higher among the patients who smoked more. Lack of family support had significant influence on exacerbation of the patient's depressive and anxiety symptoms. Patients who had recently experienced a critical situation presented with more severe COPD symptoms, lower quality of life and a higher level of depression. Higher income of the patients had positive influence on their quality of life. Farmers addicted to alcohol suffered from a higher level of anxiety.

Ordinary Social Interaction and the Main Effect Between Perceived Support and Affect.

PubMed

Lakey, Brian; Vander Molen, Randy J; Fles, Elizabeth; Andrews, Justin

2016-10-01

Relational regulation theory hypothesizes that (a) the main effect between perceived support and mental health primarily reflects ordinary social interaction rather than conversations about stress and how to cope with it, and (b) the extent to which a provider regulates a recipient's mental health primarily reflects the recipient's personal taste (i.e., is relational), rather than the provider's objective supportiveness. In three round-robin studies, participants rated each other on supportiveness and the quality of ordinary social interaction, as well as their own affect when interacting with each other. Samples included marines about to deploy to Afghanistan (N = 100; 150 dyads), students sharing apartments (N = 64; 96 dyads), and strangers (N = 48; 72 dyads). Perceived support and ordinary social interaction were primarily relational, and most of perceived support's main effect on positive affect was redundant with ordinary social interaction. The main effect between perceived support and affect emerged among strangers after brief text conversations, and these links were partially verified by independent observers. Findings for negative affect were less consistent with theory. Ordinary social interaction appears to be able to explain much of the main effect between perceived support and positive affect. © 2015 Wiley Periodicals, Inc.

A PRESSURE ULCER AND FALL RATE QUALITY COMPOSITE INDEX FOR ACUTE CARE UNITS: A MEASURE DEVELOPMENT STUDY

PubMed Central

Jayawardhana, Ananda; Burman, Mary E.; Dunton, Nancy E.; Staggs, Vincent S.; Bergquist-Beringer, Sandra; Gajewski, Byron J.

2016-01-01

Background Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement. Objective The study objective was to develop a unit-level inpatient composite nursing care quality performance index – the Pressure Ulcer and Fall Rate Quality Composite Index. Design Two-phase measure development study. Settings 5,144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors® during the year 2013. Methods The Pressure Ulcer and Fall Rate Quality Composite Index was developed in two phases. In Phase 1 the formula was generated using a utility function and generalized penalty analysis. Experts with experience in healthcare quality measurement provided the point of indicator equivalence. In Phase 2 initial validity evidence was gathered based on hypothesized relationships between the Pressure Ulcer and Fall Rate Quality Composite Index and other variables using two-level (unit, hospital) hierarchical linear mixed modeling. Results The Pressure Ulcer and Fall Rate Quality Composite Index = 100 − PUR − FR, where PUR is pressure ulcer rate and FR is total fall rate. Higher scores indicate better quality. Bland-Altman plots demonstrated agreement between pairs of experts and provided evidence for inter-rater reliability of the formula. The validation process demonstrated that higher registered nurse skill mix, higher percent of registered nurses with a baccalaureate in nursing or higher degree, higher percent of registered nurses with national specialty certification, and lower percent of hours supplied by agency staff were significantly associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Higher percentages of unit patients at risk for a hospital-acquired pressure ulcer and higher unit rates of physical restraint use were not associated with higher Pressure Ulcer and Fall Rate Quality Composite Index scores. Conclusions The Pressure Ulcer and Fall Rate Quality Composite Index is a step toward providing a more holistic perspective of unit level nursing quality than individual measures and may help nurses nursing administrators obtain a broader view of which patient care units are the higher and lower performers. Further study is needed to examine the usability of the Pressure Ulcer and Fall Rate Quality Composite Index. PMID:27607602

Agents for Change: Nonphysician Medical Providers and Health Care Quality

PubMed Central

Boucher, Nathan A; McMillen, Marvin A; Gould, James S

2015-01-01

Quality medical care is a clinical and public health imperative, but defining quality and achieving improved, measureable outcomes are extremely complex challenges. Adherence to best practice invariably improves outcomes. Nonphysician medical providers (NPMPs), such as physician assistants and advanced practice nurses (eg, nurse practitioners, advanced practice registered nurses, certified registered nurse anesthetists, and certified nurse midwives), may be the first caregivers to encounter the patient and can act as agents for change for an organization’s quality-improvement mandate. NPMPs are well positioned to both initiate and ensure optimal adherence to best practices and care processes from the moment of initial contact because they have robust clinical training and are integral to trainee/staff education and the timely delivery of care. The health care quality aspects that the practicing NPMP can affect are objective, appreciative, and perceptive. As bedside practitioners and participants in the administrative and team process, NPMPs can fine-tune care delivery, avoiding the problem areas defined by the Institute of Medicine: misuse, overuse, and underuse of care. This commentary explores how NPMPs can affect quality by 1) supporting best practices through the promotion of guidelines and protocols, and 2) playing active, if not leadership, roles in patient engagement and organizational quality-improvement efforts. PMID:25663213

75 FR 41106 - Amendments to the Water Quality Regulations, Water Code and Comprehensive Plan to Update Water...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-15

... (also called water quality criteria) for human health and aquatic life for toxic pollutants in the... Commission in 1996 adopted water quality criteria for human health and aquatic life for Water Quality Zones 2... Objectives for Toxic Pollutants for the Protection of Aquatic Life'', Table 6, ``Stream Quality Objectives...

Trajectories of Parent–Adolescent Relationship Quality Among At-Risk Youth: Parental Depression and Adolescent Developmental Outcomes

PubMed Central

Kim, JaHun; Thompson, Elaine Adams; Walsh, Elaine M.; Schepp, Karen G.

2015-01-01

Background Although the parent–adolescent relationship has been studied intensely, predictors and consequences of changes in the quality of the relationship across time have not been examined. Objectives This study examined the role of parent depression on changes in the parent–adolescent relationship, defined as support and conflict, and subsequent effects of relationship change on adolescent psychosocial outcomes including risky behavior, substance use, depressive symptoms, and hopelessness. Method Using data from a large prevention study, the sample included 110 youth at risk for high school drop out from the control condition; the sample was 48.2% of female, with a mean age of 15.9 years. The data, gathered from adolescents and their parents across a period of approximately 18 months, were analyzed using growth mixture modeling. Results Three distinct trajectories for parent–adolescent conflict (high-decreasing, low-increasing, low-stable trajectory) were identified as well as a single growth model for support, which revealed a slight decline in support across time. Parent depression was a significant predictor of perceived support, but not of membership in trajectories of conflict. Low parent–adolescent support was associated with adolescent depression and hopelessness measured 18 months post-baseline. Adolescents in the low but increasing conflict trajectory and those having a parent with depression reported increased depression and hopelessness 18 months later. Discussion Parent–Adolescent support and conflict were associated with adolescent emotional outcomes, particularly depression and hopelessness. The findings provide evidence that will inform prevention strategies to facilitate parent–adolescent support, minimize the negative impact of relationship conflict, and thereby promote healthy psychosocial outcomes for at-risk adolescence. PMID:26577559

A quality of service negotiation procedure for distributed multimedia presentational applications

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

Hafid, A.; Bochmann, G.V.; Kerherve, B.

Most of current approaches in designing and implementing distributed multimedia (MM) presentational applications, e.g. news-on-demand, have concentrated on the performance of the continuous media file servers in terms of seek time overhead, and real-time disk scheduling; particularly the QoS negotiation mechanisms they provide are used in a rather static manner that is, these mechanisms are restricted to the evaluation of the capacity of certain system components, e.g. file server a priori known to support a specific quality of service (QoS). In contrast to those approaches, we propose a general QoS negotiation framework that supports the dynamic choice of a configurationmore » of system components to support the QoS requirements of the user of a specific application: we consider different possible system configurations and select an optimal one to provide the appropriate QoS support. In this paper we document the design and implementation of a QoS negotiation procedure for distributed MM presentational applications, such as news-on-demand. The negotiation procedure described here is an instantiation of the general framework for QoS negotiation which was developed earlier Our proposal differs in many respect with the negotiation functions provided by existing approaches: (1) the negotiation process uses an optimization approach to find a configuration of system components which supports the user requirements, (2) the negotiation process supports the negotiation of a MM document and not only a single monomedia object, (3) the QoS negotiation takes into account the cost to the user, and (4) the negotiation process may be used to support automatic adaptation to react to QoS degradations, without intervention by the user/application.« less

Friendliness, functionality and freedom: Design characteristics that support midwifery practice in the hospital setting.

PubMed

Hammond, Athena; Homer, Caroline S E; Foureur, Maralyn

2017-07-01

to identify and describe the design characteristics of hospital birth rooms that support midwives and their practice. this study used a qualitative exploratory descriptive methodology underpinned by the theoretical approach of critical realism. Data was collected through 21 in-depth, face-to-face photo-elicitation interviews and a thematic analysis guided by study objectives and the aims of exploratory research was undertaken. the study was set at a recently renovated tertiary hospital in a large Australian city. participants were 16 registered midwives working in a tertiary hospital; seven in delivery suite and nine in birth centre settings. Experience as a midwife ranged from three to 39 years and the sample included midwives in diverse roles such as educator, student support and unit manager. three design characteristics were identified that supported midwifery practice. They were friendliness, functionality and freedom. Friendly rooms reduced stress and increased midwives' feelings of safety. Functional rooms enabled choice and provided options to better meet the needs of labouring women. And freedom allowed for flexible, spontaneous and responsive midwifery practice. hospital birth rooms that possess the characteristics of friendliness, functionality and freedom offer enhanced support for midwives and may therefore increase effective care provision. new and existing birth rooms can be designed or adapted to better support the wellbeing and effectiveness of midwives and may thereby enhance the quality of midwifery care delivered in the hospital. Quality midwifery care is associated with positive outcomes and experiences for labouring women. Further research is required to investigate the benefit that may be transmitted to women by implementing design intended to support and enhance midwifery practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

Integrating Water Quality and River Rehabilitation Management - A Decision-Analytical Perspective

NASA Astrophysics Data System (ADS)

Reichert, P.; Langhans, S.; Lienert, J.; Schuwirth, N.

2009-04-01

Integrative river management involves difficult decisions about alternative measures to improve their ecological state. For this reason, it seems useful to apply knowledge from the decision sciences to support river management. We discuss how decision-analytical elements can be employed for designing an integrated river management procedure. An important aspect of this procedure is to clearly separate scientific predictions of the consequences of alternatives from objectives to be achieved by river management. The key elements of the suggested procedure are (i) the quantitative elicitation of the objectives from different stakeholder groups, (ii) the compilation of the current scientific knowledge about the consequences of the effects resulting from suggested measures in the form of a probabilistic mathematical model, and (iii) the use of these predictions and valuations to prioritize alternatives, to uncover conflicting objectives, to support the design of better alternatives, and to improve the transparency of communication about the chosen management strategy. The development of this procedure led to insights regarding necessary steps to be taken for rational decision-making in river management, to guidelines about the use of decision-analytical techniques for performing these steps, but also to new insights about the application of decision-analytical techniques in general. In particular, the consideration of the spatial distribution of the effects of measures and the potential added value of connected rehabilitated river reaches leads to favoring measures that have a positive effect beyond a single river reach. As these effects only propagate within the river network, this results in a river basin oriented management concept as a consequence of a rational decision support procedure, rather than as an a priori management paradigm. There are also limitations to the support that can be expected from the decision-analytical perspective. It will not provide the societal values that are driving prioritization in river management, it will only support their elicitation and rational use. This is particularly important for the assessment of micro-pollutants because of severe limitations in scientific knowledge of their effects on river ecosystems. This makes the influence of pollution by micro-pollutants on prioritization of measures strongly dependent on the weight of the precautionary principle relative to other societal objectives of river management.

Saving Educational Dollars through Quality Objectives.

ERIC Educational Resources Information Center

Alvir, Howard P.

This document is a collection of working papers written to meet the specific needs of teachers who are starting to think about and write performance objectives. It emphasizes qualitative objectives as opposed to quantitative classroom goals. The author describes quality objectives as marked by their clarity, accessibility, accountability, and…

Time, space and technology in radiotherapy departments: how do these factors impact on patients' experiences of radiotherapy?

PubMed

Merchant, S; O'Connor, M; Halkett, G

2017-03-01

Radiation therapists (RTs) plan and deliver radiotherapy treatment for patients diagnosed with cancer. They need to communicate regularly with their patients and may have a role to play in reducing patient anxiety and distress. The objectives were to explore how the environment of radiotherapy departments supports or inhibits communication generally and information giving and supportive care provision in particular. An ethnographic approach was used to gather rich descriptive data through observations and interviews conducted in two Australian radiotherapy centres. Time, space and a technology driven culture was found to negatively affect the quality of interaction that occurred between RTs and their patients. This research has shown design/modification of spaces is needed in the radiotherapy environment to reflect a patient care centred culture and to enhance opportunities for RTs to provide supportive care for their patients. © 2015 John Wiley & Sons Ltd.

Requirements for significant problem reporting and trend analysis

NASA Technical Reports Server (NTRS)

1988-01-01

This handbook supplements policies, requirements, and procedures of NMI 8070.3 to ensure that NASA management at each organizational level is: fully aware of trends affecting both the level of safety and the potential for mission success established for both NASA manned space programs and its supporting institutions; fully and independently informed of problems that represent significant risk to the safety of all personnel (including the general populace) and to the success of a mission or operation through a program mechanism herein defined as Significant Problem Reporting; and in full agreement with the level of elimination of these problems through the closed-loop accounting of corrective actions. The requirements of this handbook are supportive of the agency's safety, reliability, maintainability, and quality assurance (SRM&QA) program objectives and are applicable to all organizational elements of NASA connected with or supporting developmental or operational manned space program/projects (including associated payloads) and the related institutional facilities.

[Resident evaluation of general surgery training programs].

PubMed

Espinoza G, Ricardo; Danilla E, Stefan; Valdés G, Fabio; San Francisco R, Ignacio; Llanos L, Osvaldo

2009-07-01

The profile of the general surgeon has changed, aiming to incorporate new skills and to develop new specialties. To assess the quality of postgraduate General Surgery training programs given by Chilean universities, the satisfaction of students and their preferences after finishing the training period. A survey with multiple choice and Likert type questions was designed and applied to 77 surgery residents, corresponding to 59% of all residents of general surgery specialization programs of Chilean universities. Fifty five per cent of residents financed with their own resources the specialization program. Thirty nine percent disagreed partially or totally with the objectives and rotations of programs. The opportunity to perform surgical interventions and the support by teachers was well evaluated. However, 23% revealed teacher maltreatment. Fifty six percent performed research activities, 73% expected to continue training in a derived specialty and 69% was satisfied with the training program. Residents considered that the quality and dedication of professors and financing of programs are issues that must be improved. The opportunity to perform surgical interventions, obtaining a salary for their work and teacher support is considered of utmost importance.

Rational therapeutic choice for older patients with lymphoma.

PubMed

Bron, Dominique; Soubeyran, Pierre

2017-09-01

The choice for an optimal treatment in older lymphoma patients is a real challenge for hemato-oncologists. They have to treat a potentially curative lymphoma, and concomitantly protect their patients from unacceptable toxicities. Some recommendations are provided for the major subtypes of lymphomas including the antitumoral treatment and primarily the optimal supportive care. All the recent literature data converge to say that the approach of an older patient with a malignant hemopathy is a multistep procedure. This process comprises the appraisal of life expectancy of the patient with or without the disease, the prognostic factors of the tumor, the functional, physiological and cognitive functions evaluation, the socio-economical environment and the patient's expectancy in terms of quality of life. Major progresses have been achieved in the management of diffuse large B cell lymphoma and mantle cell lymphoma in patients up to 80 and above 80 years old. With all these information in hands, the hematologist will decide if the treatment's objective is the standard treatment with optimal supportive care (fit patients), tailor-made adapted chemotherapy (unfit patients) or preservation of quality of life (frail patients).

Wireless Infrastructure M2M Network For Distributed Power Grid Monitoring

PubMed Central

Gharavi, Hamid; Hu, Bin

2018-01-01

With the massive integration of distributed renewable energy sources (RESs) into the power system, the demand for timely and reliable network quality monitoring, control, and fault analysis is rapidly growing. Following the successful deployment of Phasor Measurement Units (PMUs) in transmission systems for power monitoring, a new opportunity to utilize PMU measurement data for power quality assessment in distribution grid systems is emerging. The main problem however, is that a distribution grid system does not normally have the support of an infrastructure network. Therefore, the main objective in this paper is to develop a Machine-to-Machine (M2M) communication network that can support wide ranging sensory data, including high rate synchrophasor data for real-time communication. In particular, we evaluate the suitability of the emerging IEEE 802.11ah standard by exploiting its important features, such as classifying the power grid sensory data into different categories according to their traffic characteristics. For performance evaluation we use our hardware in the loop grid communication network testbed to access the performance of the network. PMID:29503505