Indiana Paths to Quality: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Indiana's Paths to Quality prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…

Oregon Child Care Quality Indicators Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Oregon's Child Care Quality Indicators Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

42 CFR 422.266 - Beneficiary rebates.

Code of Federal Regulations, 2011 CFR

2011-10-01

... plan's quality rating under a 5 star rating system, as determined by the Secretary under § 422.258(d)(7... plan with a quality rating under such system of at least 4.5 stars, 70 percent of the average per capita savings; (B) In the case of a plan with a quality rating under such system of at least 3.5 stars...

45 CFR 155.1400 - Quality rating system.

Code of Federal Regulations, 2014 CFR

2014-10-01

... the quality rating information assigned to each QHP on its Web site, in accordance with § 155.205(b)(1... 45 Public Welfare 1 2014-10-01 2014-10-01 false Quality rating system. 155.1400 Section 155.1400... EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT Quality...

How Would Programs Rate under California's Proposed Quality Rating and Improvement System? Evidence from Statewide and County Data on Early Care and Education Program Quality. Documented Briefing

ERIC Educational Resources Information Center

Karoly, Lynn A.; Zellman, Gail L.

2012-01-01

In 2010, the California Early Learning Quality Improvement System (CAEL QIS) Advisory Committee recommended a structure for a voluntary quality rating and improvement system (QRIS) that could apply to the state's 11,000 licensed centers and 36,600 licensed family child care homes (FCCHs). The proposed design consisted of an unweighted block system…

Compendium of Quality Rating Systems and Evaluations: The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Tout, Kathryn; Starr, Rebecca; Soli, Margaret; Moodie, Shannon; Kirby, Gretchen; Boller, Kimberly

2010-01-01

Quality Rating Systems (QRS) are currently operating, under development, or being piloted in over 25 states or local areas. As the QRS model becomes integrated into the landscape of child care and education service delivery, policy, and the decisions parents make about child care across the United States, there is an increasing need for…

Validation of Quality Rating and Improvement Systems for Early Care and Education and School-Age Care. Research-to-Policy, Research-to-Practice Brief. OPRE 2012-29

ERIC Educational Resources Information Center

Zellman, Gail L.; Fiene, Richard

2012-01-01

Quality Rating and Improvement Systems (QRIS) for early care and education and school age care programs are designed to collect information about quality and to use that information to produce program-level ratings, which are the foundation of a QRIS. The ratings are intended to make program quality transparent for parents and other stakeholders…

The UNO Aviation Monograph Series: The Airline Quality Rating 1998

NASA Technical Reports Server (NTRS)

Bowen, Brent D.; Headley, Dean E.

1998-01-01

The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method of comparing airline performance on combined multiple factors important to consumers. Development history and calculation details for the AQR rating system are detailed in The Airline Quality Rating 1991 issued in April, 1991, by the National Institute for Aviation Research at Wichita State University. This current report, Airline Quality Rating 1998, contains monthly Airline Quality Rating scores for 1997. Additional copies are available by contacting Wichita State University or University of Nebraska at Omaha. The Airline Quality Rating 1998 is a summary of month-by-month quality ratings for the ten major U.S. airlines operating during 1997. Using the Airline Quality Rating system and monthly performance data for each airline for the calendar year of 1997, individual and comparative ratings are reported. This research monograph contains a brief summary of the AQR methodology, detailed data and charts that track comparative quality for major airlines domestic operations for the 12 month period of 1997, and industry average results. Also, comparative Airline Quality Rating data for 1991 through 1996 are included to provide a longer term view of quality in the industry.

The Dutch Review Process for Evaluating the Quality of Psychological Tests: History, Procedure, and Results

ERIC Educational Resources Information Center

Evers, Arne; Sijtsma, Klaas; Lucassen, Wouter; Meijer, Rob R.

2010-01-01

This article describes the 2009 revision of the Dutch Rating System for Test Quality and presents the results of test ratings from almost 30 years. The rating system evaluates the quality of a test on seven criteria: theoretical basis, quality of the testing materials, comprehensiveness of the manual, norms, reliability, construct validity, and…

Moving up the Ladder: How Do States Deliver Quality Improvement Supports within Their Quality Rating and Improvement Systems? Brief

ERIC Educational Resources Information Center

Holod, Aleksandra; Faria, Ann-Marie; Weinberg, Emily; Howard, Eboni

2015-01-01

As national attention has increasingly focused on the potential for high-quality early childhood education (ECE) to improve children's school readiness, states have developed quality rating and improvement systems (QRISs) to document the quality of ECE programs, support systematic quality improvement, and provide clear information to families…

Coaching and Quality Assistance in Quality Rating Improvement Systems: Approaches Used by TA Providers to Improve Quality in Early Care and Education Programs and Home-Based Settings

ERIC Educational Resources Information Center

Smith, Sheila; Robbins, Taylor; Schneider, Will; Kreader, J. Lee; Ong, Christine

2012-01-01

Quality Rating Improvement Systems (QRISs) commonly offer on-site technical assistance (TA) and coaching to help early care and education settings achieve quality improvements and a higher QRIS rating. In surveys of administrators overseeing statewide QRISs, almost all states reported the use of on-site TA and coaching in both center-based and…

Quality Rating Systems--The Experiences of Center Directors

ERIC Educational Resources Information Center

Friedman, Dana E.

2007-01-01

Quality Rating System (QRS) initiatives define levels of quality based on research and then support providers with funding and technical assistance to increase their quality. Each program is assessed and given a number of "stars" to indicate to parents what level of quality the program has reached. In this article, the author describes…

The UNO Aviation Monograph Series: The Airline Quality Rating 1997

NASA Technical Reports Server (NTRS)

Bowen, Brent D.; Headley, Dean E.

1997-01-01

The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method of comparing airline performance on combined multiple factors important to consumers. Development history and calculation details for the AQR rating system are detailed in The Airline Quality Rating 1991 issued in April, 1991, by the National Institute for Aviation Research at Wichita State University. This current report, Airline Rating 1997, contains monthly Airline Quality Rating scores for 1996. Additional copies are available by contacting Wichita State University or the University of Nebraska at Omaha. The Airline Quality Rating (AQR) 1997 is a summary of a month-by-month quality ratings for the nine major domestic U.S. airlines operating during 1996. Using the Airline Quality Rating system and monthly performance data for each airline for the calendar year of 1996, individual and comparative ratings are reported. This research monograph contains a brief summary of the AQR methodology, detailed data and charts that track comparative quality for major domestic airlines across the 12 month period of 1996, and industry average results. Also comparative Airline Quality Rating data for 1991 through 1995 are included to provide a longer term view of quality in the industry.

Staff Preparation, Reward, and Support: Are Quality Rating and Improvement Systems Addressing All of the Key Ingredients Necessary for Change? Policy Report

ERIC Educational Resources Information Center

Austin, Lea J. E.; Whitebook, Marcy; Connors, Maia; Darrah, Rory

2011-01-01

Reflecting the growing momentum in support of quality rating and improvement systems (QRISs) as a key strategy to improve early care and education quality, significant amounts of public dollars have been devoted to their development and implementation. In this brief, the authors report on their investigation of both quality rating and improvement…

Colorado Qualistar. QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Colorado's Qualistar prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family…

Pennsylvania Keystone STARS: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Pennsylvania's Keystone STARS prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…

Minnesota Parent Aware: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Minnesota's Parent Aware prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family…

Colometer: a real-time quality feedback system for screening colonoscopy.

PubMed

Filip, Dobromir; Gao, Xuexin; Angulo-Rodríguez, Leticia; Mintchev, Martin P; Devlin, Shane M; Rostom, Alaa; Rosen, Wayne; Andrews, Christopher N

2012-08-28

To investigate the performance of a new software-based colonoscopy quality assessment system. The software-based system employs a novel image processing algorithm which detects the levels of image clarity, withdrawal velocity, and level of the bowel preparation in a real-time fashion from live video signal. Threshold levels of image blurriness and the withdrawal velocity below which the visualization could be considered adequate have initially been determined arbitrarily by review of sample colonoscopy videos by two experienced endoscopists. Subsequently, an overall colonoscopy quality rating was computed based on the percentage of the withdrawal time with adequate visualization (scored 1-5; 1, when the percentage was 1%-20%; 2, when the percentage was 21%-40%, etc.). In order to test the proposed velocity and blurriness thresholds, screening colonoscopy withdrawal videos from a specialized ambulatory colon cancer screening center were collected, automatically processed and rated. Quality ratings on the withdrawal were compared to the insertion in the same patients. Then, 3 experienced endoscopists reviewed the collected videos in a blinded fashion and rated the overall quality of each withdrawal (scored 1-5; 1, poor; 3, average; 5, excellent) based on 3 major aspects: image quality, colon preparation, and withdrawal velocity. The automated quality ratings were compared to the averaged endoscopist quality ratings using Spearman correlation coefficient. Fourteen screening colonoscopies were assessed. Adenomatous polyps were detected in 4/14 (29%) of the collected colonoscopy video samples. As a proof of concept, the Colometer software rated colonoscope withdrawal as having better visualization than the insertion in the 10 videos which did not have any polyps (average percent time with adequate visualization: 79% ± 5% for withdrawal and 50% ± 14% for insertion, P < 0.01). Withdrawal times during which no polyps were removed ranged from 4-12 min. The median quality rating from the automated system and the reviewers was 3.45 [interquartile range (IQR), 3.1-3.68] and 3.00 (IQR, 2.33-3.67) respectively for all colonoscopy video samples. The automated rating revealed a strong correlation with the reviewer's rating (ρ coefficient= 0.65, P = 0.01). There was good correlation of the automated overall quality rating and the mean endoscopist withdrawal speed rating (Spearman r coefficient= 0.59, P = 0.03). There was no correlation of automated overall quality rating with mean endoscopists image quality rating (Spearman r coefficient= 0.41, P = 0.15). The results from a novel automated real-time colonoscopy quality feedback system strongly agreed with the endoscopists' quality assessments. Further study is required to validate this approach.

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

ERIC Educational Resources Information Center

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

2014-01-01

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

Delaware Stars for Early Success. QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Delaware's Stars for Early Success prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators…

Kentucky STARS for KIDS NOW: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Kentucky's STARS for KIDS NOW prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for…

Nursing home 5-star rating system exacerbates disparities in quality, by payer source.

PubMed

Konetzka, R Tamara; Grabowski, David C; Perraillon, Marcelo Coca; Werner, Rachel M

2015-05-01

Market-based reforms in health care, such as public reporting of quality, may inadvertently exacerbate disparities. We examined how the Centers for Medicare and Medicare Services' five-star rating system for nursing homes has affected residents who are dually enrolled in Medicare and Medicaid ("dual eligibles"), a particularly vulnerable and disadvantaged population. Specifically, we assessed the extent to which dual eligibles and non-dual eligibles avoided the lowest-rated nursing homes and chose the highest-rated homes once the five-star rating system began, in late 2008. We found that both populations resided in better-quality homes over time but that by 2010 the increased likelihood of choosing the highest-rated homes was substantially smaller for dual eligibles than for non-dual eligibles. Thus, the gap in quality, as measured by a nursing home's star rating, grew over time. Furthermore, we found that the benefit of the five-star system to dual eligibles was largely due to providers' improving their ratings, not to consumers' choosing different providers. We present evidence suggesting that supply constraints play a role in limiting dual eligibles' responses to quality ratings, since high-quality providers tend to be located close to relatively affluent areas. Increases in Medicaid payment rates for nursing home services may be the only long-term solution. Project HOPE—The People-to-People Health Foundation, Inc.

Alternative Pathways in Family Child Care Quality Rating and Improvement Systems

ERIC Educational Resources Information Center

Kelton, Robyn E.; Talan, Teri N.; Bloom, Paula J.

2013-01-01

As research continues to underscore the positive impact high-quality early childhood programs have on young children, numerous states have implemented quality rating and improvement systems (QRIS) to measure and improve the services young children receive across a wide range of early learning settings. These state systems range from two to five…

The "I" in QRIS Survey: Collecting Data on Quality Improvement Activities for Early Childhood Education Programs. REL 2017-221

ERIC Educational Resources Information Center

Faria, Ann-Marie; Hawkinson, Laura; Metzger, Ivan; Bouacha, Nora; Cantave, Michelle

2017-01-01

A quality rating and improvement system (QRIS) is a voluntary state assessment system that uses multidimensional data on early childhood education programs to rate program quality, support quality improvement efforts, and provide information to families about the quality of available early childhood education programs. QRISs have two components:…

New Mexico Look for the STARS--AIM HIGH: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of New Mexico's Look for the STARS--AIM HIGH prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

Los Angeles County Steps to Excellence Project: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Los Angeles County's Steps to Excellence Project prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs;…

YoungStar in Wisconsin: Analysis of Data as of July 2014. Executive Summary: Key Findings and Analysis

ERIC Educational Resources Information Center

Wisconsin Council on Children and Families, 2014

2014-01-01

YoungStar is a five-star quality rating system for child care providers based on education, learning environment, business methods, and practices around child health and well-being. Through this rating system, the state is addressing several key issues in Wisconsin's child care system. The rating system will: (1) Improve the overall quality of…

Assessing the Validity of the Qualistar Early Learning Quality Rating and Improvement System as a Tool for Improving Child-Care Quality

ERIC Educational Resources Information Center

Zellman, Gail L.; Perlman, Michal; Le, Vi-Nhuan; Setodji, Claude Messan

2008-01-01

As a result of the generally low quality of child care in the United States and the increased emphasis on accountability in education policy, quality rating systems (QRSs) are proliferating in the child-care arena. QRSs assess child-care providers on multiple dimensions of quality and integrate these assessments into an easily understood summary…

Examining Changes to Michigan's Early Childhood Quality Rating and Improvement System (QRIS). REL 2015-029

ERIC Educational Resources Information Center

Faria, Ann-Marie; Hawkinson, Laura E.; Greenberg, Ariela C.; Howard, Eboni C.; Brown, Leah

2015-01-01

Documenting and improving early childhood program quality is a national priority, leading to a rapid expansion of Quality Rating and Improvement Systems (QRISs). QRISs document and improve the quality of early childhood education programs and provide clear information to families about their child care choices. The current study described how…

45 CFR 156.1120 - Quality rating system.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Quality rating system. 156.1120 Section 156.1120 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Quality...

High angle of attack flying qualities criteria for longitudinal rate command systems

NASA Technical Reports Server (NTRS)

Wilson, David J.; Citurs, Kevin D.; Davidson, John B.

1994-01-01

This study was designed to investigate flying qualities requirements of alternate pitch command systems for fighter aircraft at high angle of attack. Flying qualities design guidelines have already been developed for angle of attack command systems at 30, 45, and 60 degrees angle of attack, so this research fills a similar need for rate command systems. Flying qualities tasks that require post-stall maneuvering were tested during piloted simulations in the McDonnell Douglas Aerospace Manned Air Combat Simulation facility. A generic fighter aircraft model was used to test angle of attack rate and pitch rate command systems for longitudinal gross acquisition and tracking tasks at high angle of attack. A wide range of longitudinal dynamic variations were tested at 30, 45, and 60 degrees angle of attack. Pilot comments, Cooper-Harper ratings, and pilot induced oscillation ratings were taken from five pilots from NASA, USN, CAF, and McDonnell Douglas Aerospace. This data was used to form longitudinal design guidelines for rate command systems at high angle of attack. These criteria provide control law design guidance for fighter aircraft at high angle of attack, low speed flight conditions. Additional time history analyses were conducted using the longitudinal gross acquisition data to look at potential agility measures of merit and correlate agility usage to flying qualities boundaries. This paper presents an overview of this research.

Quality Rating and Improvement Systems for Early Care and Education. Early Childhood Highlights. Volume 1, Issue 1

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

Research suggests that high quality early care and education programs can have a significant impact on improving the cognitive, academic and social skills of all children, especially those most at risk for later school failure. A number of states are developing Quality Rating and Improvement Systems (QRIS) to assess and improve the quality of…

Initial Investigation of Reaction Control System Design on Spacecraft Handling Qualities for Earth Orbit Docking

NASA Technical Reports Server (NTRS)

Bailey, Randall E.; Jackson, E. Bruce; Goodrich, Kenneth H.; Ragsdale, W. Al; Neuhaus, Jason; Barnes, Jim

2008-01-01

A program of research, development, test, and evaluation is planned for the development of Spacecraft Handling Qualities guidelines. In this first experiment, the effects of Reaction Control System design characteristics and rotational control laws were evaluated during simulated proximity operations and docking. Also, the influence of piloting demands resulting from varying closure rates was assessed. The pilot-in-the-loop simulation results showed that significantly different spacecraft handling qualities result from the design of the Reaction Control System. In particular, cross-coupling between translational and rotational motions significantly affected handling qualities as reflected by Cooper-Harper pilot ratings and pilot workload, as reflected by Task-Load Index ratings. This influence is masked but only slightly by the rotational control system mode. While rotational control augmentation using Rate Command Attitude Hold can reduce the workload (principally, physical workload) created by cross-coupling, the handling qualities are not significantly improved. The attitude and rate deadbands of the RCAH introduced significant mental workload and control compensation to evaluate when deadband firings would occur, assess their impact on docking performance, and apply control inputs to mitigate that impact.

Impact of increased collection rates and the use of commingled collection systems on the quality of recovered paper. Part 1: increased collection rates.

PubMed

Miranda, Ruben; Monte, M; Blanco, Angeles

2011-11-01

The recovery and utilization of recovered paper have increased over past decades all over the world due to economic, environmental, and social issues. However, it is well known that an extended recovered paper collection is detrimental to its quality, either by the exploitation of lower quality sources such as households, or the spreading of commingled systems instead of selective collection systems. The influence of these two factors was assessed by analyzing the quality of different recovered paper grades used as raw material in a mill located in Madrid (Spain) producing newsprint and light weight coated paper from recovered paper. Part 1 of the paper deals with the impact of increased collection rates on the quality of recovered paper and Part 2 with the use of commingled collection systems. Results of Part 1 show that increased collection rates have a large impact on the quality of the recovered paper. The quality, measured as total unusable material and moisture contents, had deteriorated very rapidly in only 4 years (2005-2008) as a consequence of increased collection rates. Collection rates increased in Spain from 58.5% to 68.6% during this period, resulting in more than 50% increase of total unusable material and 25% of moisture content. The downgrading of the quality of recovered paper is one of the major threats for extending the current limits of paper recycling. Therefore, future challenge is to increase its availability but maintaining its quality. Copyright © 2011 Elsevier Ltd. 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…

Image quality and dose differences caused by vendor-specific image processing of neonatal radiographs.

PubMed

Sensakovic, William F; O'Dell, M Cody; Letter, Haley; Kohler, Nathan; Rop, Baiywo; Cook, Jane; Logsdon, Gregory; Varich, Laura

2016-10-01

Image processing plays an important role in optimizing image quality and radiation dose in projection radiography. Unfortunately commercial algorithms are black boxes that are often left at or near vendor default settings rather than being optimized. We hypothesize that different commercial image-processing systems, when left at or near default settings, create significant differences in image quality. We further hypothesize that image-quality differences can be exploited to produce images of equivalent quality but lower radiation dose. We used a portable radiography system to acquire images on a neonatal chest phantom and recorded the entrance surface air kerma (ESAK). We applied two image-processing systems (Optima XR220amx, by GE Healthcare, Waukesha, WI; and MUSICA(2) by Agfa HealthCare, Mortsel, Belgium) to the images. Seven observers (attending pediatric radiologists and radiology residents) independently assessed image quality using two methods: rating and matching. Image-quality ratings were independently assessed by each observer on a 10-point scale. Matching consisted of each observer matching GE-processed images and Agfa-processed images with equivalent image quality. A total of 210 rating tasks and 42 matching tasks were performed and effective dose was estimated. Median Agfa-processed image-quality ratings were higher than GE-processed ratings. Non-diagnostic ratings were seen over a wider range of doses for GE-processed images than for Agfa-processed images. During matching tasks, observers matched image quality between GE-processed images and Agfa-processed images acquired at a lower effective dose (11 ± 9 μSv; P < 0.0001). Image-processing methods significantly impact perceived image quality. These image-quality differences can be exploited to alter protocols and produce images of equivalent image quality but lower doses. Those purchasing projection radiography systems or third-party image-processing software should be aware that image processing can significantly impact image quality when settings are left near default values.

Low Quality of Basic Caregiving Environments in Child Care: Actual Reality or Artifact of Scoring?

ERIC Educational Resources Information Center

Norris, Deborah J.; Guss, Shannon

2016-01-01

Quality Rating Improvement Systems (QRIS) frequently include the Infant-Toddler Environment Rating Scale-Revised (ITERS-R) as part of rating and improving child care quality. However, studies utilizing the ITERS-R consistently report low quality, especially for basic caregiving items. This research examined whether the low scores reflected the…

Total Quality Management of Information System for Quality Assessment of Pesantren Using Fuzzy-SERVQUAL

NASA Astrophysics Data System (ADS)

Faizah, Arbiati; Syafei, Wahyul Amien; Isnanto, R. Rizal

2018-02-01

This research proposed a model combining an approach of Total Quality Management (TQM) and Fuzzy method of Service Quality (SERVQUAL) to asses service quality. TQM implementation was as quality management orienting on customer's satisfaction by involving all stakeholders. SERVQUAL model was used to measure quality service based on five dimensions such as tangible, reliability, responsiveness, assurance, and empathy. Fuzzy set theory was to accommodate subjectivity and ambiguity of quality assessment. Input data consisted of indicator data and quality assessment aspect. Input data was, then, processed to be service quality assessment questionnaires of Pesantren by using Fuzzy method to get service quality score. This process consisted of some steps as follows : inputting dimension and questionnaire data to data base system, filling questionnaire through system, then, system calculated fuzzification, defuzzification, gap of quality expected and received by service receivers, and calculating each dimension rating showing quality refinement priority. Rating of each quality dimension was, then, displayed at dashboard system to enable users to see information. From system having been built, it could be known that tangible dimension had the highest gap, -0.399, thus it needs to be prioritized and gets evaluation and refinement action soon.

Evaluation of the functional performance and technical quality of an Electronic Documentation System of the Nursing Process.

PubMed

de Oliveira, Neurilene Batista; Peres, Heloisa Helena Ciqueto

2015-01-01

To evaluate the functional performance and the technical quality of the Electronic Documentation System of the Nursing Process of the Teaching Hospital of the University of São Paulo. exploratory-descriptive study. The Quality Model of regulatory standard 25010 and the Evaluation Process defined under regulatory standard 25040, both of the International Organization for Standardization/International Electrotechnical Commission. The quality characteristics evaluated were: functional suitability, reliability, usability, performance efficiency, compatibility, security, maintainability and portability. The sample was made up of 37 evaluators. in the evaluation of the specialists in information technology, only the characteristic of usability obtained a rate of positive responses of less than 70%. For the nurse lecturers, all the quality characteristics obtained a rate of positive responses of over 70%. The staff nurses of the medical and surgical clinics with experience in using the system) and staff nurses from other units of the hospital and from other health institutions (without experience in using the system) obtained rates of positive responses of more than 70% referent to the functional suitability, usability, and security. However, performance efficiency, reliability and compatibility all obtained rates below the parameter established. the software achieved rates of positive responses of over 70% for the majority of the quality characteristics evaluated.

Classroom Quality Rating Systems: How Do Teachers Prepare and What Do They Think about the Process?

ERIC Educational Resources Information Center

Scott-Little, Catherine; Brown, E. Glyn; Hooks, Laura McDonald; Marshall, Betty Jo

2008-01-01

Working with the South Carolina Department of Education, the authors surveyed prekindergarten and kindergarten teachers whose schools participated in a quality rating system to see what they did to get ready for the observation and what they thought of the evaluation process. The authors also asked them what they thought about the quality of their…

Implications of QRIS Design for the Distribution of Program Ratings and Linkages between Ratings and Observed Quality. OPRE Research Brief 2014-33

ERIC Educational Resources Information Center

Tout, Kathryn; Chien, Nina; Rothenberg, Laura; Li, Weilin

2014-01-01

This Brief compares three hypothetical Quality Rating and Improvement Systems (QRIS) that use different rating structures: block, points, and hybrid. Because the quality standards in the hypothetical QRIS are held relatively constant across structures, analyses can be conducted to determine how structure relates to key QRIS outcomes. Three…

Interaction of feel system and flight control system dynamics on lateral flying qualities

NASA Technical Reports Server (NTRS)

Bailey, Randall E.; Powers, Bruce G.; Shafer, Mary F.

1988-01-01

An investigation of feel system and flight control system dynamics on lateral flying qualities was conducted using the variable stability USAF NT-33 aircraft. Experimental variations in feel system natural frequency, force-deflection gradient, control system command architecture type, flight control system filter frequency, and control system delay were made. The experiment data include pilot ratings using the Cooper-Harper (1969) rating scale, pilot comments, and tracking performance statistic. Three test pilots served as evaluators. The data indicate that as the feel system natural frequency is reduced lateral flying qualities degrade. At the slowest feel system frequency, the closed-loop response becomes nonlinear with a 'bobweight' effect apparent in the feel system. Feel system influences were essentially independent of the control system architecture. The flying qualities influence due to the feel system was different than when the identical dynamic systenm was used as a flight control system element.

Simple colonoscopy reporting system checking the detection rate of colon polyps.

PubMed

Kim, Jae Hyun; Choi, Youn Jung; Kwon, Hye Jung; Park, Seun Ja; Park, Moo In; Moon, Won; Kim, Sung Eun

2015-08-21

To present a simple colonoscopy reporting system that can be checked easily the detection rate of colon polyps. A simple colonoscopy reporting system Kosin Gastroenterology (KG quality reporting system) was developed. The polyp detection rate (PDR), adenoma detection rate (ADR), serrated polyp detection rate (SDR), and advanced adenoma detection rate (AADR) are easily calculated to use this system. In our gastroenterology center, the PDR, ADR, SDR, and AADR test results from each gastroenterologist were updated, every month. Between June 2014, when the program was started, and December 2014, the overall PDR and ADR in our center were 62.5% and 41.4%, respectively. And the overall SDR and AADR were 7.5% and 12.1%, respectively. We envision that KG quality reporting system can be applied to develop a comprehensive system to check colon polyp detection rates in other gastroenterology centers.

Validation Studies for Early Learning and Care Quality Rating and Improvement Systems: A Review of the Literature. Working Paper WR-1051-DOEL

ERIC Educational Resources Information Center

Karoly, Lynn A.

2014-01-01

Care Quality Rating and Improvement Systems (QRISs) have advanced and matured, a number of states and localities have undertaken evaluations to validate the systems. Such efforts stem from the desire to ensure that the system is designed and operating in the ways envisioned when the system was established. Given that a central component in a QRIS…

Diagnostic quality of 50 and 100 µm computed radiography compared with screen–film mammography in operative breast specimens

PubMed Central

Pagliari, C M; Hoang, T; Reddy, M; Wilkinson, L S; Poloniecki, J D; Given-Wilson, R M

2012-01-01

Objective To compare reader ratings of the clinical diagnostic quality of 50 and 100 μm computed radiography (CR) systems with screen–film mammography (SFM) in operative specimens. Methods Mammograms of 57 fresh operative breast specimens were analysed by 10 readers. Exposures were made with identical position and compression with three mammographic systems (Fuji 100CR, 50CR and SFM). Images were anonymised and readers blinded to the CR system used. A five-point comparative scoring system (−2 to +2) was used to assess seven quality criteria and overall diagnostic value. Statistical analysis was subsequently performed of reader ratings (n=16 925). Results For most quality criteria, both CR systems were rated as equivalent to or better than SFM. The CR systems were significantly better at demonstrating skin edge and background tissue (p<1×10−5). Microcalcification was best demonstrated on the CR50 system (p<1×10−5). The overall diagnostic value of both CR systems was rated as being as good as or better than SFM (p<1×10−5). Conclusion In this clinical setting, the overall diagnostic performance of both CR systems was as good as or better than SFM, with the CR50 system performing better than the CR100. PMID:22096218

42 CFR 422.266 - Beneficiary rebates.

Code of Federal Regulations, 2014 CFR

2014-10-01

... based on the plan's quality rating under a 5 star rating system, as determined by the Secretary under... the case of a plan with a quality rating under such system of at least 4.5 stars, 70 percent of the... 3.5 stars and less than 4.5 stars, 65 percent of the average per capita savings. (C) In the case of...

42 CFR 422.266 - Beneficiary rebates.

Code of Federal Regulations, 2012 CFR

2012-10-01

... based on the plan's quality rating under a 5 star rating system, as determined by the Secretary under... the case of a plan with a quality rating under such system of at least 4.5 stars, 70 percent of the... 3.5 stars and less than 4.5 stars, 65 percent of the average per capita savings. (C) In the case of...

42 CFR 422.266 - Beneficiary rebates.

Code of Federal Regulations, 2013 CFR

2013-10-01

... based on the plan's quality rating under a 5 star rating system, as determined by the Secretary under... the case of a plan with a quality rating under such system of at least 4.5 stars, 70 percent of the... 3.5 stars and less than 4.5 stars, 65 percent of the average per capita savings. (C) In the case of...

Reducing Error Rates for Iris Image using higher Contrast in Normalization process

NASA Astrophysics Data System (ADS)

Aminu Ghali, Abdulrahman; Jamel, Sapiee; Abubakar Pindar, Zahraddeen; Hasssan Disina, Abdulkadir; Mat Daris, Mustafa

2017-08-01

Iris recognition system is the most secured, and faster means of identification and authentication. However, iris recognition system suffers a setback from blurring, low contrast and illumination due to low quality image which compromises the accuracy of the system. The acceptance or rejection rates of verified user depend solely on the quality of the image. In many cases, iris recognition system with low image contrast could falsely accept or reject user. Therefore this paper adopts Histogram Equalization Technique to address the problem of False Rejection Rate (FRR) and False Acceptance Rate (FAR) by enhancing the contrast of the iris image. A histogram equalization technique enhances the image quality and neutralizes the low contrast of the image at normalization stage. The experimental result shows that Histogram Equalization Technique has reduced FRR and FAR compared to the existing techniques.

Performance of a web-based, realtime, tele-ultrasound consultation system over high-speed commercial telecommunication lines.

PubMed

Yoo, Sun K; Kim, D K; Jung, S M; Kim, E-K; Lim, J S; Kim, J H

2004-01-01

A Web-based, realtime, tele-ultrasound consultation system was designed. The system employed ActiveX control, MPEG-4 coding of full-resolution ultrasound video (640 x 480 pixels at 30 frames/s) and H.320 videoconferencing. It could be used via a Web browser. The system was evaluated over three types of commercial line: a cable connection, ADSL and VDSL. Three radiologists assessed the quality of compressed and uncompressed ultrasound video-sequences from 16 cases (10 abnormal livers, four abnormal kidneys and two abnormal gallbladders). The radiologists' scores showed that, at a given frame rate, increasing the bit rate was associated with increasing quality; however, at a certain threshold bit rate the quality did not increase significantly. The peak signal to noise ratio (PSNR) was also measured between the compressed and uncompressed images. In most cases, the PSNR increased as the bit rate increased, and increased as the number of dropped frames increased. There was a threshold bit rate, at a given frame rate, at which the PSNR did not improve significantly. Taking into account both sets of threshold values, a bit rate of more than 0.6 Mbit/s, at 30 frames/s, is suggested as the threshold for the maintenance of diagnostic image quality.

The Airline Quality Rating 2003

NASA Technical Reports Server (NTRS)

Bowen, Brent D.; Headley, Dean E.

2003-01-01

The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method of comparing airline quality on combined multiple performance criteria. This current report, the Airline Quality Rating 2003, reflects monthly Airline Quality Rating scores for 2002. AQR scores for the calendar year 2002 are based on 15 elements that focus on airline performance areas important to air travel consumers. The Airline Quality Rating 2003 is a summary of month-by-month quality ratings for the 10 largest U.S. airlines operating during 2002. Using the Airline Quality Rating system of weighted averages and monthly performance data in the areas of ontime arrivals, involuntary denied boardings, mishandled baggage, and a combination of 12 customer complaint categories, airlines comparative performance for the calendar year of 2002 is reported. This research monograph contains a brief summary of the AQR methodology, detailed data and charts that track comparative quality for domestic airline operations for the 12-month period of 2002, and industry average results. Also, comparative Airline Quality Rating data for 2001 are included for each airline to provide historical perspective regarding performance quality in the industry.

The Airline Quality Rating 2002

NASA Technical Reports Server (NTRS)

Bowen, Brent D.; Headley, Dean E.

2002-01-01

The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method of comparing airline quality on combined multiple performance criteria. This current report, Airline Quality Rating 2002, reflects monthly Airline Quality Rating scores for 2001. AQR scores for the calendar year 2001 are based on 15 elements that focus on airline performance areas important to air travel consumers. The Airline Quality Rating 2002 is a summary of month-by-month quality ratings for the 11 largest U.S. airlines operating during 2001. Using the Airline Quality Rating system of weighted averages and monthly performance data in the areas of on-time arrivals, involuntary denied boardings, mishandled baggage, and a combination of 12 customer complaint categories, airlines comparative performance for the calendar year of 2001 is reported. This research monograph contains a brief summary of the AQR methodology, detailed data and charts that track comparative quality for domestic airline operations for the 12-month period of 2001, and industry average results. Also, comparative Airline Quality Rating data for 2000 are included for each airline to provide historical perspective regarding performance quality in the industry.

The Airline Quality Rating 2001

NASA Technical Reports Server (NTRS)

Bowen, Brent D.; Headley, Dean E.

2001-01-01

The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method of comparing airline quality on combined multiple performance criteria. This current report, Airline Quality Rating 2001, reflects monthly Airline Quality Rating scores for 2000. AQR scores for the calendar year 2000 are based on 15 elements that focus on airline performance areas important to air travel consumers. The Airline Quality Rating 2001 is a summary of month-by-month quality ratings for the ten major U.S. airlines operating during 2000. Using the Airline Quality Rating system of weighted averages and monthly performance data in the areas of on-time arrivals, involuntary denied boardings, mishandled baggage, and a combination of 12 customer complaint categories, major airlines comparative performance for the calendar year of 2000 is reported. This research monograph contains a brief summary of the AQR methodology, detailed data and charts that track comparative quality for major airlines domestic operations for the 12 month period of 2000, and industry average results. Also, comparative Airline Quality Rating data for 1999 are included for each airline to provide historical perspective regarding performance quality in the industry.

The use of the general image quality equation in the design and evaluation of imaging systems

NASA Astrophysics Data System (ADS)

Cota, Steve A.; Florio, Christopher J.; Duvall, David J.; Leon, Michael A.

2009-08-01

The design of any modern imaging system is the end result of many trade studies, each seeking to optimize image quality within real world constraints such as cost, schedule and overall risk. The National Imagery Interpretability Rating Scale (NIIRS) is a useful measure of image quality, because, by characterizing the overall interpretability of an image, it combines into one metric those contributors to image quality to which a human interpreter is most sensitive. The main drawback to using a NIIRS rating as a measure of image quality in engineering trade studies is the fact that it is tied to the human observer and cannot be predicted from physical principles and engineering parameters alone. The General Image Quality Equation (GIQE) of Leachtenauer et al. 1997 [Appl. Opt. 36, 8322-8328 (1997)] is a regression of actual image analyst NIIRS ratings vs. readily calculable engineering metrics, and provides a mechanism for using the expected NIIRS rating of an imaging system in the design and evaluation process. In this paper, we will discuss how we use the GIQE in conjunction with The Aerospace Corporation's Parameterized Image Chain Analysis & Simulation SOftware (PICASSO) to evaluate imager designs, taking a hypothetical high resolution commercial imaging system as an example.

Summary of the effects of engine throttle response on airplane formation-flying qualities

NASA Technical Reports Server (NTRS)

Walsh, Kevin R.

1993-01-01

A flight evaluation was conducted to determine the effect of engine throttle response characteristics on precision formation-flying qualities. A variable electronic throttle control system was developed and flight-tested on a TF-104G airplane with a J79-11B engine at the NASA Dryden Flight Research Facility. This airplane was chosen because of its known, very favorable thrust response characteristics. Ten research flights were flown to evaluate the effects of throttle gain, time delay, and fuel control rate limiting on engine handling qualities during a demanding precision wing formation task. Handling quality effects of lag filters and lead compensation time delays were also evaluated. The Cooper and Harper Pilot Rating Scale was used to assign levels of handling quality. Data from pilot ratings and comments indicate that throttle control system time delays and rate limits cause significant degradations in handling qualities. Threshold values for satisfactory (level 1) and adequate (level 2) handling qualities of these key variables are presented. These results may provide engine manufacturers with guidelines to assure satisfactory handling qualities in future engine designs.

The Airline Quality Rating 1999

NASA Technical Reports Server (NTRS)

Bowen, Brent D.; Headley, Dean E.

1999-01-01

The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method of comparing airline performance on combined multiple criteria. This current report, Airline Quality Rating 1999, reflects an updated approach to calculating monthly Airline Quality Rating scores for 1998. AQR scores for the calendar year 1998 are based on 15 elements that focus on airline performance areas important to air travel consumers. The Airline Quality Rating is a summary of month-by-month quality ratings for the ten major U.S. airlines operating during 1998. Using the Airline Quality Rating system of weighted averages and monthly performance data in the areas of on-time arrivals, involuntary denied boardings, mishandled baggage, and a combination of 12 customer complaint categories, major airlines comparative performance for the calendar year 1998 is reported. This research monograph contains a brief summary of the AQR methodology, detailed data and charts that track comparative quality for major airlines domestic operations for the 12 month period of 1998, and industry average results. Also, comparative Airline Quality Rating data for 1997, using the updated criteria, are included to provide a reference point regarding quality in the industry.

The Airline Quality Rating 2004

NASA Technical Reports Server (NTRS)

Bowen, Brent D.; Headley, Dean E.

2004-01-01

The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method of comparing airline quality on combined multiple performance criteria. This current report, the Airline Quality Rating 2004, reflects monthly Airline Quality Rating scores for 2003. AQR scores far the calendar year 2003 are based on 15 elemnts in four major areas that focus on airline performance aspects important to air travel consumers. The Airline Quality Rating 2004 is a summary of month-by-month quality ratings for U.S. airlines that have at least 1% of domestic passenger volume during 2003. Using the Airline Quality Rating system of weighted averages and monthly performance data in the areas of on-time arrivals, involuntary denied boardings, mishandled baggage, and a combination of 12 customer complaint categories, airlines comparative performance for the calendar year of 2003 is reported. This research monograph contains a brief summary of the AQR methodology, detailed data and charts that track comparative quality for domestic airline operations for the 12-month period of 2003, and industry results. Also, comparative Airline Quality Rating data for 2002 are included, where available, to provide historical perspective

Quality Control of Structural MRI Images Applied Using FreeSurfer—A Hands-On Workflow to Rate Motion Artifacts

PubMed Central

Backhausen, Lea L.; Herting, Megan M.; Buse, Judith; Roessner, Veit; Smolka, Michael N.; Vetter, Nora C.

2016-01-01

In structural magnetic resonance imaging motion artifacts are common, especially when not scanning healthy young adults. It has been shown that motion affects the analysis with automated image-processing techniques (e.g., FreeSurfer). This can bias results. Several developmental and adult studies have found reduced volume and thickness of gray matter due to motion artifacts. Thus, quality control is necessary in order to ensure an acceptable level of quality and to define exclusion criteria of images (i.e., determine participants with most severe artifacts). However, information about the quality control workflow and image exclusion procedure is largely lacking in the current literature and the existing rating systems differ. Here, we propose a stringent workflow of quality control steps during and after acquisition of T1-weighted images, which enables researchers dealing with populations that are typically affected by motion artifacts to enhance data quality and maximize sample sizes. As an underlying aim we established a thorough quality control rating system for T1-weighted images and applied it to the analysis of developmental clinical data using the automated processing pipeline FreeSurfer. This hands-on workflow and quality control rating system will aid researchers in minimizing motion artifacts in the final data set, and therefore enhance the quality of structural magnetic resonance imaging studies. PMID:27999528

Interactions between patients, providers, and health systems and technical quality of care.

PubMed

Yelin, Edward; Yazdany, Jinoos; Tonner, Chris; Trupin, Laura; Criswell, Lindsey A; Katz, Patricia; Schmajuk, Gabriela

2015-03-01

Prior studies have established disparities by race/ethnicity and socioeconomic status (SES) in the kind, quantity, and technical quality of systemic lupus erythematosus (SLE) care and outcomes. In this study we evaluate whether disparities exist in assessments of interactions with health care providers and health plans and whether such interactions affect the technical quality of SLE care. Data derive from the Lupus Outcomes Study (LOS). Principal data collection is an annual structured phone interview including items from the Consumer Assessment of Health Plans and Interpersonal Processes of Care Scale measuring dimensions of health care interactions. We use general estimating equations to assess whether disparities exist by race/ethnicity and SES in being in the lowest quartile of ratings of such interactions and whether ratings in the lowest quartile of interactions are associated with technical quality of care after adjustment for sociodemographic and disease characteristics. In the 2012 LOS interview, there were 793 respondents, of whom 640 had ≥1 visit to their principal SLE provider. Nonwhite race/ethnicity and education were not associated with low ratings on any dimension of provider or system interaction; poverty was associated only with low ratings of health plan interactions. After adjustment for demographics, SLE status, and health care variables, ratings in the lowest quartile on all dimensions were associated with significantly lower technical quality of care. Ratings in the lowest quartile on all dimensions of interactions with providers and the health care system were associated with lower technical quality of care, potentially resulting in poorer SLE outcomes. Copyright © 2015 by the American College of Rheumatology.

Summary of the effects of engine throttle response on airplane formation-flying qualities

NASA Technical Reports Server (NTRS)

Walsh, Kevin R.

1992-01-01

A flight evaluation as conducted to determine the effect of engine throttle response characteristics on precision formation-flying qualities. A variable electronic throttle control system was developed and flight-tested on a TF-104G airplane with a J79-11B engine at the NASA Dryden Flight Research Facility. Ten research flights were flown to evaluate the effects of throttle gain, time delay, and fuel control rate limiting on engine handling qualities during a demanding precision wing formation task. Handling quality effects of lag filters and lead compensation time delays were also evaluated. Data from pilot ratings and comments indicate that throttle control system time delays and rate limits cause significant degradations in handling qualities. Threshold values for satisfactory (level 1) and adequate (level 2) handling qualities of these key variables are presented.

Evaluating supplier quality performance using analytical hierarchy process

NASA Astrophysics Data System (ADS)

Kalimuthu Rajoo, Shanmugam Sundram; Kasim, Maznah Mat; Ahmad, Nazihah

2013-09-01

This paper elaborates the importance of evaluating supplier quality performance to an organization. Supplier quality performance evaluation reflects the actual performance of the supplier exhibited at customer's end. It is critical in enabling the organization to determine the area of improvement and thereafter works with supplier to close the gaps. Success of the customer partly depends on supplier's quality performance. Key criteria as quality, cost, delivery, technology support and customer service are categorized as main factors in contributing to supplier's quality performance. 18 suppliers' who were manufacturing automotive application parts evaluated in year 2010 using weight point system. There were few suppliers with common rating which led to common ranking observed by few suppliers'. Analytical Hierarchy Process (AHP), a user friendly decision making tool for complex and multi criteria problems was used to evaluate the supplier's quality performance challenging the weight point system that was used for 18 suppliers'. The consistency ratio was checked for criteria and sub-criteria. Final results of AHP obtained with no overlap ratings, therefore yielded a better decision making methodology as compared to weight point rating system.

Analysis of Aircraft Control Performance using a Fuzzy Rule Base Representation of the Cooper-Harper Aircraft Handling Quality Rating

NASA Technical Reports Server (NTRS)

Tseng, Chris; Gupta, Pramod; Schumann, Johann

2006-01-01

The Cooper-Harper rating of Aircraft Handling Qualities has been adopted as a standard for measuring the performance of aircraft since it was introduced in 1966. Aircraft performance, ability to control the aircraft, and the degree of pilot compensation needed are three major key factors used in deciding the aircraft handling qualities in the Cooper- Harper rating. We formulate the Cooper-Harper rating scheme as a fuzzy rule-based system and use it to analyze the effectiveness of the aircraft controller. The automatic estimate of the system-level handling quality provides valuable up-to-date information for diagnostics and vehicle health management. Analyzing the performance of a controller requires a set of concise design requirements and performance criteria. Ir, the case of control systems fm a piloted aircraft, generally applicable quantitative design criteria are difficult to obtain. The reason for this is that the ultimate evaluation of a human-operated control system is necessarily subjective and, with aircraft, the pilot evaluates the aircraft in different ways depending on the type of the aircraft and the phase of flight. In most aerospace applications (e.g., for flight control systems), performance assessment is carried out in terms of handling qualities. Handling qualities may be defined as those dynamic and static properties of a vehicle that permit the pilot to fully exploit its performance in a variety of missions and roles. Traditionally, handling quality is measured using the Cooper-Harper rating and done subjectively by the human pilot. In this work, we have formulated the rules of the Cooper-Harper rating scheme as fuzzy rules with performance, control, and compensation as the antecedents, and pilot rating as the consequent. Appropriate direct measurements on the controller are related to the fuzzy Cooper-Harper rating system: a stability measurement like the rate of change of the cost function can be used as an indicator if the aircraft is under control; the tracking error is a good measurement for performance needed in the rating scheme. Finally, the change of the control amount or the output of a confidence tool, which has been developed by the authors, can be used as an indication of pilot compensation. We use a number of known aircraft flight scenarios with known pilot ratings to calibrate our fuzzy membership functions. These include normal flight conditions and situations in which partial or complete failure of tail, aileron, engine, or throttle occurs.

Stability assessment of QKD procedures in commercial quantum cryptography systems versus quality of dark channel

NASA Astrophysics Data System (ADS)

Jacak, Monika; Melniczuk, Damian; Jacak, Janusz; Jóźwiak, Ireneusz; Gruber, Jacek; Jóźwiak, Piotr

2015-02-01

In order to assess the susceptibility of the quantum key distribution (QKD) systems to the hacking attack including simultaneous and frequent system self-decalibrations, we analyze the stability of the QKD transmission organized in two commercially available systems. The first one employs non-entangled photons as flying qubits in the dark quantum channel for communication whereas the second one utilizes the entangled photon pairs to secretly share the cryptographic key. Applying standard methods of the statistical data analysis to the characteristic indicators of the quality of the QKD communication (the raw key exchange rate [RKER] and the quantum bit error rate [QBER]), we have estimated the pace of the self-decalibration of both systems and the repeatability rate in the case of controlled worsening of the dark channel quality.

Usability Evaluation and Implementation of a Health Information Technology Dashboard of Evidence-Based Quality Indicators.

PubMed

Schall, Mark Christopher; Cullen, Laura; Pennathur, Priyadarshini; Chen, Howard; Burrell, Keith; Matthews, Grace

2017-06-01

Health information technology dashboards that integrate evidence-based quality indicators can efficiently and accurately display patient risk information to promote early intervention and improve overall quality of patient care. We describe the process of developing, evaluating, and implementing a dashboard designed to promote quality care through display of evidence-based quality indicators within an electronic health record. Clinician feedback was sought throughout the process. Usability evaluations were provided by three nurse pairs and one physician from medical-surgical areas. Task completion times, error rates, and ratings of system usability were collected to compare the use of quality indicators displayed on the dashboard to the indicators displayed in a conventional electronic health record across eight experimental scenarios. Participants rated the dashboard as "highly usable" following System Usability Scale (mean, 87.5 [SD, 9.6]) and Poststudy System Usability Questionnaire (mean, 1.7 [SD, 0.5]) criteria. Use of the dashboard led to reduced task completion times and error rates in comparison to the conventional electronic health record for quality indicator-related tasks. Clinician responses to the dashboard display capabilities were positive, and a multifaceted implementation plan has been used. Results suggest application of the dashboard in the care environment may lead to improved patient care.

Independent Evaluation of California's Race to the Top: Early Learning Challenge Quality Rating and Improvement System. Half-Term Report

ERIC Educational Resources Information Center

Hawkinson, Laura E.; Quick, Heather E.; Muenchow, Susan; Anthony, Jennifer; Weinberg, Emily; Holod, Aleksandra; Parrish, Deborah; Meakin, John; Lee, Dong Hoon; Tarrant, Kate; Cannon, Jill S.; Zellman, Gail L.; Karoly, Lynn A.

2015-01-01

The first step in the Validity and Reliability Study summarizes the history and purpose of California's quality rating and improvement system (QRIS), reviews findings from other QRIS evaluation studies, and describes the approach to validating the system in California. The majority of this report focuses on providing context for the California…

Issues for the Next Decade of Quality Rating and Improvement Systems. Issue Brief. Publication #2009-14

ERIC Educational Resources Information Center

Tout, Kathryn; Zaslow, Martha; Halle, Tamara; Forry, Nicole

2009-01-01

Since the first child care Quality Rating System (QRS) was implemented in Oklahoma 11 years ago (in 1998), 16 additional statewide systems have been launched and numerous states are piloting or developing a QRS (Zaslow, Tout, & Martinez-Beck, forthcoming). As QRS stakeholders across the nation look ahead to the next decade, it is important to take…

POSSUM--a model for surgical outcome audit in quality care.

PubMed

Ng, K J; Yii, M K

2003-10-01

Comparative surgical audit to monitor quality of care should be performed with a risk-adjusted scoring system rather than using crude morbidity and mortality rates. A validated and widely applied risk adjusted scoring system, P-POSSUM (Portsmouth-Physiological and Operative Severity Score for the enUmeration of Mortality) methodology, was applied to a prospective series of predominantly general surgical patients at the Sarawak General Hospital, Kuching over a six months period. The patients were grouped into four risk groups. The observed mortality rates were not significantly different from predicted rates, showing that the quality of surgical care was at par with typical western series. The simplicity and advantages of this scoring system over other auditing tools are discussed. The P-POSSUM methodology could form the basis of local comparative surgical audit for assessment and maintenance of quality care.

A pilot's assessment of helicopter handling-quality factors common to both agility and instrument flying tasks

NASA Technical Reports Server (NTRS)

Gerdes, R. M.

1980-01-01

A series of simulation and flight investigations were undertaken to evaluate helicopter flying qualities and the effects of control system augmentation for nap-of-the-Earth (NOE) agility and instrument flying tasks. Handling quality factors common to both tasks were identified. Precise attitude control was determined to be a key requirement for successful accomplishment of both tasks. Factors that degraded attitude controllability were improper levels of control sensitivity and damping, and rotor system cross coupling due to helicopter angular rate and collective pitch input. Application of rate command, attitude command, and control input decouple augmentation schemes enhanced attitude control and significantly improved handling qualities for both tasks. The NOE agility and instrument flying handling quality considerations, pilot rating philosophy, and supplemental flight evaluations are also discussed.

A Multi-Instrument Examination of Preschool Classroom Quality and the Relationship between Program, Classroom, and Teacher Characteristics

ERIC Educational Resources Information Center

Denny, Joanna Hope; Hallam, Rena; Homer, Karen

2012-01-01

Research Findings: A statewide study of preschool classroom quality was conducted using 3 distinct classroom observation measures in order to inform a statewide quality rating system. Findings suggested that Tennessee preschool classrooms were approaching "good" quality on the Early Childhood Environment Rating Scale-Revised (ECERS-R)…

The Airline Quality Rating 2004

NASA Technical Reports Server (NTRS)

Fink, Mary M. (Editor); Bowen, Brent D.; Headley, Dean E.

2004-01-01

The Airline Quality Rating (AQR) was developed and first announced in early 1991 as an objective method of comparing airline quality on combined multiple performance criteria. This current report, the Airline Quality Rating 2004, reflects monthly Airline Quality Rating scores for 2003. AQR scores for the calendar year 2003 are based on 15 elements in four major areas that focus on airline performance aspects important to air travel consumers. The Airline Quality Rating 2004 is a summary of month-by-month quality ratings for U.S. airlines that have at least 1 % of domestic passenger volume during 2003. Using the Airline Quality Rating system of weighted averages and monthly performance data in the areas of on-time arrivals, involuntary denied boardings, mishandled baggage, and a combination of 12 customer complaint categories, airlines comparative performance for the calendar year of 2003 is reported. This research monograph contains a brief summary of the AQR methodology, detailed data and charts that track comparative quality for domestic airline operations for the 12-month period of 2003, and industry results. Also, comparative Airline Quality Rating data for 2002 are included, where available, to provide historical perspective regarding performance quality in the industry.

Quality Rating and Improvement System (QRIS) Validation Study Designs. CEELO FastFacts

ERIC Educational Resources Information Center

Schilder, D.

2013-01-01

In this "Fast Facts," a state has received Race to the Top Early Learning Challenge funds and is seeking information to inform the design of the Quality Rating and Improvement System (QRIS) validation study. The Center on Enhancing Early Learning Outcomes (CEELO) responds that according to Resnick (2012), validation of a QRIS is an…

The influence of performance-based payment on childhood immunisation coverage.

PubMed

Merilind, Eero; Salupere, Rauno; Västra, Katrin; Kalda, Ruth

2015-06-01

Pay-for-performance, also called the quality system (QS) in Estonia, was implemented in 2006 and one indicator for achievement is the childhood immunisation coverage rate. The WHO vaccination coverage in Europe for diphtheria, tetanus and pertussis, and measles in children aged around one year old should meet or exceed 90 per cent. The study was conducted using a database from the Estonian Health Insurance Fund. The study compared childhood immunisation coverage rates of all Estonian family physicians in two groups, joined and not joined to the quality system during the observation period 2006-2012. Immunisation coverage was calculated as the percentage of persons in the target age group who received a vaccine dose by a given age. The target level of immunisations in Estonia is set at 90 per cent and higher. Immunisation coverage rates of family doctors (FD) in Estonia showed significant differences between two groups of doctors: joined to the quality system and not joined. Doctors joined to the quality system met the 90 per cent vaccination criterion more frequently compared to doctors not joined to the quality system. Doctors not joined to the quality system were below the 90 per cent vaccination criterion in all vaccinations listed in the Estonian State Immunisation Schedule. Pay-for-performance as a financial incentive encourages higher levels of childhood immunisations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A pilot's assessment of helicopter handling-quality factors common to both agility and instrument flying tasks

NASA Technical Reports Server (NTRS)

Gerdes, R. M.

1980-01-01

Results from a series of simulation and flight investigations undertaken to evaluate helicopter flying qualities and the effects of control system augmentation for nap-of-the-earth (NOE) agility and instrument flying tasks were analyzed to assess handling-quality factors common to both tasks. Precise attitude control was determined to be a key requirement for successful accomplishment of both tasks. Factors that degraded attitude controllability were improper levels of control sensitivity and damping and rotor-system cross-coupling due to helicopter angular rate and collective pitch input. Application of rate-command, attitude-command, and control-input decouple augmentation schemes enhanced attitude control and significantly improved handling qualities for both tasks. NOE agility and instrument flying handling-quality considerations, pilot rating philosophy, and supplemental flight evaluations are also discussed.

Short and long term improvements in quality of chronic care delivery predict program sustainability.

PubMed

Cramm, Jane Murray; Nieboer, Anna Petra

2014-01-01

Empirical evidence on sustainability of programs that improve the quality of care delivery over time is lacking. Therefore, this study aims to identify the predictive role of short and long term improvements in quality of chronic care delivery on program sustainability. In this longitudinal study, professionals [2010 (T0): n=218, 55% response rate; 2011 (T1): n=300, 68% response rate; 2012 (T2): n=265, 63% response rate] from 22 Dutch disease-management programs completed surveys assessing quality of care and program sustainability. Our study findings indicated that quality of chronic care delivery improved significantly in the first 2 years after implementation of the disease-management programs. At T1, overall quality, self-management support, delivery system design, and integration of chronic care components, as well as health care delivery and clinical information systems and decision support, had improved. At T2, overall quality again improved significantly, as did community linkages, delivery system design, clinical information systems, decision support and integration of chronic care components, and self-management support. Multilevel regression analysis revealed that quality of chronic care delivery at T0 (p<0.001) and quality changes in the first (p<0.001) and second (p<0.01) years predicted program sustainability. In conclusion this study showed that disease-management programs based on the chronic care model improved the quality of chronic care delivery over time and that short and long term changes in the quality of chronic care delivery predicted the sustainability of the projects. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Improving Health Care Workers for Seasonal Influenza Vaccination at University Health System: A Paradigm for Closing the Quality Chasm

PubMed Central

Patterson, Jan E.; Cadena, Jose; Prigmore, Teresa; Bowling, Jason; Ayala, Beth Ann; Kirkman, Leni; Parekh, Amruta; Scepanski, Theresa

2011-01-01

Significant gaps in quality and patient safety in the US health-care system have been identified and were reported in the past decade by the Institute of Medicine. Despite recognition of these gaps in “knowing versus doing,” change in health care is slow and difficult. The quality improvement and clinical safety movement is increasing among US medical centers. Our health science center implemented the UT System Clinical Safety and Effectiveness course, providing project-based teaching of quality-improvement tools and principles of patient safety. A quality-improvement project that increased healthcare workers' influenza vaccination rate by 17.8% from that in 2008 to a rate of 76.6% in 2009 serves as a paradigm of how physicians can lead quality-improvement project teams to narrow the quality chasm (1). Local efforts to narrow the chasm are discussed in the present paper, including inter-professional education in quality improvement and clinical safety. PMID:21686222

Do Standard Measures of Preschool Quality Used in Statewide Policy Predict School Readiness?

ERIC Educational Resources Information Center

Sabol, Terri J.; Pianta, Robert C.

2014-01-01

In the majority of states using Quality Rating and Improvement Systems (QRIS) to improve children's school readiness, the Early Childhood Environmental Rating Scale-Revised (ECERS-R) is a core assessment of preschool program quality and is central to QRIS metrics and incentive structures. The present study utilizes nationally representative data…

Ranking online quality and reputation via the user activity

NASA Astrophysics Data System (ADS)

Liu, Xiao-Lu; Guo, Qiang; Hou, Lei; Cheng, Can; Liu, Jian-Guo

2015-10-01

How to design an accurate algorithm for ranking the object quality and user reputation is of importance for online rating systems. In this paper we present an improved iterative algorithm for online ranking object quality and user reputation in terms of the user degree (IRUA), where the user's reputation is measured by his/her rating vector, the corresponding objects' quality vector and the user degree. The experimental results for the empirical networks show that the AUC values of the IRUA algorithm can reach 0.9065 and 0.8705 in Movielens and Netflix data sets, respectively, which is better than the results generated by the traditional iterative ranking methods. Meanwhile, the results for the synthetic networks indicate that user degree should be considered in real rating systems due to users' rating behaviors. Moreover, we find that enhancing or reducing the influences of the large-degree users could produce more accurate reputation ranking lists.

A Two-State Study of Family Child Care Engagement in Quality Rating and Improvement Systems: A Mixed-Methods Analysis

ERIC Educational Resources Information Center

Hallam, Rena; Hooper, Alison; Bargreen, Kaitlin; Buell, Martha; Han, Myae

2017-01-01

Research Findings: The current study is a mixed-methods investigation of family child care provider participation in voluntary Quality Rating and Improvement Systems (QRIS) in 2 states. Study 1 is an analysis of matched QRIS and child care licensing administrative data extracted from both states in May, 2014. Poverty and population density…

A quality improvement project to improve the Medicare and Medicaid Services (CMS) sepsis bundle compliance rate in a large healthcare system.

PubMed

Raschke, Robert A; Groves, Robert H; Khurana, Hargobind S; Nikhanj, Nidhi; Utter, Ethel; Hartling, Didi; Stoffer, Brenda; Nunn, Kristina; Tryon, Shona; Bruner, Michelle; Calleja, Maria; Curry, Steven C

2017-01-01

Sepsis is a leading cause of mortality and morbidity in hospitalised patients. The Centers for Medicare and Medicaid Services (CMS) mandated that US hospitals report sepsis bundle compliance rate as a quality process measure in October 2015. The specific aim of our study was to improve the CMS sepsis bundle compliance rate from 30% to 40% across 20 acute care hospitals in our healthcare system within 1 year. The study included all adult inpatients with sepsis sampled according to CMS specifications from October 2015 to September 2016. The CMS sepsis bundle compliance rate was tracked monthly using statistical process control charting. A baseline rate of 28.5% with 99% control limits was established. We implemented multiple interventions including computerised decision support systems (CDSSs) to increase compliance with the most commonly missing bundle elements. Compliance reached 42% (99% statistical process control limits 18.4%-38.6%) as CDSS was implemented system-wide, but this improvement was not sustained after CMS changed specifications of the outcome measure. Difficulties encountered elucidate shortcomings of our study methodology and of the CMS sepsis bundle compliance rate as a quality process measure.

Interactions between Patients, Providers, and Health Systems and Technical Quality of Care

PubMed Central

Yelin, Edward; Yazdany, Jinoos; Tonner, Chris; Trupin, Laura; Criswell, Lindsey A.; Katz, Patricia; Schmajuk, Gabriela

2014-01-01

Objectives Prior studies have established disparities by race/ethnicity and socioeconomic status (SES) in the kind, quantity, and technical quality of SLE care and outcomes. In this study we evaluate whether disparities exist in assessments of interactions with health care providers and health plans and whether such interactions affect the technical quality of SLE care. Methods Data derive from the Lupus Outcomes Study (LOS). Principal data collection is an annual structured phone interview including items from the Consumer Assessment of Health Plans and Interpersonal Processes of Care Scale measuring dimensions of health care interactions. We use general estimating equations to assess whether disparities exist by race/ethnicity and SES in being in the lowest quartile of ratings of such interactions and whether ratings in the lowest quartile of interactions are associated with technical quality of care after adjustment for sociodemographic and disease characteristics. Results In the 2012 LOS interview, there were 793 respondents, of whom 640 had ≥1 visits to their principal SLE provider. Non-white race/ethnicity and education were not associated with low ratings on any dimension of provider or system interaction; poverty was associated only with low ratings of health plan interactions. After adjustment for demographics, SLE status, and health care variables, ratings in the lowest quartile on all dimensions were associated with significantly lower technical quality of care. Conclusions Ratings in the lowest quartile on all dimensions of interactions with providers and the health care system were associated with lower technical quality of care, potentially resulting in poorer SLE outcomes. PMID:25132660

Systematic adaptation of data delivery

DOEpatents

Bakken, David Edward

2016-02-02

This disclosure describes, in part, a system management component for use in a power grid data network to systematically adjust the quality of service of data published by publishers and subscribed to by subscribers within the network. In one implementation, subscribers may identify a desired data rate, a minimum acceptable data rate, desired latency, minimum acceptable latency and a priority for each subscription and the system management component may adjust the data rates in real-time to ensure that the power grid data network does not become overloaded and/or fail. In one example, subscriptions with lower priorities may have their quality of service adjusted before subscriptions with higher priorities. In each instance, the quality of service may be maintained, even if reduced, to meet or exceed the minimum acceptable quality of service for the subscription.

[Application of laboratory information system in the management of the key indicators of quality inspection].

PubMed

Guo, Ye; Chen, Qian; Wu, Wei; Cui, Wei

2015-03-31

To establish a system of monitoring the key indicator of quality for inspection (KIQI) on a laboratory information system (LIS), and to have a better management of KIQI. Clinical sample made in PUMCH were collected during the whole of 2014. Next, interactive input program were designed to accomplish data collecting of the disqualification rate of samples, the mistake rate of samples and the occasions of losing samples, etc. Then, a series moment of sample collection, laboratory sample arrived, sample test, sample check, response to critical value, namely, trajectory information left on LIS were recorded and the qualification rate of TAT, the notification rate of endangering result were calculated. Finally, the information about quality control were collected to build an internal quality control database and the KIQI, such as the out-of-control rate of quality control and the total error of test items were monitored. The inspection of the sample management shows the disqualification rates in 2014 were all below the target, but the rates in January and February were a little high and the rates of four wards were above 2%. The mistake rates of samples was 0.47 cases/10 000 cases, attaining the target (< 2 cases/10 000 cases). Also, there was no occasion of losing samples in 2014, attaining the target too. The inspection of laboratory reports shows the qualification rates of TAT was within the acceptable range (> 95%), however the rates of blood routine in November (94.75%) was out of range. We have solved the problem by optimizing the processes. The notification rate of endangering result attained the target (≥ 98%), while the rate of timely notification is needed to improve. Quality inspection shows the CV of APTT in August (5.02%) was rising significantly, beyond the accepted CV (5.0%). We have solved the problem by changing the reagent. The CV of TT in 2014 were all below the allowable CV, thus the allowable CV of the next year lower to 10%. It is an objective and effective method to manage KIQI with the powerful management mode of database and information process capability on LIS.

Race to the Top--Early Learning Challenge (RTT-ELC): Descriptive Study of Tiered Quality Rating and Improvement Systems (TQRIS). Master Data Collection Protocol

ERIC Educational Resources Information Center

Mathematica Policy Research, Inc., 2015

2015-01-01

This master data collection protocol describes the data that Mathematica collected for the Race to the Top-Early Learning Challenge Study of Tiered Quality Rating and Improvement Systems. This study was conducted for the Department of Education's Institute of Education Sciences. The data were collected from reviews of applications, documents, and…

Quality Rating Improvement System "for" Early Care "and" Education: Development, Implementation, Evaluation and Learning

ERIC Educational Resources Information Center

Shen, Jianping; Ma, Xin

2013-01-01

Quality Rating Improvement System (QRIS) has gained national momentum. The authors first present a national scene of QRIS and then use Children's Services Council of Palm Beach County as a case study to illustrate a number of things. First, they look at the logic model behind the QRIS. Next, they review the design and implementation of the QRIS in…

Exploring consumer understanding and preferences for pharmacy quality information

PubMed Central

Shiyanbola, Olayinka O.; Mort, Jane R.

2014-01-01

Objective: To describe consumer understanding of pharmacy quality measures and consumer preferences for pharmacy quality information. Methods: Semi-structured focus group design was combined with survey methods. Adults who filled prescription medications for self-reported chronic illnesses at community pharmacies discussed their understanding of Pharmacy Quality Alliance approved quality measures. Questions examined preference of pharmacy quality information rating systems (e.g. stars versus percentages) and desired data display/formats. During the focus group, participants completed a survey examining their understanding of each pharmacy quality measure. All focus group discussions were transcribed verbatim. Data were analyzed using thematic analysis and descriptive statistics. Results: Thirty-four individuals participated (mean age= 62.85; SD=16.05). Participants were unfamiliar with quality measures information and their level of understanding differed for each quality measure. Surveys indicated 94.1% understood “Drug-Drug Interactions” and “Helping Patients Get Needed Medications” better than other measures (e.g., 76.5% understood “Suboptimal Treatment of Hypertension in Patients with Diabetes”). Qualitative analysis indicated participants preferred an overall pharmacy rating for quick access and use. However, participants also wanted quality measures information displayed by health conditions. Participants favored comparison of their pharmacy to city data instead of state data. Most participants liked star ratings better than percentages, letter grades, or numerical ratings. Conclusions: Individuals who have a chronic illness and regularly use community pharmacies are interested in pharmacy quality measures. However, specific quality measures were not understood by some participants. Participants had specific preferences for the display of pharmacy quality information which will be helpful in the design of appropriate quality report systems. PMID:25580169

Elbow-specific clinical rating systems: extent of established validity, reliability, and responsiveness.

PubMed

The, Bertram; Reininga, Inge H F; El Moumni, Mostafa; Eygendaal, Denise

2013-10-01

The modern standard of evaluating treatment results includes the use of rating systems. Elbow-specific rating systems are frequently used in studies aiming at elbow-specific pathology. However, proper validation studies seem to be relatively sparse. In addition, these scoring systems might not always be used for appropriate populations of interest. Both of these issues might give rise to invalid conclusions being reported in the literature. Our aim was to investigate the extent to which the available elbow-specific outcome measurement tools have been validated and the quality of the validation itself. We also aimed to provide characteristics of the populations used for validation of these scales to enable clinicians to use them appropriately. A literature search identified 17 studies of 12 different elbow-specific scoring systems. These were assessed for validity, reliability, and responsiveness characteristics. The quality of these assessments was rated according to the Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist criteria, a standardized and validated tool developed specifically for this purpose. Currently, the only elbow-specific rating system that is validated using high-quality methodology is the Oxford Elbow Score, a patient-administered outcome measure tool that has been validated on heterogeneous study populations. Other rating systems still have to be proven in the future to be as good as the Oxford Elbow Score for clinical or research purposes. Additional validation studies are needed. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

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

NASA Astrophysics Data System (ADS)

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

2017-06-01

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

Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial.

PubMed

Fiks, Alexander G; Mayne, Stephanie L; Michel, Jeremy J; Miller, Jeffrey; Abraham, Manju; Suh, Andrew; Jawad, Abbas F; Guevara, James P; Grundmeier, Robert W; Blum, Nathan J; Power, Thomas J

2017-10-01

To evaluate a distance-learning, quality improvement intervention to improve pediatric primary care provider use of attention-deficit/hyperactivity disorder (ADHD) rating scales. Primary care practices were cluster randomized to a 3-part distance-learning, quality improvement intervention (web-based education, collaborative consultation with ADHD experts, and performance feedback reports/calls), qualifying for Maintenance of Certification (MOC) Part IV credit, or wait-list control. We compared changes relative to a baseline period in rating scale use by study arm using logistic regression clustered by practice (primary analysis) and examined effect modification by level of clinician participation. An electronic health record-linked system for gathering ADHD rating scales from parents and teachers was implemented before the intervention period at all sites. Rating scale use was ascertained by manual chart review. One hundred five clinicians at 19 sites participated. Differences between arms were not significant. From the baseline to intervention period and after implementation of the electronic system, clinicians in both study arms were significantly more likely to administer and receive parent and teacher rating scales. Among intervention clinicians, those who participated in at least 1 feedback call or qualified for MOC credit were more likely to give parents rating scales with differences of 14.2 (95% confidence interval [CI], 0.6-27.7) and 18.8 (95% CI, 1.9-35.7) percentage points, respectively. A 3-part clinician-focused distance-learning, quality improvement intervention did not improve rating scale use. Complementary strategies that support workflows and more fully engage clinicians may be needed to bolster care. Electronic systems that gather rating scales may help achieve this goal. Index terms: ADHD, primary care, quality improvement, clinical decision support.

Sleep Quality Estimation based on Chaos Analysis for Heart Rate Variability

NASA Astrophysics Data System (ADS)

Fukuda, Toshio; Wakuda, Yuki; Hasegawa, Yasuhisa; Arai, Fumihito; Kawaguchi, Mitsuo; Noda, Akiko

In this paper, we propose an algorithm to estimate sleep quality based on a heart rate variability using chaos analysis. Polysomnography(PSG) is a conventional and reliable system to diagnose sleep disorder and to evaluate its severity and therapeatic effect, by estimating sleep quality based on multiple channels. However, a recording process requires a lot of time and a controlled environment for measurement and then an analyzing process of PSG data is hard work because the huge sensed data should be manually evaluated. On the other hand, it is focused that some people make a mistake or cause an accident due to lost of regular sleep and of homeostasis these days. Therefore a simple home system for checking own sleep is required and then the estimation algorithm for the system should be developed. Therefore we propose an algorithm to estimate sleep quality based only on a heart rate variability which can be measured by a simple sensor such as a pressure sensor and an infrared sensor in an uncontrolled environment, by experimentally finding the relationship between chaos indices and sleep quality. The system including the estimation algorithm can inform patterns and quality of own daily sleep to a user, and then the user can previously arranges his life schedule, pays more attention based on sleep results and consult with a doctor.

Lateral-Directional Eigenvector Flying Qualities Guidelines for High Performance Aircraft

NASA Technical Reports Server (NTRS)

Davidson, John B.; Andrisani, Dominick, II

1996-01-01

This report presents the development of lateral-directional flying qualities guidelines with application to eigenspace (eigenstructure) assignment methods. These guidelines will assist designers in choosing eigenvectors to achieve desired closed-loop flying qualities or performing trade-offs between flying qualities and other important design requirements, such as achieving realizable gain magnitudes or desired system robustness. This has been accomplished by developing relationships between the system's eigenvectors and the roll rate and sideslip transfer functions. Using these relationships, along with constraints imposed by system dynamics, key eigenvector elements are identified and guidelines for choosing values of these elements to yield desirable flying qualities have been developed. Two guidelines are developed - one for low roll-to-sideslip ratio and one for moderate-to-high roll-to-sideslip ratio. These flying qualities guidelines are based upon the Military Standard lateral-directional coupling criteria for high performance aircraft - the roll rate oscillation criteria and the sideslip excursion criteria. Example guidelines are generated for a moderate-to-large, an intermediate, and low value of roll-to-sideslip ratio.

The association between quality of care and quality of life in long-stay nursing home residents with preserved cognition.

PubMed

Kim, Sun Jung; Park, Eun-Cheol; Kim, Sulgi; Nakagawa, Shunichi; Lung, John; Choi, Jong Bum; Ryu, Woo Sang; Min, Too Jae; Shin, Hyun Phil; Kim, Kyudam; Yoo, Ji Won

2014-03-01

To assess the overall quality of life of long-stay nursing home residents with preserved cognition, to examine whether the Centers for Medicare and Medicaid Service's Nursing Home Compare 5-star quality rating system reflects the overall quality of life of such residents, and to examine whether residents' demographics and clinical characteristics affect their quality of life. Quality of life was measured using the Participant Outcomes and Status Measures-Nursing Facility survey, which has 10 sections and 63 items. Total scores range from 20 (lowest possible quality of life) to 100 (highest). Long-stay nursing home residents with preserved cognition (n = 316) were interviewed. The average quality- of-life score was 71.4 (SD: 7.6; range: 45.1-93.0). Multilevel regression models revealed that quality of life was associated with physical impairment (parameter estimate = -0.728; P = .04) and depression (parameter estimate = -3.015; P = .01) but not Nursing Home Compare's overall star rating (parameter estimate = 0.683; P = .12) and not pain (parameter estimate = -0.705; P = .47). The 5-star quality rating system did not reflect the quality of life of long-stay nursing home residents with preserved cognition. Notably, pain was not associated with quality of life, but physical impairment and depression were. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist.

PubMed

Terwee, Caroline B; Mokkink, Lidwine B; Knol, Dirk L; Ostelo, Raymond W J G; Bouter, Lex M; de Vet, Henrica C W

2012-05-01

The COSMIN checklist is a standardized tool for assessing the methodological quality of studies on measurement properties. It contains 9 boxes, each dealing with one measurement property, with 5-18 items per box about design aspects and statistical methods. Our aim was to develop a scoring system for the COSMIN checklist to calculate quality scores per measurement property when using the checklist in systematic reviews of measurement properties. The scoring system was developed based on discussions among experts and testing of the scoring system on 46 articles from a systematic review. Four response options were defined for each COSMIN item (excellent, good, fair, and poor). A quality score per measurement property is obtained by taking the lowest rating of any item in a box ("worst score counts"). Specific criteria for excellent, good, fair, and poor quality for each COSMIN item are described. In defining the criteria, the "worst score counts" algorithm was taken into consideration. This means that only fatal flaws were defined as poor quality. The scores of the 46 articles show how the scoring system can be used to provide an overview of the methodological quality of studies included in a systematic review of measurement properties. Based on experience in testing this scoring system on 46 articles, the COSMIN checklist with the proposed scoring system seems to be a useful tool for assessing the methodological quality of studies included in systematic reviews of measurement properties.

SU-E-T-268: Differences in Treatment Plan Quality and Delivery Between Two Commercial Treatment Planning Systems for Volumetric Arc-Based Radiation Therapy

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

Chen, S; Zhang, H; Zhang, B

2015-06-15

Purpose: To clinically evaluate the differences in volumetric modulated arc therapy (VMAT) treatment plan and delivery between two commercial treatment planning systems. Methods: Two commercial VMAT treatment planning systems with different VMAT optimization algorithms and delivery approaches were evaluated. This study included 16 clinical VMAT plans performed with the first system: 2 spine, 4 head and neck (HN), 2 brain, 4 pancreas, and 4 pelvis plans. These 16 plans were then re-optimized with the same number of arcs using the second treatment planning system. Planning goals were invariant between the two systems. Gantry speed, dose rate modulation, MLC modulation, planmore » quality, number of monitor units (MUs), VMAT quality assurance (QA) results, and treatment delivery time were compared between the 2 systems. VMAT QA results were performed using Mapcheck2 and analyzed with gamma analysis (3mm/3% and 2mm/2%). Results: Similar plan quality was achieved with each VMAT optimization algorithm, and the difference in delivery time was minimal. Algorithm 1 achieved planning goals by highly modulating the MLC (total distance traveled by leaves (TL) = 193 cm average over control points per plan), while maintaining a relatively constant dose rate (dose-rate change <100 MU/min). Algorithm 2 involved less MLC modulation (TL = 143 cm per plan), but greater dose-rate modulation (range = 0-600 MU/min). The average number of MUs was 20% less for algorithm 2 (ratio of MUs for algorithms 2 and 1 ranged from 0.5-1). VMAT QA results were similar for all disease sites except HN plans. For HN plans, the average gamma passing rates were 88.5% (2mm/2%) and 96.9% (3mm/3%) for algorithm 1 and 97.9% (2mm/2%) and 99.6% (3mm/3%) for algorithm 2. Conclusion: Both VMAT optimization algorithms achieved comparable plan quality; however, fewer MUs were needed and QA results were more robust for Algorithm 2, which more highly modulated dose rate.« less

Rating educational quality: factors in the erosion of professional standards.

PubMed

Albanese, M

1999-06-01

Changes in the health care environment are putting increasing pressure on medical schools to make faculty accountable and to document the quality of the medical education they provide. Faculty's ratings of students' performances and students' ratings of faculty's teaching are important elements in these efforts to document educational quality. This article discusses selected research related to factors affecting raters' judgments, analyzes how changes in the health care environment are influencing such judgments, and links these influences to the system that upholds professional standards. Ratings are known to have a positive bias (generosity error), provide limited discrimination, and often fail to document serious deficits. The potential sources of these problems relate to the mechanics of the rating task, the system used to obtain ratings, and factors affecting rater judgment. As managed care demands reduce the time faculty have for teaching, as system-wide disincentives to provide negative ratings proliferate, and as social engineering challenges, such as the Americans with Disabilities Act, impose differential standards for students, the natural tendency to avoid giving negative ratings becomes even harder to resist. Ultimately, these forces compromise the capability of faculty to uphold the standards of the profession. The author calls for a national effort to stem the erosion of those standards.

Impact of Quality Improvement Educational Interventions on Documented Adherence to Quality Measures for Adults with Crohn's Disease.

PubMed

Greene, Laurence; Sapir, Tamar; Moreo, Kathleen; Carter, Jeffrey D; Patel, Barry; Higgins, Peter D R

2015-09-01

In recent years, leading organizations in inflammatory bowel disease (IBD) have developed quality measures for the care of adults with Crohn's disease or ulcerative colitis. We used chart audits to assess the impact of quality improvement educational activities on documented adherence to Physician Quality Reporting System measures for IBD. Twenty community-based gastroenterologists were recruited to participate in baseline chart audits (n = 200), a series of 4 accredited educational activities with feedback, and follow-up chart audits (n = 200). Trained abstractors reviewed randomly selected charts of adults with moderate or severe Crohn's disease. The charts were retrospectively abstracted for physicians' documented performance of the 2013 Physician Quality Reporting System IBD quality measures. We compared the physicians' baseline and posteducation rates of documented adherence with 10 of these measures. In a secondary analysis, we compared preeducation with posteducation difference scores of low-performing physicians, those whose baseline documentation rates were in the lowest quartile, and the rest of the cohort. At baseline, documentation of mean provider-level adherence to the 10 quality measures ranged from 3% to 98% (grand mean = 35.8%). In the overall analysis, baseline and posteducation rates of documented adherence did not differ significantly for any of the measures. However, for 4 measures, preeducation to posteducation difference scores were significantly greater among low performers than physicians in the highest 3 quartiles. The results of this preliminary pragmatic study indicate that quality improvement education affords the potential to improve adherence to Physician Quality Reporting System quality measures for IBD among low-performing gastroenterologists.

Effective Evaluation of Quality Rating and Improvement Systems for Early Care and Education and School-Age Care. Research-to-Policy, Research-to-Practice Brief OPRE 2011-11a

ERIC Educational Resources Information Center

Zellman, Gail L.; Brandon, Richard N.; Boller, Kimberly; Kreader, J. Lee

2011-01-01

It is important to evaluate Quality Rating and Improvement Systems (QRISs) so that policy makers and stakeholders can learn how well they are working and how they might be improved. Well-designed QRIS evaluations go beyond a "pass/fail" judgment to identify implementation successes and problems and assess what needs to be done to improve…

Development and performance evaluation of air fine bubbles on water quality of thai catfish rearing

NASA Astrophysics Data System (ADS)

Subhan, Ujang; Muthukannan, Vanitha; Azhary, Sundoro Yoga; Mulhadi, Muhammad Fakhri; Rochima, Emma; Panatarani, Camellia; Joni, I. Made

2018-02-01

The efficiency and productivity of aquaculture strongly depends on the development of advanced technology for water quality management system. The most important factor for the success of intensive aquaculture system is controlling the water quality of fish rearing media. This paper reports the design of fine bubbles (FBs) generator and performance evaluation of the system to improve water quality in thai catfish media (10 g/ind) with density (16.66 ind./L). The FBs generator was designed to control the size distribution of bubble by controlling its air flow rate entry to the mixing chamber of the generator. The performance of the system was evaluated based on the produced debit, dissolved oxygen rate and ammonia content in the catfish medium. The size distribution was observed by using a high speed camera image followed by processing using ImageJ. freeware application. The results show that air flow rate 0.05 L/min and 0.1 L/min received average bubble size of 29 µm and 31 µm respectively. The generator produced bubbles with capacity of 6 L/min and dissolved oxygen rate 0.2 ppm/min/L. The obtained DO growth was 0.455 ppm/second/L while the average decay rate was 0.20 ppm/second/L. (0.011/0.005 fold). In contrast, the recieved DO growth rate is faster compared to the DO consumption rate of the Thai catfish. This results indicated that the potential application of FBs enhanced the density of thai catfish seed rearing. In addition, ammonia can be reduced at 0.0358 ppm/hour/L and it is also observed that the inhibition of bacterial growth of air FBs is postive to Aeromonas hydrophila bacteria compared to the negative control. It is concluded that as-developed FBs system can be potentially applied for intensive thai catfish culture and expected to improve the feeding efficiency rate.

78 FR 41013 - Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-09

... [CMS-1450-CN] RIN 0938-AR52 Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014, Home Health Quality Reporting Requirements, and Cost Allocation of Home Health Survey... period titled ``Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY...

The Effects of Accountability Incentives in Early Childhood Education. CEPA Working Paper No. 17-10

ERIC Educational Resources Information Center

Bassok, Daphna; Dee, Thomas S.; Latham, Scott

2017-01-01

In an effort to enhance the quality of early childhood education (ECE) at scale, nearly all U.S. states have recently adopted Quality Rating and Improvement Systems (QRIS). These accountability systems give providers and parents information on program quality and create both reputational and financial incentives for program improvement. However,…

The Quest for Quality: How YoungStar Is Affecting Child Care in Milwaukee County

ERIC Educational Resources Information Center

Mueller, Betsy; Peterangelo, Joe; Henken, Rob

2016-01-01

The State of Wisconsin's YoungStar system was created by the Legislature and Governor in 2010 to "drive quality improvement in child care throughout the state." YoungStar uses a five-star system to rate child care providers based on several measures of quality, including staff education levels, learning environment, business methods, and…

Demand controlled ventilating systems: Sensor market survey. Energy conservation in buildings and community systems programme, annex 18, December 1991

NASA Astrophysics Data System (ADS)

Raatschen, W.; Sjoegren, M.

The subject of indoor and outdoor air quality has generated a great deal of attention in many countries. Areas of concern include outgassing of building materials as well as occupant-generated pollutants such as carbon dioxide, moisture, and odors. Progress has also been made towards addressing issues relating to the air tightness of the building envelope. Indoor air quality studies indicate that better control of supply flow rates as well as the air distribution pattern within buildings are necessary. One method of maintaining good indoor air quality without extensive energy consumption is to control the ventilation rate according to the needs and demands of the occupants, or to preserve the building envelope. This is accomplished through the use of demand controlled ventilating (DCV) systems. The specific objective of Annex 18 is to develop guidelines for demand controlled ventilating systems based on state of the art analyses, case studies on ventilation effectiveness, and proposed ventilation rates for different users in domestic, office, and school buildings.

FOCUS: Essential Elements of Quality for State-Funded Preschool Programs

ERIC Educational Resources Information Center

New Mexico Public Education Department, 2016

2016-01-01

The "FOCUS: Essential Elements of Quality, New Mexico's Tiered Quality Rating and Improvement System (TQRIS)," provides early childhood program personnel with the criteria, tools, and resources they need to improve the quality of their program. These quality improvements focus on children's growth, development, and learning--so that each…

Methods of Measurement the Quality Metrics in a Printing System

NASA Astrophysics Data System (ADS)

Varepo, L. G.; Brazhnikov, A. Yu; Nagornova, I. V.; Novoselskaya, O. A.

2018-04-01

One of the main criteria for choosing ink as a component of printing system is scumming ability of the ink. The realization of algorithm for estimating the quality metrics in a printing system is shown. The histograms of ink rate of various printing systems are presented. A quantitative estimation of stability of offset inks emulsifiability is given.

Moving base simulation evaluation of translational rate command systems for STOVL aircraft in hover

NASA Technical Reports Server (NTRS)

Franklin, James A.; Stortz, Michael W.

1996-01-01

Using a generalized simulation model, a moving-base simulation of a lift-fan short takeoff/vertical landing fighter aircraft has been conducted on the Vertical Motion Simulator at Ames Research Center. Objectives of the experiment were to determine the influence of system bandwidth and phase delay on flying qualities for translational rate command and vertical velocity command systems. Assessments were made for precision hover control and for landings aboard an LPH type amphibious assault ship in the presence of winds and rough seas. Results obtained define the boundaries between satisfactory and adequate flying qualities for these design features for longitudinal and lateral translational rate command and for vertical velocity command.

Organizational Attributes Associated With Medicare ACO Quality Performance.

PubMed

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

2018-05-08

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

Analysis of Best Management Practices for Storm Water Compliance at Air Force Airfields

DTIC Science & Technology

1993-09-01

before selecting an infiltration system. These factors include the local vegetation, soil type and condition, groundwater condition, and storm water quality . The...reduce the peak flow rate of storm water discharges and remove sediments in order to improve storm water quality . Detention facilities should be...discharge rate of runoff and/or provide significant detention time to improve storm water quality through natural physical, chemical, and biological

Motivating medical information system performance by system quality, service quality, and job satisfaction for evidence-based practice.

PubMed

Chang, Ching-Sheng; Chen, Su-Yueh; Lan, Yi-Ting

2012-11-21

No previous studies have addressed the integrated relationships among system quality, service quality, job satisfaction, and system performance; this study attempts to bridge such a gap with evidence-based practice study. The convenience sampling method was applied to the information system users of three hospitals in southern Taiwan. A total of 500 copies of questionnaires were distributed, and 283 returned copies were valid, suggesting a valid response rate of 56.6%. SPSS 17.0 and AMOS 17.0 (structural equation modeling) statistical software packages were used for data analysis and processing. The findings are as follows: System quality has a positive influence on service quality (γ11= 0.55), job satisfaction (γ21= 0.32), and system performance (γ31= 0.47). Service quality (β31= 0.38) and job satisfaction (β32= 0.46) will positively influence system performance. It is thus recommended that the information office of hospitals and developers take enhancement of service quality and user satisfaction into consideration in addition to placing b on system quality and information quality when designing, developing, or purchasing an information system, in order to improve benefits and gain more achievements generated by hospital information systems.

Quality Management, Certification and Rating of Health Information on the Net with MedCERTAIN: Using a medPICS/RDF/XML metadata structure for implementing eHealth ethics and creating trust globally

PubMed Central

Eysenbach, Gunther; Yihune, Gabriel; Lampe, Kristian; Cross, Phil; Brickley, Dan

2000-01-01

MedCERTAIN (MedPICS Certification and Rating of Trustworthy Health Information on the Net, http://www.medcertain.org/) is a recently launched international project funded under the European Union's (EU) "Action Plan for safer use of the Internet". It provides a technical infrastructure and a conceptual basis for an international system of "quality seals", ratings and self-labelling of Internet health information, with the final aim to establish a global "trustmark" for networked health information. Digital "quality seals" are evaluative metadata (using standards such as PICS=Platform for Internet Content Selection, now being replaced by RDF/XML) assigned by trusted third-party raters. The project also enables and encourages self-labelling with descriptive metainformation by web authors. Together these measures will help consumers as well as professionals to identify high-quality information on the Internet. MedCERTAIN establishes a fully functional demonstrator for a self- and third-party rating system enabling consumers and professionals to filter harmful health information and to positively identify and select high quality information. We aim to provide a trustmark system which allows citizens to place greater confidence in networked information, to encourage health information providers to follow best practices guidelines such as the Washington eHealth Code of Ethics, to provide effective feedback and law enforcement channels to handle user complaints, and to stimulate medical societies to develop standard for patient information. The project further proposes and identifies standards for interoperability of rating and description services (such as libraries or national health portals) and fosters a worldwide collaboration to guide consumers to high-quality information on the web.

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.

Truth in Reporting: How Data Capture Methods Obfuscate Actual Surgical Site Infection Rates within a Health Care Network System.

PubMed

Bordeianou, Liliana; Cauley, Christy E; Antonelli, Donna; Bird, Sarah; Rattner, David; Hutter, Matthew; Mahmood, Sadiqa; Schnipper, Deborah; Rubin, Marc; Bleday, Ronald; Kenney, Pardon; Berger, David

2017-01-01

Two systems measure surgical site infection rates following colorectal surgeries: the American College of Surgeons National Surgical Quality Improvement Program and the Centers for Disease Control and Prevention National Healthcare Safety Network. The Centers for Medicare & Medicaid Services pay-for-performance initiatives use National Healthcare Safety Network data for hospital comparisons. This study aimed to compare database concordance. This is a multi-institution cohort study of systemwide Colorectal Surgery Collaborative. The National Surgical Quality Improvement Program requires rigorous, standardized data capture techniques; National Healthcare Safety Network allows 5 data capture techniques. Standardized surgical site infection rates were compared between databases. The Cohen κ-coefficient was calculated. This study was conducted at Boston-area hospitals. National Healthcare Safety Network or National Surgical Quality Improvement Program patients undergoing colorectal surgery were included. Standardized surgical site infection rates were the primary outcomes of interest. Thirty-day surgical site infection rates of 3547 (National Surgical Quality Improvement Program) vs 5179 (National Healthcare Safety Network) colorectal procedures (2012-2014). Discrepancies appeared: National Surgical Quality Improvement Program database of hospital 1 (N = 1480 patients) routinely found surgical site infection rates of approximately 10%, routinely deemed rate "exemplary" or "as expected" (100%). National Healthcare Safety Network data from the same hospital and time period (N = 1881) revealed a similar overall surgical site infection rate (10%), but standardized rates were deemed "worse than national average" 80% of the time. Overall, hospitals using less rigorous capture methods had improved surgical site infection rates for National Healthcare Safety Network compared with standardized National Surgical Quality Improvement Program reports. The correlation coefficient between standardized infection rates was 0.03 (p = 0.88). During 25 site-time period observations, National Surgical Quality Improvement Program and National Healthcare Safety Network data matched for 52% of observations (13/25). κ = 0.10 (95% CI, -0.1366 to 0.3402; p = 0.403), indicating poor agreement. This study investigated hospitals located in the Northeastern United States only. Variation in Centers for Medicare & Medicaid Services-mandated National Healthcare Safety Network infection surveillance methodology leads to unreliable results, which is apparent when these results are compared with standardized data. High-quality data would improve care quality and compare outcomes among institutions.

Markers of data quality in computer audit: the Manchester Orthopaedic Database.

PubMed

Ricketts, D; Newey, M; Patterson, M; Hitchin, D; Fowler, S

1993-11-01

This study investigates the efficiency of the Manchester Orthopaedic Database (MOD), a computer software package for record collection and audit. Data is entered into the system in the form of diagnostic, operative and complication keywords. We have calculated the completeness, accuracy and quality (completeness x accuracy) of keyword data in the MOD in two departments of orthopaedics (Departments A and B). In each department, 100 sets of inpatient notes were reviewed. Department B obtained results which were significantly better than those in A at the 5% level. We attribute this to the presence of a systems coordinator to motivate and organise the team for audit. Senior and junior staff did not differ significantly with respect to completeness, accuracy and quality measures, but locum junior staff recorded data with a quality of 0%. Statistically, the biggest difference between the departments was the quality of operation keywords. Sample sizes were too small to permit effective statistical comparisons between the quality of complication keywords. In both departments, however, the poorest quality data was seen in complication keywords. The low complication keyword completeness contributed to this; on average, the true complication rate (39%) was twice the recorded complication rate (17%). In the recent Royal College of Surgeons of England Confidential Comparative Audit, the recorded complication rate was 4.7%. In the light of the above findings, we suggest that the true complication rate of the RCS CCA should approach 9%.

The Nencki Affective Picture System (NAPS): introduction to a novel, standardized, wide-range, high-quality, realistic picture database.

PubMed

Marchewka, Artur; Zurawski, Łukasz; Jednoróg, Katarzyna; Grabowska, Anna

2014-06-01

Selecting appropriate stimuli to induce emotional states is essential in affective research. Only a few standardized affective stimulus databases have been created for auditory, language, and visual materials. Numerous studies have extensively employed these databases using both behavioral and neuroimaging methods. However, some limitations of the existing databases have recently been reported, including limited numbers of stimuli in specific categories or poor picture quality of the visual stimuli. In the present article, we introduce the Nencki Affective Picture System (NAPS), which consists of 1,356 realistic, high-quality photographs that are divided into five categories (people, faces, animals, objects, and landscapes). Affective ratings were collected from 204 mostly European participants. The pictures were rated according to the valence, arousal, and approach-avoidance dimensions using computerized bipolar semantic slider scales. Normative ratings for the categories are presented for each dimension. Validation of the ratings was obtained by comparing them to ratings generated using the Self-Assessment Manikin and the International Affective Picture System. In addition, the physical properties of the photographs are reported, including luminance, contrast, and entropy. The new database, with accompanying ratings and image parameters, allows researchers to select a variety of visual stimulus materials specific to their experimental questions of interest. The NAPS system is freely accessible to the scientific community for noncommercial use by request at http://naps.nencki.gov.pl .

Foundations for Teaching Excellence: Connecting Early Childhood Quality Rating, Professional Development, and Competency Systems in States

ERIC Educational Resources Information Center

Howes, Carollee, Ed.; Pianta, Robert C., Ed.

2011-01-01

Improving teacher quality in early education is a major part of ensuring young children's school readiness and closing the achievement gap. This is the book decision-makers and administrators need to begin developing coordinated, effective teacher quality systems--ones that not only get teachers ready for the classroom, but also promote continuous…

A measurement system for large, complex software programs

NASA Technical Reports Server (NTRS)

Rone, Kyle Y.; Olson, Kitty M.; Davis, Nathan E.

1994-01-01

This paper describes measurement systems required to forecast, measure, and control activities for large, complex software development and support programs. Initial software cost and quality analysis provides the foundation for meaningful management decisions as a project evolves. In modeling the cost and quality of software systems, the relationship between the functionality, quality, cost, and schedule of the product must be considered. This explicit relationship is dictated by the criticality of the software being developed. This balance between cost and quality is a viable software engineering trade-off throughout the life cycle. Therefore, the ability to accurately estimate the cost and quality of software systems is essential to providing reliable software on time and within budget. Software cost models relate the product error rate to the percent of the project labor that is required for independent verification and validation. The criticality of the software determines which cost model is used to estimate the labor required to develop the software. Software quality models yield an expected error discovery rate based on the software size, criticality, software development environment, and the level of competence of the project and developers with respect to the processes being employed.

Face Recognition for Access Control Systems Combining Image-Difference Features Based on a Probabilistic Model

NASA Astrophysics Data System (ADS)

Miwa, Shotaro; Kage, Hiroshi; Hirai, Takashi; Sumi, Kazuhiko

We propose a probabilistic face recognition algorithm for Access Control System(ACS)s. Comparing with existing ACSs using low cost IC-cards, face recognition has advantages in usability and security that it doesn't require people to hold cards over scanners and doesn't accept imposters with authorized cards. Therefore face recognition attracts more interests in security markets than IC-cards. But in security markets where low cost ACSs exist, price competition is important, and there is a limitation on the quality of available cameras and image control. Therefore ACSs using face recognition are required to handle much lower quality images, such as defocused and poor gain-controlled images than high security systems, such as immigration control. To tackle with such image quality problems we developed a face recognition algorithm based on a probabilistic model which combines a variety of image-difference features trained by Real AdaBoost with their prior probability distributions. It enables to evaluate and utilize only reliable features among trained ones during each authentication, and achieve high recognition performance rates. The field evaluation using a pseudo Access Control System installed in our office shows that the proposed system achieves a constant high recognition performance rate independent on face image qualities, that is about four times lower EER (Equal Error Rate) under a variety of image conditions than one without any prior probability distributions. On the other hand using image difference features without any prior probabilities are sensitive to image qualities. We also evaluated PCA, and it has worse, but constant performance rates because of its general optimization on overall data. Comparing with PCA, Real AdaBoost without any prior distribution performs twice better under good image conditions, but degrades to a performance as good as PCA under poor image conditions.

Supplier Management System

NASA Technical Reports Server (NTRS)

Ramirez, Eric; Gutheinz, Sandy; Brison, James; Ho, Anita; Allen, James; Ceritelli, Olga; Tobar, Claudia; Nguyen, Thuykien; Crenshaw, Harrel; Santos, Roxann

2008-01-01

Supplier Management System (SMS) allows for a consistent, agency-wide performance rating system for suppliers used by NASA. This version (2.0) combines separate databases into one central database that allows for the sharing of supplier data. Information extracted from the NBS/Oracle database can be used to generate ratings. Also, supplier ratings can now be generated in the areas of cost, product quality, delivery, and audit data. Supplier data can be charted based on real-time user input. Based on these individual ratings, an overall rating can be generated. Data that normally would be stored in multiple databases, each requiring its own log-in, is now readily available and easily accessible with only one log-in required. Additionally, the database can accommodate the storage and display of quality-related data that can be analyzed and used in the supplier procurement decision-making process. Moreover, the software allows for a Closed-Loop System (supplier feedback), as well as the capability to communicate with other federal agencies.

Piloted simulator investigation of helicopter control systems effects on handling qualities during instrument flight

NASA Technical Reports Server (NTRS)

Forrest, R. D.; Chen, R. T. N.; Gerdes, R. M.; Alderete, T. S.; Gee, D. R.

1979-01-01

An exploratory piloted simulation was conducted to investigate the effects of the characteristics of helicopter flight control systems on instrument flight handling qualities. This joint FAA/NASA study was motivated by the need to improve instrument flight capability. A near-term objective is to assist in updating the airworthiness criteria for helicopter instrument flight. The experiment consisted of variations of single-rotor helicopter types and levels of stability and control augmentation systems (SCAS). These configurations were evaluated during an omnirange approach task under visual and instrument flight conditions. The levels of SCAS design included a simple rate damping system, collective decoupling plus rate damping, and an attitude command system with collective decoupling. A limited evaluation of stick force versus airspeed stability was accomplished. Some problems were experienced with control system mechanization which had a detrimental effect on longitudinal stability. Pilot ratings, pilot commentary, and performance data related to the task are presented.

Importance of relationship quality in the success of data warehouse systems

NASA Astrophysics Data System (ADS)

Almabhouh, Alaaeddin; Saleh, Abdul; Ahmad, Azizah

2011-10-01

Increased organizational dependence on data warehouse (DW) systems drives management attention towards improving DW systems success. However, the successful implementation rate of DW systems is low and many firms did not achieve intended goals. A recent studies show that improves and evaluates DW success is one of the top concerns facing IT/DW executives. Existing information system (IS) research has studied DW success more from information quality and system quality. Researchers argue in this study that we should also take the relationship quality, which has significant research and practical implications in that it connects to IS success directly. As our first attempt, this study, referring to both IS and marketing literature, examines how communication, coordination, cooperation, commitment, and trust can be achieved to some degrees by high quality relationships between DW parties.

Assessing stability and performance of a digitally enabled supply chain: Retrospective of a pilot in Uttar Pradesh, India.

PubMed

Gilbert, Sarah Skye; Thakare, Neeraj; Ramanujapuram, Arun; Akkihal, Anup

2017-04-19

Immunization supply chains in low resource settings do not always reach children with necessary vaccines. Digital information systems can enable real time visibility of inventory and improve vaccine availability. In 2014, a digital, mobile/web-based information system was implemented in two districts of Uttar Pradesh, India. This retrospective investigates improvements and stabilization of supply chain performance following introduction of the digital information system. All data were collected via the digital information system between March 2014 and September 2015. Data included metadata and transaction logs providing information about users, facilities, and vaccines. Metrics evaluated include adoption (system access, timeliness and completeness), data quality (error rates), and performance (stock availability on immunization session days, replenishment response duration, rate of zero stock events). Stability was defined as the phase in which quality and performance metrics achieved equilibrium rates with minimal volatility. The analysis compared performance across different facilities and vaccines. Adoption appeared sufficiently high from the onset to commence stability measures of data quality and supply chain performance. Data quality stabilized from month 3 onwards, and supply chain performance stabilized from month 13 onwards. For data quality, error rates reduced by two thirds post stabilization. Although vaccine availability remained high throughout the pilot, the three lowest-performing facilities improved from 91.05% pre-stability to 98.70% post-stability (p<0.01; t-test). Average replenishment duration (as a corrective response to stock-out events) decreased 52.3% from 4.93days to 2.35days (p<0.01; t-test). Diphtheria-tetanus-pertussis vaccine was significantly less likely to be stocked out than any other material. The results suggest that given sufficient adoption, stability is sequentially achieved, beginning with data quality, and then performance. Identifying when a pilot stabilizes can enable more predictable, reliable cost estimates, and outcome forecasts in the scale-up phase. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Data quality in a DRG-based information system.

PubMed

Colin, C; Ecochard, R; Delahaye, F; Landrivon, G; Messy, P; Morgon, E; Matillon, Y

1994-09-01

The aim of this study initiated in May 1990 was to evaluate the quality of the medical data collected from the main hospital of the "Hospices Civils de Lyon", Edouard Herriot Hospital. We studied a random sample of 593 discharge abstracts from 12 wards of the hospital. Quality control was performed by checking multi-hospitalized patients' personal data, checking that each discharge abstract was exhaustive, examining the quality of abstracting, studying diagnoses and medical procedures coding, and checking data entry. Assessment of personal data showed a 4.4% error rate. It was mainly accounted for by spelling mistakes in surnames and first names, and mistakes in dates of birth. The quality of a discharge abstract was estimated according to the two purposes of the medical information system: description of hospital morbidity per patient and Diagnosis Related Group's case mix. Error rates in discharge abstracts were expressed in two ways: an overall rate for errors of concordance between Discharge Abstracts and Medical Records, and a specific rate for errors modifying classification in Diagnosis Related Groups (DRG). For abstracting medical information, these error rates were 11.5% (SE +/- 2.2) and 7.5% (SE +/- 1.9) respectively. For coding diagnoses and procedures, they were 11.4% (SE +/- 1.5) and 1.3% (SE +/- 0.5) respectively. For data entry on the computerized data base, the error rate was 2% (SE +/- 0.5) and 0.2% (SE +/- 0.05). Quality control must be performed regularly because it demonstrates the degree of participation from health care teams and the coherence of the database.(ABSTRACT TRUNCATED AT 250 WORDS)

Power and Assessment: A Genealogical Analysis of the CLASS

ERIC Educational Resources Information Center

Gaches, Sonya; Hill, Diana

2017-01-01

The CLASS (classroom assessment scoring system) has become integrally linked with quality rating and improvement systems (QRIS) throughout the United States and other international locations. This relationship reinforces the neoliberal consumer-based perspectives of quality and devalues localized perspectives. This article challenges the notion of…

Two-beam combined 3.36  J, 100  Hz diode-pumped high beam quality Nd:YAG laser system.

PubMed

Qiu, J S; Tang, X X; Fan, Z W; Wang, H C; Liu, H

2016-07-20

In this paper, we develop a diode-pumped all-solid-state high-energy and high beam quality Nd:YAG laser system. A master oscillator power amplifier structure is used to provide a high pulse energy laser output with a high repetition rate. In order to decrease the amplifier working current so as to reduce the impact of the thermal effect on the beam quality, a beam splitting-amplifying-combining scheme is adopted. The energy extraction efficiency of the laser system is 50.68%. We achieve 3.36 J pulse energy at a 100 Hz repetition rate with a pulse duration of 7.1 ns, a far-field beam spot 1.71 times the diffraction limit, and 1.07% energy stability (RMS).

Motivating medical information system performance by system quality, service quality, and job satisfaction for evidence-based practice

PubMed Central

2012-01-01

Background No previous studies have addressed the integrated relationships among system quality, service quality, job satisfaction, and system performance; this study attempts to bridge such a gap with evidence-based practice study. Methods The convenience sampling method was applied to the information system users of three hospitals in southern Taiwan. A total of 500 copies of questionnaires were distributed, and 283 returned copies were valid, suggesting a valid response rate of 56.6%. SPSS 17.0 and AMOS 17.0 (structural equation modeling) statistical software packages were used for data analysis and processing. Results The findings are as follows: System quality has a positive influence on service quality (γ11= 0.55), job satisfaction (γ21= 0.32), and system performance (γ31= 0.47). Service quality (β31= 0.38) and job satisfaction (β32= 0.46) will positively influence system performance. Conclusions It is thus recommended that the information office of hospitals and developers take enhancement of service quality and user satisfaction into consideration in addition to placing b on system quality and information quality when designing, developing, or purchasing an information system, in order to improve benefits and gain more achievements generated by hospital information systems. PMID:23171394

Candidate Quality Measures for Hand Surgery.

PubMed

2017-11-01

Quality measures are tools used by physicians, health care systems, and payers to evaluate performance, monitor the outcomes of interventions, and inform quality improvement efforts. A paucity of quality measures exist that address hand surgery care. We completed a RAND/UCLA (University of California Los Angeles) Delphi Appropriateness process with the goal of developing and evaluating candidate hand surgery quality measures to be used for national quality measure development efforts. A consortium of 9 academic upper limb surgeons completed a RAND/UCLA Delphi Appropriateness process to evaluate the importance, scientific acceptability, usability, and feasibility of 44 candidate quality measures. These addressed hand problems the panelists felt were most appropriate for quality measure development. Panelists rated the measures on an ordinal scale between 1 (definitely not valid) and 9 (definitely valid) in 2 rounds (preliminary round and final round) with an intervening face-to-face discussion. Ratings from 1 to 3 were considered not valid, 4 to 6 as equivocal or uncertain, and 7 to 9 as valid. If no more than 2 of the 9 ratings were outside the 3-point range that included the median (1-3, 4-6, or 7-9), the panelists were considered to be in agreement. If 3 or more of the panelists' ratings of a measure were within the 1 to 3 range and 3 or more ratings were in the 7 to 9 range, the panelists were considered to be in disagreement. There was agreement on 43% (19) of the measures as important, 27% (12) as scientifically sound, 48% (21) as usable, and 59% (26) as feasible to complete. Ten measures met all 4 of these criteria and were, therefore, considered valid measurements of quality. Quality measures that were developed address outcomes (patient-reported outcomes for assessment and improvement of function) and processes of care (utilization rates of imaging, antibiotics, occupational therapy, ultrasound, and operative treatment). The consortium developed 10 measures of hand surgery quality using a validated methodology. These measures merit further development. Quality measures can be used to evaluate the quality of care provided by physicians and health systems and can inform quality and value-based reimbursement models. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Embracing Multiple Ways of Knowing in Regulatory Assessments of Quality in Australian Early Childhood Education and Care

ERIC Educational Resources Information Center

Jackson, Jen

2015-01-01

In 2012, a new assessment and rating process for Australian early childhood education and care (ECEC) services was introduced, using a new National Quality Standard (NQS). The NQS assessment and rating process has similarities to observational assessment systems used in educational research, and involves similar strategies for upholding…

The relationship between basic audio quality and overall listening experience.

PubMed

Schoeffler, Michael; Herre, Jürgen

2016-09-01

Basic audio quality (BAQ) is a well-known perceptual attribute, which is rated in various listening test methods to measure the performance of audio systems. Unfortunately, when it comes to purchasing audio systems, BAQ might not have a significant influence on the customers' buying decisions since other factors, like brand loyalty, might be more important. In contrast to BAQ, overall listening experience (OLE) is an affective attribute which incorporates all aspects that are important to an individual assessor, including his or her preference for music genre and audio quality. In this work, the relationship between BAQ and OLE is investigated in more detail. To this end, an experiment was carried out, in which participants rated the BAQ and the OLE of music excerpts with different timbral and spatial degradations. In a between-group-design procedure, participants were assigned into two groups, in each of which a different set of stimuli was rated. The results indicate that rating of both attributes, BAQ and OLE, leads to similar rankings, even if a different set of stimuli is rated. In contrast to the BAQ ratings, which were more influenced by timbral than spatial degradations, the OLE ratings were almost equally influenced by timbral and spatial degradations.

Effect on Longitudinal Stability and Control Characteristics of a Boeing B-29 Airplane of Variations in Stick-Force and Control-Rate Characteristics Obtained Through Use of a Booster in the Elevator-Control System

NASA Technical Reports Server (NTRS)

Mathews, Charles W; Talmage, Donald B; Whitten, James B

1952-01-01

A longitudinal stability and control characteristics of a Boeing B-29 airplane have been measured with a booster incorporated in the elevator-control system. Tests were made to determine the effects on the handling qualities of the test airplane of variations in the pilot's control-force gradients as well as the effects of variations in the maximum rate of control motion supplied by the booster. The results of the control-rate investigation indicate that large airplanes may have satisfactory handling qualities with the booster adjusted to give much lower rates of control motion than those normally used by pilots.

Online Error Reporting for Managing Quality Control Within Radiology.

PubMed

Golnari, Pedram; Forsberg, Daniel; Rosipko, Beverly; Sunshine, Jeffrey L

2016-06-01

Information technology systems within health care, such as picture archiving and communication system (PACS) in radiology, can have a positive impact on production but can also risk compromising quality. The widespread use of PACS has removed the previous feedback loop between radiologists and technologists. Instead of direct communication of quality discrepancies found for an examination, the radiologist submitted a paper-based quality-control report. A web-based issue-reporting tool can help restore some of the feedback loop and also provide possibilities for more detailed analysis of submitted errors. The purpose of this study was to evaluate the hypothesis that data from use of an online error reporting software for quality control can focus our efforts within our department. For the 372,258 radiologic examinations conducted during the 6-month period study, 930 errors (390 exam protocol, 390 exam validation, and 150 exam technique) were submitted, corresponding to an error rate of 0.25 %. Within the category exam protocol, technologist documentation had the highest number of submitted errors in ultrasonography (77 errors [44 %]), while imaging protocol errors were the highest subtype error for computed tomography modality (35 errors [18 %]). Positioning and incorrect accession had the highest errors in the exam technique and exam validation error category, respectively, for nearly all of the modalities. An error rate less than 1 % could signify a system with a very high quality; however, a more likely explanation is that not all errors were detected or reported. Furthermore, staff reception of the error reporting system could also affect the reporting rate.

Development of a Rating Tool for Mobile Cancer Apps: Information Analysis and Formal and Content-Related Evaluation of Selected Cancer Apps.

PubMed

Böhme, Cathleen; von Osthoff, Marc Baron; Frey, Katrin; Hübner, Jutta

2017-08-17

Mobile apps are offered in large numbers and have different qualities. The aim of this article was to develop a rating tool based on formal and content-related criteria for the assessment of cancer apps and to test its applicability on apps. After a thorough analysis of the literature, we developed a specific rating tool for cancer apps based on the MARS (mobile app rating system) and a rating tool for cancer websites. This instrument was applied to apps freely available in stores and focusing on some cancer topic. Ten apps were rated on the basis of 22 criteria. Sixty percent of the apps (6/10) were rated poor and insufficient. The rating by different scientists was homogenous. The good apps had reliable sources were regularly updated and had a concrete intent/purpose in their app description. In contrast, the apps that were rated poor had no distinction of scientific content and advertisement. In some cases, there was no imprint to identify the provider. As apps of poor quality can give misinformation and lead to wrong treatment decisions, efforts have to be made to increase usage of high-quality apps. Certification would help cancer patients to identify reliable apps, yet acceptance of a certification system must be backed up.

Quality Profiles in Early Childhood: An Example from Virginia's Quality Rating Improvement System

ERIC Educational Resources Information Center

Squibb, Kathryn M.

2013-01-01

Quality in early childhood settings has emerged as an important factor in determining whether the potential benefits of educational experiences before kindergarten will be realized. Research demonstrates that in order for such interventions to be beneficial to young children's development, the quality of their educational environments and…

Executing Quality: A Grounded Theory of Child Care Quality Improvement Engagement Process in Pennsylvania

ERIC Educational Resources Information Center

Critchosin, Heather

2014-01-01

Executing Quality describes the perceived process experienced by participants while engaging in Keystone Standards, Training, Assistance, Resources, and Support (Keystone STARS) quality rating improvement system (QRIS). The purpose of this qualitative inquiry was to understand the process of Keystone STARS engagement in order to generate a…

A prospective interrupted time series study of interventions to improve the quality, rating, framing and structure of goal-setting in community-based brain injury rehabilitation.

PubMed

Hassett, Leanne; Simpson, Grahame; Cotter, Rachel; Whiting, Diane; Hodgkinson, Adeline; Martin, Diane

2015-04-01

To investigate whether the introduction of an electronic goals system followed by staff training improved the quality, rating, framing and structure of goals written by a community-based brain injury rehabilitation team. Interrupted time series design. Two interventions were introduced six months apart. The first intervention comprised the introduction of an electronic goals system. The second intervention comprised a staff goal training workshop. An audit protocol was devised to evaluate the goals. A random selection of goal statements from the 12 months prior to the interventions (Time 1 baseline) were compared with all goal statements written after the introduction of the electronic goals system (Time 2) and staff training (Time 3). All goals were de-identified for client and time-period, and randomly ordered. A total of 745 goals (Time 1 n = 242; Time 2 n = 283; Time 3 n = 220) were evaluated. Compared with baseline, the introduction of the electronic goals system alone significantly increased goal rating, framing and structure (χ(2) tests 144.7, 18.9, 48.1, respectively, p < 0.001). The addition of staff training meant that the improvement in goal quality, which was only a trend at Time 2, was statistically significant at Time 3 (χ(2) 15.0, p ≤ 001). The training also led to a further significant increase in the framing and structuring of goals over the electronic goals system (χ(2) 11.5, 12.5, respectively, p ≤ 0.001). An electronic goals system combined with staff training improved the quality, rating, framing and structure of goal statements. © The Author(s) 2014.

IDMA-Based MAC Protocol for Satellite Networks with Consideration on Channel Quality

PubMed Central

2014-01-01

In order to overcome the shortcomings of existing medium access control (MAC) protocols based on TDMA or CDMA in satellite networks, interleave division multiple access (IDMA) technique is introduced into satellite communication networks. Therefore, a novel wide-band IDMA MAC protocol based on channel quality is proposed in this paper, consisting of a dynamic power allocation algorithm, a rate adaptation algorithm, and a call admission control (CAC) scheme. Firstly, the power allocation algorithm combining the technique of IDMA SINR-evolution and channel quality prediction is developed to guarantee high power efficiency even in terrible channel conditions. Secondly, the effective rate adaptation algorithm, based on accurate channel information per timeslot and by the means of rate degradation, can be realized. What is more, based on channel quality prediction, the CAC scheme, combining the new power allocation algorithm, rate scheduling, and buffering strategies together, is proposed for the emerging IDMA systems, which can support a variety of traffic types, and offering quality of service (QoS) requirements corresponding to different priority levels. Simulation results show that the new wide-band IDMA MAC protocol can make accurate estimation of available resource considering the effect of multiuser detection (MUD) and QoS requirements of multimedia traffic, leading to low outage probability as well as high overall system throughput. PMID:25126592

Voice over Internet Protocol (VoIP) Technology as a Global Learning Tool: Information Systems Success and Control Belief Perspectives

ERIC Educational Resources Information Center

Chen, Charlie C.; Vannoy, Sandra

2013-01-01

Voice over Internet Protocol- (VoIP) enabled online learning service providers struggling with high attrition rates and low customer loyalty issues despite VoIP's high degree of system fit for online global learning applications. Effective solutions to this prevalent problem rely on the understanding of system quality, information quality, and…

Investigation of the Usability of Computerized Critical Care Information Systems in Germany.

PubMed

von Dincklage, Falk; Suchodolski, Klaudiusz; Lichtner, Gregor; Friesdorf, Wolfgang; Podtschaske, Beatrice; Ragaller, Maximilian

2017-01-01

The term "usability" describes how effectively, efficiently, and with what level of user satisfaction an information system can be used to accomplish specific goals. Computerized critical care information systems (CCISs) with high usability increase quality of care and staff satisfaction, while reducing medication errors. Conversely, systems lacking usability can interrupt clinical workflow, facilitate errors, and increase charting time. The aim of this study was to investigate and compare usability across CCIS currently used in Germany. In this study, German intensive care unit (ICU) nurses and physicians completed a specialized, previously validated, web-based questionnaire. The questionnaire assessed CCIS usability based on three rating models: an overall rating of the systems, a model rating technical usability, and a model rating task-specific usability. We analyzed results from 535 survey participants and compared eight different CCIS commonly used in Germany. Our results showed that usability strongly differs across the compared systems. The system ICUData had the best overall rating and technical usability, followed by the platforms ICM and MetaVision. The same three systems performed best in the rating of task-specific usability without significant differences between each other. Across all systems, overall ratings were more dependent on ease-of-use aspects than on aspects of utility/functionality, and the general scope of the functions offered was rated better than how well the functions are realized. Our results suggest that manufacturers should shift some of their effort away from the development of new features and focus more on improving the ease-of-use and quality of existing features.

Effects of the per diem prospective payment system with DRG-like grouping system (DPC/PDPS) on resource usage and healthcare quality in Japan.

PubMed

Hamada, Hironori; Sekimoto, Miho; Imanaka, Yuichi

2012-10-01

In 2003, Japan introduced the prospective payment system (PPS) with diagnosis-related groups (DRG) rearranged grouping system called the diagnostic procedure combination/per-diem payment system (DPC/PDPS). Even after eight years, little is known about the effects of DPC/PDPS. The purpose of this study was to examine the effects of DPC/PDPS on resource usage and healthcare quality. Using 2001-2009 (fiscal year) administrative data of acute myocardial infarction patients, four indices, including inpatient total accumulated medical charges, length of stay (LOS), mortality rate, and readmission rate, were compared between patients reimbursed by DPC/PDPS or by fee-for-service. DPC/PDPS significantly reduced total accumulated medical charges by $1061 (95% confidence interval [CI], -2007, -116) and LOS by 2.29 days (95% CI, -3.71, -0.88) after risk adjustment. However, mortality rate (Odds ratio [OR], 0.94; 95% CI, 0.73, 1.21) was unchanged. Furthermore, DPC/PDPS increased the readmission rate (OR, 1.37; 95% CI, 1.03, 1.82). This study showed that DPC/PDPS was associated with reduced resource usage, but not improved healthcare quality, as with DRG/PPSs in other countries. To achieve successful healthcare reform, further discussion on additional motives will be required. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Rheumatologists' perception of systemic lupus erythematosus quality indicators: significant interest and perceived barriers.

PubMed

Casey, Carolyn; Chung, Cecilia P; Crofford, Leslie J; Barnado, April

2017-01-01

Differences in quality of care may contribute to health disparities in systemic lupus erythematosus (SLE). Studies show low physician adherence rates to the SLE quality indicators but do not assess physician perception of SLE quality indicators or quality improvement. Using a cross-sectional survey of rheumatologists in the southeastern USA, we assessed the perception and involvement of rheumatologists in quality improvement and the SLE quality indicators. Using electronic mail, an online survey of 32 questions was delivered to 568 rheumatologists. With a response rate of 19% (n = 106), the majority of participants were male, Caucasian, with over 20 years of experience, and seeing adult patients in an academic setting. Participants had a positive perception toward quality improvement (81%) with a majority responding that the SLE quality indicators would significantly impact quality of care (54%). While 66% of respondents were familiar with the SLE quality indicators, only 18% of respondents reported using them in everyday practice. The most commonly reported barrier to involvement in quality improvement and the SLE quality indicators was time. Rheumatologists had a positive perception of the SLE quality indicators and agreed that use of the quality indicators could improve quality of care in SLE; however, they identified time as a barrier to implementation. Future studies should investigate methods to increase use of the SLE quality indicators.

Effect of a commercial housing system on egg quality during extended storage.

PubMed

Jones, D R; Karcher, D M; Abdo, Z

2014-05-01

Egg producers in the United States are utilizing a variety of commercial egg production systems to provide consumer choice and meet legislative requirements. Consumer egg grades in the United States were developed for conventional cage production, and it is unclear what effect alternative production systems might have on egg quality during retail and consumer home storage. The current study was undertaken to determine what changes in egg quality characteristics occur during extended cold storage for commercially produced conventional cage, enriched colony cage, and cage-free aviary eggs. During 12 wk of cold storage, egg weight, albumen height, Haugh unit, static compression shell strength, vitelline membrane strength and deformation, yolk index, shell dynamic stiffness, and whole egg total solids were monitored. Overall, aviary and enriched eggs were significantly (P < 0.05) heavier than conventional cage. Albumen height and Haugh unit (P < 0.05) were significantly greater for conventional cage than enriched eggs. Static compression shell strength was greatest (P < 0.05) for enriched eggs compared with aviary. No overall housing system effects for yolk measurements, shell dynamic stiffness, or whole egg total solids were observed. Albumen height, Haugh unit, and yolk quality measurements were all greatest at 0 and lowest at 12 wk of storage (P < 0.05). The rate of quality change among the housing systems for each measured attribute at 4, 6, and 12 wk was determined. Other than differences in the change of egg weight at 4 wk, no significant differences in the rate of quality decline were found among the housing systems. The results of the current study indicate that current US egg quality standards should effectively define quality for commercially produced conventional cage, enriched colony cage, and cage-free aviary eggs.

Assessing the relationship between healthcare market competition and medical care quality under Taiwan's National Health Insurance programme.

PubMed

Liao, Chih-Hsien; Lu, Ning; Tang, Chao-Hsiun; Chang, Hui-Chih; Huang, Kuo-Cherh

2018-06-04

There is still significant uncertainty as to whether market competition raises or lowers clinical quality in publicly funded healthcare systems. We attempted to assess the effects of market competition on inpatient care quality of stroke patients in a retrospective study of the universal single-payer health insurance system in Taiwan. In this 11-year population-based study, we conducted a pooled time-series cross-sectional analysis with a fixed-effects model and the Hausman test approach by utilizing two nationwide datasets: the National Health Insurance Research Database and the National Hospital and Services Survey in Taiwan. Patients who were admitted to a hospital for ischemic or hemorrhagic stroke were enrolled. After excluding patients with a previous history of stroke and those with different types of stroke, 247 379 ischemic and 79 741 hemorrhagic stroke patients were included in our analysis. Four outcome indicators were applied: the in-hospital mortality rate, 30-day post-operative complication rate, 14-day re-admission rate and 30-day re-admission rate. Market competition exerted a negative or negligible effect on the medical care quality of stroke patients. Compared to hospitals located in a highly competitive market, in-hospital mortality rates for hemorrhagic stroke patients were significantly lower in moderately (β = -0.05, P < 0.01) and less competitive markets (β = -0.05, P < 0.01). Conversely, the impact of market competition on the quality of care of ischemic stroke patients was insignificant. Simply fostering market competition might not achieve the objective of improving the quality of health care. Other health policy actions need to be contemplated.

Online Ratings Systems for Physicians and Institutions: Limitations of the Current State of the Art.

PubMed

Daskivich, Timothy J; Spiegel, Brennan; Kim, Hyung L

2017-03-01

Consumers are increasingly using online ratings tools that compare surgeons and institutions to identify high-quality providers. However, concerns regarding their limitations-data quality, validity of statistical comparisons, and impact on access to care-should be considered before full-scale implementation. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

76 FR 72377 - Approval and Promulgation of Air Quality Implementation Plans; Connecticut; Determinations of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

... recorded in EPA's Air Quality System (AQS) database. To account for missing data, the procedures found in... Site Year exceedance exceedance expected days over days for exceedance 0.124 ppm missing data rate... for exceedance 0.124 ppm missing data rate 090050006 Cornwall........ 2006 0 0.0 0.3 2007 1 1.0 2008 0...

Analyses of Blood Bank Efficiency, Cost-Effectiveness and Quality

NASA Astrophysics Data System (ADS)

Lam, Hwai-Tai Chen

In view of the increasing costs of hospital care, it is essential to investigate methods to improve the labor efficiency and the cost-effectiveness of the hospital technical core in order to control costs while maintaining the quality of care. This study was conducted to develop indices to measure efficiency, cost-effectiveness, and the quality of blood banks; to identify factors associated with efficiency, cost-effectiveness, and quality; and to generate strategies to improve blood bank labor efficiency and cost-effectiveness. Indices developed in this study for labor efficiency and cost-effectiveness were not affected by patient case mix and illness severity. Factors that were associated with labor efficiency were identified as managerial styles, and organizational designs that balance workload and labor resources. Medical directors' managerial involvement was not associated with labor efficiency, but their continuing education and specialty in blood bank were found to reduce the performance of unnecessary tests. Surprisingly, performing unnecessary tests had no association with labor efficiency. This suggested the existence of labor slack in blood banks. Cost -effectiveness was associated with workers' benefits, wages, and the production of high-end transfusion products by hospital-based donor rooms. Quality indices used in this study included autologous transfusion rates, platelet transfusion rates, and the check points available in an error-control system. Because the autologous transfusion rate was related to patient case mix, severity of illness, and possible inappropriate transfusion, it was not recommended to be used for quality index. Platelet-pheresis transfusion rates were associated with the transfusion preferences of the blood bank medical directors. The total number of check points in an error -control system was negatively associated with government ownership and workers' experience. Recommendations for improving labor efficiency and cost-effectiveness were focused on an incentive system that encourages team effort, and the use of appropriate measurements for laboratory efficiency and operational system designs.

Climate Change Impacts on US Water Quality using two Models: HAWQS and US Basins

EPA Science Inventory

Climate change and freshwater quality are well-linked. Changes in climate result in changes in streamflow and rising water temperatures, which impact biochemical reaction rates and increase stratification in lakes and reservoirs. Using two water quality modeling systems (the Hydr...

National Survey on Internal Quality Control Practice for Lipid Parameters in Laboratories of China from 2014 to 2016.

PubMed

Ye, Yuanyuan; Wang, Wei; Zhao, Haijian; He, Falin; Zhong, Kun; Yuan, Shuai; Wang, Zhiguo

2017-09-01

To investigate the situation of Internal Quality Control (IQC) practice for total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol from 2014 to 2016 in laboratories in China and provide improvement measurements. A web-based External Quality Assessment (EQA) system was used to collect IQC data of lipid parameters in laboratories which continuously participated in the national EQA programs in China from 2014 to 2016. Pass rate of the coefficients of variation (CVs) of two level quality controls in four lipid parameters were calculated according to six quality specifications for precision to evaluate the current status of precision level of the four lipid parameters and their change over time in China. 533, 512, 504, and 466 laboratories continuously reported the data of level one for total cholesterol, triglyceride, HDL-cholesterol and LDL-cholesterol, and 212, 210, 208 and 198 laboratories reported the level two, respectively. The percentage of laboratories meeting the quality specification varied based on different criteria. Non-significant change can be found in the pass rate of CVs over time. The number of laboratories using a closed system increased over time, but still only accounted for a small proportion. There is no significant difference in the pass rate of CVs between closed and open systems. Triglycerides currently have a fairly good performance in China. While the performance of laboratories on total cholesterol, HDL-cholesterol and LDL-cholesterol has yet to be improved.

Feasibility of Multiplane-Transmit Beamforming for Real-Time Volumetric Cardiac Imaging: A Simulation Study.

PubMed

Chen, Yinran; Tong, Ling; Ortega, Alejandra; Luo, Jianwen; D'hooge, Jan

2017-04-01

Today's 3-D cardiac ultrasound imaging systems suffer from relatively low spatial and temporal resolution, limiting their applicability in daily clinical practice. To address this problem, 3-D diverging wave imaging with spatial coherent compounding (DWC) as well as 3-D multiline-transmit (MLT) imaging have recently been proposed. Currently, the former improves the temporal resolution significantly at the expense of image quality and the risk of introducing motion artifacts, whereas the latter only provides a moderate gain in volume rate but mostly preserves quality. In this paper, a new technique for real-time volumetric cardiac imaging is proposed by combining the strengths of both approaches. Hereto, multiple planar (i.e., 2-D) diverging waves are simultaneously transmitted in order to scan the 3-D volume, i.e., multiplane transmit (MPT) beamforming. The performance of a 3MPT imaging system was contrasted to that of a 3-D DWC system and that of a 3-D MLT system by computer simulations during both static and moving conditions of the target structures while operating at similar volume rate. It was demonstrated that for stationary targets, the 3MPT imaging system was competitive with both the 3-D DWC and 3-D MLT systems in terms of spatial resolution and sidelobe levels (i.e., image quality). However, for moving targets, the image quality quickly deteriorated for the 3-D DWC systems while it remained stable for the 3MPT system while operating at twice the volume rate of the 3-D-MLT system. The proposed MPT beamforming approach was thus demonstrated to be feasible and competitive to state-of-the-art methodologies.

Compensation for time delay in flight simulator visual-display systems

NASA Technical Reports Server (NTRS)

Crane, D. F.

1983-01-01

A piloted aircraft can be viewed as a closed-loop, man-machine control system. When a simulator pilot is performing a precision maneuver, a delay in the visual display of aircraft response to pilot-control input decreases the stability of the pilot-aircraft system. The less stable system is more difficult to control precisely. Pilot dynamic response and performance change as the pilot attempts to compensate for the decrease in system stability, and these changes bias the simulation results by influencing the pilot's rating of the handling qualities of the simulated aircraft. Delay compensation, designed to restore pilot-aircraft system stability, was evaluated in several studies which are reported here. The studies range from single-axis, tracking-task experiments (with sufficient subjects and trials to establish statistical significance of the results) to a brief evaluation of compensation of a computer-generated-imagery (CGI) visual display system in a full six-degree-of-freedom simulation. The compensation was effective - improvements in pilot performance and workload or aircraft handling-qualities rating (HQR) were observed. Results from recent aircraft handling-qualities research literature which support the compensation design approach are also reviewed.

Assessment of Power Quality based on Fuzzy Logic and Discrete Wavelet Transform for Nonstationary Disturbances

NASA Astrophysics Data System (ADS)

Sinha, Pampa; Nath, Sudipta

2010-10-01

The main aspects of power system delivery are reliability and quality. If all the customers of a power system get uninterrupted power through the year then the system is considered to be reliable. The term power quality may be referred to as maintaining near sinusoidal voltage at rated frequency at the consumers end. The power component definitions are defined according to the IEEE Standard 1459-2000 both for single phase and three phase unbalanced systems based on Fourier Transform (FFT). In the presence of nonstationary power quality (PQ) disturbances results in accurate values due to its sensitivity to the spectral leakage problem. To overcome these limitations the power quality components are calculated using Discrete Wavelet Transform (DWT). In order to handle the uncertainties associated with electric power systems operations fuzzy logic has been incorporated in this paper. A new power quality index has been introduced here which can assess the power quality under nonstationary disturbances.

Holistic model-based monitoring of the human health status in an urban environment system: pilot study in Verona city, Italy.

PubMed

Tarocco, S; Amoruso, I; Caravello, G

2011-06-01

In recent decades the global health paradigm gained an increasing systemic characterization. The ecosystem health theory states that a healthy ecosystem, whether natural or artificial, significantly contributes to the good health status of the human population. The present study describes an interdisciplinary monitoring model that retrospectively analyzes the intersection between the urban environment and citizens. The model analyzes both the biophysical and the anthropic subsystems through the application of landscape ecology and environmental quality indexes along with human health indicators. Particularly, ecological quality of landscape pattern, atmospheric pollution, outdoor noise levels and local health indicators were assessed. Verona municipality was chosen as study area to test the preliminary efficiency of the model. Territory was split into two superimposed layers of land units, which were further geo-referentiated with Geographical Information System (GIS) technology. Interdependence of any of the analyzed traits was further investigated with Fisher exact test. Landscape composition was assessed and an Average Ecological Quality (AEQ) score assigned to each land unit. A direct proportionality emerged for concentrations of considered air pollutants and traffic levels: a spatial model for the atmospheric pollution was drawn. A map depicting the distribution of traffic-related noise levels was also drawn. From chosen indicators, a quality class score was assigned to every minor and major land unit. Age-standardised rates about hospitalizations for the municipal population and specific rates for the over-65s/1000 inhabitants were calculated. Quality class assignement for each health indicator was graphically rendered. After direct standardisation of rates for the population sample, data were compared with two reference populations, the Regional population and the Local Socio-sanitary Unit (ULSS20) population. Standardised hospitalization rates for the whole municipal population always resulted lower than the ULSS20 rates, except for auditory pathologies. It was notable that rates of hospitalizations for cancerous diseases for Verona municipal population were four times and two times lower than the ULSS20 and the Regional population ones, respectively. Contingency table were made for the health main indicator (specific rates for the over-65s/1000 inhabitants) and the environmental quality key factors of landscape ecological quality, outdoor noise level and air pollution. H0 of independence was rejected for respiratory pathologies and air pollution and for the triad cardiocirculatory pathologies, air pollution and landscape ecological quality at (a = 0.05). Fisher exact test confirmed the non-independence of cardiocirculatory diseases and biophysical environment and the analogous association for respiratory pathologies when comparison was made with global environmental quality index. The first testing of the model suggests some possible elements of implementation and integration which could further enhance it. Among them, the subjective investigation of the health status assumes a primary role. On the whole the monitoring model seems to effectively represent the real complexity of the urban environment systems and should be regarded as an important contribution to the new way of health research.

Sensor Data Quality and Angular Rate Down-Selection Algorithms on SLS EM-1

NASA Technical Reports Server (NTRS)

Park, Thomas; Oliver, Emerson; Smith, Austin

2018-01-01

The NASA Space Launch System Block 1 launch vehicle is equipped with an Inertial Navigation System (INS) and multiple Rate Gyro Assemblies (RGA) that are used in the Guidance, Navigation, and Control (GN&C) algorithms. The INS provides the inertial position, velocity, and attitude of the vehicle along with both angular rate and specific force measurements. Additionally, multiple sets of co-located rate gyros supply angular rate data. The collection of angular rate data, taken along the launch vehicle, is used to separate out vehicle motion from flexible body dynamics. Since the system architecture uses redundant sensors, the capability was developed to evaluate the health (or validity) of the independent measurements. A suite of Sensor Data Quality (SDQ) algorithms is responsible for assessing the angular rate data from the redundant sensors. When failures are detected, SDQ will take the appropriate action and disqualify or remove faulted sensors from forward processing. Additionally, the SDQ algorithms contain logic for down-selecting the angular rate data used by the GN&C software from the set of healthy measurements. This paper provides an overview of the algorithms used for both fault-detection and measurement down selection.

Validating Emergency Department Vital Signs Using a Data Quality Engine for Data Warehouse

PubMed Central

Genes, N; Chandra, D; Ellis, S; Baumlin, K

2013-01-01

Background : Vital signs in our emergency department information system were entered into free-text fields for heart rate, respiratory rate, blood pressure, temperature and oxygen saturation. Objective : We sought to convert these text entries into a more useful form, for research and QA purposes, upon entry into a data warehouse. Methods : We derived a series of rules and assigned quality scores to the transformed values, conforming to physiologic parameters for vital signs across the age range and spectrum of illness seen in the emergency department. Results : Validating these entries revealed that 98% of free-text data had perfect quality scores, conforming to established vital sign parameters. Average vital signs varied as expected by age. Degradations in quality scores were most commonly attributed logging temperature in Fahrenheit instead of Celsius; vital signs with this error could still be transformed for use. Errors occurred more frequently during periods of high triage, though error rates did not correlate with triage volume. Conclusions : In developing a method for importing free-text vital sign data from our emergency department information system, we now have a data warehouse with a broad array of quality-checked vital signs, permitting analysis and correlation with demographics and outcomes. PMID:24403981

Validating emergency department vital signs using a data quality engine for data warehouse.

PubMed

Genes, N; Chandra, D; Ellis, S; Baumlin, K

2013-01-01

Vital signs in our emergency department information system were entered into free-text fields for heart rate, respiratory rate, blood pressure, temperature and oxygen saturation. We sought to convert these text entries into a more useful form, for research and QA purposes, upon entry into a data warehouse. We derived a series of rules and assigned quality scores to the transformed values, conforming to physiologic parameters for vital signs across the age range and spectrum of illness seen in the emergency department. Validating these entries revealed that 98% of free-text data had perfect quality scores, conforming to established vital sign parameters. Average vital signs varied as expected by age. Degradations in quality scores were most commonly attributed logging temperature in Fahrenheit instead of Celsius; vital signs with this error could still be transformed for use. Errors occurred more frequently during periods of high triage, though error rates did not correlate with triage volume. In developing a method for importing free-text vital sign data from our emergency department information system, we now have a data warehouse with a broad array of quality-checked vital signs, permitting analysis and correlation with demographics and outcomes.

Quality Measurement in Early Childhood Settings

ERIC Educational Resources Information Center

Zaslow, Martha, Ed.; Martinez-Beck, Ivelisse, Ed.; Tout, Kathryn, Ed.; Halle, Tamara, Ed.

2011-01-01

What constitutes quality in early childhood settings, and how can it best be measured with today's widely used tools and promising new approaches? Find authoritative answers in this book, a must-have for high-level administrators and policymakers as more and more states adopt early childhood Quality Rating and Improvement Systems. The most…

Paediatric cerebrovascular CT angiography-towards better image quality.

PubMed

Thust, Stefanie C; Chong, Wui Khean Kling; Gunny, Roxana; Mazumder, Asif; Poitelea, Marius; Welsh, Anna; Ederies, Ash; Mankad, Kshitij

2014-12-01

Paediatric cerebrovascular CT angiography (CTA) can be challenging to perform due to variable cardiovascular physiology between different age groups and the risk of movement artefact. This analysis aimed to determine what proportion of CTA at our institution was of diagnostic quality and identify technical factors which could be improved. a retrospective analysis of 20 cases was performed at a national paediatric neurovascular centre assessing image quality with a subjective scoring system and Hounsfield Unit (HU) measurements. Demographic data, contrast dose, flow rate and triggering times were recorded for each patient. Using a qualitative scoring system, 75% of studies were found to be of diagnostic quality (n=9 'good', n=6 'satisfactory') and 25% (n=5) were 'poor'. Those judged subjectively to be poor had arterial contrast density measured at less than 250 HU. Increased arterial opacification was achieved for cases performed with an increased flow rate (2.5-4 mL/s) and higher intravenous contrast dose (2 mL/kg). Triggering was found to be well timed in nine cases, early in four cases and late in seven cases. Of the scans triggered early, 75% were poor. Of the scans triggered late, less (29%) were poor. High flow rates (>2.5 mL/s) were a key factor for achieving high quality paediatric cerebrovascular CTA imaging. However, appropriate triggering by starting the scan immediately on contrast opacification of the monitoring vessel plays an important role and could maintain image quality when flow rates were lower. Early triggering appeared more detrimental than late.

Are Facebook user ratings associated with hospital cost, quality and patient satisfaction? A cross-sectional analysis of hospitals in New York State.

PubMed

Campbell, Lauren; Li, Yue

2018-02-01

Hospital care costs are high while quality varies across hospitals. Patient satisfaction may be associated with better clinical quality, and social media ratings may offer another opportunity to measure patient satisfaction with care. To test if Facebook user ratings of hospitals are associated with existing measures of patient satisfaction, cost and quality. Data were obtained from Centers for Medicare and Medicaid Services Hospital Compare, the Hospital Inpatient Prospective Payment System impact files and the Area Health Resource File for 2015. Information from hospitals' Facebook pages was collected in July 2016. Multivariate linear regression was used to test if there is an association between Facebook user ratings (star rating and adjusted number of 'likes') and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction measures, the 30-day all-cause readmission rate, and the Medicare spending per beneficiary (MSPB) ratio. One hundred and thirty-six acute care hospitals in New York State in 2015. An increase in the Facebook star rating is associated with significant increases in 21/23 HCAHPS measures (p≤0.003). An increase in the adjusted number of 'likes' is associated with very small increases in 3/23 HCAHPS measures (p<0.05). Facebook user ratings are not associated with the 30-day all-cause readmission rate or the Medicare spending per beneficiary ratio. Results demonstrate an association between HCAHPS patient satisfaction measures and Facebook star ratings. Adjusted number of 'likes' may not be a useful measure of patient satisfaction. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Within-Hospital Variation in 30-Day Adverse Events: Implications for Measuring Quality.

PubMed

Burke, Robert E; Glorioso, Thomas; Barón, Anna K; Kaboli, Peter J; Ho, P Michael

Novel measures of hospital quality are needed. Because quality improvement efforts seek to reduce variability in processes and outcomes, hospitals with higher variability in adverse events may be delivering poorer quality care. We sought to evaluate whether within-hospital variability in adverse events after a procedure might function as a quality metric that is correlated with facility-level mortality rates. We analyzed all percutaneous coronary interventions (PCIs) performed in the Veterans Health Administration (VHA) system from 2007 to 2013 to evaluate the correlation between within-hospital variability in 30-day postdischarge adverse events (readmission, emergency department visit, and repeat revascularization), and facility-level mortality rates, after adjustment for patient demographics, comorbidities, PCI indication, and PCI urgency. The study cohort included 47,567 patients at 48 VHA hospitals. The overall 30-day adverse event rate was 22.0% and 1-year mortality rate was 4.9%. The most variable sites had relative changes of 20% in 30-day rates of adverse events period-to-period. However, within-hospital variability in 30-day events was not correlated with 1-year mortality rates (correlation coefficient = .06; p = .66). Thus, measuring within-hospital variability in postdischarge adverse events may not improve identification of low-performing hospitals. Evaluation in other conditions, populations, and in relationship with other quality metrics may reveal stronger correlations with care quality.

Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health-care System: findings from an online expert panel.

PubMed

Khodyakov, Dmitry; Stockdale, Susan E; Smith, Nina; Booth, Marika; Altman, Lisa; Rubenstein, Lisa V

2017-02-01

There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens ™ . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desirability, feasibility, patient ability, physician/staff acceptance and impact on patient-centredness and care quality. Data were analysed using the RAND/UCLA Appropriateness Method for determining consensus. Experts rated consulting with patients at the local level as the most desirable and feasible patient engagement approach. Engagement at the local level was considered more desirable than engagement at the regional level. Being an equal stakeholder at the local level received the highest ratings on the patient-centredness and health-care quality criteria. Our findings illustrate expert opinion about different approaches to patient engagement and highlight the benefits and challenges posed by each. Although experts rated local consultations with patients on an as-needed basis as most desirable and feasible, they rated being an equal stakeholder at the local level as having the highest potential impact on patient-centredness and care quality. This result highlights a perceived discrepancy between what is most desirable and what is potentially most effective, but suggests that routine local engagement of patients as equal stakeholders may be a desirable first step for promoting high-quality, patient-centred care. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Lithotripsy of gallstones by means of a quality-switched giant-pulse neodymium:yttrium-aluminum-garnet laser. Basic in vitro studies using a highly flexible fiber system.

PubMed

Hochberger, J; Gruber, E; Wirtz, P; Dürr, U; Kolb, A; Zanger, U; Hahn, E G; Ell, C

1991-11-01

The quality-switched neodymium:yttrium-aluminum-garnet laser represents a new instrument for athermal fragmentation of gallstones by transformation of optical energy into mechanical energy in the form of shock waves via local plasma formation. A highly flexible 300-micron fiber transmission system was used in basic investigations to determine the influence of varying pulse repetition rates (5-30 Hz) and pulse energies (15 and 20 mJ) on shock wave intensity and stone fragmentation in vitro for 105 biliary calculi of known size and chemical composition. After performance of 1200 shock wave pressure measurements using polyvinylidenefluoride hydrophones, stone fragmentation was analyzed by determination of fragment removal rates (volume of fragments removed per fragmentation time), ablation rates (mean volume removed per laser pulse), and median fragment sizes for each laser setting. With the quality-switched neodymium:yttrium-aluminum-garnet laser system, all concrements could be reliably disintegrated into small fragments (median diameter, 0.7-1.7 mm). Compared with pure cholesterol stones, a significantly higher fragment removal rate was achieved in cholesterol stones containing 30% calcium phosphate (P = 0.039), in cholesterol stones containing 20% pigment (P = 0.015), and in pure pigment stones (P = 0.007). Fragment removal rates, local shock wave pressures, and median grain sizes were significantly higher at a pulse energy of 20 mJ than with 15 mJ. Shock wave pressures showed a distinct dependence on pulse repetition rates at 20 mJ, yet not at 15 mJ. Because there is no evident hazard of thermal damage to tissue using the quality-switched neodymium:yttrium-aluminum-garnet laser, it appears to be a promising device for nonsurgical biliary stone therapy.

Foraging behavior by Daphnia in stoichiometric gradients of food quality.

PubMed

Schatz, Greg S; McCauley, Edward

2007-10-01

Mismatches in the elemental composition of herbivores and their resources can impact herbivore growth and reproduction. In aquatic systems, the ratio of elements, such as C, P, and N, is used to characterize the food quality of algal prey. For example, large increases in the C:P ratio of edible algae can decrease rates of growth and reproduction in Daphnia. Current theory emphasizes that Daphnia utilize only assimilation and respiration processes to maintain an optimal elemental composition, yet studies of terrestrial herbivores implicate behavioral processes in coping with local variation in food quality. We tested the ability of juvenile and adult Daphnia to locate regions of high-quality food within a spatial gradient of algal prey differing in C:P ratio, while holding food density constant over space. Both juveniles and adults demonstrated similar behavior by quickly locating (i.e., <10 min) the region of high food quality. Foraging paths were centred on regions of high food quality and these differed significantly from paths of individuals exposed to a homogeneous environment of both food density and food quality. Ingestion rate experiments on algal prey of differing stoichiometric ratio show that individuals can adjust their intake rate over fast behavioral time-scales, and we use these data to examine how individuals choose foraging locations when presented with a spatial gradient that trades off food quality and food quantity. Daphnia reared under low food quality conditions chose to forage in regions of high food quality even though they could attain the same C ingestion rate elsewhere along a spatial gradient. We argue that these aspects of foraging behavior by Daphnia have important implications for how these herbivores manage their elemental composition and our understanding of the dynamics of these herbivore-plant systems in lakes and ponds where spatial variation in food quality is present.

Crystal Growth Rate Dispersion: A Predictor of Crystal Quality in Microgravity?

NASA Technical Reports Server (NTRS)

Kephart, Richard D.; Judge, Russell A.; Snell, Edward H.; vanderWoerd, Mark J.

2003-01-01

In theory macromolecular crystals grow through a process involving at least two transport phenomena of solute to the crystal surface: diffusion and convection. In absence of standard gravitational forces, the ratio of these two phenomena can change and explain why crystal growth in microgravity is different from that on Earth. Experimental evidence clearly shows, however, that crystal growth of various systems is not equally sensitive to reduction in gravitational forces, leading to quality improvement in microgravity for some crystals but not for others. We hypothesize that the differences in final crystal quality are related to crystal growth rate dispersion. If growth rate dispersion exists on Earth, decreases in microgravity, and coincides with crystal quality improvements then this dispersion is a predictor for crystal quality improvement. In order to test this hypothesis, we will measure growth rate dispersion both in microgravity and on Earth and will correlate the data with previously established data on crystal quality differences for the two environments. We present here the first crystal growth rate measurement data for three proteins (lysozyme, xylose isomerase and human recombinant insulin), collected on Earth, using hardware identical to the hardware to be used in microgravity and show how these data correlate with crystal quality improvements established in microgravity.

Evaluation of image quality of digital photo documentation of female genital injuries following sexual assault.

PubMed

Ernst, E J; Speck, Patricia M; Fitzpatrick, Joyce J

2011-12-01

With the patient's consent, physical injuries sustained in a sexual assault are evaluated and treated by the sexual assault nurse examiner (SANE) and documented on preprinted traumagrams and with photographs. Digital imaging is now available to the SANE for documentation of sexual assault injuries, but studies of the image quality of forensic digital imaging of female genital injuries after sexual assault were not found in the literature. The Photo Documentation Image Quality Scoring System (PDIQSS) was developed to rate the image quality of digital photo documentation of female genital injuries after sexual assault. Three expert observers performed evaluations on 30 separate images at two points in time. An image quality score, the sum of eight integral technical and anatomical attributes on the PDIQSS, was obtained for each image. Individual image quality ratings, defined by rating image quality for each of the data, were also determined. The results demonstrated a high level of image quality and agreement when measured in all dimensions. For the SANE in clinical practice, the results of this study indicate that a high degree of agreement exists between expert observers when using the PDIQSS to rate image quality of individual digital photographs of female genital injuries after sexual assault. © 2011 International Association of Forensic Nurses.

Approaching Error-Free Customer Satisfaction through Process Change and Feedback Systems

ERIC Educational Resources Information Center

Berglund, Kristin M.; Ludwig, Timothy D.

2009-01-01

Employee-based errors result in quality defects that can often impact customer satisfaction. This study examined the effects of a process change and feedback system intervention on error rates of 3 teams of retail furniture distribution warehouse workers. Archival records of error codes were analyzed and aggregated as the measure of quality. The…

Predictive Effects of Online Peer Feedback Types on Performance Quality

ERIC Educational Resources Information Center

Yu, Fu-Yun; Wu, Chun-Ping

2013-01-01

This study examined the individual and combined predictive effects of two types of feedback (i.e., quantitative ratings and descriptive comments) in online peer-assessment learning systems on the quality of produced work. A total of 233 students participated in the study for six weeks. An online learning system that allows students to contribute…

Impacts of extreme flooding on riverbank filtration water quality.

PubMed

Ascott, M J; Lapworth, D J; Gooddy, D C; Sage, R C; Karapanos, I

2016-06-01

Riverbank filtration schemes form a significant component of public water treatment processes on a global level. Understanding the resilience and water quality recovery of these systems following severe flooding is critical for effective water resources management under potential future climate change. This paper assesses the impact of floodplain inundation on the water quality of a shallow aquifer riverbank filtration system and how water quality recovers following an extreme (1 in 17 year, duration >70 days, 7 day inundation) flood event. During the inundation event, riverbank filtrate water quality is dominated by rapid direct recharge and floodwater infiltration (high fraction of surface water, dissolved organic carbon (DOC) >140% baseline values, >1 log increase in micro-organic contaminants, microbial detects and turbidity, low specific electrical conductivity (SEC) <90% baseline, high dissolved oxygen (DO) >400% baseline). A rapid recovery is observed in water quality with most floodwater impacts only observed for 2-3 weeks after the flooding event and a return to normal groundwater conditions within 6 weeks (lower fraction of surface water, higher SEC, lower DOC, organic and microbial detects, DO). Recovery rates are constrained by the hydrogeological site setting, the abstraction regime and the water quality trends at site boundary conditions. In this case, increased abstraction rates and a high transmissivity aquifer facilitate rapid water quality recoveries, with longer term trends controlled by background river and groundwater qualities. Temporary reductions in abstraction rates appear to slow water quality recoveries. Flexible operating regimes such as the one implemented at this study site are likely to be required if shallow aquifer riverbank filtration systems are to be resilient to future inundation events. Development of a conceptual understanding of hydrochemical boundaries and site hydrogeology through monitoring is required to assess the suitability of a prospective riverbank filtration site. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

The impact of DRGs on the cost and quality of health care in the United States.

PubMed

Davis, C; Rhodes, D J

1988-01-01

The prospective Payment System (PPS) represents a fundamental change in the way the United States government reimburses hospitals for medical services covered under Medicare, a federal health care insurance program for the elderly and disabled. PPS replaced the retrospective cost-based system of payment for Medicare services with a prospective payment system. Under PPS, a predetermined specific rate for each discharge dictates payment according to the diagnosis related group (DRG) in which the discharge is classified. The PPS was intended to create financial incentives that encourage hospitals to restrain the use of resources while providing high-quality inpatient care. Both objectives appear to have been met under PPS. Hospital utilization has declined, average length of stay has fallen, and the locus of care has shifted from the inpatient setting to less costly outpatient settings. The growth in inpatient hospital benefits has slowed and the impending insolvency of the Medicare trust fund has been forestalled. Studies have found no deterioration in the quality of care rendered to Medicare beneficiaries. Neither the mortality rate nor the rate of re-admission (presumably related to premature discharge) increased under PPS. Indeed, PPS appears to have enhanced the quality of inpatient care by discouraging unnecessary and potentially harmful procedures, and by encouraging the concentration of complex procedures in facilities in which the high frequency of these procedures promotes efficiency. Incentive-based reimbursement also appears to have contributed to the growth in alternative delivery systems, such as HMOs and PPOs, which contain costs by maintaining a high volume of a limited range of services. The success of the PPS/DRG system in controlling costs and promoting quality in this country suggests its application in other countries, either as a method of reimbursement or as a product line management tool.

Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel.

PubMed

Reddy, Viraj K; Lavoie, Marie-Claude; Verbeek, Jos H; Pahwa, Manisha

2017-11-14

Percutaneous exposure injuries from devices used for blood collection or for injections expose healthcare workers to the risk of blood borne infections such as hepatitis B and C, and human immunodeficiency virus (HIV). Safety features such as shields or retractable needles can possibly contribute to the prevention of these injuries and it is important to evaluate their effectiveness. To determine the benefits and harms of safety medical devices aiming to prevent percutaneous exposure injuries caused by needles in healthcare personnel versus no intervention or alternative interventions. We searched CENTRAL, MEDLINE, EMBASE, NHSEED, Science Citation Index Expanded, CINAHL, Nioshtic, CISdoc and PsycINFO (until 11 November 2016). We included randomised controlled trials (RCT), controlled before and after studies (CBA) and interrupted time-series (ITS) designs of the effect of safety engineered medical devices on percutaneous exposure injuries in healthcare staff. Two of the authors independently assessed study eligibility and risk of bias and extracted data. We synthesized study results with a fixed-effect or random-effects model meta-analysis where appropriate. We included six RCTs with 1838 participants, two cluster-RCTs with 795 participants and 73,454 patient days, five CBAs with approximately 22,000 participants and eleven ITS with an average of 13.8 data points. These studies evaluated safe modifications of blood collection systems, intravenous (IV) systems, injection systems, multiple devices, sharps containers and legislation on the implementation of safe devices. We estimated the needlestick injury (NSI) rate in the control groups to be about one to five NSIs per 1000 person-years. There were only two studies from low- or middle-income countries. The risk of bias was high in 20 of 24 studies. Safe blood collection systems:We found one RCT that found a safety engineered blood gas syringe having no considerable effect on NSIs (Relative Risk (RR) 0.2, 95% Confidence Interval (95% CI) 0.01 to 4.14, 550 patients, very low quality evidence). In one ITS study, safe blood collection systems decreased NSIs immediately after the introduction (effect size (ES) -6.9, 95% CI -9.5 to -4.2) but there was no further decrease over time (ES -1.2, 95% CI -2.5 to 0.1, very low quality evidence). Another ITS study evaluated an outdated recapping shield, which we did not consider further. Safe Intravenous systemsThere was very low quality evidence in two ITS studies that NSIs were reduced with the introduction of safe IV devices, whereas one RCT and one CBA study provided very low quality evidence of no effect. However, there was moderate quality evidence produced by four other RCT studies that these devices increased the number of blood splashes when the safety system had to be engaged actively (relative risk (RR) 1.6, 95% CI 1.08 to 2.36). In contrast there was low quality evidence produced by two RCTs of passive systems that showed no effect on blood splashes. Yet another RCT produced low quality evidence that a different safe active IV system also decreased the incidence of blood leakages. Safe injection devicesThere was very low quality evidence provided by one RCT and one CBA study showing that introduction of safe injection devices did not considerably change the NSI rate. One ITS study produced low quality evidence showing that the introduction of safe passive injection systems had no effect on NSI rate when compared to safe active injection systems. Multiple safe devicesThere was very low quality evidence from one CBA study and two ITS studies. According to the CBA study, the introduction of multiple safe devices resulted in a decrease in NSI,whereas the two ITS studies found no change. Safety containersOne CBA study produced very low quality evidence showing that the introduction of safety containers decreased NSI. However, two ITS studies evaluating the same intervention found inconsistent results. LegislationThere was low to moderate quality evidence in two ITS studies that introduction of legislation on the use of safety-engineered devices reduced the rate of NSIs among healthcare workers. There was also low quality evidence which showed a decrease in the trend over time for NSI rates.Twenty out of 24 studies had a high risk of bias and the lack of evidence of a beneficial effect could be due to both confounding and bias. This does not mean that these devices are not effective. For safe blood collection systems, we found very low quality evidence of inconsistent effects on NSIs. For safe passive intravenous systems, we found very low quality evidence of a decrease in NSI and a reduction in the incidence of blood leakage events but moderate quality evidence that active systems may increase exposure to blood. For safe injection needles, the introduction of multiple safety devices or the introduction of sharps containers the evidence was inconsistent or there was no clear evidence of a benefit. There was low to moderate quality evidence that introduction of legislation probably reduces NSI rates.More high-quality cluster-randomised controlled studies that include cost-effectiveness measures are needed, especially in countries where both NSIs and blood-borne infections are highly prevalent.

Remote driving with reduced bandwidth communication

NASA Technical Reports Server (NTRS)

Depiero, Frederick W.; Noell, Timothy E.; Gee, Timothy F.

1993-01-01

Oak Ridge National Laboratory has developed a real-time video transmission system for low bandwidth remote operations. The system supports both continuous transmission of video for remote driving and progressive transmission of still images. Inherent in the system design is a spatiotemporal limitation to the effects of channel errors. The average data rate of the system is 64,000 bits/s, a compression of approximately 1000:1 for the black and white National Television Standard Code video. The image quality of the transmissions is maintained at a level that supports teleoperation of a high mobility multipurpose wheeled vehicle at speeds up to 15 mph on a moguled dirt track. Video compression is achieved by using Laplacian image pyramids and a combination of classical techniques. Certain subbands of the image pyramid are transmitted by using interframe differencing with a periodic refresh to aid in bandwidth reduction. Images are also foveated to concentrate image detail in a steerable region. The system supports dynamic video quality adjustments between frame rate, image detail, and foveation rate. A typical configuration for the system used during driving has a frame rate of 4 Hz, a compression per frame of 125:1, and a resulting latency of less than 1s.

42 CFR 422.260 - Appeals of quality bonus payment determinations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... overall star rating. (ii) The reconsideration official's decision is final and binding unless a request... the star ratings (including the calculation of the overall star ratings); cut-off points for determining measure thresholds; the set of measures included in the star rating system; and the methodology...

42 CFR 422.260 - Appeals of quality bonus payment determinations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... overall star rating. (ii) The reconsideration official's decision is final and binding unless a request... the star ratings (including the calculation of the overall star ratings); cut-off points for determining measure thresholds; the set of measures included in the star rating system; and the methodology...

42 CFR 422.260 - Appeals of quality bonus payment determinations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... overall star rating. (ii) The reconsideration official's decision is final and binding unless a request... the star ratings (including the calculation of the overall star ratings); cut-off points for determining measure thresholds; the set of measures included in the star rating system; and the methodology...

42 CFR 422.260 - Appeals of quality bonus payment determinations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... overall star rating. (ii) The reconsideration official's decision is final and binding unless a request... the star ratings (including the calculation of the overall star ratings); cut-off points for determining measure thresholds; the set of measures included in the star rating system; and the methodology...

Practical, Real-Time, and Robust Watermarking on the Spatial Domain for High-Definition Video Contents

NASA Astrophysics Data System (ADS)

Kim, Kyung-Su; Lee, Hae-Yeoun; Im, Dong-Hyuck; Lee, Heung-Kyu

Commercial markets employ digital right management (DRM) systems to protect valuable high-definition (HD) quality videos. DRM system uses watermarking to provide copyright protection and ownership authentication of multimedia contents. We propose a real-time video watermarking scheme for HD video in the uncompressed domain. Especially, our approach is in aspect of practical perspectives to satisfy perceptual quality, real-time processing, and robustness requirements. We simplify and optimize human visual system mask for real-time performance and also apply dithering technique for invisibility. Extensive experiments are performed to prove that the proposed scheme satisfies the invisibility, real-time processing, and robustness requirements against video processing attacks. We concentrate upon video processing attacks that commonly occur in HD quality videos to display on portable devices. These attacks include not only scaling and low bit-rate encoding, but also malicious attacks such as format conversion and frame rate change.

The study of surgical image quality evaluation system by subjective quality factor method

NASA Astrophysics Data System (ADS)

Zhang, Jian J.; Xuan, Jason R.; Yang, Xirong; Yu, Honggang; Koullick, Edouard

2016-03-01

GreenLightTM procedure is an effective and economical way of treatment of benign prostate hyperplasia (BPH); there are almost a million of patients treated with GreenLightTM worldwide. During the surgical procedure, the surgeon or physician will rely on the monitoring video system to survey and confirm the surgical progress. There are a few obstructions that could greatly affect the image quality of the monitoring video, like laser glare by the tissue and body fluid, air bubbles and debris generated by tissue evaporation, and bleeding, just to name a few. In order to improve the physician's visual experience of a laser surgical procedure, the system performance parameter related to image quality needs to be well defined. However, since image quality is the integrated set of perceptions of the overall degree of excellence of an image, or in other words, image quality is the perceptually weighted combination of significant attributes (contrast, graininess …) of an image when considered in its marketplace or application, there is no standard definition on overall image or video quality especially for the no-reference case (without a standard chart as reference). In this study, Subjective Quality Factor (SQF) and acutance are used for no-reference image quality evaluation. Basic image quality parameters, like sharpness, color accuracy, size of obstruction and transmission of obstruction, are used as subparameter to define the rating scale for image quality evaluation or comparison. Sample image groups were evaluated by human observers according to the rating scale. Surveys of physician groups were also conducted with lab generated sample videos. The study shows that human subjective perception is a trustworthy way of image quality evaluation. More systematic investigation on the relationship between video quality and image quality of each frame will be conducted as a future study.

Quality in Family Child Care Settings: The Relationship between Provider Educational Experiences and Global Quality Scores in a Statewide Quality Rating and Improvement System

ERIC Educational Resources Information Center

Hallam, Rena A.; Bargreen, Kaitlin N.; Ridgley, Robyn

2013-01-01

This study is a secondary analysis of a statewide sample of licensed family child care providers in the Tennessee Child Care Evaluation and Report Card Program ("N"?=?1,145) that describes the general quality of family child care programs in the state and examines the relationships between provider education and global quality. Study…

Incentives for cooperation in quality improvement among hospitals--the impact of the reimbursement system.

PubMed

Kesteloot, K; Voet, N

1998-12-01

Up to now, few analytical models have studied the incentives for cooperation in quality improvements among hospitals. Only those dealing with reimbursement systems have shown that, from the point of view of individual or competing hospitals, retrospective reimbursement is more likely to encourage quality improvements than prospective financing, while the reverse holds for efficiency improvements. This paper studies the incentives to improve the quality of hospital care, in an analytical model, taking into account the possibility of cooperative agreements, price besides non-price (quality) competition and quality improvements that may simultaneously increase demand, increase or reduce costs and spill over to rival hospitals. In this setting quality improvement efforts rise with the rate of prospective reimbursement, while the impact of the rate of retrospective reimbursement is ambiguous, but likely to be negative for quality improvements that are highly cost-reducting and create large spillovers. Cooperation may lead to more or less quality improvement than non-cooperative conduct, depending on the magnitude of spillovers and the degree of product market competition, relative to the net effect of quality on profits and the share of costs that is reimbursed retrospectively. Finally, the stability of cooperative agreements, supported by grim trigger strategies, is shown to depend upon exactly the opposite interaction between these factors.

Health-Related Quality of Life Among US Workers: Variability Across Occupation Groups.

PubMed

Shockey, Taylor M; Zack, Matthew; Sussell, Aaron

2017-08-01

To examine the health-related quality of life among workers in 22 standard occupation groups using data from the 2013-2014 US Behavioral Risk Factor Surveillance System. We examined the health-related quality of life measures of self-rated health, frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days by occupation group for 155 839 currently employed adults among 17 states. We performed multiple logistic regression analyses that accounted for the Behavioral Risk Factor Surveillance System's complex survey design to obtain prevalence estimates adjusted for potential confounders. Among all occupation groups, the arts, design, entertainment, sports, and media occupation group reported the highest adjusted prevalence of frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days. The personal care and service occupation group had the highest adjusted prevalence for fair or poor self-rated health. Workers' jobs affect their health-related quality of life.

Examining the Relationship Between Perceived Quality of Care and Actual Quality of Care as Measured by 30-Day Readmission Rates.

PubMed

Salinas, Stanley R

To test the relationship between patient experience, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and actual quality of care, as measured by 30-day readmission rates. Both HCAHPS data and outcome data reported to the Centers of Medicare & Medicaid Services (CMS). This secondary, nationwide (N = 4060), hospital-level study focused only on acute care hospitals. HCAHPS question 22 "Would you recommend this hospital to your friends and family?" was used to determine level of overall satisfaction, and 30-day readmission rates, as reported to the CMS, was used as a proxy for actual quality of care. A statistically significant relationship was found between patient experience and actual quality outcomes. The results of this study reinforce the inclusion of patient experience in Medicare's Value Based Purchasing program as a matter of good public policy.

Effects of 1992 farming systems on ground-water quality at the management systems evaluation area near Princeton, Minnesota

USGS Publications Warehouse

Delin, G.N.; Landon, M.K.; Lamb, J.A.; Dowdy, R.H.

1995-01-01

Results indicate that the effects of the 1992 potassium-chloride and N fertilizer applications were reduced compared to the effects of 1991 applications. The most important factors associated with these differences were lower chemical application rates and lower recharge rates during 1992 than during 1991. Some of the chloride and N fertilizer applied to the cropped areas in 1992 likely did not reach the saturated zone in 1993 due to a 60-percent reduction in recharge compared to 1991. Therefore, analysis of data from additional years will be required to fully evaluate the effects of the fanning systems on ground-water quality.

Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa

PubMed Central

Jaya, Ziningi; Drain, Paul K.

2017-01-01

Introduction Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC) clinics in rural KwaZulu-Natal (KZN), South Africa. Material and methods We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic’s compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor). A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05. Results Nine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2%) of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics’ average rating score for compliance to the WHO guidelines ranged between 64.4% (CI: 44%– 84%) and 89.2% (CI: 74%– 100%).Ten out of eleven of the clinics were rated as moderate (70–89%). All clinic have scored highest for the following audit component: equipment; process control and specimen management; and facility ad safety, with 100%. Clinics obtained the lowest scores for the assessment audit component followed by process improvement and organisation, with 40.9% (CI: 15.7–66.1%), 45.5% (CI: 10.4–80.5%) and 56.8% (CI: 31.8 81.8%), respectively. A statistically significant correlation was observed between the following: category of staff performing the HIV rapid tests in the audited clinics and service and satisfactory audit component; weekly average number of patients using the audited PHC clinics and service and satisfactory audit component; number of HIV lay counsellors in the audited clinics and quality control audit component with p<0.05. Discussion In the small audit of primary healthcare clinics located within the rural part of KwaZulu-Natal, results revealed an overall moderate rating of the quality management system for rapid HIV testing. Improvements in the organisation, quality control, process improvement and assessment components could enable a higher quality assurance rating for rural HIV testing in KwaZulu-Natal. PMID:28829801

Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa.

PubMed

Jaya, Ziningi; Drain, Paul K; Mashamba-Thompson, Tivani P

2017-01-01

Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC) clinics in rural KwaZulu-Natal (KZN), South Africa. We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic's compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor). A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05. Nine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2%) of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics' average rating score for compliance to the WHO guidelines ranged between 64.4% (CI: 44%- 84%) and 89.2% (CI: 74%- 100%).Ten out of eleven of the clinics were rated as moderate (70-89%). All clinic have scored highest for the following audit component: equipment; process control and specimen management; and facility ad safety, with 100%. Clinics obtained the lowest scores for the assessment audit component followed by process improvement and organisation, with 40.9% (CI: 15.7-66.1%), 45.5% (CI: 10.4-80.5%) and 56.8% (CI: 31.8 81.8%), respectively. A statistically significant correlation was observed between the following: category of staff performing the HIV rapid tests in the audited clinics and service and satisfactory audit component; weekly average number of patients using the audited PHC clinics and service and satisfactory audit component; number of HIV lay counsellors in the audited clinics and quality control audit component with p<0.05. In the small audit of primary healthcare clinics located within the rural part of KwaZulu-Natal, results revealed an overall moderate rating of the quality management system for rapid HIV testing. Improvements in the organisation, quality control, process improvement and assessment components could enable a higher quality assurance rating for rural HIV testing in KwaZulu-Natal.

Speech Clarity Index (Ψ): A Distance-Based Speech Quality Indicator and Recognition Rate Prediction for Dysarthric Speakers with Cerebral Palsy

NASA Astrophysics Data System (ADS)

Kayasith, Prakasith; Theeramunkong, Thanaruk

It is a tedious and subjective task to measure severity of a dysarthria by manually evaluating his/her speech using available standard assessment methods based on human perception. This paper presents an automated approach to assess speech quality of a dysarthric speaker with cerebral palsy. With the consideration of two complementary factors, speech consistency and speech distinction, a speech quality indicator called speech clarity index (Ψ) is proposed as a measure of the speaker's ability to produce consistent speech signal for a certain word and distinguished speech signal for different words. As an application, it can be used to assess speech quality and forecast speech recognition rate of speech made by an individual dysarthric speaker before actual exhaustive implementation of an automatic speech recognition system for the speaker. The effectiveness of Ψ as a speech recognition rate predictor is evaluated by rank-order inconsistency, correlation coefficient, and root-mean-square of difference. The evaluations had been done by comparing its predicted recognition rates with ones predicted by the standard methods called the articulatory and intelligibility tests based on the two recognition systems (HMM and ANN). The results show that Ψ is a promising indicator for predicting recognition rate of dysarthric speech. All experiments had been done on speech corpus composed of speech data from eight normal speakers and eight dysarthric speakers.

Implementation and quality assessment of a pharmacy services call center for outpatient pharmacies and specialty pharmacy services in an academic health system.

PubMed

Rim, Matthew H; Thomas, Karen C; Chandramouli, Jane; Barrus, Stephanie A; Nickman, Nancy A

2018-05-15

The implementation and quality assessment of a pharmacy services call center (PSCC) for outpatient pharmacies and specialty pharmacy services within an academic health system are described. Prolonged wait times in outpatient pharmacies or hold times on the phone affect the ability of pharmacies to capture and retain prescriptions. To support outpatient pharmacy operations and improve quality, a PSCC was developed to centralize handling of all outpatient and specialty pharmacy calls. The purpose of the PSCC was to improve the quality of pharmacy telephone services by (1) decreasing the call abandonment rate, (2) improving the speed of answer, (3) increasing first-call resolution, (4) centralizing all specialty pharmacy and prior authorization calls, (5) increasing labor efficiency and pharmacy capacities, (6) implementing a quality evaluation program, and (7) improving workplace satisfaction and retention of outpatient pharmacy staff. The PSCC centralized pharmacy calls from 9 pharmacy locations, 2 outpatient clinics, and a specialty pharmacy. Since implementation, the PSCC has achieved and maintained program goals, including improved abandonment rate, speed of answer, and first-call resolution. A centralized 24-7 support line for specialty pharmacy patients was also successfully established. A quality calibration program was implemented to ensure service quality and excellent patient experience. Additional ongoing evaluations measure the impact of the PSCC on improving workplace satisfaction and retention of outpatient pharmacy staff. The design and implementation of the PSCC have significantly improved the health system's patient experiences, efficiency, and quality. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

A Blueprint for Early Care and Education Quality Improvement Initiatives. Publication #2015-07

ERIC Educational Resources Information Center

Tout, Kathryn; Epstein, Dale; Soli, Meg; Lowe, Claire

2015-01-01

As Quality Rating and Improvement Systems (QRIS) continue to launch and mature across states, questions emerge from stakeholders about how to design and implement effective quality improvement (QI) initiatives that accompany a QRIS. Funders, policymakers, and program developers with limited resources are looking to invest in activities that will…

[Integrated Quality Management System (IQMS): a model for improving the quality of reproductive health care in rural Kenya].

PubMed

Herrler, Claudia; Bramesfeld, Anke; Brodowski, Marc; Prytherch, Helen; Marx, Irmgard; Nafula, Maureen; Richter-Aairijoki, Heide; Musyoka, Lucy; Marx, Michael; Szecsenyi, Joachim

2015-01-01

To develop a model aiming to improve the quality of services for reproductive health care in rural Kenya and designed to measure the quality of reproductive health services in such a way that allows these services to identify measures for improving their performance. The Integrated Quality Management System (IQMS) was developed on the basis of a pre-existing and validated model for quality promotion, namely the European Practice Assessment (EPA). The methodology for quality assessment and feedback of assessment results to the service teams was adopted from the EPA model. Quality assessment methodology included data assessment through staff, patient surveys and service visitation. Quality is assessed by indicators, and so indicators had to be developed that were appropriate for assessing reproductive health care in rural Kenya. A search of the Kenyan and international literature was conducted to identify potential indicators. These were then rated for their relevance and clarity by a panel of Kenyan experts. 260 indicators were rated as relevant and assigned to 29 quality dimensions and 5 domains. The implementation of IQMS in ten facilities showed that IQMS is a feasible model for assessing the quality of reproductive health services in rural Kenya. IQMS enables these services to identify quality improvement targets and necessary improvement measures. Both strengths and limitations of IQMS will be discussed. Copyright © 2015. Published by Elsevier GmbH.

Development and evaluation of an instantaneous atmospheric corrosion rate monitor

NASA Astrophysics Data System (ADS)

Mansfeld, F.; Jeanjaquet, S. L.; Kendig, M. W.; Roe, D. K.

1985-06-01

A research program was carried out in which a new instantaneous atmospheric corrosion rate monitor (ACRM) was developed and evaluated, and equipment was constructed which will allow the use of many sensors in an economical way in outdoor exposures. In the first task, the ACRM was developed and tested in flow chambers in which relative humidity and gaseous and particulate pollutant levels can be controlled. Diurnal cycles and periods of rain were simulated. The effects of aerosols were studied. A computerized system was used for collection, storage, and analysis of the electrochemical data. In the second task, a relatively inexpensive electronics system for control of the ACRM and measurement of atmospheric corrosion rates was designed and built. In the third task, calibration of deterioration rates of various metallic and nonmetallic materials with the response of the ACRMs attached to these materials was carried out under controlled environmental conditions using the system developed in the second task. A Quality Assurance project plan was prepared with inputs from the Rockwell International Environmental Monitoring and Service Center and Quality Assurance System audits were performed.

Improving Immunization Rates Using Lean Six Sigma Processes: Alliance of Independent Academic Medical Centers National Initiative III Project.

PubMed

Hina-Syeda, Hussaini; Kimbrough, Christina; Murdoch, William; Markova, Tsveti

2013-01-01

Quality improvement education and work in interdisciplinary teams is a healthcare priority. Healthcare systems are trying to meet core measures and provide excellent patient care, thus improving their Hospital Consumer Assessment of Healthcare Providers & Systems scores. Crittenton Hospital Medical Center in Rochester Hills, MI, aligned educational and clinical objectives, focusing on improving immunization rates against pneumonia and influenza prior to the rates being implemented as core measures. Improving immunization rates prevents infections, minimizes hospitalizations, and results in overall improved patient care. Teaching hospitals offer an effective way to work on clinical projects by bringing together the skill sets of residents, faculty, and hospital staff to achieve superior results. WE DESIGNED AND IMPLEMENTED A STRUCTURED CURRICULUM IN WHICH INTERDISCIPLINARY TEAMS ACQUIRED KNOWLEDGE ON QUALITY IMPROVEMENT AND TEAMWORK, WHILE FOCUSING ON A SPECIFIC CLINICAL PROJECT: improving global immunization rates. We used the Lean Six Sigma process tools to quantify the initial process capability to immunize against pneumococcus and influenza. The hospital's process to vaccinate against pneumonia overall was operating at a Z score of 3.13, and the influenza vaccination Z score was 2.53. However, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 1.96. Improvement in immunization rates of high-risk patients became the focus of the project. After the implementation of solutions, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 3.9 with a defects/million opportunities rate of 9,346 and a yield of 93.5%. Revisions to the adult assessment form fixed 80% of the problems identified. This process improvement project was not only beneficial in terms of improved quality of patient care but was also a positive learning experience for the interdisciplinary team, particularly for the residents. The hospital has completed quality improvement projects in the past; however, this project was the first in which residents were actively involved. The didactic components and experiential learning were powerfully synergistic. This and similar projects can have far-reaching implications in terms of promoting patient health and improving the quality of care delivered by the healthcare systems and teaching hospitals.

Effect of Nutrient Management Planning on Crop Yield, Nitrate Leaching and Sediment Loading in Thomas Brook Watershed

NASA Astrophysics Data System (ADS)

Amon-Armah, Frederick; Yiridoe, Emmanuel K.; Ahmad, Nafees H. M.; Hebb, Dale; Jamieson, Rob; Burton, David; Madani, Ali

2013-11-01

Government priorities on provincial Nutrient Management Planning (NMP) programs include improving the program effectiveness for environmental quality protection, and promoting more widespread adoption. Understanding the effect of NMP on both crop yield and key water-quality parameters in agricultural watersheds requires a comprehensive evaluation that takes into consideration important NMP attributes and location-specific farming conditions. This study applied the Soil and Water Assessment Tool (SWAT) to investigate the effects of crop and rotation sequence, tillage type, and nutrient N application rate on crop yield and the associated groundwater leaching and sediment loss. The SWAT model was applied to the Thomas Brook Watershed, located in the most intensively managed agricultural region of Nova Scotia, Canada. Cropping systems evaluated included seven fertilizer application rates and two tillage systems (i.e., conventional tillage and no-till). The analysis reflected cropping systems commonly managed by farmers in the Annapolis Valley region, including grain corn-based and potato-based cropping systems, and a vegetable-horticulture system. ANOVA models were developed and used to assess the effects of crop management choices on crop yield and two water-quality parameters (i.e., leaching and sediment loading). Results suggest that existing recommended N-fertilizer rate can be reduced by 10-25 %, for grain crop production, to significantly lower leaching ( P > 0.05) while optimizing the crop yield. The analysis identified the nutrient N rates in combination with specific crops and rotation systems that can be used to manage leaching while balancing impacts on crop yields within the watershed.

Designing and implementing a trust-wide quality assurance programme.

PubMed

Coope, Sally-Ann

2018-04-02

Derbyshire Community Health Services (DCHS) NHS Foundation Trust provides a wide range of community-based health services. After the Care Quality Commission (CQC) found gaps in the trust's assurance process, its board decided to develop a method of continuous quality improvements that could be used as a basis for the trust's quality assurance system. The trust adapted and built on an acute model so it was suitable for community services. The final assurance system, Quality Always, has four elements: the clinical assessment and accreditation scheme; leadership development; 'champions' within clinical teams to support and promote the scheme; and dashboards to record and monitor progress. A system to recognise and reward achievement was essential for success. Quality Always has resulted in better care quality, an improved CQC rating, a sense of achievement among staff, the development of support networks, learning (especially among support staff) and good practice being shared.

Asset deterioration and discolouration in water distribution systems.

PubMed

Husband, P S; Boxall, J B

2011-01-01

Water Distribution Systems function to supply treated water safe for human consumption and complying with increasingly stringent quality regulations. Considered primarily an aesthetic issue, discolouration is the largest cause of customer dissatisfaction associated with distribution system water quality. Pro-active measures to prevent discolouration are sought yet network processes remain insufficiently understood to fully justify and optimise capital or operational strategies to manage discolouration risk. Results are presented from a comprehensive fieldwork programme in UK water distribution networks that have determined asset deterioration with respect to discolouration. This is achieved by quantification of material accumulating as cohesive layers on pipe surfaces that when mobilised are acknowledged as the primary cause of discolouration. It is shown that these material layers develop ubiquitously with defined layer strength characteristics and at a consistent and repeatable rate dependant on water quality. For UK networks iron concentration in the bulk water is shown as a potential indicator of deterioration rate. With material layer development rates determined, management decisions that balance discolouration risk and expenditure to maintain water quality integrity can be justified. In particular the balance between capital investment such as improving water treatment output or pipe renewal and operational expenditure such as the frequency of network maintenance through flushing may be judged. While the rate of development is shown to be a function of water quality, the magnitude (peak or average turbidity) of discolouration incidents is shown to be dominated by hydraulic conditions. From this it can be proposed that network hydraulic management, such as regular periodic 'stressing', is a potential strategy in reducing discolouration risk. The ultimate application of this is the hydraulic design of self-cleaning networks to maintain discolouration risk below acceptable levels. Copyright © 2010 Elsevier Ltd. All rights reserved.

An Analysis of Total Quality Management in Aeronautical Systems Division

DTIC Science & Technology

1991-09-01

Annual Review ..... ......... . 3-51 Disease 4: Mobility of Top Management ................... .3-52 Disease 5: Running a Company on Visible Figures...range Planning .................... 5-4 Merit Rating Systems and Annual Evaluation of Performance .. ..... ........... 5-4 Mobility of Management...generations of careful quality-conscious buyers. The indus- trial engine ran on the talents of designers, packagers, and advertisers . Turning out new

Improving Quality for Child Care Centers in Greater Philadelphia: An Evaluation of Success by 6®. Technical Appendix. Publication #2016-07B

ERIC Educational Resources Information Center

Warner-Richter, Mallory; Lowe, Claire; Tout, Kathryn; Epstein, Dale; Li, Weilin

2016-01-01

The Success By 6® (SB6) initiative is designed to support early care and education centers in improving and sustaining quality in Pennsylvania's Keystone STARS Quality Rating and Improvement System (QRIS). The SB6 evaluation report examines implementation and outcomes. The findings have implications for SB6 continous quality improvement process…

Improving Quality for Child Care Centers in Greater Philadelphia: An Evaluation of Success by 6®. Executive Summary. Publication #2016-07A

ERIC Educational Resources Information Center

Warner-Richter, Mallory; Lowe, Claire; Tout, Kathryn; Epstein, Dale; Li, Weilin

2016-01-01

The Success By 6® (SB6) initiative is designed to support early care and education centers in improving and sustaining quality in Pennsylvania's Keystone STARS Quality Rating and Improvement System (QRIS). The SB6 evaluation report examines implementation and outcomes. The findings have implications for SB6 continous quality improvement process…

Improving Quality for Child Care Centers in Greater Philadelphia: An Evaluation of Success by 6®. Program Design Appendix. Publication #2016-07C

ERIC Educational Resources Information Center

Warner-Richter, Mallory; Lowe, Claire; Tout, Kathryn; Epstein, Dale; Li, Weilin

2016-01-01

The Success By 6® (SB6) initiative is designed to support early care and education centers in improving and sustaining quality in Pennsylvania's Keystone STARS Quality Rating and Improvement System (QRIS). The SB6 evaluation report examines implementation and outcomes. The findings have implications for SB6 continous quality improvement process…

Improving Quality for Child Care Centers in Greater Philadelphia: An Evaluation of Success by 6®. Final Report. Publication #2016-07

ERIC Educational Resources Information Center

Warner-Richter, Mallory; Lowe, Claire; Tout, Kathryn; Epstein, Dale; Li, Weilin

2016-01-01

The Success By 6® (SB6) initiative is designed to support early care and education centers in improving and sustaining quality in Pennsylvania's Keystone STARS Quality Rating and Improvement System (QRIS). This SB6 evaluation report examines implementation and outcomes. The findings have implications for SB6 continous quality improvement process…

How can we improve stroke thrombolysis rates? A review of health system factors and approaches associated with thrombolysis administration rates in acute stroke care.

PubMed

Paul, Christine L; Ryan, Annika; Rose, Shiho; Attia, John R; Kerr, Erin; Koller, Claudia; Levi, Christopher R

2016-04-08

Thrombolysis using intravenous (IV) tissue plasminogen activator (tPA) is one of few evidence-based acute stroke treatments, yet achieving high rates of IV tPA delivery has been problematic. The 4.5-h treatment window, the complexity of determining eligibility criteria and the availability of expertise and required resources may impact on treatment rates, with barriers encountered at the levels of the individual clinician, the social context and the health system itself. The review aimed to describe health system factors associated with higher rates of IV tPA administration for ischemic stroke and to identify whether system-focussed interventions increased tPA rates for ischemic stroke. Published original English-language research from four electronic databases spanning 1997-2014 was examined. Observational studies of the association between health system factors and tPA rates were described separately from studies of system-focussed intervention strategies aiming to increase tPA rates. Where study outcomes were sufficiently similar, a pooled meta-analysis of outcomes was conducted. Forty-one articles met the inclusion criteria: 7 were methodologically rigorous interventions that met the Cochrane Collaboration Evidence for Practice and Organization of Care (EPOC) study design guidelines and 34 described observed associations between health system factors and rates of IV tPA. System-related factors generally associated with higher IV tPA rates were as follows: urban location, centralised or hub and spoke models, treatment by a neurologist/stroke nurse, in a neurology department/stroke unit or teaching hospital, being admitted by ambulance or mobile team and stroke-specific protocols. Results of the intervention studies suggest that telemedicine approaches did not consistently increase IV tPA rates. Quality improvement strategies appear able to provide modest increases in stroke thrombolysis (pooled odds ratio = 2.1, p = 0.05). In order to improve IV tPA rates in acute stroke care, specific health system factors need to be targeted. Multi-component quality improvement approaches can improve IV tPA rates for stroke, although more thoughtfully designed and well-reported trials are required to safely increase rates of IV tPA to eligible stroke patients.

Does the Quality of SafeTalk Motivational Interviewing Counseling Predict Sexual Behavior Outcomes among People Living with HIV?

PubMed Central

Grodensky, Catherine; Golin, Carol; Parikh, Megha A.; Ochtera, Rebecca; Kincaid, Carlye; Groves, Jennifer; Widman, Laura; Suchindran, Chirayath; McGirt, Camille; Amola, Kemi; Bradley-Bull, Steven

2017-01-01

Objective Although past research has demonstrated a link between the quality of motivational interviewing (MI) counseling and client behavior change, this relationship has not been examined in the context of sexual risk behavior among people living with HIV/AIDS. We studied MI quality and unprotected anal/vaginal intercourse (UAVI) in the context of SafeTalk, an evidence-based secondary HIV prevention intervention. Methods We used a structured instrument (the MISC 2.0 coding system) as well as a client-reported instrument to rate intervention sessions on aspects of MI quality. Then we correlated client-reported UAVI with specific counseling behaviors and the proportion of interactions that achieved MI quality benchmarks. Results/Conclusion Higher MISC-2.0 global ratings and a higher ratio of reflections to questions both significantly predicted fewer UAVI acts at 8-month follow-up. Analysis of client ratings, which was more exploratory, showed that clients who rated their sessions higher in counselor acceptance, client disclosure, and relevance reported higher numbers of UAVIs, whereas clients who selected higher ratings for perceived benefit were more likely to have fewer UAVI episodes. Practice Implications Further research is needed to determine the best methods of translating information about MI quality into dissemination of effective MI interventions with people living with HIV. PMID:27567497

Does the quality of safetalk motivational interviewing counseling predict sexual behavior outcomes among people living with HIV?

PubMed

Grodensky, Catherine; Golin, Carol; Parikh, Megha A; Ochtera, Rebecca; Kincaid, Carlye; Groves, Jennifer; Widman, Laura; Suchindran, Chirayath; McGirt, Camille; Amola, Kemi; Bradley-Bull, Steven

2017-01-01

Although past research has demonstrated a link between the quality of motivational interviewing (MI) counseling and client behavior change, this relationship has not been examined in the context of sexual risk behavior among people living with HIV/AIDS. We studied MI quality and unprotected anal/vaginal intercourse (UAVI) in the context of SafeTalk, an evidence-based secondary HIV prevention intervention. We used a structured instrument (the MISC 2.0 coding system) as well as a client-reported instrument to rate intervention sessions on aspects of MI quality. Then we correlated client-reported UAVI with specific counseling behaviors and the proportion of interactions that achieved MI quality benchmarks. Higher MISC-2.0 global ratings and a higher ratio of reflections to questions both significantly predicted fewer UAVI acts at 8-month follow-up. Analysis of client ratings, which was more exploratory, showed that clients who rated their sessions higher in counselor acceptance, client disclosure, and relevance reported higher numbers of UAVIs, whereas clients who selected higher ratings for perceived benefit were more likely to have fewer UAVI episodes. Further research is needed to determine the best methods of translating information about MI quality into dissemination of effective MI interventions with people living with HIV. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Effects of stick dynamics on helicopter flying qualities

NASA Technical Reports Server (NTRS)

Watson, Douglas C.; Schroeder, Jeffery A.

1990-01-01

An experiment that investigated the influence of typical helicopter force-feel system dynamics on roll-axis handling qualities was conducted in concurrent ground and inflight simulations. Variations in lateral control natural frequency and damping ratio, effected by changes in inertia and damping, were evaluated in a disturbance-rejection task. Pilot ratings indicated a preference for low-inertia feel systems, although measured performance was relatively constant over the range of stick characteristics. Force-sensing was compared with position sensing as the input to the control system. Force-sensing improved performance but did not improve pilot ratings. Overall, the results indicated that control-stick dynamics, at least within a reasonable range, did not have a significant effect on pilot-vehicle performance. However, the physical effort required to maintain a desired pilot/manipulator bandwidth became objectionable as the stick inertia increased beyond 5-7 lbm, which was reflected in the pilot ratings and comments.

Paediatric cerebrovascular CT angiography—towards better image quality

PubMed Central

Thust, Stefanie C.; Chong, Wui Khean Kling; Gunny, Roxana; Mazumder, Asif; Poitelea, Marius; Welsh, Anna; Ederies, Ash

2014-01-01

Background Paediatric cerebrovascular CT angiography (CTA) can be challenging to perform due to variable cardiovascular physiology between different age groups and the risk of movement artefact. This analysis aimed to determine what proportion of CTA at our institution was of diagnostic quality and identify technical factors which could be improved. Materials and methods a retrospective analysis of 20 cases was performed at a national paediatric neurovascular centre assessing image quality with a subjective scoring system and Hounsfield Unit (HU) measurements. Demographic data, contrast dose, flow rate and triggering times were recorded for each patient. Results Using a qualitative scoring system, 75% of studies were found to be of diagnostic quality (n=9 ‘good’, n=6 ‘satisfactory’) and 25% (n=5) were ‘poor’. Those judged subjectively to be poor had arterial contrast density measured at less than 250 HU. Increased arterial opacification was achieved for cases performed with an increased flow rate (2.5-4 mL/s) and higher intravenous contrast dose (2 mL/kg). Triggering was found to be well timed in nine cases, early in four cases and late in seven cases. Of the scans triggered early, 75% were poor. Of the scans triggered late, less (29%) were poor. Conclusions High flow rates (>2.5 mL/s) were a key factor for achieving high quality paediatric cerebrovascular CTA imaging. However, appropriate triggering by starting the scan immediately on contrast opacification of the monitoring vessel plays an important role and could maintain image quality when flow rates were lower. Early triggering appeared more detrimental than late. PMID:25525579

The Quality of Nurses' Work Environment and Workforce Outcomes From the Perspective of Swiss Allied Healthcare Assistants and Registered Nurses: A Cross-Sectional Survey.

PubMed

Lacher, Stefanie; De Geest, Sabina; Denhaerynck, Kris; Trede, Ines; Ausserhofer, Dietmar

2015-09-01

Anticipating nursing shortages, the Swiss healthcare system recently introduced the position of allied healthcare assistant (AHA). However, indicators of AHAs' integration and stability, particularly their perceptions of their work environment quality and related outcomes (i.e., burnout, job satisfaction, and intention to leave), remain unclear. (a) To describe AHAs' ratings of the quality of the nurse work environment, job satisfaction, burnout, and intention to leave their workplaces; (b) to compare AHAs' and registered nurses' (RNs') work environment quality ratings and related outcomes; and (c) to assess links between AHAs' work environment quality ratings and related workforce outcomes. A secondary analysis of RN4CAST data (October 2009 to June 2010) on 61 AHAs and 466 RNs in 13 Swiss acute care hospitals. We used descriptive statistics to summarize data of AHAs and RNs on their units and hospitals. Via binary logistic regression models, we compared AHAs and RNs and identified associations between work environment ratings and workforce outcomes. AHAs' work environment quality ratings were significantly higher than those of RNs, and were associated with lower odds of burnout and intention to leave their current job and higher odds of reported job satisfaction. This study provides primary evidence linking AHAs' work environment quality ratings to burnout, job satisfaction, and intention to leave in acute care hospitals. Given the increasing importance of AHAs for nursing care provision, hospitals should assess the quality of nurse work environment and nurse outcomes from the perspective of all nurses. © 2015 Sigma Theta Tau International.

Interaction of feel system and flight control system dynamics on lateral flying qualities

NASA Technical Reports Server (NTRS)

Bailey, R. E.; Knotts, L. H.

1990-01-01

An experimental investigation of the influence of lateral feel system characteristics on fighter aircraft roll flying qualities was conducted using the variable stability USAF NT-33. Forty-two evaluation flights were flown by three engineering test pilots. The investigation utilized the power approach, visual landing task and up-and-away tasks including formation, gun tracking, and computer-generated compensatory attitude tracking tasks displayed on the Head-Up Display. Experimental variations included the feel system frequency, force-deflection gradient, control system command type (force or position input command), aircraft roll mode time constant, control system prefilter frequency, and control system time delay. The primary data were task performance records and evaluation pilot comments and ratings using the Cooper-Harper scale. The data highlight the unique and powerful effect of the feel system of flying qualities. The data show that the feel system is not 'equivalent' in flying qualities influence to analogous control system elements. A lower limit of allowable feel system frequency appears warranted to ensure good lateral flying qualities. Flying qualities criteria should most properly treat the feel system dynamic influence separately from the control system, since the input and output of this dynamic element is apparent to the pilot and thus, does not produce a 'hidden' effect.

PILOT SCALE WATER REUSE SYSTEM

EPA Science Inventory

The efficiency of the treatment technologies is expected to vary with the source water quality. By testing the technologies with various source waters, the research will quantify the limits of the technology: testing the flow rate variations with influent water quality, evalu...

The effect of jitter on the performance of space coherent optical communication system with Costas loop

NASA Astrophysics Data System (ADS)

Li, Xin; Hong, Yifeng; Wang, Jinfang; Liu, Yang; Sun, Xun; Li, Mi

2018-01-01

Numerous communication techniques and optical devices successfully applied in space optical communication system indicates a good portability of it. With this good portability, typical coherent demodulation technique of Costas loop can be easily adopted in space optical communication system. As one of the components of pointing error, the effect of jitter plays an important role in the communication quality of such system. Here, we obtain the probability density functions (PDF) of different jitter degrees and explain their essential effect on the bit error rate (BER) space optical communication system. Also, under the effect of jitter, we research the bit error rate of space coherent optical communication system using Costas loop with different system parameters of transmission power, divergence angle, receiving diameter, avalanche photodiode (APD) gain, and phase deviation caused by Costas loop. Through a numerical simulation of this kind of communication system, we demonstrate the relationship between the BER and these system parameters, and some corresponding methods of system optimization are presented to enhance the communication quality.

Reverse Stability Kinetics of Meat Pigment Oxidation in Aqueous Extract from Fresh Beef.

PubMed

Frelka, John C; Phinney, David M; Wick, Macdonald P; Heldman, Dennis R

2017-12-01

The use of kinetic models is an evolving approach to describing quality changes in foods during processes, including storage. Previous studies indicate that the oxidation rate of myoglobin is accelerated under frozen storage conditions, a phenomenon termed reverse stability. The goal of this study was to develop a model for meat pigment oxidation to incorporate the phenomenon of reverse stability. In this investigation, the model system was an aqueous extract from beef which was stored under a range of temperatures, both unfrozen and frozen. The kinetic analysis showed that in unfrozen solutions, the temperature dependence of oxidation rate followed Arrhenius kinetics. However, under in frozen solutions the rate of oxidation increased with decreasing temperature until reaching a local maximum around -20 °C. The addition of NaCl to the model system increased oxidation rates at all temperatures, even above the initial freezing temperature. This observation suggests that this reaction is dependent on the ionic strength of the solution as well as temperature. The mechanism of this deviant kinetic behavior is not fully understood, but this study shows that the interplay of temperature and composition on the rate of oxidation of meat pigments is complicated and may involve multiple mechanisms. A better understanding of the kinetics of quality loss in a meat system allows for a re-examination of the current recommendations for frozen storage. The deviant kinetic behavior observed in this study indicates that the relationship between quality loss and temperature in a frozen food is not as simple as once thought. Product-specific recommendations could be implemented in the future that would allow for a decrease in energy consumption without a significant loss of quality. © 2017 Institute of Food Technologists®.

Methodological quality of the injury surveillance system used in international athletics championships.

PubMed

Edouard, Pascal; Branco, Pedro; Alonso, Juan Manuel; Junge, Astrid

2016-12-01

Incidence and prevalence data obtained from injury surveillance studies could be biased by the response rate as well as by the completeness and quality of the reports. It therefore appears crucial to analyse the quality of the injury surveillance system itself and thereby validate the quality of the data. This study aimed to analyse the quality of and compliance with the injury surveillance system implemented during international athletics championships. Prospective, epidemiological study. The national medical teams and the local organising committee physicians daily reported all injuries on a standardised injury report form during 14 international athletics championships from 2007 to 2015. The quality of the injury surveillance system was analysed following the guidelines laid down by the Centre for Disease Control and Prevention. On average 41.7±17.4% (mean±standard deviation) of all registered countries participated in the injury surveillance project, accounting for a coverage of athletes of 79.5±10.2% of all registered athletes. Their medical staff returned 89.2±8.4% of the expected injury report forms (information is missing for one championship). The completeness of injury data provided by medical teams and local organising committee physicians averaged 95.8±6.5%. National medical teams reported 60.6±16.6% of all injuries, and local organising committee physicians 28.7±15.0% whereas 10.6±6.5% of injuries were reported by both. The injury surveillance system used during international athletics championships provided good national medical team participation, coverage of athletes, response rate, and completeness of reports. These parameters should be systematically reported for injury surveillance studies to show the quality of the study. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

An analytical study of aircraft lateral-directional handling qualities using pilot models

NASA Technical Reports Server (NTRS)

Adams, J. J.; Moore, F. L.

1976-01-01

A procedure for predicting lateral-directional pilot ratings on the basis of the characteristics of the pilot model and the closed-loop system characteristics is demonstrated. A correlation is shown to exist between experimentally obtained pilot ratings and the computed pilot ratings.

Correlations between quality ratings of skilled nursing facilities and multidrug-resistant urinary tract infections.

PubMed

Gucwa, Azad L; Dolar, Veronika; Ye, Chao; Epstein, Stephanie

2016-11-01

The purpose of this study was to determine risk factors for the acquisition of urinary tract infections (UTIs) and multidrug-resistant organisms (MDROs) in residents of skilled nursing facilities (SNFs). Using the informational database provided by the Centers for Medicare and Medicaid Services (CMS), a retrospective logistic regression was performed on 1,523 urine cultures from 12 SNFs located in Long Island, New York. Of the 1,142 positive urine cultures, Escherichia coli was most prevalent. Additionally, 164 (14.4%) of the UTIs were attributed to an MDRO. In multivariate logistic regression, sex and overall quality rating predicted the occurrence of UTIs, whereas identification of MDROs was dependent on the level of nursing care received. The mean predicted probability of UTIs and receipt of contaminated samples was inversely dependent on the facility's rating, where the likelihood increased as overall quality ratings decreased. The CMS's quality rating system may provide some insight into the status of infection control practices in SNFs. The results of this study suggest that potential consumers should focus on the overall star ratings and the competency of the nursing staff in these facilities rather than on individual quality measures. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Algorithms to qualify respiratory data collected during the transport of trauma patients.

PubMed

Chen, Liangyou; McKenna, Thomas; Reisner, Andrew; Reifman, Jaques

2006-09-01

We developed a quality indexing system to numerically qualify respiratory data collected by vital-sign monitors in order to support reliable post-hoc mining of respiratory data. Each monitor-provided (reference) respiratory rate (RR(R)) is evaluated, second-by-second, to quantify the reliability of the rate with a quality index (QI(R)). The quality index is calculated from: (1) a breath identification algorithm that identifies breaths of 'typical' sizes and recalculates the respiratory rate (RR(C)); (2) an evaluation of the respiratory waveform quality (QI(W)) by assessing waveform ambiguities as they impact the calculation of respiratory rates and (3) decision rules that assign a QI(R) based on RR(R), RR(C) and QI(W). RR(C), QI(W) and QI(R) were compared to rates and quality indices independently determined by human experts, with the human measures used as the 'gold standard', for 163 randomly chosen 15 s respiratory waveform samples from our database. The RR(C) more closely matches the rates determined by human evaluation of the waveforms than does the RR(R) (difference of 3.2 +/- 4.6 breaths min(-1) versus 14.3 +/- 19.3 breaths min(-1), mean +/- STD, p < 0.05). Higher QI(W) is found to be associated with smaller differences between calculated and human-evaluated rates (average differences of 1.7 and 8.1 breaths min(-1) for the best and worst QI(W), respectively). Establishment of QI(W) and QI(R), which ranges from 0 for the worst-quality data to 3 for the best, provides a succinct quantitative measure that allows for automatic and systematic selection of respiratory waveforms and rates based on their data quality.

QRIS and Inclusion: Do State QRIS Standards Support the Learning Needs of All Children? CEELO FastFact

ERIC Educational Resources Information Center

Horowitz, Michelle; Squires, Jim

2014-01-01

As the country quickly builds its efforts to enhance quality in early education and care classrooms, states are implementing Quality Rating and Improvement Systems (QRIS) to recognize and improve the quality of programs. QRIS also provides technical support and increased financial benefits for participating programs to attain higher levels of…

Impact of Expert Teaching Quality on Novice Academic Performance in the Jigsaw Cooperative Learning Method

ERIC Educational Resources Information Center

Berger, Roland; Hänze, Martin

2015-01-01

We assessed the impact of expert students' instructional quality on the academic performance of novice students in 12th-grade physics classes organized in an expert model of cooperative learning ("jigsaw classroom"). The instructional quality of 129 expert students was measured by a newly developed rating system. As expected, when…

Using Generalized Additive Modeling to Empirically Identify Thresholds within the ITERS in Relation to Toddlers' Cognitive Development

ERIC Educational Resources Information Center

Setodji, Claude Messan; Le, Vi-Nhuan; Schaack, Diana

2013-01-01

Research linking high-quality child care programs and children's cognitive development has contributed to the growing popularity of child care quality benchmarking efforts such as quality rating and improvement systems (QRIS). Consequently, there has been an increased interest in and a need for approaches to identifying thresholds, or cutpoints,…

Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis.

PubMed

Gold, Rachel; Esterberg, Elizabeth; Hollombe, Celine; Arkind, Jill; Vakarcs, Patricia A; Tran, Huong; Burdick, Tim; Devoe, Jennifer E; Horberg, Michael A

2016-01-01

Guideline-discordant imaging to evaluate incident low back pain is common. We compared rates of guideline-discordant imaging in patients with low back pain in two care delivery systems with differing abilities to track care through an electronic health record (EHR), and in their patients' insurance status, to measure the association between these factors and rates of ordered low back imaging. We used data from two Kaiser Permanente (KP) Regions and from OCHIN, a community health center network. We extracted data on imaging performed after index visits for low back pain from June 1, 2011, to May 31, 2012, in these systems. Adjusted logistic regression measured associations between system-level factors and imaging rates. Imaging rates for incident low back pain using 2 national quality metrics: Clinical Quality Measure 0052, a measure for assessing Meaningful Use of EHRs, and the Healthcare Effectiveness Data and Information Set measure "Use of Imaging Studies for Low Back Pain." Among 19,503 KP patients and 2694 OCHIN patients with incident low back pain, ordered imaging was higher among men and whites but did not differ across health care systems. OCHIN's publicly insured patients had higher rates of imaging compared with those with private or no insurance. Rates of ordered imaging to evaluate incident low back pain among uninsured OCHIN patients were lower than in KP overall; among insured OCHIN patients, rates were higher than in KP overall. Research is needed to establish causality and develop interventions.

The impact of water exchange rate on the health and performance of rainbow trout Oncorhynchus mykiss in recirculation aquaculture systems

USDA-ARS?s Scientific Manuscript database

Fish mortality in recirculating aquaculture systems (RAS) has been observed by the authors to increase when RAS are managed at low makeup water exchange rates with relatively high feed loading. The precise etiology of this elevated mortality was unknown, all typical water quality parameters were wit...

Improving organizational climate for quality and quality of care: does membership in a collaborative help?

PubMed

Nembhard, Ingrid M; Northrup, Veronika; Shaller, Dale; Cleary, Paul D

2012-11-01

The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. To evaluate the impact of collaborative membership on organizational climate for quality and service quality. Twenty-one clinics, 4 of which participated in a collaborative sponsored by the Institute for Clinical Systems Improvement. Pre-post design. Preassessments occurred 2 months before the collaborative began in January 2009. Postassessments of service quality and climate occurred about 6 months and 1 year, respectively, after the collaborative ended in January 2010. We surveyed clinic employees (eg, physicians, nurses, receptionists, etc.) about the organizational climate and patients about service quality. Prioritization of quality care, high-quality staff relationships, and open communication as indicators of quality-oriented climate and timeliness of care, staff helpfulness, doctor-patient communication, rating of doctor, and willingness to recommend doctor's office as indicators of service quality. There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors' ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison clinics. Membership in the collaborative provided no significant advantage for improving quality-oriented climate and had equivocal effects on service quality.

The Study of an Integrated Rating System for Supplier Quality Performance in the Semiconductor Industry

NASA Astrophysics Data System (ADS)

Lee, Yu-Cheng; Yen, Tieh-Min; Tsai, Chih-Hung

This study provides an integrated model of Supplier Quality Performance Assesment (SQPA) activity for the semiconductor industry through introducing the ISO 9001 management framework, Importance-Performance Analysis (IPA) Supplier Quality Performance Assesment and Taguchi`s Signal-to-Noise Ratio (S/N) techniques. This integrated model provides a SQPA methodology to create value for all members under mutual cooperation and trust in the supply chain. This method helps organizations build a complete SQPA framework, linking organizational objectives and SQPA activities to optimize rating techniques to promote supplier quality improvement. The techniques used in SQPA activities are easily understood. A case involving a design house is illustrated to show our model.

Organic production systems in northern highbush blueberry: I. Impact of planting method, cultivar, fertilizer, and mulch on yield and fruit quality from planting through maturity

USDA-ARS?s Scientific Manuscript database

A long-term trial was established to identify organic production systems for maximum yield and quality in highbush blueberry. Treatments included raised beds or flat ground; granular feather meal or fish solubles at low and high rates; sawdust, yard debris compost topped with sawdust, or weed mat; a...

Educating Early Educators: Voices of Early Childhood Educators Participating in Formal Education as Part of a Statewide Quality Rating Improvement System

ERIC Educational Resources Information Center

Griess, Carolyn J.

2012-01-01

Early childhood education has gained national attention as a tool for increasing outcomes and reducing risks for young children and their families. In an effort to ensure that early childhood programs are of high quality, many states are implementing systems that identify levels of criteria that denote excellence. Pennsylvania has adopted such a…

A rapid response air quality analysis system for use in projects having stringent quality assurance requirements

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

Bowman, A.W.

1990-04-01

This paper describes an approach to solve air quality problems which frequently occur during iterations of the baseline change process. From a schedule standpoint, it is desirable to perform this evaluation in as short a time as possible while budgetary pressures limit the size of the staff available to do the work. Without a method in place to deal with baseline change proposal requests the environment analysts may not be able to produce the analysis results in the time frame expected. Using a concept called the Rapid Response Air Quality Analysis System (RAAS), the problems of timing and cost becomemore » tractable. The system could be adapted to assess other atmospheric pathway impacts, e.g., acoustics or visibility. The air quality analysis system used to perform the EA analysis (EA) for the Salt Repository Project (part of the Civilian Radioactive Waste Management Program), and later to evaluate the consequences of proposed baseline changes, consists of three components: Emission source data files; Emission rates contained in spreadsheets; Impact assessment model codes. The spreadsheets contain user-written codes (macros) that calculate emission rates from (1) emission source data (e.g., numbers and locations of sources, detailed operating schedules, and source specifications including horsepower, load factor, and duty cycle); (2) emission factors such as those published by the U.S. Environmental Protection Agency, and (3) control efficiencies.« less

Spectral Rate Theory for Two-State Kinetics

NASA Astrophysics Data System (ADS)

Prinz, Jan-Hendrik; Chodera, John D.; Noé, Frank

2014-02-01

Classical rate theories often fail in cases where the observable(s) or order parameter(s) used is a poor reaction coordinate or the observed signal is deteriorated by noise, such that no clear separation between reactants and products is possible. Here, we present a general spectral two-state rate theory for ergodic dynamical systems in thermal equilibrium that explicitly takes into account how the system is observed. The theory allows the systematic estimation errors made by standard rate theories to be understood and quantified. We also elucidate the connection of spectral rate theory with the popular Markov state modeling approach for molecular simulation studies. An optimal rate estimator is formulated that gives robust and unbiased results even for poor reaction coordinates and can be applied to both computer simulations and single-molecule experiments. No definition of a dividing surface is required. Another result of the theory is a model-free definition of the reaction coordinate quality. The reaction coordinate quality can be bounded from below by the directly computable observation quality, thus providing a measure allowing the reaction coordinate quality to be optimized by tuning the experimental setup. Additionally, the respective partial probability distributions can be obtained for the reactant and product states along the observed order parameter, even when these strongly overlap. The effects of both filtering (averaging) and uncorrelated noise are also examined. The approach is demonstrated on numerical examples and experimental single-molecule force-probe data of the p5ab RNA hairpin and the apo-myoglobin protein at low pH, focusing here on the case of two-state kinetics.

Challenges in using rater judgements in medical education.

PubMed

Albanese, M A

2000-08-01

Changes in the healthcare environment are putting increasing pressure on medical schools to make faculty accountable and to document the quality of the medical education they provide. Faculty's ratings of students' performances and students' ratings of faculty's teaching are important elements in these efforts to document educational quality. This article discusses selected research related to factors affecting raters' judgements, analyses how changes in the health care environment are influencing such judgements, offers some suggestions to moderate some of the effects and links these influences to the system that upholds professional standards. Ratings are known to have a positive bias (generosity error), provide limited discrimination and often fail to document serious deficits. The potential sources of these problems relate to the mechanics of the rating task, the system used to obtain ratings and factors affecting rater judgement. As managed care demands reduce the time faculty have for teaching, as system-wide disincentives to provide negative ratings proliferate and as social engineering challenges, such as the Americans with Disabilities Act, impose differential standards for students, the natural tendency to avoid giving negative ratings becomes even harder to resist. Ultimately, these forces compromise the capability of faculty to uphold the standards of the profession. The author calls for a national effort to stem the erosion of those standards.

Motion-base simulator results of advanced supersonic transport handling qualities with active controls

NASA Technical Reports Server (NTRS)

Feather, J. B.; Joshi, D. S.

1981-01-01

Handling qualities of the unaugmented advanced supersonic transport (AST) are deficient in the low-speed, landing approach regime. Consequently, improvement in handling with active control augmentation systems has been achieved using implicit model-following techniques. Extensive fixed-based simulator evaluations were used to validate these systems prior to tests with full motion and visual capabilities on a six-axis motion-base simulator (MBS). These tests compared the handling qualities of the unaugmented AST with several augmented configurations to ascertain the effectiveness of these systems. Cooper-Harper ratings, tracking errors, and control activity data from the MBS tests have been analyzed statistically. The results show the fully augmented AST handling qualities have been improved to an acceptable level.

National survey on turnaround time of clinical biochemistry tests in 738 laboratories in China.

PubMed

Zhang, Xiaoyan; Fei, Yang; Wang, Wei; Zhao, Haijian; Wang, Minqi; Chen, Bingquan; Zhou, Jie; Wang, Zhiguo

2018-02-01

This survey was initiated to estimate the current status of turnaround time (TAT) monitoring of clinical biochemistry in China, provide baseline data for establishment of quality specifications and analyze the impact factors of TAT. 738 laboratories were included. Questionnaires involved general information and data of related indicators of TAT during 1 week were provided to participating laboratories. Nine quality indicators were covered, which were medians, 90th and outlier rates of pre-examination, examination, and post-examination TAT. The 25th percentile, median, and 75th percentile of TATs were calculated as optimum, desirable, and minimum quality specifications. Percentages and sigma values were used to describe the outlier rates. Mann-Whitney and Kruskal-Wallis tests were used to identify the potential impacts of TAT. Response rate of this survey was 46.44%. More than 50% of the laboratories indicated they had set up target TATs in three time intervals and monitored TATs generally. The post-examination TAT of most laboratories was 0min, while the pre-examination and examination TAT varied. Sigma values of outlier rates for 45%~60% of laboratories were above 4, while 15%~20% of labs whose sigma values were below 3. Group comparisons suggested nurse or mechanical pipeline transportation, link laboratory information system with hospital information system, and using computer reporting instead of printing report were related to shorter TATs. Despite of the remarkable progresses of TATs in China, there was also room to improve. Laboratories should strengthen the construction of information systems, identify reasons for TAT delay to improve the service quality continuously. © 2017 Wiley Periodicals, Inc.

Dynamic evaluation of airflow rates for a variable air volume system serving an open-plan office.

PubMed

Mai, Horace K W; Chan, Daniel W T; Burnett, John

2003-09-01

In a typical air-conditioned office, the thermal comfort and indoor air quality are sustained by delivering the amount of supply air with the correct proportion of outdoor air to the breathing zone. However, in a real office, it is not easy to measure these airflow rates supplied to space, especially when the space is served by a variable air volume (VAV) system. The most accurate method depends on what is being measured, the details of the building and types of ventilation system. The constant concentration tracer gas method as a means to determine ventilation system performance, however, this method becomes more complicated when the air, including the tracer gas is allowed to recirculate. An accurate measurement requires significant resource support in terms of instrumentation set up and also professional interpretation. This method deters regular monitoring of the performance of an airside systems by building managers, and hence the indoor environmental quality, in terms of thermal comfort and indoor air quality, may never be satisfactory. This paper proposes a space zone model for the calculation of all the airflow parameters based on tracer gas measurements, including flow rates of outdoor air, VAV supply, return space, return and exfiltration. Sulphur hexafluoride (SF6) and carbon dioxide (CO2) are used as tracer gases. After using both SF6 and CO2, the corresponding results provide a reference to justify the acceptability of using CO2 as the tracer gas. The validity of using CO2 has the significance that metabolic carbon dioxide can be used as a means to evaluate real time airflow rates. This approach provides a practical protocol for building managers to evaluate the performance of airside systems.

The Quality of Written Feedback by Attendings of Internal Medicine Residents.

PubMed

Jackson, Jeffrey L; Kay, Cynthia; Jackson, Wilkins C; Frank, Michael

2015-07-01

Attending evaluations are commonly used to evaluate residents. Evaluate the quality of written feedback of internal medicine residents. Retrospective. Internal medicine residents and faculty at the Medical College of Wisconsin from 2004 to 2012. From monthly evaluations of residents by attendings, a randomly selected sample of 500 written comments by attendings were qualitatively coded and rated as high-, moderate-, or low-quality feedback by two independent coders with good inter-rater reliability (kappa: 0.94). Small group exercises with residents and attendings also coded the utterances as high, moderate, or low quality and developed criteria for this categorization. In-service examination scores were correlated with written feedback. There were 228 internal medicine residents who had 6,603 evaluations by 334 attendings. Among 500 randomly selected written comments, there were 2,056 unique utterances: 29% were coded as nonspecific statements, 20% were comments about resident personality, 16% about patient care, 14% interpersonal communication, 7% medical knowledge, 6% professionalism, and 4% each on practice-based learning and systems-based practice. Based on criteria developed by group exercises, the majority of written comments were rated as moderate quality (65%); 22% were rated as high quality and 13% as low quality. Attendings who provided high-quality feedback rated residents significantly lower in all six of the Accreditation Council for Graduate Medical Education (ACGME) competencies (p <0.0005 for all), and had a greater range of scores. Negative comments on medical knowledge were associated with lower in-service examination scores. Most attending written evaluation was of moderate or low quality. Attendings who provided high-quality feedback appeared to be more discriminating, providing significantly lower ratings of residents in all six ACGME core competencies, and across a greater range. Attendings' negative written comments on medical knowledge correlated with lower in-service training scores.

Flying-qualities criteria for wings-level-turn maneuvering during an air-to-ground weapon delivery task

NASA Technical Reports Server (NTRS)

Sammonds, R. I.; Bunnell, J. W.

1981-01-01

A moving base simulator experiment demonstrated that a wings-level-turn control mode improved flying qualities for air to ground weapon delivery compared with those of a conventionally controlled aircraft. Evaluations of criteria for dynamic response for this system have shown that pilot ratings correlate well on the basis of equivalent time constant of the initial response. Ranges of this time constant, as well as digital system transport delays and lateral acceleration control authorities that encompassed level 1 through 3 handling qualities, were determined.

Data quality system using reference dictionaries and edit distance algorithms

NASA Astrophysics Data System (ADS)

Karbarz, Radosław; Mulawka, Jan

2015-09-01

The real art of management it is important to make smart decisions, what in most of the cases is not a trivial task. Those decisions may lead to determination of production level, funds allocation for investments etc. Most of the parameters in decision-making process such as: interest rate, goods value or exchange rate may change. It is well know that these parameters in the decision-making are based on the data contained in datamarts or data warehouse. However, if the information derived from the processed data sets is the basis for the most important management decisions, it is required that the data is accurate, complete and current. In order to achieve high quality data and to gain from them measurable business benefits, data quality system should be used. The article describes the approach to the problem, shows the algorithms in details and their usage. Finally the test results are provide. Test results show the best algorithms (in terms of quality and quantity) for different parameters and data distribution.

Development of a Body Shield for Small Animal PET System to Reduce Random and Scatter Coincidences

NASA Astrophysics Data System (ADS)

Wada, Yasuhiro; Yamamoto, Seiichi; Watanabe, Yasuyoshi

2015-02-01

For small animal positron emission tomography (PET) research using high radioactivity, such as dynamic studies, the resulting high random coincidence rate of the system degrades image quality. The random coincidence rate is increased not only by the gamma photons from inside the axial-field-of-view (axial-FOV) of the PET system but also by those from outside the axial-FOV. For brain imaging in small animal studies, significant interference is observed from gamma photons emitted from the body. Single gamma photons from the body enter the axial-FOV and increase the random and scatter coincidences. Shielding against the gamma photons from outside the axial-FOV would improve the image quality. For this purpose, we developed a body shield for a small animal PET system, the microPET Primate 4-ring system, and evaluated its performance. The body shield is made of 9-mm-thick lead and it surrounds most of a rat's body. We evaluated the effectiveness of the body shield using a head phantom and a body phantom with a radioactivity concentration ratio of 1:2 and a maximum total activity of approximately 250 MBq. The random coincidence rate was dramatically decreased to 1/10, and the noise equivalent count rate (NECR) was increased 6 times with an activity of 7 MBq in the head phantom. The true count rate was increased to 35% due to the decrease in system deadtime. The average scatter fraction was decreased to 1/2.5 with the body shield. Count rate measurements of rat were also conducted with an injection activity of approximately 25 MBq of [C-11]N,N-dimethyl-2-(2-amino-4-cyanophenylthio) benzylamine ([C-11]DASB) and approximately 70 and 310 MBq of 2-deoxy-2-(F-18)fluoro-D-glucose ([F-18]FDG). Using the body shield, [F-18]FDG images of rats were improved by increasing the amount of radioactivity injected. The body shield designed for small animal PET systems is a promising tool for improving image quality and quantitation accuracy in small animal molecular imaging research.

Performance Analysis of Visible Light Communication Using CMOS Sensors.

PubMed

Do, Trong-Hop; Yoo, Myungsik

2016-02-29

This paper elucidates the fundamentals of visible light communication systems that use the rolling shutter mechanism of CMOS sensors. All related information involving different subjects, such as photometry, camera operation, photography and image processing, are studied in tandem to explain the system. Then, the system performance is analyzed with respect to signal quality and data rate. To this end, a measure of signal quality, the signal to interference plus noise ratio (SINR), is formulated. Finally, a simulation is conducted to verify the analysis.

Performance Analysis of Visible Light Communication Using CMOS Sensors

PubMed Central

Do, Trong-Hop; Yoo, Myungsik

2016-01-01

This paper elucidates the fundamentals of visible light communication systems that use the rolling shutter mechanism of CMOS sensors. All related information involving different subjects, such as photometry, camera operation, photography and image processing, are studied in tandem to explain the system. Then, the system performance is analyzed with respect to signal quality and data rate. To this end, a measure of signal quality, the signal to interference plus noise ratio (SINR), is formulated. Finally, a simulation is conducted to verify the analysis. PMID:26938535

Minimum airflow reset of single-duct VAV terminal boxes

NASA Astrophysics Data System (ADS)

Cho, Young-Hum

Single duct Variable Air Volume (VAV) systems are currently the most widely used type of HVAC system in the United States. When installing such a system, it is critical to determine the minimum airflow set point of the terminal box, as an optimally selected set point will improve the level of thermal comfort and indoor air quality (IAQ) while at the same time lower overall energy costs. In principle, this minimum rate should be calculated according to the minimum ventilation requirement based on ASHRAE standard 62.1 and maximum heating load of the zone. Several factors must be carefully considered when calculating this minimum rate. Terminal boxes with conventional control sequences may result in occupant discomfort and energy waste. If the minimum rate of airflow is set too high, the AHUs will consume excess fan power, and the terminal boxes may cause significant simultaneous room heating and cooling. At the same time, a rate that is too low will result in poor air circulation and indoor air quality in the air-conditioned space. Currently, many scholars are investigating how to change the algorithm of the advanced VAV terminal box controller without retrofitting. Some of these controllers have been found to effectively improve thermal comfort, indoor air quality, and energy efficiency. However, minimum airflow set points have not yet been identified, nor has controller performance been verified in confirmed studies. In this study, control algorithms were developed that automatically identify and reset terminal box minimum airflow set points, thereby improving indoor air quality and thermal comfort levels, and reducing the overall rate of energy consumption. A theoretical analysis of the optimal minimum airflow and discharge air temperature was performed to identify the potential energy benefits of resetting the terminal box minimum airflow set points. Applicable control algorithms for calculating the ideal values for the minimum airflow reset were developed and applied to actual systems for performance validation. The results of the theoretical analysis, numeric simulations, and experiments show that the optimal control algorithms can automatically identify the minimum rate of heating airflow under actual working conditions. Improved control helps to stabilize room air temperatures. The vertical difference in the room air temperature was lower than the comfort value. Measurements of room CO2 levels indicate that when the minimum airflow set point was reduced it did not adversely affect the indoor air quality. According to the measured energy results, optimal control algorithms give a lower rate of reheating energy consumption than conventional controls.

Heavy metal and waste metabolite accumulation and their affect on rainbow trout performance in a replicated water reuse system operated at low or high system flushing rates

USDA-ARS?s Scientific Manuscript database

A six-month trial was conducted to compare the effects of high and low make-up water flushing rates on rainbow trout performance and water quality in replicated water reuse aquaculture systems (WRAS). Six identical 9.5 m3 WRAS, containing a single 5.3 m3 tank and operated at a total recirculating fl...

When Rating Systems Do Not Rate: Evaluating ERA's Performance

ERIC Educational Resources Information Center

Henman, Paul; Brown, Scott D.; Dennis, Simon

2017-01-01

In 2015, the Australian Government's Excellence in Research for Australia (ERA) assessment of research quality declined to rate 1.5 per cent of submissions from universities. The public debate focused on practices of gaming or "coding errors" within university submissions as the reason for this outcome. The issue was about the…

Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey.

PubMed

Aeyels, Daan; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Coeckelberghs, Ellen; Bruyneel, Luk; Vanhaecht, Kris

2017-12-13

Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.

Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis

PubMed Central

Gold, Rachel; Esterberg, Elizabeth; Hollombe, Celine; Arkind, Jill; Vakarcs, Patricia A; Tran, Huong; Burdick, Tim; DeVoe, Jennifer E; Horberg, Michael A

2016-01-01

Context: Guideline-discordant imaging to evaluate incident low back pain is common. Objective: We compared rates of guideline-discordant imaging in patients with low back pain in two care delivery systems with differing abilities to track care through an electronic health record (EHR), and in their patients’ insurance status, to measure the association between these factors and rates of ordered low back imaging. Design: We used data from two Kaiser Permanente (KP) Regions and from OCHIN, a community health center network. We extracted data on imaging performed after index visits for low back pain from June 1, 2011, to May 31, 2012, in these systems. Adjusted logistic regression measured associations between system-level factors and imaging rates. Main Outcome Measures: Imaging rates for incident low back pain using 2 national quality metrics: Clinical Quality Measure 0052, a measure for assessing Meaningful Use of EHRs, and the Healthcare Effectiveness Data and Information Set measure “Use of Imaging Studies for Low Back Pain.” Results: Among 19,503 KP patients and 2694 OCHIN patients with incident low back pain, ordered imaging was higher among men and whites but did not differ across health care systems. OCHIN’s publicly insured patients had higher rates of imaging compared with those with private or no insurance. Conclusion: Rates of ordered imaging to evaluate incident low back pain among uninsured OCHIN patients were lower than in KP overall; among insured OCHIN patients, rates were higher than in KP overall. Research is needed to establish causality and develop interventions. PMID:26934626

Developing ratings for food products: lessons learned from media rating systems.

PubMed

Kunkel, Dale; McKinley, Christopher

2007-01-01

Children regularly consume low-nutrient, high-calorie food that is not consistent with a healthful diet, contributing to an increasing epidemic of overweight and obesity. Among the multiple causes of this problem is the food industry's emphasis on marketing calorie-dense food products to children. The Institute of Medicine (IOM) has recommended that industry adopt a uniform system of simplified food ratings to convey the nutritional qualities of food in a manner that is understandable and appealing to children and youth. This report analyzes the need for such a system in a food marketing environment that increasingly identifies healthful products for the consumer in inconsistent fashion. It considers evidence regarding current usage of food labeling and draws parallels with media rating systems in discussing the prospects for a uniform food rating system that would accomplish the IOM's objective.

Fast Batch Production of High-Quality Graphene Films in a Sealed Thermal Molecular Movement System.

PubMed

Xu, Jianbao; Hu, Junxiong; Li, Qi; Wang, Rubing; Li, Weiwei; Guo, Yufen; Zhu, Yongbo; Liu, Fengkui; Ullah, Zaka; Dong, Guocai; Zeng, Zhongming; Liu, Liwei

2017-07-01

Chemical vapor deposition (CVD) growth of high-quality graphene has emerged as the most promising technique in terms of its integrated manufacturing. However, there lacks a controllable growth method for producing high-quality and a large-quantity graphene films, simultaneously, at a fast growth rate, regardless of roll-to-roll (R2R) or batch-to-batch (B2B) methods. Here, a stationary-atmospheric-pressure CVD (SAPCVD) system based on thermal molecular movement, which enables fast B2B growth of continuous and uniform graphene films on tens of stacked Cu(111) foils, with a growth rate of 1.5 µm s -1 , is demonstrated. The monolayer graphene of batch production is found to nucleate from arrays of well-aligned domains, and the films possess few defects and exhibit high carrier mobility up to 6944 cm 2 V -1 s -1 at room temperature. The results indicate that the SAPCVD system combined with single-domain Cu(111) substrates makes it possible to realize fast batch-growth of high-quality graphene films, which opens up enormous opportunities to use this unique 2D material for industrial device applications. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Improving Immunization Rates Using Lean Six Sigma Processes: Alliance of Independent Academic Medical Centers National Initiative III Project

PubMed Central

Hina-Syeda, Hussaini; Kimbrough, Christina; Murdoch, William; Markova, Tsveti

2013-01-01

Background Quality improvement education and work in interdisciplinary teams is a healthcare priority. Healthcare systems are trying to meet core measures and provide excellent patient care, thus improving their Hospital Consumer Assessment of Healthcare Providers & Systems scores. Crittenton Hospital Medical Center in Rochester Hills, MI, aligned educational and clinical objectives, focusing on improving immunization rates against pneumonia and influenza prior to the rates being implemented as core measures. Improving immunization rates prevents infections, minimizes hospitalizations, and results in overall improved patient care. Teaching hospitals offer an effective way to work on clinical projects by bringing together the skill sets of residents, faculty, and hospital staff to achieve superior results. Methods We designed and implemented a structured curriculum in which interdisciplinary teams acquired knowledge on quality improvement and teamwork, while focusing on a specific clinical project: improving global immunization rates. We used the Lean Six Sigma process tools to quantify the initial process capability to immunize against pneumococcus and influenza. Results The hospital's process to vaccinate against pneumonia overall was operating at a Z score of 3.13, and the influenza vaccination Z score was 2.53. However, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 1.96. Improvement in immunization rates of high-risk patients became the focus of the project. After the implementation of solutions, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 3.9 with a defects/million opportunities rate of 9,346 and a yield of 93.5%. Revisions to the adult assessment form fixed 80% of the problems identified. Conclusions This process improvement project was not only beneficial in terms of improved quality of patient care but was also a positive learning experience for the interdisciplinary team, particularly for the residents. The hospital has completed quality improvement projects in the past; however, this project was the first in which residents were actively involved. The didactic components and experiential learning were powerfully synergistic. This and similar projects can have far-reaching implications in terms of promoting patient health and improving the quality of care delivered by the healthcare systems and teaching hospitals. PMID:24052758

From many deaths to some few cases of drug-resistant tuberculosis: travelling with the systems quality improvement model in Lacs Health District, Togo

PubMed Central

Afanvi, Kossivi Agbelenko

2015-01-01

The ultimate goal of every tuberculosis (TB) treatment program is a high treatment success rate. Treatment success is extremely important because, when the rate is high, it significantly contributes to declining numbers of new cases by reducing the number and period of infectious cases, TB morbidity and mortality, and prevents the emergence of resistant strains. Our aim was to decrease TB mortality by increasing pulmonary TB patients’ treatment success rate to at least 85 % in Lacs Health District by end of July 2014. A systems and dialogic analysis of the public health system related to TB patients’ treatment revealed that it was not performing well; we found weak coverage and quality of TB services, a poorly-functioning TB health information system, poor-performing health workforce, poor availability of HIV tests and antiretroviral for TB patients, and low degree of patients’ participation in their care. We redesigned the system to correct those weaknesses. The effectiveness of these changes was monitored using plan, do, study, act (PDSA) cycles. We increased TB patient success rate from 80% to 95% between February 2012 and July 2014.The mortality rate dropped from 13% to 3% and the failure to follow-up rate dropped from 3% to 2%. In conclusion, district health systems performance depends on factors such as the closeness of services to population; skilled workforce; the ability to collect and analyze data and use information for action; population empowerment, and good management and improvement capabilities of management team especially the public health director. High TB patients’ success rate depends also on the availability of antiretroviral drugs. It is highly important that every district health management team member develops improvement capabilities. PMID:26734412

77 FR 60315 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-03

... Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality... entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

Will the "Fixes" Fall Flat? Prospects for Quality Measures and Payment Incentives to Control Healthcare Spending.

PubMed

Hauswald, Erik; Sklar, David

2017-04-01

Payment systems in the US healthcare system have rewarded physicians for services and attempted to control healthcare spending, with rewards and penalties based upon projected goals for future spending. The incorporation of quality goals and alternatives to fee-for-service was introduced to replace the previous system of rewards and penalties. We describe the history of the US healthcare payment system, focusing on Medicare and the efforts to control spending through the Sustainable Growth Rate. We describe the latest evolution of the payment system, which emphasizes quality measurement and alternative payment models. We conclude with suggestions for how to influence physician behavior through education and payment reform so that their behavior aligns with alternative care models to control spending in the future.

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

PubMed Central

2011-01-01

Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes. PMID:22185479

Modeling, simulation, and flight characteristics of an aircraft designed to fly at 100,000 feet

NASA Technical Reports Server (NTRS)

Sim, Alex G.

1991-01-01

A manned real time simulation of a conceptual vehicle, the stratoplane, was developed to study the problems associated with the flight characteristics of a large, lightweight vehicle. Mathematical models of the aerodynamics, mass properties, and propulsion system were developed in support of the simulation and are presented. The simulation was at first conducted without control augmentation to determine the needs for a control system. The unaugmented flying qualities were dominated by lightly damped dutch roll oscillations. Constant pilot workloads were needed at high altitudes. Control augmentation was studied using basic feedbacks. For the longitudinal axis, flight path angle, and pitch rate feedback were sufficient to damp the phugoid mode and to provide good flying qualities. In the lateral directional axis, bank angle, roll rate, and yaw rate feedbacks were sufficient to provide a safe vehicle with acceptable handling qualities. Intentionally stalling the stratoplane to very high angles of attack (deep stall) was studied as a means of enable safe and rapid descent. It was concluded that the deep stall maneuver is viable for this class of vehicle.

A piloted simulator investigation of augmentation systems to improve helicopter nap-of-the-earth handling qualities

NASA Technical Reports Server (NTRS)

Chen, R. T. N.; Talbot, P. D.; Gerdes, R. M.; Dugan, D. C.

1978-01-01

A piloted simulation study assessed various levels of stability and control augmentation designed to improve the handling qualities of several helicopters in nap-of-the-earth (NOE) flight. Five basic single rotor helicopters - one teetering, two articulated, and two hingeless - which were found to have a variety of major deficiencies in a previous fixed-based simulator study were selected as baseline configurations. The stability and control augmentation systems (SCAS) include simple control augmentation systems (CAS) to decouple pitch and yaw responses due to collective input and to quicken the pitch and roll control responses; SCAS of rate command type designed to optimize the sensitivity and damping and to decouple the pitch-roll due to aircraft angular rate; and attitude command type SCAS. Pilot ratings and commentary are presented as well as performance data related to the task. SCAS control usage and their gain levels associated with specific rotor type are also discussed.

Efficacy of a chronic disease management model for patients with chronic liver failure.

PubMed

Wigg, Alan J; McCormick, Rosemary; Wundke, Rachel; Woodman, Richard J

2013-07-01

Despite the economic impacts of chronic liver failure (CLF) and the success of chronic disease management (CDM) programs in routine clinical practice, there have been no randomized controlled trials of CDM for CLF. We investigated the efficacy of CDM programs for CLF patients in a prospective, controlled trial. Sixty consecutive patients with cirrhosis and complications from CLF were assigned randomly to groups given intervention (n = 40) or usual care (n = 20), from 2009 to 2010. The 12-month intervention comprised 4 CDM components: delivery system redesign, self-management support, decision support, and clinical information systems. The primary outcome was the number of days spent in a hospital bed for liver-related reasons. Secondary outcomes were rates of other hospital use measures, rate of attendance at planned outpatient care, disease severity, quality of life, and quality of care. The intervention did not reduce the number of days patients spent in hospital beds for liver-related reasons, compared with usual care (17.8 vs 11.0 bed days/person/y, respectively; incidence rate ratio, 1.6; 95% confidence interval, 0.5-4.8; P = .39), or affect other measures of hospitalization. Patients given the intervention had a 30% higher rate of attendance at outpatient care (incidence rate ratio, 1.3; 95% confidence interval, 1.1-1.5; P = .004) and significant increases in quality of care, based on adherence to hepatoma screening, osteoporosis and vaccination guidelines, and referral to transplant centers (P < .05 for all). In a pilot study to determine the efficacy of CDM for patients with CLF, patients receiving CDM had significant increases in attendance at outpatient centers and quality of care, compared with patients who did not receive CDM. However, CDM did not appear to reduce hospital admission rates or disease severity or improve patient quality of life. Larger trials with longer follow-up periods are required to confirm these findings and assess cost effectiveness. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

Effluent quality from 200 on-site sewage systems: design values for guidelines.

PubMed

Charles, K J; Ashbolt, N J; Roser, D J; McGuinness, R; Deere, D A

2005-01-01

The quality of effluent from an on-site sewage treatment system is a critical factor in designing the disposal area and, hence, ensuring the sustained performance of the system. Contaminant concentrations in effluent are typically specified in regulatory guidelines or standards; however, the accuracy of these guideline values are brought into question due to the poor performance of septic tanks and the high failure rates of disposal systems reported here and elsewhere. Results from studies of septic tank effluent quality indicated that the effluent is of poorer quality than currently suggested by guidelines. Aerated wastewater treatment systems were found to perform to accreditation guidelines; however, insufficient nutrient data is presently available to assess nutrient loads. It is proposed that the 80th percentile of system performance be adopted as the design value for sizing effluent disposal areas to minimise failure associated with overloading. For septic tanks this equates to 660 mg L(-1) SS, 330 mg L(-1) BOD, 250 mg L(-1) TN and 36 mg L(-1) TP.

Seven Q-Tracks monitors of laboratory quality drive general performance improvement: experience from the College of American Pathologists Q-Tracks program 1999-2011.

PubMed

Meier, Frederick A; Souers, Rhona J; Howanitz, Peter J; Tworek, Joseph A; Perrotta, Peter L; Nakhleh, Raouf E; Karcher, Donald S; Bashleben, Christine; Darcy, Teresa P; Schifman, Ron B; Jones, Bruce A

2015-06-01

Many production systems employ standardized statistical monitors that measure defect rates and cycle times, as indices of performance quality. Clinical laboratory testing, a system that produces test results, is amenable to such monitoring. To demonstrate patterns in clinical laboratory testing defect rates and cycle time using 7 College of American Pathologists Q-Tracks program monitors. Subscribers measured monthly rates of outpatient order-entry errors, identification band defects, and specimen rejections; median troponin order-to-report cycle times and rates of STAT test receipt-to-report turnaround time outliers; and critical values reporting event defects, and corrected reports. From these submissions Q-Tracks program staff produced quarterly and annual reports. These charted each subscriber's performance relative to other participating laboratories and aggregate and subgroup performance over time, dividing participants into best and median performers and performers with the most room to improve. Each monitor's patterns of change present percentile distributions of subscribers' performance in relation to monitoring durations and numbers of participating subscribers. Changes over time in defect frequencies and the cycle duration quantify effects on performance of monitor participation. All monitors showed significant decreases in defect rates as the 7 monitors ran variously for 6, 6, 7, 11, 12, 13, and 13 years. The most striking decreases occurred among performers who initially had the most room to improve and among subscribers who participated the longest. All 7 monitors registered significant improvement. Participation effects improved between 0.85% and 5.1% per quarter of participation. Using statistical quality measures, collecting data monthly, and receiving reports quarterly and yearly, subscribers to a comparative monitoring program documented significant decreases in defect rates and shortening of a cycle time for 6 to 13 years in all 7 ongoing clinical laboratory quality monitors.

McCook Reservoir Water Quality Model. Numerical Model Investigation

DTIC Science & Technology

1991-09-01

REPT TYPE AND DATES COVERED ad September Cana Final report . LEAND SUBTITLE S. FUNDING NUERS Spinfild VA2261 ThcCook Reservoir Water Quality Model...oxygen injected by the aeration system Manufacturers of diffusers supply OTE information specific to gas flow rate and depth. The depths at which most

Educational disparities in quality of diabetes care in a universal health insurance system: evidence from the 2005 Korea National Health and Nutrition Examination Survey.

PubMed

Do, Young Kyung; Eggleston, Karen N

2011-08-01

To investigate educational disparities in the care process and health outcomes among patients with diabetes in the context of South Korea's universal health insurance system. Bivariate and multiple regression analyses of data from a cross-sectional health survey. A nationally representative and population-based survey, the 2005 Korea National Health and Nutrition Examination Survey. Respondents aged 40 or older who self-reported prior diagnosis with diabetes (n= 1418). Seven measures of the care process and health outcomes, namely (i) receiving medical treatment for diabetes, (ii) ever received diabetes education, (iii) received dilated eye examination in the past year, (iv) received microalbuminuria test in the past year, (v) having activity limitation due to diabetes, (vi) poor self-rated health and (vii) self-rated health on a visual analog scale. Except for receiving medical care for diabetes, overall process quality was low, with only 25% having ever received diabetes education, 39% having received a dilated eye examination in the past year and 51% having received a microalbuminuria test in the past year. Lower education level was associated with both poorer care processes and poorer health outcomes, whereas lower income level was only associated with poorer health outcomes. While South Korea's universal health insurance system may have succeeded in substantially reducing financial barriers related to diabetes care, the quality of diabetes care is low overall and varies by education level. System-level quality improvement efforts are required to address the weaknesses of the health system, thereby mitigating educational disparities in diabetes care quality.

Reported Effects of the SRTR 5-tier Rating System on US Transplant Centers: Results of a National Survey.

PubMed

Van Pilsum Rasmussen, Sarah E; Thomas, Alvin G; Garonzik-Wang, Jacqueline; Henderson, Macey L; Stith, Sarah S; Segev, Dorry L; Hersch Nicholas, Lauren

2018-05-26

In the US, the Scientific Registry of Transplant Recipients (SRTR) provides publicly available quality report cards. These reports have historically rated transplant programs using a 3-tier system. In 2016, the SRTR temporarily transitioned to a 5-tier system, which classified more programs as under-performing. As part of a larger survey about transplant quality metrics, we surveyed members of the American Society of Transplant Surgeons and American Society of Transplantation (N = 280 respondents) on transplant center experiences with patient and payer responses to the 5-tier SRTR ratings. Over half of respondents (n=137, 52.1%) reported ≥1 negative effect of the new 5-tier ranking system, including losing patients, losing insurers, increased concern among patients, and increased concern among referring providers. Few respondents (n=35, 13.7%) reported any positive effects of the 5-tier ranking system. Lower SRTR-reported scores on the 5-tier scale were associated with increased risk of reporting at least one negative effect in a logistic model (p<0.01). The change to a more granular rating system provoked an immediate response in the transplant community that may have long-term implications for transplant hospital finances and patient options for transplantation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

[Fundamentals of socio-hygienic monitoring of environmental conditions for students of higher education schools].

PubMed

Blinova, E G; Kuchma, V R

2012-01-01

Socioeconomic transformations and the poor environment of an industrial megalopolis negatively affected quality of life and morbidity rates in students (n = 2160). Academic intensity contributed to an increase in overall morbidity and morbidity from nervous system involvement. The regional sociohygienic monitoring of high-school training conditions within the framework of the surveillance system substantiates programs to prevent worse health and life quality in high school students.

Dose intraarticular steroid injection increase the rate of infection in subsequent arthroplasty: grading the evidence through a meta-analysis.

PubMed

Xing, Dan; Yang, Yang; Ma, Xinlong; Ma, Jianxiong; Ma, Baoyi; Chen, Yang

2014-11-13

Intraarticular steroid injections are widely used in joint arthritis. However, the data regarding an association between an increased risk for arthroplasty infection after an intraarticular steroid injection are still conflicting. We conducted a meta-analysis to evaluate the evidence from relevant studies that examine the relation between intraarticular steroid injections and infection rates in subsequent joint arthroplasty and to develop GRADE based recommendations for using the steroid before arthroplasty. A systematic search of all studies published through August 2014 was conducted using the MEDLINE, EMBASE, OVID, ScienceDirect and Cochrane CENTRAL databases. The relevant studies that examined the relation between intraarticular steroid injections and infection rates in subsequent joint arthroplasty were identified. Demographic characteristics, infection rates and clinical outcomes were manually extracted from all of the selected studies. The evidence quality levels and recommendations were assessed using the GRADE system. Eight studies looking at hip and knee arthroplasties were included. Meta-analysis showed that patients with steroid injection before arthroplasty had a higher deep infection rate than patients without steroid injection (OR = 2.13, 95% CI 1.02-4.45), but no significant effect on superficial infection rate (OR = 1.75, 95% CI 0.74-4.16). The overall GRADE system evidence quality was very low, which lowers our confidence in their recommendations. Intraarticular steroid injections may lead to increased deep infection rates of subsequent joint arthroplasty but not the superficial infection rates. Due to the poor quality of the evidence currently available, further studies are still required.

An online real time ultrasonic NDT system for the quality control of spot welding in the automotive industry

NASA Astrophysics Data System (ADS)

Athi, N.; Wylie, S. R.; Cullen, J. D.; Al-Jader, M.; Al-Shamma'a, A. I.; Shaw, A.

2009-07-01

Resistance spot welding is the main joining technique used for the fabrication of body-in-white structures in the automotive industry. The quality of the welds depends on the profile of the spot welding electrode cap. The increased use of zinc coated steel in the industry increases wear rate of the caps, making quality control more difficult. This paper presents a novel online real time ultrasonic NDE system for resistance spot welding which evaluates every weld as it is formed. SEM results are presented to show the alloying of the electrode caps.

Flying-qualities criteria for wings-level-turn maneuvering during an air-to-ground weapon delivery task

NASA Technical Reports Server (NTRS)

Sammonds, R. I.; Bunnell, J. W., Jr.

1980-01-01

A moving-base simulator experiment conducted at Ames Research Center demonstrated that a wings-level-turn control mode improved flying qualities for air-to-ground weapons delivery compared with those of a conventional aircraft. Evaluations of criteria for dynamic response for this system have shown that pilot ratings correlate well on the basis of equivalent time constant of the initial response. Ranges of this time constant, as well as digital-system transport delays and lateral-acceleration control authorities that encompassed Level I through Level III handling qualities, were determined.

Design and performance of daily quality assurance system for carbon ion therapy at NIRS

NASA Astrophysics Data System (ADS)

Saotome, N.; Furukawa, T.; Hara, Y.; Mizushima, K.; Tansho, R.; Saraya, Y.; Shirai, T.; Noda, K.

2017-09-01

At National Institute of Radiological Sciences (NIRS), we have been commissioning a rotating-gantry system for carbon-ion radiotherapy. This rotating gantry can transport heavy ions at 430 MeV/u to an isocenter with irradiation angles of ±180° that can rotate around the patient so that the tumor can be irradiated from any direction. A three-dimensional pencil-beam scanning irradiation system equipped with the rotating gantry enables the optimal use of physical characteristics of carbon ions to provide accurate treatment. To ensure the treatment quality using such a complex system, the calibration of the primary dose monitor, output check, range check, dose rate check, machine safety check, and some mechanical tests should be performed efficiently. For this purpose, we have developed a measurement system dedicated for quality assurance (QA) of this gantry system: the Daily QA system. The system consists of an ionization chamber system and a scintillator system. The ionization chamber system is used for the calibration of the primary dose monitor, output check, and dose rate check, and the scintillator system is used for the range check, isocenter, and gantry angle. The performance of the Daily QA system was verified by a beam test. The stability of the output was within 0.5%, and the range was within 0.5 mm. The coincidence of the coordinates between the patient-positioning system and the irradiation system was verified using the Daily QA system. Our present findings verified that the new Daily QA system for a rotating gantry is capable of verifying the irradiation system with sufficient accuracy.

12 CFR 8.2 - Semiannual assessment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... system (which rates risk management, operational controls, compliance, and asset quality) at its most... follows: If the bank's total assets (consolidated domestic and foreign subsidiaries) are: Over— But not.... The excess is assessed at the marginal rate shown in Column D. (3) The total semiannual assessment is...

REAL-TIME MONITORING FOR TOXICITY CAUSED BY HARMFUL ALGAL BLOOMS AND OTHER WATER QUALITY PERTURBATIONS

EPA Science Inventory

This project, sponsored by EPA's Environmental Monitoring for Public Access and Community Tracking (EMPACT) program, evaluated the ability of an automated biological monitoring system that measures fish ventilatory responses (ventilatory rate, ventilatory depth, and cough rate) t...

Describing the performance of U.S. hospitals by applying big data analytics.

PubMed

Downing, Nicholas S; Cloninger, Alexander; Venkatesh, Arjun K; Hsieh, Angela; Drye, Elizabeth E; Coifman, Ronald R; Krumholz, Harlan M

2017-01-01

Public reporting of measures of hospital performance is an important component of quality improvement efforts in many countries. However, it can be challenging to provide an overall characterization of hospital performance because there are many measures of quality. In the United States, the Centers for Medicare and Medicaid Services reports over 100 measures that describe various domains of hospital quality, such as outcomes, the patient experience and whether established processes of care are followed. Although individual quality measures provide important insight, it is challenging to understand hospital performance as characterized by multiple quality measures. Accordingly, we developed a novel approach for characterizing hospital performance that highlights the similarities and differences between hospitals and identifies common patterns of hospital performance. Specifically, we built a semi-supervised machine learning algorithm and applied it to the publicly-available quality measures for 1,614 U.S. hospitals to graphically and quantitatively characterize hospital performance. In the resulting visualization, the varying density of hospitals demonstrates that there are key clusters of hospitals that share specific performance profiles, while there are other performance profiles that are rare. Several popular hospital rating systems aggregate some of the quality measures included in our study to produce a composite score; however, hospitals that were top-ranked by such systems were scattered across our visualization, indicating that these top-ranked hospitals actually excel in many different ways. Our application of a novel graph analytics method to data describing U.S. hospitals revealed nuanced differences in performance that are obscured in existing hospital rating systems.

Open Evaluation: A Vision for Entirely Transparent Post-Publication Peer Review and Rating for Science

PubMed Central

Kriegeskorte, Nikolaus

2012-01-01

The two major functions of a scientific publishing system are to provide access to and evaluation of scientific papers. While open access (OA) is becoming a reality, open evaluation (OE), the other side of the coin, has received less attention. Evaluation steers the attention of the scientific community and thus the very course of science. It also influences the use of scientific findings in public policy. The current system of scientific publishing provides only journal prestige as an indication of the quality of new papers and relies on a non-transparent and noisy pre-publication peer-review process, which delays publication by many months on average. Here I propose an OE system, in which papers are evaluated post-publication in an ongoing fashion by means of open peer review and rating. Through signed ratings and reviews, scientists steer the attention of their field and build their reputation. Reviewers are motivated to be objective, because low-quality or self-serving signed evaluations will negatively impact their reputation. A core feature of this proposal is a division of powers between the accumulation of evaluative evidence and the analysis of this evidence by paper evaluation functions (PEFs). PEFs can be freely defined by individuals or groups (e.g., scientific societies) and provide a plurality of perspectives on the scientific literature. Simple PEFs will use averages of ratings, weighting reviewers (e.g., by H-index), and rating scales (e.g., by relevance to a decision process) in different ways. Complex PEFs will use advanced statistical techniques to infer the quality of a paper. Papers with initially promising ratings will be more deeply evaluated. The continual refinement of PEFs in response to attempts by individuals to influence evaluations in their own favor will make the system ungameable. OA and OE together have the power to revolutionize scientific publishing and usher in a new culture of transparency, constructive criticism, and collaboration. PMID:23087639

Criteria for Side-Force Control in Air-to-Ground Target Acquisition and Tracking

NASA Technical Reports Server (NTRS)

Sammonds, Robert I.; McNeill, Walter E.; Bunnell, John W.

1982-01-01

A moving-base simulator experiment conducted at Ames Research Center demonstrated that a wings-level-turn control mode improved flying qualities for air-to-ground weapons delivery compared with those of a conventional aircraft. Evaluations of criteria for dynamic response for this system have shown that pilot ratings correlate well with equivalent time constant of the initial response and with system bandwidth. Ranges of this time constant, as well as digital-system transport delays and lateral-acceleration control authorities that encompassed level 1 through level 3 handling qualities, were determined.

A Personalized Health Information Retrieval System

PubMed Central

Wang, Yunli; Liu, Zhenkai

2005-01-01

Consumers face barriers when seeking health information on the Internet. A Personalized Health Information Retrieval System (PHIRS) is proposed to recommend health information for consumers. The system consists of four modules: (1) User modeling module captures user’s preference and health interests; (2) Automatic quality filtering module identifies high quality health information; (3) Automatic text difficulty rating module classifies health information into professional or patient educational materials; and (4) User profile matching module tailors health information for individuals. The initial results show that PHIRS could assist consumers with simple search strategies. PMID:16779435

Ranking Reputation and Quality in Online Rating Systems

PubMed Central

Liao, Hao; Zeng, An; Xiao, Rui; Ren, Zhuo-Ming; Chen, Duan-Bing; Zhang, Yi-Cheng

2014-01-01

How to design an accurate and robust ranking algorithm is a fundamental problem with wide applications in many real systems. It is especially significant in online rating systems due to the existence of some spammers. In the literature, many well-performed iterative ranking methods have been proposed. These methods can effectively recognize the unreliable users and reduce their weight in judging the quality of objects, and finally lead to a more accurate evaluation of the online products. In this paper, we design an iterative ranking method with high performance in both accuracy and robustness. More specifically, a reputation redistribution process is introduced to enhance the influence of highly reputed users and two penalty factors enable the algorithm resistance to malicious behaviors. Validation of our method is performed in both artificial and real user-object bipartite networks. PMID:24819119

Barriers to the implementation of management systems: lessons from the past.

PubMed

Gardner, D

2000-01-01

There is a substantial body of evidence, both empirical and anecdotal, concerning factors associated with the success and failure of management systems. Given the increasing interest in management systems for occupational health and safety, quality, and the environment, it is worth looking at some of these factors in order to learn from them and plan for the future. One of the most comprehensive sources of information about factors that can make a management system succeed or fail lies in the material written about systems that improve the quality of products and services. Such systems were extremely widespread during the 1970s and 1980s but are now much less often cited or studied by Australian organisations. One of the reasons underlying the present relative lack of emphasis is that such programs, both here and overseas, experienced a failure rate of between 85% and 95%. While it may seem unlikely that occupational health and safety (OHS) and environmental management systems will experience similar failure rates, it is still worthwhile to look at what went wrong with other systems and to learn from these experiences.

Quality management and work environment in Swedish oral and maxillofacial surgery.

PubMed

Pilgård, Göran

2009-01-01

This thesis attempts to describe the opinion of the work with quality, quality management, and work environment among the employees at Oral and Maxillofacial Surgery (OMFS) clinics in Sweden. Analyse if the OMFS clinics in Sweden actively work with quality development and if so which systems they use. Explore the opinion of the employees about quality work. Describe how the employees of OMFS clinics in Sweden perceive good work, i.e., their image of the dimensions that the profession should contain to be really good work. Investigate whether there is a discrepancy between ideal and reality for this group. Describe how the employees of OMFS clinics in Sweden perceive their health. Analyse how work environment influenced attitudes to and knowledge of quality among employees of OMFS clinics in Sweden. The study was based on self-report questionnaires which in 2003 were sent to all OMFS clinics in Sweden. The response rate was 86%. Only at two clinics did all the respondents agree on their system. Surgeons rated intellectually stimulating work as most important, and the hazard-free work environment as least important. The nurses rated stimulating fellowship as most important, and the opportunity for career advancement as least important. The percentage unit differences between the ideal and the reality were largest for the item the work provides opportunities to have an influence on important decisions. There were significant differences between maxillofacial. surgeons and dental nurses and assistant nurses as to muscle- and joint trouble. The differences were also significant between men and women both as to muscle- and joint troubles and somatic trouble. Only work environment was significant for attitude towards quality work. Profession, gender, clinic size, and a factor for hard demand had significant associations to quality management system used or not. More than half of the respondents stated that they worked with a quality system. The dental nurses and assistant nurses had a much more positive view on the potential of quality work as a means to improve their work than had the maxillo-facial surgeons. For a majority of the dental nurses the working situation concerning the physical environment was more important than for the maxillo-facial surgeons. The employees emphasized free, influential, and intellectually stimulating work, but the dissonance between ideal and reality was rather wide concerning good work. OMFS employees are feeling unhealthy, but no worse than other high-risk-groups in human service working and better than female general practice dentists. The women of OMFS employees feel worse than the men.

A quality improvement initiative to increase HPV vaccine rates using an educational and reminder strategy with parents of preteen girls.

PubMed

Cassidy, Brenda; Braxter, Betty; Charron-Prochownik, Denise; Schlenk, Elizabeth A

2014-01-01

A quality improvement project was undertaken to determine if an evidence-based educational brochure and reminder system can increase human papillomavirus (HPV) vaccine uptake and dose completion rates. Development of a brochure to promote HPV vaccine uptake was based on predictors of parental acceptance and Health Belief Model concepts. Electronic alerts prompted telephone reminders for dose completion. This quality improvement project utilized a quasi-experimental design with 24 parents of preteen girls from a private pediatric practice and a historical control group of 29 parents. HPV vaccine rates were compared between the groups. A significant difference in HPV vaccine uptake (χ(2) = 11.668, P = .001; odds ratio [OR] = 9.429, 95% confidence interval [CI] = 2.686-33.101) and dose completion (χ(2) = 16.171, P < .001; OR = 22.500, 95% CI = 4.291-117.990) rates were found between the historical control and intervention groups. Parents who received the clinical protocol were 9.4 times and 22.5 times more likely to have HPV vaccine uptake and dose completion, respectively. Low national HPV vaccine rates demonstrate the need for theory-based vaccine delivery programs. These results show that an evidence-based educational brochure and reminder system appeared to improve HPV vaccine uptake and dose completion rates at this private pediatric practice. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

A clinimetric approach to assessing quality of life in epilepsy.

PubMed

Cramer, J A

1993-01-01

Clinimetrics is a concept involving the use of rating scales for clinical phenomena ranging from physical examinations to functional performance. Clinimetric or rating scales can be used for defining patient status and changes that occur during long-term observation. The scores derived from such scales can be used as guidelines for intervention, treatment, or prediction of outcome. In epilepsy, clinimetric scales have been developed for assessing seizure frequency, seizure severity, adverse effects related to antiepileptic drugs (AEDs), and quality of life after surgery for epilepsy. The VA Epilepsy Cooperative Study seizure rating scale combines frequency and severity in a weighted scoring system for simple and complex partial and generalized tonic-clonic seizures, summing all items in a total seizure score. Similarly, the rating scales for systemic toxicity and neurotoxicity use scores weighted for severity for assessing specific adverse effects typically related to AEDs. A composite score, obtained by adding the scores for seizures, systemic toxicity, and neurotoxicity, represents the overall status of the patient at a given time. The Chalfont Seizure Severity Scale also applies scores relative to the impact of a given item on the patient, without factoring in seizure frequency. The Liverpool Seizure Severity Scale is a patient questionnaire covering perceived seizure severity and the impact of ictal and postictal events. The UCLA Epilepsy Surgery Inventory (ESI-55) assesses quality of life for patients who have undergone surgery for epilepsy using generic health status instruments with additional epilepsy-specific items.(ABSTRACT TRUNCATED AT 250 WORDS)

Optical communication for space missions

NASA Technical Reports Server (NTRS)

Firtmaurice, M.

1991-01-01

Activities performed at NASA/GSFC (Goddard Space Flight Center) related to direct detection optical communications for space applications are discussed. The following subject areas are covered: (1) requirements for optical communication systems (data rates and channel quality; spatial acquisition; fine tracking and pointing; and transmit point-ahead correction); (2) component testing and development (laser diodes performance characterization and life testing; and laser diode power combining); (3) system development and simulations (The GSFC pointing, acquisition and tracking system; hardware description; preliminary performance analysis; and high data rate transmitter/receiver systems); and (4) proposed flight demonstration of optical communications.

Longitudinal Stability and Control Characteristics of a B-29 Airplane with a Booster Incorporated in the Elevator Control System to Provide Various Stick-Force and Control-Rate Characteristics

NASA Technical Reports Server (NTRS)

Mathews, Charles W.; Talmage, Donald B.; Whitten, James B.

1948-01-01

The longitudinal stability and control characteristics of a B-29 airplane have been measured with a booster incorporated in the elevator control system. Tests were made to determine the effects on the handling qualities of the test airplane of variations in pilots control-force gradients as well as the effects of variations in the maximum rate of control motion supplied by the booster system.

Factor information retrieval system version 2. 0 (fire) (for microcomputers). Software

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

Not Available

FIRE Version 2.0 contains EPA's unique recommended criteria and toxic air emission estimation factors. FIRE consists of: (1) an EPA internal repository system that contains emission factor data identified and collected, and (2) an external distribution system that contains only EPA's recommended factors. The emission factors, compiled from a review of the literature, are identified by pollutant name, CAS number, process and emission source descriptions, SIC code, SCC, and control status. The factors are rated for quality using AP-42 rating criteria.

Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; electronic reporting pilot; Inpatient Rehabilitation Facilities Quality Reporting Program; revision to Quality Improvement Organization regulations. Final rule with comment period.

PubMed

2012-11-15

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2013 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program. We are continuing the electronic reporting pilot for the Electronic Health Record (EHR) Incentive Program, and revising the various regulations governing Quality Improvement Organizations (QIOs), including the secure transmittal of electronic medical information, beneficiary complaint resolution and notification processes, and technical changes. The technical changes to the QIO regulations reflect CMS' commitment to the general principles of the President's Executive Order on Regulatory Reform, Executive Order 13563 (January 18, 2011).

[The establishment and application of internal quality control system for real-time quantitative PCR detection of BCR-ABL (P210) transcript levels].

PubMed

Zhong, C Q; He, N; Hua, M Q; Wei, X D; Ma, D X; Ji, C Y

2016-09-14

Objective: To set internal quality control system of BCR-ABL (P210) transcript levels for real-time quantitative PCR (RQ-PCR). Methods: Using K562 cells and HL-60 cells, we prepared high- and low-level BCR-ABL internal quality control substance. The BCR-ABL (P210) transcript levels of internal quality control substance have been determined for 184 times together with clinical samples from August 2013 to October 2015. The slope rate, intercept and correlation coefficient of standard curve were calculated according to different reagent lots (lots number 20130303, 20131212, 20140411 and 20150327 are called R1、R2、R3 and R4 for short respectively), and the detection results of quality control substance were calculated according to different reagent lots and quality control substance lots (lots number 20130725, 20140611 are called Q1、Q2 for short respectively). Then the results were analyzed by Levey-Jennings quality control chart combined with Westgard multi-rules theory. Results: ①We analyzed the slope rate and intercept of standard curve. Fifty-three times of the R1 reagent detection, 80 times of the R3 reagent detection and 14 times of the R4 reagent detection were all under control. For 37 times detection of R2 reagent, the slope rate was out of control for 6 times. It was lower than x - s for the 2-8 tests and upper the average for the 12-37 tests. The intercept was out of control for 9 times, upper the x + s for the 1-8 tests and lower the average for the 12-37 tests. ② According to the detection results of quality control substance, for Q1 quality control substance, 49 tests by R1 reagent were under control, and 1 out of 23 tests by R2 reagent was out of control. For Q2 quality control substance, 14 tests by R2 reagent detection, 72 tests by R3 reagent detection and 14 tests by R4 reagent were all under control. Conclusion: The preparation of high- and low-level quality control substance using K562 and HL-60 cells was convenient and the detection results were reliable and stable. The application of quality control substance combined with slope rate and intercept in the internal quality control may contribute to quality assurance for quantitative detection of BCR-ABL (P210) transcript levels.

National surveys on internal quality control for blood gas analysis and related electrolytes in clinical laboratories of China.

PubMed

Duan, Min; Wang, Wei; Zhao, Haijian; Zhang, Chuanbao; He, Falin; Zhong, Kun; Yuan, Shuai; Wang, Zhiguo

2018-05-01

Internal quality control (IQC) is essential for precision evaluation and continuous quality improvement. This study aims to investigate the IQC status of blood gas analysis (BGA) in clinical laboratories of China from 2014 to 2017. IQC information on BGA (including pH, pCO2, pO2, Na+, K+, Ca2+, Cl-) was submitted by external quality assessment (EQA) participant laboratories and collected through Clinet-EQA reporting system in March from 2014 to 2017. First, current CVs were compared among different years and measurement systems. Then, percentages of laboratories meeting five allowable imprecision specifications for each analyte were calculated, respectively. Finally, laboratories were divided into different groups based on control rules and frequency to compare their variation trend. The current CVs of BGA were significantly decreasing from 2014 to 2017. pH and pCO2 got the highest pass rates when compared with the minimum imprecision specification, whereas pO2, Na+, K+, Ca2+, Cl- got the highest pass rates when 1/3 TEa imprecision specification applied. The pass rates of pH, pO2, Na+, K+, Ca2+, Cl- were significantly increasing during the 4 years. The comparisons of current CVs among different measurement systems showed that the precision performance of different analytes among different measurement systems had no regular distribution from 2014 to 2017. The analysis of IQC practice indicated great progress and improvement among different years. The imprecision performance of BGA has improved from 2014 to 2017, but the status of imprecision performance in China remains unsatisfying. Therefore, further investigation and continuous improvement measures should be taken.

Data Applicability of Heritage and New Hardware for Launch Vehicle System Reliability Models

NASA Technical Reports Server (NTRS)

Al Hassan Mohammad; Novack, Steven

2015-01-01

Many launch vehicle systems are designed and developed using heritage and new hardware. In most cases, the heritage hardware undergoes modifications to fit new functional system requirements, impacting the failure rates and, ultimately, the reliability data. New hardware, which lacks historical data, is often compared to like systems when estimating failure rates. Some qualification of applicability for the data source to the current system should be made. Accurately characterizing the reliability data applicability and quality under these circumstances is crucial to developing model estimations that support confident decisions on design changes and trade studies. This presentation will demonstrate a data-source classification method that ranks reliability data according to applicability and quality criteria to a new launch vehicle. This method accounts for similarities/dissimilarities in source and applicability, as well as operating environments like vibrations, acoustic regime, and shock. This classification approach will be followed by uncertainty-importance routines to assess the need for additional data to reduce uncertainty.

An assessment system for rating scientific journals in the field of ergonomics and human factors.

PubMed

Dul, Jan; Karwowski, Waldemar

2004-05-01

A method for selecting and rating scientific and professional journals representing the discipline of ergonomics and human factors is proposed. The method is based upon the journal list, impact factors and citations provided by the Institute of Scientific Information (ISI), and the journal list published in the Ergonomics Abstracts. Three groups of journals were distinguished. The 'ergonomics journals' focus exclusively on ergonomics and human factors. The 'related journals' focus on other disciplines than ergonomics and human factors, but regularly publish ergonomics/human factors papers. The 'basic journals' focus on other technical, medical or social sciences than ergonomics, but are important for the development of ergonomics/human factors. Journal quality was rated using a maximum of four categories: top quality (A-level), high quality (B-level), good quality (C-level)) and professional (P-level). The above methods were applied to develop the Ergonomics Journal List 2004. A total of 25 'ergonomics journals', 58 'related journals' and 142 'basic journals' were classified.

Assessing Quality in Toddler Classrooms Using the CLASS-Toddler and the ITERS-R

ERIC Educational Resources Information Center

La Paro, Karen M.; Williamson, Amy C.; Hatfield, Bridget

2014-01-01

Many very young children attend early care and education programs, but current information about the quality of center-based care for toddlers is scarce. Using 2 observation instruments, the Infant/Toddler Environment Rating Scale-Revised (ITERS-R) and the Classroom Assessment Scoring System, Toddler Version (CLASS-Toddler), 93 child care…

The Implementation of an Automated Assessment Feedback and Quality Assurance System for ICT Courses

ERIC Educational Resources Information Center

Debuse, J.; Lawley, M.; Shibl, R.

2007-01-01

Providing detailed, constructive and helpful feedback is an important contribution to effective student learning. Quality assurance is also required to ensure consistency across all students and reduce error rates. However, with increasing workloads and student numbers these goals are becoming more difficult to achieve. An automated feedback…

Professional Conversations: A Collaborative Approach to Support Policy Implementation, Professional Learning and Practice Change in ECEC

ERIC Educational Resources Information Center

Irvine, Susan; Price, Julie

2014-01-01

In 2012, Australia introduced a new "National Quality Framework" (NQF), comprising enhanced quality expectations for early childhood education and care services, two national learning frameworks and a new assessment and rating system spanning childcare centres, kindergartens and preschools, family day care and outside school hours care.…

Oceanographers and the US Federal Patron: Perceptions of Agency-University Relations.

ERIC Educational Resources Information Center

Palmer, David D.; And Others

1988-01-01

Examines the patterns of contracts between academic marine scientists and two kinds of federal funding agencies. Discusses the quality of working relationships, quality of academic marine scientific work, and dilemma of conflicting value systems. Finds that the scientists rate science-oriented agencies more favorably than society-oriented ones.…

The Characteristics and Quality of Pre-School Education in Spain

ERIC Educational Resources Information Center

Sandstrom, Heather

2012-01-01

We examined 25 four-year-old pre-school classrooms from a random sample of 15 schools within a large urban city in southern Spain. Observational measures of classroom quality included the Early Childhood Environment Rating Scale-Revised, the Classroom Assessment Scoring System and the Observation of Activities in Pre-school. Findings revealed…

Investigation of Control System and Display Variations on Spacecraft Handling Qualities for Docking with Stationary and Rotating Targets

NASA Technical Reports Server (NTRS)

Jackson, E. Bruce; Goodrich, Kenneth H.; Bailey, Randall E.; Barnes, James R.; Ragsdale, William A.; Neuhaus, Jason R.

2010-01-01

This paper documents the investigation into the manual docking of a preliminary version of the Crew Exploration Vehicle with stationary and rotating targets in Low Earth Orbit. The investigation was conducted at NASA Langley Research Center in the summer of 2008 in a repurposed fixed-base transport aircraft cockpit and involved nine evaluation astronauts and research pilots. The investigation quantified the benefits of a feed-forward reaction control system thruster mixing scheme to reduce translation-into-rotation coupling, despite unmodeled variations in individual thruster force levels and off-axis center of mass locations up to 12 inches. A reduced rate dead-band in the phase-plane attitude controller also showed some promise. Candidate predictive symbology overlaid on a docking ring centerline camera image did not improve handling qualities, but an innovative attitude status indicator symbol was beneficial. The investigation also showed high workload and handling quality problems when manual dockings were performed with a rotating target. These concerns indicate achieving satisfactory handling quality ratings with a vehicle configuration similar to the nominal Crew Exploration Vehicle may require additional automation.

High Quality Teaching in a University: Identification and Description.

ERIC Educational Resources Information Center

Moses, Ingrid

1985-01-01

The teaching approaches and attitudes toward teaching of University of Queensland faculty rated superior under one rating system are examined, including professional and personal skills and attitudes such as subject area competence, ability to communicate knowledge in various classroom contexts, and commitment to facilitating learning in…

Optimizing the Energy and Throughput of a Water-Quality Monitoring System.

PubMed

Olatinwo, Segun O; Joubert, Trudi-H

2018-04-13

This work presents a new approach to the maximization of energy and throughput in a wireless sensor network (WSN), with the intention of applying the approach to water-quality monitoring. Water-quality monitoring using WSN technology has become an interesting research area. Energy scarcity is a critical issue that plagues the widespread deployment of WSN systems. Different power supplies, harvesting energy from sustainable sources, have been explored. However, when energy-efficient models are not put in place, energy harvesting based WSN systems may experience an unstable energy supply, resulting in an interruption in communication, and low system throughput. To alleviate these problems, this paper presents the joint maximization of the energy harvested by sensor nodes and their information-transmission rate using a sum-throughput technique. A wireless information and power transfer (WIPT) method is considered by harvesting energy from dedicated radio frequency sources. Due to the doubly near-far condition that confronts WIPT systems, a new WIPT system is proposed to improve the fairness of resource utilization in the network. Numerical simulation results are presented to validate the mathematical formulations for the optimization problem, which maximize the energy harvested and the overall throughput rate. Defining the performance metrics of achievable throughput and fairness in resource sharing, the proposed WIPT system outperforms an existing state-of-the-art WIPT system, with the comparison based on numerical simulations of both systems. The improved energy efficiency of the proposed WIPT system contributes to addressing the problem of energy scarcity.

Optimizing the Energy and Throughput of a Water-Quality Monitoring System

PubMed Central

Olatinwo, Segun O.

2018-01-01

This work presents a new approach to the maximization of energy and throughput in a wireless sensor network (WSN), with the intention of applying the approach to water-quality monitoring. Water-quality monitoring using WSN technology has become an interesting research area. Energy scarcity is a critical issue that plagues the widespread deployment of WSN systems. Different power supplies, harvesting energy from sustainable sources, have been explored. However, when energy-efficient models are not put in place, energy harvesting based WSN systems may experience an unstable energy supply, resulting in an interruption in communication, and low system throughput. To alleviate these problems, this paper presents the joint maximization of the energy harvested by sensor nodes and their information-transmission rate using a sum-throughput technique. A wireless information and power transfer (WIPT) method is considered by harvesting energy from dedicated radio frequency sources. Due to the doubly near–far condition that confronts WIPT systems, a new WIPT system is proposed to improve the fairness of resource utilization in the network. Numerical simulation results are presented to validate the mathematical formulations for the optimization problem, which maximize the energy harvested and the overall throughput rate. Defining the performance metrics of achievable throughput and fairness in resource sharing, the proposed WIPT system outperforms an existing state-of-the-art WIPT system, with the comparison based on numerical simulations of both systems. The improved energy efficiency of the proposed WIPT system contributes to addressing the problem of energy scarcity. PMID:29652866

Probabilistic Determination of Green Infrastructure Pollutant Removal Rates from the International Stormwater BMP Database

NASA Astrophysics Data System (ADS)

Gilliom, R.; Hogue, T. S.; McCray, J. E.

2017-12-01

There is a need for improved parameterization of stormwater best management practices (BMP) performance estimates to improve modeling of urban hydrology, planning and design of green infrastructure projects, and water quality crediting for stormwater management. Percent removal is commonly used to estimate BMP pollutant removal efficiency, but there is general agreement that this approach has significant uncertainties and is easily affected by site-specific factors. Additionally, some fraction of monitored BMPs have negative percent removal, so it is important to understand the probability that a BMP will provide the desired water quality function versus exacerbating water quality problems. The widely used k-C* equation has shown to provide a more adaptable and accurate method to model BMP contaminant attenuation, and previous work has begun to evaluate the strengths and weaknesses of the k-C* method. However, no systematic method exists for obtaining first-order removal rate constants needed to use the k-C* equation for stormwater BMPs; thus there is minimal application of the method. The current research analyzes existing water quality data in the International Stormwater BMP Database to provide screening-level parameterization of the k-C* equation for selected BMP types and analysis of factors that skew the distribution of efficiency estimates from the database. Results illustrate that while certain BMPs are more likely to provide desired contaminant removal than others, site- and design-specific factors strongly influence performance. For example, bioretention systems show both the highest and lowest removal rates of dissolved copper, total phosphorous, and total nitrogen. Exploration and discussion of this and other findings will inform the application of the probabilistic pollutant removal rate constants. Though data limitations exist, this research will facilitate improved accuracy of BMP modeling and ultimately aid decision-making for stormwater quality management in urban systems.

Functionality and operation of fluoroscopic automatic brightness control/automatic dose rate control logic in modern cardiovascular and interventional angiography systems: A Report of Task Group 125 Radiography/Fluoroscopy Subcommittee, Imaging Physics Committee, Science Council

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

Rauch, Phillip; Lin, Pei-Jan Paul; Balter, Stephen

2012-05-15

Task Group 125 (TG 125) was charged with investigating the functionality of fluoroscopic automatic dose rate and image quality control logic in modern angiographic systems, paying specific attention to the spectral shaping filters and variations in the selected radiologic imaging parameters. The task group was also charged with describing the operational aspects of the imaging equipment for the purpose of assisting the clinical medical physicist with clinical set-up and performance evaluation. Although there are clear distinctions between the fluoroscopic operation of an angiographic system and its acquisition modes (digital cine, digital angiography, digital subtraction angiography, etc.), the scope of thismore » work was limited to the fluoroscopic operation of the systems studied. The use of spectral shaping filters in cardiovascular and interventional angiography equipment has been shown to reduce patient dose. If the imaging control algorithm were programmed to work in conjunction with the selected spectral filter, and if the generator parameters were optimized for the selected filter, then image quality could also be improved. Although assessment of image quality was not included as part of this report, it was recognized that for fluoroscopic imaging the parameters that influence radiation output, differential absorption, and patient dose are also the same parameters that influence image quality. Therefore, this report will utilize the terminology ''automatic dose rate and image quality'' (ADRIQ) when describing the control logic in modern interventional angiographic systems and, where relevant, will describe the influence of controlled parameters on the subsequent image quality. A total of 22 angiography units were investigated by the task group and of these one each was chosen as representative of the equipment manufactured by GE Healthcare, Philips Medical Systems, Shimadzu Medical USA, and Siemens Medical Systems. All equipment, for which measurement data were included in this report, was manufactured within the three year period from 2006 to 2008. Using polymethylmethacrylate (PMMA) plastic to simulate patient attenuation, each angiographic imaging system was evaluated by recording the following parameters: tube potential in units of kilovolts peak (kVp), tube current in units of milliamperes (mA), pulse width (PW) in units of milliseconds (ms), spectral filtration setting, and patient air kerma rate (PAKR) as a function of the attenuator thickness. Data were graphically plotted to reveal the manner in which the ADRIQ control logic responded to changes in object attenuation. There were similarities in the manner in which the ADRIQ control logic operated that allowed the four chosen devices to be divided into two groups, with two of the systems in each group. There were also unique approaches to the ADRIQ control logic that were associated with some of the systems, and these are described in the report. The evaluation revealed relevant information about the testing procedure and also about the manner in which different manufacturers approach the utilization of spectral filtration, pulsed fluoroscopy, and maximum PAKR limitation. This information should be particularly valuable to the clinical medical physicist charged with acceptance testing and performance evaluation of modern angiographic systems.« less

Functionality and operation of fluoroscopic automatic brightness control/automatic dose rate control logic in modern cardiovascular and interventional angiography systems: a report of Task Group 125 Radiography/Fluoroscopy Subcommittee, Imaging Physics Committee, Science Council.

PubMed

Rauch, Phillip; Lin, Pei-Jan Paul; Balter, Stephen; Fukuda, Atsushi; Goode, Allen; Hartwell, Gary; LaFrance, Terry; Nickoloff, Edward; Shepard, Jeff; Strauss, Keith

2012-05-01

Task Group 125 (TG 125) was charged with investigating the functionality of fluoroscopic automatic dose rate and image quality control logic in modern angiographic systems, paying specific attention to the spectral shaping filters and variations in the selected radiologic imaging parameters. The task group was also charged with describing the operational aspects of the imaging equipment for the purpose of assisting the clinical medical physicist with clinical set-up and performance evaluation. Although there are clear distinctions between the fluoroscopic operation of an angiographic system and its acquisition modes (digital cine, digital angiography, digital subtraction angiography, etc.), the scope of this work was limited to the fluoroscopic operation of the systems studied. The use of spectral shaping filters in cardiovascular and interventional angiography equipment has been shown to reduce patient dose. If the imaging control algorithm were programmed to work in conjunction with the selected spectral filter, and if the generator parameters were optimized for the selected filter, then image quality could also be improved. Although assessment of image quality was not included as part of this report, it was recognized that for fluoroscopic imaging the parameters that influence radiation output, differential absorption, and patient dose are also the same parameters that influence image quality. Therefore, this report will utilize the terminology "automatic dose rate and image quality" (ADRIQ) when describing the control logic in modern interventional angiographic systems and, where relevant, will describe the influence of controlled parameters on the subsequent image quality. A total of 22 angiography units were investigated by the task group and of these one each was chosen as representative of the equipment manufactured by GE Healthcare, Philips Medical Systems, Shimadzu Medical USA, and Siemens Medical Systems. All equipment, for which measurement data were included in this report, was manufactured within the three year period from 2006 to 2008. Using polymethylmethacrylate (PMMA) plastic to simulate patient attenuation, each angiographic imaging system was evaluated by recording the following parameters: tube potential in units of kilovolts peak (kVp), tube current in units of milliamperes (mA), pulse width (PW) in units of milliseconds (ms), spectral filtration setting, and patient air kerma rate (PAKR) as a function of the attenuator thickness. Data were graphically plotted to reveal the manner in which the ADRIQ control logic responded to changes in object attenuation. There were similarities in the manner in which the ADRIQ control logic operated that allowed the four chosen devices to be divided into two groups, with two of the systems in each group. There were also unique approaches to the ADRIQ control logic that were associated with some of the systems, and these are described in the report. The evaluation revealed relevant information about the testing procedure and also about the manner in which different manufacturers approach the utilization of spectral filtration, pulsed fluoroscopy, and maximum PAKR limitation. This information should be particularly valuable to the clinical medical physicist charged with acceptance testing and performance evaluation of modern angiographic systems.

Application of Calspan pitch rate control system to the Space Shuttle for approach and landing

NASA Technical Reports Server (NTRS)

Weingarten, N. C.; Chalk, C. R.

1983-01-01

A pitch rate control system designed for use in the shuttle during approach and landing was analyzed and compared with a revised control system developed by NASA and the existing OFT control system. The design concept control system uses filtered pitch rate feedback with proportional plus integral paths in the forward loop. Control system parameters were designed as a function of flight configuration. Analysis included time and frequency domain techniques. Results indicate that both the Calspan and NASA systems significantly improve the flying qualities of the shuttle over the OFT. Better attitude and flight path control and less time delay are the primary reasons. The Calspan system is preferred because of reduced time delay and simpler mechanization. Further testing of the improved flight control systems in an in-flight simulator is recommended.

Improving Surgical Complications and Patient Safety at the Nation's Largest Military Hospital: An Analysis of National Surgical Quality Improvement Program Data.

PubMed

Maturo, Steve; Hughes, Charlotte; Kallingal, George; Silvey, Stephen; Johnson, A J; Soderdahl, Douglas; Renz, Evan; Brennan, Joseph

2017-03-01

The U.S. Military Health System cares for over 9 million patients and encompasses 63 hospitals and 413 clinics worldwide. Military medicine balances the simultaneous tasks of caring for those patients wounded in military engagements, treating large numbers of families of service men and women, and training the next generation of health care providers and ancillary staff. Similar to civilian health care delivery in the United States, military medicine has also seen increased scrutiny in the areas of cost and quality. In 2014, the U.S. military medical health care system was criticized for higher than average surgical complication rates and concerns regarding patient safety, quality of care, lack of transparency, and compartmentalized leadership. The San Antonio Military Medical Center was specifically cited as having "a perennial problem with surgical infection control…the infection rate of surgical wounds was 77% higher than expected given the mix of cases, according to a Pentagon-ordered comparison with civilian hospitals." To determine the scope of complication rates, data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) were analyzed. The goal of this article is to describe the NSQIP surgical outcome data for the U.S. Military's largest medical center from 2009 to 2014 and compare national averages in the areas of mortality, morbidity, cardiac occurrences, pneumonia, unplanned intubation, ventilator use greater than 48 hours, infections, readmissions, and return to operating room. Retrospective data analysis of NSQIP data from 2009 to 2014 at the San Antonio Military Medical Center, a level I trauma center for military members and eligible dependents along with civilian trauma patients. Observed event rates were compared with expected event rates for each year with the 2-tail Fisher's exact test to determine if rates were significantly different from each other. Cochran-Armitage Trend Test was performed to compare trends in time for the observed event rates. This study was exempt from institutional review board Approval. Complication rates remained stable or decreased over the 5 years studied. Significant improvement in morbidity and surgical site infections were observed during the observation period. All other variables except urinary tract infections were within expected range or decreased during this time. Urinary tract infection rates, although decreasing, remain above the expected value. NSQIP data at the Department of Defense's largest hospital reveals complication rates similar to civilian hospitals. The majority of areas studied revealed improving or stable complication rates. The ACS NSQIP is a nationally validated, risk-adjusted, outcomes program that is widely used by many leading hospital institutions. Similar to most quality data reporting articles, a weakness of our study may have been collection of all complications. Yet, we are confident that the majority of complications were captured as we have dedicated personnel monitoring the adverse events measured by ACS NSQIP. Future areas of study should focus on continued analysis of surgical quality improvement within the entire military system. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Improving oxygen therapy for children and neonates in secondary hospitals in Nigeria: study protocol for a stepped-wedge cluster randomised trial.

PubMed

Graham, Hamish R; Ayede, Adejumoke I; Bakare, Ayobami A; Oyewole, Oladapo B; Peel, David; Gray, Amy; McPake, Barbara; Neal, Eleanor; Qazi, Shamim; Izadnegahdar, Rasa; Falade, Adegoke G; Duke, Trevor

2017-10-27

Oxygen is a life-saving, essential medicine that is important for the treatment of many common childhood conditions. Improved oxygen systems can reduce childhood pneumonia mortality substantially. However, providing oxygen to children is challenging, especially in small hospitals with weak infrastructure and low human resource capacity. This trial will evaluate the implementation of improved oxygen systems at secondary-level hospitals in southwest Nigeria. The improved oxygen system includes: a standardised equipment package; training of clinical and technical staff; infrastructure support (including improved power supply); and quality improvement activities such as supportive supervision. Phase 1 will involve the introduction of pulse oximetry alone; phase 2 will involve the introduction of the full, improved oxygen system package. We have based the intervention design on a theory-based analysis of previous oxygen projects, and used quality improvement principles, evidence-based teaching methods, and behaviour-change strategies. We are using a stepped-wedge cluster randomised design with participating hospitals randomised to receive an improved oxygen system at 4-month steps (three hospitals per step). Our mixed-methods evaluation will evaluate effectiveness, impact, sustainability, process and fidelity. Our primary outcome measures are childhood pneumonia case fatality rate and inpatient neonatal mortality rate. Secondary outcome measures include a range of clinical, quality of care, technical, and health systems outcomes. The planned study duration is from 2015 to 2018. Our study will provide quality evidence on the effectiveness of improved oxygen systems, and how to better implement and scale-up oxygen systems in resource-limited settings. Our results should have important implications for policy-makers, hospital administrators, and child health organisations in Africa and globally. Australian New Zealand Clinical Trials Registry: ACTRN12617000341325 . Retrospectively registered on 6 March 2017.

Estimating occupant satisfaction of HVAC system noise using quality assessment index.

PubMed

Forouharmajd, Farhad; Nassiri, Parvin; Monazzam, Mohammad R; Yazdchi, Mohammadreza

2012-01-01

Noise may be defined as any unwanted sound. Sound becomes noise when it is too loud, unexpected, uncontrolled, happens at the wrong time, contains unwanted pure tones or unpleasant. In addition to being annoying, loud noise can cause hearing loss, and, depending on other factors, can affect stress level, sleep patterns and heart rate. The primary object for determining subjective estimations of loudness is to present sounds to a sample of listeners under controlled conditions. In heating, ventilation and air conditioning (HVAC) systems only the ventilation fan industry (e.g., bathroom exhaust and sidewall propeller fans) uses loudness ratings. In order to find satisfaction, percent of exposure to noise is the valuable issue for the personnel who are working in these areas. The room criterion (RC) method has been defined by ANSI standard S12.2, which is based on measured levels of in HVAC systems noise in spaces and is used primarily as a diagnostic tool. The RC method consists of a family of criteria curves and a rating procedure. RC measures background noise in the building over the frequency range of 16-4000 Hz. This rating system requires determination of the mid-frequency average level and determining the perceived balance between high-frequency (HF) sound and low-frequency (LF) sound. The arithmetic average of the sound levels in the 500, 1000 and 2000 Hz octave bands is 44.6 dB; therefore, the RC 45 curve is selected as the reference for spectrum quality evaluation. The spectral deviation factors in the LF, medium-frequency sound and HF regions are 2.9, 7.5 and -2.3, respectively, giving a Quality Assessment Index (QAI) of 9.8. This concludes the QAI is useful in estimating an occupant's probable reaction when the system design does not produce optimum sound quality. Thus, a QAI between 5 and 10 dB represents a marginal situation in which acceptance by an occupant is questionable. However, when sound pressure levels in the 16 or 31.5 Hz octave bands exceed 65 dB, vibration in lightweight office construction is possible.

Approach path control for powered-lift STOL aircraft

NASA Technical Reports Server (NTRS)

Clymer, D. J.; Flora, C. C.

1973-01-01

A flight control system concept is defined for approach flightpath control of an augmentor wing (or similar) powered-lift STOL configuration. The proposed STOL control concept produces aircraft transient and steady-state control responses that are familiar to pilots of conventional jet transports, and has potential for good handling qualities ratings in all approach and landing phases. The effects of trailing-edge rate limits, real-engine dynamics, and atmospheric turbulence are considered in the study. A general discussion of STOL handling qualities problems and piloting techniques is included.

The use of noise equivalent count rate and the NEMA phantom for PET image quality evaluation.

PubMed

Yang, Xin; Peng, Hao

2015-03-01

PET image quality is directly associated with two important parameters among others: count-rate performance and image signal-to-noise ratio (SNR). The framework of noise equivalent count rate (NECR) was developed back in the 1990s and has been widely used since then to evaluate count-rate performance for PET systems. The concept of NECR is not entirely straightforward, however, and among the issues requiring clarification are its original definition, its relationship to image quality, and its consistency among different derivation methods. In particular, we try to answer whether a higher NECR measurement using a standard NEMA phantom actually corresponds to better imaging performance. The paper includes the following topics: 1) revisiting the original analytical model for NECR derivation; 2) validating three methods for NECR calculation based on the NEMA phantom/standard; and 3) studying the spatial dependence of NECR and quantitative relationship between NECR and image SNR. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Automating variable rate irrigation management prescriptions for center pivots from field data maps

USDA-ARS?s Scientific Manuscript database

Variable rate irrigation (VRI) enables center pivot systems to match irrigation application to non-uniform field needs. This technology has potential to improve application and water-use efficiency while reducing environmental impacts from excess runoff and poor water quality. Proper management of V...

Ceiling-mounted personalized ventilation system integrated with a secondary air distribution system--a human response study in hot and humid climate.

PubMed

Yang, B; Sekhar, S C; Melikov, A K

2010-08-01

The benefits of thermal comfort and indoor air quality with personalized ventilation (PV) systems have been demonstrated in recent studies. One of the barriers for wide spread acceptance by architects and HVAC designers has been attributed to challenges and constraints faced in the integration of PV systems with the work station. A newly developed ceiling-mounted PV system addresses these challenges and provides a practical solution while retaining much of the apparent benefits of PV systems. Assessments of thermal environment, air movement, and air quality for ceiling-mounted PV system were performed with tropically acclimatized subjects in a Field Environmental Chamber. Thirty-two subjects performed normal office work and could choose to be exposed to four different PV airflow rates (4, 8, 12, and 16 L/s), thus offering themselves a reasonable degree of individual control. Ambient temperatures of 26 and 23.5 degrees C and PV air temperatures of 26, 23.5, and 21 degrees C were employed. The local and whole body thermal sensations were reduced when PV airflow rates were increased. Inhaled air temperature was perceived cooler and perceived air quality and air freshness improved when PV airflow rate was increased or temperature was reduced. The newly developed ceiling-mounted PV system offers a practical solution to the integration of PV air terminal devices (ATDs) in the vicinity of the workstation. By remotely locating the PV ATDs on the ceiling directly above the occupants and under their control, the conditioned outdoor air is now provided to the occupants through the downward momentum of the air. A secondary air-conditioning and air distribution system offers additional cooling in the room and maintains a higher ambient temperature, thus offering significant benefits in conserving energy. The results of this study provide designers and consultants with needed knowledge for design of PV systems.

Rapid-Testing Technology and Systems Improvement for the Elimination of Congenital Syphilis in Haiti: Overcoming the “Technology to Systems Gap”

PubMed Central

Benoit, Daphne; Zhou, Xi K.; Pape, Jean W.; Peeling, Rosanna W.; Fitzgerald, Daniel W.; Mate, Kedar S.

2013-01-01

Background. Despite the availability of rapid diagnostic tests and inexpensive treatment for pregnant women, maternal-child syphilis transmission remains a leading cause of perinatal morbidity and mortality in developing countries. In Haiti, more than 3000 babies are born with congenital syphilis annually. Methods and Findings. From 2007 to 2011, we used a sequential time series, multi-intervention study design in fourteen clinics throughout Haiti to improve syphilis testing and treatment in pregnancy. The two primary interventions were the introduction of a rapid point-of-care syphilis test and systems strengthening based on quality improvement (QI) methods. Syphilis testing increased from 91.5% prediagnostic test to 95.9% after (P < 0.001) and further increased to 96.8% (P < 0.001) after the QI intervention. Despite high rates of testing across all time periods, syphilis treatment lagged behind and only increased from 70.3% to 74.7% after the introduction of rapid tests (P = 0.27), but it improved significantly from 70.2% to 84.3% (P < 0.001) after the systems strengthening QI intervention. Conclusion. Both point-of-care diagnostic testing and health systems-based quality improvement interventions can improve the delivery of specific evidence-based healthcare interventions to prevent congenital syphilis at scale in Haiti. Improved treatment rates for syphilis were seen only after the use of systems-based quality improvement approaches. PMID:26316955

Rapid-Testing Technology and Systems Improvement for the Elimination of Congenital Syphilis in Haiti: Overcoming the "Technology to Systems Gap".

PubMed

Severe, Linda; Benoit, Daphne; Zhou, Xi K; Pape, Jean W; Peeling, Rosanna W; Fitzgerald, Daniel W; Mate, Kedar S

2013-01-01

Background. Despite the availability of rapid diagnostic tests and inexpensive treatment for pregnant women, maternal-child syphilis transmission remains a leading cause of perinatal morbidity and mortality in developing countries. In Haiti, more than 3000 babies are born with congenital syphilis annually. Methods and Findings. From 2007 to 2011, we used a sequential time series, multi-intervention study design in fourteen clinics throughout Haiti to improve syphilis testing and treatment in pregnancy. The two primary interventions were the introduction of a rapid point-of-care syphilis test and systems strengthening based on quality improvement (QI) methods. Syphilis testing increased from 91.5% prediagnostic test to 95.9% after (P < 0.001) and further increased to 96.8% (P < 0.001) after the QI intervention. Despite high rates of testing across all time periods, syphilis treatment lagged behind and only increased from 70.3% to 74.7% after the introduction of rapid tests (P = 0.27), but it improved significantly from 70.2% to 84.3% (P < 0.001) after the systems strengthening QI intervention. Conclusion. Both point-of-care diagnostic testing and health systems-based quality improvement interventions can improve the delivery of specific evidence-based healthcare interventions to prevent congenital syphilis at scale in Haiti. Improved treatment rates for syphilis were seen only after the use of systems-based quality improvement approaches.

Effects of tillage and application rate on atrazine transport to subsurface drainage: Evaluation of RZWQM using a six-year field study

USDA-ARS?s Scientific Manuscript database

Well-tested agricultural system models can improve our understanding of the water quality effects of management practices under different conditions. The Root Zone Water Quality Model (RZWQM) has been tested under a variety of conditions. However, the current model’s ability to simulate pesticide tr...

The Marine Corps Enlisted Assignment Process: The Customer’s Perspective

DTIC Science & Technology

2003-03-01

continue service in the Marine Corps or to leave. Additionally, this process affects career development, quality of life , and ultimately their lives...retention goals. If not, the Marine Corps may increase quality of life by introducing new assignment processes or systems. These changes could also increase enlisted Marines’ retention rate, and ultimately personnel readiness.

Interrater Reliability in Large-Scale Assessments--Can Teachers Score National Tests Reliably without External Controls?

ERIC Educational Resources Information Center

Pantzare, Anna Lind

2015-01-01

In most large-scale assessment systems a set of rather expensive external quality controls are implemented in order to guarantee the quality of interrater reliability. This study empirically examines if teachers' ratings of national tests in mathematics can be reliable without using monitoring, training, or other methods of external quality…

Early Brain and Child Development: Connections to Early Education and Child Care

ERIC Educational Resources Information Center

Romano, Judith T.

2013-01-01

The vast majority of young children spend time in settings outside of the home, and the nature of those settings directly impacts the child's health and development. The ecobiodevelopmental framework of early brain and child development serve as the backdrop for establishing quality. This article describes the use of quality rating systems,…

Producing high-quality negatives from ERTS black-and-white transparancies

Treesearch

Richard J. Myhre

1973-01-01

A method has been devised for producing high-quality black-and-white negatives quickly and efficiently from dense transparencies orgininating from Earth Resources Technology Satellite imagery. Transparencies are evaluated on a standard light source to determine exposure and processing information needed for making negatives. A “System ASA Rating” was developed by...

Are We at the Crossroads for Wisconsin Child Care? Policies in Conflict

ERIC Educational Resources Information Center

Wisconsin Council on Children and Families, 2016

2016-01-01

This report examines the conflicting public policies in child care and their implications. The policy analysis tracks the history of two major child care programs, the Wisconsin Shares child care subsidy program and the YoungStar Quality Rating and Improvement System. While YoungStar shows promising trends in improving the quality of early care…

Quality in the Basic Grant Delivery System: Volume 2, Corrective Actions.

ERIC Educational Resources Information Center

Advanced Technology, Inc., McLean, VA.

Alternative management procedures are recommended that may lower the rate and magnitude of errors in the award of the Basic Educational Opportunity Grants (BEOGs), or Pell Grants. The recommendations are part of the BEOG quality control project and are based on a review of current (1980-1981) levels, distribution, and significance of error in the…

DIAGNOSTIC EVALUATION OF NUMBERICAL AIR QUALITY MODELS WITH SPECIALIZED AMBIENT OBSERVATIONS: TESTING THE COMMUNITY MULTISCALE AIR QUALITY MODELING SYSTEM (CMAQ) AT SELECTED SOS 95 GROUND SITES

EPA Science Inventory

Three probes for diagnosing photochemical dynamics are presented and applied to specialized ambient surface-level observations and to a numerical photochemical model to better understand rates of production and other process information in the atmosphere and in the model. Howeve...

Marital Quality, Maternal Depressed Affect, Harsh Parenting, and Child Externalising in Hong Kong Chinese Families

ERIC Educational Resources Information Center

Chang, Lei; Lansford, Jennifer E.; Schwartz, David; Farver, Joann M.

2004-01-01

The present study used a family systems approach to examine harsh parenting, maternal depressed affect, and marital quality in relation to children's externalising behaviour problems in a sample of 158 Hong Kong primary school children. At two time points, peers and teachers provided ratings of children's externalising behaviours, and mothers…

Structured implicit review: a new method for monitoring nursing care quality.

PubMed

Pearson, M L; Lee, J L; Chang, B L; Elliott, M; Kahn, K L; Rubenstein, L V

2000-11-01

Nurses' independent decisions about assessment, treatment, and nursing interventions for hospitalized patients are important determinants of quality of care. Physician peer implicit review of medical records has been central to Medicare quality management and is considered the gold standard for reviewing physician care, but peer implicit review of nursing processes of care has not received similar attention. The objective of this study was to develop and evaluate nurse structured implicit review (SIR) methods. We developed SIR instruments for rating the quality of inpatient nursing care for congestive heart failure (CHF) and cerebrovascular accident (CVA). Nurse reviewers used the SIR form to rate a nationally representative sample of randomly selected medical records for each disease from 297 acute care hospitals in 5 states (collected by the RAND-HCFA Prospective Payment System study). The study subjects were elderly Medicare inpatients with CHF (n = 291) or CVA (n = 283). We developed and tested scales reflecting domains of nursing process, evaluated interrater and interitem reliability, and assessed the extent to which items and scales predicted overall ratings of the quality of nursing care. Interrater reliability for 14 of 16 scales (CHF) or 10 of 16 scales (CVA) was > or = 0.40. Interitem reliability was > 0.80 for all but 1 scale (both diseases). Functional Assessment, Physical Assessment, and Medication Tracking ratings were the strongest predictors of overall nursing quality ratings (P < 0.001 for each). Nurse peer review with SIR has adequate interrater and excellent scale reliabilities and can be a valuable tool for assessing nurse performance.

Assessment of image quality in soft tissue and bone visualization tasks for a dedicated extremity cone-beam CT system.

PubMed

Demehri, S; Muhit, A; Zbijewski, W; Stayman, J W; Yorkston, J; Packard, N; Senn, R; Yang, D; Foos, D; Thawait, G K; Fayad, L M; Chhabra, A; Carrino, J A; Siewerdsen, J H

2015-06-01

To assess visualization tasks using cone-beam CT (CBCT) compared to multi-detector CT (MDCT) for musculoskeletal extremity imaging. Ten cadaveric hands and ten knees were examined using a dedicated CBCT prototype and a clinical multi-detector CT using nominal protocols (80 kVp-108mAs for CBCT; 120 kVp- 300 mAs for MDCT). Soft tissue and bone visualization tasks were assessed by four radiologists using five-point satisfaction (for CBCT and MDCT individually) and five-point preference (side-by-side CBCT versus MDCT image quality comparison) rating tests. Ratings were analyzed using Kruskal-Wallis and Wilcoxon signed-rank tests, and observer agreement was assessed using the Kappa-statistic. Knee CBCT images were rated "excellent" or "good" (median scores 5 and 4) for "bone" and "soft tissue" visualization tasks. Hand CBCT images were rated "excellent" or "adequate" (median scores 5 and 3) for "bone" and "soft tissue" visualization tasks. Preference tests rated CBCT equivalent or superior to MDCT for bone visualization and favoured the MDCT for soft tissue visualization tasks. Intraobserver agreement for CBCT satisfaction tests was fair to almost perfect (κ ~ 0.26-0.92), and interobserver agreement was fair to moderate (κ ~ 0.27-0.54). CBCT provided excellent image quality for bone visualization and adequate image quality for soft tissue visualization tasks. • CBCT provided adequate image quality for diagnostic tasks in extremity imaging. • CBCT images were "excellent" for "bone" and "good/adequate" for "soft tissue" visualization tasks. • CBCT image quality was equivalent/superior to MDCT for bone visualization tasks.

A case study of quality improvement methods for complex adaptive systems applied to an academic hepatology program.

PubMed

Fontanesi, John; Martinez, Anthony; Boyo, Toritsesan O; Gish, Robert

2015-01-01

Although demands for greater access to hepatology services that are less costly and achieve better outcomes have led to numerous quality improvement initiatives, traditional quality management methods may be inappropriate for hepatology. We empirically tested a model for conducting quality improvement in an academic hepatology program using methods developed to analyze and improve complex adaptive systems. We achieved a 25% increase in volume using 15% more clinical sessions with no change in staff or faculty FTEs, generating a positive margin of 50%. Wait times for next available appointments were reduced from five months to two weeks; unscheduled appointment slots dropped from 7% to less than 1%; "no-show" rates dropped to less than 10%; Press-Ganey scores increased to the 100th percentile. We conclude that framing hepatology as a complex adaptive system may improve our understanding of the complex, interdependent actions required to improve quality of care, patient satisfaction, and cost-effectiveness.

A Comprehensive, Competency-Based Education Framework Using Medium-Sized ERP Systems

ERIC Educational Resources Information Center

Scholtz, Brenda; Cilliers, Charmain; Calitz, Andre

2012-01-01

Graduates with industry-relevant ERP competencies are highly sought after. This requirement is due to a dominance of Enterprise Resource Planning (ERP) systems and the positive affect which good quality ERP specialists have on the success rate of ERP system implementation projects. Universities are therefore increasingly pressurised to supply…

10 CFR 440.21 - Weatherization materials standards and energy audit procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 75 percent; or, in the case of a solar system, it has a thermal efficiency rating of at least 15...) of this section describes the performance and quality standards for renewable energy systems... petition from a manufacturer requesting the Secretary to certify an item as a renewable energy system...

77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-17

... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for...

[The experience of implementation of system of quality management in the Department of Laboratory Diagnostic of the N.V. Sklifosofskiy Research Institute of Emergency Care of Moscow Health Department: a lecture].

PubMed

Zenina, L P; Godkov, M A

2013-08-01

The article presents the experience of implementation of system of quality management into the practice of multi-field laboratory of emergency medical care hospital. The analysis of laboratory errors is applied and the modes of their prevention are demonstrated. The ratings of department of laboratory diagnostic of the N. V. Sklifosofskiy research institute of emergency care in the program EQAS (USA) Monthly Clinical Chemistry from 2007 are presented. The implementation of the system of quality management of laboratory analysis into department of laboratory diagnostic made it possible to support physicians of clinical departments with reliable information. The confidence of clinicians to received results increased. The effectiveness of laboratory diagnostic increased due to lowering costs of analysis without negative impact to quality of curative process.

All-Optical Wavelength-Path Service With Quality Assurance by Multilayer Integration System

NASA Astrophysics Data System (ADS)

Yagi, Mikio; Tanaka, Shinya; Satomi, Shuichi; Ryu, Shiro; Asano, Shoichiro

2006-09-01

In the future all-optical network controlled by generalized multiprotocol label switching (GMPLS), the wavelength path between end nodes will change dynamically. This inevitably means that the fiber parameters along the wavelength path will also vary. This variation in fiber parameters influences the signal quality of high-speed-transmission system (bit rates over 40 Gb/s). Therefore, at a path setup, the fiber-parameter effect should be adequately compensated. Moreover, the path setup must be completed fast enough to meet the network-application demands. To realize the rapid setup of adequate paths, a multilayer integration system for all-optical wavelength-path quality assurance is proposed. This multilayer integration system is evaluated in a field trial. In the trial, the GMPLS control plane, measurement plane, and data plane coordinated to maintain the quality of a 40-Gb/s wavelength path that would otherwise be degraded by the influence of chromatic dispersion. It is also demonstrated that the multilayer integration system can assure the signal quality in the face of not only chromatic dispersion but also degradation in the optical signal-to-noise ratio by the use of a 2R regeneration system. Our experiments confirm that the proposed multilayer integration system is an essential part of future all-optical networks.

Development of ultrasound/endoscopy PACS (picture archiving and communication system) and investigation of compression method for cine images

NASA Astrophysics Data System (ADS)

Osada, Masakazu; Tsukui, Hideki

2002-09-01

ABSTRACT Picture Archiving and Communication System (PACS) is a system which connects imaging modalities, image archives, and image workstations to reduce film handling cost and improve hospital workflow. Handling diagnostic ultrasound and endoscopy images is challenging, because it produces large amount of data such as motion (cine) images of 30 frames per second, 640 x 480 in resolution, with 24-bit color. Also, it requires enough image quality for clinical review. We have developed PACS which is able to manage ultrasound and endoscopy cine images with above resolution and frame rate, and investigate suitable compression method and compression rate for clinical image review. Results show that clinicians require capability for frame-by-frame forward and backward review of cine images because they carefully look through motion images to find certain color patterns which may appear in one frame. In order to satisfy this quality, we have chosen motion JPEG, installed and confirmed that we could capture this specific pattern. As for acceptable image compression rate, we have performed subjective evaluation. No subjects could tell the difference between original non-compressed images and 1:10 lossy compressed JPEG images. One subject could tell the difference between original and 1:20 lossy compressed JPEG images although it is acceptable. Thus, ratios of 1:10 to 1:20 are acceptable to reduce data amount and cost while maintaining quality for clinical review.

Micalastic high-voltage insulation: Design features and experience

NASA Astrophysics Data System (ADS)

Wichmann, A.

1981-12-01

High-quality mica, carefully selected epoxy resins and a well-matched vacuum/pressure impregnation process determine the characteristics of the MICALASTIC insulation for large turbine-generators. Logical development and process manufacturing quality control have led to an insulation system of high quality and operating reliability. The first winding of a turbine-generator being impregnated and cured under vacuum with solvent-free synthetic resin in 1958 was designed for 10.5 kV rated voltage. Ever since, Siemens AG and Kraftwerk Union AG have used this type of insulation for all direct-cooled windings and also for an increasing number of indirect-cooled windings. At present, 240 turbine-generators with a total of more than 115,000 MVA output have been built. Since 1960, this insulation system has been registered for Siemens AG under the trade name MICALASTIC. The stator windings of the largest, single-shaft generators to date, rated 1560 MVA, 27 kV, has been built with MICALASTIC insulation.

Near-toll quality digital speech transmission in the mobile satellite service

NASA Technical Reports Server (NTRS)

Townes, S. A.; Divsalar, D.

1986-01-01

This paper discusses system considerations for near-toll quality digital speech transmission in a 5 kHz mobile satellite system channel. Tradeoffs are shown for power performance versus delay for a 4800 bps speech compression system in conjunction with a 16 state rate 2/3 trellis coded 8PSK modulation system. The suggested system has an additional 150 ms of delay beyond the propagation delay and requires an E(b)/N(0) of about 7 dB for a Ricean channel assumption with line-of-sight to diffuse component ratio of 10 assuming ideal synchronization. An additional loss of 2 to 3 dB is expected for synchronization in fading environment.

Isolated Power Generation System Using Permanent Magnet Synchronous Generator with Improved Power Quality

NASA Astrophysics Data System (ADS)

Arya, Sabha Raj; Patel, Ashish; Giri, Ashutosh

2018-06-01

This paper deals wind energy based power generation system using Permanent Magnet Synchronous Generator (PMSG). It is controlled using advanced enhanced phase-lock loop for power quality features using distribution static compensator to eliminate the harmonics and to provide KVAR compensation as well as load balancing. It also manages rated potential at the point of common interface under linear and non-linear loads. In order to have better efficiency and reliable operation of PMSG driven by wind turbine, it is necessary to analyze the governing equation of wind based turbine and PMSG under fixed and variable wind speed. For handling power quality problems, power electronics based shunt connected custom power device is used in three wire system. The simulations in MATLAB/Simulink environment have been carried out in order to demonstrate this model and control approach used for the power quality enhancement. The performance results show the adequate performance of PMSG based power generation system and control algorithm.

Isolated Power Generation System Using Permanent Magnet Synchronous Generator with Improved Power Quality

NASA Astrophysics Data System (ADS)

Arya, Sabha Raj; Patel, Ashish; Giri, Ashutosh

2018-03-01

This paper deals wind energy based power generation system using Permanent Magnet Synchronous Generator (PMSG). It is controlled using advanced enhanced phase-lock loop for power quality features using distribution static compensator to eliminate the harmonics and to provide KVAR compensation as well as load balancing. It also manages rated potential at the point of common interface under linear and non-linear loads. In order to have better efficiency and reliable operation of PMSG driven by wind turbine, it is necessary to analyze the governing equation of wind based turbine and PMSG under fixed and variable wind speed. For handling power quality problems, power electronics based shunt connected custom power device is used in three wire system. The simulations in MATLAB/Simulink environment have been carried out in order to demonstrate this model and control approach used for the power quality enhancement. The performance results show the adequate performance of PMSG based power generation system and control algorithm.

Landscape scale measures of steelhead (Oncorhynchus mykiss) bioenergetic growth rate potential in Lake Michigan and comparison with angler catch rates

USGS Publications Warehouse

Hook, T.O.; Rutherford, E.S.; Brines, Shannon J.; Geddes, C.A.; Mason, D.M.; Schwab, D.J.; Fleischer, G.W.

2004-01-01

The relative quality of a habitat can influence fish consumption, growth, mortality, and production. In order to quantify habitat quality, several authors have combined bioenergetic and foraging models to generate spatially explicit estimates of fish growth rate potential (GRP). However, the capacity of GRP to reflect the spatial distributions of fishes over large areas has not been fully evaluated. We generated landscape scale estimates of steelhead (Oncorhynchus mykiss) GRP throughout Lake Michigan for 1994-1996, and used these estimates to test the hypotheses that GRP is a good predictor of spatial patterns of steelhead catch rates. We used surface temperatures (measured with AVHRR satellite imagery) and acoustically measured steelhead prey densities (alewife, Alosa pseudoharengus) as inputs for the GRP model. Our analyses demonstrate that potential steelhead growth rates in Lake Michigan are highly variable in both space and time. Steelhead GRP tended to increase with latitude, and mean GRP was much higher during September 1995, compared to 1994 and 1996. In addition, our study suggests that landscape scale measures of GRP are not good predictors of steelhead catch rates throughout Lake Michigan, but may provide an index of interannual variation in system-wide habitat quality.

Influence of grid control and object detection on radiation exposure and image quality using mobile C-arms - first results.

PubMed

Gosch, D; Ratzmer, A; Berauer, P; Kahn, T

2007-09-01

The objective of this study was to examine the extent to which the image quality on mobile C-arms can be improved by an innovative exposure rate control system (grid control). In addition, the possible dose reduction in the pulsed fluoroscopy mode using 25 pulses/sec produced by automatic adjustment of the pulse rate through motion detection was to be determined. As opposed to conventional exposure rate control systems, which use a measuring circle in the center of the field of view, grid control is based on a fine mesh of square cells which are overlaid on the entire fluoroscopic image. The system uses only those cells for exposure control that are covered by the object to be visualized. This is intended to ensure optimally exposed images, regardless of the size, shape and position of the object to be visualized. The system also automatically detects any motion of the object. If a pulse rate of 25 pulses/sec is selected and no changes in the image are observed, the pulse rate used for pulsed fluoroscopy is gradually reduced. This may decrease the radiation exposure. The influence of grid control on image quality was examined using an anthropomorphic phantom. The dose reduction achieved with the help of object detection was determined by evaluating the examination data of 146 patients from 5 different countries. The image of the static phantom made with grid control was always optimally exposed, regardless of the position of the object to be visualized. The average dose reduction when using 25 pulses/sec resulting from object detection and automatic down-pulsing was 21 %, and the maximum dose reduction was 60 %. Grid control facilitates C-arm operation, since optimum image exposure can be obtained independently of object positioning. Object detection may lead to a reduction in radiation exposure for the patient and operating staff.

Implementing a statewide outcomes management system for consumers of public mental health services.

PubMed

Clardy, J A; Booth, B M; Smith, L G; Nordquist, C R; Smith, G R

1998-02-01

The authors describe the development and implementation of an outcomes management system designed to measure outcomes and processes of care for public mental health consumers in Arkansas. The public-academic project was implemented in 1995 and is based on the Shewhart-Deming model of continuous quality improvement. All 15 community mental health centers (CMHCs) in the state participate in the project, which prospectively measures longitudinal outcomes of care for the tracer conditions of major depression and schizophrenia. Multiperspective measurement tools are used to measure patients' psychiatric status and general health status at periodic intervals; information is gathered on functioning, symptoms, severity of illness, social factors, demographic characteristics, and quality of life. A problem encountered during implementation was the relatively low rate of referral of patients with the tracer conditions for monitoring. Voluntary rather than mandatory participation in the outcomes management system by the CMHCs as well as clinicians' misperceptions about the system's purpose and concerns about confidentiality may have partly accounted for the low rate.

Automated evaluation of electronic discharge notes to assess quality of care for cardiovascular diseases using Medical Language Extraction and Encoding System (MedLEE)

PubMed Central

Lin, Jou-Wei; Yang, Chen-Wei

2010-01-01

The objective of this study was to develop and validate an automated acquisition system to assess quality of care (QC) measures for cardiovascular diseases. This system combining searching and retrieval algorithms was designed to extract QC measures from electronic discharge notes and to estimate the attainment rates to the current standards of care. It was developed on the patients with ST-segment elevation myocardial infarction and tested on the patients with unstable angina/non-ST-segment elevation myocardial infarction, both diseases sharing almost the same QC measures. The system was able to reach a reasonable agreement (κ value) with medical experts from 0.65 (early reperfusion rate) to 0.97 (β-blockers and lipid-lowering agents before discharge) for different QC measures in the test set, and then applied to evaluate QC in the patients who underwent coronary artery bypass grafting surgery. The result has validated a new tool to reliably extract QC measures for cardiovascular diseases. PMID:20442141

Four-man rated dual catalyst system for the recovery of water from urine

NASA Technical Reports Server (NTRS)

Budininkas, P.

1978-01-01

The catalytic system was integrated with a 4-man rated urine wick evaporator. During operation, urine vapor produced by the wick-evaporator was treated in the catalytic system to remove ammonia and volatile hydrocarbons, and water was recovered by condensation in a water cooled condenser. The system operated completely automatically and required no manual adjustments, except periodic supply of urine and removal of the recovered water. Although the system was designed for treating 0.325 kg urine per hour, this rate could be achieved only with a fresh wick, then gradually decreased as the wick became saturated with urine solids. The average urine treatment rates achieved during each of the three endurance tests were 0.137, 0.217, and 0.235 kg/hr. The quality of the recovered water meets drinking water standards, with the exception of a generally low pH.

A Network and Visual Quality Aware N-Screen Content Recommender System Using Joint Matrix Factorization

PubMed Central

Ullah, Farman; Sarwar, Ghulam; Lee, Sungchang

2014-01-01

We propose a network and visual quality aware N-Screen content recommender system. N-Screen provides more ways than ever before to access multimedia content through multiple devices and heterogeneous access networks. The heterogeneity of devices and access networks present new questions of QoS (quality of service) in the realm of user experience with content. We propose, a recommender system that ensures a better visual quality on user's N-screen devices and the efficient utilization of available access network bandwidth with user preferences. The proposed system estimates the available bandwidth and visual quality on users N-Screen devices and integrates it with users preferences and contents genre information to personalize his N-Screen content. The objective is to recommend content that the user's N-Screen device and access network are capable of displaying and streaming with the user preferences that have not been supported in existing systems. Furthermore, we suggest a joint matrix factorization approach to jointly factorize the users rating matrix with the users N-Screen device similarity and program genres similarity. Finally, the experimental results show that we also enhance the prediction and recommendation accuracy, sparsity, and cold start issues. PMID:24982999

Levels of Evidence in Cosmetic Surgery: Analysis and Recommendations Using a New CLEAR Classification

PubMed Central

2013-01-01

Background: The Level of Evidence rating was introduced in 2011 to grade the quality of publications. This system evaluates study design but does not assess several other quality indicators. This study introduces a new “Cosmetic Level of Evidence And Recommendation” (CLEAR) classification that includes additional methodological criteria and compares this new classification with the existing system. Methods: All rated publications in the Cosmetic Section of Plastic and Reconstructive Surgery, July 2011 through June 2013, were evaluated. The published Level of Evidence rating (1–5) and criteria relevant to study design and methodology for each study were tabulated. A new CLEAR rating was assigned to each article, including a recommendation grade (A–D). The published Level of Evidence rating (1–5) was compared with the recommendation grade determined using the CLEAR classification. Results: Among the 87 cosmetic articles, 48 studies (55%) were designated as level 4. Three articles were assigned a level 1, but they contained deficiencies sufficient to undermine the conclusions. The correlation between the published Level of Evidence classification (1–5) and CLEAR Grade (A–D) was weak (ρ = 0.11, not significant). Only 41 studies (48%) evaluated consecutive patients or consecutive patients meeting inclusion criteria. Conclusions: The CLEAR classification considers methodological factors in evaluating study reliability. A prospective study among consecutive patients meeting eligibility criteria, with a reported inclusion rate, the use of contemporaneous controls when indicated, and consideration of confounders is a realistic goal. Such measures are likely to improve study quality. PMID:25289261

Recreational Stream Crossing Effects on Sediment Delivery and Macroinvertebrates in Southwestern Virginia, USA

NASA Astrophysics Data System (ADS)

Kidd, Kathryn R.; Aust, W. Michael; Copenheaver, Carolyn A.

2014-09-01

Trail-based recreation has increased over recent decades, raising the environmental management issue of soil erosion that originates from unsurfaced, recreational trail systems. Trail-based soil erosion that occurs near stream crossings represents a non-point source of pollution to streams. We modeled soil erosion rates along multiple-use (hiking, mountain biking, and horseback riding) recreational trails that approach culvert and ford stream crossings as potential sources of sediment input and evaluated whether recreational stream crossings were impacting water quality based on downstream changes in macroinvertebrate-based indices within the Poverty Creek Trail System of the George Washington and Jefferson National Forest in southwestern Virginia, USA. We found modeled soil erosion rates for non-motorized recreational approaches that were lower than published estimates for an off-road vehicle approach, bare horse trails, and bare forest operational skid trail and road approaches, but were 13 times greater than estimated rates for undisturbed forests and 2.4 times greater than a 2-year old clearcut in this region. Estimated soil erosion rates were similar to rates for skid trails and horse trails where best management practices (BMPs) had been implemented. Downstream changes in macroinvertebrate-based indices indicated water quality was lower downstream from crossings than in upstream reference reaches. Our modeled soil erosion rates illustrate recreational stream crossing approaches have the potential to deliver sediment into adjacent streams, particularly where BMPs are not being implemented or where approaches are not properly managed, and as a result can negatively impact water quality below stream crossings.

Feasibility of certified quality management in a comprehensive stroke care network using telemedicine: STENO project.

PubMed

Handschu, René; Scibor, Mateusz; Wacker, Angela; Stark, David R; Köhrmann, Martin; Erbguth, Frank; Oschmann, Patrick; Schwab, Stefan; Marquardt, Lars

2014-12-01

Stroke care networks with and without telemedicine have been established in several countries over the last decade to provide specialized stroke expertise to patients in rural areas. Acute consultation is a first step in the management of stroke, but not the only one. Methods of standardization of care and treatment are much needed. So far, quality management systems have only been used for single stroke units. To the best of our knowledge, we are the first stroke network worldwide to aim for certification of a network-wide quality management system. The Stroke Network Using Telemedicine in Northern Bavaria (STENO), currently with 20 associated medical institutions, is one of the world's largest stroke networks, caring for over 5000 stroke patients each year. In 2010, we initiated the implementation of a network-wide 'total' quality management system according to ISO standard 9001:2008 in cooperation with the German Stroke Society and a third-party certification organization (LGA InterCert). Certification according to ISO 9001:2008 was awarded in March 2011 and maintained over a complete certification cycle of 3 years without major deviation from the norm in three external third-party audits. Thrombolysis rate significantly increased from 8·2% (2009) to 12·8% (2012). Certified quality management within a large stroke network using telemedicine is possible and might improve stroke care procedures and thrombolysis rates. Outcome studies comparing conventional stroke care and telestroke care are inevitable. © 2014 World Stroke Organization.

A Performance Improvement Method for Low-Cost Land Vehicle GPS/MEMS-INS Attitude Determination

PubMed Central

Cong, Li; Li, Ercui; Qin, Honglei; Ling, Keck Voon; Xue, Rui

2015-01-01

Global positioning system (GPS) technology is well suited for attitude determination. However, in land vehicle application, low-cost single frequency GPS receivers which have low measurement quality are often used, and external factors such as multipath and low satellite visibility in the densely built-up urban environment further degrade the quality of the GPS measurements. Due to the low-quality receivers used and the challenging urban environment, the success rate of the single epoch ambiguity resolution for dynamic attitude determination is usually quite low. In this paper, a micro-electro-mechanical system (MEMS)—inertial navigation system (INS)-aided ambiguity resolution method is proposed to improve the GPS attitude determination performance, which is particularly suitable for land vehicle attitude determination. First, the INS calculated baseline vector is augmented with the GPS carrier phase and code measurements. This improves the ambiguity dilution of precision (ADOP), resulting in better quality of the unconstrained float solution. Second, the undesirable float solutions caused by large measurement errors are further filtered and replaced using the INS-aided ambiguity function method (AFM). The fixed solutions are then obtained by the constrained least squares ambiguity decorrelation (CLAMBDA) algorithm. Finally, the GPS/MEMS-INS integration is realized by the use of a Kalman filter. Theoretical analysis of the ADOP is given and experimental results demonstrate that our proposed method can significantly improve the quality of the float ambiguity solution, leading to high success rate and better accuracy of attitude determination. PMID:25760057

Application of active controls technology to aircraft bide smoothing systems

NASA Technical Reports Server (NTRS)

Lapins, M.; Jacobson, I. D.

1975-01-01

A critical review of past efforts in the design and testing of ride smoothing and gust alleviation systems is presented. Design trade offs involving sensor types, choice of feedback loops, human comfort, and aircraft handling-qualities criteria are discussed. Synthesis of a system designed to employ direct-lift and side-force producing surfaces is reported. Two STOL aircraft and an executive transport are considered. Theoretically predicted system performance is compared with hybrid simulation and flight test data. Pilot opinion rating, pilot workload, and passenger comfort rating data for the basic and augmented aircraft are included.

Application of Active Controls Technology to Aircraft Ride Smoothing Systems

NASA Technical Reports Server (NTRS)

Lapins, Maris; Jacobson, Ira D.

1975-01-01

A critical review of past efforts in the design and testing of ride smoothing and gust alleviation systems is presented. Design trade-offs involving sensor types, choice of feedback loops, human comfort and aircraft handling-qualities criteria are discussed. Synthesis of a system designed to employ direct-lift and side-force producing surfaces is reported. Two STOL-class aircraft and an executive transport are considered. Theoretically-predicted system performance is compared with hybrid simulation and flight test data. Pilot opinion rating, pilot workload, and passenger comfort rating data for the basic and augmented aircraft are included.

Where is information quality lost at clinical level? A mixed-method study on information systems and data quality in three urban Kenyan ANC clinics

PubMed Central

Hahn, Daniel; Wanjala, Pepela; Marx, Michael

2013-01-01

Background Well-working health information systems are considered vital with the quality of health data ranked of highest importance for decision making at patient care and policy levels. In particular, health facilities play an important role, since they are not only the entry point for the national health information system but also use health data (and primarily) for patient care. Design A multiple case study was carried out between March and August 2012 at the antenatal care (ANC) clinics of two private and one public Kenyan hospital to describe clinical information systems and assess the quality of information. The following methods were developed and employed in an iterative process: workplace walkthroughs, structured and in-depth interviews with staff members, and a quantitative assessment of data quality (completeness and accurate transmission of clinical information and reports in ANC). Views of staff and management on the quality of employed information systems, data quality, and influencing factors were captured qualitatively. Results Staff rated the quality of information higher in the private hospitals employing computers than in the public hospital which relies on paper forms. Several potential threats to data quality were reported. Limitations in data quality were common at all study sites including wrong test results, missing registers, and inconsistencies in reports. Feedback was seldom on content or quality of reports and usage of data beyond individual patient care was low. Conclusions We argue that the limited data quality has to be seen in the broader perspective of the information systems in which it is produced and used. The combination of different methods has proven to be useful for this. To improve the effectiveness and capabilities of these systems, combined measures are needed which include technical and organizational aspects (e.g. regular feedback to health workers) and individual skills and motivation. PMID:23993022

Where is information quality lost at clinical level? A mixed-method study on information systems and data quality in three urban Kenyan ANC clinics.

PubMed

Hahn, Daniel; Wanjala, Pepela; Marx, Michael

2013-08-29

Well-working health information systems are considered vital with the quality of health data ranked of highest importance for decision making at patient care and policy levels. In particular, health facilities play an important role, since they are not only the entry point for the national health information system but also use health data (and primarily) for patient care. A multiple case study was carried out between March and August 2012 at the antenatal care (ANC) clinics of two private and one public Kenyan hospital to describe clinical information systems and assess the quality of information. The following methods were developed and employed in an iterative process: workplace walkthroughs, structured and in-depth interviews with staff members, and a quantitative assessment of data quality (completeness and accurate transmission of clinical information and reports in ANC). Views of staff and management on the quality of employed information systems, data quality, and influencing factors were captured qualitatively. Staff rated the quality of information higher in the private hospitals employing computers than in the public hospital which relies on paper forms. Several potential threats to data quality were reported. Limitations in data quality were common at all study sites including wrong test results, missing registers, and inconsistencies in reports. Feedback was seldom on content or quality of reports and usage of data beyond individual patient care was low. We argue that the limited data quality has to be seen in the broader perspective of the information systems in which it is produced and used. The combination of different methods has proven to be useful for this. To improve the effectiveness and capabilities of these systems, combined measures are needed which include technical and organizational aspects (e.g. regular feedback to health workers) and individual skills and motivation.

The Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality Demonstration: a descriptive overview.

PubMed

Reilly, Karen E; Mueller, Christine; Zimmerman, David R

2007-01-01

This paper presents the first comprehensive account of a major national demonstration designed to integrate skilled nursing facilities (SNF) prospective case-mix payment and quality of care. It describes the Centers for Medicare and Medicaid Services' Nursing Home Case-Mix and Quality (NHCMQ) Demonstration-the template for Medicare's SNF Prospective Payment System (PPS) implemented July 1998. The NHCMQ Demonstration provided the basis for one of the most significant changes in SNF reimbursement and quality monitoring policies to date. Prospective reimbursement policies created positive incentive for providers to admit Medicare residents under more equitable payment rates. However, controversy regarding unanticipated perverse provider incentives remains. The quality management system designed under the NHCMQDemonstration is currently used in over 17,000 nursing homes. Furthermore, under the NHCMQ Demonstration, one standardized assessment tool-the MDS-was used to assess a resident's clinical condition, to monitor quality, and to calculate provider reimbursement. Experiences from the NHCMQ Demonstration and continued evaluation of the current national PPS, along with state systems, provide a rich information source regarding prospective, case-mix reimbursement, and provider incentives.

European beef consumers' interest in a beef eating-quality guarantee Insights from a qualitative study in four EU countries.

PubMed

Verbeke, Wim; Van Wezemael, Lynn; de Barcellos, Marcia D; Kügler, Jens O; Hocquette, Jean-François; Ueland, Øydis; Grunert, Klaus G

2010-04-01

Consumer demand in relation to food is shifting towards products that are safe, nutritious, and of good eating quality. Beef consumers are demanding for experience quality that matches their expectations, particularly with respect to beef tenderness. The development of a beef quality grading and guarantee system obtained through muscle profiling research, can allow the beef industry to meet these demands. A qualitative consumer study has been carried out with beef consumers in France, Spain, United Kingdom and Germany to assess their opinions about beef muscle profiling and their interest in a beef eating-quality guarantee. Findings indicate that both concepts are well accepted by European beef consumers, although not unconditional. Participants express some reserve related to the possible upgrading of lower value cuts, too much standardisation, and the fact that tenderness is to some extent subjective. They further require the system to be simple, sufficiently documented and independent-party controlled. This study indicates good opportunities for the development of a beef eating-quality guarantee system in Europe. As an increase in consumers' satisfaction could lead to higher consumption rates and industry profitability, the introduction of an eating-quality guarantee system can contribute to market development and improved competitiveness of the European beef industry. Copyright 2009 Elsevier Ltd. All rights reserved.

Collecting, analyzing and assessing big land use data: Results from the cropland capture game

NASA Astrophysics Data System (ADS)

Salk, C.; Sturn, T.; Fritz, S.; See, L. M.; McCallum, I.; Fuss, S.; Perger, C.; Duerauer, M.; Obersteiner, M.

2014-12-01

The International Institute for Applied Systems Analysis (IIASA) has developed a number of tools for assessing the socioeconomic benefit of Earth Observation such as quantifying the monetary benefit of improved land cover information for mitigation policies. Recently, IIASA has been assessing the benefit of an improved global carbon observation system in the GEOCARBON Project. Because traditional ground-based land cover validation is expensive, IIASA has developed crowdsourcing projects such as Geo-Wiki which to contribute to land-cover validation. A recent activity is the 'Cropland Capture' game which can be played in a browser or mobile device. It can be downloaded or played online at http://www.geo-wiki.org/games/croplandcapture/. In the game, players see an image (from a satellite or ground-based camera) and are asked if they see any cropland in it. They can answer "yes", "no" or "maybe" if they are unsure. The game had over 3,000 players who made about 4,500,000 classifications on 190,000 unique images. The benefits delivered by crowdsourcing relative to conventional data acquisition depends critically on the quality of the data received. Players' rating quality was compared by assessing their agreement with the crowd, consistency on images rated more than once, and agreement with expert validators. These metrics were compared with one another and with potential predictors of user quality: the total number of images rated by a player, and their professional background in land-cover science. Individual users' agreement with the crowd and self-agreement were highly positively correlated. The frequency of admitting uncertainty about an image was a good measure of user caution, showing a negative relationship with self-contradiction rate. Many users were more reliable in either identifying cropland or non-cropland, and these two skills were uncorrelated. Overall, user reliability increased with number of images rated, although among the top decile of users, this trend was reversed. Surprisingly, professional background had little influence on quality of ratings. We explore implications of these results for assessing potential benefits of user contributed data in the context of differential user quality and compare this with conventional data collection methods.

Imaging of pharmacokinetic rates of indocyanine green in mouse liver with a hybrid fluorescence molecular tomography/x-ray computed tomography system.

PubMed

Zhang, Guanglei; Liu, Fei; Zhang, Bin; He, Yun; Luo, Jianwen; Bai, Jing

2013-04-01

Pharmacokinetic rates have the potential to provide quantitative physiological and pathological information for biological studies and drug development. Fluorescence molecular tomography (FMT) is an attractive imaging tool for three-dimensionally resolving fluorophore distribution in small animals. In this letter, pharmacokinetic rates of indocyanine green (ICG) in mouse liver are imaged with a hybrid FMT and x-ray computed tomography (XCT) system. A recently developed FMT method using structural priors from an XCT system is adopted to improve the quality of FMT reconstruction. In the in vivo experiments, images of uptake and excretion rates of ICG in mouse liver are obtained, which can be used to quantitatively evaluate liver function. The accuracy of the results is validated by a fiber-based fluorescence measurement system.

Assessing systems quality in a changing health care environment: the 2009-10 national survey of children with special health care needs.

PubMed

Strickland, Bonnie B; Jones, Jessica R; Newacheck, Paul W; Bethell, Christina D; Blumberg, Stephen J; Kogan, Michael D

2015-02-01

To provide a national, population-based assessment of the quality of the health care system for children and youth with special health care needs using a framework of six health care system quality indicators. 49,242 interviews with parents of children with special health care needs from the 2009-10 National Survey of Children with Special Health Care Needs (NS-CSHCN) were examined to determine the extent to which CSHCN had access to six quality indicators of a well-functioning system of services. Criteria for determining access to each indicator were established and applied to the survey data to estimate the proportion of CSHCN meeting each quality indicator by socio-demographic status and functional limitations. 17.6% of CSHCN received care consistent with all six quality indicators. Results for each component of the system quality framework ranged from a high of 70.3% of parents reporting that they shared decision-making with healthcare providers to a low of 40% of parents reporting receipt of services needed for transition to adult health care. Attainment rates were lower for CSHCN of minority racial and ethnic groups, those residing in households where English was not the primary language, those in lower income households, and those most impacted by their health condition. Only a small proportion of CSHCN receive all identified attributes of a high-quality system of services. Moreover, significant disparities exist whereby those most impacted by their conditions and those in traditionally disadvantaged groups are served least well by the current system. A small proportion of CSHCN appear to remain essentially outside of the system, having met few if any of the elements studied.

Assessing Systems Quality in a Changing Health Care Environment: The 2009–10 National Survey of Children with Special Health Care Needs

PubMed Central

Jones, Jessica R.; Newacheck, Paul W.; Bethell, Christina D.; Blumberg, Stephen J.; Kogan, Michael D.

2016-01-01

To provide a national, population-based assessment of the quality of the health care system for children and youth with special health care needs using a framework of six health care system quality indicators. 49,242 interviews with parents of children with special health care needs from the 2009–10 National Survey of Children with Special Health Care Needs (NS-CSHCN) were examined to determine the extent to which CSHCN had access to six quality indicators of a well-functioning system of services. Criteria for determining access to each indicator were established and applied to the survey data to estimate the proportion of CSHCN meeting each quality indicator by socio-demographic status and functional limitations. 17.6 % of CSHCN received care consistent with all six quality indicators. Results for each component of the system quality framework ranged from a high of 70.3 % of parents reporting that they shared decision-making with healthcare providers to a low of 40 % of parents reporting receipt of services needed for transition to adult health care. Attainment rates were lower for CSHCN of minority racial and ethnic groups, those residing in households where English was not the primary language, those in lower income households, and those most impacted by their health condition. Only a small proportion of CSHCN receive all identified attributes of a high-quality system of services. Moreover, significant disparities exist whereby those most impacted by their conditions and those in traditionally disadvantaged groups are served least well by the current system. A small proportion of CSHCN appear to remain essentially outside of the system, having met few if any of the elements studied. PMID:24912943

Impact of the use of an endorectal coil for 3 T prostate MRI on image quality and cancer detection rate

NASA Astrophysics Data System (ADS)

Gawlitza, Josephin; Reiss-Zimmermann, Martin; Thörmer, Gregor; Schaudinn, Alexander; Linder, Nicolas; Garnov, Nikita; Horn, Lars-Christian; Minh, Do Hoang; Ganzer, Roman; Stolzenburg, Jens-Uwe; Kahn, Thomas; Moche, Michael; Busse, Harald

2017-02-01

This work aims to assess the impact of an additional endorectal coil on image quality and cancer detection rate within the same patients. At a single academic medical center, this transversal study included 41 men who underwent T2- and diffusion-weighted imaging at 3 T using surface coils only or in combination with an endorectal coil in the same session. Two blinded readers (A and B) randomly evaluated all image data in separate sessions. Image quality with respect to localization and staging was rated on a five-point scale. Lesions were classified according to their prostate imaging reporting and data system (PIRADS) score version 1. Standard of reference was provided by whole-mount step-section analysis. Mean image quality scores averaged over all localization-related items were significantly higher with additional endorectal coil for both readers (p < 0.001), corresponding staging-related items were only higher for reader B (p < 0.001). With an endorectal coil, the rate of correctly detecting cancer per patient was significantly higher for reader B (p < 0.001) but not for reader A (p = 0.219). The numbers of histologically confirmed tumor lesions were rather similar for both settings. The subjectively rated 3-T image quality was improved with an endorectal coil. In terms of diagnostic performance, the use of an additional endorectal coil was not superior.

Impact of the use of an endorectal coil for 3 T prostate MRI on image quality and cancer detection rate

PubMed Central

Gawlitza, Josephin; Reiss-Zimmermann, Martin; Thörmer, Gregor; Schaudinn, Alexander; Linder, Nicolas; Garnov, Nikita; Horn, Lars-Christian; Minh, Do Hoang; Ganzer, Roman; Stolzenburg, Jens-Uwe; Kahn, Thomas; Moche, Michael; Busse, Harald

2017-01-01

This work aims to assess the impact of an additional endorectal coil on image quality and cancer detection rate within the same patients. At a single academic medical center, this transversal study included 41 men who underwent T2- and diffusion-weighted imaging at 3 T using surface coils only or in combination with an endorectal coil in the same session. Two blinded readers (A and B) randomly evaluated all image data in separate sessions. Image quality with respect to localization and staging was rated on a five-point scale. Lesions were classified according to their prostate imaging reporting and data system (PIRADS) score version 1. Standard of reference was provided by whole-mount step-section analysis. Mean image quality scores averaged over all localization-related items were significantly higher with additional endorectal coil for both readers (p < 0.001), corresponding staging-related items were only higher for reader B (p < 0.001). With an endorectal coil, the rate of correctly detecting cancer per patient was significantly higher for reader B (p < 0.001) but not for reader A (p = 0.219). The numbers of histologically confirmed tumor lesions were rather similar for both settings. The subjectively rated 3-T image quality was improved with an endorectal coil. In terms of diagnostic performance, the use of an additional endorectal coil was not superior. PMID:28145525

Impact of the use of an endorectal coil for 3 T prostate MRI on image quality and cancer detection rate.

PubMed

Gawlitza, Josephin; Reiss-Zimmermann, Martin; Thörmer, Gregor; Schaudinn, Alexander; Linder, Nicolas; Garnov, Nikita; Horn, Lars-Christian; Minh, Do Hoang; Ganzer, Roman; Stolzenburg, Jens-Uwe; Kahn, Thomas; Moche, Michael; Busse, Harald

2017-02-01

This work aims to assess the impact of an additional endorectal coil on image quality and cancer detection rate within the same patients. At a single academic medical center, this transversal study included 41 men who underwent T2- and diffusion-weighted imaging at 3 T using surface coils only or in combination with an endorectal coil in the same session. Two blinded readers (A and B) randomly evaluated all image data in separate sessions. Image quality with respect to localization and staging was rated on a five-point scale. Lesions were classified according to their prostate imaging reporting and data system (PIRADS) score version 1. Standard of reference was provided by whole-mount step-section analysis. Mean image quality scores averaged over all localization-related items were significantly higher with additional endorectal coil for both readers (p < 0.001), corresponding staging-related items were only higher for reader B (p < 0.001). With an endorectal coil, the rate of correctly detecting cancer per patient was significantly higher for reader B (p < 0.001) but not for reader A (p = 0.219). The numbers of histologically confirmed tumor lesions were rather similar for both settings. The subjectively rated 3-T image quality was improved with an endorectal coil. In terms of diagnostic performance, the use of an additional endorectal coil was not superior.

International PV QA Task Force's Proposed Comparative Rating System for PV Modules: Preprint

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

Wohlgemuth, J.; Kurtz, S.

The International PV Quality Assurance Task Force is developing a rating system that provides comparative information about the relative durability of PV modules. Development of accelerated stress tests that can provide such comparative information is seen as a major step toward being able to predict PV module service life. This paper will provide details of the ongoing effort to determine the format of such an overall module rating system. The latest proposal is based on using three distinct climate zones as defined in IEC 60721-2-1 for two different mounting systems. Specific stresses beyond those used in the qualification tests aremore » being developed for each of the selected climate zones.« less

Comparison of methods for cultivation and isolation of Chlamydia trachomatis.

PubMed Central

Benes, S; McCormack, W M

1982-01-01

McCoy cells treated with cycloheximide, iododeoxyuridine, and DEAE-dextran and untreated McCoy cells were inoculated with two stock strains of Chlamydia trachomatis and with 231 urethral specimens from men, 53 (23%) of which contained C. trachomatis. Isolation rates, number and quality of inclusions, and quality of the cell monolayers were compared. There were no significant differences between the isolation rates in the four systems, although the most isolations were made in the untreated and cycloheximide-treated cells. Cycloheximide-treated cells produced, from both the clinical specimens and the two stock strains, significantly more inclusions than any of the other systems. The monolayer of the cycloheximide-treated cells and the inclusions that grew in these cells were optimal for examination and detection of C. trachomatis. PMID:6185530

Geographic Disparities in Access to Nursing Home Services: Assessing Fiscal Stress and Quality of Care.

PubMed

Park, Young Joo; Martin, Erika G

2017-11-12

We test whether nursing homes serving predominately low-income and racial minority residents (compositional explanation) or located in neighborhoods with higher concentrations of low-income and racial minority residents (contextual explanation) have worse financial outcomes and care quality. Healthcare Cost Report Information System, Nursing Home Compare, Online Survey Certification and Reporting Certification, and American Community Survey. A cross-sectional study design of nursing homes within U.S. metropolitan areas. Data were obtained from Centers for Medicare & Medicaid Services and U.S. Census Bureau. Medicaid-dependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64-point lower quality rating. A 1 percent increase in the neighborhood population living in poverty is associated with a 1.20-point lower quality rating, on a scale from 10 to 50, and a 1 percent increase in the portion of neighborhood black residents is associated with a 0.8 percentage point lower operating ratio and a 0.37 lower quality rating. Medicaid dependency (compositional effect) and concentration of racial minority residents in neighborhoods (contextual effect) are associated with higher fiscal stress and lower quality of care, indicating that nursing homes' geographic location may exacerbate long-term care inequalities. © Health Research and Educational Trust.

Characteristics and verification of a car-borne survey system for dose rates in air: KURAMA-II.

PubMed

Tsuda, S; Yoshida, T; Tsutsumi, M; Saito, K

2015-01-01

The car-borne survey system KURAMA-II, developed by the Kyoto University Research Reactor Institute, has been used for air dose rate mapping after the Fukushima Dai-ichi Nuclear Power Plant accident. KURAMA-II consists of a CsI(Tl) scintillation detector, a GPS device, and a control device for data processing. The dose rates monitored by KURAMA-II are based on the G(E) function (spectrum-dose conversion operator), which can precisely calculate dose rates from measured pulse-height distribution even if the energy spectrum changes significantly. The characteristics of KURAMA-II have been investigated with particular consideration to the reliability of the calculated G(E) function, dose rate dependence, statistical fluctuation, angular dependence, and energy dependence. The results indicate that 100 units of KURAMA-II systems have acceptable quality for mass monitoring of dose rates in the environment. Copyright © 2014 Elsevier Ltd. All rights reserved.

Advanced dendritic web growth development

NASA Technical Reports Server (NTRS)

Hopkins, R. H.

1985-01-01

A program to develop the technology of the silicon dendritic web ribbon growth process is examined. The effort is being concentrated on the area rate and quality requirements necessary to meet the JPL/DOE goals for terrestrial PV applications. Closed loop web growth system development and stress reduction for high area rate growth is considered.

The Relationship between ISO 9000 Participation and Educational Outcomes of Schools

ERIC Educational Resources Information Center

Bae, Sang Hoon

2007-01-01

Purpose: The study seeks to examine the relationship between the implementation of the ISO 9000 quality management system and educational outcomes of schools, measured by student achievement on the state-mandated tests and school attendance rates--graduation rates, in the case of high schools. Design/methodology/approach: The study was conducted…

Information-Theoretic Assessment of Sample Imaging Systems

NASA Technical Reports Server (NTRS)

Huck, Friedrich O.; Alter-Gartenberg, Rachel; Park, Stephen K.; Rahman, Zia-ur

1999-01-01

By rigorously extending modern communication theory to the assessment of sampled imaging systems, we develop the formulations that are required to optimize the performance of these systems within the critical constraints of image gathering, data transmission, and image display. The goal of this optimization is to produce images with the best possible visual quality for the wide range of statistical properties of the radiance field of natural scenes that one normally encounters. Extensive computational results are presented to assess the performance of sampled imaging systems in terms of information rate, theoretical minimum data rate, and fidelity. Comparisons of this assessment with perceptual and measurable performance demonstrate that (1) the information rate that a sampled imaging system conveys from the captured radiance field to the observer is closely correlated with the fidelity, sharpness and clarity with which the observed images can be restored and (2) the associated theoretical minimum data rate is closely correlated with the lowest data rate with which the acquired signal can be encoded for efficient transmission.

Iraqi health system in kurdistan region: medical professionals' perspectives on challenges and priorities for improvement.

PubMed

Shabila, Nazar P; Al-Tawil, Namir G; Tahir, Rebaz; Shwani, Falah H; Saleh, Abubakir M; Al-Hadithi, Tariq S

2010-11-30

The views of medical professionals on efficiency of health system and needs for any changes are very critical and constitute a cornerstone for any health system improvement. This is particularly relevant to Iraqi Kurdistan case as the events of the last few decades have significantly devastated the national Iraqi health system while the necessity for adopting a new health care system is increasingly recognized since 2004. This study aims to examine the regional health system in Iraqi Kurdistan from medical professionals' perspectives and try to define its problems and priorities for improvement. A survey questionnaire was developed and administered to a convenience sample of 250 medical professionals in Erbil governorate. The questionnaire included four items; rating of the quality of services and availability of resources in the health institutions, view on different aspects of the health system, the perceived priority needs for health system improvement and gender and professional characteristics of the respondents. The response rate to the survey was 83.6%. A high proportion of respondents rated the different aspects of services and resources in the health institutions as weak or very weak including the availability of the required quantity and quality of medicines (68.7%), the availability of sufficient medical equipment and investigation tools (68.7%), and the quality of offered services (65.3%). Around 72% of respondents had a rather negative view on the overall health system. The weak role of medical research, the weak role of professional associations in controlling the system and the inefficient health education were identified as important problems in the current health system (87.9%, 87.1% and 84.9%, respectively). The priority needs of health system improvement included adoption of social insurance for medical care of the poor (82%), enhancing the role of family medicine (77.2%), adopting health insurance system (76.1%) and periodic scientific evaluation of physicians and other health staff (69.8%). Medical professionals were generally unsatisfied with the different aspects of the health system in Iraqi Kurdistan region. A number of problems and different priority needs for health system improvement have been recognized that require to be studied in more details.

Simulation evaluation of a speed-guidance law for Harrier approach transitions

NASA Technical Reports Server (NTRS)

Merrick, Vernon K.; Moralez, Ernesto; Stortz, Michael W.; Hardy, Gordon H.; Gerdes, Ronald M.

1991-01-01

An exponential-deceleration speed guidance law is formulated which mimics the technique currently used by Harrier pilots to perform decelerating approaches to a hover. This guidance law was tested along with an existing two-step constant deceleration speed guidance law, using a fixed-base piloted simulator programmed to represent a YAV-8B Harrier. Decelerating approaches to a hover at a predetermined station-keeping point were performed along a straight (-3 deg glideslope) path in headwinds up to 40 knots and turbulence up to 6 ft./sec. Visibility was fixed at one-quarter nautical mile and 100 ft. cloud ceiling. Three Harrier pilots participated in the experiment. Handling qualities with the aircraft equipped with the standard YAV-8B rate damped attitude stability augmentation system were adequate (level 2) using either speed guidance law. However, the exponential deceleration speed guidance law was rated superior to the constant-deceleration speed guidance law by a Cooper-Harper handling qualities rating of about one unit independent of the level of wind and turbulence. Replacing the attitude control system of the YAV-8B with a high fidelity model following attitude flight controller increased the approach accuracy and reduced the pilot workload. With one minor exception, the handling qualities for the approach were rated satisfactory (level 1). It is concluded that the exponential deceleration speed guidance law is the most cost effective.

Sampling frequency for water quality variables in streams: Systems analysis to quantify minimum monitoring rates.

PubMed

Chappell, Nick A; Jones, Timothy D; Tych, Wlodek

2017-10-15

Insufficient temporal monitoring of water quality in streams or engineered drains alters the apparent shape of storm chemographs, resulting in shifted model parameterisations and changed interpretations of solute sources that have produced episodes of poor water quality. This so-called 'aliasing' phenomenon is poorly recognised in water research. Using advances in in-situ sensor technology it is now possible to monitor sufficiently frequently to avoid the onset of aliasing. A systems modelling procedure is presented allowing objective identification of sampling rates needed to avoid aliasing within strongly rainfall-driven chemical dynamics. In this study aliasing of storm chemograph shapes was quantified by changes in the time constant parameter (TC) of transfer functions. As a proportion of the original TC, the onset of aliasing varied between watersheds, ranging from 3.9-7.7 to 54-79 %TC (or 110-160 to 300-600 min). However, a minimum monitoring rate could be identified for all datasets if the modelling results were presented in the form of a new statistic, ΔTC. For the eight H + , DOC and NO 3 -N datasets examined from a range of watershed settings, an empirically-derived threshold of 1.3(ΔTC) could be used to quantify minimum monitoring rates within sampling protocols to avoid artefacts in subsequent data analysis. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Quality-improvement initiatives focused on enhancing customer service in the outpatient pharmacy.

PubMed

Poulin, Tenley J; Bain, Kevin T; Balderose, Bonnie K

2015-09-01

The development and implementation of quality-improvement initiatives to enhance customer service in an outpatient pharmacy of a Veterans Affairs (VA) medical center are described. Historically low customer service satisfaction rates with the outpatient pharmacy at the Philadelphia Veterans Affairs Medical Center prompted this quality-improvement project. A three-question survey was designed to be easily and quickly administered to veterans in the outpatient pharmacy waiting area. Using 5-point Likert scale, veterans were asked to rate (1) their overall experience with the outpatient pharmacy service and (2) their satisfaction with the customer service provided by the pharmacy department. They were also asked how they thought the pharmacy department could improve its customer service. After receiving feedback from the survey, several quality-improvement initiatives were developed. The initiatives were categorized as environmental, personnel, communicative, and technological. For each initiative, one or more tasks were developed and the initiatives were subsequently implemented over eight months. After each task was completed, veterans were surveyed to measure the impact of the change. A total of 79 veterans were surveyed before the implementation of the quality-improvement initiatives, and 49% and 68% rated their experience with the outpatient pharmacy and customer service favorably, respectively. Twenty-five veterans were surveyed after the implementation of numerous quality-improvement interventions, with 44% and 72% rating their experience with the outpatient pharmacy and customer service favorably. Customer service satisfaction with an outpatient pharmacy service at a VA medical center was enhanced through the implementation of various quality-improvement initiatives. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Developing a framework of, and quality indicators for, general practice management in Europe.

PubMed

Engels, Yvonne; Campbell, Stephen; Dautzenberg, Maaike; van den Hombergh, Pieter; Brinkmann, Henrik; Szécsényi, Joachim; Falcoff, Hector; Seuntjens, Luc; Kuenzi, Beat; Grol, Richard

2005-04-01

To develop a framework for general practice management made up of quality indicators shared by six European countries. Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six national expert panels, each consisting of 10 members, primarily primary care practitioners and experts in the field of quality in primary care participated in the study. The main outcome measures were: (a) a European framework with indicators for the organization of primary care; and (b) ratings of the face validity of the usefulness of the indicators by expert panels in six countries. Agreement was reached about a definition of practice management across five domains (infrastructure, staff, information, finance, and quality and safety), and a common set of indicators for the organization of general practice. The panellist response rate was 95%. Sixty-two indicators (37%) were rated face valid by all six panels. Examples include out of hours service, accessibility, the content of doctors' bags and staff involvement in quality improvement. No indicators were rated invalid by all six panels. It proved to be possible to develop a European set of indicators for assessing the quality of practice management, despite the differences in health care systems and cultures in the six different countries. These indicators will now be used in a quality assessment procedure of practice management in nine European countries. While organizational indicators are part of the new GMS contract in the UK, this research shows that many practice management issues within primary care are also of relevance in other European countries.

Discharge documentation of patients discharged to subacute facilities: a three-year quality improvement process across an integrated health care system.

PubMed

Gandara, Esteban; Ungar, Jonathan; Lee, Jason; Chan-Macrae, Myrna; O'Malley, Terrence; Schnipper, Jeffrey L

2010-06-01

Effective communication among physicians during hospital discharge is critical to patient care. Partners Healthcare (Boston) has been engaged in a multi-year process to measure and improve the quality of documentation of all patients discharged from its five acute care hospitals to subacute facilities. Partners first engaged stakeholders to develop a consensus set of 12 required data elements for all discharges to subacute facilities. A measurement process was established and later refined. Quality improvement interventions were then initiated to address measured deficiencies and included education of physicians and nurses, improvements in information technology, creation of or improvements in discharge documentation templates, training of hospitalists to serve as role models, feedback to physicians and their service chiefs regarding reviewed cases, and case manager review of documentation before discharge. To measure improvement in quality as a result of these efforts, rates of simultaneous inclusion of all 12 applicable data elements ("defect-free rate") were analyzed over time. Some 3,101 discharge documentation packets of patients discharged to subacute facilities from January 1, 2006, through September 2008 were retrospectively studied. During the 11 monitored quarters, the defect-free rate increased from 65% to 96% (p < .001 for trend). The largest improvements were seen in documentation of preadmission medication lists, allergies, follow-up, and warfarin information. Institution of rigorous measurement, feedback, and multidisciplinary, multimodal quality improvement processes improved the inclusion of data elements in discharge documentation required for safe hospital discharge across a large integrated health care system.

Split Nitrogen Application Improves Wheat Baking Quality by Influencing Protein Composition Rather Than Concentration.

PubMed

Xue, Cheng; Auf'm Erley, Gunda Schulte; Rossmann, Anne; Schuster, Ramona; Koehler, Peter; Mühling, Karl-Hermann

2016-01-01

The use of late nitrogen (N) fertilization (N application at late growth stages of wheat, e.g., booting, heading or anthesis) to improve baking quality of wheat has been questioned. Although it increases protein concentration, the beneficial effect on baking quality (bread loaf volume) needs to be clearly understood. Two pot experiments were conducted aiming to evaluate whether late N is effective under controlled conditions and if these effects result from increased N rate or N splitting. Late N fertilizers were applied either as additional N or split from the basal N at late boot stage or heading in the form of nitrate-N or urea. Results showed that late N fertilization improved loaf volume of wheat flour by increasing grain protein concentration and altering its composition. Increasing N rate mainly enhanced grain protein quantitatively. However, N splitting changed grain protein composition by enhancing the percentages of gliadins and glutenins as well as certain high molecular weight glutenin subunits (HMW-GS), which led to an improved baking quality of wheat flour. The late N effects were greater when applied as nitrate-N than urea. The proportions of glutenin and x-type HMW-GS were more important than the overall protein concentration in determining baking quality. N splitting is more effective in improving wheat quality than the increase in the N rate by late N, which offers the potential to cut down N fertilization rates in wheat production systems.

Split Nitrogen Application Improves Wheat Baking Quality by Influencing Protein Composition Rather Than Concentration

PubMed Central

Xue, Cheng; auf’m Erley, Gunda Schulte; Rossmann, Anne; Schuster, Ramona; Koehler, Peter; Mühling, Karl-Hermann

2016-01-01

The use of late nitrogen (N) fertilization (N application at late growth stages of wheat, e.g., booting, heading or anthesis) to improve baking quality of wheat has been questioned. Although it increases protein concentration, the beneficial effect on baking quality (bread loaf volume) needs to be clearly understood. Two pot experiments were conducted aiming to evaluate whether late N is effective under controlled conditions and if these effects result from increased N rate or N splitting. Late N fertilizers were applied either as additional N or split from the basal N at late boot stage or heading in the form of nitrate-N or urea. Results showed that late N fertilization improved loaf volume of wheat flour by increasing grain protein concentration and altering its composition. Increasing N rate mainly enhanced grain protein quantitatively. However, N splitting changed grain protein composition by enhancing the percentages of gliadins and glutenins as well as certain high molecular weight glutenin subunits (HMW-GS), which led to an improved baking quality of wheat flour. The late N effects were greater when applied as nitrate-N than urea. The proportions of glutenin and x-type HMW-GS were more important than the overall protein concentration in determining baking quality. N splitting is more effective in improving wheat quality than the increase in the N rate by late N, which offers the potential to cut down N fertilization rates in wheat production systems. PMID:27313585

Development and Application of the Key Technologies for the Quality Control and Inspection of National Geographical Conditions Survey Products

NASA Astrophysics Data System (ADS)

Zhao, Y.; Zhang, L.; Ma, W.; Zhang, P.; Zhao, T.

2018-04-01

The First National Geographical Condition Survey is a predecessor task to dynamically master basic situations of the nature, ecology and human activities on the earth's surface and it is the brand-new mapping geographic information engineering. In order to ensure comprehensive, real and accurate survey results and achieve the quality management target which the qualified rate is 100 % and the yield is more than 80 %, it is necessary to carry out the quality control and result inspection for national geographical conditions survey on a national scale. To ensure that achievement quality meets quality target requirements, this paper develops the key technology method of "five-in-one" quality control that is constituted by "quality control system of national geographical condition survey, quality inspection technology system, quality evaluation system, quality inspection information management system and national linked quality control institutions" by aiming at large scale, wide coverage range, more undertaking units, more management levels, technical updating, more production process and obvious regional differences in the national geographical condition survey and combining with novel achievement manifestation, complicated dependency, more special reference data, and large data size. This project fully considering the domestic and foreign related research results and production practice experience, combined with the technology development and the needs of the production, it stipulates the inspection methods and technical requirements of each stage in the quality inspection of the geographical condition survey results, and extends the traditional inspection and acceptance technology, and solves the key technologies that are badly needed in the first national geographic survey.

A vision-based weld quality evaluation system

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

Barnett, R.J.; Cook, G.E.; Strauss, A.M.

1996-12-31

Inspection of the appearance of weld beads is an integral part of the overall welding process. Lack of satisfactory appearance in itself may be sufficient grounds for part rejection or the lack of satisfactory appearance may be used as an indirect indicator of more substantive problems such as poor fusion or subsurface cracks. In all cases the inspection process tends to be both time and labor intensive. The present research uses a video system and appropriate image capture and processing to determine the quality of the weld based upon surface appearance. This relative quality rating was compared to similar ratingsmore » performed by human inspectors and was found to give very good correlation. The system was implemented for the Gas Tungsten Arc Welding (GTAW) and Gas Metal Arc Welding (GMAW) processes.« less

Microbial Monitoring of Surface Water in South Africa: An Overview

PubMed Central

Luyt, Catherine D.; Tandlich, Roman; Muller, Wilhelmine J.; Wilhelmi, Brendan S.

2012-01-01

Infrastructural problems force South African households to supplement their drinking water consumption from water resources of inadequate microbial quality. Microbial water quality monitoring is currently based on the Colilert®18 system which leads to rapidly available results. Using Escherichia coli as the indicator microorganism limits the influence of environmental sources on the reported results. The current system allows for understanding of long-term trends of microbial surface water quality and the related public health risks. However, rates of false positive for the Colilert®18-derived concentrations have been reported to range from 7.4% to 36.4%. At the same time, rates of false negative results vary from 3.5% to 12.5%; and the Colilert medium has been reported to provide for cultivation of only 56.8% of relevant strains. Identification of unknown sources of faecal contamination is not currently feasible. Based on literature review, calibration of the antibiotic-resistance spectra of Escherichia coli or the bifidobacterial tracking ratio should be investigated locally for potential implementation into the existing monitoring system. The current system could be too costly to implement in certain areas of South Africa where the modified H2S strip test might be used as a surrogate for the Colilert®18. PMID:23066390

Fast subsurface fingerprint imaging with full-field optical coherence tomography system equipped with a silicon camera

NASA Astrophysics Data System (ADS)

Auksorius, Egidijus; Boccara, A. Claude

2017-09-01

Images recorded below the surface of a finger can have more details and be of higher quality than the conventional surface fingerprint images. This is particularly true when the quality of the surface fingerprints is compromised by, for example, moisture or surface damage. However, there is an unmet need for an inexpensive fingerprint sensor that is able to acquire high-quality images deep below the surface in short time. To this end, we report on a cost-effective full-field optical coherent tomography system comprised of a silicon camera and a powerful near-infrared LED light source. The system, for example, is able to record 1.7 cm×1.7 cm en face images in 0.12 s with the spatial sampling rate of 2116 dots per inch and the sensitivity of 93 dB. We show that the system can be used to image internal fingerprints and sweat ducts with good contrast. Finally, to demonstrate its biometric performance, we acquired subsurface fingerprint images from 240 individual fingers and estimated the equal-error-rate to be ˜0.8%. The developed instrument could also be used in other en face deep-tissue imaging applications because of its high sensitivity, such as in vivo skin imaging.

Examination of State-of-the-Art Rehabilitation Technologies for the Nation’s Water Infrastructure

EPA Science Inventory

The average rate of water and wastewater system rehabilitation is not adequate to keep pace with increasing needs, quality demands, and continually deteriorating systems. Rehabilitation technologies in use today are generally effective, but there is still considerable room for i...

Changes in Quality of Health Care Delivery after Vertical Integration.

PubMed

Carlin, Caroline S; Dowd, Bryan; Feldman, Roger

2015-08-01

To fill an empirical gap in the literature by examining changes in quality of care measures occurring when multispecialty clinic systems were acquired by hospital-owned, vertically integrated health care delivery systems in the Twin Cities area. Administrative data for health plan enrollees attributed to treatment and control clinic systems, merged with U.S. Census data. We compared changes in quality measures for health plan enrollees in the acquired clinics to enrollees in nine control groups using a differences-in-differences model. Our dataset spans 2 years prior to and 4 years after the acquisitions. We estimated probit models with errors clustered within enrollees. Data were assembled by the health plan's informatics team. Vertical integration is associated with increased rates of colorectal and cervical cancer screening and more appropriate emergency department use. The probability of ambulatory care-sensitive admissions increased when the acquisition caused disruption in admitting patterns. Moving a clinic system into a vertically integrated delivery system resulted in limited increases in quality of care indicators. Caution is warranted when the acquisition causes disruption in referral patterns. © Health Research and Educational Trust.

Endometriosis: an overview of Cochrane Reviews.

PubMed

Brown, Julie; Farquhar, Cindy

2014-03-10

This overview reports on interventions for pain relief and for subfertility in pre-menopausal women with clinically diagnosed endometriosis. The objective of this overview was to summarise the evidence from Cochrane systematic reviews on treatment options for women with pain or subfertility associated with endometriosis. Published Cochrane systematic reviews reporting pain or fertility outcomes in women with clinically diagnosed endometriosis were eligible for inclusion in the overview. We also identified Cochrane reviews in preparation (protocols and titles) for future inclusion. The reviews, protocols and titles were identified by searching the Cochrane Database of Systematic Reviews and Archie (the Cochrane information management system) in March 2014.Pain-related outcomes of the overview were pain relief, clinical improvement or resolution and pain recurrence. Fertility-related outcomes were live birth, clinical pregnancy, ongoing pregnancy, miscarriage and adverse events.Selection of systematic reviews, data extraction and quality assessment were undertaken in duplicate. Review quality was assessed using the AMSTAR tool. The quality of the evidence for each outcome was assessed using GRADE methods. Review findings were summarised in the text and the data for each outcome were reported in 'Additional tables'. Seventeen systematic reviews published in The Cochrane Library were included. All the reviews were high quality. The quality of the evidence for specific comparisons ranged from very low to moderate. Limitations in the evidence included risk of bias in the primary studies, inconsistency between the studies, and imprecision in effect estimates. Pain relief (14 reviews) Gonadotrophin-releasing hormone (GnRH) analogues One systematic review reported low quality evidence of an overall benefit for GnRH analogues compared with placebo or no treatment. Ovulation suppression Five systematic reviews reported on medical treatment using ovulation suppression. There was moderate quality evidence that the levonorgestrel-releasing intrauterine system (LNG-IUD) was more effective than expectant management, and very low quality evidence that danazol was more effective than placebo. There was no consistent evidence of a difference in effectiveness between oral contraceptives and goserelin, estrogen plus progestogen and placebo, or progestogens and placebo, though in all cases the relevant evidence was of low or very low quality. Non-steroidal anti-inflammatory drugs (NSAIDS)A review of NSAIDs reported inconclusive evidence of a benefit in symptom relief compared with placebo. Surgical interventions There were two reviews of surgical interventions. One reported moderate quality evidence of a benefit in pain relief following laparoscopic surgery compared to diagnostic laparoscopy only. The other reported very low quality evidence that recurrence rates of endometriomata were lower after excisional surgery than after ablative surgery. Post-surgical medical interventions Two reviews reported on post-surgical medical interventions. Neither found evidence of an effect on pain outcomes, though in both cases the evidence was of low or very low quality. Alternative medicine There were two systematic reviews of alternative medicine. One reported evidence of a benefit from auricular acupuncture compared to Chinese herbal medicine, and the other reported no evidence of a difference between Chinese herbal medicine and danazol. In both cases the evidence was of low or very low quality. Anti-TNF-α drugs One review found no evidence of a difference in effectiveness between anti-TNF-α drugs and placebo. However, the evidence was of low quality. Reviews reporting fertility outcomes (8 reviews) Medical interventions Four reviews reported on medical interventions for improving fertility in women with endometriosis. One compared three months of GnRH agonists with a control in women undergoing assisted reproduction and found very low quality evidence of an increase in clinical pregnancies in the treatment group. There was no evidence of a difference in effectiveness between the interventions in the other three reviews, which compared GnRH agonists versus antagonists, ovulation suppression versus placebo or no treatment, and pre-surgical medical therapy versus surgery alone. In all cases the evidence was of low or very low quality. Surgical interventions Three reviews reported on surgical interventions. There was moderate quality evidence that both live births or ongoing pregnancy rates and clinical pregnancy rates were higher after laparoscopic surgery than after diagnostic laparoscopy alone. There was low quality evidence of no difference in effectiveness between surgery and expectant management for endometrioma. One review found low quality evidence that excisional surgery resulted in higher clinical pregnancy rates than drainage or ablation of endometriomata. Post-surgical interventions Two reviews reported on post-surgical medical interventions. They found no evidence of an effect on clinical pregnancy rates. The evidence was of low or very low quality. Alternative medicine A review of Chinese herbal medicine in comparison with gestrinone found no evidence of a difference between the groups in clinical pregnancy rates. However, the evidence was of low quality. Adverse events Reviews of GnRH analogues and of danazol reported that the interventions were associated with higher rates of adverse effects than placebo; and depot progestagens were associated with higher rates of adverse events than other treatments. Chinese herbal medicine was associated with fewer side effects than gestrinone or danazol.Three reviews reported miscarriage as an outcome. No difference was found between surgical and diagnostic laparoscopy, between GnRH agonists and antagonists, or between aspiration of endometrioma and expectant management. However, in all cases the quality of the evidence was of low quality. For women with pain and endometriosis, suppression of menstrual cycles with gonadotrophin-releasing hormone (GnRH) analogues, the levonorgestrel-releasing intrauterine system (LNG-IUD) and danazol were beneficial interventions. Laparoscopic treatment of endometriosis and excision of endometriomata were also associated with improvements in pain. The evidence on NSAIDs was inconclusive. There was no evidence of benefit with post-surgical medical treatment.In women with endometriosis undergoing assisted reproduction, three months of treatment with GnRH agonist improved pregnancy rates. Excisional surgery improved spontaneous pregnancy rates in the nine to 12 months after surgery compared to ablative surgery. Laparoscopic surgery improved live birth and pregnancy rates compared to diagnostic laparoscopy alone. There was no evidence that medical treatment improved clinical pregnancy rates.Evidence on harms was scanty, but GnRH analogues, danazol and depot progestagens were associated with higher rates than other interventions.

Medicare and Medicaid programs; CY 2015 Home Health Prospective Payment System rate update; Home Health Quality Reporting Requirements; and survey and enforcement requirements for home health agencies. Final rule.

PubMed

2014-11-06

This final rule updates Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2015. As required by the Affordable Care Act, this rule implements the second year of the four-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule provides information on our efforts to monitor the potential impacts of the rebasing adjustments and the Affordable Care Act mandated face-to-face encounter requirement. This rule also implements: Changes to simplify the face-to-face encounter regulatory requirements; changes to the HH PPS case-mix weights; changes to the home health quality reporting program requirements; changes to simplify the therapy reassessment timeframes; a revision to the Speech-Language Pathology (SLP) personnel qualifications; minor technical regulations text changes; and limitations on the reviewability of the civil monetary penalty provisions. Finally, this rule also discusses Medicare coverage of insulin injections under the HH PPS, the delay in the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), and a HH value-based purchasing (HH VBP) model.

Elastography using multi-stream GPU: an application to online tracked ultrasound elastography, in-vivo and the da Vinci Surgical System.

PubMed

Deshmukh, Nishikant P; Kang, Hyun Jae; Billings, Seth D; Taylor, Russell H; Hager, Gregory D; Boctor, Emad M

2014-01-01

A system for real-time ultrasound (US) elastography will advance interventions for the diagnosis and treatment of cancer by advancing methods such as thermal monitoring of tissue ablation. A multi-stream graphics processing unit (GPU) based accelerated normalized cross-correlation (NCC) elastography, with a maximum frame rate of 78 frames per second, is presented in this paper. A study of NCC window size is undertaken to determine the effect on frame rate and the quality of output elastography images. This paper also presents a novel system for Online Tracked Ultrasound Elastography (O-TRuE), which extends prior work on an offline method. By tracking the US probe with an electromagnetic (EM) tracker, the system selects in-plane radio frequency (RF) data frames for generating high quality elastograms. A novel method for evaluating the quality of an elastography output stream is presented, suggesting that O-TRuE generates more stable elastograms than generated by untracked, free-hand palpation. Since EM tracking cannot be used in all systems, an integration of real-time elastography and the da Vinci Surgical System is presented and evaluated for elastography stream quality based on our metric. The da Vinci surgical robot is outfitted with a laparoscopic US probe, and palpation motions are autonomously generated by customized software. It is found that a stable output stream can be achieved, which is affected by both the frequency and amplitude of palpation. The GPU framework is validated using data from in-vivo pig liver ablation; the generated elastography images identify the ablated region, outlined more clearly than in the corresponding B-mode US images.

Elastography Using Multi-Stream GPU: An Application to Online Tracked Ultrasound Elastography, In-Vivo and the da Vinci Surgical System

PubMed Central

Deshmukh, Nishikant P.; Kang, Hyun Jae; Billings, Seth D.; Taylor, Russell H.; Hager, Gregory D.; Boctor, Emad M.

2014-01-01

A system for real-time ultrasound (US) elastography will advance interventions for the diagnosis and treatment of cancer by advancing methods such as thermal monitoring of tissue ablation. A multi-stream graphics processing unit (GPU) based accelerated normalized cross-correlation (NCC) elastography, with a maximum frame rate of 78 frames per second, is presented in this paper. A study of NCC window size is undertaken to determine the effect on frame rate and the quality of output elastography images. This paper also presents a novel system for Online Tracked Ultrasound Elastography (O-TRuE), which extends prior work on an offline method. By tracking the US probe with an electromagnetic (EM) tracker, the system selects in-plane radio frequency (RF) data frames for generating high quality elastograms. A novel method for evaluating the quality of an elastography output stream is presented, suggesting that O-TRuE generates more stable elastograms than generated by untracked, free-hand palpation. Since EM tracking cannot be used in all systems, an integration of real-time elastography and the da Vinci Surgical System is presented and evaluated for elastography stream quality based on our metric. The da Vinci surgical robot is outfitted with a laparoscopic US probe, and palpation motions are autonomously generated by customized software. It is found that a stable output stream can be achieved, which is affected by both the frequency and amplitude of palpation. The GPU framework is validated using data from in-vivo pig liver ablation; the generated elastography images identify the ablated region, outlined more clearly than in the corresponding B-mode US images. PMID:25541954

Poster — Thur Eve — 19: Performance assessment of a 160-leaf beam collimation system

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

Ali, E. S. M.; La Russa, D. J.; Vandervoort, E.

2014-08-15

In this study, the performance of the new beam collimation system with 160 leaves, each with a 5 mm leaf width projected at isocenter, is evaluated in terms of positional accuracy and plan/delivery quality. Positional accuracy was evaluated using a set of static and dynamic MLC/jaw delivery patterns at different gantry angles, dose rates, and MLC/jaw speeds. The impact on IMRT plan quality was assessed by comparing against a previous generation collimation system using the same optimization parameters, while delivery quality was quantified using a combination of patient-specific QA measurements with ion chambers, film, and a bi-planar diode array. Positionalmore » accuracy for four separate units was comparable. The field size accuracy, junction width, and total displacement over 16 cm leaf travel are 0.3 ± 0.2 mm, 0.4 ± 0.3 mm, and 0.5 ± 0.2 mm, respectively. The typical leaf minor offset is 0.05 ± 0.04 mm, and MLC hysteresis effects are 0.2 ± 0.1 mm over 16 cm travel. The dynamic output is linear with MU and MLC/jaw speed, and is within 0.7 ± 0.3 % of the planning system value. Plan quality is significantly improved both in terms of target coverage and OAR sparing due, in part, to the larger allowable MLC and jaw speeds. γ-index pass rates for the patient-specific QA measurements exceeded 97% using criteria of 2%/2 mm. In conclusion, the performance of the Agility system is consistent among four separate installations, and is superior to its previous generations of collimation systems.« less

40 CFR Appendix K to Part 75 - Quality Assurance and Operating Procedures for Sorbent Trap Monitoring Systems

Code of Federal Regulations, 2010 CFR

2010-07-01

... until the leak check is passed. Post-test leak check ≤4% of average sampling rate After sampling ** See... the test site. The sorbent media must be obtained from a source that can demonstrate the quality...-traceable calibration gas standards and reagents shall be used for the tests and procedures required under...

Examining Ratings on the VAL-ED Evaluation Instrument of Principals to Improve Instructional Leadership Practices

ERIC Educational Resources Information Center

Babin, Erin Pevey

2017-01-01

The biggest challenge facing American public schools today is increasing student achievement, and this depends on the educational system's ability to improve the quality of instruction. Principals play a key role in improving the quality of instruction on their campus through the instructional leadership practices they engage in on a daily basis.…

Quality Ratings and Improvement Systems in Early Childhood Education: Promising Approaches for Pennsylvania. A PACER Policy Brief

ERIC Educational Resources Information Center

Jenkins, Della; Englander, Katie

2016-01-01

Policymakers are recognizing that Pennsylvania has fallen behind in providing equitable access to high quality early childhood education. Governor Tom Wolf ran on a campaign promise of universal pre-k access and proposed an unprecedented budget increase for early childhood programs in 2016. In Philadelphia, Mayor Jim Kenney has made pre-k a…

Assurance of energy efficiency and data security for ECG transmission in BASNs.

PubMed

Ma, Tao; Shrestha, Pradhumna Lal; Hempel, Michael; Peng, Dongming; Sharif, Hamid; Chen, Hsiao-Hwa

2012-04-01

With the technological advancement in body area sensor networks (BASNs), low cost high quality electrocardiographic (ECG) diagnosis systems have become important equipment for healthcare service providers. However, energy consumption and data security with ECG systems in BASNs are still two major challenges to tackle. In this study, we investigate the properties of compressed ECG data for energy saving as an effort to devise a selective encryption mechanism and a two-rate unequal error protection (UEP) scheme. The proposed selective encryption mechanism provides a simple and yet effective security solution for an ECG sensor-based communication platform, where only one percent of data is encrypted without compromising ECG data security. This part of the encrypted data is essential to ECG data quality due to its unequally important contribution to distortion reduction. The two-rate UEP scheme achieves a significant additional energy saving due to its unequal investment of communication energy to the outcomes of the selective encryption, and thus, it maintains a high ECG data transmission quality. Our results show the improvements in communication energy saving of about 40%, and demonstrate a higher transmission quality and security measured in terms of wavelet-based weighted percent root-mean-squared difference.

Design, analysis, and control of a large transport aircraft utilizing selective engine thrust as a backup system for the primary flight control. Ph.D. Thesis

NASA Technical Reports Server (NTRS)

Gerren, Donna S.

1995-01-01

A study has been conducted to determine the capability to control a very large transport airplane with engine thrust. This study consisted of the design of an 800-passenger airplane with a range of 5000 nautical miles design and evaluation of a flight control system, and design and piloted simulation evaluation of a thrust-only backup flight control system. Location of the four wing-mounted engines was varied to optimize the propulsive control capability, and the time constant of the engine response was studied. The goal was to provide level 1 flying qualities. The engine location and engine time constant did not have a large effect on the control capability. The airplane design did meet level 1 flying qualities based on frequencies, damping ratios, and time constants in the longitudinal and lateral-directional modes. Project pilots consistently rated the flying qualities as either level 1 or level 2 based on Cooper-Harper ratings. However, because of the limited control forces and moments, the airplane design fell short of meeting the time required to achieve a 30 deg bank and the time required to respond a control input.

The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals.

PubMed

Willems, Elise; Smismans, Annick; Cartuyvels, Reinoud; Coppens, Guy; Van Vaerenbergh, Kristien; Van den Abeele, Anne-Marie; Frans, Johan

2012-05-01

Bloodstream infections remain a major challenge in medicine. Optimal detection of pathogens is only possible if the quality of preanalytical factors is thoroughly controlled. Since the laboratory is responsible for this preanalytical phase, the quality control of critical factors should be integrated in its quality control program. The numerous recommendations regarding blood culture collection contain controversies. Only an unambiguous guideline permits standardization and interlaboratory quality control. We present an evidence-based concise guideline of critical preanalytical determinants for blood culture collection and summarize key performance indicators with their concomitant target values. In an attempt to benchmark, we compared the true-positive rate, contamination rate, and collected blood volume of blood culture bottles in 5 Belgian hospital laboratories. The true-positive blood culture rate fell within previously defined acceptation criteria by Baron et al. (2005) in all 5 hospitals, whereas the contamination rate exceeded the target value in 4 locations. Most unexpected, in each of the 5 laboratories, more than one third of the blood culture bottles were incorrectly filled, irrespective of the manufacturer of the blood culture vials. As a consequence of this shortcoming, one manufacturer recently developed an automatic blood volume monitoring system. In conclusion, clear recommendations for standardized blood culture collection combined with quality control of critical factors of the preanalytical phase are essential for diagnostic blood culture improvement. Copyright © 2012 Elsevier Inc. All rights reserved.

PATRAM '80. Proceedings. Volume 1

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

Huebner, H.W.

Volume 1 contains papers from the following sessions: Plenary Session; Regulations, Licensing and Standards; LMFBR Systems Concepts; Risk/Safety Assessment I; Systems and Package Design; US Institutional Issues; Risk/Safety Assessment II; Leakage, Leak Rate and Seals; Poster Session A; Operations and Systems Experience I; Manufacturing Processes and Materials; and Quality Assurance and Maintenance. Individual papers were processed. (LM)

Effect of Stocking Rate on Growing Juvenile Sunshine Bass (Morone chrysops x M. saxatilis) in an Outdoor Biofloc Production System

USDA-ARS?s Scientific Manuscript database

The biofloc technology production system is a production intensifying management strategy used primarily for culturing tilapia and penaeid shrimp, both of which can consume the biofloc. Other fish can be grown in biofloc technology production systems because the biofloc serves as a water quality man...

Rapid permeation measurement system for the production control of monolayer and multilayer films

NASA Astrophysics Data System (ADS)

Botos, J.; Müller, K.; Heidemeyer, P.; Kretschmer, K.; Bastian, M.; Hochrein, T.

2014-05-01

Plastics have been used for packaging films for a long time. Until now the development of new formulations for film applications, including process optimization, has been a time-consuming and cost-intensive process for gases like oxygen (O2) or carbon dioxide (CO2). By using helium (He) the permeation measurement can be accelerated from hours or days to a few minutes. Therefore a manometric measuring system for tests according to ISO 15105-1 is coupled with a mass spectrometer to determine the helium flow rate and to calculate the helium permeation rate. Due to the accelerated determination the permeation quality of monolayer and multilayer films can be measured atline. Such a system can be used to predict for example the helium permeation rate of filled polymer films. Defined quality limits for the permeation rate can be specified as well as the prompt correction of process parameters if the results do not meet the specification. This method for process control was tested on a pilot line with a corotating twin-screw extruder for monolayer films. Selected process parameters were varied iteratively without changing the material formulation to obtain the best process parameter set and thus the lowest permeation rate. Beyond that the influence of different parameters on the helium permeation rate was examined on monolayer films. The results were evaluated conventional as well as with artificial neuronal networks in order to determine the non-linear correlation between all process parameters.

Medicare and Medicaid programs; Home Health Prospective Payment System rate update for CY 2014, home health quality reporting requirements, and cost allocation of home health survey expenses. Final rule.

PubMed

2013-12-02

This final rule will update the Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, the low-utilization payment adjustment (LUPA) add-on, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective January 1, 2014. As required by the Affordable Care Act, this rule establishes rebasing adjustments, with a 4-year phase-in, to the national, standardized 60-day episode payment rates; the national per-visit rates; and the NRS conversion factor. In addition, this final rule will remove 170 diagnosis codes from assignment to diagnosis groups within the HH PPS Grouper, effective January 1, 2014. Finally, this rule will establish home health quality reporting requirements for CY 2014 payment and subsequent years and will clarify that a state Medicaid program must provide that, in certifying HHAs, the state's designated survey agency carry out certain other responsibilities that already apply to surveys of nursing facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID), including sharing in the cost of HHA surveys. For that portion of costs attributable to Medicare and Medicaid, we will assign 50 percent to Medicare and 50 percent to Medicaid, the standard method that CMS and states use in the allocation of expenses related to surveys of nursing homes.

Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2015-11-05

This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.

The role of complexity metrics in a multi-institutional dosimetry audit of VMAT

PubMed Central

Agnew, Christina E; Hussein, Mohammad; Tsang, Yatman; McWilliam, Alan; Hounsell, Alan R; Clark, Catharine H

2016-01-01

Objective: To demonstrate the benefit of complexity metrics such as the modulation complexity score (MCS) and monitor units (MUs) in multi-institutional audits of volumetric-modulated arc therapy (VMAT) delivery. Methods: 39 VMAT treatment plans were analysed using MCS and MU. A virtual phantom planning exercise was planned and independently measured using the PTW Octavius® phantom and seven29® 2D array (PTW-Freiburg GmbH, Freiburg, Germany). MCS and MU were compared with the median gamma index pass rates (2%/2 and 3%/3 mm) and plan quality. The treatment planning systems (TPS) were grouped by VMAT modelling being specifically designed for the linear accelerator manufacturer's own treatment delivery system (Type 1) or independent of vendor for VMAT delivery (Type 2). Differences in plan complexity (MCS and MU) between TPS types were compared. Results: For Varian® linear accelerators (Varian® Medical Systems, Inc., Palo Alto, CA), MCS and MU were significantly correlated with gamma pass rates. Type 2 TPS created poorer quality, more complex plans with significantly higher MUs and MCS than Type 1 TPS. Plan quality was significantly correlated with MU for Type 2 plans. A statistically significant correlation was observed between MU and MCS for all plans (R = −0.84, p < 0.01). Conclusion: MU and MCS have a role in assessing plan complexity in audits along with plan quality metrics. Plan complexity metrics give some indication of plan deliverability but should be analysed with plan quality. Advances in knowledge: Complexity metrics were investigated for a national rotational audit involving 34 institutions and they showed value. The metrics found that more complex plans were created for planning systems which were independent of vendor for VMAT delivery. PMID:26511276

The role of complexity metrics in a multi-institutional dosimetry audit of VMAT.

PubMed

McGarry, Conor K; Agnew, Christina E; Hussein, Mohammad; Tsang, Yatman; McWilliam, Alan; Hounsell, Alan R; Clark, Catharine H

2016-01-01

To demonstrate the benefit of complexity metrics such as the modulation complexity score (MCS) and monitor units (MUs) in multi-institutional audits of volumetric-modulated arc therapy (VMAT) delivery. 39 VMAT treatment plans were analysed using MCS and MU. A virtual phantom planning exercise was planned and independently measured using the PTW Octavius(®) phantom and seven29(®) 2D array (PTW-Freiburg GmbH, Freiburg, Germany). MCS and MU were compared with the median gamma index pass rates (2%/2 and 3%/3 mm) and plan quality. The treatment planning systems (TPS) were grouped by VMAT modelling being specifically designed for the linear accelerator manufacturer's own treatment delivery system (Type 1) or independent of vendor for VMAT delivery (Type 2). Differences in plan complexity (MCS and MU) between TPS types were compared. For Varian(®) linear accelerators (Varian(®) Medical Systems, Inc., Palo Alto, CA), MCS and MU were significantly correlated with gamma pass rates. Type 2 TPS created poorer quality, more complex plans with significantly higher MUs and MCS than Type 1 TPS. Plan quality was significantly correlated with MU for Type 2 plans. A statistically significant correlation was observed between MU and MCS for all plans (R = -0.84, p < 0.01). MU and MCS have a role in assessing plan complexity in audits along with plan quality metrics. Plan complexity metrics give some indication of plan deliverability but should be analysed with plan quality. Complexity metrics were investigated for a national rotational audit involving 34 institutions and they showed value. The metrics found that more complex plans were created for planning systems which were independent of vendor for VMAT delivery.

Reducing patient mortality, length of stay and readmissions through machine learning-based sepsis prediction in the emergency department, intensive care unit and hospital floor units

PubMed Central

McCoy, Andrea

2017-01-01

Introduction Sepsis management is a challenge for hospitals nationwide, as severe sepsis carries high mortality rates and costs the US healthcare system billions of dollars each year. It has been shown that early intervention for patients with severe sepsis and septic shock is associated with higher rates of survival. The Cape Regional Medical Center (CRMC) aimed to improve sepsis-related patient outcomes through a revised sepsis management approach. Methods In collaboration with Dascena, CRMC formed a quality improvement team to implement a machine learning-based sepsis prediction algorithm to identify patients with sepsis earlier. Previously, CRMC assessed all patients for sepsis using twice-daily systemic inflammatory response syndrome screenings, but desired improvements. The quality improvement team worked to implement a machine learning-based algorithm, collect and incorporate feedback, and tailor the system to current hospital workflow. Results Relative to the pre-implementation period, the post-implementation period sepsis-related in-hospital mortality rate decreased by 60.24%, sepsis-related hospital length of stay decreased by 9.55% and sepsis-related 30-day readmission rate decreased by 50.14%. Conclusion The machine learning-based sepsis prediction algorithm improved patient outcomes at CRMC. PMID:29450295

Recharge beneath low-impact design rain gardens and the influence of El Niño Southern Oscillation on urban, coastal groundwater resources

NASA Astrophysics Data System (ADS)

Newcomer, M. E.; Gurdak, J. J.

2011-12-01

Groundwater resources in urban, coastal environments are highly vulnerable to increased human pressures and climate variability. Impervious surfaces, such as buildings, roads, and parking lots prevent infiltration, reduce recharge to underlying aquifers, and increase contaminants in surface runoff that often overflow sewage systems. To mitigate these effects, cities worldwide are adopting low impact design (LID) approaches that direct runoff into natural vegetated systems, such as rain gardens that reduce, filter, and slow stormwater runoff, and are hypothesized to increase infiltration and recharge rates to aquifers. The effects of LID on recharge rates and quality is unknown, particularly during intense precipitation events for cities along the Pacific coast in response to interannual variability of the El Niño Southern Oscillation (ENSO). Using vadose zone monitoring sensors and instruments, I collected and monitored soil, hydraulic, and geochemical data to quantify the rates and quality of infiltration and recharge to the California Coastal aquifer system beneath a LID rain garden and traditional turf-lawn setting in San Francisco, CA. The data were used to calibrate a HYDRUS-3D model to simulate recharge rates under historical and future variability of ENSO. Understanding these processes has important implications for managing groundwater resources in urban, coastal environments.

Determination of Water Quality Status at Sampean Watershed Bondowoso Residence Using Storet Method

NASA Astrophysics Data System (ADS)

Sugiyarto; Hariono, B.; Destarianto, P.; Nuruddin, M.

2018-01-01

Sampean watershed has an important social and economic function for the people surroundings. Sampean watershed wich cover Bondowoso and Situbondo residence is an urban watershed that has strategic value for national context needs special traetment. Construction activity at upper and lower course of Sampean watershed is highly intensive and growth of inhabitant also increase. The change of land utilization and increase of settlement area at upper, midlle, and lower course caused polutant infiltration to Sampean river watershed so it has impact on water quality. The source of pollution at Sampean river comes from domestic waste, industrial waste, agricultural waste and animal husbandry waste. The purpose of this research is to determine load of pollution and analize the pollution load carrying capacity at Sampean watershed. The data used in this research are rainfall, river flow rate and water quality at 6 certain points within 3 years during 2014 until 2016. The method to determine overall pollution rate is STORET (Storage and Retrieval of Water Quality Data System) method. The analysis results for the first, second, third and forth grade are -24 (moderate quality), -12 (moderate quality), -2 (good quality), and 0 (good quality) respectively.

Poor tap water quality experiences and poor sleep quality during the Flint, Michigan Municipal Water Crisis.

PubMed

Kruger, Daniel J; Kodjebacheva, Gergana D; Cupal, Suzanne

2017-08-01

After inadequate official response to community concerns over water quality following changes in Flint's municipal water supply, this study sought evidence for a relationship between water quality and community mental health. The Speak to Your Health Community Survey is a community-based participatory component of the health surveillance system in Genesee County, Michigan. This cross-sectional survey recruits participants from every residential Census Tract of the county and strives for demographic representativeness. Respondents (n=834) rated their tap water quality (taste, smell, appearance) as poor (36%), fair (18%), good (20%), very good (17%), and excellent (10%). They rated their sleep quality as poor (12%), fair (28%), good (39%), very good (18%), and excellent (4%), and had an average (SD) sleep length of 408(90) minutes. Controlling for age, sex, years of education, and whether respondents were African American and Hispanic/Latino/a, lower perceived tap water quality was associated with lower sleep quality and shorter sleep length. Results indicate that adverse health conditions related to the water crisis extend beyond lead poisoning in children and include deterioration of sleep conditions among adult residents. Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Evaluating the impact of AMDAR data quality control in China on the short-range convection forecasts using the WRF model

NASA Astrophysics Data System (ADS)

Wang, Xiaofeng; Jiang, Qin; Zhang, Lei

2016-04-01

A quality control system for the Aircraft Meteorological Data Relay (AMDAR) data has been implemented in China. This system is an extension to the AMDAR quality control system used at the US National Centers for Environmental Prediction. We present a study in which the characteristics of each AMDAR data quality type were examined and the impact of the AMDAR data quality system on short-range convective weather forecasts using the WRF model was investigated. The main results obtained from this study are as follows. (1) The hourly rejection rate of AMDAR data during 2014 was 5.79%, and most of the rejections happened in Near Duplicate Check. (2) There was a significant diurnal variation for both quantity and quality of AMDAR data. Duplicated reports increased with the increase of data quantity, while suspicious and disorderly reports decreased with the increase of data quantity. (3) The characteristics of the data quality were different in each model layer, with the quality problems occurring mainly at the surface as well as at the height where the power or the flight mode of the aircraft underwent adjustment. (4) Assimilating the AMDAR data improved the forecast accuracy, particularly over the region where strong convection occurred. (5) Significant improvements made by assimilating AMDAR data were found after six hours into the model forecast. The conclusion from this study is that the newly implemented AMDAR data quality system can help improve the accuracy of short-range convection forecasts using the WRF model.

External quality assurance performance of clinical research laboratories in sub-saharan Africa.

PubMed

Amukele, Timothy K; Michael, Kurt; Hanes, Mary; Miller, Robert E; Jackson, J Brooks

2012-11-01

Patient Safety Monitoring in International Laboratories (JHU-SMILE) is a resource at Johns Hopkins University that supports and monitors laboratories in National Institutes of Health-funded international clinical trials. To determine the impact of the JHU-SMILE quality assurance scheme in sub-Saharan African laboratories, we reviewed 40 to 60 months of external quality assurance (EQA) results of the College of American Pathologists (CAP) in these laboratories. We reviewed the performance of 8 analytes: albumin, alanine aminotransferase, creatinine, sodium, WBC, hemoglobin, hematocrit, and the human immunodeficiency virus antibody rapid test. Over the 40- to 60-month observation period, the sub-Saharan laboratories had a 1.63% failure rate, which was 40% lower than the 2011 CAP-wide rate of 2.8%. Seventy-six percent of the observed EQA failures occurred in 4 of the 21 laboratories. These results demonstrate that a system of remote monitoring, feedback, and audits can support quality in low-resource settings, even in places without strong regulatory support for laboratory quality.

Establishing the overall service quality of engineering education: fuzzy logic approach

NASA Astrophysics Data System (ADS)

Shekhar, N. Chandra; Venkatasubbaiah, K.; Kandukuria, N. R.

2012-12-01

Measuring overall service quality (OSQ) is gaining prominence in higher education due to the increased competition among engineering education institutions (EEIs) and growing awareness about value for money among the public. Determination of OSQ on certain institutional aspects is done by various agencies throughout the world. Each system uses a different set of weighted indicators to measure the overall service quality of institutions. Five service quality factors, namely professionalism, integrated education, facilities, responsiveness and empathy are considered in the study. Trapezoidal fuzzy numbers are used to determine the aggregate weights of the factors to handle the vagueness present in the linguistic values of the stakeholders' subjective opinions. Final weights of the factors are assessed by taking the distances of each factor between Fuzzy Positive Ideal Rating and Fuzzy Negative Ideal Rating. An illustrative study is presented to determine the OSQ of EEIs. The results help to focus on the factors which need immediate attention to enhance the quality of EEIs.

Particle loading rates for HVAC filters, heat exchangers, and ducts.

PubMed

Waring, M S; Siegel, J A

2008-06-01

The rate at which airborne particulate matter deposits onto heating, ventilation, and air-conditioning (HVAC) components is important from both indoor air quality (IAQ) and energy perspectives. This modeling study predicts size-resolved particle mass loading rates for residential and commercial filters, heat exchangers (i.e. coils), and supply and return ducts. A parametric analysis evaluated the impact of different outdoor particle distributions, indoor emission sources, HVAC airflows, filtration efficiencies, coils, and duct system complexities. The median predicted residential and commercial loading rates were 2.97 and 130 g/m(2) month for the filter loading rates, 0.756 and 4.35 g/m(2) month for the coil loading rates, 0.0051 and 1.00 g/month for the supply duct loading rates, and 0.262 g/month for the commercial return duct loading rates. Loading rates are more dependent on outdoor particle distributions, indoor sources, HVAC operation strategy, and filtration than other considered parameters. The results presented herein, once validated, can be used to estimate filter changing and coil cleaning schedules, energy implications of filter and coil loading, and IAQ impacts associated with deposited particles. The results in this paper suggest important factors that lead to particle deposition on HVAC components in residential and commercial buildings. This knowledge informs the development and comparison of control strategies to limit particle deposition. The predicted mass loading rates allow for the assessment of pressure drop and indoor air quality consequences that result from particle mass loading onto HVAC system components.

Does adding clinical data to administrative data improve agreement among hospital quality measures?

PubMed

Hanchate, Amresh D; Stolzmann, Kelly L; Rosen, Amy K; Fink, Aaron S; Shwartz, Michael; Ash, Arlene S; Abdulkerim, Hassen; Pugh, Mary Jo V; Shokeen, Priti; Borzecki, Ann

2017-09-01

Hospital performance measures based on patient mortality and readmission have indicated modest rates of agreement. We examined if combining clinical data on laboratory tests and vital signs with administrative data leads to improved agreement with each other, and with other measures of hospital performance in the nation's largest integrated health care system. We used patient-level administrative and clinical data, and hospital-level data on quality indicators, for 2007-2010 from the Veterans Health Administration (VA). For patients admitted for acute myocardial infarction (AMI), heart failure (HF) and pneumonia we examined changes in hospital performance on 30-d mortality and 30-d readmission rates as a result of adding clinical data to administrative data. We evaluated whether this enhancement yielded improved measures of hospital quality, based on concordance with other hospital quality indicators. For 30-d mortality, data enhancement improved model performance, and significantly changed hospital performance profiles; for 30-d readmission, the impact was modest. Concordance between enhanced measures of both outcomes, and with other hospital quality measures - including Joint Commission process measures, VA Surgical Quality Improvement Program (VASQIP) mortality and morbidity, and case volume - remained poor. Adding laboratory tests and vital signs to measure hospital performance on mortality and readmission did not improve the poor rates of agreement across hospital quality indicators in the VA. Efforts to improve risk adjustment models should continue; however, evidence of validation should precede their use as reliable measures of quality. Published by Elsevier Inc.

High quality digital holographic reconstruction on analog film

NASA Astrophysics Data System (ADS)

Nelsen, B.; Hartmann, P.

2017-05-01

High quality real-time digital holographic reconstruction, i.e. at 30 Hz frame rates, has been at the forefront of research and has been hailed as the holy grail of display systems. While these efforts have produced a fascinating array of computer algorithms and technology, many applications of reconstructing high quality digital holograms do not require such high frame rates. In fact, applications such as 3D holographic lithography even require a stationary mask. Typical devices used for digital hologram reconstruction are based on spatial-light-modulator technology and this technology is great for reconstructing arbitrary holograms on the fly; however, it lacks the high spatial resolution achievable by its analog counterpart, holographic film. Analog holographic film is therefore the method of choice for reconstructing highquality static holograms. The challenge lies in taking a static, high-quality digitally calculated hologram and effectively writing it to holographic film. We have developed a theoretical system based on a tunable phase plate, an intensity adjustable high-coherence laser and a slip-stick based piezo rotation stage to effectively produce a digitally calculated hologram on analog film. The configuration reproduces the individual components, both the amplitude and phase, of the hologram in the Fourier domain. These Fourier components are then individually written on the holographic film after interfering with a reference beam. The system is analogous to writing angularly multiplexed plane waves with individual component phase control.

Real-time demonstration hardware for enhanced DPCM video compression algorithm

NASA Technical Reports Server (NTRS)

Bizon, Thomas P.; Whyte, Wayne A., Jr.; Marcopoli, Vincent R.

1992-01-01

The lack of available wideband digital links as well as the complexity of implementation of bandwidth efficient digital video CODECs (encoder/decoder) has worked to keep the cost of digital television transmission too high to compete with analog methods. Terrestrial and satellite video service providers, however, are now recognizing the potential gains that digital video compression offers and are proposing to incorporate compression systems to increase the number of available program channels. NASA is similarly recognizing the benefits of and trend toward digital video compression techniques for transmission of high quality video from space and therefore, has developed a digital television bandwidth compression algorithm to process standard National Television Systems Committee (NTSC) composite color television signals. The algorithm is based on differential pulse code modulation (DPCM), but additionally utilizes a non-adaptive predictor, non-uniform quantizer and multilevel Huffman coder to reduce the data rate substantially below that achievable with straight DPCM. The non-adaptive predictor and multilevel Huffman coder combine to set this technique apart from other DPCM encoding algorithms. All processing is done on a intra-field basis to prevent motion degradation and minimize hardware complexity. Computer simulations have shown the algorithm will produce broadcast quality reconstructed video at an average transmission rate of 1.8 bits/pixel. Hardware implementation of the DPCM circuit, non-adaptive predictor and non-uniform quantizer has been completed, providing realtime demonstration of the image quality at full video rates. Video sampling/reconstruction circuits have also been constructed to accomplish the analog video processing necessary for the real-time demonstration. Performance results for the completed hardware compare favorably with simulation results. Hardware implementation of the multilevel Huffman encoder/decoder is currently under development along with implementation of a buffer control algorithm to accommodate the variable data rate output of the multilevel Huffman encoder. A video CODEC of this type could be used to compress NTSC color television signals where high quality reconstruction is desirable (e.g., Space Station video transmission, transmission direct-to-the-home via direct broadcast satellite systems or cable television distribution to system headends and direct-to-the-home).

Signal loss during fetal heart rate monitoring using maternal abdominal surface electrodes between 28 and 42 weeks of pregnancy.

PubMed

Fuchs, Tomasz; Pomorski, Michał; Grobelak, Krzysztof; Tomiałowicz, Marek; Zimmer, Mariusz

2014-01-01

Fetal electrocardiography is one of the methods for monitoring the well-being of the fetus. Signal loss limits the proper interpretation of electrocardiogram traces. The aim of this study was to assess the average signal loss in non-invasive abdominal fetal electrocardiogram (fECG) monitoring using the KOMPOREL fetal monitoring system (ITAM, Zabrze, Poland) in women between 28 and 42 week of pregnancy. The results were compared to FIGO (International Federation of Gynaecology and Obstetric) and DGGG (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e.V.) recommendations concerning fetal heart monitoring. The correlation between fetal ECG signal quality, week of pregnancy and patient BMI was evaluated. 773 pregnant women, hospitalized and diagnosed in the Department of Gynecology and Obstetrics, Wroclaw Medical University, underwent 30 min of abdominal fECG recordings using the KOMPOREL fetal monitoring system. The average signal loss in abdominal fECG monitoring in the study group was 32%. FIGO recommendations describe an acceptable fetal signal loss of 20%. In our study, 46% (357/773) of the recordings were up to FIGO standards, with fetal heart rate success rates above 80%. According to DGGG guidelines, with acceptable fetal signal loss of 15%, only 39% (303/773) of the recordings could be assessed as accurate. No correlation between fECG signal quality, week of pregnancy and patient BMI was proved. The average signal loss in abdominal fECG monitoring in our study group was 32%. Low fECG signal quality may constitute a potentially limiting factor of the described fetal heart monitoring system. No relationship between fECG signal quality, week of pregnancy and patient BMI was proved.

Psychometric evaluation of the pediatric and parent-proxy Patient-Reported Outcomes Measurement Information System and the Neurology and Traumatic Brain Injury Quality of Life measurement item banks in pediatric traumatic brain injury.

PubMed

Bertisch, Hilary; Rivara, Frederick P; Kisala, Pamela A; Wang, Jin; Yeates, Keith Owen; Durbin, Dennis; Zonfrillo, Mark R; Bell, Michael J; Temkin, Nancy; Tulsky, David S

2017-07-01

The primary objective is to provide evidence of convergent and discriminant validity for the pediatric and parent-proxy versions of the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, Depression, Anger, Peer Relations, Mobility, Pain Interference, and Fatigue item banks, the Neurology Quality of Life measurement system (Neuro-QOL) Cognition-General Concerns and Stigma item banks, and the Traumatic Brain Injury Quality of Life (TBI-QOL) Executive Function and Headache item banks in a pediatric traumatic brain injury (TBI) sample. Participants were 134 parent-child (ages 8-18 years) days. Children all sustained TBI and the dyads completed outcome ratings 6 months after injury at one of six medical centers across the United States. Ratings included PROMIS, Neuro-QOL, and TBI-QOL item banks, as well as the Pediatric Quality of Life inventory (PedsQL), the Health Behavior Inventory (HBI), and the Strengths and Difficulties Questionnaire (SDQ) as legacy criterion measures against which these item banks were validated. The PROMIS, Neuro-QOL, and TBI-QOL item banks demonstrated good convergent validity, as evidenced by moderate to strong correlations with comparable scales on the legacy measures. PROMIS, Neuro-QOL, and TBI-QOL item banks showed weaker correlations with ratings of unrelated constructs on legacy measures, providing evidence of discriminant validity. Our results indicate that the constructs measured by the PROMIS, Neuro-QOL, and TBI-QOL item banks are valid in our pediatric TBI sample and that it is appropriate to use these standardized scores for our primary study analyses.

State of Technology for Rehabilitation of Wastewater Collection Systems

EPA Science Inventory

The variety of tools available to the sewer utility engineer today is remarkably different than it was during the 1960s. However, the average rate of system rehabilitation and upgrading within the U.S. is still not adequate to keep pace with increasing needs, quality demands, an...

Case Management Agency Systems of Administering Long-Term Care: Evidence from the Channeling Demonstration.

ERIC Educational Resources Information Center

Kemper, Peter

1990-01-01

Examines what was learned from channeling demonstration about potential of case management agency systems for administering home care benefits. Considers both advantages (substitution of lower cost for higher cost services, negotiation of lower prices for services, quality assurance) and disadvantages (difficulty controlling participation rates,…

Do the stars align? Distribution of high-quality ratings of healthcare sectors across US markets.

PubMed

Figueroa, Jose; Feyman, Yevgeniy; Blumenthal, Daniel; Jha, Ashish

2018-04-01

The US government created five-star rating systems to evaluate hospital, nursing homes, home health agency and dialysis centre quality. The degree to which quality is a property of organisations versus geographical markets is unclear. To determine whether high-quality healthcare service sectors are clustered within US healthcare markets. Using data from the Centers for Medicare and Medicaid Services' Hospital, Dialysis, Nursing Home and Home Health Compare databases, we calculated the mean star ratings of four healthcare sectors in 304 US hospital referral regions (HRRs). For each sector, we ranked HRRs into terciles by mean star rating. Within each HRR, we assessed concordance of tercile rank across sectors using a multirater kappa. Using t-tests, we compared characteristics of HRRs with three to four top-ranked sectors, one to two top-ranked sectors and zero top-ranked sectors. Six HRRs (2.0% of HRRs) had four top-ranked healthcare sectors, 38 (12.5%) had three top-ranked health sectors, 71 (23.4%) had two top-ranked sectors, 111 (36.5%) had one top-ranked sector and 78 (25.7%) HRRs had no top-ranked sectors. A multirater kappa across all sectors showed poor to slight agreement (K=0.055). Compared with HRRs with zero top-ranked sectors, those with three to four top-ranked sectors had higher median incomes, fewer black residents, lower mortality rates and were less impoverished. Results were similar for HRRs with one to two top-ranked sectors. Few US healthcare markets exhibit high-quality performance across four distinct healthcare service sectors, suggesting that high-quality care in one sector may not be dependent on or improve care quality in other sectors. Policies that promote accountability for quality across sectors (eg, bundled payments and shared quality metrics) may be needed to systematically improve quality across sectors. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Preventable Hospitalization Rates and Neighborhood Poverty among New York City Residents, 2008-2013.

PubMed

Bocour, Angelica; Tria, Maryellen

2016-12-01

Knowing which demographic groups have higher rates of preventable hospitalizations can help identify geographic areas where improvements in primary care access and quality can be made. This study assessed whether preventable hospitalization rates by neighborhood poverty decreased from 2008 to 2013 and whether the gap between very high and low poverty neighborhoods changed. We examined trends in age-adjusted preventable hospitalization rates and rate ratios by neighborhood poverty overall and by sex using JoinPoint regression. Prevention Quality Indicators (PQIs) developed by the Agency for Healthcare Research and Quality were applied to inpatient hospitalization data from the New York State Department of Health's Statewide Planning and Research Cooperative System. PQIs were classified into composites. From 2008 to 2013, preventable hospitalization rates per 100,000 adults across each poverty group decreased. For very high poverty neighborhoods (ZIP codes with ≥30 % of persons living below the federal poverty level (FPL)), there were significant decreases overall (3430.56 to 2543.10, annual percent change [APC] = -5.91 %), for diabetes (676.15 to 500.83, APC = -5.75 %), respiratory (830.78 to 660.29, APC = -4.85 %), circulatory (995.69 to 701.81, APC = -7.24 %), and acute composites (928.18 to 680.17, APC = -5.62 %). The rate ratios also decreased over time; however, in 2013, the rates for very high poverty neighborhoods were two to four times higher than low poverty neighborhoods (ZIP codes with <10 % of persons below the FPL). While preventable hospitalization rates have decreased over time, disparities still exist. These findings underscore the need to ensure adequate access to quality and timely primary care among individuals living in high poverty neighborhoods.

Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, and End-Stage Renal Disease Quality Incentive Program. Final rule.

PubMed

2017-11-01

This rule updates and makes revisions to the end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2018. It also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also sets forth requirements for the ESRD Quality Incentive Program (QIP), including for payment years (PYs) 2019 through 2021.

Anchoring bias in online voting

NASA Astrophysics Data System (ADS)

Yang, Zimo; Zhang, Zi-Ke; Zhou, Tao

2012-12-01

Voting online with explicit ratings could largely reflect people's preferences and objects' qualities, but ratings are always irrational, because they may be affected by many unpredictable factors like mood, weather and other people's votes. By analyzing two real systems, this paper reveals a systematic bias embedding in the individual decision-making processes, namely people tend to give a low rating after a low rating, as well as a high rating following a high rating. This so-called anchoring bias is validated via extensive comparisons with null models, and numerically speaking, the extent of bias decays with voting interval in a logarithmic form. Our findings could be applied in the design of recommender systems and considered as important complementary materials to previous knowledge about anchoring effects on financial trades, performance judgments, auctions, and so on.

Influence of Continuing Medical Education on Rheumatologists' Performance on National Quality Measures for Rheumatoid Arthritis.

PubMed

Sapir, Tamar; Rusie, Erica; Greene, Laurence; Yazdany, Jinoos; Robbins, Mark L; Ruderman, Eric M; Carter, Jeffrey D; Patel, Barry; Moreo, Kathleen

2015-12-01

In recent years researchers have reported deficits in the quality of care provided to patients with rheumatoid arthritis (RA), including low rates of performance on quality measures. We sought to determine the influence of a quality improvement (QI) continuing education program on rheumatologists' performance on national quality measures for RA, along with other measures aligned with National Quality Strategy priorities. Performance was assessed through baseline and post-education chart audits. Twenty community-based rheumatologists across the United States were recruited to participate in the QI education program and chart audits. Charts were retrospectively audited before (n = 160 charts) and after (n = 160 charts) the rheumatologists participated in a series of accredited QI-focused educational activities that included private audit feedback, small-group webinars, and online- and mobile-accessible print and video activities. The charts were audited for patient demographics and the rheumatologists' documented performance on the 6 quality measures for RA included in the Physician Quality Reporting System (PQRS). In addition, charts were abstracted for documentation of patient counseling about medication benefits/risks and adherence, lifestyle modifications, and quality of life; assessment of RA medication side effects; and assessment of RA medication adherence. Mean rates of documented performance on 4 of the 6 PQRS measures for RA were significantly higher in the post-education versus baseline charts (absolute increases ranged from 9 to 24% of patient charts). In addition, after the intervention, significantly higher mean rates were observed for patient counseling about medications and quality of life, and for assessments of medication side effects and adherence (absolute increases ranged from 9 to 40% of patient charts). This pragmatic study provides preliminary evidence for the positive influence of QI-focused education in helping rheumatologists improve performance on national quality measures for RA.

An Investigation Relating Longitudinal Pilot-Induced Oscillation Tendency Rating to Describing Function Predictions for Rate-Limited Actuators

DTIC Science & Technology

2004-03-01

2-15 2-10. Pitch Tracking Closed Loop System for Gap Criterion...................................... 2-16 2-11. Four Resulting Gap ...Level 1 Minimize Resonance Closed Loop Bode Diagram ( ) ( ) s sCommand θ θ ( ) ( ) s sCommand θ θ         BWω 2-16 Gap Criterion...System for Gap Criterion In modern fly-by-wire aircraft, feedback is an integral part of obtaining more desirable closed loop flying qualities

Implementation of a Surgeon-Level Comparative Quality Performance Review to Improve Positive Surgical Margin Rates during Radical Prostatectomy.

PubMed

Matulewicz, Richard S; Tosoian, Jeffrey J; Stimson, C J; Ross, Ashley E; Chappidi, Meera; Lotan, Tamara L; Humphreys, Elizabeth; Partin, Alan W; Schaeffer, Edward M

2017-05-01

Success in the era of value-based payment will depend on the capacity of health systems to improve quality while controlling costs. Comparative quality performance review can be used to drive improvements in surgical outcomes and thereby reduce costs. We sought to determine the efficacy of a comparative quality performance review to improve a surgeon-level measure of surgical oncologic quality, that is the positive surgical margin rate at the time of radical prostatectomy. Eight surgeons who performed consecutive radical prostatectomies at a single high volume institution between January 1, 2015 and December 31, 2015 were included in analysis. Individual surgeons were provided with confidential report cards every 6 months detailing their case mix, case volume and pT2 radical prostatectomy positive surgical margin rate relative to 1) their own self-matched data, 2) the de-identified data of their colleagues and 3) institutional aggregate data during the study period. Positive surgical margin rates were compared before and after intervention. Hierarchal logistic regression analysis was used to examine the association of study period on the odds of positive surgical margins, adjusted for prostate specific antigen level and National Comprehensive Cancer Network® risk group. Overall, 1,822 (1,392 before and 430 after intervention) radical prostatectomies were performed that met study inclusion criteria. The aggregate departmental unadjusted positive surgical margin rates were 10.6% and 7.4% in the pre-intervention and post-intervention groups, respectively. After adjusting for higher risk cancer in the post-intervention group, there was a significant protective association of post-intervention status on positive margins (OR 0.64, 95% CI 0.43-0.97, p = 0.03). All 5 surgeons with positive surgical margin rates higher than the aggregate department rate in the pre-intervention period showed improvement after intervention. Comparative quality performance review can be implemented at the surgeon level and can promote improvement in an objective measure of surgical oncology quality. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Quality and adequacy of training of expanded function dental auxiliaries in the U.S. Army.

PubMed

Chisick, M C

1994-08-01

This study explores the quality and adequacy of training U.S. Army expanded function dental auxiliaries (X2s). Data were collected in the spring of 1989 using self-administered questionnaires from dental commanders, clinic chiefs, X2 graduates, dentists working with X2s, and potential X2 students. Nearly all (94.2%) dental activities personnel responded. Results show overall performance of X2s was rated excellent or very good by 76% of commanders, 70% of clinic chiefs, and 42% of dentists. Of 23 job-specific tasks assessed, X2s received lowest performance ratings for placement of complex composite restorations and highest ratings for individual topical fluoride application. Of X2 graduates, 82% rated the overall quality of X2 training as very good or excellent. X2 graduates and their supervisors recommend retaining each job-specific skill in the X2 training program while lengthening the program from 16 to 28-30 weeks. Training of U.S. Army X2s may offer a model to other dental care systems with limited resources.

Low-rate image coding using vector quantization

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

Makur, A.

1990-01-01

This thesis deals with the development and analysis of a computationally simple vector quantization image compression system for coding monochrome images at low bit rate. Vector quantization has been known to be an effective compression scheme when a low bit rate is desirable, but the intensive computation required in a vector quantization encoder has been a handicap in using it for low rate image coding. The present work shows that, without substantially increasing the coder complexity, it is indeed possible to achieve acceptable picture quality while attaining a high compression ratio. Several modifications to the conventional vector quantization coder aremore » proposed in the thesis. These modifications are shown to offer better subjective quality when compared to the basic coder. Distributed blocks are used instead of spatial blocks to construct the input vectors. A class of input-dependent weighted distortion functions is used to incorporate psychovisual characteristics in the distortion measure. Computationally simple filtering techniques are applied to further improve the decoded image quality. Finally, unique designs of the vector quantization coder using electronic neural networks are described, so that the coding delay is reduced considerably.« less

Time-lapse systems for embryo incubation and assessment in assisted reproduction.

PubMed

Armstrong, Sarah; Bhide, Priya; Jordan, Vanessa; Pacey, Allan; Farquhar, Cindy

2018-05-25

Embryo incubation and assessment is a vital step in assisted reproductive technology (ART). Traditionally, embryo assessment has been achieved by removing embryos from a conventional incubator daily for quality assessment by an embryologist, under a light microscope. Over recent years time-lapse systems have been developed which can take digital images of embryos at frequent time intervals. This allows embryologists, with or without the assistance of embryo selection software, to assess the quality of the embryos without physically removing them from the incubator.The potential advantages of a time-lapse system (TLS) include the ability to maintain a stable culture environment, therefore limiting the exposure of embryos to changes in gas composition, temperature and movement. A TLS has the potential advantage of improving embryo selection for ART treatment by utilising additional information gained through continuously monitoring embryo development. Use of a TLS often adds significant extra cost onto an in vitro fertilisation (IVF) cycle. To determine the effect of a TLS compared to conventional embryo incubation and assessment on clinical outcomes in couples undergoing ART. We used standard methodology recommended by Cochrane. We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, CINAHL and two trials registers on 2 August 2017. We included randomised controlled trials (RCTs) in the following comparisons: comparing a TLS, with or without embryo selection software, versus conventional incubation with morphological assessment; and TLS with embryo selection software versus TLS without embryo selection software among couples undergoing ART. We used standard methodological procedures recommended by Cochrane. The primary review outcomes were live birth, miscarriage and stillbirth. Secondary outcomes were clinical pregnancy and cumulative clinical pregnancy. We reported quality of the evidence for important outcomes using GRADE methodology. We made the following comparisons.TLS with conventional morphological assessment of still TLS images versus conventional incubation and assessmentTLS utilising embryo selection software versus TLS with conventional morphological assessment of still TLS images TLS utilising embryo selection software versus conventional incubation and assessment MAIN RESULTS: We included eight RCTs (N = 2303 women). The quality of the evidence ranged from very low to moderate. The main limitations were imprecision and risk of bias associated with lack of blinding of participants and researchers, and indirectness secondary to significant heterogeneity between interventions in some studies. There were no data on cumulative clinical pregnancy.TLS with conventional morphological assessment of still TLS images versus conventional incubation and assessmentThere is no evidence of a difference between the interventions in terms of live birth rates (odds ratio (OR) 0.73, 95% CI 0.47 to 1.13, 2 RCTs, N = 440, I 2 = 11% , moderate-quality evidence) and may also be no evidence of difference in miscarriage rates (OR 2.25, 95% CI 0.84 to 6.02, 2 RCTs, N = 440, I 2 = 44%, low-quality evidence). The evidence suggests that if the live birth rate associated with conventional incubation and assessment is 33%, the rate with use of TLS with conventional morphological assessment of still TLS images is between 19% and 36%; and that if the miscarriage rate with conventional incubation is 3%, the rate associated with conventional morphological assessment of still TLS images would be between 3% and 18%. There is no evidence of a difference between the interventions in the stillbirth rate (OR 1.00, 95% CI 0.13 to 7.49, 1 RCT, N = 76, low-quality evidence). There is no evidence of a difference between the interventions in clinical pregnancy rates (OR 0.88, 95% CI 0.58 to 1.33, 3 RCTs, N = 489, I 2 = 0%, moderate-quality evidence).TLS utilising embryo selection software versus TLS with conventional morphological assessment of still TLS imagesNo data were available on live birth or stillbirth. We are uncertain whether TLS utilising embryo selection software influences miscarriage rates (OR 1.39, 95% CI 0.64 to 3.01, 2 RCTs, N = 463, I 2 = 0%, very low-quality evidence) and there may be no difference in clinical pregnancy rates (OR 0.97, 95% CI 0.67 to 1.42, 2 RCTs, N = 463, I 2 = 0%, low-quality evidence). The evidence suggests that if the miscarriage rate associated with assessment of still TLS images is 5%, the rate with embryo selection software would be between 3% and 14%.TLS utilising embryo selection software versus conventional incubation and assessmentThere is no evidence of a difference between TLS utilising embryo selection software and conventional incubation improving live birth rates (OR 1.21, 95% CI 0.96 to 1.54, 2 RCTs, N = 1017, I 2 = 0%, very low-quality evidence). We are uncertain whether TLS influences miscarriage rates (OR 0.73, 95% CI 0.49 to 1.08, 3 RCTs, N = 1351, I 2 = 0%, very low-quality evidence). The evidence suggests that if the live birth rate associated with no TLS is 38%, the rate with use of conventional incubation would be between 36% and 58%, and that if miscarriage rate with conventional incubation is 9%, the rate associated with TLS would be between 4% and 10%. No data on stillbirths were available. It was uncertain whether the intervention influenced clinical pregnancy rates (OR 1.17, 95% CI 0.94 to 1.45, 3 RCTs, N = 1351, I 2 = 42%, very low-quality evidence). There is insufficient evidence of differences in live birth, miscarriage, stillbirth or clinical pregnancy to choose between TLS, with or without embryo selection software, and conventional incubation. The studies were at high risk of bias for randomisation and allocation concealment, the result should be interpreted with extreme caution.

Simultaneous signal transmission of different data-rates in a DWDM system employing external injection locking technique

NASA Astrophysics Data System (ADS)

Das, Anindya Sundar; Patra, Ardhendu Sekhar

2014-12-01

A novel architecture of DWDM-PON is proposed and demonstrated for downlink transmission of different data-rates of 622 Mbps, 1 Gbps, 1.25 Gbps and 2.5 Gbps simultaneously over a long-haul single mode fiber (SMF). The data rates are directly modulated by Fabry-Pérot laser diodes (FPLD), which are externally injection locked by asynchronous spontaneous emission (ASE) source. The transmission performances are checked by the bit error rate (BER), Quality (Q) factor and clear eye-diagrams. Since this proposed system consists of one ASE source, FPLDs and depends on the direct modulation technique, it reveals a prominent alternative with advantages in simplicity and cost.

Is there a preference for linearity when viewing natural images?

NASA Astrophysics Data System (ADS)

Kane, David; Bertamío, Marcelo

2015-01-01

The system gamma of the imaging pipeline, defined as the product of the encoding and decoding gammas, is typically greater than one and is stronger for images viewed with a dark background (e.g. cinema) than those viewed in lighter conditions (e.g. office displays).1-3 However, for high dynamic range (HDR) images reproduced on a low dynamic range (LDR) monitor, subjects often prefer a system gamma of less than one,4 presumably reflecting the greater need for histogram equalization in HDR images. In this study we ask subjects to rate the perceived quality of images presented on a LDR monitor using various levels of system gamma. We reveal that the optimal system gamma is below one for images with a HDR and approaches or exceeds one for images with a LDR. Additionally, the highest quality scores occur for images where a system gamma of one is optimal, suggesting a preference for linearity (where possible). We find that subjective image quality scores can be predicted by computing the degree of histogram equalization of the lightness distribution. Accordingly, an optimal, image dependent system gamma can be computed that maximizes perceived image quality.

National Utility Rate Database: Preprint

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

Ong, S.; McKeel, R.

2012-08-01

When modeling solar energy technologies and other distributed energy systems, using high-quality expansive electricity rates is essential. The National Renewable Energy Laboratory (NREL) developed a utility rate platform for entering, storing, updating, and accessing a large collection of utility rates from around the United States. This utility rate platform lives on the Open Energy Information (OpenEI) website, OpenEI.org, allowing the data to be programmatically accessed from a web browser, using an application programming interface (API). The semantic-based utility rate platform currently has record of 1,885 utility rates and covers over 85% of the electricity consumption in the United States.

Are leaf breakdown rates a useful measure of stream integrity along an agricultural landuse gradient?

Treesearch

E.M. Hagen; J.R. Webster; E.F. Benfield

2006-01-01

Biological indicators often are used to assess and manage water quality in anthropogenically altered stream systems. Leaf breakdown has the potential to be a good indicator of stream integrity because it integrates a varietyof biological, chemical, and physical conditions. Red maple (Acer rubrum L.) leaf breakdown rates were measured along a gradient...

Modification of sperm quality after sexual abstinence in Seba's short-tailed bat, Carollia perspicillata.

PubMed

Wesseling, Charlotte; Fasel, Nicolas; Richner, Heinz; Helfenstein, Fabrice

2016-05-01

In polygynous mating systems, few males have stable access to sexual mates. With an expected higher copulation rate, harem males may deplete seminal fluids or increase epididymal sperm maturation, generating poor sperm quality. In a first study, we reported a higher sperm quality in sneaker males of Carollia perspicillata To test whether the lower sperm quality observed in harem males was generated by an elevated copulation rate, we temporarily removed males of both social statuses from the colony. We thus assessed status-related changes of sperm quality resulting from sexual abstinence. Moreover, released from territory and female guarding, harem males were expected to show a reduction in somatic costs. On the basis of sperm competition models, we predicted a higher resource investment in the ejaculate with the reduction of pre-copulatory efforts. In line with our predictions, sperm quality of harem males improved significantly in contrast to sneaker males, whose sperm quality did not change. Without an increase in ejaculate lipid peroxidation, our results also provide evidence that the duration of sexual abstinence was not sufficient to generate sperm oxidative damage through senescence. Harem males did not show a reduction in blood lipid peroxidation or in the ratio of oxidized to reduced glutathione. In line with the maintenance of these somatic costs, harem males did not invest more superoxide dismutase to the ejaculate to maintain sperm quality. Our results suggest that a difference in copulation rate rather than an adaptation to sperm competition provides sneaker males with higher sperm quality in C. perspicillata. © 2016. Published by The Company of Biologists Ltd.

Breast cancer mammographic diagnosis performance in a public health institution: a retrospective cohort study.

PubMed

Mello, Juliana M R B; Bittelbrunn, Fernando P; Rockenbach, Marcio A B C; May, Guilherme G; Vedolin, Leonardo M; Kruger, Marilia S; Soldatelli, Matheus D; Zwetsch, Guilherme; de Miranda, Gabriel T F; Teixeira, Saone I P; Arruda, Bruna S

2017-12-01

To evaluate the quality assurance of mammography results at a reference institution for the diagnosis and treatment of breast cancer in southern Brazil, based on the BIRADS (Breast Imaging Reporting and Data System) 5th edition recommendations for auditing purposes. Retrospective cohort and cross-sectional study with 4502 patients (9668 mammographies)) who underwent at least one or both breast mammographies throughout 2013 at a regional public hospital, linked to a federal public university. The results were followed until 31 December 2014, including true positives (TPs), true negatives (TNs), false positives (FPs), false negatives (FNs), positive predictive values (PPVs), negative predictive value (NPV), sensitivity and specificity, with a confidence interval of 95%. The study showed high quality assurance, particularly regarding sensitivity (90.22%) and specificity (92.31%). The overall positive predictive value (PPV) was 65.35%, and the negative predictive value (NPV) was 98.32%. The abnormal interpretation rate (recall rate) was 12.26%. The results are appropriate when compared to the values proposed by the BIRADS 5th edition. Additionally, the study provided self-reflection considering our radiological practice, which is essential for improvements and collaboration regarding breast cancer detection. It may stimulate better radiological practice performance and continuing education, despite possible infrastructure and facility limitations. • Accurate quality performance rates are possible despite financial and governmental limitations. • Low-income institutions should develop standardised teamwork to improve radiological practice. • Regular mammography audits may help to increase the quality of public health systems.

Multiple dynamics in a single predator-prey system: experimental effects of food quality.

PubMed Central

Nelson, W A; McCauley, E; Wrona, F J

2001-01-01

Recent work with the freshwater zooplankton Daphnia has suggested that the quality of its algal prey can have a significant effect on its demographic rates and life-history patterns. Predator-prey theory linking food quantity and food quality predicts that a single system should be able to display two distinct patterns of population dynamics. One pattern is predicted to have high herbivore and low algal biomass dynamics (high HBD), whereas the other is predicted to have low herbivore and high algal biomass dynamics (low HBD). Despite these predictions and the stoichiometric evidence that many phytoplankton communities may have poor access to food of quality, there have been few tests of whether a dynamic predator-prey system can display both of these distinct patterns. Here we report, to the authors' knowledge, the first evidence for two dynamical patterns, as predicted by theory, in a single predator-prey system. We show that the high HBD is a result of food quantity effects and that the low HBD is a result of food quality effects, which are maintained by phosphorus limitation in the predator. These results provide an important link between the known effects of nutrient limitation in herbivores and the significance of prey quality in predator-prey population dynamics in natural zooplankton communities. PMID:11410147

A comparison of two types of neural network for weld quality prediction in small scale resistance spot welding

NASA Astrophysics Data System (ADS)

Wan, Xiaodong; Wang, Yuanxun; Zhao, Dawei; Huang, YongAn

2017-09-01

Our study aims at developing an effective quality monitoring system in small scale resistance spot welding of titanium alloy. The measured electrical signals were interpreted in combination with the nugget development. Features were extracted from the dynamic resistance and electrode voltage curve. A higher welding current generally indicated a lower overall dynamic resistance level. A larger electrode voltage peak and higher change rate of electrode voltage could be detected under a smaller electrode force or higher welding current condition. Variation of the extracted features and weld quality was found more sensitive to the change of welding current than electrode force. Different neural network model were proposed for weld quality prediction. The back propagation neural network was more proper in failure load estimation. The probabilistic neural network model was more appropriate to be applied in quality level classification. A real-time and on-line weld quality monitoring system may be developed by taking advantages of both methods.

What Is the Best Way to Measure Surgical Quality? Comparing the American College of Surgeons National Surgical Quality Improvement Program versus Traditional Morbidity and Mortality Conferences.

PubMed

Zhang, Jacques X; Song, Diana; Bedford, Julie; Bucevska, Marija; Courtemanche, Douglas J; Arneja, Jugpal S

2016-04-01

Morbidity and mortality conferences have played a traditional role in tracking complications. Recently, the American College of Surgeons National Surgical Quality Improvement Program Pediatrics (ACS NSQIP-P) has gained popularity as a risk-adjusted means of addressing quality assurance. The purpose of this article is to report an analysis of the two methodologies used within pediatric plastic surgery to determine the best way to manage quality. ACS NSQIP-P and morbidity and mortality data were extracted for 2012 and 2013 at a quaternary care institution. Overall complication rates were compared statistically, segregated by type and severity, followed by a subset comparison of ACS NSQIP-P-eligible cases only. Concordance and discordance rates between the two methodologies were determined. One thousand two hundred sixty-one operations were performed in the study period. Only 51.4 percent of cases were ACS NSQIP-P eligible. The overall complication rates of ACS NSQIP-P (6.62 percent) and morbidity and mortality conferences (6.11 percent) were similar (p = 0.662). Comparing for only ACS NSQIP-P-eligible cases also yielded a similar rate (6.62 percent versus 5.71 percent; p = 0.503). Although different complications are tracked, the concordance rate for morbidity and mortality and ACS NSQIP-P was 35.1 percent and 32.5 percent, respectively. The ACS NSQIP-P database is able to accurately track complication rates similarly to morbidity and mortality conferences, although it samples only half of all procedures. Although both systems offer value, limitations exist, such as differences in definitions and purpose. Because of the rigor of the ACS NSQIP-P, we recommend that it be expanded to include currently excluded cases and an extension of the study interval.

Performance indicators used to assess the quality of primary dental care.

PubMed

González, Grisel Zacca; Klazinga, Niek; ten Asbroek, Guus; Delnoij, Diana M

2006-12-01

An appropriate quality of medical care including dental care should be an objective of every government that aims to improve the oral health of its population. To determine performance indicators that could be used to assess the quality of primary dental care at different levels of a health care system, the sources for data collection and finally, the dimensions of quality measured by these indicators. An explorative study of the international literature was conducted using medical databases, journals and books, and official websites of organisations and associations. This resulted in a set of 57 indicators, which were classified into the following dimensions for each intended user group: For patients: health outcomes and subjective indicators; for professionals: their performance and the rates of success, failure and complications; for health care system managers and policymakers: their resources, finances and health care utilisation. A set of 57 performance indicators were identified to assess the quality of primary dental care at the levels of patients, professionals and the health care system. These indicators could be used by managers and decision-makers at any level of the health care system according to the characteristics of the services.

The element of naturalness when evaluating image quality of digital photo documentation after sexual assault.

PubMed

Ernst, E J; Speck, P M; Fitzpatrick, J J

2012-01-01

Digital photography is a valuable adjunct to document physical injuries after sexual assault. In order for a digital photograph to have high image quality, there must exist a high level of naturalness. Digital photo documentation has varying degrees of naturalness; however, for a photograph to be natural, specific technical elements for the viewer must be satisfied. No tool was available to rate the naturalness of digital photo documentation of female genital injuries after sexual assault. The Photo Documentation Image Quality Scoring System (PDIQSS) tool was developed to rate technical elements for naturalness. Using this tool, experts evaluated randomly selected digital photographs of female genital injuries captured following sexual assault. Naturalness of female genital injuries following sexual assault was demonstrated when measured in all dimensions.

Community health profile of Windsor, Ontario, Canada: anatomy of a Great Lakes area of concern.

PubMed Central

Gilbertson, M; Brophy, J

2001-01-01

The rates of mortality, morbidity as hospitalizations, and congenital anomalies in the Windsor Area of Concern ranked among the highest of the 17 Areas of Concern on the Canadian side of the Great Lakes for selected end points that might be related to pollution in this relatively highly industrialized city. Mortality and morbidity rates from all causes were higher than in the rest of the province. Anomalously high rates of diseases included various cancers; endocrine, nutritional, metabolic, and immunity disorders; diseases of the blood and blood-forming organs, nervous system and sense organs, circulatory and respiratory systems, digestive system, genitourinary system, skin and subcutaneous tissue, musculoskeletal system and connective tissues; congenital anomalies, and infant mortality. Of particular concern was the early onset of the elevated rates of many of these diseases and conditions. Comparison of these incident rates with those in Hamilton, another industrial municipality in southern Ontario, suggested that in addition to a variety of local sources of industrial pollution from automobile manufacturing and use, transboundary air and water pollution from Detroit, Michigan, should be investigated as potentially important causes of these health outcomes in the Windsor Area of Concern. Some of the institutional and political trends of the past decade may need to be reversed before effective remedial programs are implemented for cleaning up contaminated sediments and for containment of leaking hazardous waste sites. This pilot project would seem to be a useful preliminary method of integrating human health concerns and of priority setting for the administration of the Great Lakes Water Quality Agreement and the Canada-United States Air Quality Agreement. PMID:11744501

Downflow limestone beds for treatment of net-acidic, oxic, iron-laden drainage from a flooded anthracite mine, Pennsylvania, USA: 2. Laboratory evaluation

USGS Publications Warehouse

Cravotta, C.A.; Ward, S.J.; Hammarstrom, J.M.

2008-01-01

Acidic mine drainage (AMD) containing elevated concentrations of dissolved iron and other metals can be neutralized to varying degrees by reactions with limestone in passive treatment systems. We evaluated the chemical and mineralogical characteristics and the effectiveness of calcitic and dolomitic limestone for the neutralization of net-acidic, oxic, iron-laden AMD from a flooded anthracite mine. The calcitic limestone, with CaCO3 and MgCO3 contents of 99.8 and <0.1 wt%, respectively, and the dolomitic limestone, with CaCO3 and MgCO3 contents of 60.3 and 40.2 wt%, were used to construct a downflow treatment system in 2003 at the Bell Mine, a large source of AMD and baseflow to the Schuylkill River in the Southern Anthracite Coalfield, in east-central Pennsylvania. In the winter of 2002-2003, laboratory neutralization-rate experiments evaluated the evolution of effluent quality during 2 weeks of continuous contact between AMD from the Bell Mine and the crushed calcitic or dolomitic limestone in closed, collapsible containers (cubitainers). The cubitainer tests showed that: (1) net-alkaline effluent could be achieved with detention times greater than 3 h, (2) effluent alkalinities and associated dissolution rates were equivalent for uncoated and Fe(OH)3-coated calcitic limestone, and (3) effluent alkalinities and associated dissolution rates for dolomitic limestone were about half those for calcitic limestone. The dissolution rate data for the cubitainer tests were used with data on the volume of effuent and surface area of limestone in the treatment system at the Bell Mine to evaluate the water-quality data for the first 1.5 years of operation of the treatment system. These rate models supported the interpretation of field results and indicated that treatment benefits were derived mainly from the dissolution of calcitic limestone, despite a greater quantity of dolomitic limestone within the treatment system. The dissolution-rate models were extrapolated on a decadal scale to indicate the expected decreases in the mass of limestone and associated alkalinities resulting from the long-term reaction of AMD with the treatment substrate. The models indicated the calcitic limestone would need to be replenished approaching the 5-year anniversary of treatment operations to maintain net-alkaline effluent quality. ?? 2008 Springer-Verlag.

Implementation of quality management in early stages of research and development projects at a university.

PubMed

Fiehe, Sandra; Wagner, Georg; Schlanstein, Peter; Rosefort, Christiane; Kopp, Rüdger; Bensberg, Ralf; Knipp, Peter; Schmitz-Rode, Thomas; Steinseifer, Ulrich; Arens, Jutta

2014-04-01

The ultimate objective of university research and development projects is usually to create knowledge, but also to successfully transfer results to industry for subsequent marketing. We hypothesized that the university technology transfer requires efficient measures to improve this important step. Besides good scientific practice, foresighted and industry-specific adapted documentation of research processes in terms of a quality management system might improve the technology transfer. In order to bridge the gap between research institute and cooperating industry, a model project has been accompanied by a project specific amount of quality management. However, such a system had to remain manageable and must not constrain the researchers' creativity. Moreover, topics and research team are strongly interdisciplinary, which entails difficulties regarding communication because of different perspectives and terminology. In parallel to the technical work of the model project, an adaptable quality management system with a quality manual, defined procedures, and forms and documents accompanying the research, development and validation was implemented. After process acquisition and analysis the appropriate amount of management for the model project was identified by a self-developed rating system considering project characteristics like size, innovation, stakeholders, interdisciplinarity, etc. Employees were trained according to their needs. The management was supported and the technical documentation was optimized. Finally, the quality management system has been transferred successfully to further projects.

Using game theory for perceptual tuned rate control algorithm in video coding

NASA Astrophysics Data System (ADS)

Luo, Jiancong; Ahmad, Ishfaq

2005-03-01

This paper proposes a game theoretical rate control technique for video compression. Using a cooperative gaming approach, which has been utilized in several branches of natural and social sciences because of its enormous potential for solving constrained optimization problems, we propose a dual-level scheme to optimize the perceptual quality while guaranteeing "fairness" in bit allocation among macroblocks. At the frame level, the algorithm allocates target bits to frames based on their coding complexity. At the macroblock level, the algorithm distributes bits to macroblocks by defining a bargaining game. Macroblocks play cooperatively to compete for shares of resources (bits) to optimize their quantization scales while considering the Human Visual System"s perceptual property. Since the whole frame is an entity perceived by viewers, macroblocks compete cooperatively under a global objective of achieving the best quality with the given bit constraint. The major advantage of the proposed approach is that the cooperative game leads to an optimal and fair bit allocation strategy based on the Nash Bargaining Solution. Another advantage is that it allows multi-objective optimization with multiple decision makers (macroblocks). The simulation results testify the algorithm"s ability to achieve accurate bit rate with good perceptual quality, and to maintain a stable buffer level.

What Consumers Say About Nursing Homes in Online Reviews.

PubMed

Kellogg, Caitlyn; Zhu, Yujun; Cardenas, Valeria; Vazquez, Katalina; Johari, Kayla; Rahman, Anna; Enguidanos, Susan

2018-04-20

Although patient-centered care is an expressed value of our healthcare system, no studies have examined what consumers say in online reviews about nursing homes (NHs). Insight into themes addressed in these reviews could inform improvement efforts that promote patient-centered NH care. We analyzed nursing home (NH) Yelp reviews. From a list of all NHs in California, we drew a purposeful sample of 51 NHs, selecting facilities representing a range of geographical areas and occupancy rates. Two research teams analyzed the reviews using grounded theory to identify codes and tracked how frequently each code was mentioned. We evaluated 264 reviews, identifying 24 codes, grouped under five categories: quality of staff care and staffing; physical facility and setting; resident safety and security; clinical care quality; and financial issues. More than half (53.41%) of Yelp reviewers posted comments related to staff attitude and caring and nearly a third (29.2%) posted comments related to staff responsiveness. Yelp reviewers also often posted about NHs' physical environment. Infrequently mentioned were the quality of health care provided and concerns about resident safety and security. Our results are consistent with those from related studies. Yelp reviewers focus on NH aspects that are not evaluated in most other NH rating systems. The federal Nursing Home Compare website, for instance, does not report measures of staff attitudes or the NH's physical setting. Rather, it reports measures of staffing levels and clinical processes and outcomes. We recommend that NH consumers consult both types of rating systems because they provide complementary information.

Melter Throughput Enhancements for High-Iron HLW

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

Kruger, A. A.; Gan, Hoa; Joseph, Innocent

2012-12-26

This report describes work performed to develop and test new glass and feed formulations in order to increase glass melting rates in high waste loading glass formulations for HLW with high concentrations of iron. Testing was designed to identify glass and melter feed formulations that optimize waste loading and waste processing rate while meeting all processing and product quality requirements. The work included preparation and characterization of crucible melts to assess melt rate using a vertical gradient furnace system and to develop new formulations with enhanced melt rate. Testing evaluated the effects of waste loading on glass properties and themore » maximum waste loading that can be achieved. The results from crucible-scale testing supported subsequent DuraMelter 100 (DM100) tests designed to examine the effects of enhanced glass and feed formulations on waste processing rate and product quality. The DM100 was selected as the platform for these tests due to its extensive previous use in processing rate determination for various HLW streams and glass compositions.« less

Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process.

PubMed

Sweidan, Michelle; Williamson, Margaret; Reeve, James F; Harvey, Ken; O'Neill, Jennifer A; Schattner, Peter; Snowdon, Teri

2010-04-15

Electronic prescribing is increasingly being used in primary care and in hospitals. Studies on the effects of e-prescribing systems have found evidence for both benefit and harm. The aim of this study was to identify features of e-prescribing software systems that support patient safety and quality of care and that are useful to the clinician and the patient, with a focus on improving the quality use of medicines. Software features were identified by a literature review, key informants and an expert group. A modified Delphi process was used with a 12-member multidisciplinary expert group to reach consensus on the expected impact of the features in four domains: patient safety, quality of care, usefulness to the clinician and usefulness to the patient. The setting was electronic prescribing in general practice in Australia. A list of 114 software features was developed. Most of the features relate to the recording and use of patient data, the medication selection process, prescribing decision support, monitoring drug therapy and clinical reports. The expert group rated 78 of the features (68%) as likely to have a high positive impact in at least one domain, 36 features (32%) as medium impact, and none as low or negative impact. Twenty seven features were rated as high positive impact across 3 or 4 domains including patient safety and quality of care. Ten features were considered "aspirational" because of a lack of agreed standards and/or suitable knowledge bases. This study defines features of e-prescribing software systems that are expected to support safety and quality, especially in relation to prescribing and use of medicines in general practice. The features could be used to develop software standards, and could be adapted if necessary for use in other settings and countries.

Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process

PubMed Central

2010-01-01

Background Electronic prescribing is increasingly being used in primary care and in hospitals. Studies on the effects of e-prescribing systems have found evidence for both benefit and harm. The aim of this study was to identify features of e-prescribing software systems that support patient safety and quality of care and that are useful to the clinician and the patient, with a focus on improving the quality use of medicines. Methods Software features were identified by a literature review, key informants and an expert group. A modified Delphi process was used with a 12-member multidisciplinary expert group to reach consensus on the expected impact of the features in four domains: patient safety, quality of care, usefulness to the clinician and usefulness to the patient. The setting was electronic prescribing in general practice in Australia. Results A list of 114 software features was developed. Most of the features relate to the recording and use of patient data, the medication selection process, prescribing decision support, monitoring drug therapy and clinical reports. The expert group rated 78 of the features (68%) as likely to have a high positive impact in at least one domain, 36 features (32%) as medium impact, and none as low or negative impact. Twenty seven features were rated as high positive impact across 3 or 4 domains including patient safety and quality of care. Ten features were considered "aspirational" because of a lack of agreed standards and/or suitable knowledge bases. Conclusions This study defines features of e-prescribing software systems that are expected to support safety and quality, especially in relation to prescribing and use of medicines in general practice. The features could be used to develop software standards, and could be adapted if necessary for use in other settings and countries. PMID:20398294

Characteristics of Inpatient Units Associated With Sustained Hand Hygiene Compliance.

PubMed

Wolfe, Jonathan D; Domenico, Henry J; Hickson, Gerald B; Wang, Deede; Dubree, Marilyn; Feistritzer, Nancye; Wells, Nancy; Talbot, Thomas R

2018-04-20

Following institution of a hand hygiene (HH) program at an academic medical center, HH compliance increased from 58% to 92% for 3 years. Some inpatient units modeled early, sustained increases, and others exhibited protracted improvement rates. We examined the association between patterns of HH compliance improvement and unit characteristics. Adult inpatient units (N = 35) were categorized into the following three tiers based on their pattern of HH compliance: early adopters, nonsustained and late adopters, and laggards. Unit-based culture measures were collected, including nursing practice environment scores (National Database of Nursing Quality Indicators [NDNQI]), patient rated quality and teamwork (Hospital Consumer Assessment of Healthcare Provider and Systems), patient complaint rates, case mix index, staff turnover rates, and patient volume. Associations between variables and the binary outcome of laggard (n = 18) versus nonlaggard (n = 17) were tested using a Mann-Whitney U test. Multivariate analysis was performed using an ordinal regression model. In direct comparison, laggard units had clinically relevant differences in NDNQI scores, Hospital Consumer Assessment of Healthcare Provider and Systems scores, case mix index, patient complaints, patient volume, and staff turnover. The results were not statistically significant. In the multivariate model, the predictor variables explained a significant proportion of the variability associated with laggard status, (R = 0.35, P = 0.0481) and identified NDNQI scores and patient complaints as statistically significant. Uptake of an HH program was associated with factors related to a unit's safety culture. In particular, NDNQI scores and patient complaint rates might be used to assist in identifying units that may require additional attention during implementation of an HH quality improvement program.

Sensor Data Quality and Angular Rate Down-Selection Algorithms on SLS EM-1

NASA Technical Reports Server (NTRS)

Park, Thomas; Smith, Austin; Oliver, T. Emerson

2018-01-01

The NASA Space Launch System Block 1 launch vehicle is equipped with an Inertial Navigation System (INS) and multiple Rate Gyro Assemblies (RGA) that are used in the Guidance, Navigation, and Control (GN&C) algorithms. The INS provides the inertial position, velocity, and attitude of the vehicle along with both angular rate and specific force measurements. Additionally, multiple sets of co-located rate gyros supply angular rate data. The collection of angular rate data, taken along the launch vehicle, is used to separate out vehicle motion from flexible body dynamics. Since the system architecture uses redundant sensors, the capability was developed to evaluate the health (or validity) of the independent measurements. A suite of Sensor Data Quality (SDQ) algorithms is responsible for assessing the angular rate data from the redundant sensors. When failures are detected, SDQ will take the appropriate action and disqualify or remove faulted sensors from forward processing. Additionally, the SDQ algorithms contain logic for down-selecting the angular rate data used by the GNC software from the set of healthy measurements. This paper explores the trades and analyses that were performed in selecting a set of robust fault-detection algorithms included in the GN&C flight software. These trades included both an assessment of hardware-provided health and status data as well as an evaluation of different algorithms based on time-to-detection, type of failures detected, and probability of detecting false positives. We then provide an overview of the algorithms used for both fault-detection and measurement down selection. We next discuss the role of trajectory design, flexible-body models, and vehicle response to off-nominal conditions in setting the detection thresholds. Lastly, we present lessons learned from software integration and hardware-in-the-loop testing.

Changes for the new AMA Guides to impairment ratings, 6th Edition: implications and applications for physician disability evaluations.

PubMed

Rondinelli, Robert D

2009-07-01

U.S. Disability Systems share a common procedural approach to the determination of disability for purposes of compensation. The structural and anatomical consequences of the injury or disease are defined and measured according to medical impairment, which is used to estimate the individual's loss in terms of their capacity to perform activities of daily living (ADLs) and, presumptively, their losses in terms of vocational and non-vocational pursuits and quality of life. The physician is traditionally empowered to rate the severity of impairment in terms of a percentage loss to the "whole person" and according to criteria specific to each disability system. Often, the impairment percentage so derived, then is directly translated into a monetary sum for purposes of compensating these losses. The AMA periodically publishes and updates a physician impairment rating guide (the AMA Guides). The 6th Edition, published in 2008, incorporates the definitions and terminology of the ICF and provides a simple means of assessment of ADLs as part of the rating process. It also has shifted the ratings criteria towards a diagnosis-based approach, ostensibly to improve inter-rater consistency and reliability. Further work is needed to refine and validate ADL-based functional assessment tools applicable to medical impairment ratings, and to demonstrate the levels of consistency and reliability of the new rating method. Of equal importance, operational standardization across systems is also needed to enable common criteria and metrics to be developed and applied when determining the non-medical aspects of disability according to vocational and non-vocational pursuits and quality of life. Impairment ratings cannot be optimally designed to serve as the singular determinant of, nor be held solely accountable for, the disability awards.

YoungStar: We're Turning Five! Five Year Analysis as of July 2015. YoungStar Progress Report 6

ERIC Educational Resources Information Center

Wisconsin Council on Children and Families, 2015

2015-01-01

This report is the sixth in a series of Wisconsin Council on Children & Families (WCCF) reports tracking the progress of Wisconsin's YoungStar program, a quality rating and improvement system (QRIS) launched in 2010 to improve the quality of Wisconsin child care programs. YoungStar focuses on children of low-income working families receiving…

Engaging with Quality Improvement Initiatives: A Descriptive Study of Learning in the Complex and Dynamic Context of Everyday Life for Family Child Care Providers

ERIC Educational Resources Information Center

Tonyan, Holli A.; Nuttall, Joce; Torres, Jeannette; Bridgewater, Jessie

2017-01-01

Research Findings: This article reports on family child care providers' views about their engagement with professional development programs, including providers who were and were not participating in Quality Rating and Improvement Systems in Los Angeles, California. Most providers participating in the study were taking active steps to improve…

[Construction and operation status of management system of laboratories of schistosomiasis control institutions in Hubei Province].

PubMed

Zhao-Hui, Zheng; Jun, Qin; Li, Chen; Hong, Zhu; Li, Tang; Zu-Wu, Tu; Ming-Xing, Zeng; Qian, Sun; Shun-Xiang, Cai

2016-10-09

To analyze the construction and operation status of management system of laboratories of schistosomiasis control institutions in Hubei Province, so as to provide the reference for the standardized detection and management of schistosomiasis laboratories. According to the laboratory standard of schistosomiasis at provincial, municipal and county levels, the management system construction and operation status of 60 schistosomiasis control institutions was assessed by the acceptance examination method from 2013 to 2015. The management system was already occupied over all the laboratories of schistosomiasis control institutions and was officially running. There were 588 non-conformities and the inconsistency rate was 19.60%. The non-conformity rate of the management system of laboratory quality control was 38.10% (224 cases) and the non-conformity rate of requirements of instrument and equipment was 23.81% (140 cases). The management system has played an important role in the standardized management of schistosomiasis laboratories.

Reducing Non-Attendance Rates for Assessment at an Eating Disorders Service: A Quality Improvement Initiative.

PubMed

Jenkins, Paul E

2017-10-01

Rates of non-attendance at initial appointments within community eating disorder (ED) services are frequently high, although this has received relatively little research attention and no reports of interventions designed to address this. The current report describes outcomes following a change of procedure introducing a 'partial booking' system. Attendance rates at first appointments (N = 1260) were audited following introduction of a system designed to reduce non-attendance in January 2013 within a UK ED service. Rates were compared following implementation of the new system, using a historical control group for comparison, and showed a decline from 20.4 to 15.1%, a medium-sized effect. Use of a system asking patients to book an appointment reduced non-attendance at initial appointments and may be of use to similar services experiencing high non-attendance rates. Opt-in initiatives can reduce burden resulting from long waiting times and can be easily adapted to individual services.

Assessment of Automatically Exported Clinical Data from a Hospital Information System for Clinical Research in Multiple Myeloma.

PubMed

Torres, Viviana; Cerda, Mauricio; Knaup, Petra; Löpprich, Martin

2016-01-01

An important part of the electronic information available in Hospital Information System (HIS) has the potential to be automatically exported to Electronic Data Capture (EDC) platforms for improving clinical research. This automation has the advantage of reducing manual data transcription, a time consuming and prone to errors process. However, quantitative evaluations of the process of exporting data from a HIS to an EDC system have not been reported extensively, in particular comparing with manual transcription. In this work an assessment to study the quality of an automatic export process, focused in laboratory data from a HIS is presented. Quality of the laboratory data was assessed in two types of processes: (1) a manual process of data transcription, and (2) an automatic process of data transference. The automatic transference was implemented as an Extract, Transform and Load (ETL) process. Then, a comparison was carried out between manual and automatic data collection methods. The criteria to measure data quality were correctness and completeness. The manual process had a general error rate of 2.6% to 7.1%, obtaining the lowest error rate if data fields with a not clear definition were removed from the analysis (p < 10E-3). In the case of automatic process, the general error rate was 1.9% to 12.1%, where lowest error rate is obtained when excluding information missing in the HIS but transcribed to the EDC from other physical sources. The automatic ETL process can be used to collect laboratory data for clinical research if data in the HIS as well as physical documentation not included in HIS, are identified previously and follows a standardized data collection protocol.

Direct broadcast satellite-audio, portable and mobile reception tradeoffs

NASA Technical Reports Server (NTRS)

Golshan, Nasser

1992-01-01

This paper reports on the findings of a systems tradeoffs study on direct broadcast satellite-radio (DBS-R). Based on emerging advanced subband and transform audio coding systems, four ranges of bit rates: 16-32 kbps, 48-64 kbps, 96-128 kbps and 196-256 kbps are identified for DBS-R. The corresponding grades of audio quality will be subjectively comparable to AM broadcasting, monophonic FM, stereophonic FM, and CD quality audio, respectively. The satellite EIRP's needed for mobile DBS-R reception in suburban areas are sufficient for portable reception in most single family houses when allowance is made for the higher G/T of portable table-top receivers. As an example, the variation of the space segment cost as a function of frequency, audio quality, coverage capacity, and beam size is explored for a typical DBS-R system.

[Comparison of the image quality of conventional and digital radiography in lizards. Mammography technique versus digital detector system].

PubMed

Bochmann, Monika; Ludewig, E; Pees, M

2011-01-01

A conventional high-resolution screen-film system (Film Kodak MIN-R S, Kodak MIN-R 2000) was compared with an indirect digital detector system (Varian PaxScan 4030E) for use in radiography of lizards. A total of 20 bearded dragons (Pogona vitticeps ) with body masses between 123 g and 487 g were investigated by using conventional and digital image acquisition techniques. The digital image was taken with the same dose as well as half the dose of the conventional radiograph. The study was conducted semi-blinded as the x-ray images were encoded and randomised. Five veterinarians with clinical experience in reptile medicine served as observers. Exactly defined structures in three anatomical regions were assessed using a three-step scale. Furthermore, the overall quality of the respective region was evaluated using a five-step scale. Evaluation of the data was done by visual grading analysis. None of the structures examined was assessed to be of significantly inferior quality on the digital images in comparison to the conventional radiographs. The majority of the results demonstrated an equal quality of both systems. For assessment of the lung tissue and the pulmonary vessels as well as the overall assessment of the lung, the digital radiographs with full dose were rated to be significantly superior in comparison to the film-screen system. Furthermore, the joint contours of the shoulder and cubital joints and the overall assessments of the humerus and the caudal coelomic cavity were rated significantly better on digital images with full dose compared to those with reduced dose. The digital flat panel detector technique examined in this study is equal or superior to the conventional high-resolution screen-film system used. Nevertheless, the practicability of a dose reduction is limited in bearded dragons. Digital imaging systems are progressively being used in veterinary practice. The results of the study demonstrate the useful application of the digital detector systems in lizards.

Payment system reform: one state's journey.

PubMed

Millwee, Billy; Goldfield, Norbert; Averill, Richard; Hughes, John

2013-01-01

In June 2011, Texas enacted Senate Bill 7, which mandates a Medicaid quality-based outcomes payment program on the basis of a common set of outcomes that apply to all types of provider systems including hospitals, managed care plans, medical homes, managed long-term care plans, and Accountable Care Organizations. The quality-based outcome measures focus on potentially preventable events (services) such as preventable admissions and readmissions that result in unnecessary expense, patient inconvenience, and risk of complications. The payment adjustments relate to a provider system's effectiveness in reducing the rate at which potentially preventable events occur. The program envisioned by Texas Medicaid is one that is administratively simple, establishes the right financial incentives to drive delivery system improvement, and does not intrude on the provider practice or the patient. Rather than imposing a series of processes that must be followed or require rigid adherence to standardized protocols, the payment adjustments are based on risk-adjusted comparisons of the rate of potentially preventable events for an individual provider systems to an empirically derived performance standard such as the state average. This article proposes a payment system design that can meet the ambitious objectives of the Texas legislation.

Influence of spatial and temporal spot distribution on the ocular surface quality and maximum ablation depth after photoablation with a 1050 Hz excimer laser system.

PubMed

Mrochen, Michael; Schelling, Urs; Wuellner, Christian; Donitzky, Christof

2009-02-01

To investigate the effect of temporal and spatial distributions of laser spots (scan sequences) on the corneal surface quality after ablation and the maximum ablation of a given refractive correction after photoablation with a high-repetition-rate scanning-spot laser. IROC AG, Zurich, Switzerland, and WaveLight AG, Erlangen, Germany. Bovine corneas and poly(methyl methacrylate) (PMMA) plates were photoablated using a 1050 Hz excimer laser prototype for corneal laser surgery. Four temporal and spatial spot distributions (scan sequences) with different temporal overlapping factors were created for 3 myopic, 3 hyperopic, and 3 phototherapeutic keratectomy ablation profiles. Surface quality and maximum ablation depth were measured using a surface profiling system. The surface quality factor increased (rough surfaces) as the amount of temporal overlapping in the scan sequence and the amount of correction increased. The rise in surface quality factor was less for bovine corneas than for PMMA. The scan sequence might cause systematic substructures at the surface of the ablated material depending on the overlapping factor. The maximum ablation varied within the scan sequence. The temporal and spatial distribution of the laser spots (scan sequence) during a corneal laser procedure affected the surface quality and maximum ablation depth of the ablation profile. Corneal laser surgery could theoretically benefit from smaller spot sizes and higher repetition rates. The temporal and spatial spot distributions are relevant to achieving these aims.

Model Refinement and Simulation of Groundwater Flow in Clinton, Eaton, and Ingham Counties, Michigan

USGS Publications Warehouse

Luukkonen, Carol L.

2010-01-01

A groundwater-flow model that was constructed in 1996 of the Saginaw aquifer was refined to better represent the regional hydrologic system in the Tri-County region, which consists of Clinton, Eaton, and Ingham Counties, Michigan. With increasing demand for groundwater, the need to manage withdrawals from the Saginaw aquifer has become more important, and the 1996 model could not adequately address issues of water quality and quantity. An updated model was needed to better address potential effects of drought, locally high water demands, reduction of recharge by impervious surfaces, and issues affecting water quality, such as contaminant sources, on water resources and the selection of pumping rates and locations. The refinement of the groundwater-flow model allows simulations to address these issues of water quantity and quality and provides communities with a tool that will enable them to better plan for expansion and protection of their groundwater-supply systems. Model refinement included representation of the system under steady-state and transient conditions, adjustments to the estimated regional groundwater-recharge rates to account for both temporal and spatial differences, adjustments to the representation and hydraulic characteristics of the glacial deposits and Saginaw Formation, and updates to groundwater-withdrawal rates to reflect changes from the early 1900s to 2005. Simulations included steady-state conditions (in which stresses remained constant and changes in storage were not included) and transient conditions (in which stresses changed in annual and monthly time scales and changes in storage within the system were included). These simulations included investigation of the potential effects of reduced recharge due to impervious areas or to low-rainfall/drought conditions, delineation of contributing areas with recent pumping rates, and optimization of pumping subject to various quantity and quality constraints. Simulation results indicate potential declines in water levels in both the upper glacial aquifer and the upper sandstone bedrock aquifer under steady-state and transient conditions when recharge was reduced by 20 and 50 percent in urban areas. Transient simulations were done to investigate reduced recharge due to low rainfall and increased pumping to meet anticipated future demand with 24 months (2 years) of modified recharge or modified recharge and pumping rates. During these two simulation years, monthly recharge rates were reduced by about 30 percent, and monthly withdrawal rates for Lansing area production wells were increased by 15 percent. The reduction in the amount of water available to recharge the groundwater system affects the upper model layers representing the glacial aquifers more than the deeper bedrock layers. However, with a reduction in recharge and an increase in withdrawals from the bedrock aquifer, water levels in the bedrock layers are affected more than those in the glacial layers. Differences in water levels between simulations with reduced recharge and reduced recharge with increased pumping are greatest in the Lansing area and least away from pumping centers, as expected. Additionally, the increases in pumping rates had minimal effect on most simulated streamflows. Additional simulations included updating the estimated 10-year wellhead-contributing areas for selected Lansing-area wells under 2006-7 pumping conditions. Optimization of groundwater withdrawals with a water-resource management model was done to determine withdrawal rates while minimizing operational costs and to determine withdrawal locations to achieve additional capacity while meeting specified head constraints. In these optimization scenarios, the desired groundwater withdrawals are achieved by simulating managed wells (where pumping rates can be optimized) and unmanaged wells (where pumping rates are not optimized) and by using various combinations of existing and proposed well locations.

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.

The role of non-financial performance measures in predicting hospital financial performance: the case of for-profit system hospitals.

PubMed

Vélez-González, Heltie; Pradhan, Rohit; Weech-Maldonado, Robert

2011-01-01

Non-financial measures have found increasing acceptance in the business world--however, their application in the health care industry remains limited. The purpose of this article is to understand the influence of non-financial measures (efficiency, productivity, and quality) on the financial performance of for-profit system hospitals. The sample consists of 499 for-profit system hospitals in the United States from 1999 to 2002. Data analyzed include the American Hospital Association's Annual Survey, Medicare Cost Reports, Joint Commission's quality scores, and the Centers for Medicare & Medicaid Services' Hospital Case Mix Index. Dependent variables consist of financial measures (operating and total margins), while independent variables include measures of efficiency, productivity, and quality. Our results suggest the influence of non-financial performance measures on financial performance; occupancy rate positively influences financial performance while greater labor intensity may have negative implications for financial performance. In addition, we show that quality positively influences financial performance thereby offering a potential business case for quality. This result has important managerial and policy implications as it may incentivize capital and human resource investments required to improve hospital quality of care.

Health system guidance appraisal--concept evaluation and usability testing.

PubMed

Ako-Arrey, Denis E; Brouwers, Melissa C; Lavis, John N; Giacomini, Mita K

2016-01-05

Health system guidance (HSG) provides recommendations aimed to address health system challenges. However, there is a paucity of methods to direct, appraise, and report HSG. Earlier research identified 30 candidate criteria (concepts) that can be used to evaluate the quality of HSG and guide development and reporting requirements. The objective of this paper was to describe two studies aimed at evaluating the importance of these 30 criteria, design a draft HSG appraisal tool, and test its usability. This study involved a two-step survey process. In step 1, respondents rated the 30 concepts for appropriateness to, relevance to, and priority for health system decisions and HSG. This led to a draft tool. In step 2, respondents reviewed HSG documents, appraised them using the tool, and answered a series of questions. Descriptive analyses were computed. Fifty participants were invited in step 1, and we had a response rate of 82 %. The mean response rates for each concept within each survey question were universally favorable. There was also an overall agreement about the need for a high-quality tool to systematically direct the development, appraisal, and reporting of HSG. Qualitative feedback and a consensus process by the team led to refinements to some of the concepts and the creation of a beta (draft) version of the HSG tool. In step 2, 35 participants were invited and we had a response rate of 74 %. Exploratory analyses showed that the quality of the HSGs reviewed varied as a function of the HSG item and the specific document assessed. A favorable consensus was reached with participants agreeing that the HSG items were easy to understand and easy to apply. Moreover, the overall agreement was high for the usability of the tool to systematically direct the development (85 %), appraisal (92 %), and reporting (81 %) of HSG. From this process, version 1.0 of the HSG appraisal tool was generated complete with 32 items (and their descriptions) and 4 domains. The final tool, named the Appraisal of Guidelines for Research and Evaluation for Health Systems (AGREE-HS) (version 1), defines expectations of HSG and facilitates informed decisions among policymakers on health system delivery, financial, and governance arrangements.

Why organic resources and current fertilizer formulations in Southern Africa cannot sustain maize productivity: Evidence from a long-term experiment in Zimbabwe.

PubMed

Mtangadura, Tongai J; Mtambanengwe, Florence; Nezomba, Hatirarami; Rurinda, Jairos; Mapfumo, Paul

2017-01-01

Sustainability of maize-based cropping systems is a major challenge for southern Africa, yet the demand for maize as staple food and animal feed in the region continues to increase. A study was conducted on a sandy clay loam (220 g clay kg-1 soil) at Domboshawa in Zimbabwe to investigate the long-term effects of organic resource quality and application rate, and nitrogen (N) fertilization on soil chemical properties and maize (Zea mays L.) productivity. Crotalaria juncea (high quality), Calliandra calothyrsus (medium quality), cattle manure (variable quality), maize stover and Pinus patula sawdust (both low quality) were incorporated into soil at 4.0 t C ha-1 (high rate) and 1.2 t C ha-1 (low rate) at the start of each cropping season for nine consecutive years. At both high and low application rates, each of the five organic resources was applied in combination with or without mineral nitrogen (N) fertilizer at 120 kg N ha-1. The nine-year period saw maize grain yields declining by 22% to 84% across treatments despite increases in soil organic carbon, total N and available P from 6% to 80%. Crotalaria, Calliandra and manure led to a less steep yield decline. Exchangeable calcium (Ca), magnesium (Mg) and potassium (K), and soil pH explained much of the variation in yield patterns observed under the different organic resource applications. Maize grain yield was positively correlated with exchangeable Ca (r = 0.51), Mg (r = 0.62) and K (r = 0.53), and soil pH (r = 0.49), but negatively correlated with other soil properties over the 9-year period. We concluded that declining soil exchangeable basic cations were the underlying causes of decreasing maize productivity, and was aggravated by use of low rates of organic resource inputs, particularly with N fertilization. Current nutrient management and fertilizer recommendations that emphasize inorganic N, P and K significantly undervalue the role played by organic resources in sustainability of maize cropping systems in southern Africa.

Why organic resources and current fertilizer formulations in Southern Africa cannot sustain maize productivity: Evidence from a long-term experiment in Zimbabwe

PubMed Central

Mtangadura, Tongai J.

2017-01-01

Sustainability of maize-based cropping systems is a major challenge for southern Africa, yet the demand for maize as staple food and animal feed in the region continues to increase. A study was conducted on a sandy clay loam (220 g clay kg-1 soil) at Domboshawa in Zimbabwe to investigate the long-term effects of organic resource quality and application rate, and nitrogen (N) fertilization on soil chemical properties and maize (Zea mays L.) productivity. Crotalaria juncea (high quality), Calliandra calothyrsus (medium quality), cattle manure (variable quality), maize stover and Pinus patula sawdust (both low quality) were incorporated into soil at 4.0 t C ha-1 (high rate) and 1.2 t C ha-1 (low rate) at the start of each cropping season for nine consecutive years. At both high and low application rates, each of the five organic resources was applied in combination with or without mineral nitrogen (N) fertilizer at 120 kg N ha-1. The nine-year period saw maize grain yields declining by 22% to 84% across treatments despite increases in soil organic carbon, total N and available P from 6% to 80%. Crotalaria, Calliandra and manure led to a less steep yield decline. Exchangeable calcium (Ca), magnesium (Mg) and potassium (K), and soil pH explained much of the variation in yield patterns observed under the different organic resource applications. Maize grain yield was positively correlated with exchangeable Ca (r = 0.51), Mg (r = 0.62) and K (r = 0.53), and soil pH (r = 0.49), but negatively correlated with other soil properties over the 9-year period. We concluded that declining soil exchangeable basic cations were the underlying causes of decreasing maize productivity, and was aggravated by use of low rates of organic resource inputs, particularly with N fertilization. Current nutrient management and fertilizer recommendations that emphasize inorganic N, P and K significantly undervalue the role played by organic resources in sustainability of maize cropping systems in southern Africa. PMID:28797062

Characterization of urban air quality using GIS as a management system.

PubMed

Puliafito, E; Guevara, M; Puliafito, C

2003-01-01

Keeping the air quality acceptable has become an important task for decision makers as well as for non-governmental organizations. Particulate and gaseous emissions of pollutant from industries and auto-exhausts are responsible for rising discomfort, increasing airway diseases, decreasing productivity and the deterioration of artistic and cultural patrimony in urban centers. A model to determine the air quality in urban areas using a geographical information system will be presented here. This system permits the integration, handling, analysis and simulation of spatial and temporal data of the ambient concentration of the main pollutant. It allows the users to characterize and recognize areas with a potential increase or improvement in its air pollution situation. It is also possible to compute past or present conditions by changing basic input information as traffic flow, or stack emission rates. Additionally the model may be used to test the compliance of local standard air quality, to study the environmental impact of new industries or to determine the changes in the conditions when the vehicle circulation is increased.

Association between quality domains and health care spending across physician networks

PubMed Central

Rahman, Farah; Guan, Jun; Glazier, Richard H.; Brown, Adalsteinn; Bierman, Arlene S.; Croxford, Ruth; Stukel, Therese A.

2018-01-01

One of the more fundamental health policy questions is the relationship between health care quality and spending. A better understanding of these relationships is needed to inform health systems interventions aimed at increasing quality and efficiency of care. We measured 65 validated quality indicators (QI) across Ontario physician networks. QIs were aggregated into domains representing six dimensions of care: screening and prevention, evidence-based medications, hospital-community transitions (7-day post-discharge visit with a primary care physician; 30-day post-discharge visit with a primary care physician and specialist), potentially avoidable hospitalizations and emergency department (ED) visits, potentially avoidable readmissions and unplanned returns to the ED, and poor cancer end of life care. Each domain rate was computed as a weighted average of QI rates, weighting by network population at risk. We also measured overall and sector-specific per capita healthcare network spending. We evaluated the associations between domain rates, and between domain rates and spending using weighted correlations, weighting by network population at risk, using an ecological design. All indicators were measured using Ontario health administrative databases. Large variations were seen in timely hospital-community transitions and potentially avoidable hospitalizations. Networks with timely hospital-community transitions had lower rates of avoidable admissions and readmissions (r = -0.89, -0.58, respectively). Higher physician spending, especially outpatient primary care spending, was associated with lower rates of avoidable hospitalizations (r = -0.83) and higher rates of timely hospital-community transitions (r = 0.81) and moderately associated with lower readmission rates (r = -0.46). Investment in effective primary care services may help reduce burden on the acute care sector and associated expenditures. PMID:29614131

The Implications of Handling Qualities in Civil Helicopter Accidents Involving Hover and Low Speed Flight

NASA Technical Reports Server (NTRS)

Dugan, Daniel C.; Delamer, Kevin J.

2005-01-01

Because of increasing accident rates in Army helicopters in hover and low speed flight, a study was made in 1999 of accidents which could be attributed to inadequate stability augmentation. A study of civil helicopter accidents from 1993-2004 was then undertaken to pursue the issue of poor handling qualities in helicopters which, in almost all cases, had no stability augmentation. The vast majority of the mishaps studied occurred during daylight in visual meteorological condition, reducing the impact of degraded visual environments (DVE) on the results. Based on the Cooper-Harper Rating Scale, the handling qualities of many of the helicopters studied could be described as having from "very objectionable" to "major" deficiencies. These costly deficiencies have resulted in unnecessary loss of life, injury, and high dollar damage. Low cost and lightweight augmentation systems for helicopters have been developed in the past and are still being investigated. They offer the potential for significant reductions in the accident rate.

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

PubMed

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

2013-07-23

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

A multilevel reuse system with source separation process for printing and dyeing wastewater treatment: A case study.

PubMed

Wang, Rui; Jin, Xin; Wang, Ziyuan; Gu, Wantao; Wei, Zhechao; Huang, Yuanjie; Qiu, Zhuang; Jin, Pengkang

2018-01-01

This paper proposes a new system of multilevel reuse with source separation in printing and dyeing wastewater (PDWW) treatment in order to dramatically improve the water reuse rate to 35%. By analysing the characteristics of the sources and concentrations of pollutants produced in different printing and dyeing processes, special, highly, and less contaminated wastewaters (SCW, HCW, and LCW, respectively) were collected and treated separately. Specially, a large quantity of LCW was sequentially reused at multiple levels to meet the water quality requirements for different production processes. Based on this concept, a multilevel reuse system with a source separation process was established in a typical printing and dyeing enterprise. The water reuse rate increased dramatically to 62%, and the reclaimed water was reused in different printing and dyeing processes based on the water quality. This study provides promising leads in water management for wastewater reclamation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Image quality evaluation and patient dose assessment of medical fluoroscopic X-ray systems: a national study.

PubMed

Economides, S; Hourdakis, C J; Kalivas, N; Kalathaki, M; Simantirakis, G; Tritakis, P; Manousaridis, G; Vogiatzi, S; Kipouros, P; Boziari, A; Kamenopoulou, V

2008-01-01

This study presents the results from a survey conducted by the Greek Atomic Energy Commission (GAEC), during the period 1998-2003, in 530 public and private owned fluoroscopic X-ray systems in Greece. Certain operational parameters for conventional and remote control systems were assessed, according to a quality control protocol developed by GAEC on the basis of the current literature. Public (91.5%) and private (81.5%) owned fluoroscopic units exhibit high-contrast resolution values over 1 lp mm(-1). Moreover, 88.5 and 87.1% of the fluoroscopic units installed in the public and private sector, respectively, present Maximum Patient Entrance Kerma Rate values lower than 100 mGy min(-1). Additionally, 68.3% of the units assessed were found to perform within the acceptance limits. Finally, the third quartile of the Entrance Surface Dose Rate distribution was estimated according to the Dose Reference Level definition and found equal to 35 mGy min(-1).

Objective Speech Quality Assessment Based on Payload Discrimination of Lost Packets for Cellular Phones in NGN Environment

NASA Astrophysics Data System (ADS)

Uemura, Satoshi; Fukumoto, Norihiro; Yamada, Hideaki; Nakamura, Hajime

A feature of services provided in a Next Generation Network (NGN) is that the end-to-end quality is guaranteed. This is quite a challenging issue, given the considerable fluctuation in network conditions within a Fixed Mobile Convergence (FMC) network. Therefore, a novel approach, whereby a network node and a mobile terminal such as a cellular phone cooperate with each other to control service quality is essential. In order to achieve such cooperation, the mobile terminal needs to become more intelligent so it can estimate the service quality, including the user's perceptual quality, and notify the measurement result to the network node. Subsequently, the network node implements some kind of service control function, such as a resource and admission control function, based on the notification from the mobile terminal. In this paper, the role of the mobile terminal in such collaborative system is focused on. As a part of a QoS/QoE measurement system, we describe an objective speech quality assessment with payload discrimination of lost packets to measure the user's perceptual quality of VoIP. The proposed assessment is so simple that it can be implemented on a cellular phone. We therefore did this as part of the QoS/QoE measurement system. By using the implemented system, we can measure the user's perceptual quality of VoIP as well as the network QoS metrics, in terms of criteria such as packet loss rate, jitter and burstiness in real time.

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

PubMed

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

2018-07-01

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

Video rate color region segmentation for mobile robotic applications

NASA Astrophysics Data System (ADS)

de Cabrol, Aymeric; Bonnin, Patrick J.; Hugel, Vincent; Blazevic, Pierre; Chetto, Maryline

2005-08-01

Color Region may be an interesting image feature to extract for visual tasks in robotics, such as navigation and obstacle avoidance. But, whereas numerous methods are used for vision systems embedded on robots, only a few use this segmentation mainly because of the processing duration. In this paper, we propose a new real-time (ie. video rate) color region segmentation followed by a robust color classification and a merging of regions, dedicated to various applications such as RoboCup four-legged league or an industrial conveyor wheeled robot. Performances of this algorithm and confrontation with other methods, in terms of result quality and temporal performances are provided. For better quality results, the obtained speed up is between 2 and 4. For same quality results, the it is up to 10. We present also the outlines of the Dynamic Vision System of the CLEOPATRE Project - for which this segmentation has been developed - and the Clear Box Methodology which allowed us to create the new color region segmentation from the evaluation and the knowledge of other well known segmentations.

A programmable display layer for virtual reality system architectures.

PubMed

Smit, Ferdi Alexander; van Liere, Robert; Froehlich, Bernd

2010-01-01

Display systems typically operate at a minimum rate of 60 Hz. However, existing VR-architectures generally produce application updates at a lower rate. Consequently, the display is not updated by the application every display frame. This causes a number of undesirable perceptual artifacts. We describe an architecture that provides a programmable display layer (PDL) in order to generate updated display frames. This replaces the default display behavior of repeating application frames until an update is available. We will show three benefits of the architecture typical to VR. First, smooth motion is provided by generating intermediate display frames by per-pixel depth-image warping using 3D motion fields. Smooth motion eliminates various perceptual artifacts due to judder. Second, we implement fine-grained latency reduction at the display frame level using a synchronized prediction of simulation objects and the viewpoint. This improves the average quality and consistency of latency reduction. Third, a crosstalk reduction algorithm for consecutive display frames is implemented, which improves the quality of stereoscopic images. To evaluate the architecture, we compare image quality and latency to that of a classic level-of-detail approach.

Preliminary Two-Phase Terry Turbine Nozzle Models for RCIC Off-Design Operation Conditions

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

Zhao, Haihua; O'Brien, James

This report presents the effort to extend the single-phase analytical Terry turbine model to cover two-phase off-design conditions. The work includes: (1) adding well-established two-phase choking models – the Isentropic Homogenous Equilibrium Model (IHEM) and Moody’s model, and (2) theoretical development and implementation of a two-phase nozzle expansion model. The two choking models provide bounding cases for the two-phase choking mass flow rate. The new two-phase Terry turbine model uses the choking models to calculate the mass flow rate, the critical pressure at the nozzle throat, and steam quality. In the divergent stage, we only consider the vapor phase withmore » a similar model for the single-phase case by assuming that the liquid phase would slip along the wall with a much slower speed and will not contribute the impulse on the rotor. We also modify the stagnation conditions according to two-phase choking conditions at the throat and the cross-section areas for steam flow at the nozzle throat and at the nozzle exit. The new two-phase Terry turbine model was benchmarked with the same steam nozzle test as for the single-phase model. Better agreement with the experimental data is observed than from the single-phase model. We also repeated the Terry turbine nozzle benchmark work against the Sandia CFD simulation results with the two-phase model for the pure steam inlet nozzle case. The RCIC start-up tests were simulated and compared with the single-phase model. Similar results are obtained. Finally, we designed a new RCIC system test case to simulate the self-regulated Terry turbine behavior observed in Fukushima accidents. In this test, a period inlet condition for the steam quality varying from 1 to 0 is applied. For the high quality inlet period, the RCIC system behaves just like the normal operation condition with a high pump injection flow rate and a nominal steam release rate through the turbine, with the net addition of water to the primary system; for the low quality inlet period, the RCIC turbine shaft work dramatically decreases and results in a much reduced pump injection flow rate, and the mixture flow rate through the turbine increases due to the high liquid phase flow rate. The net effect for this period is net removal of coolant from the primary loop. With the periodic addition and removal of coolant to the primary loop, the self-regulation mode of the RCIC system can be maintained for a quite long time. Both the IHEM and Moody’s models generate similar phenomena; however noticeable differences can be observed.« less

Clinical comparative study with a large-area amorphous silicon flat-panel detector: image quality and visibility of anatomic structures on chest radiography.

PubMed

Fink, Christian; Hallscheidt, Peter J; Noeldge, Gerd; Kampschulte, Annette; Radeleff, Boris; Hosch, Waldemar P; Kauffmann, Günter W; Hansmann, Jochen

2002-02-01

The objective of this study was to compare clinical chest radiographs of a large-area, flat-panel digital radiography system and a conventional film-screen radiography system. The comparison was based on an observer preference study of image quality and visibility of anatomic structures. Routine follow-up chest radiographs were obtained from 100 consecutive oncology patients using a large-area, amorphous silicon flat-panel detector digital radiography system (dose equivalent to a 400-speed film system). Hard-copy images were compared with previous examinations of the same individuals taken on a conventional film-screen system (200-speed). Patients were excluded if changes in the chest anatomy were detected or if the time interval between the examinations exceeded 1 year. Observer preference was evaluated for the image quality and the visibility of 15 anatomic structures using a five-point scale. Dose measurements with a chest phantom showed a dose reduction of approximately 50% with the digital radiography system compared with the film-screen radiography system. The image quality and the visibility of all but one anatomic structure of the images obtained with the digital flat-panel detector system were rated significantly superior (p < or = 0.0003) to those obtained with the conventional film-screen radiography system. The image quality and visibility of anatomic structures on the images obtained by the flat-panel detector system were perceived as equal or superior to the images from conventional film-screen chest radiography. This was true even though the radiation dose was reduced approximately 50% with the digital flat-panel detector system.

Feasibility study of computed vs measured high b-value (1400 s/mm²) diffusion-weighted MR images of the prostate

PubMed Central

Bittencourt, Leonardo K; Attenberger, Ulrike I; Lima, Daniel; Strecker, Ralph; de Oliveira, Andre; Schoenberg, Stefan O; Gasparetto, Emerson L; Hausmann, Daniel

2014-01-01

AIM: To evaluate the impact of computed b = 1400 s/mm2 (C-b1400) vs measured b = 1400 s/mm2 (M-b1400) diffusion-weighted images (DWI) on lesion detection rate, image quality and quality of lesion demarcation using a modern 3T-MR system based on a small-field-of-view sequence (sFOV). METHODS: Thirty patients (PSA: 9.5 ± 8.7 ng/mL; 68 ± 12 years) referred for magnetic resonance imaging (MRI) of the prostate were enrolled in this study. All measurements were performed on a 3T MR system. For DWI, a single-shot EPI diffusion sequence (b = 0, 100, 400, 800 s/mm²) was utilized. C-b1400 was calculated voxelwise from the ADC and diffusion images. Additionally, M-b1400 was acquired for evaluation and comparison. Lesion detection rate and maximum lesion diameters were obtained and compared. Image quality and quality of lesion demarcation were rated according to a 5-point Likert-type scale. Ratios of lesion-to-bladder as well as prostate-to-bladder signal intensity (SI) were calculated to estimate the signal-to-noise-ratio (SNR). RESULTS: Twenty-four lesions were detected on M-b1400 images and compared to C-b1400 images. C-b1400 detected three additional cancer suspicious lesions. Overall image quality was rated significantly better and SI ratios were significantly higher on C-b1400 (2.3 ± 0.8 vs 3.1 ± 1.0, P < 0.001; 5.6 ± 1.8 vs 2.8 ± 0.9, P < 0.001). Comparison of lesion size showed no significant differences between C- and M-b1400 (P = 0.22). CONCLUSION: Combination of a high b-value extrapolation and sFOV may contribute to increase diagnostic accuracy of DWI without an increase of acquisition time, which may be useful to guide targeted prostate biopsies and to improve quality of multiparametric MRI (mMRI) especially under economical aspects in a private practice setting. PMID:24976938

High-power picosecond laser with 400W average power for large scale applications

NASA Astrophysics Data System (ADS)

Du, Keming; Brüning, Stephan; Gillner, Arnold

2012-03-01

Laser processing is generally known for low thermal influence, precise energy processing and the possibility to ablate every type of material independent on hardness and vaporisation temperature. The use of ultra-short pulsed lasers offers new possibilities in the manufacturing of high end products with extra high processing qualities. For achieving a sufficient and economical processing speed, high average power is needed. To scale the power for industrial uses the picosecond laser system has been developed, which consists of a seeder, a preamplifier and an end amplifier. With the oscillator/amplifier system more than 400W average power and maximum pulse energy 1mJ was obtained. For study of high speed processing of large embossing metal roller two different ps laser systems have been integrated into a cylinder engraving machine. One of the ps lasers has an average power of 80W while the other has 300W. With this high power ps laser fluencies of up to 30 J/cm2 at pulse repetition rates in the multi MHz range have been achieved. Different materials (Cu, Ni, Al, steel) have been explored for parameters like ablation rate per pulse, ablation geometry, surface roughness, influence of pulse overlap and number of loops. An enhanced ablation quality and an effective ablation rate of 4mm3/min have been achieved by using different scanning systems and an optimized processing strategy. The max. achieved volume rate is 20mm3/min.

The new Caribbean Nitrogen Index to assess nitrogen dynamics in vegetable production systems in southwestern Puerto Rico

USDA-ARS?s Scientific Manuscript database

Nutrient loss from agricultural fields is one of the main factors influencing surface- and ground-water quality. Typical fertilizer nitrogen (N) consumption rates in vegetable production systems and horticultural crops in Puerto Rico, fluctuate between 112 to 253 kg N/ha. Nitrogen use efficiency of ...

Factors Influencing Response Rates in Online Student Evaluation Systems: A Systematic Review Approach

ERIC Educational Resources Information Center

Asare, Samuel; Daniel, Ben Kei

2018-01-01

Students' feedback on teaching activities significantly contributes to the enhancement of the quality of teaching and learning. Conventionally students evaluate teaching activities through paper based systems, where they fill out and return paper copies of teaching or course evaluation. In the last decades, institutions are moving student…

Is It Time to Rethink Teacher Pensions in Maryland?

ERIC Educational Resources Information Center

Podgursky, Michael

2006-01-01

Many states are struggling to finance under-funded teacher pension systems as well as recruit and retain a high-quality teaching workforce. This paper compares Maryland's former (prior to Spring, 2006) teacher pension system to those in Pennsylvania and several other states. On the basis of simple replacement rates, the former Maryland state plan…

Weld analysis and control system

NASA Technical Reports Server (NTRS)

Kennedy, Larry Z. (Inventor); Rodgers, Michael H. (Inventor); Powell, Bradley W. (Inventor); Burroughs, Ivan A. (Inventor); Goode, K. Wayne (Inventor)

1994-01-01

The invention is a Weld Analysis and Control System developed for active weld system control through real time weld data acquisition. Closed-loop control is based on analysis of weld system parameters and weld geometry. The system is adapted for use with automated welding apparatus having a weld controller which is capable of active electronic control of all aspects of a welding operation. Enhanced graphics and data displays are provided for post-weld analysis. The system provides parameter acquisition, including seam location which is acquired for active torch cross-seam positioning. Torch stand-off is also monitored for control. Weld bead and parent surface geometrical parameters are acquired as an indication of weld quality. These parameters include mismatch, peaking, undercut, underfill, crown height, weld width, puddle diameter, and other measurable information about the weld puddle regions, such as puddle symmetry, etc. These parameters provide a basis for active control as well as post-weld quality analysis and verification. Weld system parameters, such as voltage, current and wire feed rate, are also monitored and archived for correlation with quality parameters.

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

Uchida, Y., E-mail: h1312101@mailg.nc-toyama.ac.jp; Takada, E.; Fujisaki, A.

Neutron and γ-ray (n-γ) discrimination with a digital signal processing system has been used to measure the neutron emission profile in magnetic confinement fusion devices. However, a sampling rate must be set low to extend the measurement time because the memory storage is limited. Time jitter decreases a discrimination quality due to a low sampling rate. As described in this paper, a new charge comparison method was developed. Furthermore, automatic n-γ discrimination method was examined using a probabilistic approach. Analysis results were investigated using the figure of merit. Results show that the discrimination quality was improved. Automatic discrimination was appliedmore » using the EM algorithm and k-means algorithm.« less

Synthesis, grading, and presentation of evidence in guidelines: article 7 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Guyatt, Gordon; Akl, Elie A; Oxman, Andy; Wilson, Kevin; Puhan, Milo A; Wilt, Timothy; Gutterman, David; Woodhead, Mark; Antman, Elliott M; Schünemann, Holger J

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the seventh of a series of 14 articles that were prepared to advise guideline developers in respiratory and other diseases on approaches for guideline development. This article focuses on synthesizing, rating, and presenting evidence in guidelines. In this review we addressed the following questions. (1) What evidence should guideline panels use to inform their recommendations? (2) How should they rate the quality of the evidence they use? (3) How should they grade evidence regarding diagnostic tests? (4) What should they do when quality of evidence differs across outcomes? (5) How should they present the evidence in a guideline? We did not conduct systematic reviews ourselves. We relied on prior evaluations of electronic databases and systematic reviews suggesting that the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach includes the desired features of a system for grading quality of evidence, including provision of models for presenting evidence for guideline panels, and for the consumers of practice guidelines. This article describes the GRADE approach to grading the quality of evidence and presenting evidence. Available evidence, the practice of leading guideline developers, and workshop discussions provide the basis for our conclusions. GRADE rates the quality of evidence for each outcome across studies rather than for each study. In the GRADE approach randomized trials start as high-quality evidence and observational studies as low-quality evidence, but both can be rated down or up. Five factors may lead to rating down the quality of evidence: study limitations or risk of bias, inconsistency of results, indirectness of evidence, imprecision, and publication bias. Three factors may lead to rating up the quality of evidence from observational studies: large magnitude of effect, dose-response gradient, and situations in which all plausible confounders would decrease an apparent treatment effect, or would create a spurious effect when results suggest no effect. GRADE suggests use of evidence profiles that provide a comprehensive way to display the key evidence relevant to a clinical question. Guideline developers who follow this structure will find the transparency of their recommendations markedly enhanced.

Exploration of indigenous bacteria in an intensive aquaculture system of African catfish (Clarias sp.) in Banyuwangi, Indonesia

NASA Astrophysics Data System (ADS)

Prayogo; Rahardja, B. S.; Asshanti, A. N.; Dewi, N. N.; Santanumurti, M. B.

2018-04-01

Intensive African catfish culture in tarpaulin pond was popular in Banyuwangi, Indonesia since the government supported the fisheries sector. Unfortunately, the failure of African catfish culture still occurred since the waste from fish metabolite process and feed residue decreased the water quality. Bacteria in the water could be the solution to increase the success rate of aquaculture by improving the water quality. This study purpose was to obtained indigenous bacteria in intensive aquaculture system of African catfish to improve water quality. This study successfully isolated bacteria contained with amylase, protease and lipase characteristic. Isolated bacteria in this study were identified as Pseudomonas pseudomallei (97.81%), Bacillus subtilis (95.81%) and Pseudomonas stutzeri (61.21%).

Comparison of two treatments for the removal of selected organic micropollutants and bulk organic matter: conventional activated sludge followed by ultrafiltration versus membrane bioreactor.

PubMed

Sahar, E; Ernst, M; Godehardt, M; Hein, A; Herr, J; Kazner, C; Melin, T; Cikurel, H; Aharoni, A; Messalem, R; Brenner, A; Jekel, M

2011-01-01

The potential of membrane bioreactor (MBR) systems to remove organic micropollutants was investigated at different scales, operational conditions, and locations. The effluent quality of the MBR system was compared with that of a plant combining conventional activated sludge (CAS) followed by ultrafiltration (UF). The MBR and CAS-UF systems were operated and tested in parallel. An MBR pilot plant in Israel was operated for over a year at a mixed liquor suspended solids (MLSS) range of 2.8-10.6 g/L. The MBR achieved removal rates comparable to those of a CAS-UF plant at the Tel-Aviv wastewater treatment plant (WWTP) for macrolide antibiotics such as roxythromycin, clarithromycin, and erythromycin and slightly higher removal rates than the CAS-UF for sulfonamides. A laboratory scale MBR unit in Berlin - at an MLSS of 6-9 g/L - showed better removal rates for macrolide antibiotics, trimethoprim, and 5-tolyltriazole compared to the CAS process of the Ruhleben sewage treatment plant (STP) in Berlin when both were fed with identical quality raw wastewater. The Berlin CAS exhibited significantly better benzotriazole removal and slightly better sulfamethoxazole and 4-tolyltriazole removal than its MBR counterpart. Pilot MBR tests (MLSS of 12 g/L) in Aachen, Germany, showed that operating flux significantly affected the resulting membrane fouling rate, but the removal rates of dissolved organic matter and of bisphenol A were not affected.

Tank cultivation of the red algae Palmaria mollis: Effects of nutrients on growth rate, biochemical quality, and epiphytic growth

NASA Astrophysics Data System (ADS)

Ben, D.; Langdon, C. J.

2016-02-01

Pacific dulse (Palmaria mollis) is a candidate for aquaculture production in Oregon due to its high protein content, fast growth rate, and ability to fare in cold water conditions. Current cultivation methods use the F/2 medium to supply nutrients to macroalgae cultures. The F/2 medium is a costly mixture of nitrate, phosphate, trace metals and vitamins. The F/2 medium has been the standard for microalgae cultivation, but research has lacked on the necessity of all or part of this mixture for macroalgae cultivation. This study is designed to contribute to the development of Pacific dulse cultivation by measuring how different fertilizer regimens affect the growth, biochemical composition, and quality of Palmaria mollis (C-3 variety) in hopes to reduce the production cost. I hypothesis that dulse will not require additional nutrients during summer cultivation, due to summer upwelling conditions. Experiments were conducted in a flow-through water system, controlling for flow rate, stocking density, and nutrient supplementation. To test this, two replicates of four nutrient regimes were organized: no supplemental nutrients, all nutrients (standard F/2 medium), nitrate/phosphate only, and nitrate/phosphate with trace metals. Each tank was monitored weekly for color quality, epiphytic growth, specific growth rate, production and a final biochemical analysis. This study has preliminarily concluded that supplemental nutrients have no significant effect on production or biochemical quality, but does have an effect quality of epiphytic growth.

Fast subsurface fingerprint imaging with full-field optical coherence tomography system equipped with a silicon camera.

PubMed

Auksorius, Egidijus; Boccara, A Claude

2017-09-01

Images recorded below the surface of a finger can have more details and be of higher quality than the conventional surface fingerprint images. This is particularly true when the quality of the surface fingerprints is compromised by, for example, moisture or surface damage. However, there is an unmet need for an inexpensive fingerprint sensor that is able to acquire high-quality images deep below the surface in short time. To this end, we report on a cost-effective full-field optical coherent tomography system comprised of a silicon camera and a powerful near-infrared LED light source. The system, for example, is able to record 1.7  cm×1.7  cmen face images in 0.12 s with the spatial sampling rate of 2116 dots per inch and the sensitivity of 93 dB. We show that the system can be used to image internal fingerprints and sweat ducts with good contrast. Finally, to demonstrate its biometric performance, we acquired subsurface fingerprint images from 240 individual fingers and estimated the equal-error-rate to be ∼0.8%. The developed instrument could also be used in other en face deep-tissue imaging applications because of its high sensitivity, such as in vivo skin imaging. (2017) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE).

Quality assurance for high dose rate brachytherapy treatment planning optimization: using a simple optimization to verify a complex optimization

NASA Astrophysics Data System (ADS)

Deufel, Christopher L.; Furutani, Keith M.

2014-02-01

As dose optimization for high dose rate brachytherapy becomes more complex, it becomes increasingly important to have a means of verifying that optimization results are reasonable. A method is presented for using a simple optimization as quality assurance for the more complex optimization algorithms typically found in commercial brachytherapy treatment planning systems. Quality assurance tests may be performed during commissioning, at regular intervals, and/or on a patient specific basis. A simple optimization method is provided that optimizes conformal target coverage using an exact, variance-based, algebraic approach. Metrics such as dose volume histogram, conformality index, and total reference air kerma agree closely between simple and complex optimizations for breast, cervix, prostate, and planar applicators. The simple optimization is shown to be a sensitive measure for identifying failures in a commercial treatment planning system that are possibly due to operator error or weaknesses in planning system optimization algorithms. Results from the simple optimization are surprisingly similar to the results from a more complex, commercial optimization for several clinical applications. This suggests that there are only modest gains to be made from making brachytherapy optimization more complex. The improvements expected from sophisticated linear optimizations, such as PARETO methods, will largely be in making systems more user friendly and efficient, rather than in finding dramatically better source strength distributions.

Perceptual compression of magnitude-detected synthetic aperture radar imagery

NASA Technical Reports Server (NTRS)

Gorman, John D.; Werness, Susan A.

1994-01-01

A perceptually-based approach for compressing synthetic aperture radar (SAR) imagery is presented. Key components of the approach are a multiresolution wavelet transform, a bit allocation mask based on an empirical human visual system (HVS) model, and hybrid scalar/vector quantization. Specifically, wavelet shrinkage techniques are used to segregate wavelet transform coefficients into three components: local means, edges, and texture. Each of these three components is then quantized separately according to a perceptually-based bit allocation scheme. Wavelet coefficients associated with local means and edges are quantized using high-rate scalar quantization while texture information is quantized using low-rate vector quantization. The impact of the perceptually-based multiresolution compression algorithm on visual image quality, impulse response, and texture properties is assessed for fine-resolution magnitude-detected SAR imagery; excellent image quality is found at bit rates at or above 1 bpp along with graceful performance degradation at rates below 1 bpp.

77 FR 67449 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-09

... Blended Payment a. Update to the Drug Add-on to the Composite Rate Portion of the ESRD Blended Payment Rate i. Estimating Growth in Expenditures for Drugs and Biologicals in CY 2013 ii. Estimating Per Patient Growth iii. Applying the Growth Update to the Drug Add-On Adjustment iv. Update to the Drug Add-On...

Causes of the Decline of Education in Pakistan and Its Remedies

ERIC Educational Resources Information Center

Ghazi, Safdar Rehman; Ali, Riasat; Khan, Muhammad Saeed; Hussain, Shaukat; Fatima, Zakia Tanzeela

2010-01-01

Low literacy rate and poor quality of education are the major drawbacks of the educational system in Pakistan. Our education is influenced by a number of factors that cause this downfall. Some of them are more prominent, such as low enrollment and high dropout rate at the primary level, different standards of education, low budget allocation for…

Impact of a health maintenance organization hospitalist system in academic pediatrics.

PubMed

Landrigan, Christopher P; Srivastava, Rajendu; Muret-Wagstaff, Sharon; Soumerai, Stephen B; Ross-Degnan, Dennis; Graef, John W; Homer, Charles J; Goldmann, Donald A

2002-10-01

Hospitalist systems decrease length of stay (LOS) and cost for hospitalized adults. Whether hospitalist systems decrease LOS and cost for hospitalized children has not been conclusively established. We wanted to determine whether a health maintenance organization's (HMO's) implementation of a pediatric hospitalist system affected LOS, costs, mortality, readmission rate, follow-up rate, and parents' ratings of care. Interrupted time-series study of general pediatric patients admitted to a freestanding pediatric teaching hospital from 1993 to 1998. The intervention group consisted of all patients admitted to a staff model not-for-profit HMO that began using hospitalists in October 1996. Patients in other HMOs and traditional insurance groups were studied for comparison. The main outcomes were mean LOS and inflation-adjusted costs. Other outcomes included parents' ratings of care and mortality, readmission, and follow-up rates. Immediately after the introduction of the hospitalist system, mean LOS for staff model not-for-profit HMO fell 12% (0.3 days), and mean cost of hospitalization decreased 16% ($217) compared with prehospitalist levels. Parental ratings of care, initially somewhat low, improved substantially. Seven-day follow-up rates, mortality, and readmission rates did not change. Comparison groups experienced no concurrent improvements in LOS, cost, parental ratings, mortality, or readmission rates. A pediatric hospitalist system within a staff-model HMO significantly improved LOS, cost, and parental ratings of care without affecting rates of posthospitalization follow-up. Additional studies are needed both to measure broader aspects of quality and to assess the impact of such a program on patients being cared for through other types of delivery and insurance systems.

Changes in Quality of Health Care Delivery after Vertical Integration

PubMed Central

Carlin, Caroline S; Dowd, Bryan; Feldman, Roger

2015-01-01

Objectives To fill an empirical gap in the literature by examining changes in quality of care measures occurring when multispecialty clinic systems were acquired by hospital-owned, vertically integrated health care delivery systems in the Twin Cities area. Data Sources/Study Setting Administrative data for health plan enrollees attributed to treatment and control clinic systems, merged with U.S. Census data. Study Design We compared changes in quality measures for health plan enrollees in the acquired clinics to enrollees in nine control groups using a differences-in-differences model. Our dataset spans 2 years prior to and 4 years after the acquisitions. We estimated probit models with errors clustered within enrollees. Data Collection/Extraction Methods Data were assembled by the health plan’s informatics team. Principal Findings Vertical integration is associated with increased rates of colorectal and cervical cancer screening and more appropriate emergency department use. The probability of ambulatory care–sensitive admissions increased when the acquisition caused disruption in admitting patterns. Conclusions Moving a clinic system into a vertically integrated delivery system resulted in limited increases in quality of care indicators. Caution is warranted when the acquisition causes disruption in referral patterns. PMID:25529312

Influence of liquid-volume and airflow rates on spray application quality and homogeneity in super-intensive olive tree canopies.

PubMed

Miranda-Fuentes, Antonio; Rodríguez-Lizana, Antonio; Gil, Emilio; Agüera-Vega, J; Gil-Ribes, Jesús A

2015-12-15

Olive is a key crop in Europe, especially in countries around the Mediterranean Basin. Optimising the parameters of a spray is essential for sustainable pesticide use, especially in high-input systems, such as the super-intensive hedgerow system. Parameters may be optimised by adjusting the applied volume and airflow rate of sprays, in addition to the liquid to air proportion and the relationship between air velocity and airflow rate. Two spray experiments using a commercial airblast sprayer were conducted in a super-intensive orchard to study how varying the liquid volume rate (testing volumes of 182, 619, and 1603 l ha(-1)) and volumetric airflow rate (with flow rates of 11.93, 8.90, and 6.15 m(3) s(-1)) influences the coverage parameters and the amount and distribution of deposits in different zones of the canopy.. Our results showed that an increase in the application volume raised the mean deposit and percentage coverage, but decreased the application efficiency, spray penetration, and deposit homogeneity. Furthermore, we found that the volumetric airflow rate had a lower influence on the studied parameters than the liquid volume; however, an increase in the airflow rate improved the application efficiency and homogeneity to a certain threshold, after which the spray quality decreased. This decrease was observed in the high-flow treatment. Our results demonstrate that intermediate liquid volume rates and volumetric airflow rates are required for the optimal spraying of pesticides on super-intensive olive crops, and would reduce current pollution levels. Copyright © 2015 Elsevier B.V. All rights reserved.

A System for Cost and Reimbursement Control in Hospitals

PubMed Central

Fetter, Robert B.; Thompson, John D.; Mills, Ronald E.

1976-01-01

This paper approaches the design of a regional or statewide hospital rate-setting system as the underpinning of a larger system which permits a regulatory agency to satisfy the requirements of various public laws now on the books or in process. It aims to generate valid interinstitutional monitoring on the three parameters of cost, utilization, and quality review. Such an approach requires the extension of the usual departmental cost and budgeting system to include consideration of the mix of patients treated and the utilization of various resources, including patient days, in the treatment of these patients. A sampling framework for the application of process-based quality studies and the generation of selected performance measurements is also included. PMID:941461

Impact of a DRG-based hospital financing system on quality and outcomes of care in Italy.

PubMed Central

Louis, D Z; Yuen, E J; Braga, M; Cicchetti, A; Rabinowitz, C; Laine, C; Gonnella, J S

1999-01-01

OBJECTIVE: To examine potential changes in quality of care associated with a recent financing system implementation in Italy: in 1995, hospital financing reform implemented in Italy included the introduction of a DRG-based hospital financing system with the goals of controlling the growth of hospital costs and making hospitals more accountable for their productivity. DATA SOURCES: Hospital discharge abstract data from 1993 through 1996 for all hospitals (N=32) in the Friuli-Venezia-Giulia region of Italy. Regional population data were used to calculate rates. STUDY DESIGN: Changes between 1993 and 1996 in hospital admissions, length of stay, mortality rates, severity of illness, and readmission rates were studied for nine common medical and surgical conditions: appendicitis, diabetes mellitus, colorectal cancer, cholecystitis, bronchitis/chronic obstructive pulmonary disease (COPD), bacterial pneumonia, coronary artery disease, cerebrovascular disease, and hip fracture. PRINCIPAL FINDINGS: The total number of ordinary hospital admissions decreased from 244,581 to 204,054 between 1993 and 1996, a population-based decrease of 17.3 percent (p<.001). The mean length of stay decreased from 9.1 days to 8.8 days, resulting in a 21.1 percent decrease in hospital bed days (p<.001). Day hospital use increased sevenfold from 16,871 encounters in 1993 to 108,517 encounters in 1996. The largest decrease in hospital admissions among study conditions was a 41 percent decrease for diabetes (from 2.25 per 1,000 in 1993 to 1.31 in 1996, p<.001). For eight of the nine conditions, severity of illness increased. Differences between severity-adjusted expected and observed in-hospital mortality rates were small. CONCLUSIONS: Observed trends showed a decrease in ordinary hospital admissions, an increase in day hospital admissions, and a greater severity of illness among hospitalized patients. There was little or no change in mortality and readmission rates. Administrative data can be used to track changes in patterns of care and to identify potential quality problems deserving further review. PMID:10199684

Safety of clinical and non-clinical decision makers in telephone triage: a narrative review.

PubMed

Wheeler, Sheila Q; Greenberg, Mary E; Mahlmeister, Laura; Wolfe, Nicole

2015-09-01

Patient safety is a persistent problem in telephone triage research; however, studies have not differentiated between clinicians' and non-clinicians' respective safety. Currently, four groups of decision makers perform aspects of telephone triage: clinicians (physicians, nurses), and non-clinicians (emergency medical dispatchers (EMD) and clerical staff). Using studies published between 2002-2012, we applied Donabedian's structure-process-outcome model to examine groups' systems for evidence of system completeness (a minimum measure of structure and quality). We defined system completeness as the presence of a decision maker and four additional components: guidelines, documentation, training, and standards. Defining safety as appropriate referrals (AR) - (right time, right place with the right person), we measured each groups' corresponding AR rate percentages (outcomes). We analyzed each group's respective decision-making process as a safe match to the telephone triage task, based on each group's system structure completeness, process and AR rates (outcome). Studies uniformly noted system component presence: nurses (2-4), physicians (1), EMDs (2), clerical staff (1). Nurses had the highest average appropriate referral (AR) rates (91%), physicians' AR (82% average). Clerical staff had no system and did not perform telephone triage by standard definitions; EMDs may represent the use of the wrong system. Telephone triage appears least safe after hours when decision makers with the least complete systems (physicians, clerical staff) typically manage calls. At minimum, telephone triage decision makers should be clinicians; however, clinicians' safety calls for improvement. With improved training, standards and CDSS quality, the 24/7 clinical call center has potential to represent the national standard. © The Author(s) 2015.

Quantitative evaluation of patient-specific quality assurance using online dosimetry system

NASA Astrophysics Data System (ADS)

Jung, Jae-Yong; Shin, Young-Ju; Sohn, Seung-Chang; Min, Jung-Whan; Kim, Yon-Lae; Kim, Dong-Su; Choe, Bo-Young; Suh, Tae-Suk

2018-01-01

In this study, we investigated the clinical performance of an online dosimetry system (Mobius FX system, MFX) by 1) dosimetric plan verification using gamma passing rates and dose volume metrics and 2) error-detection capability evaluation by deliberately introduced machine error. Eighteen volumetric modulated arc therapy (VMAT) plans were studied. To evaluate the clinical performance of the MFX, we used gamma analysis and dose volume histogram (DVH) analysis. In addition, to evaluate the error-detection capability, we used gamma analysis and DVH analysis utilizing three types of deliberately introduced errors (Type 1: gantry angle-independent multi-leaf collimator (MLC) error, Type 2: gantry angle-dependent MLC error, and Type 3: gantry angle error). A dosimetric verification comparison of physical dosimetry system (Delt4PT) and online dosimetry system (MFX), gamma passing rates of the two dosimetry systems showed very good agreement with treatment planning system (TPS) calculation. For the average dose difference between the TPS calculation and the MFX measurement, most of the dose metrics showed good agreement within a tolerance of 3%. For the error-detection comparison of Delta4PT and MFX, the gamma passing rates of the two dosimetry systems did not meet the 90% acceptance criterion with the magnitude of error exceeding 2 mm and 1.5 ◦, respectively, for error plans of Types 1, 2, and 3. For delivery with all error types, the average dose difference of PTV due to error magnitude showed good agreement between calculated TPS and measured MFX within 1%. Overall, the results of the online dosimetry system showed very good agreement with those of the physical dosimetry system. Our results suggest that a log file-based online dosimetry system is a very suitable verification tool for accurate and efficient clinical routines for patient-specific quality assurance (QA).

Neural Flight Control System

NASA Technical Reports Server (NTRS)

Gundy-Burlet, Karen

2003-01-01

The Neural Flight Control System (NFCS) was developed to address the need for control systems that can be produced and tested at lower cost, easily adapted to prototype vehicles and for flight systems that can accommodate damaged control surfaces or changes to aircraft stability and control characteristics resulting from failures or accidents. NFCS utilizes on a neural network-based flight control algorithm which automatically compensates for a broad spectrum of unanticipated damage or failures of an aircraft in flight. Pilot stick and rudder pedal inputs are fed into a reference model which produces pitch, roll and yaw rate commands. The reference model frequencies and gains can be set to provide handling quality characteristics suitable for the aircraft of interest. The rate commands are used in conjunction with estimates of the aircraft s stability and control (S&C) derivatives by a simplified Dynamic Inverse controller to produce virtual elevator, aileron and rudder commands. These virtual surface deflection commands are optimally distributed across the aircraft s available control surfaces using linear programming theory. Sensor data is compared with the reference model rate commands to produce an error signal. A Proportional/Integral (PI) error controller "winds up" on the error signal and adds an augmented command to the reference model output with the effect of zeroing the error signal. In order to provide more consistent handling qualities for the pilot, neural networks learn the behavior of the error controller and add in the augmented command before the integrator winds up. In the case of damage sufficient to affect the handling qualities of the aircraft, an Adaptive Critic is utilized to reduce the reference model frequencies and gains to stay within a flyable envelope of the aircraft.

Water Quality Conditions in the Missouri River Mainstem System: 2008 Report

DTIC Science & Technology

2009-09-01

aluminum, arsenic, cadmium , chromium, copper, cyanide, lead, nickel, selenium, silver, and zinc . The acute and chronic water quality standards criteria for... adipose , etc.) tend to accumulate toxicants at different rates. Therefore, when used as an indicator, fish tissue analysis typically uses whole...for metals (i.e., cadmium , chromium, copper, lead, nickel, silver, and zinc ) are based on hardness. Criteria shown for those metals were calculated

Guide for Indoor Air Quality Surveys

DTIC Science & Technology

1992-05-01

investigations, but is most useful as a tool for the Heating, Ventilating, and Air-Conditioning ( HVAC ) experts. The standard describes two procedures for...providing acceptable air quality and includes design criteria for HVAC systems. Perhaps the most important contribution from ASHRAE 62-1989 is its...Selected Selected Cause Subcauses Subrates(%) Overall Rate(%) A. Inadequate Design or Maintenance of HVAC 70 (32/46) Al. Mold 47 (15/32) 33 (15/46) A2

Classification and Quality Evaluation of Tobacco Leaves Based on Image Processing and Fuzzy Comprehensive Evaluation

PubMed Central

Zhang, Fan; Zhang, Xinhong

2011-01-01

Most of classification, quality evaluation or grading of the flue-cured tobacco leaves are manually operated, which relies on the judgmental experience of experts, and inevitably limited by personal, physical and environmental factors. The classification and the quality evaluation are therefore subjective and experientially based. In this paper, an automatic classification method of tobacco leaves based on the digital image processing and the fuzzy sets theory is presented. A grading system based on image processing techniques was developed for automatically inspecting and grading flue-cured tobacco leaves. This system uses machine vision for the extraction and analysis of color, size, shape and surface texture. Fuzzy comprehensive evaluation provides a high level of confidence in decision making based on the fuzzy logic. The neural network is used to estimate and forecast the membership function of the features of tobacco leaves in the fuzzy sets. The experimental results of the two-level fuzzy comprehensive evaluation (FCE) show that the accuracy rate of classification is about 94% for the trained tobacco leaves, and the accuracy rate of the non-trained tobacco leaves is about 72%. We believe that the fuzzy comprehensive evaluation is a viable way for the automatic classification and quality evaluation of the tobacco leaves. PMID:22163744

Initial clinical results with a new needle screen storage phosphor system in chest radiograms.

PubMed

Körner, M; Wirth, S; Treitl, M; Reiser, M; Pfeifer, K-J

2005-11-01

To evaluate image quality and anatomical detail depiction in dose-reduced digital plain chest radiograms using a new needle screen storage phosphor (NIP) in comparison to full dose conventional powder screen storage phosphor (PIP) images. 24 supine chest radiograms were obtained with PIP at standard dose and compared to follow-up studies of the same patients obtained with NIP with dose reduced to 50 % of the PIP dose (all imaging systems: AGFA-Gevaert, Mortsel, Belgium). In both systems identical versions of post-processing software supplied by the manufacturer were used with matched parameters. Six independent readers blinded to both modality and dose evaluated the images for depiction and differentiation of defined anatomical regions (peripheral lung parenchyma, central lung parenchyma, hilum, heart, diaphragm, upper mediastinum, and bone). All NIP images were compared to the corresponding PIP images using a five-point scale (- 2, clearly inferior to + 2, clearly superior). Overall image quality was rated for each PIP and NIP image separately (1, not usable to 5, excellent). PIP and dose reduced NIP images were rated equivalent. Mean image noise impression was only slightly higher on NIP images. Mean image quality for NIP showed no significant differences (p > 0.05, Mann-Whitney U test). With the use of the new needle structured storage phosphors in chest radiography, dose reduction of up to 50 % is possible without detracting from image quality or detail depiction. Especially in patients with multiple follow-up studies the overall dose can be decreased significantly.