Where's the beef? Retail channel choice and beef preferences in Argentina.

PubMed

Colella, Florencia; Ortega, David L

2017-11-01

Argentinean beef is recognized and demanded internationally. Locally, consumers are often unable to afford certified beef products, and may rely on external cues to determine beef quality. Uncovering demand for beef attributes and marketing them accordingly, may require an understanding of consumers' product purchasing strategies, which involves retailer choice. We develop a framework utilizing latent class analysis to identify consumer groups with different retailer preferences, and separately estimate their demand for beef product attributes. This framework accounts for the interrelationship between consumers' choice of retail outlets and beef product preferences. Our analysis of data from the city of Buenos Aires identifies two groups of consumers, a convenience- (67%) and a service- (33%) oriented group. We find significant differences in demand for beef attributes across these groups, and find that the service oriented group, while not willing to pay for credence attributes, relies on a service-providing retailer-namely a butcher-as a source of product quality assurance. Copyright © 2017. Published by Elsevier Ltd.

A roadmap for improving healthcare service quality.

PubMed

Kennedy, Denise M; Caselli, Richard J; Berry, Leonard L

2011-01-01

A data-driven, comprehensive model for improving service and creating long-term value was developed and implemented at Mayo Clinic Arizona (MCA). Healthcare organizations can use this model to prepare for value-based purchasing, a payment system in which quality and patient experience measures will influence reimbursement. Surviving and thriving in such a system will require a comprehensive approach to sustaining excellent service performance from physicians and allied health staff (e.g., nurses, technicians, nonclinical staff). The seven prongs in MCA's service quality improvement model are (1) multiple data sources to drive improvement, (2) accountability for service quality, (3) service consultation and improvement tools, (4) service values and behaviors, (5) education and training, (6) ongoing monitoring and control, and (7) recognition and reward. The model was fully implemented and tested in five departments in which patient perception of provider-specific service attributes and/or overall quality of care were below the 90th percentile for patient satisfaction in the vendor's database. Extent of the implementation was at the discretion of department leadership. Perception data rating various service attributes were collected from randomly selected patients and monitored over a 24-month period. The largest increases in patient perception of excellence over the pilot period were realized when all seven prongs of the model were implemented as a comprehensive improvement approach. The results of this pilot may help other healthcare organizations prepare for value-based purchasing.

CoSEC: Connecting Living With a Star Research

NASA Astrophysics Data System (ADS)

Hurlburt, N.; Freeland, S.; Bose, P.; Zimdars, A.; Slater, G.

2006-12-01

The Collaborative Sun-Earth Connector (CoSEC) provide the means for heliophysics researchers to compose the data sources and processing services published by their peers into processing workflows that reliably generate publication-worthy data. It includes: composition of computational and data services into easy-to- read workflows with data quality and version traceability; straightforward translation of existing services into workflow components, and advertisement of those components to other members of the CoSEC community; annotation of published services with functional attributes to enable discovery of capabilities required by particular workflows and identify peer subgroups in the CoSEC community; and annotation of published services with nonfunctional attributes to enable selection on the basis of quality of service (QoS). We present an overview and demonstration of the CoSEC system, discuss applications, the lessons learned and future developments.

Physician Service Attribution Methods for Examining Provision of Low-Value Care

PubMed Central

Chang, Eva; Buist, Diana SM; Handley, Matthew; Pardee, Roy; Gundersen, Gabrielle; Reid, Robert J.

2016-01-01

Objectives: There has been significant research on provider attribution for quality and cost. Low-value care is an area of heightened focus, with little of the focus being on measurement; a key methodological decision is how to attribute delivered services and procedures. We illustrate the difference in relative and absolute physician- and panel-attributed services and procedures using overuse in cervical cancer screening. Study Design: A retrospective, cross-sectional study in an integrated health care system. Methods: We used 2013 physician-level data from Group Health Cooperative to calculate two utilization attributions: (1) panel attribution with the procedure assigned to the physician’s predetermined panel, regardless of who performed the procedure; and (2) physician attribution with the procedure assigned to the performing physician. We calculated the percentage of low-value cervical cancer screening tests and ranked physicians within the clinic using the two utilization attribution methods. Results: The percentage of low-value cervical cancer screening varied substantially between physician and panel attributions. Across the whole delivery system, median panel- and physician-attributed percentages were 15 percent and 10 percent, respectively. Among sampled clinics, panel-attributed percentages ranged between 10 percent and 17 percent, and physician-attributed percentages ranged between 9 percent and 13 percent. Within a clinic, median panel-attributed screening percentage was 17 percent (range 0 percent–27 percent) and physician-attributed percentage was 11 percent (range 0 percent–24 percent); physician rank varied by attribution method. Conclusions: The attribution method is an important methodological decision when developing low-value care measures since measures may ultimately have an impact on national benchmarking and quality scores. Cross-organizational dialogue and transparency in low-value care measurement will become increasingly important for all stakeholders. PMID:28203612

Physician Service Attribution Methods for Examining Provision of Low-Value Care.

PubMed

Chang, Eva; Buist, Diana Sm; Handley, Matthew; Pardee, Roy; Gundersen, Gabrielle; Reid, Robert J

2016-01-01

There has been significant research on provider attribution for quality and cost. Low-value care is an area of heightened focus, with little of the focus being on measurement; a key methodological decision is how to attribute delivered services and procedures. We illustrate the difference in relative and absolute physician- and panel-attributed services and procedures using overuse in cervical cancer screening. A retrospective, cross-sectional study in an integrated health care system. We used 2013 physician-level data from Group Health Cooperative to calculate two utilization attributions: (1) panel attribution with the procedure assigned to the physician's predetermined panel, regardless of who performed the procedure; and (2) physician attribution with the procedure assigned to the performing physician. We calculated the percentage of low-value cervical cancer screening tests and ranked physicians within the clinic using the two utilization attribution methods. The percentage of low-value cervical cancer screening varied substantially between physician and panel attributions. Across the whole delivery system, median panel- and physician-attributed percentages were 15 percent and 10 percent, respectively. Among sampled clinics, panel-attributed percentages ranged between 10 percent and 17 percent, and physician-attributed percentages ranged between 9 percent and 13 percent. Within a clinic, median panel-attributed screening percentage was 17 percent (range 0 percent-27 percent) and physician-attributed percentage was 11 percent (range 0 percent-24 percent); physician rank varied by attribution method. The attribution method is an important methodological decision when developing low-value care measures since measures may ultimately have an impact on national benchmarking and quality scores. Cross-organizational dialogue and transparency in low-value care measurement will become increasingly important for all stakeholders.

Essential managerial attributes of the nowadays nursing service manager in the South African context.

PubMed

Jooste, K

2003-08-01

Nursing service managers need certain essential managerial attributes in taking the lead in effective management of the nowadays health care organisations in South Africa. Major changes in restructuring and human resources planning are taking place through transformation of health services and specific managerial attributes are needed in this scenario. Without nursing service managers with the necessary managerial attributes, change in the health care environment will be hampered and planning, organising, directing and control of the delivering of quality care will be negatively influenced. The research problem was addressed in the following question that guided the study: Which essential attributes/characteristics should a nursing service manager possess to run a health care service effectively? It was unclear what the opinions of all level of nurse managers were regarding the necessary managerial attributes the health services manager currently need to run the current health care services effectively. This study aimed at highlighting the necessary attributes of the nowadays nursing service manager in running a health care institution in the current health care environment of South Africa. Purposive sampling was done and forty-five functional, middle and top-level managers registered for a second year degree course in Health Services Management at a South African university participated in the study. The findings indicated important managerial and leadership attributes, which the current nursing service manager should possess. This article will only discuss the important managerial attributes needed. A conceptual framework came to the fore according to which an example of a self-evaluation instrument was compiled for nursing service managers for future use. The results of the data analysis indicated that the nursing service manager should promote good interpersonal relationships with colleagues, subordinates and patients through the attributes of openness, being inviting and empowering behavior. The purpose of this article is to make nursing service managers more aware of the necessary attributes they should possess and should develop to manage nursing services more effectively.

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

PubMed

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

2017-10-01

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

Impact of service attributes on customer satisfaction and loyalty in a healthcare context.

PubMed

Lonial, Subash; Raju, P S

2015-01-01

The purpose of this paper is to examine the role of perceived service attributes in the development of overall customer satisfaction (OCS) and customer loyalty (CL) in a health-care setting. This paper also sheds light on the role of hospitalist physicians (HPs) and offers suggestions to improve patient satisfaction and loyalty. A telephone survey was used to collect data from recently hospitalized patients with respect to their HP. Structural equations modeling (SEM) was used to confirm the overall relationships between perceived service quality (PSQ), OCS and CL. The sample was then divided into customer relationship groups (CRGs) based on satisfaction and loyalty measures. Discriminant analysis was used to determine which attributes differentiated most between high and low satisfaction and loyalty groups. Overall relationships among PSQ, OCS and CL were in conformity with the conceptual model. Findings also revealed that service attributes played an important role in distinguishing between high and low satisfaction and loyalty groups, although some attributes were more important than others and different attributes emerged as being key influencers for satisfaction and loyalty. The conceptual model used is a fairly straight forward model, and we have not considered the impact of individual factors such as expectations and value perceptions or involvement levels and demographic characteristics on service quality and overall satisfaction. The data for this study were provided by a major health maintenance organization (HMO), and there is room for improvement in the manner in which certain constructs were measured. For example, OCS, recommendation and retention all used single item measures, and it might have been preferable to use multiple item measures for these constructs. The study shows that organizations can benefit by identifying and focusing on critical attributes as part of their customer relationship management program. The SEM results provide strong support for the overall model linking service quality, OCS and CL in a health-care setting. As one would expect, PSQ has a strong impact on OCS, which, in turn, has a fairly strong impact on CL. However, there is also a significant direct linkage between PSQ and CL. This linkage shows that at least a certain portion of CL could evolve independent of the satisfaction level with the HP. This shows that, in addition to trying to improve satisfaction, organizations should also explore influencing loyalty directly, perhaps by the strategic use of service attribute perceptions. The study shows that customer perceptions at the service attribute level can often be the key to the generation and management of customer satisfaction and loyalty. It also has significance for how satisfaction and loyalty with HPs can be improved in a hospital setting.

E-Services quality assessment framework for collaborative networks

NASA Astrophysics Data System (ADS)

Stegaru, Georgiana; Danila, Cristian; Sacala, Ioan Stefan; Moisescu, Mihnea; Mihai Stanescu, Aurelian

2015-08-01

In a globalised networked economy, collaborative networks (CNs) are formed to take advantage of new business opportunities. Collaboration involves shared resources and capabilities, such as e-Services that can be dynamically composed to automate CN participants' business processes. Quality is essential for the success of business process automation. Current approaches mostly focus on quality of service (QoS)-based service selection and ranking algorithms, overlooking the process of service composition which requires interoperable, adaptable and secure e-Services to ensure seamless collaboration, data confidentiality and integrity. Lack of assessment of these quality attributes can result in e-Service composition failure. The quality of e-Service composition relies on the quality of each e-Service and on the quality of the composition process. Therefore, there is the need for a framework that addresses quality from both views: product and process. We propose a quality of e-Service composition (QoESC) framework for quality assessment of e-Service composition for CNs which comprises of a quality model for e-Service evaluation and guidelines for quality of e-Service composition process. We implemented a prototype considering a simplified telemedicine use case which involves a CN in e-Healthcare domain. To validate the proposed quality-driven framework, we analysed service composition reliability with and without using the proposed framework.

You Can Make Your Facilities Services Provider Part of the College Community.

ERIC Educational Resources Information Center

Ledbetter, Randy

2002-01-01

Discusses five attributes that, when well implemented, form the framework for successful relationships between college administration and services companies: reporting relationships, Quality of Service (QoS) measures, formal reports and reviews, employee relations, and subcontractor relations. (EV)

The impact of a quality-improvement package on reproductive health services delivered by private providers in Uganda.

PubMed

Agha, Sohail

2010-09-01

This study assesses the effectiveness of a quality-improvement (QI) package designed to enable small-scale commercial reproductive health (RH) service providers to improve the services they offer. The study was conducted among midwives who are members of the Uganda Private Midwives Association. A pretest-post-test quasi-experimental panel study design was used wherein midwife clinics were allocated to two experimental groups and one control group. Baseline and follow-up measurements of structural and process attributes of quality were taken at the clinics by means of a facility inventory, interviews with midwives, and observations of client-provider interactions. Nearly 70 percent of the midwives who were trained to use the package reported that it was easy to use. Among clinics in which midwives received training in the use of the self-assessment tool and in developing action plans, structural and process attributes of quality improved only among those clinics in which the midwives' supervisors received training in finding solutions to the problems identified through self-assessments. The QI package may be implemented with small-scale private providers of RH services who are part of a professional association, network, or franchise that supervises their performance.

Patient satisfaction in Japan.

PubMed

Elleuch, Amira

2008-01-01

To extend existing knowledge about health care quality and patient satisfaction by exploring Japanese context having a different health care system and a different culture from the USA and Europe. A structural equation model is used to explore links between quality perception and patient satisfaction as well as between patient satisfaction and intentional behavior relying on 159 Japanese outpatient replies. Japanese healthcare service quality is evaluated using its process characteristics (patient-provider interaction) and physical attributes (settings and appearance). Process quality attributes were found to be patient satisfaction antecedents. Satisfaction in turn predicts patient intentional behavior (to return and to recommend). Japanese society cultural specificity seems to be an interesting background to understand Japanese evaluation when patients assess health service quality. The sample investigated is relatively small. The study relied on a linear approach to assess patient satisfaction and intentional behavior. However, the non-linear model should yield a better reality fit. To improve Japanese patient satisfaction, cultural values such as courtesy, empathy and harmony should be emphasized when delivering medical services. Satisfied consumers are an important asset for the healthcare provider as they intend to reuse the service and to recommend it to their families and friends. Both foreign and Japanese providers should adopt a consumer perspective to enhance the service quality and then to maintain long-term relationships with their customers. The study used structural equation analysis to assess patient satisfaction in a scarcely investigated context. Moreover, the study relies on Japanese society's cultural characteristics to explain and understand results.

Critical to quality in telemedicine service management: application of DFSS (Design for Six Sigma) and SERVQUAL).

PubMed

Yun, Eun Kyoung; Chun, Kee Moon

2008-01-01

Telemedicine generally refers to the use of communications and information technologies for the delivery of health care. owever, telemedicine is not merely a simple combination of health care and technology. The researchers propose a systematic approach for assessing needs of telemedicine customers, called critical-to-quality (CTQ) in Six Sigma, with a purpose of continuous quality improvement. The combination approach using DFSS (Design for Six Sigma) and SERVQUAL (Service Quality Framework) was applied to define the critical quality attributes of telemedicine service management and to match them with the current telemedicine process. With a step-by-step procedure, telemedicine service process was reviewed and all the important CTQ candidates identified via a case study. The findings suggest that nurses need further understanding and research methods that will improve and manage the quality of health care service in various medical fields.

Plate versus bulk trolley food service in a hospital: comparison of patients' satisfaction.

PubMed

Hartwell, Heather J; Edwards, John S A; Beavis, John

2007-03-01

The aim of this research was to compare plate with bulk trolley food service in hospitals in terms of patient satisfaction. Key factors distinguishing satisfaction with each system would also be identified. A consumer opinion card (n = 180), concentrating on the quality indicators of core foods, was used to measure patient satisfaction and compare two systems of delivery, plate and trolley. Binary logistic regression analysis was used to build a model that would predict food service style on the basis of the food attributes measured. Further investigation used multinomial logistic regression to predict opinion for the assessment of each food attribute within food service style. Results showed that the bulk trolley method of food distribution enables all foods to have a more acceptable texture, and for some foods (potato, P = 0.007; poached fish, P = 0.001; and minced beef, P < or = 0.0005) temperature, and for other foods (broccoli, P < or = 0.0005; carrots, P < or = 0.0005; and poached fish, P = 0.001) flavor, than the plate system of delivery, where flavor is associated with bad opinion or dissatisfaction. A model was built indicating patient satisfaction with the two service systems. This research confirms that patient satisfaction is enhanced by choice at the point of consumption (trolley system); however, portion size was not the controlling dimension. Temperature and texture were the most important attributes that measure patient satisfaction with food, thus defining the focus for hospital food service managers. To date, a model predicting patient satisfaction with the quality of food as served has not been proposed, and as such this work adds to the body of knowledge in this field. This report brings new information about the service style of dishes for improving the quality of food and thus enhancing patient satisfaction.

Preferences for home- and community-based long-term care services in Germany: a discrete choice experiment.

PubMed

Lehnert, T; Günther, O H; Hajek, A; Riedel-Heller, S G; König, H H

2018-04-06

Most people prefer to "age in place" and to remain in their homes for as long as possible even in case they require long-term care. While informal care is projected to decrease in Germany, the use of home- and community-based services (HCBS) can be expected to increase in the future. Preference-based data on aspects of HCBS is needed to optimize person-centered care. To investigate preferences for home- and community-based long-term care services packages. Discrete choice experiment conducted in mailed survey. Randomly selected sample of the general population aged 45-64 years in Germany (n = 1.209). Preferences and marginal willingness to pay (WTP) for HCBS were assessed with respect to five HCBS attributes (with 2-4 levels): care time per day, service level of the HCBS provider, quality of care, number of different caregivers per month, co-payment. Quality of care was the most important attribute to respondents and small teams of regular caregivers (1-2) were preferred over larger teams. Yet, an extended range of services of the HCBS provider was not preferred over a more narrow range. WTP per hour of HCBS was €8.98. Our findings on preferences for HCBS in the general population in Germany add to the growing international evidence of preferences for LTC. In light of the great importance of high care quality to respondents, reimbursement for services by HCBS providers could be more strongly linked to the quality of services.

Ambient assisted living healthcare frameworks, platforms, standards, and quality attributes.

PubMed

Memon, Mukhtiar; Wagner, Stefan Rahr; Pedersen, Christian Fischer; Beevi, Femina Hassan Aysha; Hansen, Finn Overgaard

2014-03-04

Ambient Assisted Living (AAL) is an emerging multi-disciplinary field aiming at exploiting information and communication technologies in personal healthcare and telehealth systems for countering the effects of growing elderly population. AAL systems are developed for personalized, adaptive, and anticipatory requirements, necessitating high quality-of-service to achieve interoperability, usability, security, and accuracy. The aim of this paper is to provide a comprehensive review of the AAL field with a focus on healthcare frameworks, platforms, standards, and quality attributes. To achieve this, we conducted a literature survey of state-of-the-art AAL frameworks, systems and platforms to identify the essential aspects of AAL systems and investigate the critical issues from the design, technology, quality-of-service, and user experience perspectives. In addition, we conducted an email-based survey for collecting usage data and current status of contemporary AAL systems. We found that most AAL systems are confined to a limited set of features ignoring many of the essential AAL system aspects. Standards and technologies are used in a limited and isolated manner, while quality attributes are often addressed insufficiently. In conclusion, we found that more inter-organizational collaboration, user-centered studies, increased standardization efforts, and a focus on open systems is needed to achieve more interoperable and synergetic AAL solutions.

Ambient Assisted Living Healthcare Frameworks, Platforms, Standards, and Quality Attributes

PubMed Central

Memon, Mukhtiar; Wagner, Stefan Rahr; Pedersen, Christian Fischer; Beevi, Femina Hassan Aysha; Hansen, Finn Overgaard

2014-01-01

Ambient Assisted Living (AAL) is an emerging multi-disciplinary field aiming at exploiting information and communication technologies in personal healthcare and telehealth systems for countering the effects of growing elderly population. AAL systems are developed for personalized, adaptive, and anticipatory requirements, necessitating high quality-of-service to achieve interoperability, usability, security, and accuracy. The aim of this paper is to provide a comprehensive review of the AAL field with a focus on healthcare frameworks, platforms, standards, and quality attributes. To achieve this, we conducted a literature survey of state-of-the-art AAL frameworks, systems and platforms to identify the essential aspects of AAL systems and investigate the critical issues from the design, technology, quality-of-service, and user experience perspectives. In addition, we conducted an email-based survey for collecting usage data and current status of contemporary AAL systems. We found that most AAL systems are confined to a limited set of features ignoring many of the essential AAL system aspects. Standards and technologies are used in a limited and isolated manner, while quality attributes are often addressed insufficiently. In conclusion, we found that more inter-organizational collaboration, user-centered studies, increased standardization efforts, and a focus on open systems is needed to achieve more interoperable and synergetic AAL solutions. PMID:24599192

Where Would You Go for Your Next Hospitalization?

PubMed Central

Jung, Kyoungrae; Feldman, Roger; Scanlon, Dennis

2014-01-01

We examine the effects of diverse dimensions of hospital quality – including consumers’ perceptions of unobserved attributes – on future hospital choice. We utilize consumers’ stated preference weights to obtain hospital-specific estimates of perceptions about unmeasured attributes such as reputation. We report three findings. First, consumers’ perceptions of reputation and medical services contribute substantially to utility for a hospital choice. Second, consumers tend to select hospitals with high clinical quality scores even before the scores are publicized. However, the effect of clinical quality on hospital choice is relatively small. Third, satisfaction with a prior hospital admission has a large impact on future hospital choice. Our findings suggest that including measures of consumers’ experience in report cards may increase their responsiveness to publicized information, but other strategies are needed to overcome the large effects of consumers’ beliefs about other quality attributes. PMID:21665300

Close relationships and attributions for peer victimization among late adolescents.

PubMed

Chen, Xiaochen; Graham, Sandra

2012-12-01

This study examined the effect of close relationships (best friendship and romantic relationship) on late adolescents' casual attributions for peer victimization. A total of 1106 twelfth grade students completed self-report measures of perceived peer victimization, self-blame attribution, psychological maladjustment (loneliness and social anxiety), and quality of close peer relationships. Results indicated that self-blame partly mediated the link between peer victimization and psychological maladjustment. Relationship quality moderated the victimization-self-blame relation. Participants were more likely to endorse self-blame attributions for peer victimization when they had a negative relationship with a best friend or romantic partner. The moderated effect of negative best friendship quality was only significant for girls, whereas the moderated effect of negative romantic relationship quality was only significant for boys. Implications of these findings for future research on close relations during adolescence and for interventions to reduce the effects of peer victimization were discussed. Copyright © 2012 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Quality of care and the demand for health services in Bamako, Mali: the specific roles of structural, process, and outcome components.

PubMed

Mariko, Mamadou

2003-03-01

The public finance and foreign exchange crisis of the 1980s aggravated the unfavourable economic trends in many developing countries and resulted in budget cuts in the health sector. Policymakers, following the suggestions of World Bank experts, introduced user fees. Economic analysis of the demand for health care in these countries focused on the impact of price and income on health service utilisation. But the lesson to date from experiences in cost recovery is that without visible and fairly immediate improvements in the quality of care, the implementation of user fees will cause service utilisation to drop. For this reason, the role of quality of health care has been recently a subject of investigation in a number of health care demand studies. In spite of using the data from both households and facilities, recent studies are quite limited because they measure quality only by structural attributes (availability of drugs, equipment, number and qualifications of staff, and so on). Structural attributes of quality are necessary but not sufficient conditions for demand. A unique feature of this study is that it also considers the processes followed by practitioners and the outcome of care, to determine simultaneously the respective influence of price and quality on decision making. A nested multinomial logit was used to examine the choice between six alternatives (self-treatment, modern treatment at home, public hospital, public dispensary, for-profit facility and non-profit facility). The estimations are based on data from a statistically representative sample of 1104 patients from 1191 households and the data from a stratified random sample of 42 out of 84 facilities identified. The results indicate that omitting the process quality variables from the demand model produces a bias not only in the estimated coefficient of the "price" variable but also in coefficients of some structural attributes of the quality. The simulations suggest that price has a minor effect on utilisation of health services, and that health authorities can simultaneously double user fees and increase utilisation by emphasising improvement of both the structural and process quality of care in public health facilities.

Penalty-rewards contrast analysis (PRCA) on the KL monorail services

NASA Astrophysics Data System (ADS)

Muda, Nora; Suradi, Nur Riza; Mat Roji, Noor Sulawati

2013-04-01

Changes in living standards, tastes, views and education has changed the lifestyles where people are more emphasizing on quality and satisfaction with public amenities provided. One of the services provided is the KL Monorail; a public transport service which is based on a single beam track in the city that connects the north and center of Kuala Lumpur. Therefore, this study measures the customer satisfaction on the KL Monorail services and to identify the factors that should be given priority in improving their service levels. There were seven attributes being studied, namely the informations, the situation at the station, the situation in the KL Monorail, customer service, safety, efficiency and other aspects. The analysis found that the overall customer satisfactionis mean is 4.86. Based on the measurement of Penalty-Reward Contrast Analysis (PRCA), most of the KL Monorail service attribute are at moderate level of satisfaction except for the attributes at the station that have lower level of satisfaction. Therefore, a remedial actions or planning is needed to improve the customer satisfaction on the KL Monorail services.

Managing the System of Higher Education: Competition or Collaboration?

ERIC Educational Resources Information Center

Maguad, Ben A.

2018-01-01

The systems view of quality postulates that product or service quality comes as the result of interactions between various components that comprise a production process. In view of this, most problems in the organization, like an institution of higher education, can be attributed to the system. To be effective, any quality improvement initiative…

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

PubMed Central

2011-01-01

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

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

PubMed

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

2011-08-24

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

Train users’ perceptions of walking distance to train station and attributes of paratransit service: understanding their association with decision using paratransit or not towards the train station

NASA Astrophysics Data System (ADS)

Syafriharti, R.; Kombaitan, B.; Kusumantoro, I. P.; Syabri, I.

2018-05-01

Access mode is an important factor in public transport systems. Most of the train users from Cicalengka to Padalarang via Bandung use paratransit as access mode. Access modes under this study are only paratransit and walking. This study aims to explore the relationship between access mode choice to the station and the perception about walking distance to station, perception about attributes of paratransit service quality which consist of accessibility, cheapness, comfortable, swiftness, safety, security and easiness. Of all the variables tested, walking distance to the station is the only variable relating to the mode access choice. So, a person will tend to use paratransit when his/her perception of walking distance to station is relatively far away. While perceptions about the quality of paratransit service can not determine whether a person will choose paratransit or not.

The association between attributions of responsibility for motor vehicle accidents and patient satisfaction: a study within a no-fault injury compensation system.

PubMed

Thompson, Jason; Berk, Michael; O'Donnell, Meaghan; Stafford, Lesley; Nordfjaern, Trond

2015-05-01

This study set out to test the relationship between attributions of responsibility for motor vehicle accidents and satisfaction with personal injury compensation systems. The study analysed survey data from 1394 people injured in a motor vehicle accident who were compensated under a no-fault personal injury compensation system. Patients' ratings of satisfaction with the compensation system across five domains (resolves your issues, keeps you up-to-date, treats you as an individual, cares about you, and overall satisfaction) were analysed alongside patient attributions of responsibility for their accident (not responsible, partly responsible, totally responsible). Postaccident physical and mental health status, age, gender, and duration of compensation claim were controlled for in the analysis. A multivariate analysis of covariance indicated attributions of responsibility for accidents were significantly associated with levels of patient satisfaction across all five domains under study (F (10, 2084) = 3.7, p<0.001, η(2)  =0.02). Despite access to virtually indistinguishable services, patients who attributed responsibility for their accidents to others were significantly less satisfied with the injury compensation system than those who attributed responsibility to themselves. Satisfaction with no-fault motor vehicle injury compensation services are associated with patients' attributions of responsibility for their accident. Compensation systems and other rehabilitation services monitoring patient satisfaction should adjust for attributions of responsibility when assessing levels of patient satisfaction between time periods, services, or injured populations. Differences in levels of patient satisfaction observed between compensation or rehabilitation populations may reflect differences in attributions of responsibility for accidents rather than objective service quality. © The Author(s) 2014.

Quality, Organization Design, and Standards.

ERIC Educational Resources Information Center

Gardner, James F.

1992-01-01

This paper discusses regulations and voluntary standards within the context of organizational mission and management leadership for quality in human services. Regulation is seen as a measure of organizational formalism; formalism is seen as an attribute of the machine organization; and both are contrasted to organic control organization models and…

Definition, willingness-to-pay, and ranking of quality attributes of U.S. pork as defined by importers in Asia and Mexico.

PubMed

Murphy, R G L; Howard, S T; Woerner, D R; Pendell, D L; Dixon, C L; Desimone, T L; Green, M D; Igo, J L; Tatum, J D; Belk, K E

2015-01-01

A survey was conducted from November 2009 to April 2010 to determine how importers of pork define 7 predetermined quality categories (food safety, customer service, eating quality, product specification, packaging, visual characteristics, and production history) and to estimate willingness-to-pay (WTP) and establish best-worst (B/W) scaling (rank) for the 7 quality categories. Interviews were conducted in Hong Kong/China (n = 83), Japan (n = 48), Mexico (n = 70) and Russia (n = 54) with importers of U.S. pork or those who had purchased U.S. pork from distributors in the last 3 yr. Interviews used dynamic routing software and were structured such that economic factors for purchase were addressed first, allowing all responses to focus on quality. Questions about WTP and B/W were asked and then each respondent was asked to define what each quality category meant to them. Generalized linear mixed models were used to analyze frequency data. Over 70% of interviewees in Hong Kong/China, Japan, and Mexico responded that purchase price was influential in deciding whether or not to purchase imported pork. This number was lower in Russia, where respondents stated tariff rates were also important, indicating market access was a larger issue in Russia. Food safety was the most important quality category (price was not included as a part of quality) for imported pork followed by specifications. Respondents indicated some form of government inspection was how they defined food safety, whereas product size, weight, and subcutaneous fat were all included in the definition of specifications. Interviewees were more likely to pay premiums for customer service and less likely to pay premiums for packaging (P < 0.05). The premiums that were willing to be paid for guarantees of quality for imported pork variety meats were numerically lower than for whole muscle cuts or processed products. A guarantee associated with food safety of processed pork products was found to be the quality attribute for which importers would be willing to pay the highest premium. Production history was found to be the least important quality attribute for importers of all types of U.S. pork, except those in Japan. Exporters could increase profitability if a guarantee of customer service was made. Price, tariffs, and exchange rates are important to pork importers; these results indicated that if certain quality attributes could be guaranteed, exporters could increase profitability.

The identification and measurement of quality dimensions in health care: focus group interview results.

PubMed

Jun, M; Peterson, R T; Zsidisin, G A

1998-01-01

The identification and measurement of service quality are critical factors that are responsible for customer satisfaction. This article identifies 11 attributes that define quality of care and patient satisfaction and reveals various gaps among the patient, physician, and administrator groups in the perceived importance of those dimensions. Managerial implications for patient-focused health care are discussed.

Analysis of Student Satisfaction in The Process of Teaching and Learning Using Importance Performance Analysis

NASA Astrophysics Data System (ADS)

Sembiring, P.; Sembiring, S.; Tarigan, G.; Sembiring, OD

2017-12-01

This study aims to determine the level of student satisfaction in the learning process at the University of Sumatra Utara, Indonesia. The sample size of the study consisted 1204 students. Students’ response measured through questionnaires an adapted on a 5-point likert scale and interviews directly to the respondent. SERVQUAL method used to measure the quality of service with five dimensions of service characteristics, namely, physical evidence, reliability, responsiveness, assurance and concern. The result of Importance Performance Analysis reveals that six services attributes must be corrected by policy maker of University Sumatera Utara. The quality of service is still considered low by students.

Conjoint Analysis for New Service Development on Electricity Distribution in Indonesia

NASA Astrophysics Data System (ADS)

Widaningrum, D. L.; Chynthia; Astuti, L. D.; Seran, M. A. B.

2017-07-01

Many cases of illegal use of electricity in Indonesia is still rampant, especially for activities where the power source is not available, such as in the location of street vendors. It is not only detrimental to the state, but also harm the perpetrators of theft of electricity and the surrounding communities. The purpose of this study is to create New Service Development (NSD) to provide a new electricity source for street vendors' activity based on their preferences. The methods applied in NSD is Conjoint Analysis, Cluster Analysis, Quality Function Deployment (QFD), Service Blueprint, Process Flow Diagrams and Quality Control Plan. The results of this study are the attributes and their importance in the new electricity’s service based on street vendors’ preferences as customers, customer segmentation, service design for new service, designing technical response, designing operational procedures, the quality control plan of any existing operational procedures.

Valuation of environmental quality and eco-cultural attributes in Northwestern Idaho: Native Americans are more concerned than Caucasians

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

Burger, Joanna, E-mail: burger@biology.rutgers.edu; Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ 08854-8082

Valuation of features of habitats and ecosystems usually encompasses the goods and services that ecosystems provide, but rarely also examine how people value ecological resources in terms of eco-cultural and sacred activities. The social, sacred, and cultural aspects of ecosystems are particularly important to Native Americans, but western science has rarely examined the importance of eco-cultural attributes quantitatively. In this paper I explore differences in ecosystem evaluations, and compare the perceptions and evaluations of places people go for consumptive and non-consumptive resource use with evaluations of the same qualities for religious and sacred places. Qualities of ecosystems included goods (abundantmore » fish and crabs, butterflies and flowers, clean water), services (complexity of nature, lack of radionuclides that present a health risk), and eco-cultural attributes (appears unspoiled, scenic horizons, noise-free). Native Americans and Caucasians were interviewed at a Pow Wow at Post Falls, Idaho, which is in the region with the Department of Energy's Hanford Site, known for its storage of radioactive wastes and contamination. A higher percentage of Native American subjects engaged in consumptive and religious activities than did Caucasians. Native Americans engaged in higher rates of many activities than did Caucasians, including commune with nature, pray or meditate, fish or hunt, collect herbs, and conduct vision quests or other ceremonies. For nearly all attributes, there was no difference in the relative ratings given by Native Americans for characteristics of sites used for consumption/non-consumptive activities compared to religious/sacred places. However, Caucasians rated nearly all attributes lower for religious/sacred places than they did for places where they engaged in consumptive or non-consumptive activities. Native Americans were less concerned with distance from home for consumptive/non-consumptive activities, compared to religious activities. - Research Highlights: {yields} A higher percentage of Native Americans engaged in consumptive and religious activities than did Caucasians interviewed. {yields} Caucasians rated environmental attributes as more important for consumptive and non-consumptive activities than they did for places where they engaged in religious/cultural ones. {yields} Native Americans rated environmental attributes as equally important regardless of the activities performed. {yields} Eco-cultural attributes (such as 'appears unspoiled') were rated as high as ecosystem services (e.g. unpolluted water).« less

Employing the Five-Factor Mentoring Instrument: Analysing Mentoring Practices for Teaching Primary Science

ERIC Educational Resources Information Center

Hudson, Peter; Usak, Muhammet; Savran-Gencer, Ayse

2009-01-01

Primary science education is a concern around the world and quality mentoring within schools can develop pre-service teachers' practices. A five-factor model for mentoring has been identified, namely, personal attributes, system requirements, pedagogical knowledge, modelling, and feedback. Final-year pre-service teachers (mentees, n = 211) from…

Cancer patients' perceptions of quality-of-care attributes-Associations with age, perceived health status, gender and education.

PubMed

Suhonen, Riitta; Stolt, Minna; Berg, Agneta; Katajisto, Jouko; Lemonidou, Chryssoula; Patiraki, Elisabeth; Sjövall, Katarina; Charalambous, Andreas

2018-01-01

The aim of this study was to explore the associations between patients' gender, education, health status in relation to assessments of patient-centred quality and individuality in care and trust in nurses for those <65 (working age) and ≥65 years (older people). Patients' assessments of the quality of care they receive are essential for the development of the provision of patient care and services. Previous studies have revealed age of the patient is associated with their assessment of care quality attributes. The study employed a cross-sectional, multicultural comparative survey design. The data were collected using questionnaires among hospitalised cancer patients (N = 876, n = 599, 68%) in four European countries: Greece, Cyprus, Sweden and Finland. The data were divided into two subgroups based on age (cut point 65 years) and were analysed statistically. Cancer patients' age, gender and level of education were not related to their assessments of care quality attributes: person-centred care quality, individuality in care and trust in nurses. Subgroup analysis of the older adults and those of working age showed clear associations with patients' assessments of quality-of-care attributes and perceived health status. The lower the perceived health status, the lower the assessment of care quality attributes. The results suggest that the cancer itself is the strongest determinant of the care delivered, rather than any patient characteristics, such as age, education or gender. Perceived health status, in association with cancer patient assessments of care quality attributes, may be useful in the development of patient-centred, individualised care strategies alongside a stronger focus on people instead of cancer-care-related processes and duties. Health status was the only factor associated with cancer patients' assessments of care quality attributes. Cancer itself may be the strongest determinant of the care quality perceptions, rather than any patient characteristics. The findings of this study have implications for cancer care professionals in terms of patient assessment and care planning. The measures may be useful in assessing quality of cancer nursing care. © 2017 John Wiley & Sons Ltd.

The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians.

PubMed

Peikes, Deborah; Dale, Stacy; Ghosh, Arkadipta; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Day, Timothy J; Duda, Nancy; Singh, Pragya; Anglin, Grace; Sessums, Laura L; Brown, Randall S

2018-06-01

The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions. The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures. As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care.

Research Challenges in Managing and Using Service Level Agreements

NASA Astrophysics Data System (ADS)

Rana, Omer; Ziegler, Wolfgang

A Service Level Agreement (SLA) represents an agreement between a service user and a provider in the context of a particular service provision. SLAs contain Quality of Service properties that must be maintained by a provider, and as agreed between a provider and a user/client. These are generally defined as a set of Service Level Objectives (SLOs). These properties need to be measurable and must be monitored during the provision of the service that has been agreed in the SLA. The SLA must also contain a set of penalty clauses specifying what happens when service providers fail to deliver the pre-agreed quality. Hence, an SLA may be used by both a user and a provider - from a user perspective, an SLA defines what is required - often defined using non-functional attributes of service provision. From a providers perspective, an SLA may be used to support capacity planning - especially if a provider is making it's capability available to multiple users. An SLA may be used by a client and provider to manage their behaviour over time - for instance, to optimise their long running revenue (cost) or QoS attributes (such as execution time), for instance. The lifecycle of an SLA is outlined, along with various uses of SLAs to support infrastructure management. A discussion about WS-Agreement - the emerging standard for specifying SLAs - is also provided.

Importance-performance analysis of dental satisfaction among three ethnic groups in malaysia.

PubMed

Dewi, Fellani Danasra; Gundavarapu, Kalyan C; Cugati, Navaneetha

2013-01-01

To find the differences in patient satisfaction related to dental services among three ethnic groups - Chinese, Indian and Malay - at AIMST University Dental Centre and analyse them with an importance-performance grid, identifying the weak and strong points, in order to provide better service. This questionnaire-based study consisted of convenience samples of 174 patients of Chinese, Indian and Malay ethnicity. Importance-performance analysis for 20 attributes were compared using Likert's scale. The data obtained were statistically analysed using the Kruskal-Wallis test. Chinese and Indians both emphasised low performance on the interpersonal relationship attribute in terms of the receptionist's courtesy, whereas the Malay participants were concerned with convenience attributes. All the ethnic groups favoured maintaining existing major attributes towards technical competency, interpersonal relationship and facility factors. This study demonstrated priority differences between the ethnic groups' perception of the quality of dental services, where ethnic Chinese showed the highest gap (measure of dissatisfaction) between importance and performance compared to ethnic Malays, followed by ethnic Indians. The patients from the three major ethnic groups of Malaysia were generally well satisfied. Perhaps more priority should be placed on improving the interpersonal relationship attribute, especially with the receptionists.

An effective XML based name mapping mechanism within StoRM

NASA Astrophysics Data System (ADS)

Corso, E.; Forti, A.; Ghiselli, A.; Magnoni, L.; Zappi, R.

2008-07-01

In a Grid environment the naming capability allows users to refer to specific data resources in a physical storage system using a high level logical identifier. This logical identifier is typically organized in a file system like structure, a hierarchical tree of names. Storage Resource Manager (SRM) services map the logical identifier to the physical location of data evaluating a set of parameters as the desired quality of services and the VOMS attributes specified in the requests. StoRM is a SRM service developed by INFN and ICTP-EGRID to manage file and space on standard POSIX and high performing parallel and cluster file systems. An upcoming requirement in the Grid data scenario is the orthogonality of the logical name and the physical location of data, in order to refer, with the same identifier, to different copies of data archived in various storage areas with different quality of service. The mapping mechanism proposed in StoRM is based on a XML document that represents the different storage components managed by the service, the storage areas defined by the site administrator, the quality of service they provide and the Virtual Organization that want to use the storage area. An appropriate directory tree is realized in each storage component reflecting the XML schema. In this scenario StoRM is able to identify the physical location of a requested data evaluating the logical identifier and the specified attributes following the XML schema, without querying any database service. This paper presents the namespace schema defined, the different entities represented and the technical details of the StoRM implementation.

Assessment of child and adult users of the degree of orientation of Primary Healthcare in the city of Rio de Janeiro, Brazil.

PubMed

Harzheim, Erno; Pinto, Luiz Felipe; Hauser, Lisiane; Soranz, Daniel

2016-05-01

In the first half of 2014, 6,675 adults and caregivers of children using Primary Care (PC) services in Rio de Janeiro were interviewed using the Primary Care Assessment Tool - PCATool-Brazil. The aim was to arrive at an accurate overview of the extent to which PC services in all of the Planning Areas (PA) of the Rio de Janeiro City Health Department (CHD) - Municipal Health Secretariat have the essential and derivative attributes. This was a cross-sectional study of random, independent samples of the service users (children and adults). Results were measured using the scores assigned to PC attributes. In the opinion of adults and children using PC services, Type A Units - Municipal Healthcare Centers and Family Clinics staffed only with Family Health Teams, performed better than Type B units. The scores for the attributes "first contact accessibility", "comprehensive service - services provided", "community orientation" and "family orientation" still need to be improved. On the other hand "coordinated care" and "continuity" are on their way to quality scores, being always rated at around 6.0 or even higher.

[Quality planning of Family Health Units using Quality Function Deployment (QFD)].

PubMed

Volpato, Luciana Fernandes; Meneghim, Marcelo de Castro; Pereira, Antonio Carlos; Ambrosano, Gláucia Maria Bovi

2010-08-01

Quality is an indispensible requirement in the health field, and its pursuit is necessary in order to meet demands by a population that is aware of its rights, as part of the essence of good work relations, and to decrease technological costs. Quality thus involves all parties to the process (users and professionals), and is no longer merely an attribute of the health service. This study aimed to verify the possibility of quality planning in the Family Health Units, using Quality Function Deployment (QFD). QFD plans quality according to user satisfaction, involving staff professionals and identifying new approaches to improve work processes. Development of the array, called the House of Quality, is this method's most important characteristics. The results show a similarity between the quality demanded by users and the quality planned by professionals. The current study showed that QFD is an efficient tool for quality planning in public health services.

Federal Workforce. A Framework for Studying Its Quality over Time. Report to the Chairman, Committee on Post Office and Civil Service, House of Representatives.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Program Evaluation and Methodology Div.

The General Accounting Office (GAO) examined the feasibility of assessing the quality of the federal civilian work force, focusing on professional and administrative staff. The agency developed a measurable definition of quality centered on attributes of the individual and the match of the individual's capabilities to the needs of the job. It…

Valuation of environmental quality and eco-cultural attributes in Northwestern Idaho: Native Americans are more concerned than Caucasians

PubMed Central

Burger, Joanna

2015-01-01

Valuation of features of habitats and ecosystems usually encompasses the goods and services that ecosystems provide, but rarely also examine how people value ecological resources in terms of eco-cultural and sacred activities. The social, sacred, and cultural aspects of ecosystems are particularly important to Native Americans, but western science has rarely examined the importance of eco-cultural attributes quantitatively. In this paper I explore differences in ecosystem evaluations, and compare the perceptions and evaluations of places people go for consumptive and non-consumptive resource use with evaluations of the same qualities for religious and sacred places. Qualities of ecosystems included goods (abundant fish and crabs, butterflies and flowers, clean water), services (complexity of nature, lack of radionuclides that present a health risk), and eco-cultural attributes (appears unspoiled, scenic horizons, noise-free). Native Americans and Caucasians were interviewed at a Pow Wow at Post Falls, Idaho, which is in the region with the Department of Energy’s Hanford Site, known for its storage of radioactive wastes and contamination. A higher percentage of Native American subjects engaged in consumptive and religious activities than did Caucasians. Native Americans engaged in higher rates of many activities than did Caucasians, including commune with nature, pray or meditate, fish or hunt, collect herbs, and conduct vision quests or other ceremonies. For nearly all attributes, there was no difference in the relative ratings given by Native Americans for characteristics of sites used for consumption/non-consumptive activities compared to religious/sacred places. However, Caucasians rated nearly all attributes lower for religious/sacred places than they did for places where they engaged in consumptive or non-consumptive activities. Native Americans were less concerned with distance from home for consumptive/non-consumptive activities, compared to religious activities. PMID:21035796

Availability and Primary Health Care Orientation of Dementia-Related Services in Rural Saskatchewan, Canada.

PubMed

Morgan, Debra G; Kosteniuk, Julie G; Stewart, Norma J; O'Connell, Megan E; Kirk, Andrew; Crossley, Margaret; Dal Bello-Haas, Vanina; Forbes, Dorothy; Innes, Anthea

2015-01-01

Community-based services are important for improving outcomes for individuals with dementia and their caregivers. This study examined: (a) availability of rural dementia-related services in the Canadian province of Saskatchewan, and (b) orientation of services toward six key attributes of primary health care (i.e., information/education, accessibility, population orientation, coordinated care, comprehensiveness, quality of care). Data were collected from 71 rural Home Care Assessors via cross-sectional survey. Basic health services were available in most communities (e.g., pharmacists, family physicians, palliative care, adult day programs, home care, long-term care facilities). Dementia-specific services typically were unavailable (e.g., health promotion, counseling, caregiver support groups, transportation, week-end/night respite). Mean scores on the primary health care orientation scales were low (range 12.4 to 17.5/25). Specific services to address needs of rural individuals with dementia and their caregivers are limited in availability and fit with primary health care attributes.

A cross sectional comparison of postnatal care quality in facilities participating in a maternal health voucher program versus non-voucher facilities in Kenya.

PubMed

Warren, Charlotte E; Abuya, Timothy; Kanya, Lucy; Obare, Francis; Njuki, Rebecca; Temmerman, Marleen; Bellows, Ben

2015-07-24

Health service fees constitute substantial barriers for women seeking childbirth and postnatal care. In an effort to reduce health inequities, the government of Kenya in 2006 introduced the output-based approach (OBA), or voucher programme, to increase poor women's access to quality Safe Motherhood services including postnatal care. To help improve service quality, OBA programmes purchase services on behalf of the poor and marginalised, with provider reimbursements for verified services. Kenya's programme accredited health facilities in three districts as well as in two informal Nairobi settlements. Postnatal care quality in voucher health facilities (n = 21) accredited in 2006 and in similar non-voucher health facilities (n = 20) are compared with cross sectional data collected in 2010. Summary scores for quality were calculated as additive sums of specific aspects of each attribute (structure, process, outcome). Measures of effect were assessed in a linear regression model accounting for clustering at facility level. Data were analysed using Stata 11.0. The overall quality of postnatal care is poor in voucher and non-voucher facilities, but many facilities demonstrated 'readiness' for postnatal care (structural attributes: infrastructure, equipment, supplies, staffing, training) indicated by high scores (83/111), with public voucher facilities scoring higher than public non-voucher facilities. The two groups of facilities evinced no significant differences in postnatal care mean process scores: 14.2/55 in voucher facilities versus 16.4/55 in non-voucher facilities; coefficient: -1.70 (-4.9, 1.5), p = 0.294. Significantly more newborns were seen within 48 hours (83.5% versus 72.1%: p = 0.001) and received Bacillus Calmette-Guerin (BCG) (82.5% versus 76.5%: p < 0.001) at voucher facilities than at non-voucher facilities. Four years after facility accreditation in Kenya, scores for postnatal care quality are low in all facilities, even those with Safe Motherhood vouchers. We recommend the Kenya OBA programme review its Safe Motherhood reimbursement package and draw lessons from supply side results-based financing initiatives, to improve postnatal care quality.

Care Models of eHealth Services: A Case Study on the Design of a Business Model for an Online Precare Service.

PubMed

van Meeuwen, Dorine Pd; van Walt Meijer, Quirine J; Simonse, Lianne Wl

2015-03-24

With a growing population of health care clients in the future, the organization of high-quality and cost-effective service providing becomes an increasing challenge. New online eHealth services are proposed as innovative options for the future. Yet, a major barrier to these services appears to be the lack of new business model designs. Although design efforts generally result in visual models, no such artifacts have been found in the literature on business model design. This paper investigates business model design in eHealth service practices from a design perspective. It adopts a research by design approach and seeks to unravel what characteristics of business models determine an online service and what are important value exchanges between health professionals and clients. The objective of the study was to analyze the construction of care models in-depth, framing the essential elements of a business model, and design a new care model that structures these elements for the particular context of an online pre-care service in practice. This research employs a qualitative method of an in-depth case study in which different perspectives on constructing a care model are investigated. Data are collected by using the visual business modeling toolkit, designed to cocreate and visualize the business model. The cocreated models are transcribed and analyzed per actor perspective, transactions, and value attributes. We revealed eight new actors in the business model for providing the service. Essential actors are: the intermediary network coordinator connecting companies, the service dedicated information technology specialists, and the service dedicated health specialist. In the transactions for every service providing we found a certain type of contract, such as a license contract and service contracts for precare services and software products. In addition to the efficiency, quality, and convenience, important value attributes appeared to be: timelines, privacy and credibility, availability, pleasantness, and social interaction. Based on the in-depth insights from the actor perspectives, the business model for online precare services is modeled with a visual design. A new care model of the online precare service is designed and compiled of building blocks for the business model. For the construction of a care model, actors, transactions, and value attributes are essential elements. The design of a care model structures these elements in a visual way. Guided by the business modeling toolkit, the care model design artifact is visualized in the context of an online precare service. Important building blocks include: provision of an online flow of information with regular interactions to the client stimulates self-management of personal health and service-dedicated health expert ensure an increase of the perceived quality of the eHealth service.

Care Models of eHealth Services: A Case Study on the Design of a Business Model for an Online Precare Service

PubMed Central

2015-01-01

Background With a growing population of health care clients in the future, the organization of high-quality and cost-effective service providing becomes an increasing challenge. New online eHealth services are proposed as innovative options for the future. Yet, a major barrier to these services appears to be the lack of new business model designs. Although design efforts generally result in visual models, no such artifacts have been found in the literature on business model design. This paper investigates business model design in eHealth service practices from a design perspective. It adopts a research by design approach and seeks to unravel what characteristics of business models determine an online service and what are important value exchanges between health professionals and clients. Objective The objective of the study was to analyze the construction of care models in-depth, framing the essential elements of a business model, and design a new care model that structures these elements for the particular context of an online pre-care service in practice. Methods This research employs a qualitative method of an in-depth case study in which different perspectives on constructing a care model are investigated. Data are collected by using the visual business modeling toolkit, designed to cocreate and visualize the business model. The cocreated models are transcribed and analyzed per actor perspective, transactions, and value attributes. Results We revealed eight new actors in the business model for providing the service. Essential actors are: the intermediary network coordinator connecting companies, the service dedicated information technology specialists, and the service dedicated health specialist. In the transactions for every service providing we found a certain type of contract, such as a license contract and service contracts for precare services and software products. In addition to the efficiency, quality, and convenience, important value attributes appeared to be: timelines, privacy and credibility, availability, pleasantness, and social interaction. Based on the in-depth insights from the actor perspectives, the business model for online precare services is modeled with a visual design. A new care model of the online precare service is designed and compiled of building blocks for the business model. Conclusions For the construction of a care model, actors, transactions, and value attributes are essential elements. The design of a care model structures these elements in a visual way. Guided by the business modeling toolkit, the care model design artifact is visualized in the context of an online precare service. Important building blocks include: provision of an online flow of information with regular interactions to the client stimulates self-management of personal health and service-dedicated health expert ensure an increase of the perceived quality of the eHealth service. PMID:25831094

Effects of Ethnic Attributes on the Quality of Family Planning Services in Lima, Peru: A Randomized Crossover Trial

PubMed Central

Planas, Maria-Elena; García, Patricia J.; Bustelo, Monserrat; Carcamo, Cesar P.; Martinez, Sebastian; Nopo, Hugo; Rodriguez, Julio; Merino, Maria-Fernanda; Morrison, Andrew

2015-01-01

Most studies reporting ethnic disparities in the quality of healthcare come from developed countries and rely on observational methods. We conducted the first experimental study to evaluate whether health providers in Peru provide differential quality of care for family planning services, based on the indigenous or mestizo (mixed ethnoracial ancestry) profile of the patient. In a crossover randomized controlled trial conducted in 2012, a sample of 351 out of the 408 public health establishments in Metropolitan Lima, Peru were randomly assigned to receive unannounced simulated patients enacting indigenous and mestizo profiles (sequence-1) or mestizo and then indigenous profiles (sequence-2), with a five week wash-out period. Both ethnic profiles used the same scripted scenario for seeking contraceptive advice but had distinctive cultural attributes such as clothing, styling of hair, make-up, accessories, posture and patterns of movement and speech. Our primary outcome measure of quality of care is the proportion of technical tasks performed by providers, as established by Peruvian family planning clinical guidelines. Providers and data analysts were kept blinded to the allocation. We found a non-significant mean difference of -0·7% (p = 0·23) between ethnic profiles in the percentage of technical tasks performed by providers. However we report large deficiencies in the compliance with quality standards of care for both profiles. Differential provider behaviour based on the patient's ethnic profiles compared in the study did not contribute to deficiencies in family planning outcomes observed. The study highlights the need to explore other determinants for poor compliance with quality standards, including demand and supply side factors, and calls for interventions to improve the quality of care for family planning services in Metropolitan Lima. PMID:25671664

Effects of ethnic attributes on the quality of family planning services in Lima, Peru: a randomized crossover trial.

PubMed

Planas, Maria-Elena; García, Patricia J; Bustelo, Monserrat; Carcamo, Cesar P; Martinez, Sebastian; Nopo, Hugo; Rodriguez, Julio; Merino, Maria-Fernanda; Morrison, Andrew

2015-01-01

Most studies reporting ethnic disparities in the quality of healthcare come from developed countries and rely on observational methods. We conducted the first experimental study to evaluate whether health providers in Peru provide differential quality of care for family planning services, based on the indigenous or mestizo (mixed ethnoracial ancestry) profile of the patient. In a crossover randomized controlled trial conducted in 2012, a sample of 351 out of the 408 public health establishments in Metropolitan Lima, Peru were randomly assigned to receive unannounced simulated patients enacting indigenous and mestizo profiles (sequence-1) or mestizo and then indigenous profiles (sequence-2), with a five week wash-out period. Both ethnic profiles used the same scripted scenario for seeking contraceptive advice but had distinctive cultural attributes such as clothing, styling of hair, make-up, accessories, posture and patterns of movement and speech. Our primary outcome measure of quality of care is the proportion of technical tasks performed by providers, as established by Peruvian family planning clinical guidelines. Providers and data analysts were kept blinded to the allocation. We found a non-significant mean difference of -0.7% (p = 0.23) between ethnic profiles in the percentage of technical tasks performed by providers. However we report large deficiencies in the compliance with quality standards of care for both profiles. Differential provider behaviour based on the patient's ethnic profiles compared in the study did not contribute to deficiencies in family planning outcomes observed. The study highlights the need to explore other determinants for poor compliance with quality standards, including demand and supply side factors, and calls for interventions to improve the quality of care for family planning services in Metropolitan Lima.

Influence of cold storage prior to and after ripening on quality factors and sensory attributes of ‘Hass’ avocados

USDA-ARS?s Scientific Manuscript database

Partially-ripened avocados are often held in cold storage in an attempt to enable the consistent delivery of ripe fruit to food service or retail outlets, although the effect on the quality of such fruit is incompletely understood. ‘Hass’ avocados were ripened to near ripeness (13.3 - 17.8 N) at 20 ...

A quality function deployment framework for the service quality of health information websites.

PubMed

Chang, Hyejung; Kim, Dohoon

2010-03-01

This research was conducted to identify both the users' service requirements on health information websites (HIWs) and the key functional elements for running HIWs. With the quality function deployment framework, the derived service attributes (SAs) are mapped into the suppliers' functional characteristics (FCs) to derive the most critical FCs for the users' satisfaction. Using the survey data from 228 respondents, the SAs, FCs and their relationships were analyzed using various multivariate statistical methods such as principal component factor analysis, discriminant analysis, correlation analysis, etc. Simple and compound FC priorities were derived by matrix calculation. Nine factors of SAs and five key features of FCs were identified, and these served as the basis for the house of quality model. Based on the compound FC priorities, the functional elements pertaining to security and privacy, and usage support should receive top priority in the course of enhancing HIWs. The quality function deployment framework can improve the FCs of the HIWs in an effective, structured manner, and it can also be utilized for critical success factors together with their strategic implications for enhancing the service quality of HIWs. Therefore, website managers could efficiently improve website operations by considering this study's results.

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

PubMed

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

2017-04-01

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

Stakeholder analysis: theAndalusian Agency For Healthcare Quality case.

PubMed

Reyes-Alcázar, Víctor; Casas-Delgado, Marta; Herrera-Usagre, Manuel; Torres-Olivera, Antonio

2012-01-01

The aim of this study was to identify the different groups that can affect or be affected by an agency charged with the promoting and guaranteeing of health care quality in Andalusian region (Spain) and to provide a framework with the stakeholders included in different categories. The study adopted a cross-sectional research design. A case study with structured interviews among Andalusian Agency for Healthcare Quality Steering Committee members was carried out in 2010 to define stakeholders' categories and map the interest groups using 5 attributes: influence, importance, legitimacy, power, and urgency. After identification and categorization, stakeholders were weighted qualitatively according to the attributes of importance and influence using 4 possible levels. A matrix was made with the collected data relating both attributes. Furthermore, 8 different types of stakeholders were identified according to attributes power, legitimacy, and urgency. The study concludes that identifying and classifying stakeholders are fundamental to ensuring the success of an organization that must respond to needs and expectations, especially those of its clients. Moreover, knowing stakeholder linkages can contribute to increase organizational worth. This is essential for organizations basically directed to the provision of services in the scope of health care.

Health: The No-Man's-Land Between Physics and Biology.

PubMed

Mansfield, Peter J

2015-10-01

Health as a positive attribute is poorly understood because understanding requires concepts from physics, of which physicians and other life scientists have a very poor grasp. This paper reviews the physics that bears on biology, in particular complex quaternions and scalar fields, relates these to the morphogenetic fields proposed by biologists, and defines health as an attribute of living action within these fields. The distinction of quality, as juxtaposed with quantity, proves essential. Its basic properties are set out, but a science and mathematics of quality are awaited. The implications of this model are discussed, particularly as proper health enhancement could set a natural limit to demand for, and therefore the cost of, medical services.

Assessment of primary health care: health professionals' perspective.

PubMed

Silva, Simone Albino da; Nogueira, Denismar Alves; Paraizo, Camila Maria da Silva; Fracolli, Lislaine Aparecida

2014-08-01

Objective To assess primary health care attributes of access to a first contact, comprehensiveness, coordination, continuity, family guidance and community orientation. Method An evaluative, quantitative and cross-sectional study with 35 professional teams in the Family Health Program of the Alfenas region, Minas Gerais, Brazil. Data collection was done with the Primary Care Assessment Tool - Brazil, professional version. Results Results revealed a low percentage of medical experts among the participants who evaluated the attributes with high scores, with the exception of access to a first contact. Data analysis revealed needs for improvement: hours of service; forms of communication between clients and healthcare services and between clients and professionals; the mechanism of counter-referral. Conclusion It was concluded that there is a mismatch between the provision of services and the needs of the population, which compromises the quality of primary health care.

Hyporheic flow patterns in relation to large river floodplain attributes

EPA Science Inventory

Field-calibrated models of hyporheic flow have emphasized low-order headwater systems. In many cases, however, hyporheic flow in large lowland river floodplains may be an important contributor to ecosystem services such as maintenance of water quality and habitat. In this study, ...

Hyporheic flow patterns in relation to large river floodplain attributes Journal

EPA Science Inventory

Field-calibrated models of hyporheic flow have emphasized low-order headwater systems. In many cases, however, hyporheic flow in large lowland river floodplains may be an important contributor to ecosystem services such as maintenance of water quality and habitat. In this study, ...

[Assessment levels of the user's satisfaction in a private hospital].

PubMed

da Cruz, Wilma Batista Souza; Melleiro, Marta Maria

2010-03-01

The objective of this study was to analyze the satisfaction of the users of a private hospital in terms of a number of attributes of the services in units. This exploratory, descriptive study used a quantitative approach and was developed in a private hospital in the city of São Paulo. The casuistry consisted of 71 users and data collection was performed during the period from March to August 2007, using a derivative of the scale model of the Service Quality (SERVQUAL) of the evaluative model of Parasuraman et al. The level of overall satisfaction ranged around 95%. The assurance (96%) and reliability (96%) were considered the most important dimensions of quality, followed by empathy (95%), responsiveness (93%) and tangibility (88%). Medical and nursing staffs introduced high levels of satisfaction. 91% has intention to recommend the hospital. This research provided the knowledge of the attributes most important in terms of satisfaction and contributed to confirming or reshaping assistance and management processes.

Household's willingness to pay for heterogeneous attributes of drinking water quality and services improvement: an application of choice experiment

NASA Astrophysics Data System (ADS)

Dauda, Suleiman Alhaji; Yacob, Mohd Rusli; Radam, Alias

2015-09-01

The service of providing good quality of drinking water can greatly improve the lives of the community and maintain a normal health standard. For a large number of population in the world, specifically in the developing countries, the availability of safe water for daily sustenance is none. Damaturu is the capital of Yobe State, Nigeria. It hosts a population of more than two hundred thousand, yet only 45 % of the households are connected to the network of Yobe State Water Corporation's pipe borne water services; this has led people to source for water from any available source and thus, exposed them to the danger of contracting waterborne diseases. In order to address the problem, Yobe State Government has embarked on the construction of a water treatment plant with a capacity and facility to improve the water quality and connect the town with water services network. The objectives of this study are to assess the households' demand preferences of the heterogeneous water attributes in Damaturu, and to estimate their marginal willingness to pay, using mixed logit model in comparison with conditional logit model. A survey of 300 households randomly sampled indicated that higher education greatly influenced the households' WTP decisions. The most significant variable from both of the models is TWQ, which is MRS that rates the water quality from the level of satisfactory to very good. 219 % in simple model is CLM, while 126 % is for the interaction model. As for MLM, 685 % is for the simple model and 572 % is for the interaction model. Estimate of MLM has more explanatory powers than CLM. Essentially, this finding can help the government in designing cost-effective management and efficient tariff structure.

Primary Health Care Evaluation: the view of clients and professionals about the Family Health Strategy.

PubMed

da Silva, Simone Albino; Baitelo, Tamara Cristina; Fracolli, Lislaine Aparecida

2015-01-01

to evaluate the attributes of primary health care as for access; longitudinality; comprehensiveness; coordination; family counseling and community counseling in the Family Health Strategy, triangulating and comparing the views of stakeholders involved in the care process. evaluative research with a quantitative approach and cross-sectional design. Data collected using the Primary Care Assessment Tool for interviews with 527 adult clients, 34 health professionals, and 330 parents of children up to two years old, related to 33 family health teams, in eleven municipalities. Analysis conducted in the Statistical Package for Social Sciences software, with a confidence interval of 95% and error of 0.1. the three groups assessed the first contact access - accessibility with low scores. Professionals evaluated with a high score the other attributes. Clients assigned low score evaluations for the attributes: community counseling; family counseling; comprehensiveness - services rendered; comprehensiveness - available services. the quality of performance self-reported by the professionals of the Family Health Strategy is not perceived or valued by clients, and the actions and services may have been developed inappropriately or insufficiently to be apprehended by the experience of clients.

Assessing Bus Performance Rating in Kajang, Selangor

NASA Astrophysics Data System (ADS)

Norhisham, S.; Ismail, A.; Sidek, L. M.; Borhan, M. N.; Zaini, N.; Yen, A. T. G.

2018-04-01

The Transit Capacity and Quality of Service Manual (TCQSM) was chosen based on the review with four manuals and guidelines for the method will be applied. Six (6) attributes, namely Hours of Service, Passenger Load, Transit Auto Travel Time, Service Frequency, Punctuality Performance and Service Coverage were chosen for evaluation.[6][7][8]. A total of three (3) operators with seven (7) routes were identified in Kajang. Based on the final results, the Quality of Service (QOS) findings was rated as D, which was regarded as minimum or satisfactory. Most stakeholders’ recommendations were: for the operators to provide information on bus scheduling and have accurate information for the passengers. It was suggested that in future this study can be extended to all routes and could be repeated after the opening of the Mass Rapid Transit (MRT) stations in Kajang, so as to provide a comparison and better evaluation of the public buses in Kajang.

User satisfaction with child and adolescent mental health services: impact of the service unit level.

PubMed

Bjørngaard, Johan Håkon; Wessel Andersson, Helle; Osborg Ose, Solveig; Hanssen-Bauer, Ketil

2008-08-01

Child and adolescent mental health service units (CAMHS) play an important role in the supply of services to children and adolescents with mental illness. The purpose of this study was to examine the service unit effect on parent satisfaction with outpatient treatment. The study was undertaken in 49 of 72 Norwegian outpatient CAMHS in 2004. A total of 2253 of the parents who were asked to participate (87%) responded. Parent satisfaction was measured using two summated scales: clinician interaction/information and treatment outcome. Multilevel analyses were used to assess the contribution of the service units to satisfaction and to investigate patient level predictors of parent satisfaction. About 96-98% of the parent satisfaction variance could be attributed to factors within CAMHS, leaving only 2-4% of the variance attributable to the CAMHS level. Parents of patients aged 0-6 years were more satisfied than older patients' parents. Longer treatment episodes were positively associated with satisfaction. Parents whose children had been referred with externalizing symptoms were less satisfied with treatment outcome than those referred for internalizing symptoms. Waiting time was negatively associated with treatment outcome satisfaction. Adjustments for patient characteristics did not substantially change the relative effect of CAMHS on satisfaction ratings. The results indicate that information from user satisfaction surveys has clear limitations as an indicator of CAMHS quality. From a quality improvement perspective, the factors affecting the variance within CAMHS are of dominating importance compared to factors affecting between CAMHS variance.

Valuation of environmental quality and eco-cultural attributes in Northwestern Idaho: Native Americans are more concerned than Caucasians.

PubMed

Burger, Joanna

2011-01-01

Valuation of features of habitats and ecosystems usually encompasses the goods and services that ecosystems provide, but rarely also examine how people value ecological resources in terms of eco-cultural and sacred activities. The social, sacred, and cultural aspects of ecosystems are particularly important to Native Americans, but western science has rarely examined the importance of eco-cultural attributes quantitatively. In this paper I explore differences in ecosystem evaluations, and compare the perceptions and evaluations of places people go for consumptive and non-consumptive resource use with evaluations of the same qualities for religious and sacred places. Qualities of ecosystems included goods (abundant fish and crabs, butterflies and flowers, clean water), services (complexity of nature, lack of radionuclides that present a health risk), and eco-cultural attributes (appears unspoiled, scenic horizons, noise-free). Native Americans and Caucasians were interviewed at a Pow Wow at Post Falls, Idaho, which is in the region with the Department of Energy's Hanford Site, known for its storage of radioactive wastes and contamination. A higher percentage of Native American subjects engaged in consumptive and religious activities than did Caucasians. Native Americans engaged in higher rates of many activities than did Caucasians, including commune with nature, pray or meditate, fish or hunt, collect herbs, and conduct vision quests or other ceremonies. For nearly all attributes, there was no difference in the relative ratings given by Native Americans for characteristics of sites used for consumption/non-consumptive activities compared to religious/sacred places. However, Caucasians rated nearly all attributes lower for religious/sacred places than they did for places where they engaged in consumptive or non-consumptive activities. Native Americans were less concerned with distance from home for consumptive/non-consumptive activities, compared to religious activities. Copyright © 2010 Elsevier Inc. All rights reserved.

Impacts on quality of life related to dental caries in a national representative sample of Thai 12- and 15-year-olds.

PubMed

Krisdapong, S; Prasertsom, P; Rattanarangsima, K; Sheiham, A

2013-01-01

Dental caries is generally given the highest priority in national oral health services for school-aged populations. Yet, there is no study exploring the impacts on quality of life specifically related to dental caries in national samples of school-aged children. This study assessed prevalence and characteristics of oral impacts attributed to dental caries on quality of life and compared them with overall oral health impacts. In addition, associations of oral impacts attributed to dental caries and dental caries status were investigated. A national representative sample of 1,063 12- and 811 15-year-olds completed a sociodemographic and behavioural questionnaire, and were orally examined and interviewed about oral health-related quality of life using the Child-OIDP or OIDP indexes, respectively. Associations of condition-specific impacts (CS impacts) attributed to dental caries with components of DMF were investigated using χ(2) tests and multivariate logistic regressions. CS impacts attributed to dental caries were reported by nearly half the children and such impacts accounted for half of overall oral impacts from all oral conditions. The majority of impacts were of little intensity and affected only 1-2 daily performances, particularly performances on Eating, Emotional stability and Cleaning teeth. CS impacts were significantly positively associated with number of decayed teeth, and strongly associated with severe decay. Copyright © 2012 S. Karger AG, Basel.

Women's birth place preferences in the United Kingdom: a systematic review and narrative synthesis of the quantitative literature.

PubMed

Hollowell, Jennifer; Li, Yangmei; Malouf, Reem; Buchanan, James

2016-08-08

Current clinical guidelines and national policy in England support offering 'low risk' women a choice of birth setting, but despite an increase in provison of midwifery units in England the vast majority of women still give birth in obstetric units and there is uncertainty around how best to configure services. There is therefore a need to better understand women's birth place preferences. The aim of this review was to summarise the recent quantitative evidence on UK women's birth place preferences with a focus on identifying the service attributes that 'low risk' women prefer and on identifying which attributes women prioritise when choosing their intended maternity unit or birth setting. We searched Medline, Embase, PsycINFO, Science Citation Index, Social Science Index, CINAHL and ASSIA to identify quantitative studies published in scientific journals since 1992 and designed to describe and explore women's preferences in relation to place of birth. We included experimental stated preference studies, surveys and mixed-methods studies containing relevant quantitative data, where participants were 'low risk' or 'unselected' groups of women with experience of UK maternity services. We included five experimental stated preference studies and four observational surveys, including a total of 4201 respondents. Most studies were old with only three conducted since 2000. Methodological quality was generally poor. The attributes and preferences most commonly explored related to pain relief, continuity of midwife, involvement/availability of medical staff, 'homely' environment/atmosphere, decision-making style, distance/travel time and need for transfer. Service attributes that were almost universally valued by women included local services, being attended by a known midwife and a preference for a degree of control and involvement in decision-making. A substantial proportion of women had a strong preference for care in a hospital setting where medical staff are not necessarily involved in their care, but are readily available. The majority of women appear to value some service attributes while preferences differ for others. Policy makers, commissioners and service providers might usefully consider how to extend the availability of services that most women value while offering a choice of options that enable women to access services that best fit their needs and preferences.

The Development of a Qualitative Dynamic Attribute Value Model for Healthcare Institutes

PubMed Central

Lee, Wan-I

2010-01-01

Background: Understanding customers has become an urgent topic for increasing competitiveness. The purpopse of the study was to develop a qualitative dynamic attribute value model which provides insight into the customers’ value for healthcare institute managers by conducting the initial open-ended questionnaire survey to select participants purposefully. Methods: A total number of 427 questionnaires was conducted in two hospitals in Taiwan (one district hospital with 635 beds and one academic hospital with 2495 beds) and 419 questionnaires were received in nine weeks. Then, apply qualitative in-depth interviews to explore customers’ perspective of values for building a model of partial differential equations. Results: This study concludes nine categories of value, including cost, equipment, physician background, physicain care, environment, timing arrangement, relationship, brand image and additional value, to construct objective network for customer value and qualitative dynamic attribute value model where the network shows the value process of loyalty development via its effect on customer satisfaction, customer relationship, customer loyalty and healthcare service. Conclusion: One set predicts the customer relationship based on comminent, including service quality, communication and empahty. As the same time, customer loyalty based on trust, involves buzz marketing, brand and image. Customer value of the current instance is useful for traversing original customer attributes and identifing customers on different service share. PMID:23113034

The development of a qualitative dynamic attribute value model for healthcare institutes.

PubMed

Lee, Wan-I

2010-01-01

Understanding customers has become an urgent topic for increasing competitiveness. The purpopse of the study was to develop a qualitative dynamic attribute value model which provides insight into the customers' value for healthcare institute managers by conducting the initial open-ended questionnaire survey to select participants purposefully. A total number of 427 questionnaires was conducted in two hospitals in Taiwan (one district hospital with 635 beds and one academic hospital with 2495 beds) and 419 questionnaires were received in nine weeks. Then, apply qualitative in-depth interviews to explore customers' perspective of values for building a model of partial differential equations. This study concludes nine categories of value, including cost, equipment, physician background, physicain care, environment, timing arrangement, relationship, brand image and additional value, to construct objective network for customer value and qualitative dynamic attribute value model where the network shows the value process of loyalty development via its effect on customer satisfaction, customer relationship, customer loyalty and healthcare service. One set predicts the customer relationship based on comminent, including service quality, communication and empahty. As the same time, customer loyalty based on trust, involves buzz marketing, brand and image. Customer value of the current instance is useful for traversing original customer attributes and identifing customers on different service share.

Factors influencing choice of veterinary service provider by pastoralist in Kenya.

PubMed

Onono, Joshua Orungo; Wieland, Barbara; Rushton, Jonathan

2013-08-01

This study analyzed the determinants for choice of animal health providers in a semiarid pastoral area with an aim of identifying specific attributes that could be targeted for intervention to enhance pastoralist access to quality veterinary services. The data were collected through administration of semi-structured questionnaires to 350 randomly selected household heads in different locations in Narok County of Kenya. Most of these respondents had no formal education (66.9%), and most households were headed by men (88.9%). The men were in control of sales (84.2%), purchases (83.7%), and treatment of sick cattle (70.3%), while women were responsible for milking (83.8%). Animal health services were delivered by drug stockists (87.76%) and government veterinarians (12.24%). The time spent while seeking animal health services and transport cost were specific attributes with impact on the probability of choice for service providers. Although distance covered to the preferred service provider was a significant attribute, it was inversely related to the probability of choice. The other factors including herd sizes, age and sex of household head, cost incurred per visit, level of education of household head, and the number of visits did not have significant impact on choices. These findings support commercialization of veterinary services in marginalized areas where the delivery of essential animal health services such as disease control programs are often viewed as a public good. In order to enhance delivery of veterinary services in these areas, it is proposed that public and private means are investigated to support qualified veterinarians and to strengthen the activities of untrained personnel operating drug outlets.

The link between past informal payments and willingness of the Hungarian population to pay formal fees for health care services: results from a contingent valuation study.

PubMed

Baji, Petra; Pavlova, Milena; Gulácsi, László; Farkas, Miklós; Groot, Wim

2014-11-01

We examine the willingness of health care consumers to pay formal fees for health care use and how this willingness to pay is associated with past informal payments. We use data from a survey carried out in Hungary in 2010 among a representative sample of 1,037 respondents. The contingent valuation method is used to elicit the willingness to pay official charges for health care services covered by the social health insurance if certain quality attributes (regarding the health care facility, access to the services and health care personnel) are guaranteed. A bivariate probit model is applied to examine the relationship between willingness to pay and past informal payments. We find that 66% of the respondents are willing to pay formal fees for specialist examinations and 56% are willing to pay for planned hospitalizations if these services are provided with certain quality and access attributes. The act of making past informal payments for health care services is positively associated with the willingness to pay formal charges. The probability that a respondent is willing to pay official charges for health care services is 22% points higher for specialist examinations and 45% points higher for hospitalization if the respondent paid informally during the last 12 months. The introduction of formal fees should be accompanied by adequate service provision to assure acceptance of the fees. Furthermore, our results suggest that the problem of informal patient payments may remain even after the implementation of user fees.

Systematic synthesis of barriers and facilitators to service user-led care planning.

PubMed

Bee, Penny; Price, Owen; Baker, John; Lovell, Karina

2015-08-01

Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice. To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur. Systematic evidence synthesis. Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes. Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs. © The Royal College of Psychiatrists 2015.

Systematic synthesis of barriers and facilitators to service user-led care planning

PubMed Central

Bee, Penny; Price, Owen; Baker, John; Lovell, Karina

2015-01-01

Background Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice. Aims To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur. Method Systematic evidence synthesis. Results Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes. Conclusions Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs. PMID:26243762

QaaS (quality as a service) model for web services using big data technologies

NASA Astrophysics Data System (ADS)

Ahmad, Faisal; Sarkar, Anirban

2017-10-01

Quality of service (QoS) determines the service usability and utility and both of which influence the service selection process. The QoS varies from one service provider to other. Each web service has its own methodology for evaluating QoS. The lack of transparent QoS evaluation model makes the service selection challenging. Moreover, most QoS evaluation processes do not consider their historical data which not only helps in getting more accurate QoS but also helps for future prediction, recommendation and knowledge discovery. QoS driven service selection demands a model where QoS can be provided as a service to end users. This paper proposes a layered QaaS (quality as a service) model in the same line as PaaS and software as a service, where users can provide QoS attributes as inputs and the model returns services satisfying the user's QoS expectation. This paper covers all the key aspects in this context, like selection of data sources, its transformation, evaluation, classification and storage of QoS. The paper uses server log as the source for evaluating QoS values, common methodology for its evaluation and big data technologies for its transformation and analysis. This paper also establishes the fact that Spark outperforms the Pig with respect to evaluation of QoS from logs.

A Quality Function Deployment Framework for the Service Quality of Health Information Websites

PubMed Central

Kim, Dohoon

2010-01-01

Objectives This research was conducted to identify both the users' service requirements on health information websites (HIWs) and the key functional elements for running HIWs. With the quality function deployment framework, the derived service attributes (SAs) are mapped into the suppliers' functional characteristics (FCs) to derive the most critical FCs for the users' satisfaction. Methods Using the survey data from 228 respondents, the SAs, FCs and their relationships were analyzed using various multivariate statistical methods such as principal component factor analysis, discriminant analysis, correlation analysis, etc. Simple and compound FC priorities were derived by matrix calculation. Results Nine factors of SAs and five key features of FCs were identified, and these served as the basis for the house of quality model. Based on the compound FC priorities, the functional elements pertaining to security and privacy, and usage support should receive top priority in the course of enhancing HIWs. Conclusions The quality function deployment framework can improve the FCs of the HIWs in an effective, structured manner, and it can also be utilized for critical success factors together with their strategic implications for enhancing the service quality of HIWs. Therefore, website managers could efficiently improve website operations by considering this study's results. PMID:21818418

Evaluation of the clinical protocol quality for family planning services of people living with HIV/AIDS.

PubMed

Brasil, Raquel Ferreira Gomes; Silva, Maria Josefina da; Moura, Escolástica Rejane Ferreira

2018-01-01

To evaluate the quality of a clinical protocol for family planning care for people living with HIV/AIDS. An evaluative study based on the six domains of the Appraisal of Guidelines for Research & Evaluation II and on Pearson's Coefficient of Variation. The protocol reached between 88.8% and 100.0% quality in the domains of the Appraisal of Guidelines for Research & Evaluation II and 93.3% in the overall evaluation. The obtained Pearson's coefficient of variation was between zero and 18.6. Considering that a minimum percentage of 70.0% was adopted for the quality attributed by the evaluators, quality has been achieved for all domains of the Appraisal of Guidelines for Research & Evaluation II. As a coefficient for all domains was less than 25%, we can infer that the scores attributed by the evaluators were linear or homogeneous, meaning high agreement between them. The protocol was evaluated as a quality instrument, recommended for use by health professionals who deal with family planning for people living with HIV/AIDS.

Validity and test-retest reliability of the self-completion adult social care outcomes toolkit (ASCOT-SCT4) with adults with long-term physical, sensory and mental health conditions in England.

PubMed

Rand, Stacey; Malley, Juliette; Towers, Ann-Marie; Netten, Ann; Forder, Julien

2017-08-18

The Adult Social Care Outcomes Toolkit (ASCOT-SCT4) is a multi-attribute utility index designed for the evaluation of long-term social care services. The measure comprises eight attributes that capture aspects of social care-related quality of life. The instrument has previously been validated with a sample of older adults who used home care services in England. This paper aims to demonstrate the instrument's test-retest reliability and provide evidence for its validity in a diverse sample of adults who use publicly-funded, community-based social care in England. A survey of 770 social care service users was conducted in England. A subsample of 100 services users participated in a follow-up interview between 7 and 21 days after baseline. Spearman rank correlation coefficients between the ASCOT-SCT4 index score and the EQ-5D-3 L, the ICECAP-A or ICECAP-O and overall quality of life were used to assess convergent validity. Data on variables hypothesised to be related to the ASCOT-SCT4 index score, as well as rating of individual attributes, were also collected. Hypothesised relationships were tested using one-way ANOVA or Fisher's exact test. Test-retest reliability was assessed using the intra-class correlation coefficient for the ASCOT-SCT4 index score at baseline and follow-up. There were moderate to strong correlations between the ASCOT-SCT4 index and EQ-5D-3 L, the ICECAP-A or ICECAP-O, and overall quality of life (all correlations ≥ 0.3). The construct validity was further supported by statistically significant hypothesised relationships between the ASCOT-SCT4 index and individual characteristics in univariate and multivariate analysis. There was also further evidence for the construct validity for the revised Food and drink and Dignity items. The test-retest reliability was considered to be good (ICC = 0.783; 95% CI: 0.678-0.857). The ASCOT-SCT4 index has good test-retest reliability for adults with physical or sensory disabilities who use social care services. The index score and the attributes appear to be valid for adults receiving social care for support reasons connected to underlying mental health problems, and physical or sensory disabilities. Further reliability testing with a wider sample of social care users is warranted, as is further exploration of the relationship between the ASCOT-SCT4, ICECAP-A/O and EQ-5D-3 L indices.

Healthcare service quality: towards a broad definition.

PubMed

Mosadeghrad, Ali Mohammad

2013-01-01

The main purpose of this study is to define healthcare quality to encompass healthcare stakeholder needs and expectations because healthcare quality has varying definitions for clients, professionals, managers, policy makers and payers. This study represents an exploratory effort to understand healthcare quality in an Iranian context. In-depth individual and focus group interviews were conducted with key healthcare stakeholders. Quality healthcare is defined as "consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical guidelines and standards, which meet the patient's needs and satisfies providers". Healthcare quality definitions common to all stakeholders involve offering effective care that contributes to the patient well-being and satisfaction. This study helps us to understand quality healthcare, highlighting its complex nature, which has direct implications for healthcare providers who are encouraged to regularly monitor healthcare quality using the attributes identified in this study. Accordingly, they can initiate continuous quality improvement programmes to maintain high patient-satisfaction levels. This is the first time a comprehensive healthcare quality definition has been developed using various healthcare stakeholder perceptions and expectations.

Market Innovation, Rational Housing Supply and Urban Quality at the Neighbourhood Scale

NASA Astrophysics Data System (ADS)

Puglisi, Valentina; Celani, Alberto

2017-10-01

Innovation of product, process and markets are the three categories to assess the improvement of a sector. This document is aimed to provide a review of papers about innovation in housing market and analyses solutions adopted by the international market in terms of definition of attributes of housing products. Enlightening aspects linked to quality attributes of housing products and it has been tried to read a common scheme in any study analysed to provide solutions to set innovation hints to enhance market innovation in the sector. The idea of choice, user and buyer categories definition, assessment and rating system is the backbone of the paper, as the parallelism between marketing of industrial goods and services and built environment objects. Quality of the neighbourhood and the idea of an ex-post assessment is the theme behind the last case presented, based on a research made by ABC Department of Politecnico di Milano in a neighbourhood in Milano, aimed to assess its quality.

Measuring, evaluating and improving hospital quality parameters/dimensions--an integrated healthcare quality approach.

PubMed

Zineldin, Mosad; Camgöz-Akdağ, Hatice; Vasicheva, Valiantsina

2011-01-01

This paper aims to examine the major factors affecting cumulative summation, to empirically examine the major factors affecting satisfaction and to address the question whether patients in Kazakhstan evaluate healthcare similarly or differently from patients in Egypt and Jordan. A questionnaire, adapted from previous research, was distributed to Kazakhstan inpatients. The questionnaire contained 39 attributes about five newly-developed quality dimensions (5Qs), which were identified to be the most relevant attributes for hospitals. The questionnaire was translated into Russian to increase the response rate and improve data quality. Almost 200 usable questionnaires were returned. Frequency distribution, factor analysis and reliability checks were used to analyze the data. The three biggest concerns for Kazakhstan patients are: infrastructure; atmosphere; and interaction. Hospital staffs concern for patients' needs, parking facilities for visitors, waiting time and food temperature were all common specific attributes, which were perceived as concerns. These were shortcomings in all three countries. Improving health service quality by applying total relationship management and the 5Qs model together with a customer-orientation strategy is recommended. Results can be used by hospital staff to reengineer and redesign creatively their quality management processes and help move towards more effective healthcare quality strategies. Patients in three countries have similar concerns and quality perceptions. The paper describes a new instrument and method. The study assures relevance, validity and reliability, while being explicitly change-oriented. The authors argue that patient satisfaction is a cumulative construct, summing satisfaction as five different qualities (5Qs): object; processes; infrastructure; interaction and atmosphere.

The Alternative Quality Contract: Impact on Service Use and Spending for Children With ADHD.

PubMed

Joyce, Nina R; Huskamp, Haiden A; Hadland, Scott E; Donohue, Julie M; Greenfield, Shelly F; Stuart, Elizabeth A; Barry, Colleen L

2017-12-01

In 2009, Blue Cross-Blue Shield of Massachusetts (BCBSMA) implemented the alternative quality contract (AQC), which pays provider organizations a global payment for all services used by enrollees. BCBSMA claims for 2006-2011 were used to compare youths enrolled in provider organizations participating in the AQC (7,407 person-years [PYs]) with those not participating (45,398 PYs). Difference-in-differences models estimated changes in mental health and substance abuse treatment service utilization and spending attributable to the AQC. The AQC was associated with small increases in the probability of any outpatient visits and in the probability and number of medication management visits among children with attention-deficit hyperactivity disorder (ADHD). Spending did not change, and there was no evidence of reductions in service utilization or spending for children with ADHD in the first three years of AQC implementation.

An assessment of technology-based service encounters & network security on the e-health care systems of medical centers in Taiwan

PubMed Central

Chang, Hsin Hsin; Chang, Ching Sheng

2008-01-01

Background Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters. Methods This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54) to analyze and evaluate the data. Results The findings are as follows: (1) Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2) After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3) Network security contributes a positive moderating effect on service quality and patient satisfaction. Conclusion It revealed that the impact of electronic workflow (online appointment system service) on service quality was greater than electronic facilities (electronic medical record systems) in technology-based service encounters. Convenience and credibility are the most important factors of service quality in technology-based service encounters that patients demand. Due to the openness of networks, patients worry that transaction information could be intercepted; also, the credibility of the hospital involved is even a bigger concern, as patients have a strong sense of distrust. Therefore, in the operation of technology-based service encounters, along with providing network security, it is essential to build an atmosphere of psychological trust. PMID:18419820

An assessment of technology-based service encounters & network security on the e-health care systems of medical centers in Taiwan.

PubMed

Chang, Hsin Hsin; Chang, Ching Sheng

2008-04-17

Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters. This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54) to analyze and evaluate the data. The findings are as follows: (1) Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2) After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3) Network security contributes a positive moderating effect on service quality and patient satisfaction. It revealed that the impact of electronic workflow (online appointment system service) on service quality was greater than electronic facilities (electronic medical record systems) in technology-based service encounters. Convenience and credibility are the most important factors of service quality in technology-based service encounters that patients demand. Due to the openness of networks, patients worry that transaction information could be intercepted; also, the credibility of the hospital involved is even a bigger concern, as patients have a strong sense of distrust. Therefore, in the operation of technology-based service encounters, along with providing network security, it is essential to build an atmosphere of psychological trust.

[Challenges and barriers in the promotion of quality in health care services].

PubMed

Brezis, Mayer; Cohen, Matan J; Frankel, Meir; Chinitz, David

2012-03-01

The promotion of quality and safety in health care faces many challenges and barriers including lack of cooperation by physicians. Complexity and uncertainty in measuring quality raise methodological difficulties. Lack of sufficient awareness about these limitations, also among those who measure quality, contributes to physicians lack of interest, suspicion and mistrust. Strategic issues associated with quality assessment in the Israeli health care system derive from lack of regulation and evasiveness about the accountability of executives and governing bodies regarding the quality of the services provided to patients in hospitals and clinics. Some of these challenges relate to the intrusion of market forces into the world of medicine without needed adaptations, so that reimbursement is often conveniently linked to the quantity of services and not to their quality. Efficiency, which characterizes competitive markets, is not easily translated in the clinical world where empathy, listening skills, and capability of explaining are critical physician attributes. This clinical world values giving beyond monetary compensation, and cooperation between institutions--rather than competition--all crucial for the continuity of patient's care. The interface between economics and health care calls for creative thinking, with a novel definition for the social value of medical and nursing care according to their quality and not their quantity.

An assessment of primary care attributes from the perspective of female healthcare users1

PubMed Central

Lima, Eliane de Fátima Almeida; Sousa, Ana Inês; Primo, Cândida Caniçali; Leite, Francielie Marabotti Costa; Lima, Rita de Cassia Duarte; Maciel, Ethel Leonor Nóia

2015-01-01

OBJECTIVE: this study sought to assess the quality of the Family Health Strategy (FHS) and investigated the association between primary care attributes (PCAs) and the sociodemographic characteristics of users. METHOD: a total of 215 female FHS users were interviewed for this descriptive and cross-sectional study. The Primary Care Assessment Tool (PCATool), Adult Edition was used, and the results were analyzed using Fisher's exact tests, Pearson's chi-square tests and logistic regressions. RESULTS: the lowest average score corresponded to the dimension "accessibility" (1.80), and the highest score corresponded to "access" (8.76). The results corresponding to the attributes "longitudinality", "coordination", "comprehensiveness", and "orientation" were not significant. No association was found between the participants' sociodemographic characteristics and the essential, derivative, and general attributes (p>0.05). CONCLUSION: several attributes must be improved across all the investigated services from the perspective of female FHS users. PMID:26155006

Increased Use of Productivity Management Can Help Control Government Costs.

DTIC Science & Technology

1983-11-10

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

Reach Out and Touch Someone: West Alabama Designs a New Emergency Link.

ERIC Educational Resources Information Center

Coogan, Mercy Hardie

1980-01-01

Quality on-the-scene emergency care for a rural area is provided by West Alabama's Emergency Medical Services. The success of this delivery system is attributed to a radio/telephone communications system that provides quick, direct contact between paramedics at the scene and medical doctors miles away. (DS)

Learning Objects and Virtual Learning Environments Technical Evaluation Criteria

ERIC Educational Resources Information Center

Kurilovas, Eugenijus; Dagiene, Valentina

2009-01-01

The main scientific problems investigated in this article deal with technical evaluation of quality attributes of the main components of e-Learning systems (referred here as DLEs--Digital Libraries of Educational Resources and Services), i.e., Learning Objects (LOs) and Virtual Learning Environments (VLEs). The main research object of the work is…

The impact of using kiosk on enterprise systems in service industry

NASA Astrophysics Data System (ADS)

Chen, Jengchung V.; Yen, David; Dunk, Kimberly; Widjaja, Andree E.

2015-11-01

The hospitality industry services many types of travellers. Each of them needs to be analysed differently in order to accurately determine their respective service quality attributes and customer delight. The effective and efficient enterprise information systems (EISs) play a significant role in traveller's experience and in the competitive advantages that hotels can gain. For this study, self-service kiosks and guest service agents as part of hotel's EISs are used to investigate the impact each has on the experience of business and leisure travellers. This study provides empirical results that further investigate how to improve the service quality for both types of travellers during the registration process. This process is the first physical interaction between the travellers and the hotel. Any problem in registering would generate a long-lasting negative first impression on the travellers, thus diminishing the customer delight. In the light of our findings, this study will contribute to the effective and efficient design of self-service kiosk systems, hotel's EISs, and improved front office management to better accommodate the specific needs of both types of travellers.

Incorporating Servqual-QFD with Taguchi Design for optimizing service quality design

NASA Astrophysics Data System (ADS)

Arbi Hadiyat, M.

2018-03-01

Deploying good service design in service companies has been updated issue in improving customer satisfaction, especially based on the level of service quality measured by Parasuraman’s SERVQUAL. Many researchers have been proposing methods in designing the service, and some of them are based on engineering viewpoint, especially by implementing the QFD method or even using robust Taguchi method. The QFD method would found the qualitative solution by generating the “how’s”, while Taguchi method gives more quantitative calculation in optimizing best solution. However, incorporating both QFD and Taguchi has been done in this paper and yields better design process. The purposes of this research is to evaluate the incorporated methods by implemented it to a case study, then analyze the result and see the robustness of those methods to customer perception of service quality. Started by measuring service attributes using SERVQUAL and find the improvement with QFD, the deployment of QFD solution then generated by defining Taguchi factors levels and calculating the Signal-to-noise ratio in its orthogonal array, and optimized Taguchi response then found. A case study was given for designing service in local bank. Afterward, the service design obtained from previous analysis was then evaluated and shows that it was still meet the customer satisfaction. Incorporating QFD and Taguchi has performed well and can be adopted and developed for another research for evaluating the robustness of result.

Consumer Behavior in Shopping Streets: The Importance of the Salesperson's Professional Personal Attention

PubMed Central

Medrano, Natalia; Olarte-Pascual, Cristina; Pelegrín-Borondo, Jorge; Sierra-Murillo, Yolanda

2016-01-01

Since the early 2010s, the emergence of a new consumer has begun. In this context, consumer behavior represents one of the greatest interests of marketing scholars and business managers due to their need to adapt their companies' strategies to the new frontier. In order to advance understanding of this new consumer, this article focuses on analyzing consumer behavior in shopping streets. Thus, the aim of this research is to know what customers value in terms of salesperson–customer interaction quality nowadays. To achieve this, the authors conducted two studies. The results of the first study show that customers cite personal attention as the primary factor motivating their preference for small retailers in shopping streets. However, this motivation is not as relevant one for those who prefer malls. This result provides a point on which to research service quality incorporating personal attention in a second study. Using the SERVQUAL-P scale, the authors elaborate three lenses through which the quality of service from the customer's point of view can be analyzed: normative expectations, predictive expectations, and the importance of each attribute. The most striking result is that the dimensions of expectations (normative and predictive) are the same; these results demonstrate that customers are coherent in making assessments of their expectations, evaluating service quality and satisfaction with similar criteria. However, these dimensions are different from the dimensions of importance. Our main contribution lies in the finding that personal attention, when assessed using the scale of attribute importance, is split into two dimensions: (1) courteous attention and (2) personal relationship. Courteous attention is always welcome, but personal relationships are less valued and are often even rejected. The article concludes with a discussion of the implications of these findings for marketing practices and research. PMID:26903927

Consumer Behavior in Shopping Streets: The Importance of the Salesperson's Professional Personal Attention.

PubMed

Medrano, Natalia; Olarte-Pascual, Cristina; Pelegrín-Borondo, Jorge; Sierra-Murillo, Yolanda

2016-01-01

Since the early 2010s, the emergence of a new consumer has begun. In this context, consumer behavior represents one of the greatest interests of marketing scholars and business managers due to their need to adapt their companies' strategies to the new frontier. In order to advance understanding of this new consumer, this article focuses on analyzing consumer behavior in shopping streets. Thus, the aim of this research is to know what customers value in terms of salesperson-customer interaction quality nowadays. To achieve this, the authors conducted two studies. The results of the first study show that customers cite personal attention as the primary factor motivating their preference for small retailers in shopping streets. However, this motivation is not as relevant one for those who prefer malls. This result provides a point on which to research service quality incorporating personal attention in a second study. Using the SERVQUAL-P scale, the authors elaborate three lenses through which the quality of service from the customer's point of view can be analyzed: normative expectations, predictive expectations, and the importance of each attribute. The most striking result is that the dimensions of expectations (normative and predictive) are the same; these results demonstrate that customers are coherent in making assessments of their expectations, evaluating service quality and satisfaction with similar criteria. However, these dimensions are different from the dimensions of importance. Our main contribution lies in the finding that personal attention, when assessed using the scale of attribute importance, is split into two dimensions: (1) courteous attention and (2) personal relationship. Courteous attention is always welcome, but personal relationships are less valued and are often even rejected. The article concludes with a discussion of the implications of these findings for marketing practices and research.

EPA Facility Registry Service (FRS): CERCLIS

EPA Pesticide Factsheets

This data provides location and attribute information on Facilities regulated under the Comprehensive Environmental Responsibility Compensation and Liability Information System (CERCLIS) for a intranet web feature service . The data provided in this service are obtained from EPA's Facility Registry Service (FRS). The FRS is an integrated source of comprehensive (air, water, and waste) environmental information about facilities, sites or places. This service connects directly to the FRS database to provide this data as a feature service. FRS creates high-quality, accurate, and authoritative facility identification records through rigorous verification and management procedures that incorporate information from program national systems, state master facility records, data collected from EPA's Central Data Exchange registrations and data management personnel. Additional Information on FRS is available at the EPA website https://www.epa.gov/enviro/facility-registry-service-frs.

Missouri's forest 1999-2003, part B

Treesearch

Andrew D. Hill; Mark H. Hansen; W. Keith Moser; Gary Brand; Ronald E. McRoberts

2011-01-01

This report presents the methods used in the 1999-2003 inventory of the forest resources of Missouri along with tables of important forest attribute estimates and discussion of quality of these estimates. This inventory is part of the Forest Inventory and Analysis (FIA) program conducted by U.S. Forest Service, a national program to continuously inventory and report on...

Person-Centeredness in Home- and Community-Based Services and Supports: Domains, Attributes, and Assisted Living Indicators.

PubMed

Zimmerman, Sheryl; Love, Karen; Cohen, Lauren W; Pinkowitz, Jackie; Nyrop, Kirsten A

2014-01-01

As a result of the Centers for Medicare & Medicaid Services (CMS) interest in creating a unifying definition of "community living" for its Medicaid Home and Community Based Services and Support (HCBS) programs, it needed clarifying descriptors of person-centered (PC) practices in assisted living to distinguish them from institutional ones. Additionally, CMS's proposed language defining "community living" had the unintended potential to exclude many assisted living communities and disadvantage residents who receive Medicaid. This manuscript describes the consensus process through which clarifying language for "community living" and a framework for HCBS PC domains, attributes, and indicators specific to assisted living were developed. It examines the validity of those domains based on literature review, surveys, and stakeholder focus groups, and identifies nine domains and 43 indicators that provide a foundation for defining and measuring PC practice in assisted living. Ongoing efforts using community-based participatory research methods are further refining and testing PC indicators for assisted living to advance knowledge, operational policies, practices, and quality outcomes.

Service design attributes affecting diabetic patient preferences of telemedicine in South Korea.

PubMed

Park, Hayoung; Chon, Yucheong; Lee, Jongsu; Choi, Ie-Jung; Yoon, Kun-Ho

2011-01-01

Attempts to introduce telemedicine in South Korea have failed mostly, leaving critical questions for service developers and providers about whether patients would be willing to pay for the service and how the service should be designed to encourage patient buy-in. In this study, we explore patients' valuations and preferences for each attribute of telemedicine service for diabetes management and evaluate patient willingness to pay for specific service attributes. We conducted a conjoint survey to collect data on patients' stated preferences among telemedicine service alternatives. The alternatives for diabetes-related service differed in 10 attributes, including those related to price, type of service provider, and service scope. To estimate the relative importance of attributes, patients' willingness to pay for each attribute, and their probable choice of specific alternatives, we used a rank-ordered logit model. A total of 118 respondents participated in the survey. All 10 attributes significantly affected patients' valuations and preferences, and demographic and disease characteristics, such as existence of complications and comorbidities, significantly affected patients' valuations of the attributes. Price was the most important attribute, followed by comprehensive scope of service, the availability of mobile phone-based delivery, and large general-hospital provided services. The study findings have significant implications for adoption policy and strategy of telemedicine in diabetes management care. Further, the methodology presented in this study can be used to draw knowledge needed to formulate effective policy for adoption of the necessary technology and for the design of services that attract potential beneficiaries.

A Socio-technical assessment of the success of picture archiving and communication systems: the radiology technologist’s perspective

PubMed Central

2013-01-01

Background With the increasing prevalence of Picture Archiving and Communication Systems (PACS) in healthcare institutions, there is a growing need to measure their success. However, there is a lack of published literature emphasizing the technical and social factors underlying a successful PACS. Methods An updated Information Systems Success Model was utilized by radiology technologists (RTs) to evaluate the success of PACS at a large medical center in Taiwan. A survey, consisting of 109 questionnaires, was analyzed by Structural Equation Modeling. Results Socio-technical factors (including system quality, information quality, service quality, perceived usefulness, user satisfaction, and PACS dependence) were proven to be effective measures of PACS success. Although the relationship between service quality and perceived usefulness was not significant, other proposed relationships amongst the six measurement parameters of success were all confirmed. Conclusions Managers have an obligation to improve the attributes of PACS. At the onset of its deployment, RTs will have formed their own subjective opinions with regards to its quality (system quality, information quality, and service quality). As these personal concepts are either refuted or reinforced based on personal experiences, RTs will become either satisfied or dissatisfied with PACS, based on their perception of its usefulness or lack of usefulness. A satisfied RT may play a pivotal role in the implementation of PACS in the future. PMID:24053458

Interpretations of referral appropriateness by senior health managers in five PCT areas in England: a qualitative investigation.

PubMed

Blundell, N; Clarke, Aileen; Mays, N

2010-06-01

To explore interpretations of "appropriate" and "inappropriate" elective referral from primary to secondary surgical care among senior clinical and non-clinical managers in five purposively sampled primary care trusts (PCTs) and their main associated acute hospitals in the English National Health Service (NHS). Semi-structured face-to-face interviews were undertaken with senior managerial staff from clinical and non-clinical backgrounds. Interviews were tape-recorded, transcribed and analysed according to the Framework approach developed at the National Centre for Social Research using N6 (NUD*IST6) qualitative data analysis software. Twenty-two people of 23 approached were interviewed (between three and five respondents per PCT and associated acute hospital). Three attributes relating to appropriateness of referral were identified: necessity: whether a patient with given characteristics was believed suitable for referral; destination or level: where or to whom a patient should be referred; and quality (or process): how a referral was carried out, including (eg, investigations undertaken before referral, information contained in the referral and extent of patient involvement in the referral decision. Attributes were hierarchical. "Necessity" was viewed as the most fundamental attribute, followed by "destination" and, finally, "quality". In general, but not always, all three attributes were perceived as necessary for a referral to be defined as appropriate. For senior clinical and non-clinical managers at the local level in the English NHS, three hierarchical attributes (necessity, appropriateness of destination and quality of referral process) contributed to the overall concept of appropriateness of referral from primary to secondary surgical care.

The effects of convenience and quality on the demand for vaccination: Results from a discrete choice experiment.

PubMed

Guo, Na; Zhang, Guojie; Zhu, Dawei; Wang, Jian; Shi, Luwen

2017-05-15

Vaccination is an effective way to prevent infectious diseases. Most studies analysed people's vaccine decisions, but few studies have analysed the effects of convenience such as immunisation schedule and distance and the quality of vaccination service on vaccination uptake. The aim of this paper was to investigate adults' preferences for convenience and quality of vaccination service, calculate the private economic benefit from convenience (vaccination schedule and distance) and quality, and predict the uptake rate for different vaccine scenarios. In our study, we interviewed 266 adults in 2 counties of Shandong province in China. The discrete choice experiment (DCE) was employed to analyse the preference for hepatitis B virus (HBV) vaccination, and a mixed logit model was used to estimate respondent preferences for vaccination attributes included in the DCE. The protection rate against hepatitis B (HB), duration of protection, risk of side effects, vaccination cost, schedule, and vaccination sites were proved to influence adults' preferences for HBV vaccination. The estimated willingness to pay (WTP) for 1 dose schedule instead of 3 doses and for a third-level vaccination site instead of a first-level site was almost equal (19 RMB). However, if the protection duration of the vaccination programme changed from 5years to 20years, the adults were willing to pay 35.05 RMB, and WTP for a 99% protection rate instead of a 79% rate was 67.71 RMB. The predicted uptake rate is almost 43% for the base case of HBV vaccination. Adults made trade-offs between vaccination schedules, vaccination sites, and other characteristics of HBV vaccine. The impact of attributes of the vaccine itself, especially protection rate against HB, duration of protection, and risk of side-effects, is more dramatic than convenience and quality of vaccination service. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

An Exploratory Study of Residents' Perception of Place Image: The Case of Kavala.

PubMed

Stylidis, Dimitrios; Sit, Jason; Biran, Avital

2016-05-01

Studies on place image have predominantly focused on the tourists' destination image and have given limited attention to other stakeholders' perspectives. This study aims to address this gap by focusing on the notion of residents' place image, whereby it reviews existing literature on residents' place image in terms of whether common attributes can be identified, and examines the role of community-focused attributes in its measurement. Data collected from a sample of 481 Kavala residents (Greece) were subjected to exploratory and confirmatory factor analysis. The study reveals that the existing measurement tools have typically emphasized destination-focused attributes and neglected community-focused attributes. This study contributes to the residents' place image research by proposing a more holistic measurement, which consisted of four dimensions: physical appearance, community services, social environment, and entertainment opportunities. The study also offers practical insights for developing and promoting a tourist place while simultaneously enhancing its residents' quality of life.

An Exploratory Study of Residents’ Perception of Place Image

PubMed Central

Stylidis, Dimitrios; Sit, Jason; Biran, Avital

2014-01-01

Studies on place image have predominantly focused on the tourists’ destination image and have given limited attention to other stakeholders’ perspectives. This study aims to address this gap by focusing on the notion of residents’ place image, whereby it reviews existing literature on residents’ place image in terms of whether common attributes can be identified, and examines the role of community-focused attributes in its measurement. Data collected from a sample of 481 Kavala residents (Greece) were subjected to exploratory and confirmatory factor analysis. The study reveals that the existing measurement tools have typically emphasized destination-focused attributes and neglected community-focused attributes. This study contributes to the residents’ place image research by proposing a more holistic measurement, which consisted of four dimensions: physical appearance, community services, social environment, and entertainment opportunities. The study also offers practical insights for developing and promoting a tourist place while simultaneously enhancing its residents’ quality of life. PMID:29708109

[Using the concept of universal health coverage to promote the health system reform in China].

PubMed

Hu, S L

2016-11-06

The paper is systematically explained the definition, contents of universal health coverage (UHC). Universal health coverage calls for all people to have access to quality health services they need without facing undue financial burden. The relationship between five main attributes, i.e., quality, efficiency, equity, accountability and resilience, and their 15 action plans has been explained. The nature of UHC is belonged to the State and government. The core function is commitment with equality. The whole-of-system method is used to promoting the health system reform. In China, the universal health coverage has been reached to the preliminary achievements, which include universal coverage of social medical insurance, basic medical services, basic public health services, and the provision of essential medicines. China has completed millennium development goals (MDG) and is being stepped to the sustainable development goals (SDG).

Delivery of video-on-demand services using local storages within passive optical networks.

PubMed

Abeywickrama, Sandu; Wong, Elaine

2013-01-28

At present, distributed storage systems have been widely studied to alleviate Internet traffic build-up caused by high-bandwidth, on-demand applications. Distributed storage arrays located locally within the passive optical network were previously proposed to deliver Video-on-Demand services. As an added feature, a popularity-aware caching algorithm was also proposed to dynamically maintain the most popular videos in the storage arrays of such local storages. In this paper, we present a new dynamic bandwidth allocation algorithm to improve Video-on-Demand services over passive optical networks using local storages. The algorithm exploits the use of standard control packets to reduce the time taken for the initial request communication between the customer and the central office, and to maintain the set of popular movies in the local storage. We conduct packet level simulations to perform a comparative analysis of the Quality-of-Service attributes between two passive optical networks, namely the conventional passive optical network and one that is equipped with a local storage. Results from our analysis highlight that strategic placement of a local storage inside the network enables the services to be delivered with improved Quality-of-Service to the customer. We further formulate power consumption models of both architectures to examine the trade-off between enhanced Quality-of-Service performance versus the increased power requirement from implementing a local storage within the network.

Service Design Attributes Affecting Diabetic Patient Preferences of Telemedicine in South Korea

PubMed Central

Chon, YuCheong; Lee, Jongsu; Choi, Ie-Jung; Yoon, Kun-Ho

2011-01-01

Abstract Objective Attempts to introduce telemedicine in South Korea have failed mostly, leaving critical questions for service developers and providers about whether patients would be willing to pay for the service and how the service should be designed to encourage patient buy-in. In this study, we explore patients' valuations and preferences for each attribute of telemedicine service for diabetes management and evaluate patient willingness to pay for specific service attributes. Materials and Methods We conducted a conjoint survey to collect data on patients' stated preferences among telemedicine service alternatives. The alternatives for diabetes-related service differed in 10 attributes, including those related to price, type of service provider, and service scope. To estimate the relative importance of attributes, patients' willingness to pay for each attribute, and their probable choice of specific alternatives, we used a rank-ordered logit model. A total of 118 respondents participated in the survey. Results All 10 attributes significantly affected patients' valuations and preferences, and demographic and disease characteristics, such as existence of complications and comorbidities, significantly affected patients' valuations of the attributes. Price was the most important attribute, followed by comprehensive scope of service, the availability of mobile phone-based delivery, and large general-hospital provided services. Conclusions The study findings have significant implications for adoption policy and strategy of telemedicine in diabetes management care. Further, the methodology presented in this study can be used to draw knowledge needed to formulate effective policy for adoption of the necessary technology and for the design of services that attract potential beneficiaries. PMID:21631382

Practical Approaches to Quality Improvement for Radiologists.

PubMed

Kelly, Aine Marie; Cronin, Paul

2015-10-01

Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

Women's preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery.

PubMed

Kruk, M E; Paczkowski, M M; Tegegn, A; Tessema, F; Hadley, C; Asefa, M; Galea, S

2010-11-01

Delivery attended by skilled professionals is essential to reducing maternal mortality. Although the facility delivery rate in Ethiopia's rural areas is extremely low, little is known about which health system characteristics most influence women's preferences for delivery services. In this study, women's preferences for attributes of health facilities for delivery in rural Ethiopia were investigated. A population-based discrete choice experiment (DCE) was fielded in Gilgel Gibe, in southwest Ethiopia, among women with a delivery in the past 5 years. Women were asked to select a hypothetical health facility for future delivery from two facilities on a picture card. A hierarchical Bayesian procedure was used to estimate utilities associated with facility attributes: distance, type of provider, provider attitude, drugs and medical equipment, transport and cost. 1006 women completed 8045 DCE choice tasks. Among them, 93.8% had delivered their last child at home. The attributes with the greatest influence on the overall utility of a health facility for delivery were availability of drugs and equipment (mean β=3.9, p<0.01), seeing a doctor versus a health extension worker (mean β=2.1, p<0.01) and a receptive provider attitude (mean β=1.4, p<0.01). Women in rural southwest Ethiopia who have limited personal experience with facility delivery nonetheless value health facility attributes that indicate high technical quality: availability of drugs and equipment and physician providers. Well-designed policy experiments that measure the contribution of quality improvements to facility delivery rates in Ethiopia and other countries with low health service utilisation and high maternal mortality may inform national efforts to reduce maternal mortality.

Design Challenges of an Episode-Based Payment Model in Oncology: The Centers for Medicare & Medicaid Services Oncology Care Model.

PubMed

Kline, Ronald M; Muldoon, L Daniel; Schumacher, Heidi K; Strawbridge, Larisa M; York, Andrew W; Mortimer, Laura K; Falb, Alison F; Cox, Katherine J; Bazell, Carol; Lukens, Ellen W; Kapp, Mary C; Rajkumar, Rahul; Bassano, Amy; Conway, Patrick H

2017-07-01

The Centers for Medicare & Medicaid Services developed the Oncology Care Model as an episode-based payment model to encourage participating practitioners to provide higher-quality, better-coordinated care at a lower cost to the nearly three-quarter million fee-for-service Medicare beneficiaries with cancer who receive chemotherapy each year. Episode payment models can be complex. They combine into a single benchmark price all payments for services during an episode of illness, many of which may be delivered at different times by different providers in different locations. Policy and technical decisions include the definition of the episode, including its initiation, duration, and included services; the identification of beneficiaries included in the model; and beneficiary attribution to practitioners with overall responsibility for managing their care. In addition, the calculation and risk adjustment of benchmark episode prices for the bundle of services must reflect geographic cost variations and diverse patient populations, including varying disease subtypes, medical comorbidities, changes in standards of care over time, the adoption of expensive new drugs (especially in oncology), as well as diverse practice patterns. Other steps include timely monitoring and intervention as needed to avoid shifting the attribution of beneficiaries on the basis of their expected episode expenditures as well as to ensure the provision of necessary medical services and the development of a meaningful link to quality measurement and improvement through the episode-based payment methodology. The complex and diverse nature of oncology business relationships and the specific rules and requirements of Medicare payment systems for different types of providers intensify these issues. The Centers for Medicare & Medicaid Services believes that by sharing its approach to addressing these decisions and challenges, it may facilitate greater understanding of the model within the oncology community and provide insight to others considering the development of episode-based payment models in the commercial or government sectors.

Group clearfell harvest can promote regeneration of aspen forests affected by sudden aspen decline in western Colorado

Treesearch

Wayne D. Shepperd; Frederick W. Smith; Kristen A. Pelz

2015-01-01

An experimental assessment of the use of clearfell harvesting to initiate a regeneration response in commercially managed aspen forests affected by sudden aspen decline (SAD) was conducted in western Colorado in cooperation with the USDA Forest Service. Nine pure commercial quality aspen stands, with three levels of mortality attributed to SAD, were selected (...

Incorporating elements of social franchising in government health services improves the quality of infant and young child feeding counselling services at commune health centres in Vietnam.

PubMed

Nguyen, Phuong H; Kim, Sunny S; Keithly, Sarah C; Hajeebhoy, Nemat; Tran, Lan M; Ruel, Marie T; Rawat, Rahul; Menon, Purnima

2014-12-01

Although social franchising has been shown to enhance the quality of reproductive health services in developing countries, its effect on nutrition services remains unexamined. This study assessed the effects of incorporating elements of social franchising on shaping the quality of infant and young child feeding (IYCF) counselling facilities and services in Vietnam. Process-related data collected 12 months after the launch of the first franchises were used to compare randomly assigned Alive & Thrive-supported health facilities (AT-F, n = 20) with standard facilities (SF, n = 12) across three dimensions of service quality: 'structure', 'process' and 'outcome' that capture the quality of facilities, service delivery, and client perceptions and use, respectively. Data collection included facility assessments (n = 32), staff surveys (n = 96), counselling observations (n = 137), client exit interviews (n = 137) and in-depth interviews with mothers (n = 48). Structure: AT-F were more likely to have an unshared, well-equipped room for nutrition counselling than SF (65.0% vs 10.0%). Compared with SF providers, AT-F staff had better IYCF knowledge (mean score 9.9 vs 8.8, range 0-11 for breastfeeding; mean score 3.6 vs 3.2, range 0-4 for complementary feeding). AT-F providers also demonstrated significantly better interpersonal communication skills (score 9.6 vs 5.1, range 0-13) and offered more comprehensive counselling sessions. Overall utilization of franchises was low (10%). A higher proportion of pregnant women utilized franchise services (48.9%), compared with mothers with children 6-23.9 months (1.4%). There was no quantitative difference in client satisfaction with counselling services between AT-F and SF, but franchise users praised the AT-F for problem solving related to child feeding. Incorporating elements of social franchising significantly enhances the quality of IYCF counselling services within government primary healthcare facilities, particularly their structural and process attributes. Provided that service utilization is improved through demand generation, this model has the potential to impact IYCF practices and child nutrition. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Methods for assessing the quality of data in public health information systems: a critical review.

PubMed

Chen, Hong; Yu, Ping; Hailey, David; Wang, Ning

2014-01-01

The quality of data in public health information systems can be ensured by effective data quality assessment. In order to conduct effective data quality assessment, measurable data attributes have to be precisely defined. Then reliable and valid measurement methods for data attributes have to be used to measure each attribute. We conducted a systematic review of data quality assessment methods for public health using major databases and well-known institutional websites. 35 studies were eligible for inclusion in the study. A total of 49 attributes of data quality were identified from the literature. Completeness, accuracy and timeliness were the three most frequently assessed attributes of data quality. Most studies directly examined data values. This is complemented by exploring either data users' perception or documentation quality. However, there are limitations of current data quality assessment methods: a lack of consensus on attributes measured; inconsistent definition of the data quality attributes; a lack of mixed methods for assessing data quality; and inadequate attention to reliability and validity. Removal of these limitations is an opportunity for further improvement.

A New Look at Data Usage by Using Metadata Attributes as Indicators of Data Quality

NASA Technical Reports Server (NTRS)

Won, Young-In; Wanchoo, Lalit; Behnke, Jeanne

2016-01-01

This study reviews the key metrics (users, distributed volume, and files) in multiple ways to gain an understanding of the significance of the metadata. Characterizing the usability of data by key metadata elements, such as discipline and study area, will assist in understanding how the user needs have evolved over time. The data usage pattern based on product level provides insight into the level of data quality. In addition, the data metrics by various services, such as the Open-source Project for a Network Data Access Protocol (OPeNDAP) and subsets, address how these services have extended the usage of data. Over-all, this study presents the usage of data and metadata by metrics analyses, which may assist data centers in better supporting the needs of the users.

A Fine-Grained API Link Prediction Approach Supporting CMDA Mashup Recommendation

NASA Astrophysics Data System (ADS)

Zhang, J.; Bao, Q.; Lee, T. J.; Ramachandran, R.; Lee, S.; Pan, L.; Gatlin, P. N.; Maskey, M.

2017-12-01

Service (API) discovery and recommendation is key to the wide spread of service oriented architecture and service oriented software engineering. Service recommendation typically relies on service linkage prediction calculated by the semantic distances (or similarities) among services based on their collection of inherent attributes. Given a specific context (mashup goal), however, different attributes may contribute differently to a service linkage. In this work, instead of training a model for all attributes as a whole, a novel approach is presented to simultaneously train separate models for individual attributes. Our contributions are summarized in three-fold. First is that we have developed a scalable attribute-level data model, featuring scalability and extensibility. We have extended Multiplicative Attribute Graph (MAG) model to represent node profiles featuring rich categorical attributes, while relaxing its constraint of requiring a priori knowledge of predefined attributes. LDA is leveraged to dynamically identify attributes based on attribute modeling, and multiple Gaussian fit is applied to find global optimal values. The second contribution is that we have seamlessly integrated the latent relationships between API attributes as well as observed network structure based on historical API usage data. Such a layered information model enables us to predict the probability of a link between two APIs based on their attribute link affinities carrying a variety of information including meta data, semantic data, historical usage data, as well as crowdsourcing user comments and annotations. The third contribution is that we have developed a finegrained context-aware mashup-API recommendation technique. On top of individual models trained for separate attributes, a dedicated layer is trained to represent the latent attribute distribution regarding mashup purpose, i.e., sensitivity of attributes to context. Thus, given the description of an intended mashup, the attributes sensitive to the goal will be identified, and corresponding attribute models will be exploited to compute the possibility of API linkages under the context. Such a layered model increases search accuracy.

Beef quality attributes: A systematic review of consumer perspectives.

PubMed

Henchion, Maeve M; McCarthy, Mary; Resconi, Virginia C

2017-06-01

Informed by quality theory, this systematic literature review seeks to determine the relative importance of beef quality attributes from a consumer perspective, considering search, experience and credence quality attributes. While little change is anticipated in consumer ranking of search and experience attributes in the future, movement is expected in terms of ranking within the credence category and also in terms of the ranking of credence attributes overall. This highlights an opportunity for quality assurance schemes (QAS) to become more consumer focused through including a wider range of credence attributes. To capitalise on this opportunity, the meat industry should actively anticipate new relevant credence attributes and researchers need to develop new or better methods to measure them. This review attempts to identify the most relevant quality attributes in beef that may be considered in future iterations of QAS, to increase consumer satisfaction and, potentially, to increase returns to industry. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Forests of Southern New England, 2007: A report on the forest resources of Connecticut, Massachusetts, and Rhode Island

Treesearch

Brett J. Butler; Charles J. Barnett; Susan J. Crocker; Grant M. Domke; Dale Gormanson; William N. Hill; Cassandra M. Kurtz; Tonya Lister; Christopher Martin; Patrick D. Miles; Randall Morin; W. Keith Moser; Mark D. Nelson; Barbara O' Connell; Bruce Payton; Charles H. Perry; Ronald J. Piva; Rachel Riemann; Christopher W. Woodall

2011-01-01

This report summarizes the results of the fifth forest inventory of the forests of Southern New England, defined as Connecticut, Massachusetts, and Rhode Island, conducted by the U.S. Forest Service, Forest Inventory and analysis program. Information on forest attributes, ownership, land use change, carbon, timber products, forest health, and statistics and quality...

Counselling and psychotherapy services in more developed and developing regions in China: a comparative investigation of practitioners and current service delivery.

PubMed

Qian, Mingyi; Chen, Ruiyun; Chen, Hong; Hu, Sherlyn; Zhong, Jie; Yao, Ping; Yi, Chunli

2012-09-01

Counselling and psychotherapy services have taken off with uneven speed across China since the 1980s after several years of stagnation. Researchers have attributed socioeconomic development (or the lack thereof) and regional differences as main barriers to the development in this field. However, little is known today about the status of counselling and psychotherapy services across China. To investigate and compare the current situation of practitioners and service delivery of counselling and psychotherapy in more developed and developing regions across China. Convenience sampling methods from counselling and psychological services organizations in 29 Chinese provinces, municipalities or autonomous regions were used to recruit 1,543 participants to take part in the investigation by completing a 93-item self-designed questionnaire. Organizations in developing and more developed regions in China varied in their current practices and employment situation of their practitioners, and in the quality of service delivery. However, counselling and psychotherapy offered at universities in both types of regions are of similar quality. In China, the level of socioeconomic development significantly influences the development of professional counselling and psychotherapy services. Important progress is evident in the field; however, the lack of systematic training and the scarcity of professional practitioners remain a challenge.

The quality of health care and patient satisfaction: an exploratory investigation of the 5Qs model at some Egyptian and Jordanian medical clinics.

PubMed

Zineldin, Mosad

2006-01-01

To examine the major factors affecting patients' perception of cumulative satisfaction and to address the question whether patients in Egypt and Jordan evaluate quality of health care similarly or differently. A conceptual model including behavioural dimensions of patient-physician relationships and patient satisfaction has been developed. As the empirical research setting, this study concerns three hospitals in Egypt and Jordan. The survey instrument in a questionnaire form was designed to achieve the research objectives. A total of 48 items (attributes) of the newly developed five quality dimensions were identified to be the most relevant. A total of 224 complete and usable questionnaires were received from the in-patients. Hospital C has above-average total and dimensional qualities and patients are the most satisfied in accordance with all dimensions of services. Hospitals A and B have under-average total qualities as the majority of patients are not satisfied with services. Comparing hospitals A and B, in the majority of dimensions (with the exception of Q5), the quality in hospital B is higher than in hospital A. Patients' satisfaction with different service quality dimensions is correlated with their willingness to recommend the hospital to others. A cure to improve the quality for health-care services can be an application of total relationship management and the 5Qs model together with customer orientation strategy. The result can be used by the hospitals to reengineer and redesign creatively their quality management processes and the future direction of their more effective health-care quality strategies. In this research a study is described involving a new instrument and a new method which assure a reasonable level of relevance, validity and reliability, while being explicitly change-oriented. This study argues that a patient's satisfaction is a cumulative construct, summing satisfaction with five different qualities (5Qs) of the hospital: quality of object, processes, infrastructure, interaction, and atmosphere.

Comparison of patient perceived primary care quality in public clinics, public hospitals and private clinics in rural China.

PubMed

Wang, Wenhua; Maitland, Elizabeth; Nicholas, Stephen; Loban, Ekaterina; Haggerty, Jeannie

2017-10-03

In rural China, patients have free choice of health facilities for outpatient services. Comparison studies exploring the attributes of different health facilities can help identify optimal primary care service models. Using a representative sample of Chinese provinces, this study aimed to compare patients' rating of three primary care service models used by rural residents (public clinics, public hospitals and private clinics) on a range of health care attributes related to responsiveness. This was a secondary analysis using the household survey data from World Health Organization (WHO) Study on global AGEing and adult health (SAGE). Using a multistage cluster sampling strategy, eight provinces were selected and finally 3435 overall respondents reporting they had visited public clinics, public hospitals or private clinics during the last year, were included in our analysis. Five items were used to measure patient perceived quality in five domains including prompt attention, communication and autonomy, dignity and confidentiality. ANOVA and Turkey's post hoc tests were used to conduct comparative analysis of five domains. Separate multivariate linear regression models were estimated to examine the association of primary care service models with each domain after controlling for patient characteristics. The distribution of last health facilities visited was: 29.5% public clinics; 31.2% public hospitals and; 39.3% private clinics. Public clinics perform best in all five domains: prompt attention (4.15), dignity (4.17), communication (4.07), autonomy (4.05) and confidentiality (4.02). Public hospitals perform better than private clinics in dignity (4.03 vs 3.94), communication (3.97 vs 3.82), autonomy (3.92 vs 3.74) and confidentiality (3.94 vs 3.73), but equivalently in prompt attention (3.92 vs 3.93). Rural residents who are older, wealthier, and with higher self-rated health status have significantly higher patient perceived quality of care in all domains. Rural public clinics, which share many characteristics with the optimal primary care delivery model, should be strongly strengthened to respond to patients' needs. Better doctor-patient interaction training would improve respect, confidentiality, autonomy and, most importantly, health care quality for rural patients.

Overall satisfaction of health care users with the quality of and access to health care services: a cross-sectional study in six Central and Eastern European countries.

PubMed

Stepurko, Tetiana; Pavlova, Milena; Groot, Wim

2016-08-02

The measurement of consumer satisfaction is an essential part of the assessment of health care services in terms of service quality and health care system responsiveness. Studies across Europe have described various strategies health care users employ to secure services with good quality and quick access. In Central and Eastern European countries, such strategies also include informal payments to health care providers. This paper analyzes the satisfaction of health care users with the quality of and access to health care services. The study focuses on six Central and Eastern European countries (Bulgaria, Hungary, Lithuania, Poland, Romania and Ukraine). We use data on past experience with health care use collected in 2010 through uniform national surveys in these countries. Based on these data, we carry out a multi-country analysis to investigate factors associated with the satisfaction of health care users in the six countries. The results indicate that about 10-14 % of the service users are not satisfied with the quality of, or access to health care services they used in the preceding year. However, significant differences across countries and services are observed, e.g. the highest level of dissatisfaction with access to outpatient services (16.4 %) is observed among patients in Lithuania, while in Poland, the level of dissatisfaction with quality of outpatient and inpatient services are much lower than dissatisfaction with access. The study also analyses the association of users' satisfaction with factors such as making informal payments, inability to pay and relative importance of service attributes stated by the service users. These multi-country findings provide evidence for health policy making in the Central and Eastern European countries. Although the average rates of satisfactions per country are relatively high, the results suggest that there is ample room for improvements. Specifically, many service-users still report dissatisfaction especially those who pay informally and those unable to pay. The high shares of informal payments and inability of users to deal with the health expenditures lead to doubts about the fairness of the health care provision in Central and Eastern Europe. There is an urgent need for policy makers in the region to not only acknowledge but also to effectively address this key problem.

Preferences for working in rural clinics among trainee health professionals in Uganda: a discrete choice experiment.

PubMed

Rockers, Peter C; Jaskiewicz, Wanda; Wurts, Laura; Kruk, Margaret E; Mgomella, George S; Ntalazi, Francis; Tulenko, Kate

2012-07-23

Health facilities require teams of health workers with complementary skills and responsibilities to efficiently provide quality care. In low-income countries, failure to attract and retain health workers in rural areas reduces population access to health services and undermines facility performance, resulting in poor health outcomes. It is important that governments consider health worker preferences in crafting policies to address attraction and retention in underserved areas. We investigated preferences for job characteristics among final year medical, nursing, pharmacy, and laboratory students at select universities in Uganda. Participants were administered a cadre-specific discrete choice experiment that elicited preferences for attributes of potential job postings they were likely to pursue after graduation. Job attributes included salary, facility quality, housing, length of commitment, manager support, training tuition, and dual practice opportunities. Mixed logit models were used to estimate stated preferences for these attributes. Data were collected from 246 medical students, 132 nursing students, 50 pharmacy students and 57 laboratory students. For all student-groups, choice of job posting was strongly influenced by salary, facility quality and manager support, relative to other attributes. For medical and laboratory students, tuition support for future training was also important, while pharmacy students valued opportunities for dual practice. In Uganda, financial and non-financial incentives may be effective in attracting health workers to underserved areas. Our findings contribute to mounting evidence that salary is not the only important factor health workers consider when deciding where to work. Better quality facilities and supportive managers were important to all students. Similarities in preferences for these factors suggest that team-based, facility-level strategies for attracting health workers may be appropriate. Improving facility quality and training managers to be more supportive of facility staff may be particularly cost-effective, as investments are borne once while benefits accrue to a range of health workers at the facility.

Improvement attributes in healthcare: implications for integrated care.

PubMed

Harnett, Patrick John

2018-04-16

Purpose Healthcare quality improvement is a key concern for policy makers, regulators, carers and service users. Despite a contemporary consensus among policy makers that integrated care represents a means to substantially improve service outcomes, progress has been slow. Difficulties achieving sustained improvement at scale imply that methods employed are not sufficient and that healthcare improvement attributes may be different when compared to prior reference domains. The purpose of this paper is to examine and synthesise key improvement attributes relevant to a complex healthcare change process, specifically integrated care. Design/methodology/approach This study is based on an integrative literature review on systemic improvement in healthcare. Findings A central theme emerging from the literature review indicates that implementing systemic change needs to address the relationship between vision, methods and participant social dynamics. Practical implications Accommodating personal and professional network dynamics is required for systemic improvement, especially among high autonomy individuals. This reinforces the need to recognise the change process as taking place in a complex adaptive system where personal/professional purpose/meaning is central to the process. Originality/value Shared personal/professional narratives are insufficiently recognised as a powerful change force, under-represented in linear and rational empirical improvement approaches.

Strategies for improved French-language health services: Perspectives of family physicians in northeastern Ontario.

PubMed

Gauthier, Alain P; Timony, Patrick E; Serresse, Suzanne; Goodale, Natalie; Prpic, Jason

2015-08-01

To identify strategies to improve the quality of health services for Francophone patients. A series of semistructured key informant interviews. Northeastern Ontario. Participants A total of 18 physicians were interviewed. Ten physicians were interviewed in French, 7 physicians were women, and 10 physicians were located in urban communities. Purposive and snowball sampling strategies were used to conduct a series of semistructured key informant interviews with family physicians practising in communities with a large Francophone population. Principles of grounded theory were applied, guided by a framework for patient-professional communication. Results were inductively derived following an iterative data collection–data analysis process and were analyzed using a detailed thematic approach. Respondents identified several strategies for providing high-quality French-language health services. Some were unique to non–French-speaking physicians (eg, using appropriate interpreter services), some were unique to French-speaking physicians (eg, using a flexible dialect), and some strategies were common to all physicians serving French populations (eg, hiring bilingual staff or having pamphlets and posters in both French and English). Physicians interviewed for this study provided high-quality health care by attributing substantial importance to effective communication. While linguistic patient-to-physician concordance is ideal, it might not always be possible. Thus, conscious efforts to attenuate communication barriers are necessary, and several effective strategies exist.

Introducing care pathway commissioning to primary dental care: measuring performance.

PubMed

Harris, R; Bridgman, C; Ahmad, M; Bowes, L; Haley, R; Saleem, S; Singh, R; Taylor, S

2011-12-09

Care pathways have been used in a variety of ways: firstly to support quality improvement through standardising clinical processes, but also for secondary purposes, by purchasers of healthcare, to monitor activity and health outcomes and to commission services. This paper focuses on reporting a secondary use of care pathways: to commission and monitor performance of primary dental care services. Findings of a project involving three dental practices implementing a system based on rating patients according to their risk of disease and need for care are outlined. Data from surgery-based clinical databases and interviews from commissioners and providers are reported. The use of both process and outcome key performance indicators in this context is discussed, as well as issues which arise such as attributability of outcome measures and strategic approaches to improving quality of care.

A New Look at Data Usage by Using Metadata Attributes as Indicators of Data Quality

NASA Astrophysics Data System (ADS)

Won, Y. I.; Wanchoo, L.; Behnke, J.

2016-12-01

NASA's Earth Observing System Data and Information System (EOSDIS) stores and distributes data from EOS satellites, as well as ancillary, airborne, in-situ, and socio-economic data. Twelve EOSDIS data centers support different scientific disciplines by providing products and services tailored to specific science communities. Although discipline oriented, these data centers provide common data management functions of ingest, archive and distribution, as well as documentation of their data and services on their web-sites. The Earth Science Data and Information System (ESDIS) Project collects these metrics from the EOSDIS data centers on a daily basis through a tool called the ESDIS Metrics System (EMS). These metrics are used in this study. The implementation of the Earthdata Login - formerly known as the User Registration System (URS) - across the various NASA data centers provides the EMS additional information about users obtaining data products from EOSDIS data centers. These additional user attributes collected by the Earthdata login, such as the user's primary area of study can augment the understanding of data usage, which in turn can help the EOSDIS program better understand the users' needs. This study will review the key metrics (users, distributed volume, and files) in multiple ways to gain an understanding of the significance of the metadata. Characterizing the usability of data by key metadata elements such as discipline and study area, will assist in understanding how the users have evolved over time. The data usage pattern based on version numbers may also provide some insight into the level of data quality. In addition, the data metrics by various services such as the Open-source Project for a Network Data Access Protocol (OPeNDAP), Web Map Service (WMS), Web Coverage Service (WCS), and subsets, will address how these services have extended the usage of data. Over-all, this study will present the usage of data and metadata by metrics analyses and will assist data centers in better supporting the needs of the users.

Preferences for physician services in Ukraine: a discrete choice experiment.

PubMed

Danyliv, Andriy; Pavlova, Milena; Gryga, Irena; Groot, Wim

2015-01-01

Evidence on preferences of Ukrainian consumers for healthcare improvements can help to design reforms that correspond to societal priorities. This study aims to elicit and to place monetary values on public preferences for out-patient physician services in Ukraine. The method of discrete choice experiment is used on a sample of 303 respondents, representative of the adult Ukrainian population. The random effect logit model with interactions provides the best fit for the data and is used to calculate the marginal willingness to pay (MWTP) for quality and access improvements. At a sample level, there is no clear preference to pay formally rather than informally or vice versa. We also do not find that visiting a general practitioner is preferred over direct access to a medical specialist. However, there are differences between population groups. Quality-related attributes of physician services appear important to respondents, especially the attitude of medical staff. Thus, interpersonal aspects of out-patient care should be given priority in decisions about investments in quality improvements. Other aspects, that is social quality and access, are important as well but their improvement brings fewer social gains. Measures should be taken to eradicate the informal payment channels and to strengthen the gate-keeping role of primary care. Copyright © 2014 John Wiley & Sons, Ltd.

Ecosystem attributes related to tidal wetland effects on water quality.

PubMed

Findlay, S; Fischer, D

2013-01-01

Biogeochemical functioning of ecosystems is central to nutrient cycling, carbon balance, and several ecosystem services, yet it is not always clear why levels of function might vary among systems. Wetlands are widely recognized for their ability to alter concentrations of solutes and particles as water moves through them, but we have only general expectations for what attributes of wetlands are linked to variability in these processes. We examined changes in several water quality variables (dissolved oxygen, dissolved organic carbon, nutrients, and suspended particles) to ascertain which constituents are influenced during tidal exchange with a range of 17 tidal freshwater wetlands along the Hudson River, New York, USA. Many of the constituents showed significant differences among wetlands or between flooding and ebbing tidal concentrations, indicating wetland-mediated effects. For dissolved oxygen, the presence of even small proportional cover by submerged aquatic vegetation increased the concentration of dissolved oxygen in water returned to the main channel following a daytime tidal exchange. Nitrate concentrations showed consistent declines during ebbing tides, but the magnitude of decline varied greatly among sites. The proportional cover by graminoid-dominated high intertidal vegetation accounted for over 40% of the variation in nitrate decline. Knowing which water-quality alterations are associated with which attributes helps suggest underlying mechanisms and identifies what functions might be susceptible to change as sea level rise or salinity intrusion drives shifts in wetland vegetation cover.

Seniors' views on the use of electronic health records.

PubMed

Morin, Diane; Tourigny, Andre; Pelletier, Daniel; Robichaud, Line; Mathieu, Luc; Vézina, Aline; Bonin, Lucie; Buteau, Martin

2005-01-01

In the Mauricie and Centre-du-Québec region of the province of Quebec, Canada, an integrated services network has been implemented for frail seniors. It combines three of the best practices in the field of integrated services, namely: single-entry point, case management and personalized care plan. A shared interdisciplinary electronic health record (EHR) system was set up in 1998. A consensus on the relevance of using EHRs is growing in Quebec, in Canada and around the world. However, technology has out-paced interest in the notions of confidentiality, informed consent and the impact perceived by the clientele. This study specifically examines how frail seniors perceive these issues related to an EHR. The conceptual framework is inspired by the DeLone and McLean model whose main attributes are: system quality, information quality, utilisation modes and the impact on organisations and individuals. This last attribute is the focus of this study, which is a descriptive with quantitative and qualitative component. Thirty seniors were surveyed. Positive information they provided falls under three headings: (i) being better informed; (ii) trust and consideration for professionals; and (iii) appreciation of innovation. The opinions of the seniors are generally favourable regarding the use of computers and the EHR in their presence. Improvements in EHR systems for seniors can be encouraged.

Quality and comparison of antenatal care in public and private providers in the United Republic of Tanzania.

PubMed Central

Boller, Christoph; Wyss, Kaspar; Mtasiwa, Deo; Tanner, Marcel

2003-01-01

OBJECTIVE: To compare the quality of public and private first-tier antenatal care services in Dar es Salaam, United Republic of Tanzania, using defined criteria. METHODS: Structural attributes of quality were assessed through a checklist, and process attributes, including interpersonal and technical aspects, through observation and exit interviews. A total of 16 health care providers, and 166 women in the public and 188 in the private sector, were selected by systematic random sampling for inclusion in the study. Quality was measured against national standards, and an overall score calculated for the different aspects to permit comparison. FINDINGS: The results showed that both public and private providers were reasonably good with regard to the structural and interpersonal aspects of quality of care. However, both were poor when it came to technical aspects of quality. For example, guidelines for dispensing prophylactic drugs against anaemia or malaria were not respected, and diagnostic examinations for the assessment of gestation, anaemia, malaria or urine infection were frequently not performed. In all aspects, private providers were significantly better than public ones. CONCLUSION: Approaches to improving quality of care should emerge progressively as a result of regular quality assessments. Changes should be introduced using an incremental approach addressing few improvements at a time, while ensuring participation in, and ownership of, every aspect of the strategy by health personnel, health planners and managers and also the community. PMID:12751419

Patient perceptions and expectations of an anticoagulation service: a quantitative comparison study of clinic-based testers and patient self-testers.

PubMed

Money, Arthur G; Barnett, Julie; Kuljis, Jasna; Duffin, Debbie

2015-12-01

Government initiatives see the provision of technology-assisted self-care as one of the key areas in which there is capacity for improving quality of care whilst reducing costs. However, levels of patient engagement in self-testing and management (STM) remain low. Little emphasis has been placed on understanding the patients' perspectives of the reasons for this limited engagement. Typically, patient engagement in STM is achieved via the provision of patient education programmes, which aim to enable patients to make the changes necessary to become competent self-carers. However, placing the onus to change on the individual patient is unrealistic. If levels of patient engagement are to be improved, patient needs and expectations of clinical services must be better understood and service provision must be adapted accordingly. Explore patient perceptions and expectations of clinical service provision and their views of having and making choices about care. Participants [N = 191, 103 patient self-tester managers (PSTMs) and 87 clinic-based testers (CBTs)] completed the SERVQUAL and ChQ instruments to capture perspectives on service quality and choice, respectively. A comparative statistical analysis explored the similarities and differences between PSTMs' and CBTs' responses. Clinic-based testers' perceptions of service quality were significantly more positive than PSTMs', as were their expectations of the 'tangible' aspects of service delivery. PSTMs' expectations of service quality were significantly higher than their perceptions. PSTMs attributed significantly more value to making choices compared with CBTs. To close the gap between PSTMs expectations and perceptions of service quality and better cater for their choice preferences, service providers may benefit from taking into account the following practice considerations: maintain frequent, timely, personalised and direct interactions with PSTMs; prioritise investment in resources to facilitate patient/practitioner interaction over tangible facilities; ensure that PSTMs are given the opportunity to make choices about their care. © 2015 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.

Partners’ Attributions for Service Members’ Symptoms of Combat-Related Posttraumatic Stress Disorder

PubMed Central

Renshaw, Keith D.; Allen, Elizabeth S.; Carter, Sarah P.; Markman, Howard J.; Stanley, Scott M.

2014-01-01

The association of service members’ combat-related PTSD with partners’ distress is weaker when spouses/partners believe that service members experienced more traumatic events during deployment. Also, when simultaneously examining partners’ perceptions of all PTSD symptoms, perceptions of re-experiencing symptoms (the symptoms most obviously connected to traumatic events) are significantly, negatively related to distress in partners. These findings are consistent with the notion that partners may be less distressed if they make external, rather than internal, attributions for service members’ symptoms. The present study explicitly tests this possibility. Civilian wives of active duty service members completed measures regarding their own marital satisfaction, their perceptions of service members’ combat exposure during deployments, their perceptions of service members’ symptoms of PTSD, and their attributions for those symptoms. External attributions were significantly, positively associated with perceptions of combat exposure (rp = .31) and re-experiencing symptoms (β = .33) and significantly, negatively associated with perceptions of numbing/withdrawal symptoms (rp = −.22). In contrast, internal attributions were significantly, negatively associated with perceptions of re-experiencing symptoms (β = −.18) and significantly, positively associated with perceptions of numbing/withdrawal symptoms (β = .46). Internal attributions significantly moderated the negative association of PTSD symptoms with marital satisfaction, such that the association strengthened as internal attributions increased. These findings are the first explicit support for an attributional understanding of distress in partners of combat veterans. Interventions that alter partners’ attributions may improve marital functioning. PMID:24491194

Investigating preferences for support with life after stroke: a discrete choice experiment.

PubMed

Burton, Christopher R; Fargher, Emily; Plumpton, Catrin; Roberts, Gwerfyl W; Owen, Heledd; Roberts, Eryl

2014-02-08

There is little evidence of service user preferences to guide the commissioning and improvement of services that support life after stroke. We report the first investigation of patients' and family carers' preferences for community services after stroke using a discrete choice experiment (DCE). Two workshops with patients and family carers (n = 8) explored stroke experiences, identifying attributes important in shaping views about service design, and piloted data collection strategies. Attributes were group versus individual support; service provider; additional support for social and leisure activities; and the total time required to access services. Patients and family carers were recruited six months post stroke-onset (mean 331 days) from four stroke services, and invited to participate in the DCE. Patients' general health (EQ5D) and functional dependence (Barthel Index) were also assessed. Of 474 eligible patients, 144 (30%) expressed an interest in the study, and 80 (56%) of these completed the survey questionnaire. 34 of 74 (46%) family carers recruited through patients completed the DCE. All four attributes were significant in shaping patients preferences for stroke support service delivery (p < 0.05), confirming the interpretation of workshop findings. Patients prefer help and support for emotional needs, communication problems and physical difficulties to be provided on an individual basis; and to be offered additional social and leisure activities that they are able to attend on their own. Patients would appear to prefer that voluntary organisations do not provide these services, although this may be linked to lack of experience of these services. Family carers would prefer help and support in their caring role on a one-to-one basis. Whilst health related quality of life is associated with preference for format of service, results were relatively consistent across sub-groups, with the exception of time since stroke, where social and leisure activities had a greater impact on preferences of established service users. The data provide unique insights into how preferences for community services that support life after stroke are shaped. This information can be used to inform both service re-design, and barriers to implementation that will need to be accounted for in policy shifts towards a more mixed economy of service provision.

Evaluation of the visual performance of image processing pipes: information value of subjective image attributes

NASA Astrophysics Data System (ADS)

Nyman, G.; Häkkinen, J.; Koivisto, E.-M.; Leisti, T.; Lindroos, P.; Orenius, O.; Virtanen, T.; Vuori, T.

2010-01-01

Subjective image quality data for 9 image processing pipes and 8 image contents (taken with mobile phone camera, 72 natural scene test images altogether) from 14 test subjects were collected. A triplet comparison setup and a hybrid qualitative/quantitative methodology were applied. MOS data and spontaneous, subjective image quality attributes to each test image were recorded. The use of positive and negative image quality attributes by the experimental subjects suggested a significant difference between the subjective spaces of low and high image quality. The robustness of the attribute data was shown by correlating DMOS data of the test images against their corresponding, average subjective attribute vector length data. The findings demonstrate the information value of spontaneous, subjective image quality attributes in evaluating image quality at variable quality levels. We discuss the implications of these findings for the development of sensitive performance measures and methods in profiling image processing systems and their components, especially at high image quality levels.

Empirical research on Kano’s model and customer satisfaction

PubMed Central

Lin, Feng-Han; Tsai, Sang-Bing; Lee, Yu-Cheng; Hsiao, Cheng-Fu; Zhou, Jie; Wang, Jiangtao; Shang, Zhiwen

2017-01-01

Products are now developed based on what customers desire, and thus attractive quality creation has become crucial. In studies on customer satisfaction, methods for analyzing quality attributes and enhancing customer satisfaction have been proposed to facilitate product development. Although substantial studies have performed to assess the impact of the attributes on customer satisfaction, little research has been conducted that quantitatively calculate the odds of customer satisfaction for the Kano classification, fitting a nonlinear relationship between attribute-level performance and customer satisfaction. In the present study, the odds of customer satisfaction were determined to identify the classification of quality attributes, and took customer psychology into account to suggest how decision-makers should prioritize the allocation of resources. A novel method for quantitatively assessing quality attributes was proposed to determine classification criteria and fit the nonlinear relationship between quality attributes and customer satisfaction. Subsequently, a case study was conducted on bicycle user satisfaction to verify the novel method. The concept of customer satisfaction odds was integrated with the value function from prospect theory to understand quality attributes. The results of this study can serve as a reference for product designers to create attractive quality attributes in their products and thus enhance customer satisfaction. PMID:28873418

Empirical research on Kano's model and customer satisfaction.

PubMed

Lin, Feng-Han; Tsai, Sang-Bing; Lee, Yu-Cheng; Hsiao, Cheng-Fu; Zhou, Jie; Wang, Jiangtao; Shang, Zhiwen

2017-01-01

Products are now developed based on what customers desire, and thus attractive quality creation has become crucial. In studies on customer satisfaction, methods for analyzing quality attributes and enhancing customer satisfaction have been proposed to facilitate product development. Although substantial studies have performed to assess the impact of the attributes on customer satisfaction, little research has been conducted that quantitatively calculate the odds of customer satisfaction for the Kano classification, fitting a nonlinear relationship between attribute-level performance and customer satisfaction. In the present study, the odds of customer satisfaction were determined to identify the classification of quality attributes, and took customer psychology into account to suggest how decision-makers should prioritize the allocation of resources. A novel method for quantitatively assessing quality attributes was proposed to determine classification criteria and fit the nonlinear relationship between quality attributes and customer satisfaction. Subsequently, a case study was conducted on bicycle user satisfaction to verify the novel method. The concept of customer satisfaction odds was integrated with the value function from prospect theory to understand quality attributes. The results of this study can serve as a reference for product designers to create attractive quality attributes in their products and thus enhance customer satisfaction.

Main Quality Attributes of Monoclonal Antibodies and Effect of Cell Culture Components

PubMed

Torkashvand, Fatemeh; Vaziri, Behrouz

2017-05-01

The culture media optimization is an inevitable part of upstream process development in therapeutic monoclonal antibodies (mAbs) production. The quality by design (QbD) approach defines the assured quality of the final product through the development stage. An important step in QbD is determination of the main quality attributes. During the media optimization, some of the main quality attributes such as glycosylation pattern, charge variants, aggregates, and low-molecular-weight species, could be significantly altered. Here, we provide an overview of how cell culture medium components affects the main quality attributes of the mAbs. Knowing the relationship between the culture media components and the main quality attributes could be successfully utilized for a rational optimization of mammalian cell culture media for industrial mAbs production.

What is the empirical basis for paying for quality in health care?

PubMed

Rosenthal, Meredith B; Frank, Richard G

2006-04-01

Despite more than a decade of bench-marking and public reporting of quality problems in the health care sector, changes in medical practice have been slow to materialize. To accelerate quality improvement, many private and public payers have begun to offer financial incentives to physicians and hospitals based on their performance on clinical and service quality measures. The authors review the empirical literature on paying for quality in health care and comparable interventions in other sectors. They find little evidence to support the effectiveness of paying for quality. The absence of findings for an effect may be attributable to the small size of the bonuses studied and the fact that payers often accounted for only a fraction of the targeted provider's panel. Even in non-health settings, however, where the institutional features are more favorable to a positive impact, the literature contains mixed results on the effectiveness of analogous pay-for-performance schemes.

[Comment on "La Calidad de Atencion en la Provision de Servicios Clinicos" of Juan Diaz and Hans Halbe].

PubMed

Trias, M

1990-12-01

Rather than a commentary on a specific article, this work contains reflections on the concept of quality in provision of family planning services and its possible use to deflect family planning efforts. Quality is a difficult concept to define precisely. Applied to family planning, it may be defined as the totality of attributes possessed by a program that does not place impediments in the way of comfortable adoption of a contraceptive method. Another definition of quality, achievable only by a long list of ideal characteristics which are often expensive and sometimes unattainable, has been and continues to be used by enemies of family planning to slow its diffusion; they hold that if perfect quality is not offered, it is better to offer nothing. A specific tactic of this group is to oppose the quantity of services with their quality. The hard-fought campaign to discredit the measurement of concrete goals and results is part of this strategy. But it is apparent that without a reasonably satisfactory quality of service, no program would achieve significant growth. People would not continue to come, and in growing numbers, to a program where they received poor quality service. Each goal, each statistic, each percentage represents human problems confronted and resolved by programs and personnel. Profamilia has become 1 of the largest nongovernmental family planning organizations. Profamilia has always paid attention to the quality of its services and has conducted numerous studies to assess results and identify shortcomings. The high percentage of positive results attests to the quality of Profamilia programs. In an age of scarce resources and tight budgets, the objective of family planning programs is to provide an austere but acceptable quality of attention so that the quantity of services will be sufficient to meet demand. Program elements that have a real cost without offering a measurable benefit should be avoided. Another problem is that integrated programs that aim to combine family planning with maternal-child health or other services often end by neglecting the family planning component. Profamilia believes that good information should be provided with services, but it is limited to what is needed for proper and safe use of each method. And integration is not presently needed to disguise or dress up family planning programs. It is justifiable only when for political reasons there is no alternative or when it can provide other resources to subsidize family planning programs.

Incorporation of Socio-Economic Features' Ranking in Multicriteria Analysis Based on Ecosystem Services for Marine Protected Area Planning

PubMed Central

Portman, Michelle E.; Shabtay-Yanai, Ateret; Zanzuri, Asaf

2016-01-01

Developed decades ago for spatial choice problems related to zoning in the urban planning field, multicriteria analysis (MCA) has more recently been applied to environmental conflicts and presented in several documented cases for the creation of protected area management plans. Its application is considered here for the development of zoning as part of a proposed marine protected area management plan. The case study incorporates specially-explicit conservation features while considering stakeholder preferences, expert opinion and characteristics of data quality. It involves the weighting of criteria using a modified analytical hierarchy process. Experts ranked physical attributes which include socio-economically valued physical features. The parameters used for the ranking of (physical) attributes important for socio-economic reasons are derived from the field of ecosystem services assessment. Inclusion of these feature values results in protection that emphasizes those areas closest to shore, most likely because of accessibility and familiarity parameters and because of data biases. Therefore, other spatial conservation prioritization methods should be considered to supplement the MCA and efforts should be made to improve data about ecosystem service values farther from shore. Otherwise, the MCA method allows incorporation of expert and stakeholder preferences and ecosystem services values while maintaining the advantages of simplicity and clarity. PMID:27183224

Incorporation of Socio-Economic Features' Ranking in Multicriteria Analysis Based on Ecosystem Services for Marine Protected Area Planning.

PubMed

Portman, Michelle E; Shabtay-Yanai, Ateret; Zanzuri, Asaf

2016-01-01

Developed decades ago for spatial choice problems related to zoning in the urban planning field, multicriteria analysis (MCA) has more recently been applied to environmental conflicts and presented in several documented cases for the creation of protected area management plans. Its application is considered here for the development of zoning as part of a proposed marine protected area management plan. The case study incorporates specially-explicit conservation features while considering stakeholder preferences, expert opinion and characteristics of data quality. It involves the weighting of criteria using a modified analytical hierarchy process. Experts ranked physical attributes which include socio-economically valued physical features. The parameters used for the ranking of (physical) attributes important for socio-economic reasons are derived from the field of ecosystem services assessment. Inclusion of these feature values results in protection that emphasizes those areas closest to shore, most likely because of accessibility and familiarity parameters and because of data biases. Therefore, other spatial conservation prioritization methods should be considered to supplement the MCA and efforts should be made to improve data about ecosystem service values farther from shore. Otherwise, the MCA method allows incorporation of expert and stakeholder preferences and ecosystem services values while maintaining the advantages of simplicity and clarity.

The Right Tree for the Job? Perceptions of Species Suitability for the Provision of Ecosystem Services

NASA Astrophysics Data System (ADS)

Smaill, Simeon J.; Bayne, Karen M.; Coker, Graham W. R.; Paul, Thomas S. H.; Clinton, Peter W.

2014-04-01

Stakeholders in plantation forestry are increasingly aware of the importance of the ecosystem services and non-market values associated with forests. In New Zealand, there is significant interest in establishing species other than Pinus radiata D. Don (the dominant plantation species) in the belief that alternative species are better suited to deliver these services. Significant risk is associated with this position as there is little objective data to support these views. To identify which species were likely to be planted to deliver ecosystem services, a survey was distributed to examine stakeholder perceptions. Stakeholders were asked which of 15 tree attributes contributed to the provision of five ecosystem services (amenity value, bioenergy production, carbon capture, the diversity of native habitat, and erosion control/water quality) and to identify which of 22 candidate tree species possessed those attributes. These data were combined to identify the species perceived most suitable for the delivery of each ecosystem service. Sequoia sempervirens (D.Don) Endl. closely matched the stakeholder derived ideotypes associated with all five ecosystem services. Comparisons to data from growth, physiological and ecological studies demonstrated that many of the opinions held by stakeholders were inaccurate, leading to erroneous assumptions regarding the suitability of most candidate species. Stakeholder perceptions substantially influence tree species selection, and plantations established on the basis of inaccurate opinions are unlikely to deliver the desired outcomes. Attitudinal surveys associated with engagement campaigns are essential to improve stakeholder knowledge, advancing the development of fit-for-purpose forest management that provides the required ecosystem services.

The right tree for the job? perceptions of species suitability for the provision of ecosystem services.

PubMed

Smaill, Simeon J; Bayne, Karen M; Coker, Graham W R; Paul, Thomas S H; Clinton, Peter W

2014-04-01

Stakeholders in plantation forestry are increasingly aware of the importance of the ecosystem services and non-market values associated with forests. In New Zealand, there is significant interest in establishing species other than Pinus radiata D. Don (the dominant plantation species) in the belief that alternative species are better suited to deliver these services. Significant risk is associated with this position as there is little objective data to support these views. To identify which species were likely to be planted to deliver ecosystem services, a survey was distributed to examine stakeholder perceptions. Stakeholders were asked which of 15 tree attributes contributed to the provision of five ecosystem services (amenity value, bioenergy production, carbon capture, the diversity of native habitat, and erosion control/water quality) and to identify which of 22 candidate tree species possessed those attributes. These data were combined to identify the species perceived most suitable for the delivery of each ecosystem service. Sequoia sempervirens (D.Don) Endl. closely matched the stakeholder derived ideotypes associated with all five ecosystem services. Comparisons to data from growth, physiological and ecological studies demonstrated that many of the opinions held by stakeholders were inaccurate, leading to erroneous assumptions regarding the suitability of most candidate species. Stakeholder perceptions substantially influence tree species selection, and plantations established on the basis of inaccurate opinions are unlikely to deliver the desired outcomes. Attitudinal surveys associated with engagement campaigns are essential to improve stakeholder knowledge, advancing the development of fit-for-purpose forest management that provides the required ecosystem services.

Quality Attributes for Mission Flight Software: A Reference for Architects

NASA Technical Reports Server (NTRS)

Wilmot, Jonathan; Fesq, Lorraine; Dvorak, Dan

2016-01-01

In the international standards for architecture descriptions in systems and software engineering (ISO/IEC/IEEE 42010), "concern" is a primary concept that often manifests itself in relation to the quality attributes or "ilities" that a system is expected to exhibit - qualities such as reliability, security and modifiability. One of the main uses of an architecture description is to serve as a basis for analyzing how well the architecture achieves its quality attributes, and that requires architects to be as precise as possible about what they mean in claiming, for example, that an architecture supports "modifiability." This paper describes a table, generated by NASA's Software Architecture Review Board, which lists fourteen key quality attributes, identifies different important aspects of each quality attribute and considers each aspect in terms of requirements, rationale, evidence, and tactics to achieve the aspect. This quality attribute table is intended to serve as a guide to software architects, software developers, and software architecture reviewers in the domain of mission-critical real-time embedded systems, such as space mission flight software.

[The concept of quality of life in medicine: its history and current relevance].

PubMed

Bullinger, Monika

2014-01-01

This paper attempts to review 40 years of quality-of-life research. The increasing recognition of the topic is obvious from the number of publications and its representation in academic discussions. Despite a rather weak theoretical foundation, methods of quality-of-life assessment have been developed successfully. Both the number and the quality of assessment tools have increased over the years so that there is now a broad spectrum of instruments for adults and children available, which is used from epidemiological studies to health services research, and especially in quality assurance and comparative benchmarking. Assessment is still underrepresented in clinical trials, which is why only few meta-analyses and reviews are available. Also, implementation of results in recommendations for treatment and in guidelines has just started. Implications for clinical practice also relate to the patient orientation in the physician-patient communication. A future perspective is the widespread use of available instruments, provided that relevant information is gained, which depends on the study design as well as the interpretation and dissemination of results. Consequences for the healthcare systems are expected if improvements in quality of life can be attributed to benefits of treatment and surrounding services. Copyright © 2014. Published by Elsevier GmbH.

Healthcare Transformation and Changing Roles for Nursing

PubMed Central

Salmond, Susan W.; Echevarria, Mercedes

2017-01-01

Factors driving healthcare transformation include fragmentation, access problems, unsustainable costs, suboptimal outcomes, and disparities. Cost and quality concerns along with changing social and disease-type demographics created the greatest urgency for the need for change. Caring for and paying for medical treatments for patients suffering from chronic health conditions are a significant concern. The Affordable Care Act includes programs now led by the Centers for Medicare & Medicaid Services aiming to improve quality and control cost. Greater coordination of care—across providers and across settings—will improve quality care, improve outcomes, and reduce spending, especially attributed to unnecessary hospitalization, unnecessary emergency department utilization, repeated diagnostic testing, repeated medical histories, multiple prescriptions, and adverse drug interactions. As a nation, we have taken incremental steps toward achieving better quality and lower costs for decades. Nurses are positioned to contribute to and lead the transformative changes that are occurring in healthcare by being a fully contributing member of the interprofessional team as we shift from episodic, provider-based, fee-for-service care to team-based, patient-centered care across the continuum that provides seamless, affordable, and quality care. These shifts require a new or an enhanced set of knowledge, skills, and attitudes around wellness and population care with a renewed focus on patient-centered care, care coordination, data analytics, and quality improvement. PMID:28107295

Efficiently Selecting the Best Web Services

NASA Astrophysics Data System (ADS)

Goncalves, Marlene; Vidal, Maria-Esther; Regalado, Alfredo; Yacoubi Ayadi, Nadia

Emerging technologies and linking data initiatives have motivated the publication of a large number of datasets, and provide the basis for publishing Web services and tools to manage the available data. This wealth of resources opens a world of possibilities to satisfy user requests. However, Web services may have similar functionality and assess different performance; therefore, it is required to identify among the Web services that satisfy a user request, the ones with the best quality. In this paper we propose a hybrid approach that combines reasoning tasks with ranking techniques to aim at the selection of the Web services that best implement a user request. Web service functionalities are described in terms of input and output attributes annotated with existing ontologies, non-functionality is represented as Quality of Services (QoS) parameters, and user requests correspond to conjunctive queries whose sub-goals impose restrictions on the functionality and quality of the services to be selected. The ontology annotations are used in different reasoning tasks to infer service implicit properties and to augment the size of the service search space. Furthermore, QoS parameters are considered by a ranking metric to classify the services according to how well they meet a user non-functional condition. We assume that all the QoS parameters of the non-functional condition are equally important, and apply the Top-k Skyline approach to select the k services that best meet this condition. Our proposal relies on a two-fold solution which fires a deductive-based engine that performs different reasoning tasks to discover the services that satisfy the requested functionality, and an efficient implementation of the Top-k Skyline approach to compute the top-k services that meet the majority of the QoS constraints. Our Top-k Skyline solution exploits the properties of the Skyline Frequency metric and identifies the top-k services by just analyzing a subset of the services that meet the non-functional condition. We report on the effects of the proposed reasoning tasks, the quality of the top-k services selected by the ranking metric, and the performance of the proposed ranking techniques. Our results suggest that the number of services can be augmented by up two orders of magnitude. In addition, our ranking techniques are able to identify services that have the best values in at least half of the QoS parameters, while the performance is improved.

Program structure and counselor-client contact in outpatient substance abuse treatment.

PubMed

Knight, Danica K; Broome, Kirk M; Simpson, D Dwayne; Flynn, Patrick M

2008-04-01

To examine organizational structural attributes associated with counselor-client contact. Data were collected in 2004 and 2005 for a federally funded project, which simultaneously examines organizational structure, functioning, and resources among outpatient substance abuse treatment programs. The study uses a naturalistic design to investigate organizational structure measures-ownership, accreditation, and supplemental services-as predictors of time in counseling and case management, and caseload size, controlling for geographic differences. Directors at 116 outpatient drug-free treatment programs located in four regions across the U.S. (Great Lakes, Gulf Coast, Northwest, and Southeast) voluntarily completed a survey about program structure. Clients received more counseling hours in programs that were "intensive," publicly owned, accredited, and had a lower proportion of recently hired counselors. More case management hours were offered in "intensive," private-for-profit or publicly owned (versus private-nonprofit) programs, serving a lower proportion of dual-diagnosis clients, and providing more on-site supplemental services. Smaller caseloads were found in programs that were accredited and had a smaller average client census and a lower proportion of criminal justice referred clients. Organizational attributes are related to counselor-client contact and may have implications for staff turnover and service quality.

Modeling for Ecosystem Services: Challenges and Opportunities

NASA Astrophysics Data System (ADS)

Guswa, A. J.; Brauman, K. A.; Ghile, Y.

2012-12-01

Ecosystem services are those values provided to human society by the structure and processes of ecosystems and landscapes. Water-related services include the transformation of precipitation impulses into supplies of water for hydropower, irrigation, and industrial and municipal uses, the retention and removal of applied nutrients and pollutants, flood-damage mitigation, recreation, and the provision of cultural and aesthetic values. Incorporation of changes to the value of these services in land-use planning and decision making requires identification of the relevant services, engagement of stakeholders, knowledge of how land-use changes impact water quality, quantity, and timing, and mechanisms for putting value on the hydrologic and biogeochemical changes. We present three examples that highlight the characteristics, challenges, and opportunities associated with prototypical decisions that incorporate ecosystem services values: scenario analysis, payment for ecosystem services, and optimal spatial planning. Through these examples, we emphasize the challenges of data availability, model resolution and complexity, and attribution of value. We also provide some suggestions for ways forward.

Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China

PubMed Central

Richards, Esther; Zhang, Weihong; Hu, Lina; Wu, Shangchun; Tolhurst, Rachel

2017-01-01

Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers’ perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces—Zhejiang, Hubei and Yunnan—were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources. PMID:29045434

Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China.

PubMed

Jiang, Hong; Xu, Jieshuang; Richards, Esther; Qian, Xu; Zhang, Weihong; Hu, Lina; Wu, Shangchun; Tolhurst, Rachel

2017-01-01

Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers' perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces-Zhejiang, Hubei and Yunnan-were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources.

Quality of Primary Health Care for children and adolescents living with HIV 1

PubMed Central

do Nascimento, Leticia; de Paula, Cristiane Cardoso; Magnago, Tania Solange Bosi de Souza; Padoin, Stela Maris de Mello; Harzheim, Erno; da Silva, Clarissa Bohrer

2016-01-01

Abstract Objective: to evaluate the quality of health care for children and adolescents living with HIV, among the different types of Primary Health Care services of Santa Maria, Rio Grande do Sul. Method: cross-sectional study, developed with 118 Primary Health Care professionals. The Primary Care Evaluation Instrument, Professional version, was used. For verification of the variables associated with the high score, Poisson Regression was used. Results: the professionals of the Family Health Strategy, when compared to those of the Primary Health Units, obtained a greater degree of orientation to primary care, both for the overall score and for the derived attributes score, as well as for the integrality and community orientation attributes. A specialization in Primary Health Care, other employment and a statutory work contract were associated with quality of care. Conclusion: the Family Health Strategy was shown to provide higher quality health care for children and adolescents living with HIV, however, the coverage is still low. The need was highlighted to expand this coverage and invest in vocational training directed toward Primary Care and making the professionals effective, through public selection procedure, as well as an improvement program that recognizes the care requirements, in these settings, of children and adolescents infected with HIV. PMID:27579927

Ontology Based Quality Evaluation for Spatial Data

NASA Astrophysics Data System (ADS)

Yılmaz, C.; Cömert, Ç.

2015-08-01

Many institutions will be providing data to the National Spatial Data Infrastructure (NSDI). Current technical background of the NSDI is based on syntactic web services. It is expected that this will be replaced by semantic web services. The quality of the data provided is important in terms of the decision-making process and the accuracy of transactions. Therefore, the data quality needs to be tested. This topic has been neglected in Turkey. Data quality control for NSDI may be done by private or public "data accreditation" institutions. A methodology is required for data quality evaluation. There are studies for data quality including ISO standards, academic studies and software to evaluate spatial data quality. ISO 19157 standard defines the data quality elements. Proprietary software such as, 1Spatial's 1Validate and ESRI's Data Reviewer offers quality evaluation based on their own classification of rules. Commonly, rule based approaches are used for geospatial data quality check. In this study, we look for the technical components to devise and implement a rule based approach with ontologies using free and open source software in semantic web context. Semantic web uses ontologies to deliver well-defined web resources and make them accessible to end-users and processes. We have created an ontology conforming to the geospatial data and defined some sample rules to show how to test data with respect to data quality elements including; attribute, topo-semantic and geometrical consistency using free and open source software. To test data against rules, sample GeoSPARQL queries are created, associated with specifications.

Learning essentials: what graduates of mental health nursing programmes need to know from an industry perspective.

PubMed

McAllister, Margaret; Happell, Brenda; Flynn, Trudi

2014-12-01

To explore the perspectives of nursing directors in mental health in Queensland, Australia, regarding the skills and attributes of graduates of comprehensive nursing programme to provide an industry perspective and thus augment knowledge from theoretical and professional dimensions. There is a worldwide shortage of appropriately qualified nurses with the knowledge, skills and attitudes to work effectively in mental health services. Within Australia, this has been well documented since the introduction of comprehensive nursing education. The underrepresentation of mental health content in undergraduate curricula has been identified as the primary reason for nursing graduates not being adequately prepared for practice in this field. To date, this issue has primarily been addressed from the perspective of university academics, with the voice of industry relatively silent in the published literature. Qualitative exploratory. In-depth telephone interviews with Director of Nursing (Mental Health) in Queensland, Australia. The concerns of participants were expressed in six main themes: (1) foundational knowledge of mental health and disorders, (2) recovery-oriented skills, (3) physical as well as mental health skills, (4) therapeutic strategies, (5) resilience and self-development and (6) advanced knowledge and skills. The education of comprehensive nursing education needs to be reviewed as a matter of priority to ensure graduates with the attributes required to provide high-quality care for consumers of mental health services. A skilled and knowledgeable workforce is an essential component of high-quality mental health services. Research highlighting the current deficits and issues is therefore of the highest priority. © 2014 John Wiley & Sons Ltd.

Effect of Temporal Relationships in Associative Rule Mining for Web Log Data

PubMed Central

Mohd Khairudin, Nazli; Mustapha, Aida

2014-01-01

The advent of web-based applications and services has created such diverse and voluminous web log data stored in web servers, proxy servers, client machines, or organizational databases. This paper attempts to investigate the effect of temporal attribute in relational rule mining for web log data. We incorporated the characteristics of time in the rule mining process and analysed the effect of various temporal parameters. The rules generated from temporal relational rule mining are then compared against the rules generated from the classical rule mining approach such as the Apriori and FP-Growth algorithms. The results showed that by incorporating the temporal attribute via time, the number of rules generated is subsequently smaller but is comparable in terms of quality. PMID:24587757

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

Strategies for improved French-language health services

PubMed Central

Gauthier, Alain P.; Timony, Patrick E.; Serresse, Suzanne; Goodale, Natalie; Prpic, Jason

2015-01-01

Abstract Objective To identify strategies to improve the quality of health services for Francophone patients. Design A series of semistructured key informant interviews. Setting Northeastern Ontario. Participants A total of 18 physicians were interviewed. Ten physicians were interviewed in French, 7 physicians were women, and 10 physicians were located in urban communities. Methods Purposive and snowball sampling strategies were used to conduct a series of semistructured key informant interviews with family physicians practising in communities with a large Francophone population. Principles of grounded theory were applied, guided by a framework for patient-professional communication. Results were inductively derived following an iterative data collection–data analysis process and were analyzed using a detailed thematic approach. Main findings Respondents identified several strategies for providing high-quality French-language health services. Some were unique to non–French-speaking physicians (eg, using appropriate interpreter services), some were unique to French-speaking physicians (eg, using a flexible dialect), and some strategies were common to all physicians serving French populations (eg, hiring bilingual staff or having pamphlets and posters in both French and English). Conclusion Physicians interviewed for this study provided high-quality health care by attributing substantial importance to effective communication. While linguistic patient-to-physician concordance is ideal, it might not always be possible. Thus, conscious efforts to attenuate communication barriers are necessary, and several effective strategies exist. PMID:26505060

Advantages and Disadvantages of Health Care Accreditation Mod-els.

PubMed

Tabrizi, Jafar S; Gharibi, Farid; Wilson, Andrew J

2011-01-01

This systematic review seeks to define the general advantages and disadvan-tages of accreditation programs to assist in choosing the most appropriate approach. Systematic search of SID, Ovid Medline & PubMed databases was conducted by the keywords of accreditation, hospital, medical practice, clinic, accreditation models, health care and Persian meanings. From 2379 initial articles, 83 articles met the full inclusion criteria. From initial analysis, 23 attributes were identified which appeared to define advantages and disadvantages of different accreditation approaches and the available systems were compared on these. Six systems were identified in the international literature including the JCAHO from USA, the Canadian program of CCHSA, and the accreditation programs of UK, Australia, New Zealand and France. The main distinguishing attributes among them were: quality improve-ment, patient and staff safety, improving health services integration, public's confi-dence, effectiveness and efficiency of health services, innovation, influence global standards, information management, breadth of activity, history, effective relationship with stakeholders, agreement with AGIL attributes and independence from government. Based on 23 attributes of comprehensive accreditation systems we have defined from a systematic review, the JCAHO accreditation program of USA and then CCHSA of Can-ada offered the most comprehensive systems with the least disadvantages. Other programs such as the ACHS of Australia, ANAES of France, QHNZ of New Zealand and UK accredita-tion programs were fairly comparable according to these criteria. However the decision for any country or health system should be based on an assessment weighing up their specific objec-tives and needs.

Developing Cyberinfrastructure Tools and Services for Metadata Quality Evaluation

NASA Astrophysics Data System (ADS)

Mecum, B.; Gordon, S.; Habermann, T.; Jones, M. B.; Leinfelder, B.; Powers, L. A.; Slaughter, P.

2016-12-01

Metadata and data quality are at the core of reusable and reproducible science. While great progress has been made over the years, much of the metadata collected only addresses data discovery, covering concepts such as titles and keywords. Improving metadata beyond the discoverability plateau means documenting detailed concepts within the data such as sampling protocols, instrumentation used, and variables measured. Given that metadata commonly do not describe their data at this level, how might we improve the state of things? Giving scientists and data managers easy to use tools to evaluate metadata quality that utilize community-driven recommendations is the key to producing high-quality metadata. To achieve this goal, we created a set of cyberinfrastructure tools and services that integrate with existing metadata and data curation workflows which can be used to improve metadata and data quality across the sciences. These tools work across metadata dialects (e.g., ISO19115, FGDC, EML, etc.) and can be used to assess aspects of quality beyond what is internal to the metadata such as the congruence between the metadata and the data it describes. The system makes use of a user-friendly mechanism for expressing a suite of checks as code in popular data science programming languages such as Python and R. This reduces the burden on scientists and data managers to learn yet another language. We demonstrated these services and tools in three ways. First, we evaluated a large corpus of datasets in the DataONE federation of data repositories against a metadata recommendation modeled after existing recommendations such as the LTER best practices and the Attribute Convention for Dataset Discovery (ACDD). Second, we showed how this service can be used to display metadata and data quality information to data producers during the data submission and metadata creation process, and to data consumers through data catalog search and access tools. Third, we showed how the centrally deployed DataONE quality service can achieve major efficiency gains by allowing member repositories to customize and use recommendations that fit their specific needs without having to create de novo infrastructure at their site.

Attributes of patient-centered primary care associated with the public perception of good healthcare quality in Brazil, Colombia, Mexico and El Salvador.

PubMed

Doubova, Svetlana V; Guanais, Frederico C; Pérez-Cuevas, Ricardo; Canning, David; Macinko, James; Reich, Michael R

2016-09-01

This study evaluated primary care attributes of patient-centered care associated with the public perception of good quality in Brazil, Colombia, Mexico and El Salvador. We conducted a secondary data analysis of a Latin American survey on public perceptions and experiences with healthcare systems. The primary care attributes examined were access, coordination, provider-patient communication, provision of health-related information and emotional support. A double-weighted multiple Poisson regression with robust variance model was performed. The study included between 1500 and 1503 adults in each country. The results identified four significant gaps in the provision of primary care: not all respondents had a regular place of care or a regular primary care doctor (Brazil 35.7%, Colombia 28.4%, Mexico 22% and El Salvador 45.4%). The communication with the primary care clinic was difficult (Brazil 44.2%, Colombia 41.3%, Mexico 45.1% and El Salvador 56.7%). There was a lack of coordination of care (Brazil 78.4%, Colombia 52.3%, Mexico 48% and El Salvador 55.9%). Also, there was a lack of information about healthy diet (Brazil 21.7%, Colombia 32.9%, Mexico 16.9% and El Salvador 20.8%). The public's perception of good quality was variable (Brazil 67%, Colombia 71.1%, Mexico 79.6% and El Salvador 79.5%). The primary care attributes associated with the perception of good quality were a primary care provider 'who knows relevant information about a patient's medical history', 'solves most of the health problems', 'spends enough time with the patient', 'coordinates healthcare' and a 'primary care clinic that is easy to communicate with'. In conclusion, the public has a positive perception of the quality of primary care, although it has unfulfilled expectations; further efforts are necessary to improve the provision of patient-centered primary care services in these four Latin American countries. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Nursing-sensitive indicators: a concept analysis

PubMed Central

Heslop, Liza; Lu, Sai

2014-01-01

Aim To report a concept analysis of nursing-sensitive indicators within the applied context of the acute care setting. Background The concept of ‘nursing sensitive indicators’ is valuable to elaborate nursing care performance. The conceptual foundation, theoretical role, meaning, use and interpretation of the concept tend to differ. The elusiveness of the concept and the ambiguity of its attributes may have hindered research efforts to advance its application in practice. Design Concept analysis. Data sources Using ‘clinical indicators’ or ‘quality of nursing care’ as subject headings and incorporating keyword combinations of ‘acute care’ and ‘nurs*’, CINAHL and MEDLINE with full text in EBSCOhost databases were searched for English language journal articles published between 2000–2012. Only primary research articles were selected. Methods A hybrid approach was undertaken, incorporating traditional strategies as per Walker and Avant and a conceptual matrix based on Holzemer's Outcomes Model for Health Care Research. Results The analysis revealed two main attributes of nursing-sensitive indicators. Structural attributes related to health service operation included: hours of nursing care per patient day, nurse staffing. Outcome attributes related to patient care included: the prevalence of pressure ulcer, falls and falls with injury, nosocomial selective infection and patient/family satisfaction with nursing care. Conclusion This concept analysis may be used as a basis to advance understandings of the theoretical structures that underpin both research and practical application of quality dimensions of nursing care performance. PMID:25113388

[Users' and community leaders' perceptions of their capacity to influence the quality of health care: case studies of Colombia and Brazil].

PubMed

Delgado-Gallego, María Eugenia; Vázquez, María Luisa

2009-01-01

Health system reforms in Colombia and Brazil introduced policies that promote social participation in health care quality control. The objective of this paper was to analyze users' and leaders' perceptions of their capacity to achieve changes in the countries' health services. An exploratory and descriptive qualitative study was performed with individual interviews and focus groups of users and leaders in Colombia and Brazil. Most informants perceived themselves as having the capacity to induce changes to improve the quality of health services. They attributed this capacity primarily to internal factors related to their participatory behavior, plus only one external factor, the availability of institutional participatory spaces. The lack of capacity to influence change was only related to passive attitudes and fear of retaliation in Colombia. The existence of a population with high self-perceived capacity to achieve change appears as a potential factor to be strengthened, while institutional democratic space needs to improve in order to enhance the effectiveness of social participation in health policies.

The effect of community-based support services on clinical efficacy and health-related quality of life in HIV/AIDS patients in resource-limited settings in sub-Saharan Africa.

PubMed

Kabore, Inoussa; Bloem, Jeanette; Etheredge, Gina; Obiero, Walter; Wanless, Sebastian; Doykos, Patricia; Ntsekhe, Pearl; Mtshali, Nomantshali; Afrikaner, Eric; Sayed, Rauf; Bostwelelo, John; Hani, Andiswa; Moshabesha, Tiisetso; Kalaka, Agnes; Mameja, Jerry; Zwane, Nompumelelo; Shongwe, Nomvuyo; Mtshali, Phangisile; Mohr, Beryl; Smuts, Archie; Tiam, Appolinaire

2010-09-01

Antiretroviral therapy (ART) for HIV/AIDS in developing countries has been rapidly scaled up through directed public and private resources. Data on the efficacy of ART in developing countries are limited, as are operational research studies to determine the effect of selected nonmedical supportive care services on health outcomes in patients receiving ART. We report here on an investigation of the delivery of medical care combined with community-based supportive services for patients with HIV/AIDS in four resource-limited settings in sub-Saharan Africa, carried out between 2005 and 2007. The clinical and health-related quality of life (HRQOL) efficacy of ART combined with community support services was studied in a cohort of 377 HIV-infected patients followed for 18 months, in community-based clinics through patient interviews, clinical evaluations, and questionnaires. Patients exposed to community-based supportive services experienced a more rapid and greater overall increase in CD4 cell counts than unexposed patients. They also had higher levels of adherence, attributed primarily to exposure to home-based care services. In addition, patients receiving home-based care and/or food support services showed greater improvements in selected health-related QOL indicators. This report discusses the feasibility of effective ART in a large number of patients in resource-limited settings and the added value of concomitant community-based supportive care services.

Assessing Consumer Emotional Responses in the Presence and Absence of Critical Quality Attributes: A Case Study with Chicken Eggs.

PubMed

Wardy, Wisdom; Sae-Eaw, Amporn; Sriwattana, Sujinda; No, Hong Kyoon; Prinyawiwatkul, Witoon

2015-07-01

Effects of attribute presence and absence on the emotional profile and consumer acceptability of products with varying qualities were assessed using eggs as an example. An online survey (n = 320) was used to evaluate emotional responses and acceptability to 5 types of egg quality attributes: intrinsic, aesthetic, extrinsic, expediency, and wholesome/safety, for both present and absent conditions. Attribute absence rather than presence evoked greater consumer discriminating emotions associated with eggs. Mean emotion intensity elicited by the presence of all quality attributes ranged from 1.67 (intrinsic; guilty) to 4.05 (wholesome; good) versus 2.01 (wholesome; satisfied) to 3.29 (wholesome; disgusted) when absent. Key positive emotions elicited by presence of attributes were active, calm, good, interested, happy, safe, and satisfied; while dominant negative emotions elicited by absence of attributes included disgusted and worried. Wholesome quality (constituted by egg freshness, "packing/best-before-date" and absence of visible cracks) exhibited the highest liking (7.65) and emotion intensities, while the emotional responses to both the presence and absence of intrinsic quality (constituted by nutrient-fortified egg, organic egg, and USDA-certified farm egg) were similar, reflecting their dynamic effects on emotions. Emotions and acceptability were more correlated for attribute absence than presence; and good, happy, and satisfied emotions were strongly related to egg acceptability (r ≥ 0.6). Egg product/packaging design can be oriented toward emphasizing wholesome and expedient attributes, since they enhance good, safe, and satisfied emotions, while minimizing disgust, worry, and boredom. The use of emotional responses and hedonic testing regarding attribute presence and absence would allow for improved selection of attributes critical to consumer acceptance of products. Assessing effects of attribute presence compared with absence on food-evoked emotions may offer valuable insights for differentiation of competing or otherwise similar products. Affective consumer responses to food products with varying sensory and quality attributes are influenced by several factors including psychographics, demographics, product category, and test design. In this study, a scenario is depicted where product developers can identify critical product features based on emotional assessment of products with and without quality attributes. This study is beneficial to product developers and the egg industry, as it identifies opportunities to better understand consumer needs, thereby, designing products destined for success in the marketplace. © 2015 Institute of Food Technologists®

The new landscape for nonprofits.

PubMed

Ryan, W P

1999-01-01

For most of this century, society's caring functions have been the work of government and charities. But social services in the United States are in a period of transition. Today the U.S. government no longer considers nonprofits to be entitled--or even best qualified--to provide social services. Profit-seeking companies like Lockheed Martin are now winning contracts for such services. William Ryan describes how government outsourcing and a new business mind-set have changed the landscape of social services. The change raises fundamental questions about the mission and future of nonprofits. Ryan attributes the growth of for-profits in the social service industry to four factors: size, capital, mobility, and responsiveness. While those attributes give for-profits an advantage in acquiring new contracts, nonprofits have not yet lost their foothold. Ryan cites examples of organizations like the YWCA and Abraxas to demonstrate various ways that nonprofits are responding--from subcontracting to partnership to outright conversion to for-profit status. By playing in the new marketplace, nonprofits will be forced to reconfigure their operations and organizations in ways that could compromise their missions. Because nonprofits now find themselves sharing territory with for-profits, sometimes as collaborators and sometimes as competitors, the distinctions between these organizations will continue to blur. The point, Ryan argues, is not whether nonprofits can survive opposition from for-profits. Many have already adjusted to the new competitive environment. The real issue is whether nonprofits can adapt without compromising the qualities that distinguish them from for-profit organizations.

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study.

PubMed

Reid, Rachel O; Deb, Partha; Howell, Benjamin L; Conway, Patrick H; Shrank, William H

2016-02-01

To facilitate informed decision-making in the Medicare Advantage marketplace, the Centers for Medicare & Medicaid Services publishes plan information on the Medicare Plan Finder website, including costs, benefits, and star ratings reflecting quality. Little is known about how beneficiaries weigh costs versus quality in enrollment decisions. We aimed to assess associations between publicly reported Medicare Advantage plan attributes (i.e., costs, quality, and benefits) and brand market share and beneficiaries' enrollment decisions. We performed a nationwide, beneficiary-level cross-sectional analysis of 847,069 beneficiaries enrolling in Medicare Advantage for the first time in 2011. Matching beneficiaries with their plan choice sets, we used conditional logistic regression to estimate associations between plan attributes and enrollment to assess the proportion of enrollment variation explained by plan attributes and willingness to pay for quality. Relative to the total variation explained by the model, the variation in plan choice explained by premiums (25.7 %) and out-of-pocket costs (11.6 %) together explained nearly three times as much as quality ratings (13.6 %), but brand market share explained the most variation (35.3 %). Further, while beneficiaries were willing to pay more in total annual combined premiums and out-of-pocket costs for higher-rated plans (from $4,154.93 for 2.5-star plans to $5,698.66 for 5-star plans), increases in willingness to pay diminished at higher ratings, from $549.27 (95 %CI: $541.10, $557.44) for a rating increase from 2.5 to 3 stars to $68.22 (95 %CI: $61.44, $75.01) for an increase from 4.5 to 5 stars. Willingness to pay varied among subgroups: beneficiaries aged 64-65 years were more willing to pay for higher-rated plans, while black and rural beneficiaries were less willing to pay for higher-rated plans. While beneficiaries prefer higher-quality and lower-cost Medicare Advantage plans, marginal utility for quality diminishes at higher star ratings, and their decisions are strongly associated with plans' brand market share.

Recent progress in the development of ISO 19751

NASA Astrophysics Data System (ADS)

Farnand, Susan P.; Dalal, Edul N.; Ng, Yee S.

2006-01-01

A small number of general visual attributes have been recognized as essential in describing image quality. These include micro-uniformity, macro-uniformity, colour rendition, text and line quality, gloss, sharpness, and spatial adjacency or temporal adjacency attributes. The multiple-part International Standard discussed here was initiated by the INCITS W1 committee on the standardization of office equipment to address the need for unambiguously documented procedures and methods, which are widely applicable over the multiple printing technologies employed in office applications, for the appearance-based evaluation of these visually significant image quality attributes of printed image quality. 1,2 The resulting proposed International Standard, for which ISO/IEC WD 19751-1 3 presents an overview and an outline of the overall procedure and common methods, is based on a proposal that was predicated on the idea that image quality could be described by a small set of broad-based attributes. 4 Five ad hoc teams were established (now six since a sharpness team is in the process of being formed) to generate standards for one or more of these image quality attributes. Updates on the colour rendition, text and line quality, and gloss attributes are provided.

Prioritising wheelchair services for children: a pilot discrete choice experiment to understand how child wheelchair users and their parents prioritise different attributes of wheelchair services.

PubMed

Bray, Nathan; Yeo, Seow Tien; Noyes, Jane; Harris, Nigel; Edwards, Rhiannon Tudor

2016-01-01

Approximately 95 million children worldwide are disabled; 10 % use a wheelchair. In the UK, an estimated 770,000 children are disabled. National Health Service Wheelchair Services are the largest provider of wheelchairs in the UK; however, recent reports have highlighted issues with these services. This study explores the use of discrete choice experiment methods to inform wheelchair service provision for disabled children based on service user preferences. The aim was to explore how disabled children and their parents prioritise different attributes of wheelchair services. The secondary aims were to compare priorities between parents and disabled children and to explore marginal rate of substitution for incremental changes in attributes. Discrete choice experiments are a method of attribute-based stated preference valuation used by health economists to understand how individuals prioritise different attributes of healthcare services and treatments. We conducted the first pilot discrete choice experiment to explore how disabled children (aged 11 to 18) and their parents prioritise different attributes of hypothetical wheelchair services. Eleven disabled children (aged 11 to 18) and 30 parents of disabled children completed eight pairwise choice tasks based on five service attributes: wheelchair assessment, cost contribution, training, delivery time and frequency of review. Data were analysed using conditional logistic regression. For each pairwise choice, the participants were asked to choose which service scenario (A or B) they preferred. Comprehensiveness of wheelchair assessment and wheelchair delivery time significantly ( P  < 0.05) affected service preferences of children ( β -coefficients = 1.43 [95 % bootstrapped CI = 1.42 to 2.08] and -0.92 [95 % bootstrapped CI = -1.41 to -0.84], respectively) and parents ( β -coefficients = 1.53 [95 % bootstrapped CI = 1.45 to 2.16] and -1.37 [95 % bootstrapped CI = -1.99 to -1.31], respectively). Parents were willing to contribute more financially to receive preferred services, although this was non-significant. Both samples placed the greatest importance on holistic wheelchair assessments encompassing more than health. The National Health Service should consider using discrete choice experiment methods to examine wheelchair service preferences of disabled children (aged 11 and over) and their parents on a wider scale; however, care must be taken to ensure that this method is used appropriately.

The Semanticscience Integrated Ontology (SIO) for biomedical research and knowledge discovery

PubMed Central

2014-01-01

The Semanticscience Integrated Ontology (SIO) is an ontology to facilitate biomedical knowledge discovery. SIO features a simple upper level comprised of essential types and relations for the rich description of arbitrary (real, hypothesized, virtual, fictional) objects, processes and their attributes. SIO specifies simple design patterns to describe and associate qualities, capabilities, functions, quantities, and informational entities including textual, geometrical, and mathematical entities, and provides specific extensions in the domains of chemistry, biology, biochemistry, and bioinformatics. SIO provides an ontological foundation for the Bio2RDF linked data for the life sciences project and is used for semantic integration and discovery for SADI-based semantic web services. SIO is freely available to all users under a creative commons by attribution license. See website for further information: http://sio.semanticscience.org. PMID:24602174

How Source Affects Response to Public Service Advertising.

ERIC Educational Resources Information Center

Lynn, Jerry R.; And Others

1978-01-01

Reports that public service advertising attributed to the Advertising Council elicited higher message ratings than did public service advertising attributed to a commercial source, a noncommercial source, or no source; however, it produced the lowest behavioral responses. (GT)

Prediction of quality attributes of chicken breast fillets by using Vis/NIR spectroscopy combined with factor analysis method

USDA-ARS?s Scientific Manuscript database

Visible/near-infrared (Vis/NIR) spectroscopy with wavelength range between 400 and 2500 nm combined with factor analysis method was tested to predict quality attributes of chicken breast fillets. Quality attributes, including color (L*, a*, b*), pH, and drip loss were analyzed using factor analysis ...

Listening to the customer: implementing a patient satisfaction measurement system.

PubMed

Cohen, L; Delaney, P; Boston, P

1994-01-01

Patient satisfaction is an important issue in positioning ambulatory medical services. An effective patient satisfaction measurement program not only helps hospital managers improve the quality of clinical and administrative activities, but also helps the hospital remain viable in increasingly competitive markets. A method for the design and measurement of patient satisfaction with outpatient Endoscopy Lab services is described in this article. The survey focuses on the sequence of events experienced by the patient. Outcome measures of primary interest include global patient satisfaction and the likelihood of using the service again if given a choice. Analysis of patient responses shows that global satisfaction with the outpatient experience is positively associated with service return intention. Additional analysis shows that facility cleanliness, privacy and nurse attention are most strongly associated with global patient satisfaction. Results underscore the importance of various service attributes on patient satisfaction and return intention and of the need to further expand the uses of patient satisfaction measurement in the outpatient Endoscopy Lab.

Technological developments and the need for technical competencies in food services.

PubMed

Rodgers, Svetlana

2005-05-01

The growing scale of institutional and commercial food services poses a technological challenge of producing large quantities of high quality meals in terms of their safety, sensory and nutritional attributes. Developments in food service technology and systems (cook-freeze, cook-chill and others) allow the replacement of fast food with the service of cooked meals, which are often nutritionally superior. Reliance on equipment, packaging and technological 'know-how' makes food service operations more complex. Operators have to minimise the impact of the numerous steps in the production process, the fundamental weaknesses of cook-chill food safety design, coupled with the practical limitations of Hazard Analysis Critical Control Points management, the potential unevenness of temperature distribution and product deterioration during storage. The fundamental knowledge of food science and microbiology, engineering and packaging technologies is needed. At present, the 'high tech' options, which can improve a product's nutritional value, such as natural preservation hurdles or functional meals, are not used in practice.

Leveraging Terminology Services for Extract-Transform-Load Processes: A User-Centered Approach

PubMed Central

Peterson, Kevin J.; Jiang, Guoqian; Brue, Scott M.; Liu, Hongfang

2016-01-01

Terminology services serve an important role supporting clinical and research applications, and underpin a diverse set of processes and use cases. Through standardization efforts, terminology service-to-system interactions can leverage well-defined interfaces and predictable integration patterns. Often, however, users interact more directly with terminologies, and no such blueprints are available for describing terminology service-to-user interactions. In this work, we explore the main architecture principles necessary to build a user-centered terminology system, using an Extract-Transform-Load process as our primary usage scenario. To analyze our architecture, we present a prototype implementation based on the Common Terminology Services 2 (CTS2) standard using the Patient-Centered Network of Learning Health Systems (LHSNet) project as a concrete use case. We perform a preliminary evaluation of our prototype architecture using three architectural quality attributes: interoperability, adaptability and usability. We find that a design-time focus on user needs, cognitive models, and existing patterns is essential to maximize system utility. PMID:28269898

The French contribution to the voluntary observing ships network of sea surface salinity

NASA Astrophysics Data System (ADS)

Alory, G.; Delcroix, T.; Téchiné, P.; Diverrès, D.; Varillon, D.; Cravatte, S.; Gouriou, Y.; Grelet, J.; Jacquin, S.; Kestenare, E.; Maes, C.; Morrow, R.; Perrier, J.; Reverdin, G.; Roubaud, F.

2015-11-01

Sea Surface Salinity (SSS) is an essential climate variable that requires long term in situ observation. The French SSS Observation Service (SSS-OS) manages a network of Voluntary Observing Ships equipped with thermosalinographs (TSG). The network is global though more concentrated in the tropical Pacific and North Atlantic oceanic basins. The acquisition system is autonomous with real time transmission and is regularly serviced at harbor calls. There are distinct real time and delayed time processing chains. Real time processing includes automatic alerts to detect potential instrument problems, in case raw data are outside of climatic limits, and graphical monitoring tools. Delayed time processing relies on a dedicated software for attribution of data quality flags by visual inspection, and correction of TSG time series by comparison with daily water samples and collocated Argo data. A method for optimizing the automatic attribution of quality flags in real time, based on testing different thresholds for data deviation from climatology and retroactively comparing the resulting flags to delayed time flags, is presented. The SSS-OS real time data feed the Coriolis operational oceanography database, while the research-quality delayed time data can be extracted for selected time and geographical ranges through a graphical web interface. Delayed time data have been also combined with other SSS data sources to produce gridded files for the Pacific and Atlantic oceans. A short review of the research activities conducted with such data is given. It includes observation-based process-oriented and climate studies from regional to global scale as well as studies where in situ SSS is used for calibration/validation of models, coral proxies or satellite data.

The French Contribution to the Voluntary Observing Ships Network of Sea Surface Salinity

NASA Astrophysics Data System (ADS)

Delcroix, T. C.; Alory, G.; Téchiné, P.; Diverrès, D.; Varillon, D.; Cravatte, S. E.; Gouriou, Y.; Grelet, J.; Jacquin, S.; Kestenare, E.; Maes, C.; Morrow, R.; Perrier, J.; Reverdin, G. P.; Roubaud, F.

2016-02-01

Sea Surface Salinity (SSS) is an essential climate variable that requires long term in situ observation. The French SSS Observation Service (SSS-OS) manages a network of Voluntary Observing Ships equipped with thermosalinographs (TSG). The network is global though more concentrated in the tropical Pacific and North Atlantic oceanic basins. The acquisition system is autonomous with real time transmission and is regularly serviced at harbor calls. There are distinct real time and delayed time processing chains. Real time processing includes automatic alerts to detect potential instrument problems, in case raw data are outside of climatic limits, and graphical monitoring tools. Delayed time processing relies on a dedicated software for attribution of data quality flags by visual inspection, and correction of TSG time series by comparison with daily water samples and collocated Argo data. A method for optimizing the automatic attribution of quality flags in real time, based on testing different thresholds for data deviation from climatology and retroactively comparing the resulting flags to delayed time flags, is presented. The SSS-OS real time data feed the Coriolis operational oceanography database, while the research-quality delayed time data can be extracted for selected time and geographical ranges through a graphical web interface. Delayed time data have been also combined with other SSS data sources to produce gridded files for the Pacific and Atlantic oceans. A short review of the research activities conducted with such data is given. It includes observation-based process-oriented and climate studies from regional to global scale as well as studies where in situ SSS is used for calibration/validation of models, coral proxies or satellite data.

Training the eye care team: principles and practice.

PubMed

Garg, Prashant; Reddy, Snigdha; Nelluri, Chaitanya

2014-01-01

One of the crucial factors to make high quality eye care services available, accessible and affordable to all is the availability of appropriately trained human resources. Providing health through a health care team is a better and cost effective alternative. The concept of the team approach is based on the principles of working together; task shifting; and ensuring continuity of care. Composition of a team varies based on the community needs, population characteristics and disease burden. But for it to be effective, a team must possess four attributes - availability, competency, productivity, and responsiveness. Therefore, training of all team members and training the team to work together as a unit are crucial components in the success of this concept. Some of the critical attributes include: Training across the health spectrum through quality and responsive curricula administered by motivated teachers; accreditation of programs or institutions by national or international bodies; certification and recertification of team members; and training in working together as a team through inter- and intra- disciplinary workshops both during training and as a part of the job activity.

Training the Eye Care Team: Principles and Practice

PubMed Central

Garg, Prashant; Reddy, Snigdha; Nelluri, Chaitanya

2014-01-01

One of the crucial factors to make high quality eye care services available, accessible and affordable to all is the availability of appropriately trained human resources. Providing health through a health care team is a better and cost effective alternative. The concept of the team approach is based on the principles of working together; task shifting; and ensuring continuity of care. Composition of a team varies based on the community needs, population characteristics and disease burden. But for it to be effective, a team must possess four attributes - availability, competency, productivity, and responsiveness. Therefore, training of all team members and training the team to work together as a unit are crucial components in the success of this concept. Some of the critical attributes include: Training across the health spectrum through quality and responsive curricula administered by motivated teachers; accreditation of programs or institutions by national or international bodies; certification and recertification of team members; and training in working together as a team through inter- and intra- disciplinary workshops both during training and as a part of the job activity. PMID:24791103

Visualizing desirable patient healthcare experiences.

PubMed

Liu, Sandra S; Kim, Hyung T; Chen, Jie; An, Lingling

2010-01-01

High healthcare cost has drawn much attention and healthcare service providers (HSPs) are expected to deliver high-quality and consistent care. Therefore, an intimate understanding of the most desirable experience from a patient's and/or family's perspective as well as effective mapping and communication of such findings should facilitate HSPs' efforts in attaining sustainable competitive advantage in an increasingly discerning environment. This study describes (a) the critical quality attributes (CQAs) of the experience desired by patients and (b) the application of two visualization tools that are relatively new to the healthcare sector, namely the "spider-web diagram" and "promotion and detraction matrix." The visualization tools are tested with primary data collected from telephone surveys of 1,800 patients who had received care during calendar year 2005 at 6 of 61 hospitals within St. Louis, Missouri-based, Ascension Health. Five CQAs were found by factor analysis. The spider-web diagram illustrates that communication and empowerment and compassionate and respectful care are the most important CQAs, and accordingly, the promotion and detraction matrix shows those attributes that have the greatest effect for creating promoters, preventing detractors, and improving consumer's likelihood to recommend the healthcare provider.

Maternal and child health in China.

PubMed Central

Hesketh, T.; Zhu, W. X.

1997-01-01

China has made great progress in improving the health of women and children over the past two generations. The success has been attributed to improved living standards, public health measures, and good access to health services. Although overall infant and maternal mortality rates are relatively low there are large differences in patterns of mortality between urban and rural areas. The Chinese have developed a hierarchical network of maternal and child health services, with each level taking a supervisory and teaching role for the level below it. Maternal and child health in China came to international attention in 1995 with the promulgation of the maternal and child health law. In China this was seen as a means of prioritising resources and improving the quality of services, but in the West it was widely described as a law on eugenics. PMID:9224139

What characteristics do service users with intellectual disability value in direct support staff within residential forensic services?

PubMed

Clarkson, Rachael; Murphy, Glynis H; Coldwell, Jon B; Dawson, David L

2009-12-01

This study explores the perceptions of a group of adults with intellectual disability regarding direct support staff. Semi-structured interviews relating to experiences of direct support staff were developed from two focus groups. These interviews were conducted with 11 adults with intellectual disability residing within a forensic inpatient service. Interpretative Phenomenological Analysis (IPA) revealed two superordinate themes; namely, staff relationship factors and positive and negative attributes of staff. The participants valued relationships with staff based on qualities such as honesty, trust, and a caring, nurturing manner that enabled individuals to feel safe. Staff characteristics such as immaturity, inexperience, and a short temper appeared to lead to feelings of discontentment amongst the participants. The implications of the findings are discussed in relation to clinical practice, staff recruitment, and training.

Profiles of the evaluators: impact of psychographic variables on the consumer-oriented quality assessment of mobile television

NASA Astrophysics Data System (ADS)

Jumisko-Pyykkö, Satu; Häkkinen, Jukka

2008-02-01

In the product development of services it is important to adjust mobile video quality according to the quality requirements of potential users. Therefore, a careful participant selection is very important. However, in the literature the details of participant selection are often handled without great detail. This is also reflected in the handling of experimental results, where the impact of psychographic factors on quality is rarely reported. As the user attributes potentially have a large effect to the results, we investigated the role of various psychographical variables on the subjective evaluation of audiovisual video quality in two different experiments. The studied variables were age, gender, education, professionalism, television consumption, experiences of different digital video qualities, and attitude towards technology. The results showed that quality evaluations were affected by almost all background factors. The most significant variables were age, professionalism, knowledge of digital quality features and attitude towards technology. The knowledge of these factors can be exploited in careful participant selection, which will in turn increase the validity of results as the subjective evaluations reflect better the requirements of potential users.

A Cross-Sectional Comparison of Perceived Quality of Primary Care by Hypertensive Patients in Shanghai and Shenzhen, China

PubMed Central

Li, Haitao; Wei, Xiaolin; Wong, Martin Chi-Sang; Wong, Samuel Yeung-Shan; Yang, Nan; Griffiths, Sian M.

2015-01-01

Abstract Hypertension should be best managed under primary care settings. This study aimed to compare, between Shanghai and Shenzhen, the perceived quality of primary care in terms of accessibility, continuity, co-ordination, and comprehensiveness among hypertensive patients. A cross-sectional study was conducted in Shanghai and Shenzhen, China. Multistage random sampling method was used to select 8 community health centers. Data from primary care users were collected through on-site face-to-face interviews using the primary care assessment tool. Good quality standard was set as a value of 3 for each attribute and a value of 18 for total score. We included 568 patients in Shanghai and 128 patients in Shenzhen. Compared with those in Shenzhen, hypertensive patients in Shanghai reported a higher score in co-ordination of information (3.37 vs 3.66; P < 0.001), but lower scores in continuity of care (3.36 vs 3.27; P < 0.001), and comprehensiveness-service provision (3.26 vs 2.79; P < 0.001). There was no statistically significant difference in total scores between the 2 cities (18.19 vs 18.15). Over 3-quarters of hypertensive patients in both cities reported accessibility (97.2% vs 91.4%) and co-ordination of services (76.1% vs 80.5%) under good quality standard, while <1-quarter of them rated continuity of care (23.6% vs 22.7%), co-ordination of information (4.8% vs 21.1%), and comprehensiveness-service availability (15.1% vs 25.0%) under that standard. Compared with Shenzhen, the perceived quality of primary care for hypertensive patients in Shanghai was better in terms of co-ordination of information, but poorer on continuity of care and comprehensiveness-service provision. Our study suggests that there is room for quality improvement in both cities. PMID:26313780

Architecture Design of Healthcare Software-as-a-Service Platform for Cloud-Based Clinical Decision Support Service.

PubMed

Oh, Sungyoung; Cha, Jieun; Ji, Myungkyu; Kang, Hyekyung; Kim, Seok; Heo, Eunyoung; Han, Jong Soo; Kang, Hyunggoo; Chae, Hoseok; Hwang, Hee; Yoo, Sooyoung

2015-04-01

To design a cloud computing-based Healthcare Software-as-a-Service (SaaS) Platform (HSP) for delivering healthcare information services with low cost, high clinical value, and high usability. We analyzed the architecture requirements of an HSP, including the interface, business services, cloud SaaS, quality attributes, privacy and security, and multi-lingual capacity. For cloud-based SaaS services, we focused on Clinical Decision Service (CDS) content services, basic functional services, and mobile services. Microsoft's Azure cloud computing for Infrastructure-as-a-Service (IaaS) and Platform-as-a-Service (PaaS) was used. The functional and software views of an HSP were designed in a layered architecture. External systems can be interfaced with the HSP using SOAP and REST/JSON. The multi-tenancy model of the HSP was designed as a shared database, with a separate schema for each tenant through a single application, although healthcare data can be physically located on a cloud or in a hospital, depending on regulations. The CDS services were categorized into rule-based services for medications, alert registration services, and knowledge services. We expect that cloud-based HSPs will allow small and mid-sized hospitals, in addition to large-sized hospitals, to adopt information infrastructures and health information technology with low system operation and maintenance costs.

Advantages and Disadvantages of Health Care Accreditation Mod­els

PubMed Central

Tabrizi, Jafar S.; Gharibi, Farid; Wilson, Andrew J.

2011-01-01

Background: This systematic review seeks to define the general advantages and disadvan­tages of accreditation programs to assist in choosing the most appropriate approach. Method: Systematic search of SID, Ovid Medline & PubMed databases was conducted by the keywords of accreditation, hospital, medical practice, clinic, accreditation models, health care and Persian meanings. From 2379 initial articles, 83 articles met the full inclusion criteria. From initial analysis, 23 attributes were identified which appeared to define advantages and disadvantages of different accreditation approaches and the available systems were compared on these. Results: Six systems were identified in the international literature including the JCAHO from USA, the Canadian program of CCHSA, and the accreditation programs of UK, Australia, New Zealand and France. The main distinguishing attributes among them were: quality improve­ment, patient and staff safety, improving health services integration, public’s confi­dence, effectiveness and efficiency of health services, innovation, influence global standards, information management, breadth of activity, history, effective relationship with stakeholders, agreement with AGIL attributes and independence from government. Conclusion: Based on 23 attributes of comprehensive accreditation systems we have defined from a systematic review, the JCAHO accreditation program of USA and then CCHSA of Can­ada offered the most comprehensive systems with the least disadvantages. Other programs such as the ACHS of Australia, ANAES of France, QHNZ of New Zealand and UK accredita­tion programs were fairly comparable according to these criteria. However the decision for any country or health system should be based on an assessment weighing up their specific objec­tives and needs. PMID:24688896

Analysis of information quality attribute for SME towards adoption of research result

NASA Astrophysics Data System (ADS)

Febriani, E.; Dewobroto, W. S.; Anggraini, R. D.

2017-12-01

Small and Medium Enterprises (SME) holds significant role in fostering Indonesian economy. However, the research that is supposed to support the development of SMEs business has not yet fully adopted or utilized. Information attributes may be used as the benchmark to find the intention of SMEs from a research result and develop the strategy of quality information for all organizations both SMEs and the researcher. Therefore, because of the importance of information quality attribute required by SMEs, the research aims to analyses the information quality required by SMEs to clarify the information quality into the dimension of information quality. The research was started by distributing online questionnaire to SMEs. The questionnaire result showed that the content dimension is the most aspect required by SMEs, followed by time and form dimension, respectively. Quality information attribute required by SMEs from a research is that the result may be applied to the business.

Attributes of quality in audiovisual materials for health professionals.

PubMed

Suter, E; Waddell, W H

1981-07-01

Utilizing a series of meetings and incorporating individual efforts of producers, evaluators, and users of audiovisual materials; an attempt has been made to define the quality of an instructional item. Attributes of quality in content, instructional design, technical production, and packaging of audiovisual materials are addressed through questions about general criteria that permit expression of individual dictates off creativity and taste. These attributes of quality are intended for use by the producers and evaluators of audiovisual instruction.

To explore preferences and willingness to pay for attributes regarding stoma appliances amongst patients in the UK, France and Germany.

PubMed

Nafees, Beenish; Lloyd, Andrew; Elkin, Eric; Porret, Terri

2015-04-01

To explore patient preferences regarding stoma appliances in the UK, France and Germany and to estimate willingness to pay (WTP) for attributes of stoma appliances. A discrete choice (DCE) survey was developed based on published literature, attributes of current available appliances and qualitative interviews with patients from the UK (N = 3), France (N = 2) and Germany (N = 2). Members from a patient panel in the UK, France and Germany were asked to participate in the DCE survey and to fill out two quality of life (QoL) questionnaires. Data were analyzed using the conditional logit model whereby the coefficients obtained from the model provided an estimate of the (log) odds ratios (ORs) of preference for attributes. WTP was estimated for each level of a given identified attribute. Seven key attributes were identified for the DCE survey: comfort and elastic flexibility, skin problems, early detection of leakage, leakage, filter performance, service/help after hospital discharge and out-of-pocket cost. A total of 415 participants (166 patients in UK, 99 in France, and 150 in Germany) completed the questionnaires. All attributes were significant predictors of choice. The two most important drivers of preference were the attributes comfort and elastic flexibility and skin problems which resulted in high WTP values. Appliances which were able to detect episodes of leakage were also of high importance to participants' appliances. The results show the importance of different attributes of stoma appliances for patients. Improving comfort and elastic flexibility, and risk of skin problems were the most important aspects of appliances. The WTP values indicate the value people place on improvement in each attribute of appliances.

Factors affecting clinical reasoning of occupational therapists: a qualitative study

PubMed Central

Shafaroodi, Narges; Kamali, Mohammad; Parvizy, Soroor; Mehraban, Afsoon Hassani; O’Toole, Giyn

2014-01-01

Background: Clinical reasoning is generally defined as the numerous modes of thinking that guide clinical practice but little is known about the factors affecting how occupational therapists manage the decision-making process. The aim of this qualitative study was to explore the factors influencing the clinical reasoning of occupational therapists. Methods: Twelve occupational therapy practitioners working in mental and physical dysfunction fields participated in this study. The sampling method was purposeful and interviews were continued until data saturation. All the interviews were recorded and transcribed. The data were analyzed through a qualitative content analysis method. Results: There were three main themes. The first theme: socio-cultural conditions included three subthemes: 1- client beliefs; 2- therapist values and beliefs; 3- social attitude to disability. The second theme: individual attributions included two subthemes 1- client attributions; 2- therapist attributions. The final theme was the workplace environment with the three subthemes: 1- knowledge of the managers of rehabilitation services, 2- working in an inter-professional team; 3- limited clinical facilities and resources. Conclusion: In this study, the influence of the attitudes and beliefs of client, therapist and society about illness, abilities and disabilities upon reasoning was different to previous studies. Understanding these factors, especially the socio-cultural beliefs basis can play a significant role in the quality of occupational therapy services. Accurate understanding of these influential factors requires more extensive qualitative and quantitative studies. PMID:25250253

Association of Employee Attributes and Exceptional Performance Rating at a National Center of the US Centers for Disease Control and Prevention, 2011.

PubMed

Roberts, Henry; Myles, Ranell L; Truman, Benedict I; Dean, Hazel D

2015-01-01

Employee performance evaluation motivates and rewards exceptional individual performance that advances the achievement of organizational goals. The Centers for Disease Control and Prevention (CDC) and its operating units evaluate employee performance annually and reward exceptional performance with a cash award or quality step increase in pay. A summary performance rating (SPR) of "exceptional" indicated personal achievements in 2011 that were beyond expectations described in the employee's performance plan. To determine whether personal attributes and job setting of civil service employees were associated with an exceptional SPR in National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) in 2011. Data from the CDC 2011 performance management database collected in 2012 were analyzed in 2013 to identify SPR, personal attributes, and job settings of full-time civil service employees. Multivariate logistic regression controlled for confounding and stratified analysis detected effect modifiers of the association between receiving an exceptional SPR in 2011 and gender, race/ethnicity, education, job location, job series, grade level, years in grade, years of federal service, supervisory role, and NCHHSTP division. Among the 1037 employees, exceptional SPR was independently associated with: female gender (adjusted odds ratio: 1.7 [1.3, 2.3]), advanced degrees (doctorate: 1.7 [1.1, 2.5] master's: [1.1, 2.0]), headquarters location (2.8 [1.9, 4.1]), higher pay grade (3.3 [2.4, 4.5]) and years in grade (0-1 years: 1.7 [1.3, 2.4]; 2-4 years: 1.5 [1.1, 2.0]), division level (Division A: 5.0 [2.5, 9.9]; Division B: 5.5 [3.5, 8.8]), and supervisory status (at a lower-pay grade) (odds ratio: 3.7 [1.1, 11.3]). Exceptional SPR is independently associated with personal employee attributes and job settings that are not modifiable by interventions designed to improve employee performance based on accomplishments.

Association of Employee Attributes and Exceptional Performance Rating at a National Center of the U.S. Centers for Disease Control and Prevention, 2011

PubMed Central

Roberts, Henry; Myles, Ranell L.; Truman, Benedict I.; Dean, Hazel D.

2015-01-01

Context Employee performance evaluation motivates and rewards exceptional individual performance that advances the achievement of organizational goals. CDC and its operating units evaluate employee performance annually and reward exceptional performance with a cash award or quality step increase in pay. A summary performance rating (SPR) of “exceptional” indicated personal achievements in 2011 that were beyond expectations described in the employee's performance plan. Objective To determine if personal attributes and job setting of civil service employees were associated with an exceptional SPR in NCHHSTP in 2011. Design Data from the CDC 2011 performance management database collected in 2012 were analyzed in 2013 to identify SPR, personal attributes, job-settings of full-time civil service employees. Multivariate logistic regression controlled for confounding and stratified analysis detected effect modifiers of the association between receiving an exceptional SPR in 2011 and gender, race/ethnicity, education, job location, job series, grade level, years in grade, years of federal service, supervisory role, and NCHHSTP division. Results Among the 1,037 employees, exceptional SPR was independently associated with: female gender (aOR: 1.7 [1.3,2.3]), advanced degrees (Doctorate: 1.7 [1.1,2.5]) Master's: 1.1, 2.0]), headquarters location (2.8 [1.9, 4.1]), higher pay grade (3.3 [2.4,4.5]) and years in grade (0-1yrs: 1.7 [1.3,2.4]; 2-4yrs: 1.5 [1.1,2.0]), division level (Division A: 5.0 [2.5,9.9]; Division B: 5.5 [3.5, 8.8]), and supervisory status (at a lower pay grade) (OR: 3.7 [1.1, 11.3]). Conclusions Exceptional SPR is independently associated with personal employee attributes and job-settings that are not modifiable by interventions designed to improve employee performance based on accomplishments. PMID:25271386

Effects of brand variants on smokers' choice behaviours and risk perceptions.

PubMed

Hoek, Janet; Gendall, Philip; Eckert, Christine; Kemper, Joya; Louviere, Jordan

2016-03-01

Australian tobacco companies have introduced evocative variant names that could re-create the aspirational connotations plain packaging aims to remove. To inform future regulation, we explored how brand descriptors affected smokers' responses to plain packs featuring different variant name combinations. An online survey of 254 daily smokers or social smokers aged between 18 and 34 used a within-subjects best-worst experiment to estimate the relative effects of variant names. A 2×4×4×4 design contained four attributes: quality (premium or none), taste (smooth, fine, rich or none) connotation (classic, midnight, infinite or none) and colour (red, blue, white or none). In a between-subjects component, respondents evaluated one of two alternative packs according to its perceived harm and ease of quitting. The most important variant attribute was connotation, followed by taste, colour and quality; within these attributes, the most attractive descriptors were 'classic' and 'smooth'. We identified four distinct segments that differed significantly in their sociodemographic attributes and variant preferences, although not in their perceptions of the harm or quitting ease associated with two different variants. Some descriptors significantly enhance the appeal of tobacco products among different groups of smokers and may undermine plain packaging's dissuasive intent. Policymakers should explicitly regulate variant names to avoid the 'poetry on a package' evident in Australia. Options include disallowing new descriptors, limiting the number of descriptors permitted or banning descriptors altogether. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Variations in the implementation and characteristics of chiropractic services in VA.

PubMed

Lisi, Anthony J; Khorsan, Raheleh; Smith, Monica M; Mittman, Brian S

2014-12-01

In 2004, the US Department of Veterans Affairs expanded its delivery of chiropractic care by establishing onsite chiropractic clinics at select facilities across the country. Systematic information regarding the planning and implementation of these clinics and describing their features and performance is lacking. To document the planning, implementation, key features and performance of VA chiropractic clinics, and to identify variations and their underlying causes and key consequences as well as their implications for policy, practice, and research on the introduction of new clinical services into integrated health care delivery systems. Comparative case study of 7 clinics involving site visit-based and telephone-based interviews with 118 key stakeholders, including VA clinicians, clinical leaders and administrative staff, and selected external stakeholders, as well as reviews of key documents and administrative data on clinic performance and service delivery. Interviews were recorded, transcribed, and analyzed using a mixed inductive (exploratory) and deductive approach. Interview data revealed considerable variations in clinic planning and implementation processes and clinic features, as well as perceptions of clinic performance and quality. Administrative data showed high variation in patterns of clinic patient care volume over time. A facility's initial willingness to establish a chiropractic clinic, along with a higher degree of perceived evidence-based and collegial attributes of the facility chiropractor, emerged as key factors associated with higher and more consistent delivery of chiropractic services and higher perceived quality of those services.

Summative Co-Assessment: A Deep Learning Approach To Enhancing Employability Skills and Attributes

ERIC Educational Resources Information Center

Deeley, Susan J.

2014-01-01

Service-learning is a pedagogy that combines academic study with service to the community. Voluntary work placements are integral to service-learning and offer students an ideal opportunity to develop their employability skills and attributes. In a service-learning course, it was considered good practice to raise students' awareness of the…

Bayesian framework inspired no-reference region-of-interest quality measure for brain MRI images

PubMed Central

Osadebey, Michael; Pedersen, Marius; Arnold, Douglas; Wendel-Mitoraj, Katrina

2017-01-01

Abstract. We describe a postacquisition, attribute-based quality assessment method for brain magnetic resonance imaging (MRI) images. It is based on the application of Bayes theory to the relationship between entropy and image quality attributes. The entropy feature image of a slice is segmented into low- and high-entropy regions. For each entropy region, there are three separate observations of contrast, standard deviation, and sharpness quality attributes. A quality index for a quality attribute is the posterior probability of an entropy region given any corresponding region in a feature image where quality attribute is observed. Prior belief in each entropy region is determined from normalized total clique potential (TCP) energy of the slice. For TCP below the predefined threshold, the prior probability for a region is determined by deviation of its percentage composition in the slice from a standard normal distribution built from 250 MRI volume data provided by Alzheimer’s Disease Neuroimaging Initiative. For TCP above the threshold, the prior is computed using a mathematical model that describes the TCP–noise level relationship in brain MRI images. Our proposed method assesses the image quality of each entropy region and the global image. Experimental results demonstrate good correlation with subjective opinions of radiologists for different types and levels of quality distortions. PMID:28630885

The Air Quality Health Index and Asthma Morbidity: A Population-Based Study

PubMed Central

Shen, Shixin; Atenafu, Eshetu G.; Guan, Jun; McLimont, Susan; Stocks, Brian; Licskai, Christopher

2012-01-01

Background: Exposure to air pollution has been linked to the exacerbation of respiratory diseases. The Air Quality Health Index (AQHI), developed in Canada, is a new health risk scale for reporting air quality and advising risk reduction actions. Objective: We used the AQHI to estimate the impact of air quality on asthma morbidity, adjusting for potential confounders. Methods: Daily air pollutant measures were obtained from 14 regional monitoring stations in Ontario. Daily counts of asthma-attributed hospitalizations, emergency department (ED) visits, and outpatient visits were obtained from a provincial registry of 1.5 million patients with asthma. Poisson regression was used to estimate health services rate ratios (RRs) as a measure of association between the AQHI or individual pollutants and health services use. We adjusted for age, sex, season, year, and region of residence. Results: The AQHI values were significantly associated with increased use of asthma health services on the same day and on the 2 following days, depending on the specific outcome assessed. A 1-unit increase in the AQHI was associated with a 5.6% increase in asthma outpatient visits (RR = 1.056; 95% CI: 1.053, 1.058) and a 2.1% increase in the rate of hospitalization (RR = 1.021; 95% CI: 1.014, 1.028) on the same day and with a 1.3% increase in the rate of ED visits (RR = 1.013; 95% CI: 1.010, 1.017) after a 2-day lag. Conclusions: The AQHI values were significantly associated with the use of asthma-related health services. Timely AQHI health risk advisories with integrated risk reduction messages may reduce morbidity associated with air pollution in patients with asthma. PMID:23060364

Interpersonal relationship quality mediates the association between military-related posttraumatic stress and academic dysfunction among student veterans.

PubMed

Fredman, Steffany J; Marshall, Amy D; Le, Yunying; Aronson, Keith R; Perkins, Daniel F; Hayes, Jeffrey A

2018-05-03

Large numbers of United States service members and veterans are enrolling in colleges and universities. Many are experiencing posttraumatic stress symptoms secondary to their military service, and these symptoms are associated with academic dysfunction. However, little is known about the mechanism(s) through which posttraumatic stress increases risk for academic difficulties. The goal of the current study was to evaluate perceived interpersonal relationship quality as a mediator of this association. The current study investigated the indirect effect of posttraumatic stress on academic dysfunction through three indices of perceived interpersonal relationship quality (i.e., family distress, family support, and social network support) in a clinical sample of 2,120 student service members and veterans. Participants were further divided into four groups based on relationship status and gender (i.e., partnered women, nonpartnered women, partnered men, and nonpartnered men), and moderation by group was examined. For all four groups, there were significant indirect effects of posttraumatic stress on academic dysfunction through greater family distress and lower social network support. Further, the overall indirect effect of posttraumatic stress on academic dysfunction was stronger for partnered women compared with the three other groups and was attributable to the stronger path from family distress to academic dysfunction for partnered women. Poor perceived relationship quality may be a modifiable risk factor for academic dysfunction among student service members and veterans experiencing military-related posttraumatic stress. Partnered women may be especially well-suited to interventions that enhance the interpersonal context of posttraumatic stress as a way to optimize academic outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The effects of digital elevation model resolution on the calculation and predictions of topographic wetness indices.

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

Drover, Damion, Ryan

2011-12-01

One of the largest exports in the Southeast U.S. is forest products. Interest in biofuels using forest biomass has increased recently, leading to more research into better forest management BMPs. The USDA Forest Service, along with the Oak Ridge National Laboratory, University of Georgia and Oregon State University are researching the impacts of intensive forest management for biofuels on water quality and quantity at the Savannah River Site in South Carolina. Surface runoff of saturated areas, transporting excess nutrients and contaminants, is a potential water quality issue under investigation. Detailed maps of variable source areas and soil characteristics would thereforemore » be helpful prior to treatment. The availability of remotely sensed and computed digital elevation models (DEMs) and spatial analysis tools make it easy to calculate terrain attributes. These terrain attributes can be used in models to predict saturated areas or other attributes in the landscape. With laser altimetry, an area can be flown to produce very high resolution data, and the resulting data can be resampled into any resolution of DEM desired. Additionally, there exist many maps that are in various resolutions of DEM, such as those acquired from the U.S. Geological Survey. Problems arise when using maps derived from different resolution DEMs. For example, saturated areas can be under or overestimated depending on the resolution used. The purpose of this study was to examine the effects of DEM resolution on the calculation of topographic wetness indices used to predict variable source areas of saturation, and to find the best resolutions to produce prediction maps of soil attributes like nitrogen, carbon, bulk density and soil texture for low-relief, humid-temperate forested hillslopes. Topographic wetness indices were calculated based on the derived terrain attributes, slope and specific catchment area, from five different DEM resolutions. The DEMs were resampled from LiDAR, which is a laser altimetry remote sensing method, obtained from the USDA Forest Service at Savannah River Site. The specific DEM resolutions were chosen because they are common grid cell sizes (10m, 30m, and 50m) used in mapping for management applications and in research. The finer resolutions (2m and 5m) were chosen for the purpose of determining how finer resolutions performed compared with coarser resolutions at predicting wetness and related soil attributes. The wetness indices were compared across DEMs and with each other in terms of quantile and distribution differences, then in terms of how well they each correlated with measured soil attributes. Spatial and non-spatial analyses were performed, and predictions using regression and geostatistics were examined for efficacy relative to each DEM resolution. Trends in the raw data and analysis results were also revealed.« less

No Magic Bullet: A Theory-Based Meta-Analysis of Markov Transition Probabilities in Studies of Service Systems for Persons With Mental Disabilities.

PubMed

Leff, Hugh Stephen; Chow, Clifton M; Graves, Stephen C

2017-03-01

A random-effects meta-analysis of studies that used Markov transition probabilities (TPs) to describe outcomes for mental health service systems of differing quality for persons with serious mental illness was implemented to improve the scientific understanding of systems performance, to use in planning simulations to project service system costs and outcomes over time, and to test a theory of how outcomes for systems varying in quality differ. Nineteen systems described in 12 studies were coded as basic (B), maintenance (M), and recovery oriented (R) on the basis of descriptions of services provided. TPs for studies were aligned with a common functional-level framework, converted to a one-month time period, synthesized, and compared with theory-based expectations. Meta-regression was employed to explore associations between TPs and characteristics of service recipients and studies. R systems performed better than M and B systems. However, M systems did not perform better than B systems. All systems showed negative as well as positive TPs. For approximately one-third of synthesized TPs, substantial interstudy heterogeneity was noted. Associations were found between TPs and service recipient and study variables Conclusions: Conceptualizing systems as B, M, and R has potential for improving scientific understanding and systems planning. R systems appear more effective than B and M systems, although there is no "magic bullet" system for all service recipients. Interstudy heterogeneity indicates need for common approaches to reporting service recipient states, time periods for TPs, service recipient attributes, and service system characteristics. TPs found should be used in Markov simulations to project system effectiveness and costs of over time.

Stakeholder experiences with general practice pharmacist services: a qualitative study.

PubMed

Tan, Edwin C K; Stewart, Kay; Elliott, Rohan A; George, Johnson

2013-09-11

To explore general practice staff, pharmacist and patient experiences with pharmacist services in Australian general practice clinics within the Pharmacists in Practice Study. Qualitative study. Two general practice clinics in Melbourne, Australia, in which pharmacists provided medication reviews, patient and staff education, medicines information and quality assurance services over a 6-month period. Patients, practice staff and pharmacists. Semi-structured telephone interviews with patients, focus groups with practice staff and semi-structured interviews and periodic narrative reports with practice pharmacists. Data were analysed thematically and theoretical frameworks used to explain the findings. 34 participants were recruited: 18 patients, 14 practice staff (9 general practitioners, 4 practice nurses, 1 practice manager) and 2 practice pharmacists. Five main themes emerged: environment; professional relationships and integration; pharmacist attributes; staff and patient benefits and logistical challenges. Participants reported that colocation and the interdisciplinary environment of general practice enabled better communication and collaboration compared to traditional community and consultant pharmacy services. Participants felt that pharmacists needed to possess certain attributes to ensure successful integration, including being personable and proactive. Attitudinal, professional and logistical barriers were identified but were able to be overcome. The findings were explained using D'Amour's structuration model of collaboration and Roger's diffusion of innovation theory. This is the first qualitative study to explore the experiences of general practice staff, pharmacists and patients on their interactions within the Australian general practice environment. Participants were receptive of colocated pharmacist services, and various barriers and facilitators to integration were identified. Future research should investigate the feasibility and sustainability of general practice pharmacist roles.

[Real-time detection of quality of Chinese materia medica: strategy of NIR model evaluation].

PubMed

Wu, Zhi-sheng; Shi, Xin-yuan; Xu, Bing; Dai, Xing-xing; Qiao, Yan-jiang

2015-07-01

The definition of critical quality attributes of Chinese materia medica ( CMM) was put forward based on the top-level design concept. Nowadays, coupled with the development of rapid analytical science, rapid assessment of critical quality attributes of CMM was firstly carried out, which was the secondary discipline branch of CMM. Taking near infrared (NIR) spectroscopy as an example, which is a rapid analytical technology in pharmaceutical process over the past decade, systematic review is the chemometric parameters in NIR model evaluation. According to the characteristics of complexity of CMM and trace components analysis, a multi-source information fusion strategy of NIR model was developed for assessment of critical quality attributes of CMM. The strategy has provided guideline for NIR reliable analysis in critical quality attributes of CMM.

Effects of physician-owned specialized facilities in health care: a systematic review.

PubMed

Trybou, Jeroen; De Regge, Melissa; Gemmel, Paul; Duyck, Philippe; Annemans, Lieven

2014-12-01

Multiple studies have investigated physician-owned specialized facilities (specialized hospitals and ambulatory surgery centres). However, the evidence is fragmented and the literature lacks cohesion. To provide a comprehensive overview of the effects of physician-owned specialized facilities by synthesizing the findings of published empirical studies. Two reviewers independently researched relevant studies using a standardized search strategy. The Institute of Medicine's quality framework (safe, effective, equitable, efficient, patient-centred, and accessible care) was applied in order to evaluate the performance of such facilities. In addition, the impact on the performance of full-service general hospitals was assessed. Forty-six studies were included in the systematic review. Overall, the quality of the included studies was satisfactory. Our results show that little evidence exists to confirm the advantages attributed to physician-owned specialized facilities, and their impact on full-service general hospitals remains limited. Although data is available on a wide variety of effects, the evidence base is surprisingly thin. There is no compelling evidence available demonstrating the added value of physician-owned specialized facilities in terms of quality or cost of the delivered care. More research is necessary on the relative merits of physician-owned specialized facilities. In addition, their corresponding impact on full-service general hospitals remains unclear. The development of physician-owned specialized facilities should thus be monitored carefully. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The Early Impact Of The ‘Alternative Quality Contract’ On Mental Health Service Use And Spending In Massachusetts

PubMed Central

Barry, Colleen L.; Stuart, Elizabeth A.; Donohue, Julie M.; Greenfield, Shelly F.; Kouri, Elena; Duckworth, Kenneth; Song, Zirui; Mechanic, Robert E.; Chernew, Michael E.; Huskamp, Haiden A.

2016-01-01

Accountable care using global payment with performance bonuses has shown promise in controlling spending growth and improving care. This study examined how an early model, the Alternative Quality Contract (AQC) established in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA), has affected care for mental illness. We compared spending and use for enrollees in AQC organizations that did and did not accept financial risk for mental health with enrollees not participating in the contract. Compared with BCBSMA enrollees in organizations not participating in the AQC, we found that enrollees in organizations participating in the AQC were slightly less likely to use mental health services and had small declines in total health care spending, but no change was found in mental health spending among all users. The declines in probability of use of mental health services and in total health spending attributable to the AQC were concentrated among enrollees in AQC organizations that accepted financial risk for behavioral health. Interviews with AQC organization leaders suggested that the contractual arrangements did not meaningfully affect mental health care delivery in the program’s initial years, but organizations are now at varying stages of efforts to improve integration. PMID:26643628

Patient satisfaction and referral intention: effect of patient-physician match on ethnic origin and cultural similarity.

PubMed

Lin, Xiaohua; Guan, Jian

2002-01-01

The study brought a cultural perspective into the mainstream model of health service quality by taking into account minorities' unique experience, patient-physician match on ethnic origin and cultural similarity. Survey data from Asian-American respondents supported a three-dimensional humaneness-professionalism-competence model of physician attributes. Physician humaneness and professionalism, patient-physician match on ethnic origin and cultural similarity predicted patient overall satisfaction and referral intention among Asian-Americans. Interestingly, the 3-dimensional model of physician attributes was also revealed in a Caucasian-American sample. However, Caucasian-Americans differ from Asian-Americans in several ways: physician competence was a significant predictor of overall satisfaction; professionalism was the only determinant of referral intention; and cultural similarity was not a significant factor with regards to either overall satisfaction or referral intention.

The Attributive Theory of Quality: A Model for Quality Measurement in Higher Education.

ERIC Educational Resources Information Center

Afshar, Arash

A theoretical basis for defining and measuring the quality of institutions of higher education, namely for accreditation purposes, is developed. The theory, the Attributive Theory of Quality, is illustrated using a calculation model that is based on general systems theory. The theory postulates that quality only exists in relation to the…

Important features of home-based support services for older Australians and their informal carers.

PubMed

McCaffrey, Nikki; Gill, Liz; Kaambwa, Billingsley; Cameron, Ian D; Patterson, Jan; Crotty, Maria; Ratcliffe, Julie

2015-11-01

In Australia, newly initiated, publicly subsidised 'Home-Care Packages' designed to assist older people (≥ 65 years of age) living in their own home must now be offered on a 'consumer-directed care' (CDC) basis by service providers. However, CDC models have largely developed in the absence of evidence on users' views and preferences. The aim of this study was to determine what features (attributes) of consumer-directed, home-based support services are important to older people and their informal carers to inform the design of a discrete choice experiment (DCE). Semi-structured, face-to-face interviews were conducted in December 2012-November 2013 with 17 older people receiving home-based support services and 10 informal carers from 5 providers located in South Australia and New South Wales. Salient service characteristics important to participants were determined using thematic and constant comparative analysis and formulated into attributes and attribute levels for presentation within a DCE. Initially, eight broad themes were identified: information and knowledge, choice and control, self-managed continuum, effective co-ordination, effective communication, responsiveness and flexibility, continuity and planning. Attributes were formulated for the DCE by combining overlapping themes such as effective communication and co-ordination, and the self-managed continuum and planning into single attributes. Six salient service features that characterise consumer preferences for the provision of home-based support service models were identified: choice of provider, choice of support worker, flexibility in care activities provided, contact with the service co-ordinator, managing the budget and saving unspent funds. Best practice indicates that qualitative research with individuals who represent the population of interest should guide attribute selection for a DCE and this is the first study to employ such methods in aged care service provision. Further development of services could incorporate methods of consumer engagement such as DCEs which facilitate the identification and quantification of users' views and preferences on alternative models of delivery. © 2015 John Wiley & Sons Ltd.

Engineering Quality Software: 10 Recommendations for Improved Software Quality Management

DTIC Science & Technology

2010-04-27

lack of user involvement • Inadequate Software Process Management & Control By Contractors • No “Team” of Vendors and users; little SME participation...1990 Quality Perspectives • Process Quality ( CMMI ) • Product Quality (ISO/IEC 2500x) – Internal Quality Attributes – External Quality Attributes... CMMI /ISO 9000 Assessments – Capture organizational knowledge • Identify best practices, lessons learned Know where you are, and where you need to be

Framing Extreme Event Attribution from the Bottom up - an Enquiry into the Social Representations of key stakeholders, of the Press and of Climate Scientists.

NASA Astrophysics Data System (ADS)

Vanderlinden, J. P.; Fellmer, M.; Capellini, N.; Meinke, I.; Remvikos, Y.; Bray, D.; Pacteau, C.; Von Storch, H.

2014-12-01

Attribution of extreme weather events has recently generated a lot of interest simultaneously within the general public, the scientific community, and stakeholders affected by meteorological extremes. This interest calls for the need to explore the potential convergence of the current atttribution science with the desire and needs of stakeholders. Such an euiry contributes to the development of climate services aiming at quantifying the human responsibility for particular events. Through interviews with climate scientists, through the analysis of the press coverage of extreme meteorological events, and through stakeholder (private sector, covernment services and local and regional government) focus groups, we analyze how social representations of the concepts associated with extreme event attribution are theorized. From the corpuses generated in the course of this enquiry, we build up a grounded, bottom-up, theorization of extreme weather event attribution. This bottom-up theorization allows for a framing of the potential climate services in a way that is attuned to the needs and expectations of the stakeholders. From apparently simple formulations: "what is an extreme event?", "what makes it extreme?", "what is meant by attribution of extreme weather events?", "what do we want to attribute?", "what is a climate service?", we demonstrate the polysemy of these terms and propose ways to address the challenges associated with the juxtaposition of four highly loaded concepts: extreme - event - attribution - climate services.

The consumer: silent or intimate player in the quality revolution.

PubMed

Meisenheimer, C

1991-04-01

Nurses are an agency's frontline representative; their centrality to the development of realistic and positive perceptions of care received must be acknowledged by the agency's management staff. Nurses must be recognized, not just as employees, but as entrepreneurs selling a product; the product of nursing care is a satisfied client with positive outcomes. The satisfied client is a major "marketer" for the health care facility and nursing services. It has been reported that satisfied customers will relate their satisfaction to four or five other people; dissatisfied customers will elaborate their dissatisfaction to 9 or 10 other people. As public policy on health care resource allocation is drafted, clients and third-party payors must collaborate with providers. Because public consumption will provide the principal advantage in the competitive health care industry, decisions regarding quality, cost, and access must be based on a national database of information (in universally understandable language), including an analysis of nursing and medical interventions, health outcomes, and health expenditures. The new paradigm shift toward total quality management recognizes that quality is no longer simply an attribute of a product or service; it also measures a relationship. A balanced relationship, reflecting trust between nurses, employers, underwriters, physicians, and the client, allows every player to define quality dimensions, make judgments, and contribute to the quality of care delivered and received. The consumer must be an intimate player in this scenario, or the health care system will continue to falter.

Reducing seclusion and restraint: meeting the organizational challenge.

PubMed

Visalli, H; McNasser, G

2000-07-01

The Mohawk Valley Psychiatric Center has experienced a major reduction in the use of seclusion and restraint in the past five years. It has used the traditional quality improvement (QI) tools like the Plan Do Check Act, Flowcharts, Fishbone diagrams, and Parieto Charts as suggested in the QI literature. The original work to reduce seclusion and restraint are described in two previous articles by Visalli and McNasser. This article describes the additional work since that time. The seclusion/restraint rate in adult service per 1,000 patient days is 0.13 for restraint and 0.15 for seclusion for calendar year 1998. Children and youth service also has comparatively minimal use of seclusion and restraint. The success of this program is attributed to the organizational leadership and the interdisciplinary approach taken to provide individualized treatment. Many of the initiatives stem from a working relationship with patients on how to improve customer service.

Attributes of quality programs in universities in developing countries: Case studies of two private universities in Ecuador and beyond

NASA Astrophysics Data System (ADS)

Uriguen, Monica I.

This study sought to identify the key attributes of high-quality programs with an eye toward helping developing countries such as Ecuador advance program quality. The dissertation is divided into five chapters: (1) introduction to high-quality programs; (2) literature review of attributes of high-quality programs; (3) grounded theory method (including interviews with 60 individuals) used to identify program attributes that enhance student learning; (4) findings; and (5) conclusions and recommendations. Following are the five clusters and thirteen attributes of high-quality programs that I identified: Cluster One: Highly Qualified Participants: (1) Highly Qualified Faculty, and (2) Highly Qualified Students; Cluster Two: Learning-Centered Cultures: (3) Shared Program Direction Focused on Learning, (4) Real-World Learning Experiences, (5) Reading-Centered Culture, and (6) Supportive and Risk-Taking Environment; Cluster Three: Interactive Teaching and Learning: (7) Integrative learning: Theory with Practice, Self with Subject, and (8) Exclusive Tutoring and Mentoring; Cluster Four: Connected Program Requirements: (9) Planned Breadth and Depth Course Work, and (10) Tangible Products; and Cluster Five: Adequate Resources: (11) Support for Students, (12) Support for Faculty, and (13) Support for Campus Infrastructure. The study was guided by Haworth and Conrad's (1997) "Engagement Theory of High-Quality Programs." Eleven of the attributes of high-quality programs are closely connected to Haworth and Conrad's theory and the other two attributes---real-world learning experiences and a reading-centered culture---make the signature theoretical contributions of the study. Real-world learning experiences encourage the active involvement of stakeholders in designing curricula with real-world learning experiences. The second attribute---a reading-centered culture---has never before been identified in the literature. There are four key differences between Haworth and Conrad's theory and the theory developed in this study. This study identified four attributes that are highly important in Ecuador and, possibly, other developing countries: highly-qualified faculty, highly-qualified students, reading-centered cultures, and real-world learning experiences. If Latin American universities implement the recommendations proposed in the study, particularly Ecuadorian universities, there is a foundation for envisioning a better future for Ecuadorian universities.

Assessing the role of appropriate primary health care on the use of dental services by Brazilian low-income preschool children.

PubMed

Baldani, Márcia Helena; Rocha, Juliana Schaia; Fadel, Cristina Berger; Nascimento, Antonio Carlos; Antunes, José Leopoldo Ferreira; Moysés, Samuel Jorge

2017-11-21

This cross-sectional study aimed to assess the association between the quality of primary health care (PHC) and the use of dental services by preschoolers served by the Family Health Strategy (FHS), controlling for socio-demographic determinants and perceived need. The sample encompassed 438 children aged 3-5 years, enrolled in 19 FHS facilities in Ponta Grossa, Paraná State, Brazil. Individual level variables were collected by interviewing parents or caregivers at home. They answered a questionnaire on socioeconomic conditions, oral hygiene habits and use of dental services. Parental perception of child's oral health related quality of life, as perceived need, was assessed by the Brazilian version of Early Childhood Oral Health Impact Scale (ECOHIS). Normative need was assessed by oral examinations, according to guidelines standardized by the World Health Organization. The contextual level factor was defined as the extent of implementation of PHC in the facilities. Managers responded to PCATool-Brazil, a validated questionnaire which measures the extent of PHC. Dentists answered to a version of PCATool, which was adapted and pretested for dental services. Multilevel analysis, based on Andersen's behavioral model, fitted the adjustment of "having ever consulted a dentist" to contextual and individual covariates. We observed high prevalence of dental caries. Almost half of the sample had had dental appointments in life. Social gradients were observed for the use of dental services. Although it was not able to eliminate the impact of adverse social conditions, higher levels of PHC attributes in dental services favored the effective use of such services by low-income children.

Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries

PubMed Central

Sun, Zeye

2017-01-01

Background It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)—the structural inputs to care—predicts the clinical quality of care provided to patients. Methods and findings Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers’ adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from −0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilities with similar infrastructure scores delivered care of widely varying quality in each service. We did not detect a minimum level of infrastructure that was reliably associated with higher quality of care delivered in any service. These findings rely on cross-sectional data, preventing assessment of relationships between structural inputs and clinical quality over time; measurement error may attenuate the estimated associations. Conclusion Inputs to care are poorly correlated with provision of evidence-based care in these 4 clinical services. Healthcare workers in well-equipped facilities often provided poor care and vice versa. While it is important to have strong infrastructure, it should not be used as a measure of quality. Insight into health system quality requires measurement of processes and outcomes of care. PMID:29232377

Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries.

PubMed

Leslie, Hannah H; Sun, Zeye; Kruk, Margaret E

2017-12-01

It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)-the structural inputs to care-predicts the clinical quality of care provided to patients. Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers' adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from -0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilities with similar infrastructure scores delivered care of widely varying quality in each service. We did not detect a minimum level of infrastructure that was reliably associated with higher quality of care delivered in any service. These findings rely on cross-sectional data, preventing assessment of relationships between structural inputs and clinical quality over time; measurement error may attenuate the estimated associations. Inputs to care are poorly correlated with provision of evidence-based care in these 4 clinical services. Healthcare workers in well-equipped facilities often provided poor care and vice versa. While it is important to have strong infrastructure, it should not be used as a measure of quality. Insight into health system quality requires measurement of processes and outcomes of care.

Developing a discrete choice experiment in Malawi: eliciting preferences for breast cancer early detection services.

PubMed

Kohler, Racquel E; Lee, Clara N; Gopal, Satish; Reeve, Bryce B; Weiner, Bryan J; Wheeler, Stephanie B

2015-01-01

In Malawi, routine breast cancer screening is not available and little is known about women's preferences regarding early detection services. Discrete choice experiments are increasingly used to reveal preferences about new health services; however, selecting appropriate attributes that describe a new health service is imperative to ensure validity of the choice experiment. To identify important factors that are relevant to Malawian women's preferences for breast cancer detection services and to select attributes and levels for a discrete choice experiment in a setting where both breast cancer early detection and choice experiments are rare. We reviewed the literature to establish an initial list of potential attributes and levels for a discrete choice experiment and conducted qualitative interviews with health workers and community women to explore relevant local factors affecting decisions to use cancer detection services. We tested the design through cognitive interviews and refined the levels, descriptions, and designs. Themes that emerged from interviews provided critical information about breast cancer detection services, specifically, that breast cancer interventions should be integrated into other health services because asymptomatic screening may not be practical as an individual service. Based on participants' responses, the final attributes of the choice experiment included travel time, health encounter, health worker type and sex, and breast cancer early detection strategy. Cognitive testing confirmed the acceptability of the final attributes, comprehension of choice tasks, and women's abilities to make trade-offs. Applying a discrete choice experiment for breast cancer early detection was feasible with appropriate tailoring for a low-income, low-literacy African setting.

Attributional Patterns towards Students with and without Learning Disabilities: A Comparison of Pre- and In-Service Teachers in China

ERIC Educational Resources Information Center

Jiang, Han; Woodcock, Stuart

2018-01-01

This study aims to investigate the differences of attributional responses to students with and without learning disabilities (LD) between pre- and in-service teachers in mainland China. A total of 204 teachers (101 pre-service and 103 in-service teachers) were surveyed using vignettes and Likert scale questions to ascertain their responses to…

Assessing the quality of healthcare provided to children.

PubMed

Mangione-Smith, R; McGlynn, E A

1998-10-01

To present a conceptual framework for evaluating quality of care for children and adolescents, summarize the key issues related to developing measures to assess pediatric quality of care, examine some existing measures, and present evidence about their current level of performance. Assessing the quality of care for children poses many challenges not encountered when making these measurements in the adult population. Children and adolescents (from this point forward referred to collectively as children unless differentiation is necessary) differ from adults in two clinically important ways (Jameson and Wehr 1993): (1) their normal developmental trajectory is characterized by change, and (2) they have differential morbidity. These factors contribute to the limitations encountered when developing measures to assess the quality of care for children. The movement of a child through the various stages of development makes it difficult to establish what constitutes a "normal" outcome and by extension what constitutes a poor outcome. Additionally, salient developmental outcomes that result from poor quality of care may not be observed for several years. This implies that poor outcomes may be observed when the child is receiving care from a delivery system other than the one that provided the low-quality care. Attributing the suboptimal outcome to the new delivery system would be inappropriate. Differential morbidity refers to the fact that the type, prevalence, and severity of illness experienced by children is measurably different from that observed in adults. Most children experience numerous self-limited illness of mild severity. A minority of children suffer from markedly more severe diseases. Thus, condition-specific measures in children are problematic to implement for routine assessments because of the extremely low incidence and prevalence of most severe pediatric diseases (Halfon 1996). However, children with these conditions are potentially the segment of the pediatric population that can be most affected by variations in the quality of care. Improving the care provided to these children is likely to have the largest impact on quality of life and longevity. The low prevalence of most severe pediatric diseases also makes it difficult to evaluate the effectiveness of new treatment modalities; multi-center trials or long enrollment periods are usually required to obtain a large enough patient sample to conduct the necessary randomized controlled trials or cohort studies. Another challenge encountered when measuring quality of care for children is that, in most cases, they depend on adults to both obtain care and to report on the outcomes of that care. Parents and their children may have different perceptions of what defines health or have different levels of satisfaction with the care they receive. Children, particularly those with special needs, also depend on a broad range of services including the medical system, community intervention programs, social programs, and school-based services. Dependency on these various services adds to the difficulty of measuring and appropriately attributing health outcomes observed in children to a particular service delivery entity. Adolescents also depend on adults for access to some of their care; however, they have special needs related to confidentiality and parent-child information sharing. Adolescents commonly seek care at facilities, such as school-based clinics, that allow them to obtain confidential care. These facilities usually provide out-of-health plan care for these children, which raises special issues related to information availability for quality assessments and for assessing utilization patterns in this population. If the source of poor health outcomes is not known, quality improvement is not possible. The many challenges faced when constructing pediatric (this term will be used to refer to both children and adolescents) quality of care measures have resulted in few of these instruments being developed specifically for children. Most of the measures developed to date have either a very limited pediatric component or still require the process or outcome validation step. Although several practice guidelines and indicators of quality have been constructed, a conceptual framework to guide the development of such tools for quality assessment in the pediatric population is lacking. Pediatric health services researchers and the organizations that fund this work need to focus on developing a set of quality assessment tools that will address several challenging issues. Working within the context of the conceptual framework presented, we draw several conclusions related to issues that should be considered in developing quality of care measures for children.

[Perception of the linguistic and cultural context minority on the lived experiences of pregnancy].

PubMed

Lacaze-Masmonteil, Thierry; Leis, Anne; Lauriol, Emmanuelle; Normandeau, Joane; Moreau, Denise; Bouchard, Louise; Vaillancourt, Cathy

2013-06-07

From a public health perspective, the follow-up of women during pregnancy and the perinatal period requires quality communication and health services that take into account the context in which these women live. However, challenges related to access to health services in French in a minority situation have been documented in recent research. The objective of this pilot study is to better understand the perceptions, the lived experiences and the needs of pregnant Francophone women living in Canada within a linguistic minority context. Given the exploratory nature of the inquiry, a mixed method descriptive study was conducted in Alberta and New Brunswick, whose populations are 2% and 33% Francophone, respectively. Two semi-structured interviews and a series of validated questionnaires were administered to 21 pregnant women during the third trimester of pregnancy and at six weeks postnatal. Based on the questionnaires, a descriptive analysis documented participants' characteristics, and qualitative interviews were transcribed, coded and analyzed through an inductive process by four independent readers to uncover key themes related to the participants' experiences. Most of the women were bilingual and language in which health services were received did not appear to be a major issue for them, except during times of stress and at critical periods of the pregnancy. In contrast, almost one third of the women reported being unsatisfied with services they had received and attributed this dissatisfaction to gaps in French language services. Women prefer to receive health services in their mother tongue, however services are delivered in English most of the time. Participants report that during times of stress and emergency, communication in French is essential to a quality follow-up of patients. Linguistic and cultural congruence seems to be a key factor for quality care during pregnancy. A comparative study would assist in better ascertaining the relative impact of language on Francophone women's lived experiences during pregnancy.

Responsibility Attribution for Violence against Women: A Study of Chinese Public Service Professionals

ERIC Educational Resources Information Center

Tang, Catherine So-kum; Pun, Shuk Han; Cheung, Fanny Mui-ching

2002-01-01

This study examined how Chinese public service professionals attributed responsibility to victims and perpetrators of violence against women (VAW). A total of 2,308 Chinese public service professionals in Hong Kong completed questionnaires on attitudes toward women, VAW-related perceptions, and assignment of responsibility to actors in written VAW…

Quality Improvement in Virtual Higher Education: A Grounded Theory Approach

ERIC Educational Resources Information Center

Mahdiuon, Rouhollah; Masoumi, Davoud; Farasatkhah, Maghsoud

2017-01-01

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

Decision Support for Personalized Cloud Service Selection through Multi-Attribute Trustworthiness Evaluation

PubMed Central

Ding, Shuai; Xia, Chen-Yi; Zhou, Kai-Le; Yang, Shan-Lin; Shang, Jennifer S.

2014-01-01

Facing a customer market with rising demands for cloud service dependability and security, trustworthiness evaluation techniques are becoming essential to cloud service selection. But these methods are out of the reach to most customers as they require considerable expertise. Additionally, since the cloud service evaluation is often a costly and time-consuming process, it is not practical to measure trustworthy attributes of all candidates for each customer. Many existing models cannot easily deal with cloud services which have very few historical records. In this paper, we propose a novel service selection approach in which the missing value prediction and the multi-attribute trustworthiness evaluation are commonly taken into account. By simply collecting limited historical records, the current approach is able to support the personalized trustworthy service selection. The experimental results also show that our approach performs much better than other competing ones with respect to the customer preference and expectation in trustworthiness assessment. PMID:24972237

Decision support for personalized cloud service selection through multi-attribute trustworthiness evaluation.

PubMed

Ding, Shuai; Xia, Cheng-Yi; Xia, Chen-Yi; Zhou, Kai-Le; Yang, Shan-Lin; Shang, Jennifer S

2014-01-01

Facing a customer market with rising demands for cloud service dependability and security, trustworthiness evaluation techniques are becoming essential to cloud service selection. But these methods are out of the reach to most customers as they require considerable expertise. Additionally, since the cloud service evaluation is often a costly and time-consuming process, it is not practical to measure trustworthy attributes of all candidates for each customer. Many existing models cannot easily deal with cloud services which have very few historical records. In this paper, we propose a novel service selection approach in which the missing value prediction and the multi-attribute trustworthiness evaluation are commonly taken into account. By simply collecting limited historical records, the current approach is able to support the personalized trustworthy service selection. The experimental results also show that our approach performs much better than other competing ones with respect to the customer preference and expectation in trustworthiness assessment.

Architecture Design of Healthcare Software-as-a-Service Platform for Cloud-Based Clinical Decision Support Service

PubMed Central

Oh, Sungyoung; Cha, Jieun; Ji, Myungkyu; Kang, Hyekyung; Kim, Seok; Heo, Eunyoung; Han, Jong Soo; Kang, Hyunggoo; Chae, Hoseok; Hwang, Hee

2015-01-01

Objectives To design a cloud computing-based Healthcare Software-as-a-Service (SaaS) Platform (HSP) for delivering healthcare information services with low cost, high clinical value, and high usability. Methods We analyzed the architecture requirements of an HSP, including the interface, business services, cloud SaaS, quality attributes, privacy and security, and multi-lingual capacity. For cloud-based SaaS services, we focused on Clinical Decision Service (CDS) content services, basic functional services, and mobile services. Microsoft's Azure cloud computing for Infrastructure-as-a-Service (IaaS) and Platform-as-a-Service (PaaS) was used. Results The functional and software views of an HSP were designed in a layered architecture. External systems can be interfaced with the HSP using SOAP and REST/JSON. The multi-tenancy model of the HSP was designed as a shared database, with a separate schema for each tenant through a single application, although healthcare data can be physically located on a cloud or in a hospital, depending on regulations. The CDS services were categorized into rule-based services for medications, alert registration services, and knowledge services. Conclusions We expect that cloud-based HSPs will allow small and mid-sized hospitals, in addition to large-sized hospitals, to adopt information infrastructures and health information technology with low system operation and maintenance costs. PMID:25995962

Costs of alcohol and drug-involved crime.

PubMed

Miller, Ted R; Levy, David T; Cohen, Mark A; Cox, Kenya L C

2006-12-01

A large proportion of violent and property crimes involve alcohol or other drugs (AOD). AOD use only causes some of these crimes. This paper estimates the costs of AOD-involved and AOD-attributable crimes. Crime counts are from government statistics adjusted for underreporting. The AOD-involved portion of crime costs is estimated from inmate surveys on alcohol and illicit drug use at the time of the crime. The costs and AOD-attributable portion of AOD-involved crimes come from published studies. They include tangible medical, mental health, property loss, future earnings, public services, adjudication, and sanctioning costs, as well as the value of pain and suffering. An estimated 5.4 million violent crimes and 8 million property crimes involved AOD use in 1999. Those AOD-involved crimes cost society over 6.5 billion dollars in medical and mental health care and almost 65 billion dollars in other tangible expenses (in 1999 dollars). If the value of pain, suffering, and lost quality of life is added, AOD-involved crime costs totaled 205 billion dollars. Violent crimes accounted for more than 85% of the costs. Roughly estimated, crimes attributable to alcohol cost 84 billion dollars, more than 2 times the 38 billion dollars attributable to drugs. Although American media--news and entertainment--dwell on the links between drugs and crime, alcohol-attributable crime costs are double drug-attributable ones. Effective efforts to reduce the abuse of alcohol and illicit drugs should reduce costs associated with crime.

A review of data quality assessment methods for public health information systems.

PubMed

Chen, Hong; Hailey, David; Wang, Ning; Yu, Ping

2014-05-14

High quality data and effective data quality assessment are required for accurately evaluating the impact of public health interventions and measuring public health outcomes. Data, data use, and data collection process, as the three dimensions of data quality, all need to be assessed for overall data quality assessment. We reviewed current data quality assessment methods. The relevant study was identified in major databases and well-known institutional websites. We found the dimension of data was most frequently assessed. Completeness, accuracy, and timeliness were the three most-used attributes among a total of 49 attributes of data quality. The major quantitative assessment methods were descriptive surveys and data audits, whereas the common qualitative assessment methods were interview and documentation review. The limitations of the reviewed studies included inattentiveness to data use and data collection process, inconsistency in the definition of attributes of data quality, failure to address data users' concerns and a lack of systematic procedures in data quality assessment. This review study is limited by the coverage of the databases and the breadth of public health information systems. Further research could develop consistent data quality definitions and attributes. More research efforts should be given to assess the quality of data use and the quality of data collection process.

A Review of Data Quality Assessment Methods for Public Health Information Systems

PubMed Central

Chen, Hong; Hailey, David; Wang, Ning; Yu, Ping

2014-01-01

High quality data and effective data quality assessment are required for accurately evaluating the impact of public health interventions and measuring public health outcomes. Data, data use, and data collection process, as the three dimensions of data quality, all need to be assessed for overall data quality assessment. We reviewed current data quality assessment methods. The relevant study was identified in major databases and well-known institutional websites. We found the dimension of data was most frequently assessed. Completeness, accuracy, and timeliness were the three most-used attributes among a total of 49 attributes of data quality. The major quantitative assessment methods were descriptive surveys and data audits, whereas the common qualitative assessment methods were interview and documentation review. The limitations of the reviewed studies included inattentiveness to data use and data collection process, inconsistency in the definition of attributes of data quality, failure to address data users’ concerns and a lack of systematic procedures in data quality assessment. This review study is limited by the coverage of the databases and the breadth of public health information systems. Further research could develop consistent data quality definitions and attributes. More research efforts should be given to assess the quality of data use and the quality of data collection process. PMID:24830450

Relationship between Quality of Life, Relationship Beliefs and Attribution Style in Infertile Couples.

PubMed

Navid, Behnaz; Mohammadi, Maryam; Maroufizadeh, Saman; Amini, Payam; Shirin, Zahra; Omani-Saman, Reza

2018-07-01

Many infertile couples experience psychological distress and suffer from impaired quality of life. Generally, when couples are dealing with uncontrolled events such as infertility, it is important to manage it well and to use the suitable coping style; so this can represent an example of attribution style. The purpose of this study is to investigate the quality of life, relationship beliefs and attribution style in infertile couples. This cross-sectional study consisted of 50 infertile couples, who were at least 18 years of age and could read and write in Persian. Participants provided demographic and general characteristics and completed the quality of life (SF-12), relationship belief inventory (RBI) and attribution style (ASQ) forms. Data was analyzed by the paired t test, Pearson correlation tests and multiple linear regression analysis, using SPSS version 22 statistical software. Overall, 50 infertile couples participated in our study. The males had a significantly higher score for quality of life compared to the females (P=0.019). In RBI subscales except "Disagreement is Destructive" all others significantly higher in wives than husbands. All subscales of RBI had a negative correlation with the quality of life. The quality of life had a significant correlation with positive internal (r=0.213, P=0.033). The adjusted regression model showed that the quality of life for males was higher than in females (β=-3.098, P=0.024). The current data indicate that in infertile couples, the husbands have a higher quality of life in comparison to their wives. Also, all subscales of relationship beliefs have a negative correlation with the quality of life, but in attribution style, just internal attribution style for positive events is associated with the quality of life. In general, there is a correlation between relationship beliefs and the quality of life in infertile couples. Copyright© by Royan Institute. All rights reserved.

Actors, observers, and causal attributions of homelessness: Differences in attribution for the causes of homelessness among domiciled and homeless people in Madrid (Spain).

PubMed

Vázquez, José Juan; Panadero, Sonia; Zúñiga, Claudia

2017-01-01

The study analyzes the differences in causal attributions of homelessness and attributions of responsibility among the members of 3 groups: homeless group, consisting of a representative sample of homeless people in Madrid, Spain (n = 188); domiciled service-users group, consisting of people at risk of homelessness (n = 164); and domiciled nonservice-users group, consisting of people at no imminent risk of homelessness (n = 180). The domiciled service-users group and domiciled nonservice-users group were matched to the homeless group or sex, age, and nationality. The article also analyzes homeless people's causal attributions as regards their own situation. The results show that compared with the domiciled nonservice-users group, a higher percentage of members of the homeless group and domiciled service-users group attributed homelessness to individualistic causes and they blamed homeless people for their situation to a greater extent. The results also show that there was no "actor-observer bias" in causal attributions for homelessness in Madrid. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Fermentanomics: Relating quality attributes of a monoclonal antibody to cell culture process variables and raw materials using multivariate data analysis.

PubMed

Rathore, Anurag S; Kumar Singh, Sumit; Pathak, Mili; Read, Erik K; Brorson, Kurt A; Agarabi, Cyrus D; Khan, Mansoor

2015-01-01

Fermentanomics is an emerging field of research and involves understanding the underlying controlled process variables and their effect on process yield and product quality. Although major advancements have occurred in process analytics over the past two decades, accurate real-time measurement of significant quality attributes for a biotech product during production culture is still not feasible. Researchers have used an amalgam of process models and analytical measurements for monitoring and process control during production. This article focuses on using multivariate data analysis as a tool for monitoring the internal bioreactor dynamics, the metabolic state of the cell, and interactions among them during culture. Quality attributes of the monoclonal antibody product that were monitored include glycosylation profile of the final product along with process attributes, such as viable cell density and level of antibody expression. These were related to process variables, raw materials components of the chemically defined hybridoma media, concentration of metabolites formed during the course of the culture, aeration-related parameters, and supplemented raw materials such as glucose, methionine, threonine, tryptophan, and tyrosine. This article demonstrates the utility of multivariate data analysis for correlating the product quality attributes (especially glycosylation) to process variables and raw materials (especially amino acid supplements in cell culture media). The proposed approach can be applied for process optimization to increase product expression, improve consistency of product quality, and target the desired quality attribute profile. © 2015 American Institute of Chemical Engineers.

Water Quality Assessment in the Harbin Reach of the Songhuajiang River (China) Based on a Fuzzy Rough Set and an Attribute Recognition Theoretical Model

PubMed Central

An, Yan; Zou, Zhihong; Li, Ranran

2014-01-01

A large number of parameters are acquired during practical water quality monitoring. If all the parameters are used in water quality assessment, the computational complexity will definitely increase. In order to reduce the input space dimensions, a fuzzy rough set was introduced to perform attribute reduction. Then, an attribute recognition theoretical model and entropy method were combined to assess water quality in the Harbin reach of the Songhuajiang River in China. A dataset consisting of ten parameters was collected from January to October in 2012. Fuzzy rough set was applied to reduce the ten parameters to four parameters: BOD5, NH3-N, TP, and F. coli (Reduct A). Considering that DO is a usual parameter in water quality assessment, another reduct, including DO, BOD5, NH3-N, TP, TN, F, and F. coli (Reduct B), was obtained. The assessment results of Reduct B show a good consistency with those of Reduct A, and this means that DO is not always necessary to assess water quality. The results with attribute reduction are not exactly the same as those without attribute reduction, which can be attributed to the α value decided by subjective experience. The assessment results gained by the fuzzy rough set obviously reduce computational complexity, and are acceptable and reliable. The model proposed in this paper enhances the water quality assessment system. PMID:24675643

Website Quality, Expectation, Confirmation, and End User Satisfaction: The Knowledge-Intensive Website of the Korean National Cancer Information Center

PubMed Central

Koo, Chulmo; Wati, Yulia; Park, Keeho

2011-01-01

Background The fact that patient satisfaction with primary care clinical practices and physician-patient communications has decreased gradually has brought a new opportunity to the online channel as a supplementary service to provide additional information. Objective In this study, our objectives were to examine the process of cognitive knowledge expectation-confirmation from eHealth users and to recommend the attributes of a “knowledge-intensive website.”. Knowledge expectation can be defined as users’ existing attitudes or beliefs regarding expected levels of knowledge they may gain by accessing the website. Knowledge confirmation is the extent to which user’s knowledge expectation of information systems use is realized during actual use. In our hypothesized research model, perceived information quality, presentation and attractiveness as well as knowledge expectation influence knowledge confirmation, which in turn influences perceived usefulness and end user satisfaction, which feeds back to knowledge expectation. Methods An empirical study was conducted at the National Cancer Center (NCC), Republic of Korea (South Korea), by evaluating its official website. A user survey was administered containing items to measure subjectively perceived website quality and expectation-confirmation attributes. A study sample of 198 usable responses was used for further analysis. We used the structural equation model to test the proposed research model. Results Knowledge expectation exhibited a positive effect on knowledge confirmation (beta = .27, P < .001). The paths from information quality, information presentation, and website attractiveness to knowledge confirmation were also positive and significant (beta = .24, P < .001; beta = .29, P < .001; beta = .18, P < .001, respectively). Moreover, the effect of knowledge confirmation on perceived usefulness was also positively significant (beta = .64, P < .001). Knowledge expectation together with knowledge confirmation and perceived usefulness also significantly affected end user satisfaction (beta = .22 P < .001; beta = .39, P < .001; beta = .25, P < .001, respectively). Conclusions Theoretically, this study has (1) identified knowledge-intensive website attributes, (2) enhanced the theoretical foundation of eHealth from the information systems (IS) perspective by adopting the expectation-confirmation theory (ECT), and (3) examined the importance of information and knowledge attributes and explained their impact on user satisfaction. Practically, our empirical results suggest that perceived website quality (ie, information quality, information presentation, and website attractiveness) is a core requirement for knowledge building. In addition, our study has also shown that knowledge confirmation has a greater effect on satisfaction than both knowledge expectation and perceived usefulness. PMID:22047810

Tailoring recombinant protein quality by rational media design.

PubMed

Brühlmann, David; Jordan, Martin; Hemberger, Jürgen; Sauer, Markus; Stettler, Matthieu; Broly, Hervé

2015-01-01

Clinical efficacy and safety of recombinant proteins are closely associated with their structural characteristics. The major quality attributes comprise glycosylation, charge variants (oxidation, deamidation, and C- & N-terminal modifications), aggregates, low-molecular-weight species (LMW), and misincorporation of amino acids in the protein backbone. Cell culture media design has a great potential to modulate these quality attributes due to the vital role of medium in mammalian cell culture. The purpose of this review is to provide an overview of the way both classical cell culture medium components and novel supplements affect the quality attributes of recombinant therapeutic proteins expressed in mammalian hosts, allowing rational and high-throughput optimization of mammalian cell culture media. A selection of specific and/or potent inhibitors and activators of oligosaccharide processing as well as components affecting multiple quality attributes are presented. Extensive research efforts in this field show the feasibility of quality engineering through media design, allowing to significantly modulate the protein function. © 2015 American Institute of Chemical Engineers.

Growth and fillet quality attributes of five genetic strains of rainbow trout (Oncorhynchus mykiss) reared in a partial water reuse system and harvested at different sizes

USDA-ARS?s Scientific Manuscript database

Genetics and environment can interact to influence fish growth performance and product quality attributes. Interaction in recirculating aquaculture systems (RAS) makes selection of fish strain and harvest sizes critical for optimizing fish quality. Definition of growth performance and quality outcom...

INCITS W1.1 development update: appearance-based image quality standards for printers

NASA Astrophysics Data System (ADS)

Zeise, Eric K.; Rasmussen, D. René; Ng, Yee S.; Dalal, Edul; McCarthy, Ann; Williams, Don

2008-01-01

In September 2000, INCITS W1 (the U.S. representative of ISO/IEC JTC1/SC28, the standardization committee for office equipment) was chartered to develop an appearance-based image quality standard. (1),(2) The resulting W1.1 project is based on a proposal (3) that perceived image quality can be described by a small set of broad-based attributes. There are currently six ad hoc teams, each working towards the development of standards for evaluation of perceptual image quality of color printers for one or more of these image quality attributes. This paper summarizes the work in progress of the teams addressing the attributes of Macro-Uniformity, Colour Rendition, Gloss & Gloss Uniformity, Text & Line Quality and Effective Resolution.

ATTRIBUTES OF AESTHETIC QUALITY USED BY TEXTILE CONSERVATORS IN EVALUATING CONSERVATION INTERVENTIONS ON MUSEUM COSTUMES.

PubMed

Nilsson, Johanna; Axelsson, Östen

2015-08-01

Aesthetic quality is central to textile conservators when evaluating a conservation method. However, the literature on textile conservation chiefly focuses on physical properties, and little is known about what factors determine aesthetic quality according to textile conservators. The latter was explored through two experiments. Experiment 1 explored the underlying attributes of aesthetic quality of textile conservation interventions. Experiment 2 explored the relationships between these attributes and how well they predicted aesthetic quality. Rank-order correlation analyses revealed two latent factors called Coherence and Completeness. Ordinal regression analysis revealed that Coherence was the most important predictor of aesthetic quality. This means that a successful conservation intervention is visually well-integrated with the textile item in terms of the material and method.

What They Think: Attributions Made by Youth Workers about Youth Circumstances and the Implications for Service-Delivery in Out-of-School Time Programs

ERIC Educational Resources Information Center

Travis, Raphael

2010-01-01

The current study explored attributions made by youth work professionals ("workers") in out-of-school time (OST) programs about the social circumstances of and perceived need of program youth. It followed prior research examining impacts of worker-level attributions on decision-making in service delivery. Two types of OST programs were…

Using Quality Attributes to Bridge Systems Engineering Gaps : A Juno Ground Data Systems Case Study

NASA Technical Reports Server (NTRS)

Dubon, Lydia P.; Jackson, Maddalena M.; Thornton, Marla S.

2012-01-01

The Juno Mission to Jupiter is the second mission selected by the NASA New Frontiers Program. Juno launched August 2011 and will reach Jupiter July 2016. Juno's payload system is composed of nine instruments plus a gravity science experiment. One of the primary functions of the Juno Ground Data System (GDS) is the assembly and distribution of the CFDP (CCSDS File Delivery Protocol) product telemetry, also referred to as raw science data, for eight out of the nine instruments. The GDS accomplishes this with the Instrument Data Pipeline (IDP). During payload integration, the first attempt to exercise the IDP in a flight like manner revealed that although the functional requirements were well understood, the system was unable to meet latency requirements with the as-is heritage design. A systems engineering gap emerged between Juno instrument data delivery requirements and the assumptions behind the heritage flight-ground interactions. This paper describes the use of quality attributes to measure and overcome this gap by introducing a new systems engineering activity, and a new monitoring service architecture that successfully delivered the performance metrics needed to validate Juno IDP.

Dynamic biosignal management and transmission during telemedicine incidents handled by Mobile Units over diverse network types.

PubMed

Mandellos, George J; Koutelakis, George V; Panagiotakopoulos, Theodor C; Koukias, Andreas M; Koukias, Mixalis N; Lymberopoulos, Dimitrios K

2008-01-01

Early and specialized pre-hospital patient treatment improves outcome in terms of mortality and morbidity, in emergency cases. This paper focuses on the design and implementation of a telemedicine system that supports diverse types of endpoints including moving transports (MT) (ambulances, ships, planes, etc.), handheld devices and fixed units, using diverse communication networks. Target of the above telemedicine system is the pre-hospital patient treatment. While vital sign transmission is prior to other services provided by the telemedicine system (videoconference, remote management, voice calls etc.), a predefined algorithm controls provision and quality of the other services. A distributed database system controlled by a central server, aims to manage patient attributes, exams and incidents handled by different Telemedicine Coordination Centers (TCC).

A Phenomenological Study of the Work Environment in Long-Term Care Facilities for the Older Adults.

PubMed

Choi, Sandy Pin Pin; Yeung, Cheryl Chi Yan; Lee, Joseph Kok Long

2018-05-01

Attempts to meet the increasing demand for long-term care (LTC) services have been hindered by acute staff shortages and high turnover. Distinct from previous studies, a descriptive phenomenological approach with van Kaam's controlled explication method was adopted in this study, to delineate how attributes of the LTC work environment shape the workforce crisis. Individual interviews were conducted with 40 LTC workers from 10 facilities in Hong Kong. The results suggest that the work environment in LTC facilities is not only characterized by organization- and job-related attributes that influence staff outcomes but also is a socially constructed concept with derogatory connotations that can influence staff recruitment and retention. Concerted efforts from facility administrators and policy makers are needed to improve the quality of the work environment. Future initiatives should focus on developing a vision and strategic plan to facilitate the rise of the LTC sector as a profession.

A Qualitative Study on Incentives and Disincentives for Care of Common Mental Disorders in Ontario Family Health Teams

PubMed Central

Silveira, Jose; Mckenzie, Kwame

2016-01-01

Background: An opportunity to address the needs of patients with common mental disorders (CMDs) resides in primary care. Barriers are restricting availability of treatment for CMDs in primary care. By understanding the incentives that promote and the disincentives that deter treatment for CMDs in a collaborative primary care context, this study aims to help contribute to goals of greater access to mental healthcare. Method: A qualitative pilot study using semi-structured interviews with thematic analysis. Results: Participants identified 10 themes of incentives and disincentives influencing quality treatment of CMDs in a collaborative primary care setting: high service demands, clinical presentation, patient-centred care, patient attributes, education, physician attributes, organizational, access to mental health resources, psychiatry and physician payment model. Conclusion: An understanding of the incentives and disincentives influencing care is essential to achieve greater integration and capacity for care for the treatment of CMDs in primary care. PMID:27585029

Visually Exploring Transportation Schedules.

PubMed

Palomo, Cesar; Guo, Zhan; Silva, Cláudio T; Freire, Juliana

2016-01-01

Public transportation schedules are designed by agencies to optimize service quality under multiple constraints. However, real service usually deviates from the plan. Therefore, transportation analysts need to identify, compare and explain both eventual and systemic performance issues that must be addressed so that better timetables can be created. The purely statistical tools commonly used by analysts pose many difficulties due to the large number of attributes at trip- and station-level for planned and real service. Also challenging is the need for models at multiple scales to search for patterns at different times and stations, since analysts do not know exactly where or when relevant patterns might emerge and need to compute statistical summaries for multiple attributes at different granularities. To aid in this analysis, we worked in close collaboration with a transportation expert to design TR-EX, a visual exploration tool developed to identify, inspect and compare spatio-temporal patterns for planned and real transportation service. TR-EX combines two new visual encodings inspired by Marey's Train Schedule: Trips Explorer for trip-level analysis of frequency, deviation and speed; and Stops Explorer for station-level study of delay, wait time, reliability and performance deficiencies such as bunching. To tackle overplotting and to provide a robust representation for a large numbers of trips and stops at multiple scales, the system supports variable kernel bandwidths to achieve the level of detail required by users for different tasks. We justify our design decisions based on specific analysis needs of transportation analysts. We provide anecdotal evidence of the efficacy of TR-EX through a series of case studies that explore NYC subway service, which illustrate how TR-EX can be used to confirm hypotheses and derive new insights through visual exploration.

Towards Integrating Soil Quality Monitoring Targets as Measures of Soil Natural Capital Stocks with the Provision of Ecosystem Services

NASA Astrophysics Data System (ADS)

Taylor, M. D.; Mackay, A. D.; Dominati, E.; Hill, R. B.

2012-04-01

This paper presents the process used to review soil quality monitoring in New Zealand to better align indicators and indicator target ranges with critical values of change in soil function. Since its inception in New Zealand 15 year ago, soil quality monitoring has become an important state of the environment reporting tool for Regional Councils. This tool assists councils to track the condition of soils resources, assess the impact of different land management practices, and provide timely warning of emerging issues to allow early intervention and avoid irreversible loss of natural capital stocks. Critical to the effectiveness of soil quality monitoring is setting relevant, validated thresholds or target ranges. Provisional Target Ranges were set in 2003 using expert knowledge available and data on production responses. Little information was available at that time for setting targets for soil natural capital stocks other than those for food production. The intention was to revise these provisional ranges as further information became available and extend target ranges to cover the regulating and cultural services provided by soils. A recently developed ecosystems service framework was used to explore the feasibility of linking soil natural capital stocks measured by the current suite of soil quality indicators to the provision of ecosystem services by soils. Importantly the new approach builds on and utilises the time series data sets collected by current suite of soil quality indicators, adding value to the current effort, and has the potential to set targets ranges based on the economic and environmental outcomes required for a given farm, catchment or region. It is now timely to develop a further group of environmental indicators for measuring specific soil issues. As with the soil quality indicators, these environmental indicators would be aligned with the provision of ecosystem services. The toolbox envisaged is a set of indicators for specific soil issues with appropriate targets tied to ecosystem services and changes in critical soil function. Such indicators would be used for specific purposes for limited periods, rather than long-term, continuous monitoring. Some examples will be presented. An important step needed to successfully initiate and complete the review was assigning national oversight. Reigniting scientific interest (which had declined with the cessation of funding in 2003) and documentation of the process were other important steps. We had to extend the recently developed ecosystem service approach to accommodate the catchment scale. This required additional attributes in the framework and recognition that some of the proxies will change with scale as will the techniques to value the services. The framework was originally developed for use at the farm scale. Macroporosity, one of the two indicators used to monitor the physical condition of the soil, was used to illustrate how the ecosystem service framework could be used to link a change in the physical condition of the soil with the provision of services. The sum of the dollar values of selected soil ecosystem services were used to inform the state of soil natural capital stocks. This estimate provides a new insight into the value of the soil quality indicators and existing target ranges. Doing so will enable targets to be more closely aligned and integrated with the provision of a range of ecosystem services, going far beyond food production.

Variation in the health and biochemical condition of the coral Acropora tenuis along two water quality gradients on the Great Barrier Reef, Australia.

PubMed

Rocker, Melissa M; Francis, David S; Fabricius, Katharina E; Willis, Bette L; Bay, Line K

2017-06-30

This study explores how plasticity in biochemical attributes, used as indicators of health and condition, enables the coral Acropora tenuis to respond to differing water quality regimes in inshore regions of the Great Barrier Reef. Health attributes were monitored along a strong and weak water quality gradient, each with three reefs at increasing distances from a major river source. Attributes differed significantly only along the strong gradient; corals grew fastest, had the least dense skeletons, highest symbiont densities and highest lipid concentrations closest to the river mouth, where water quality was poorest. High nutrient and particulate loads were only detrimental to skeletal density, which decreased as linear extension increased, highlighting a trade-off. Our study underscores the importance of assessing multiple health attributes in coral reef monitoring. For example, autotrophic indices are poor indicators of coral health and condition, but improve when combined with attributes like lipid content and biomass. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Self-Organized Archive: SPASE, PDS and Archive Cooperatives

NASA Astrophysics Data System (ADS)

King, T. A.; Hughes, J. S.; Roberts, D. A.; Walker, R. J.; Joy, S. P.

2005-05-01

Information systems with high quality metadata enable uses and services which often go beyond the original purpose. There are two types of metadata: annotations which are items that comment on or describe the content of a resource and identification attributes which describe the external properties of the resource itself. For example, annotations may indicate which columns are present in a table of data, whereas an identification attribute would indicate source of the table, such as the observatory, instrument, organization, and data type. When the identification attributes are collected and used as the basis of a search engine, a user can constrain on an attribute, the archive can then self-organize around the constraint, presenting the user with a particular view of the archive. In an archive cooperative where each participating data system or archive may have its own metadata standards, providing a multi-system search engine requires that individual archive metadata be mapped to a broad based standard. To explore how cooperative archives can form a larger self-organized archive we will show how the Space Physics Archive Search and Extract (SPASE) data model will allow different systems to create a cooperative and will use Planetary Data System (PDS) plus existing space physics activities as a demonstration.

Measuring Environmental Quality in the Southern Appalachian Mountains

Treesearch

Linwood Pendleton; Brent Sohngen; Robert Mendelsohn; Thomas Holmes

1998-01-01

This study presents a method for valuing recreational environmental quality in the forests of the southeastern United States. The paper offers a method for choosing, measuring, and valuing forest attributes. Surveys and popular recreation literature are used to identify forest attributes that contribute to recreational quality. Standard ecological techniques are...

Dyadic Processes in Early Marriage: Attributions, Behavior, and Marital Quality

ERIC Educational Resources Information Center

Durtschi, Jared A.; Fincham, Frank D.; Cui, Ming; Lorenz, Frederick O.; Conger, Rand D.

2011-01-01

Marital processes in early marriage are important for understanding couples' future marital quality. Spouses' attributions about a partner's behavior have been linked to marital quality, yet the mechanisms underlying this association remain largely unknown. When we used couple data from the Family Transitions Project (N = 280 couples) across the…

Parents' perspectives on centralized cleft services for children: the development of a DCE questionnaire.

PubMed

Ke, K M; Mackichan, F; Sandy, J R; Ness, A R; Hollingworth, W

2013-03-01

Incorporating user's perspectives in healthcare delivery is important. Simple questionnaires may not capture these as well as a discrete choice experiment (DCE) which enables the exploration of users' trade-offs between different service attributes. Qualitative methods are increasingly used to improve a DCE's face validity, but few studies adequately describe them. This paper describes the qualitative investigations in the development of a DCE questionnaire to elicit parents' perspectives on centralized services for children with cleft lip and palate. Semi-structured telephone interviews were conducted with 16 parents from across the UK, except Wales. Data analysis was carried out by the constant comparative method. Five attributes and their levels were inductively identified: usefulness and amount of information (four levels); staff attitude at cleft centres (two levels); continuity of care (two levels); personal costs of attending appointments (four levels); and cleft centres facilities (two levels). An unexpected finding was that parents' sense of responsibility towards their child made a 'willingness-to-travel' attribute unacceptable to them, but they were receptive to a 'willingness-to-pay' attribute. Using qualitative methods with service users in attribute development for a DCE helps to uncover issues that may not be apparent to researchers or health service staff. © 2012 John Wiley & Sons A/S.

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

PubMed

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

2017-06-08

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

Portrayal of the Human Resource Crisis and Accountability in Healthcare: A Qualitative Analysis of Ugandan Newspapers

PubMed Central

Wojczewski, Silvia; Willcox, Merlin; Mubangizi, Vincent; Hoffmann, Kathryn; Peersman, Wim; Niederkrotenthaler, Thomas; Natukunda, Silvia; Maling, Samuel; Maier, Manfred; Mant, David; Kutalek, Ruth

2015-01-01

Background Uganda is one of the 57 countries with a critical shortage of health workers. The aim of this study was to determine how the human resources and health service crisis was covered in Ugandan newspapers and, in particular, how the newspapers attributed accountability for problems in the health services. Methods We collected all articles related to health workers and health services for the calendar year 2012 in the two largest national newspapers in Uganda (collection on daily basis) and in one local newspaper (collection on weekly basis). These articles were analysed qualitatively regarding the main themes covered and attribution of accountability. Results The two more urban national newspapers published 229 articles on human resources and health services in Uganda (on average over two articles per week), whereas the local more rural newspaper published only a single article on this issue in the 12 month period. The majority of articles described problems in the health service without discussing accountability. The question of accountability is raised in only 46% of articles (106 articles). The responsibility of the government was discussed in 50 articles (21%), and negligence, corruption and misbehaviour by individual health workers was reported in 56 articles (25%). In the articles about corruption (n=35), 60% (21 articles) mention corruption by health workers and 40% (14 articles) mention corruption by government officials. Six articles defended the situation of health workers in Uganda. Conclusions The coverage of accountability in the Ugandan newspapers surveyed is insufficient to generate informed debate on what political actions need to be taken to improve the crisis in health care and services. There exists not only an “inverse care law” but also an “inverse information law”: those sections of society with the greatest health needs and problems in accessing quality health care receive the least information about health services. PMID:25837490

Portrayal of the human resource crisis and accountability in healthcare: a qualitative analysis of ugandan newspapers.

PubMed

Wojczewski, Silvia; Willcox, Merlin; Mubangizi, Vincent; Hoffmann, Kathryn; Peersman, Wim; Niederkrotenthaler, Thomas; Natukunda, Silvia; Maling, Samuel; Maier, Manfred; Mant, David; Kutalek, Ruth

2015-01-01

Uganda is one of the 57 countries with a critical shortage of health workers. The aim of this study was to determine how the human resources and health service crisis was covered in Ugandan newspapers and, in particular, how the newspapers attributed accountability for problems in the health services. We collected all articles related to health workers and health services for the calendar year 2012 in the two largest national newspapers in Uganda (collection on daily basis) and in one local newspaper (collection on weekly basis). These articles were analysed qualitatively regarding the main themes covered and attribution of accountability. The two more urban national newspapers published 229 articles on human resources and health services in Uganda (on average over two articles per week), whereas the local more rural newspaper published only a single article on this issue in the 12 month period. The majority of articles described problems in the health service without discussing accountability. The question of accountability is raised in only 46% of articles (106 articles). The responsibility of the government was discussed in 50 articles (21%), and negligence, corruption and misbehaviour by individual health workers was reported in 56 articles (25%). In the articles about corruption (n=35), 60% (21 articles) mention corruption by health workers and 40% (14 articles) mention corruption by government officials. Six articles defended the situation of health workers in Uganda. The coverage of accountability in the Ugandan newspapers surveyed is insufficient to generate informed debate on what political actions need to be taken to improve the crisis in health care and services. There exists not only an "inverse care law" but also an "inverse information law": those sections of society with the greatest health needs and problems in accessing quality health care receive the least information about health services.

Psychosocial experiences and needs of Australian caregivers of people with stroke: prognosis messages, caregiver resilience, and relationships.

PubMed

El Masry, Yasmeen; Mullan, Barbara; Hackett, Maree

2013-01-01

Despite stroke being the most common form of cerebrovascular disease, there has been relatively little attention paid to the psychosocial experiences and needs of Australian caregivers of people who have had a stroke. Twenty Australian informal caregivers and 10 stroke survivors participated in individual semi-structured qualitative interviews covering all aspects of caregiving, including stroke survivors' views on their caregiver's experiences. The 5 interrelated topics most discussed were changes in relationships and support services, including being told to expect a poor outcome; caregiver attributes and coping strategies; stroke survivor limitations; external employment and financial stressors; and unexpected positive changes in relationships and priorities. Caring for a stroke survivor involves a complex interaction of these factors that appear to be moderated by the quality of the pre-existing stroke survivor-caregiver relationship and the poststroke coping strategies used. Particular attention should be paid to how prognosis is conveyed and whether appropriate outpatient services are available. Clinicians should also consider discussing appropriate caregiver coping strategies and the quality of the relationship between the stroke survivor and caregiver.

Managing Minor Ailments; The Public's Preferences for Attributes of Community Pharmacies. A Discrete Choice Experiment.

PubMed

Porteous, Terry; Ryan, Mandy; Bond, Christine; Watson, Margaret; Watson, Verity

2016-01-01

Demand for health services continues to rise. Greater use of community pharmacy services instead of medical services for minor ailments could help relieve pressure on healthcare providers in high-cost settings. Community pharmacies are recognised sources of treatment and advice for people wishing to manage these ailments. However, increasing the public's use of pharmacy services may depend on attributes of pharmacies and their staff. This study aimed to determine the general public's relative preferences for community pharmacy attributes using a discrete choice experiment (DCE). A UK-wide DCE survey of the general public was conducted using face-to-face computer-assisted personal interviews. Attributes and levels for the DCE were informed by a literature review and a cohort study of community pharmacy customers. The context for the experiment was a minor ailment scenario describing flu-like symptoms. The DCE choice sets described two hypothetical community pharmacy services; respondents were asked to choose which (if either) of the two pharmacies they would prefer to help them manage symptoms. Data from 1,049 interviews were analysed using an error components logit model. Willingness to pay (WTP), a monetary measure of benefit, was estimated for the different attribute levels. When seeking help or treatment for flu-like symptoms, respondents most valued a pharmacy service that would improve their understanding and management of symptoms (WTP = £6.28), provided by staff who are trained (WTP (pharmacist) = £2.63: WTP(trained assistant) = £3.22), friendly and approachable (WTP = £3.38). Waiting time, pharmacy location and availability of parking also contributed to respondents' preferences. WTP for a service comprising the best possible combination of attributes and levels was calculated as £55.43. Attributes of a community pharmacy and its staff may influence people's decisions about which pharmacy they would visit to access treatment and advice for minor ailments. In line with the public's preferences, offering community pharmacy services that help people to better understand and manage symptoms, are provided promptly by trained staff who are friendly and approachable, and in a local setting with easy access to parking, has the potential to increase uptake amongst those seeking help to manage minor ailments. In this way it may be possible to shift demand away from high-cost health services and make more efficient use of scarce public resources.

Composition of web services using Markov decision processes and dynamic programming.

PubMed

Uc-Cetina, Víctor; Moo-Mena, Francisco; Hernandez-Ucan, Rafael

2015-01-01

We propose a Markov decision process model for solving the Web service composition (WSC) problem. Iterative policy evaluation, value iteration, and policy iteration algorithms are used to experimentally validate our approach, with artificial and real data. The experimental results show the reliability of the model and the methods employed, with policy iteration being the best one in terms of the minimum number of iterations needed to estimate an optimal policy, with the highest Quality of Service attributes. Our experimental work shows how the solution of a WSC problem involving a set of 100,000 individual Web services and where a valid composition requiring the selection of 1,000 services from the available set can be computed in the worst case in less than 200 seconds, using an Intel Core i5 computer with 6 GB RAM. Moreover, a real WSC problem involving only 7 individual Web services requires less than 0.08 seconds, using the same computational power. Finally, a comparison with two popular reinforcement learning algorithms, sarsa and Q-learning, shows that these algorithms require one or two orders of magnitude and more time than policy iteration, iterative policy evaluation, and value iteration to handle WSC problems of the same complexity.

Pediatric Palliative Care in Iran: Applying Regionalization of Health Care Systems

PubMed

Khanali Mojen, Leila; Rassouli, Maryam; Eshghi, Peyman; Zendedel, Kazem; Akbari Sari, Ali; Heravi Karimooi, Majideh; Tahmasebi, Mamak; Shirin Abadi Farahani, Azam

2018-05-26

Background: Establishing palliative care services is a priority in the health system of Iran. Considering the necessity of integrating these services into the health system, this study aimed to explore the stakeholders’ perceptions about the provision of a conceptual framework for palliative care services for children with cancer according to the health system in of Iran. Methods: The present qualitative study was conducted through in-depth semi-structured interviews held with 29 participants including palliative care specialists, policy-makers, health care providers, the parents of children with cancer selected through purposive sampling, between August 2016 and February 2017. Interviews continued until saturation of data. All interviews were recorded, transcribed and analyzed using MAXQDA10 software. Results: The codes extracted from interviews produced the main theme “ classes of palliative care services” with the two main categories “comprehensive care” including, strengthening family shelter, maintaining the child in a familiar environment, achieving stability and “establishing social justice” including, easy access to services, financial relief and quality care. Conclusion: Presenting a framework based on level of palliative care services, the findings of this study paves the way for integrating these services into Iranian health system. Creative Commons Attribution License

Change in drinking water quality from source to point-of-use and storage: a case study from Guwahati, India.

PubMed

Khadse, Gajanan Kisan; Kalita, Moromi D; Labhsetwar, Pawan K

2012-09-01

To ascertain the quality of drinking water being supplied and maintained at Guwahati, the study was conducted on the status of water supply in city through surveillance of drinking water quality for consecutive 7 days at various treatment stages, distribution network and consumer ends. The performance of five water treatment plants (WTPs), viz. Panbazar WTP, Satpukhuri WTP, Kamakhya WTP, PHED WTP and Hegrabari WTP were assessed for summer, piost-post-monsoon and winter seasons. No significant change in raw water quality was observed on day-to-day basis. Residual chlorine was found in the range of nil to 0.2 mg/L in the treated water. During post-monsoon, winter, and summer seasons the thermotolerent TC and FC counts ranged between Nil to 168 CFU/100 ml and Nil to 84 CFU/100 ml; Nil to 3356 CFU/100 ml and Nil to 152 CFU/100 ml; and Nil to 960 CFU/100 ml and Nil to 108 CFU/100 ml respectively. There was variation in bacterial counts among the different service reservoirs and consumer ends, which may be attributed to the general management practices for maintenance of service reservoirs and the possibility of enroute contamination. Evaluation of the raw water quality indicate that the water is suitable for drinking after conventional treatment followed by disinfection. The finished water quality meets the level of standards described as per Bureau of Indian Standard specifications (BIS:10500 1991) for potability in terms of its physico-chemical characteristics.

A Cross-sectional Survey of Disability Attributed to Mental Disorders and Service Use in China

PubMed Central

Shang, Li-Li; Huang, Yue-Qin; Liu, Zhao-Rui; Chen, Hong-Guang

2017-01-01

Background: Mental disorders are strongly associated with disabilities. National survey on disability could provide a reliable basis for policymaking in care and rehabilitation of disabled persons. This study aimed to describe the disability prevalence rates attributed to mental disorders, their distribution by sociodemographic factors, and utilizations of service. Methods: This study is a secondary data analysis of the Second National Sample Survey on Disability in 2006. The disability and severity were assessed using the World Health Organization Disability Assessment Schedule 2.0. Mental disorders were diagnosed according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision Classification of Mental and Behavioral Disorders. Using descriptive and analytic epidemiological methods, prevalence rates of disability attributed to mental disorders and service use were calculated. Results: Data of 2,526,145 respondents were analyzed. The disability prevalence rate attributed to mental disorders in China was 6.3‰, accounting for 9.9% of all disabled people. Regarding disability prevalence attributed to mental disorders, it showed that gender, residential area, marital status, education level, and economic area were related to the prevalence distributions. The proportions of mild disability were highest in the disabled people with onset age of 18–64 years, while the proportion of extremely severe disability was highest in the disabled people with onset age of 65 years and above. Only 58.6% of disabled people attributed to mental disorders used some of the services. Conclusions: There are statistical differences of disability prevalence attributed to mental disorders by people and region in China. Service use in disabled people with mental disorders is insufficient. PMID:28584207

Correlating wine quality indicators to chemical and sensory measurements.

PubMed

Hopfer, Helene; Nelson, Jenny; Ebeler, Susan E; Heymann, Hildegarde

2015-05-12

Twenty-seven commercial Californian Cabernet Sauvignon wines of different quality categories were analyzed with sensory and chemical methods. Correlations between five quality proxies-points awarded during a wine competition, wine expert scores, retail price, vintage, and wine region-were correlated to sensory attributes, volatile compounds, and elemental composition. Wine quality is a multi-faceted construct, incorporating many different layers. Depending on the quality proxy studied, significant correlations between quality and attributes, volatiles and elements were found, some of them previously reported in the literature.

Evaluating Quality Metrics and Cost After Discharge: A Population-based Cohort Study of Value in Health Care Following Elective Major Vascular Surgery.

PubMed

de Mestral, Charles; Salata, Konrad; Hussain, Mohamad A; Kayssi, Ahmed; Al-Omran, Mohammed; Roche-Nagle, Graham

2018-04-18

Early readmission to hospital after surgery is an omnipresent quality metric across surgical fields. We sought to understand the relative importance of hospital readmission among all health services received after hospital discharge. The aim of this study was to characterize 30-day postdischarge cost and risk of an emergency department (ED) visit, readmission, or death after hospitalization for elective major vascular surgery. This is a population-based retrospective cohort study of patients who underwent elective major vascular surgery - carotid endarterectomy, EVAR, open AAA repair, bypass for lower extremity peripheral arterial disease - in Ontario, Canada, between 2004 and 2015. The outcomes of interest included quality metrics - ED visit, readmission, death - and cost to the Ministry of Health, within 30 days of discharge. Costs after discharge included those attributable to hospital readmission, ED visits, rehab, physician billing, outpatient nursing and allied health care, medications, interventions, and tests. Multivariable regression models characterized the association of pre-discharge characteristics with the above-mentioned postdischarge quality metrics and cost. A total of 30,752 patients were identified. Within 30 days of discharge, 2588 (8.4%) patients were readmitted to hospital and 13 patients died (0.04%). Another 4145 (13.5%) patients visited an ED without requiring admission. Across all patients, over half of 30-day postdischarge costs were attributable to outpatient care. Patients at an increased risk of an ED visit, readmission, or death within 30 days of discharge differed from those patients with relatively higher 30-day costs. Events occurring outside the hospital setting should be integral to the evaluation of quality of care and cost after hospitalization for major vascular surgery.

Dynamic Pricing in Electronic Commerce Using Neural Network

NASA Astrophysics Data System (ADS)

Ghose, Tapu Kumar; Tran, Thomas T.

In this paper, we propose an approach where feed-forward neural network is used for dynamically calculating a competitive price of a product in order to maximize sellers’ revenue. In the approach we considered that along with product price other attributes such as product quality, delivery time, after sales service and seller’s reputation contribute in consumers purchase decision. We showed that once the sellers, by using their limited prior knowledge, set an initial price of a product our model adjusts the price automatically with the help of neural network so that sellers’ revenue is maximized.

Research of three level match method about semantic web service based on ontology

NASA Astrophysics Data System (ADS)

Xiao, Jie; Cai, Fang

2011-10-01

An important step of Web service Application is the discovery of useful services. Keywords are used in service discovery in traditional technology like UDDI and WSDL, with the disadvantage of user intervention, lack of semantic description and low accuracy. To cope with these problems, OWL-S is introduced and extended with QoS attributes to describe the attribute and functions of Web Services. A three-level service matching algorithm based on ontology and QOS in proposed in this paper. Our algorithm can match web service by utilizing the service profile, QoS parameters together with input and output of the service. Simulation results shows that it greatly enhanced the speed of service matching while high accuracy is also guaranteed.

Service user involvement in mental health care: an evolutionary concept analysis.

PubMed

Millar, Samantha L; Chambers, Mary; Giles, Melanie

2016-04-01

The concept of service user involvement is an evolving concept in the mental health-care literature. This study sought to explore and analyse the concept of service user involvement as used in within the field of mental health care. An evolutionary concept analysis was conducted using a literature-based sample extracted from an electronic database search. One hundred and thirty-four papers met the inclusion criteria and were analysed to discover key attributes, antecedents and consequences of service user involvement and to produce a definition of the concept. Five key attributes of service user involvement within the context of mental health care were identified: a person-centred approach, informed decision making, advocacy, obtaining service user views and feedback and working in partnership. Clarity of the attributes and definition of the concept of service user involvement aims to promote understanding of the concept among key stakeholders including mental health professionals, service users and community and voluntary organizations. The findings of the research have utility in the areas of theory and policy development, research on service user involvement in mental health care and service user involvement in mental health practice. Directions for further research regarding the concept are identified. © 2015 John Wiley & Sons Ltd.

Describing Quality and Sensory Attributes of 3 Mango (Mangifera indica L.) Cultivars at 3 Ripeness Stages Based on Firmness.

PubMed

Nassur, Rita de Cássia Mirela Resende; González-Moscoso, Sara; Crisosto, Gayle M; Lima, Luiz Carlos de Oliveira; Vilas Boas, Eduardo Valério de Barros; Crisosto, Carlos H

2015-09-01

To determine the ideal ripening stage for consumption of the mango cultivars, "Ataulfo," "Haden," and "Tommy Atkins"; fruits at 3 flesh firmness levels (ripeness stages) were evaluated by a trained panel using descriptive analysis after instrumental measurements were made. After harvest, all fruits were ripened to allow softening and quality and sensory attribute changes. Ripening changes during softening of Ataulfo mangos were expressed by a characteristic increase in the perception of "tropical fruit" and "peach" aromas, an increase in "juiciness," "sweetness," and "tropical fruit" flavor, while "fibrousness," "chewiness," and "sourness" decreased. Similar desirable sensory changes were also detected during softening of Haden mangos; an increase in tropical fruit and peach aromas, sweetness and tropical fruit flavor, and a decrease in chewiness, sourness, and bitterness. Softening of Tommy Atkins mangos was followed by reduced chewiness and sourness and increased peach aroma. Softening of all cultivars was followed by decreased sourness and titratable acidity (TA) and increased soluble solids concentration (SSC) and SSC:TA ratio. The results indicate that mango ripening leads to increased expression of sensory attributes such as tropical fruit and peach aromas, tropical flavor, and sweetness that have been related to improved eating quality and these final changes in sensory quality attributes are specific for each cultivar. For example, Ataulfo and Haden mangos had greater improvement in quality and sensory attributes related to fruit eating quality during ripening-softening than Tommy Atkins. In our consumer test, these quality-sensory attributes expressed during ripening that were perceived by the trained panel were also validated, supporting the need for a controlled ripening protocol in mangos. © 2015 Institute of Food Technologists®

Consumer preferences for general practitioner services.

PubMed

Morrison, Mark; Murphy, Tom; Nalder, Craig

2003-01-01

This study focuses on segmenting the market for General Practitioner services in a regional setting. Using factor analysis, five main service attributes are identified. These are clear communication, ongoing doctor-patient relationship, same gender as the patient, provides advice to the patient, and empowers the patient to make his/her own decisions. These service attributes are used as a basis for market segmentation, using both socio-demographic variables and cluster analysis. Four distinct market segments are identified, with varying degrees of viability in terms of target marketing.

Service User- and Carer-Reported Measures of Involvement in Mental Health Care Planning: Methodological Quality and Acceptability to Users

PubMed Central

Gibbons, Chris J.; Bee, Penny E.; Walker, Lauren; Price, Owen; Lovell, Karina

2014-01-01

Background: Increasing service user and carer involvement in mental health care planning is a key healthcare priority but one that is difficult to achieve in practice. To better understand and measure user and carer involvement, it is crucial to have measurement questionnaires that are both psychometrically robust and acceptable to the end user. Methods: We conducted a systematic review using the terms “care plan$,” “mental health,” “user perspective$,” and “user participation” and their linguistic variants as search terms. Databases were searched from inception to November 2012, with an update search at the end of September 2014. We included any articles that described the development, validation or use of a user and/or carer-reported outcome measures of involvement in mental health care planning. We assessed the psychometric quality of each instrument using the “Evaluating the Measurement of Patient-Reported Outcomes” (EMPRO) criteria. Acceptability of each instrument was assessed using novel criteria developed in consultation with a mental health service user and carer consultation group. Results: We identified eleven papers describing the use, development, and/or validation of nine user/carer-reported outcome measures. Psychometric properties were sparsely reported and the questionnaires met few service user/carer-nominated attributes for acceptability. Where reported, basic psychometric statistics were of good quality, indicating that some measures may perform well if subjected to more rigorous psychometric tests. The majority were deemed to be too long for use in practice. Discussion: Multiple instruments are available to measure user/carer involvement in mental health care planning but are either of poor quality or poorly described. Existing measures cannot be considered psychometrically robust by modern standards, and cannot currently be recommended for use. Our review has identified an important knowledge gap, and an urgent need to develop new user and carer measures of care-planning involvement. PMID:25566099

The individual supported living (ISL) manual: a planning and review instrument for individual supported living arrangements for adults with intellectual and developmental disabilities.

PubMed

Cocks, E; Thoresen, S; Williamson, M; Boaden, R

2014-07-01

Following the closure of large residential facilities over the past several decades, emphasis on community living for adults with developmental disabilities has strengthened. However, the concept of community living is ambiguous. The term is often associated with congregation of people with disabilities in ordinary houses 'in' the community. Group homes, the most common contemporary formal expression of 'community living', may use ordinary houses and accommodate a small number of residents comparable to a large family. Individual supported living (ISL) arrangements around a single person with a disability using person-centred principles are occurring with increasing frequency. The ISL manual was developed over 4 years in two sequential research projects to produce a quality framework articulating ISL and operationalising the framework into a review and planning instrument for ISL arrangements. The ISL manual was developed in three stages and overseen by a reference group of key stakeholders purposively recruited as well-versed in ISL. The first stage operationalised the quality framework over two half-day workshops with a group of key informants. Participants identified indicators and sources of evidence for each attribute of the quality framework. The quality framework, indicators, and sources of evidence were compiled into an initial evaluation instrument of nine themes consisting of 27 attributes. This was piloted in two rounds to enhance the utility of the instrument and develop the final manual which contained eight themes and 21 attributes. A comprehensive literature search was carried out to identify relevant empirical ISL studies. The literature search identified four empirical studies that incorporated ISL over the preceding 3 years. A previous literature search from the first research project that produced the quality framework spanned 27 years and identified five empirical studies. We concluded that the empirical base for developing evidence for the nature and outcomes of ISL arrangements was sparse. The ISL manual and scoring booklet developed in the current research project includes six illustrative case studies of ISL, instructions for potential users to review living arrangements or set up a new arrangement, and the review framework consisting of descriptions of themes and attributes, indicators, and sources of evidence. The dearth of empirical studies of ISL arrangements for people with developmental disabilities, despite increased policy emphasis on individualised options, underscores the importance of planning and review tools to promote quality outcomes. The ISL manual can assist adults with developmental disabilities, families, carers, and service providers to plan and review ISL arrangements. Further research will enhance the properties of this instrument and establish the relationship between quality of ISL arrangements and outcomes such as quality of life, and participation and inclusion. © 2013 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Does hospital ownership affect patient experience? An investigation into public-private sector differences in England.

PubMed

Pérotin, Virginie; Zamora, Bernarda; Reeves, Rachel; Bartlett, Will; Allen, Pauline

2013-05-01

Using patient experience survey data, the paper investigates whether hospital ownership affects the level of quality reported by patients whose care is funded by the National Health Service in areas other than clinical quality. We estimate a switching regression model that accounts for (i) some observable characteristics of the patient and the hospital episode; (ii) selection into private hospitals; and (iii) unmeasured hospital characteristics captured by hospital fixed effects. We find that the experience reported by patients in public and private hospitals is different, i.e. most dimensions of quality are delivered differently by the two types of hospitals, with each sector offering greater quality in certain specialties or to certain groups of patients. However, the sum of all ownership effects is not statistically different from zero at sample means. In other words, hospital ownership in and of itself does not affect the level of quality of the average patient's reported experience. Differences in mean reported quality levels between the private and public sectors are entirely attributable to patient characteristics, the selection of patients into public or private hospitals and unobserved characteristics specific to individual hospitals, rather than to hospital ownership. Copyright © 2013 Elsevier B.V. All rights reserved.

Quality of Life of Nepalese Women Post Mastectomy

PubMed

Maharjan, Muna; Thapa, Niresh; Adhikari, Raj Devi; Petrini, Marcia A; Amatya, Kapendra Shekhar

2018-04-25

Introduction: Worldwide breast cancer is the common invasive cancer among the females. The quality of life of women after treatment, which is often a mastectomy, is frequently decreased. Objective: To determine the life quality of Nepalese women post mastectomy. Materials and Methods: One hundred seven women after a mastectomy were selected and interviewed by using the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and its Breast Specific Module to assess women’s quality of life. Result: The study findings revealed a good score on global health status/quality of life. The respondents performed well on functional and symptom scales. In the Breast Specific Module, all respondents performed poor regarding sexual function and sexual enjoyment. Global Health Status was found useful among the women involved in service/business/agriculture and the survivors using breast prosthesis. In Breast Specific Module, systemic therapy side effects showed strong statistical associations with age, marital status, occupation, education, use of breast prosthesis and co-morbidity. Body image was highly significant with age, occupation, education, use of breast prosthesis and co-morbidity. Conclusion: Based on the study findings, counseling, and a structured educational programme is recommended to improve the QOL of women after a mastectomy. Creative Commons Attribution License

Gluten-Free Sources of Fermentable Extract: Effect of Temperature and Germination Time on Quality Attributes of Teff [Eragrostis tef (zucc.) Trotter] Malt and Wort.

PubMed

Di Ghionno, Lidia; Marconi, Ombretta; Lee, Eung Gwan; Rice, Christopher J; Sileoni, Valeria; Perretti, Giuseppe

2017-06-14

This study was conducted to evaluate the behavior of a white teff variety called Witkop during malting by using different parameters (germination temperature and duration) and to identify the best malting program. Samples were evaluated for standard quality malt and wort attributes, pasting characteristics, β-glucan and arabinoxylan content, and sugar profile. It was concluded that malting teff at 24 °C for 6 days produced acceptable malt in terms of quality attributes and sugar profile for brewing. The main attributes were 80.4% extract, 80.9% fermentability, 1.53 mPa s viscosity, 7.4 EBC-U color, 129 mg/L FAN, and 72.1 g/L of total fermentable sugars. Statistical analysis showed that pasting characteristics of teff malt were negatively correlated with some malt quality attributes, such as extract and fermentability. Witkop teff appeared to be a promising raw material for malting and brewing. However, the small grain size may lead to difficulties in handling malting process, and a bespoke brewhouse plant should be developed for the production at industrial scale.

Evaluation of the chemical quality traits of soybean seeds, as related to sensory attributes of soymilk.

PubMed

Ma, Lei; Li, Bin; Han, Fenxia; Yan, Shurong; Wang, Lianzheng; Sun, Junming

2015-04-15

The soybean seed chemical quality traits (including protein content, oil content, fatty acid composition, isoflavone content, and protein subunits), soymilk chemical character (soluble solid), and soymilk sensory attributes were evaluated among 70 genotypes to determine the correlation between seed chemical quality traits and soymilk sensory attributes. Six sensory parameters (i.e., soymilk aroma, smoothness in the mouth, thickness in the mouth, sweetness, colour and appearance, and overall acceptability) and a seven-point hedonic scale for each parameter were developed. Significant positive correlations were observed between overall acceptability and the other five evaluation parameters, suggesting that overall acceptability is an ideal parameter for evaluating soymilk flavour. The soymilk sensory attributes were significantly positively correlated with the characteristics of the glycinin (11S)/beta-conglycinin (7S) protein ratio, soluble solid, and oil content but negatively correlated with glycitein and protein content. Our results indicated that soymilk sensory attributes could be improved by selecting the desirable seed chemical quality traits in practical soybean breeding programs. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Remote sensing, geographical information systems, and spatial modeling for analyzing public transit services

NASA Astrophysics Data System (ADS)

Wu, Changshan

Public transit service is a promising transportation mode because of its potential to address urban sustainability. Current ridership of public transit, however, is very low in most urban regions, particularly those in the United States. This woeful transit ridership can be attributed to many factors, among which poor service quality is key. Given this, there is a need for transit planning and analysis to improve service quality. Traditionally, spatially aggregate data are utilized in transit analysis and planning. Examples include data associated with the census, zip codes, states, etc. Few studies, however, address the influences of spatially aggregate data on transit planning results. In this research, previous studies in transit planning that use spatially aggregate data are reviewed. Next, problems associated with the utilization of aggregate data, the so-called modifiable areal unit problem (MAUP), are detailed and the need for fine resolution data to support public transit planning is argued. Fine resolution data is generated using intelligent interpolation techniques with the help of remote sensing imagery. In particular, impervious surface fraction, an important socio-economic indicator, is estimated through a fully constrained linear spectral mixture model using Landsat Enhanced Thematic Mapper Plus (ETM+) data within the metropolitan area of Columbus, Ohio in the United States. Four endmembers, low albedo, high albedo, vegetation, and soil are selected to model heterogeneous urban land cover. Impervious surface fraction is estimated by analyzing low and high albedo endmembers. With the derived impervious surface fraction, three spatial interpolation methods, spatial regression, dasymetric mapping, and cokriging, are developed to interpolate detailed population density. Results suggest that cokriging applied to impervious surface is a better alternative for estimating fine resolution population density. With the derived fine resolution data, a multiple route maximal covering/shortest path (MRMCSP) model is proposed to address the tradeoff between public transit service quality and access coverage in an established bus-based transit system. Results show that it is possible to improve current transit service quality by eliminating redundant or underutilized service stops. This research illustrates that fine resolution data can be efficiently generated to support urban planning, management and analysis. Further, this detailed data may necessitate the development of new spatial optimization models for use in analysis.

A Novel Hybrid MADM Based Competence Set Expansions of a SOC Design Service Firm

NASA Astrophysics Data System (ADS)

Huang, Chi-Yo; Tzeng, Gwo-Hshiung; Lue, Yeou-Feng; Chuang, Hsiu-Tyan

As the IC (integrated circuit) industry migrates to the System-on-Chip (SOC) era, a novel business model, the SOC design service (DS), is emerging. However, how to expand a firm’s innovation competences while satisfying multiple objectives including highest quality, lowest cost, and fastest time to market as well as most revenues for economics of scale are always problems for a design service firm. Therefore, attempts to expand the innovation competences, and thus the competitiveness, of latecomers in the SOC DS industry have already become the most critical issue facing the top managers of SOC design service firms. In this paper, a novel multiple attribute decision making (MADM) analytic framework based on the concept of competence set expansion, as well as MADM methods consisting with DEMATEL, ANP and multiple objective decision making (MODM) will be proposed in order to define a path for expanding a late-coming SOC DS firm’s innovation capabilities. An empirical study on expanding innovation competence sets, of a late-coming Taiwanese DS firm then will be presented.

Neighborhood scale quantification of ecosystem goods and ...

EPA Pesticide Factsheets

Ecosystem goods and services are those ecological structures and functions that humans can directly relate to their state of well-being. Ecosystem goods and services include, but are not limited to, a sufficient fresh water supply, fertile lands to produce agricultural products, shading, air and water of sufficient quality for designated uses, flood water retention, and places to recreate. The US Environmental Protection Agency (USEPA) Office of Research and Development’s Tampa Bay Ecosystem Services Demonstration Project (TBESDP) modeling efforts organized existing literature values for biophysical attributes and processes related to EGS. The goal was to develop a database for informing mapped-based EGS assessments for current and future land cover/use scenarios at multiple scales. This report serves as a demonstration of applying an EGS assessment approach at the large neighborhood scale (~1,000 acres of residential parcels plus common areas). Here, we present mapped inventories of ecosystem goods and services production at a neighborhood scale within the Tampa Bay, FL region. Comparisons of the inventory between two alternative neighborhood designs are presented as an example of how one might apply EGS concepts at this scale.

[Analysis of the effectiveness of the public health system with special reference to the health of children].

PubMed

Köhler, L; Brogren, P O

1990-01-01

A well structured, efficient health service is an important component of the welfare state, in Sweden for example. But its significance for the state of the nation's health is limited and will be affected, inter alia, by life styles and the environment. A progressive health policy must be based on cooperation between various sectors of society, and here the health service plays a central part. Therefore social policy must be well documented and subjected to continuous review. This is an important prerequisite for planning and correction at different levels. The analysis must take account of society as a whole, organization, and the individual! In so doing, greater significance should be attributed to the effectiveness and quality of the health service than to structures, capacity and statistics. With reference to the health of children in the Nordic countries, it is encouraging to see that this conception of evaluation has also gained greater acceptance in preventive care, firstly in the field of paediatric health care and more recently in the school health service as well.

Shuttle bus services quality assessment Tangerang Selatan toward smart city

NASA Astrophysics Data System (ADS)

Fassa, Ferdinand; Sitorus, Fredy Jhon Philip; Adikesuma, Tri Nugraha

2017-11-01

Around the world, shuttle bus operation played the significant role to accommodate transportation for commuting bus passengers. Shuttle Bus services in cities are provided by various bus agencies with kinds of own specific purposes. For instance, at Tangerang Selatan, Indonesia, it was said that shuttle bus In Trans Bintaro is run and operated by private bus companies hire by Bintaro developer. The aim of this research is to identify factors of satisfaction of shuttle bus service in Kota Tangerang Selatan, Indonesia. Several factors are used to analyze sums of 20 parameters performance indicators of Shuttle Bus. A face to face interview using a questionnaire (N=200) was used to collect data on October and March 2017. Likert and diagram Cartesian were used to model the all the parameters. This research succeeded in finding some categories of Shuttle bus service attributes such as accessibility, comfort, and safety. Users agreed that eight indicators in shuttle bus have the excellent achievement, while three indicators on performance remain low and should receive more attention especially punctuality of the bus.

The response to challenging behaviour by care staff: emotional responses, attributions of cause and observations of practice.

PubMed

Bailey, B A; Hare, D J; Hatton, C; Limb, K

2006-03-01

Previous studies have attempted to apply Weiner's attributional model of helping behaviour to care staff who work with service users with intellectual disabilities and challenging behaviours by using studies based on vignettes. The aims of the current study were to investigate the application of Weiner's model to 'real' service users with intellectual disabilities and challenging behaviours and to observe the care staff's actual responses to challenging behaviours displayed by service users. Also, to compare care staff attributions, emotions, optimism, willingness to help and observed helping behaviours for self-injurious behaviours in comparison to other forms of challenging behaviours. A total of 27 care staff completed two sets of measures, one set regarding a self-injurious behaviour and the other regarding other forms of challenging behaviour. An additional 16 staff completed one set of measures. The measures focused on care staff attributions, emotions, optimism and willingness to help. Also, 16 of the care staff were observed interacting with the service users to collect data regarding their responses to challenging behaviours. For both self-injurious behaviours and other forms of challenging behaviour, associations were found between the care staff internal, stable and uncontrollable attribution scores and care staff negative emotion scores. However, no associations were found between the care staff levels of emotion, optimism and willingness to help. Some associations were found between the care staff levels of willingness to help and observed helping behaviours. There were significant differences between the care staff attribution scores with higher scores being obtained for uncontrollable and stable attributions for other forms of challenging behaviours. No significant differences were found between the care staff emotions, optimism, willingness to help and observed helping behaviours. The results did not provide support for Weiner's attributional model of helping behaviour. However, a preliminary model of negative care staff behaviour was derived from the exploratory analyses completed. This model proposes that there are associations between internal, stable and uncontrollable attributions and negative emotions in care staff and also between negative emotions and negative behaviours displayed by care staff in response to the actions of service users.

[Masculinity, nationhood and a body fit for the Swiss army in 1875].

PubMed

Rychner, M

1999-01-01

The article looks at the model of the male body, as it emerged in Switzerland in the second half of the 19th century, an era of military centralization and the establishment of the national state (Nationalstaat). Focusing on different conceptions of fitness for military service, Rychner discusses how masculinity is reduced to physical attributes, and thereby objectified and reified. The context is the prevailing gender discourse which (while reducing women to little more than their bodily functions), positioned men as representatives of general human qualities, such as individuality and autonomy. Against this background and somewhat in opposition to it, for the Swiss republican army and its compulsory military service, the issue of each soldier's free will is a crucial issue - an issue that also informs the various conceptions of military fitness.

Quality-by-design III: application of near-infrared spectroscopy to monitor roller compaction in-process and product quality attributes of immediate release tablets.

PubMed

Kona, Ravikanth; Fahmy, Raafat M; Claycamp, Gregg; Polli, James E; Martinez, Marilyn; Hoag, Stephen W

2015-02-01

The objective of this study is to use near-infrared spectroscopy (NIRS) coupled with multivariate chemometric models to monitor granule and tablet quality attributes in the formulation development and manufacturing of ciprofloxacin hydrochloride (CIP) immediate release tablets. Critical roller compaction process parameters, compression force (CFt), and formulation variables identified from our earlier studies were evaluated in more detail. Multivariate principal component analysis (PCA) and partial least square (PLS) models were developed during the development stage and used as a control tool to predict the quality of granules and tablets. Validated models were used to monitor and control batches manufactured at different sites to assess their robustness to change. The results showed that roll pressure (RP) and CFt played a critical role in the quality of the granules and the finished product within the range tested. Replacing binder source did not statistically influence the quality attributes of the granules and tablets. However, lubricant type has significantly impacted the granule size. Blend uniformity, crushing force, disintegration time during the manufacturing was predicted using validated PLS regression models with acceptable standard error of prediction (SEP) values, whereas the models resulted in higher SEP for batches obtained from different manufacturing site. From this study, we were able to identify critical factors which could impact the quality attributes of the CIP IR tablets. In summary, we demonstrated the ability of near-infrared spectroscopy coupled with chemometrics as a powerful tool to monitor critical quality attributes (CQA) identified during formulation development.

Performance Evaluation of an Enhanced Uplink 3.5G System for Mobile Healthcare Applications.

PubMed

Komnakos, Dimitris; Vouyioukas, Demosthenes; Maglogiannis, Ilias; Constantinou, Philip

2008-01-01

The present paper studies the prospective and the performance of a forthcoming high-speed third generation (3.5G) networking technology, called enhanced uplink, for delivering mobile health (m-health) applications. The performance of 3.5G networks is a critical factor for successful development of m-health services perceived by end users. In this paper, we propose a methodology for performance assessment based on the joint uplink transmission of voice, real-time video, biological data (such as electrocardiogram, vital signals, and heart sounds), and healthcare records file transfer. Various scenarios were concerned in terms of real-time, nonreal-time, and emergency applications in random locations, where no other system but 3.5G is available. The accomplishment of quality of service (QoS) was explored through a step-by-step improvement of enhanced uplink system's parameters, attributing the network system for the best performance in the context of the desired m-health services.

Performance Evaluation of an Enhanced Uplink 3.5G System for Mobile Healthcare Applications

PubMed Central

Komnakos, Dimitris; Vouyioukas, Demosthenes; Maglogiannis, Ilias; Constantinou, Philip

2008-01-01

The present paper studies the prospective and the performance of a forthcoming high-speed third generation (3.5G) networking technology, called enhanced uplink, for delivering mobile health (m-health) applications. The performance of 3.5G networks is a critical factor for successful development of m-health services perceived by end users. In this paper, we propose a methodology for performance assessment based on the joint uplink transmission of voice, real-time video, biological data (such as electrocardiogram, vital signals, and heart sounds), and healthcare records file transfer. Various scenarios were concerned in terms of real-time, nonreal-time, and emergency applications in random locations, where no other system but 3.5G is available. The accomplishment of quality of service (QoS) was explored through a step-by-step improvement of enhanced uplink system's parameters, attributing the network system for the best performance in the context of the desired m-health services. PMID:19132096

Proposal of Secure VoIP System Using Attribute Certificate

NASA Astrophysics Data System (ADS)

Kim, Jin-Mook; Jeong, Young-Ae; Hong, Seong-Sik

VoIP is a service that changes the analogue audio signal into a digital signal and then transfers the audio information to the users after configuring it as a packet; and it has an advantage of lower price than the existing voice call service and better extensibility. However, VoIP service has a system structure that, compared to the existing PSTN (Public Switched Telephone Network), has poor call quality and is vulnerable in the security aspect. To make up these problems, TLS service was introduced to enhance the security. In practical system, however, since QoS problem occurs, it is necessary to develop the VoIP security system that can satisfy QoS at the same time in the security aspect. In this paper, a user authentication VoIP system that can provide a service according to the security and the user through providing a differential service according to the approach of the users by adding AA server at the step of configuring the existing VoIP session is suggested. It was found that the proposed system of this study provides a quicker QoS than the TLS-added system at a similar level of security. Also, it is able to provide a variety of additional services by the different users.

How do Housing Subsidies Improve Quality of Life Among Homeless Adults? A Mediation Analysis.

PubMed

O'Connell, Maria; Sint, Kyaw; Rosenheck, Robert

2018-03-01

Supported housing, combining rent subsidies with intensive case management, is associated with improvements in quality of life of homeless adults, but factors mediating their impact on quality of life have not been studied. Twelve-month outcome data from a randomized trial of the Housing and Urban Development- Veterans Affairs Supported Housing program (HUD-VASH) showed that access to a housing rent subsidy plus intensive case management (ICM) was associated with greater improvement in subjective quality of life than ICM alone. Multiple mediation analyses were applied to identify variables that significantly mediated the relationship between receipt of housing voucher and improvements in quality of life. Significant mediating covariates were those whose 95% bias-corrected confidence intervals, when added to the model predicting improvement in quality of life, did not overlap zero. Increases in the number of days housed, size of social network, and availability of emotional support appear to mediate improvement in quality of life and account for 71% of the benefit attributable to having a rent subsidy. Improvement in subjective quality of life though housing subsidies is mediated by gains in both material and psychosocial factors. Mediating factors deserve special attention in supported housing services. © Society for Community Research and Action 2018.

Quality of life and ethics.

PubMed

Fumincelli, Laís; Mazzo, Alessandra; Martins, José Carlos Amado; Mendes, Isabel Amélia Costa

2017-01-01

In health, ethics is an essential aspect of practice and care and guarantees a better quality of life for patients and their caregivers. To outline a conceptual analysis of quality of life and ethics, identifying attributes, contexts and magnitudes for health. A qualitative design about quality of life and ethics in health, considering the evolutionary approach in order to analyse the concept. To collect the data, a search was done using the keywords ethic*, quality of life and health. After, in total, 152 studies were found, finalizing seven relevant studies for the proposed concept analysis. Of seven studies analysed, their main results were shown by means of antecedents, consequences and attributes of the concepts. The three final attributes that synthesize the concept of quality of life and ethics in health were highlighted: Ethics dilemmas and quality of life; Human ethics and quality of life; and Ethics of care and quality of life. In fact, the attributes and context clearly reveal that ethics and quality of life influence the ability to solve ethical dilemmas, guarantee human ethics in healthcare and impact ethics in healthcare for the production of effective health policies and care that encompasses professional quality of life as well. The magnitude of ethical knowledge in each professional discipline permits cultivating a solidary attitude and developing the willingness to improve healthcare. The right to access, dignity and respect in care delivery are rooted in behaviours and are spontaneously applied in practice to the extent that they play an ethical role.

Modeling relationships between catchment attributes and river water quality in southern catchments of the Caspian Sea.

PubMed

Hasani Sangani, Mohammad; Jabbarian Amiri, Bahman; Alizadeh Shabani, Afshin; Sakieh, Yousef; Ashrafi, Sohrab

2015-04-01

Increasing land utilization through diverse forms of human activities, such as agriculture, forestry, urban growth, and industrial development, has led to negative impacts on the water quality of rivers. To find out how catchment attributes, such as land use, hydrologic soil groups, and lithology, can affect water quality variables (Ca(2+), Mg(2+), Na(+), Cl(-), HCO 3 (-) , pH, TDS, EC, SAR), a spatio-statistical approach was applied to 23 catchments in southern basins of the Caspian Sea. All input data layers (digital maps of land use, soil, and lithology) were prepared using geographic information system (GIS) and spatial analysis. Relationships between water quality variables and catchment attributes were then examined by Spearman rank correlation tests and multiple linear regression. Stepwise approach-based multiple linear regressions were developed to examine the relationship between catchment attributes and water quality variables. The areas (%) of marl, tuff, or diorite, as well as those of good-quality rangeland and bare land had negative effects on all water quality variables, while those of basalt, forest land cover were found to contribute to improved river water quality. Moreover, lithological variables showed the greatest most potential for predicting the mean concentration values of water quality variables, and noting that measure of EC and TDS have inversely associated with area (%) of urban land use.

The two faces of enhancing utilization of health-care services: determinants of patient initiation and retention in rural Burkina Faso.

PubMed Central

Mugisha, Frederick; Bocar, Kouyate; Dong, Hengjin; Chepng'eno, Gloria; Sauerborn, Rainer

2004-01-01

OBJECTIVE: To explore the factors that determine whether a patient will initiate treatment within a system of health-care services, and the factors that determine whether the patient will be retained in the chosen system, in Nouna, rural Burkina Faso. METHODS: The data used were pooled from four rounds of a household survey conducted in Nouna, rural Burkina Faso. The ongoing demographic surveillance system provided a sampling framework for this survey in which 800 households were sampled using a two-stage cluster sampling procedure. More than one treatment episode was observed for a single episode of illness per patient. The multinomial logit model was used to explore the determinants of patient initiation to systems of modern, traditional and home treatment, and a binary logit model was used to explore the determinants of patient retention within the chosen health-care provider system. FINDINGS: The results suggest that the determinants of patient initiation and their subsequent retention are different. Household income, education, urban residence and expected competency of the provider are positive predictors of initiation, but not of retention, for modern health-care services. Only perceived quality of care positively predicted retention in modern health-care services. CONCLUSION: Interventions focusing on patient initiation and patient retention are likely to be different. Policies directed at enhancing initiation for modern health-care services would primarily focus on reducing financial barriers, while those directed at increasing retention would primarily focus on attributes that improve the perceived quality of care. PMID:15375446

Using Geographic Information Systems (GIS) to understand a community's primary care needs.

PubMed

Dulin, Michael F; Ludden, Thomas M; Tapp, Hazel; Blackwell, Joshua; de Hernandez, Brisa Urquieta; Smith, Heather A; Furuseth, Owen J

2010-01-01

A key element for reducing health care costs and improving community health is increased access to primary care and preventative health services. Geographic information systems (GIS) have the potential to assess patterns of health care utilization and community-level attributes to identify geographic regions most in need of primary care access. GIS, analytical hierarchy process, and multiattribute assessment and evaluation techniques were used to examine attributes describing primary care need and identify areas that would benefit from increased access to primary care services. Attributes were identified by a collaborative partnership working within a practice-based research network using tenets of community-based participatory research. Maps were created based on socioeconomic status, population density, insurance status, and emergency department and primary care safety-net utilization. Individual and composite maps identified areas in our community with the greatest need for increased access to primary care services. Applying GIS to commonly available community- and patient-level data can rapidly identify areas most in need of increased access to primary care services. We have termed this a Multiple Attribute Primary Care Targeting Strategy. This model can be used to plan health services delivery as well as to target and evaluate interventions designed to improve health care access.

The effect of source credibility on consumers' perceptions of the quality of health information on the Internet.

PubMed

Bates, Benjamin R; Romina, Sharon; Ahmed, Rukhsana; Hopson, Danielle

2006-03-01

Recent use of the Internet as a source of health information has raised concerns about consumers' ability to tell 'good' information from 'bad' information. Although consumers report that they use source credibility to judge information quality, several observational studies suggest that consumers make little use of source credibility. This study examines consumer evaluations of web pages attributed to a credible source as compared to generic web pages on measures of message quality. In spring 2005, a community-wide convenience survey was distributed in a regional hub city in Ohio, USA. 519 participants were randomly assigned one of six messages discussing lung cancer prevention: three messages each attributed to a highly credible national organization and three identical messages each attributed to a generic web page. Independent sample t-tests were conducted to compare each attributed message to its counterpart attributed to a generic web page on measures of trustworthiness, truthfulness, readability, and completeness. The results demonstrated that differences in attribution to a source did not have a significant effect on consumers' evaluations of the quality of the information.Conclusions. The authors offer suggestions for national organizations to promote credibility to consumers as a heuristic for choosing better online health information through the use of media co-channels to emphasize credibility.

Learning for clinical leadership.

PubMed

Cook, Michael J; Leathard, Helen L

2004-11-01

Clinical leadership has been acclaimed widely as a major factor influencing the quality of patient care but research has revealed a paucity of preparation for this significant role. Leadership literature has rarely addressed clinical leadership specifically or referred to the difficulties in characterizing effective clinical leaders. The research informing this paper focused on clinical leadership and identified five attributes of effective clinical leaders: creativity, highlighting, influencing, respecting, and supporting. Effective clinical leaders adopted a transformational leadership style and improved care, through others, by including transformational (soft) knowledge as an integral part of their effective practice repertoire. Phronesis is introduced as practical wisdom that is gained through immersion in relevant experience, and as an essential element of preparation for clinical nursing leadership practice. It is argued, that learning to transform care requires opportunities to work within an environment that engenders and supports aspiring leaders. The paper describes the research process, elucidates the attributes through illustrative examples from the research data, and discusses an emergent educational strategy for the development of these attributes by clinicians in their practice environments. The paper also describes the application of this research through an interdisciplinary programme for staff leading teams in both health and social services sectors.

Ethnicity and pathways to care during first episode psychosis: the role of cultural illness attributions.

PubMed

Singh, Swaran P; Brown, Luke; Winsper, Catherine; Gajwani, Ruchika; Islam, Zoebia; Jasani, Rubina; Parsons, Helen; Rabbie-Khan, Fatemeh; Birchwood, Max

2015-11-16

Studies demonstrate ethnic variations in pathways to care during first episode psychosis (FEP). There are no extant studies, however, that have statistically examined the influence of culturally mediated illness attributions on these variations. We conducted an observational study of 123 (45 White; 35 Black; 43 Asian) patients recruited over a two-year period from an Early Intervention Service (EIS) in Birmingham, UK. Sociodemographic factors (age; sex; education; country of birth; religious practice; marital status; living alone), duration of untreated psychosis (DUP), service contacts (general practitioner; emergency services; faith-based; compulsory detention; criminal justice) and illness attributions ("individual;" "natural;" "social;" "supernatural;" "no attribution") were assessed. Ethnic groups did not differ in DUP (p = 0.86). Asian patients were more likely to report supernatural illness attributions in comparison to White (Odds Ratio: 4.02; 95 % Confidence Intervals: 1.52, 10.62) and Black (OR: 3.48; 95 % CI: 1.25, 9.67) patients. In logistic regressions controlling for confounders and illness attributions, Black (OR: 14.00; 95 % CI: 1.30, 151.11) and Asian (OR: 13.29; 95 % CI: 1.26, 140.47) patients were more likely to consult faith-based institutions than White patients. Black patients were more likely to be compulsorily detained than White patients (OR: 4.56; 95 % CI: 1.40, 14.85). Illness attributions and sociodemographic confounders do not fully explain the ethnic tendency to seek out faith-based institutions. While Asian and Black patients are more likely to seek help from faith-based organisations, this does not appear to lead to a delay in contact with mental health services.

Residents’ Preferences for Household Kitchen Waste Source Separation Services in Beijing: A Choice Experiment Approach

PubMed Central

Yuan, Yalin; Yabe, Mitsuyasu

2014-01-01

A source separation program for household kitchen waste has been in place in Beijing since 2010. However, the participation rate of residents is far from satisfactory. This study was carried out to identify residents’ preferences based on an improved management strategy for household kitchen waste source separation. We determine the preferences of residents in an ad hoc sample, according to their age level, for source separation services and their marginal willingness to accept compensation for the service attributes. We used a multinomial logit model to analyze the data, collected from 394 residents in Haidian and Dongcheng districts of Beijing City through a choice experiment. The results show there are differences of preferences on the services attributes between young, middle, and old age residents. Low compensation is not a major factor to promote young and middle age residents accept the proposed separation services. However, on average, most of them prefer services with frequent, evening, plastic bag attributes and without instructor. This study indicates that there is a potential for local government to improve the current separation services accordingly. PMID:25546279

Customers' attributional judgments towards complaint handling in airline service: a confirmatory study based on attribution theory.

PubMed

Chiou, Wen-Bin

2007-06-01

Besides flight safety, complaint handling plays a crucial role in airline service. Based upon Kelley's attribution theory, in the present study customers' attributions were examined under different conditions of complaint handling by the airlines. There were 531 passengers (216 women; ages 21 to 63 years, M = 41.5, SD = 11.1) with experiences of customer complaints who were recruited while awaiting boarding. Participants received one hypothetical scenario of three attributional conditions about complaint handling and then reported their attributional judgments. The findings indicated that the passengers were most likely to attribute the company's complaint handling to unconditional compliance when the airline company reacted to customer complaints under low distinctiveness, high consistency, and when consensus among the airlines was low. On the other hand, most passengers attributed the company's complaint handling to conditional compliance under the conditions in which distinctiveness, consistency, and consensus were all high. The results provide further insights into how different policies of complaint management affect customers' attributions. Future directions and managerial implications are also discussed.

Determinants of antenatal care attendance among women residing in highly disadvantaged communities in northern Jordan: a cross-sectional study.

PubMed

Hijazi, Heba H; Alyahya, Mohammad S; Sindiani, Amer M; Saqan, Rola S; Okour, Abdulhakeem M

2018-06-07

One of the major reproductive health challenges among disadvantaged populations is to provide pregnant women with the necessary antenatal care (ANC). In this study, we suggest applying an integrated conceptual framework aimed at ascertaining the extent to which attendance at ANC clinics may be attributed to individual determinants or to the quality of the care received. Using a cross-sectional design, data were collected from a sample of 831 women residing in nine sub-districts in three northern governorates of Jordan and designated according to national categorization as persistent poverty pockets. All of the sampled women were recruited from public maternal and child health centers and interviewed using a structured pre-tested survey. This tool covered certain predictors, ranging from the user's attributes, including predisposing, enabling, and need factors, to the essential components of the experience of care. These components assessed the quality of ANC in terms of five elements: woman-provider relations, technical management, information exchange, continuity of care, and appropriate constellation of services. Adequate ANC content was assessed in relation to the frequency of antenatal visits and the time of each visit. The results of multivariate logistic regression analyses show that the use of ANC facilities is affected by various factors related to the quality of service delivery. These include receiving information and education on ANC during clinic visits (OR = 9.1; 95% CI = 4.9-16.9), providing pregnant women with opportunities for dialogue and health talks (OR = 7.2; 95% CI = 4.1-12.8), having scheduled follow-up appointments (OR = 6.5; 95% CI = 3.5-12.0), and offering dignified and respectful care (OR = 5.7; 95% CI = 2.5-13.1). At the individual level, our findings have identified a woman's education level (OR = 1.2; 95% CI = 1.1-1.3), desire for the pregnancy (OR = 1.7; 95% CI = 1.1-2.7), and living in a district served by an ANC clinic (OR = 4.3; 95% CI = 2.3-8.1) as determinants affecting ANC utilization. Taking women's experiences of ANC as a key metric for reporting the quality of the care is more likely to lead to increased utilization of ANC services by women in highly disadvantaged communities. Our findings suggest that the degree to which women feel that they are respected, informed, and engaged in their care has potential favorable implications for ANC.

Managing Minor Ailments; The Public’s Preferences for Attributes of Community Pharmacies. A Discrete Choice Experiment

PubMed Central

Ryan, Mandy; Bond, Christine; Watson, Margaret

2016-01-01

Background Demand for health services continues to rise. Greater use of community pharmacy services instead of medical services for minor ailments could help relieve pressure on healthcare providers in high-cost settings. Community pharmacies are recognised sources of treatment and advice for people wishing to manage these ailments. However, increasing the public’s use of pharmacy services may depend on attributes of pharmacies and their staff. This study aimed to determine the general public’s relative preferences for community pharmacy attributes using a discrete choice experiment (DCE). Method A UK-wide DCE survey of the general public was conducted using face-to-face computer-assisted personal interviews. Attributes and levels for the DCE were informed by a literature review and a cohort study of community pharmacy customers. The context for the experiment was a minor ailment scenario describing flu-like symptoms. The DCE choice sets described two hypothetical community pharmacy services; respondents were asked to choose which (if either) of the two pharmacies they would prefer to help them manage symptoms. Data from 1,049 interviews were analysed using an error components logit model. Willingness to pay (WTP), a monetary measure of benefit, was estimated for the different attribute levels. Results When seeking help or treatment for flu-like symptoms, respondents most valued a pharmacy service that would improve their understanding and management of symptoms (WTP = £6.28), provided by staff who are trained (WTP (pharmacist) = £2.63: WTP(trained assistant) = £3.22), friendly and approachable (WTP = £3.38). Waiting time, pharmacy location and availability of parking also contributed to respondents’ preferences. WTP for a service comprising the best possible combination of attributes and levels was calculated as £55.43. Conclusion Attributes of a community pharmacy and its staff may influence people’s decisions about which pharmacy they would visit to access treatment and advice for minor ailments. In line with the public’s preferences, offering community pharmacy services that help people to better understand and manage symptoms, are provided promptly by trained staff who are friendly and approachable, and in a local setting with easy access to parking, has the potential to increase uptake amongst those seeking help to manage minor ailments. In this way it may be possible to shift demand away from high-cost health services and make more efficient use of scarce public resources. PMID:27031588

Recreational SCUBA divers' willingness to pay for marine biodiversity in Barbados.

PubMed

Schuhmann, Peter W; Casey, James F; Horrocks, Julia A; Oxenford, Hazel A

2013-05-30

The use of natural resources and the services they provide often do not have an explicit price and are therefore undervalued in decision-making, leading to environmental degradation. To 'monetize' the benefits from these services requires the use of non-market valuation techniques. Using a stated preference survey of recreational divers in Barbados conducted between 2007 and 2009, the economic value of marine biodiversity to recreational SCUBA divers in Barbados was estimated. In addition to a variety of demographic variables, divers were asked about their level of experience, expenditures related to travel and diving, and encounters with fish and sea turtles. Divers then completed a choice experiment, selecting between alternative dives with varying characteristics including price, crowding, fish diversity, encounters with sea turtles, and coral cover. Results indicate that divers in Barbados have a clear appreciation of reef quality variables. Willingness to pay for good coral cover, fish diversity and presence of sea turtles is significantly higher than prices paid for dives. In general, divers valued reef attributes similarly, although their appreciation of low density of divers at a site and high coral cover varied with prior diving experience. The results of this study demonstrate the economic value generated in Barbados by the recreational SCUBA diving industry and highlight the potential for substantial additional economic contributions with improvements to the quality of a variety of reef attributes. These results could inform management decisions regarding reef use and sea turtle conservation, and could aid in the development of informed 'win-win' policies aimed at maximizing returns from diving while reducing negative impacts often associated with tourism activities. Copyright © 2013 Elsevier Ltd. All rights reserved.

Smart Location Database - Service

EPA Pesticide Factsheets

The Smart Location Database (SLD) summarizes over 80 demographic, built environment, transit service, and destination accessibility attributes for every census block group in the United States. Future updates to the SLD will include additional attributes which summarize the relative location efficiency of a block group when compared to other block groups within the same metropolitan region. EPA also plans to periodically update attributes and add new attributes to reflect latest available data. A log of SLD updates is included in the SLD User Guide. See the user guide for a full description of data sources, data currency, and known limitations: https://edg.epa.gov/data/Public/OP/SLD/SLD_userguide.pdf

Attribute importance segmentation of Norwegian seafood consumers: The inclusion of salient packaging attributes.

PubMed

Olsen, Svein Ottar; Tuu, Ho Huu; Grunert, Klaus G

2017-10-01

The main purpose of this study is to identify consumer segments based on the importance of product attributes when buying seafood for homemade meals on weekdays. There is a particular focus on the relative importance of the packaging attributes of fresh seafood. The results are based on a representative survey of 840 Norwegian consumers between 18 and 80 years of age. This study found that taste, freshness, nutritional value and naturalness are the most important attributes for the home consumption of seafood. Except for the high importance of information about expiration date, most other packaging attributes have only medium importance. Three consumer segments are identified based on the importance of 33 attributes associated with seafood: Perfectionists, Quality Conscious and Careless Consumers. The Quality Conscious consumers feel more self-confident in their evaluation of quality, and are less concerned with packaging, branding, convenience and emotional benefits compared to the Perfectionists. Careless Consumers are important as regular consumers of convenient and pre-packed seafood products and value recipe information on the packaging. The seafood industry may use the results provided in this study to strengthen their positioning of seafood across three different consumer segments. Copyright © 2017 Elsevier Ltd. All rights reserved.

Product design enhancement using apparent usability and affective quality.

PubMed

Seva, Rosemary R; Gosiaco, Katherine Grace T; Santos, Ma Crea Eurice D; Pangilinan, Denise Mae L

2011-03-01

In this study, apparent usability and affective quality were integrated in a design framework called the Usability Perception and Emotion Enhancement Model (UPEEM). The UPEEM was validated using structural equation modeling (SEM). The methodology consists of four phases namely product selection, attribute identification, design alternative generation, and design alternative evaluation. The first stage involved the selection of a product that highly involves the consumer. In the attribute identification stage, design elements of the product were identified. The possible values of these elements were also determined for use in the experimentation process. Design of experiments was used to identify how the attributes will be varied in the design alternative stage and which of the attributes significantly contribute to affective quality, apparent usability, and desirability in the design evaluation stage. Results suggest that product attributes related to form are relevant in eliciting intense affect and perception of usability in mobile phones especially those directly related to functionality and aesthetics. This study considered only four product attributes among so many due to the constraints of the research design employed. Attributes related to aesthetic perception of a product enhance apparent usability such as those related to dimensional ratios. Copyright © 2010 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Mapping by sequencing in cotton (Gossypium hirsutum) line MD52ne identified candidate genes for fiber strength and its related quality attributes

USDA-ARS?s Scientific Manuscript database

Fiber strength, length, maturity and fineness determine the market value of cotton fibers and the quality of spun yarn. Cotton fiber strength has been recognized as a critical quality attribute in the modern textile industry. Fine mapping along with quantitative trait loci (QTL) validation and candi...

Deriving health utilities from the MacNew Heart Disease Quality of Life Questionnaire.

PubMed

Chen, Gang; McKie, John; Khan, Munir A; Richardson, Jeff R

2015-10-01

Quality of life is included in the economic evaluation of health services by measuring the preference for health states, i.e. health state utilities. However, most intervention studies include a disease-specific, not a utility, instrument. Consequently, there has been increasing use of statistical mapping algorithms which permit utilities to be estimated from a disease-specific instrument. The present paper provides such algorithms between the MacNew Heart Disease Quality of Life Questionnaire (MacNew) instrument and six multi-attribute utility (MAU) instruments, the Euroqol (EQ-5D), the Short Form 6D (SF-6D), the Health Utilities Index (HUI) 3, the Quality of Wellbeing (QWB), the 15D (15 Dimension) and the Assessment of Quality of Life (AQoL-8D). Heart disease patients and members of the healthy public were recruited from six countries. Non-parametric rank tests were used to compare subgroup utilities and MacNew scores. Mapping algorithms were estimated using three separate statistical techniques. Mapping algorithms achieved a high degree of precision. Based on the mean absolute error and the intra class correlation the preferred mapping is MacNew into SF-6D or 15D. Using the R squared statistic the preferred mapping is MacNew into AQoL-8D. The algorithms reported in this paper enable MacNew data to be mapped into utilities predicted from any of six instruments. This permits studies which have included the MacNew to be used in cost utility analyses which, in turn, allows the comparison of services with interventions across the health system. © The European Society of Cardiology 2014.

What influences where they seek care? Caregivers’ preferences for under-five child healthcare services in urban slums of Malawi: A discrete choice experiment

PubMed Central

Guda Obse, Amarech; Darker, Catherine; Biesma, Regien

2018-01-01

Access to and utilisation of quality healthcare promotes positive child health outcomes. However, to be optimally utilised, the healthcare system needs to be responsive to the expectations of the population it serves. Health systems in many sub-Saharan African countries, including Malawi, have historically focused on promoting access to health services by the rural poor. However, in the context of increasing urbanisation and consequent proliferation of urban slums, promoting health of children under five years of age in these settings is a public health imperative. We conducted a discrete choice experiment to determine the relative importance of health facility factors in seeking healthcare for childhood illnesses in urban slums of Malawi. Caregivers of children under five years of age were presented with choice cards that depicted two hypothetical health facilities using six health facility attributes: availability of medicines and supplies, thoroughness of physical examination of the child, attitude of health workers, cost, distance, and waiting time. Caregivers were asked to indicate the health facility they would prefer to use. A mixed logit model was used to estimate the relative importance of and willingness to pay (WTP) for health facility attributes. Attributes with greatest influence on choice were: availability of medicines and supplies (β = 0.842, p<0.001) and thorough examination of the child (β = 0.479, p <0.001) with WTP of MK3698.32 ($11) (95% CI: $8–$13) and MK2049.13 ($6) (95% CI: $3–$9) respectively. Respondents were willing to pay 1.8 and 2.4 times more for medicine availability over thorough examination and positive attitude of health workers respectively. Therefore, strengthening health service delivery system through investment in sustained availability of essential medicines and supplies, sufficient and competent health workforce with positive attitude and clinical discipline to undertake thorough examination, and reductions in waiting times have the potential to improve child healthcare utilization in the urban slums. PMID:29351299

What influences where they seek care? Caregivers' preferences for under-five child healthcare services in urban slums of Malawi: A discrete choice experiment.

PubMed

Lungu, Edgar Arnold; Guda Obse, Amarech; Darker, Catherine; Biesma, Regien

2018-01-01

Access to and utilisation of quality healthcare promotes positive child health outcomes. However, to be optimally utilised, the healthcare system needs to be responsive to the expectations of the population it serves. Health systems in many sub-Saharan African countries, including Malawi, have historically focused on promoting access to health services by the rural poor. However, in the context of increasing urbanisation and consequent proliferation of urban slums, promoting health of children under five years of age in these settings is a public health imperative. We conducted a discrete choice experiment to determine the relative importance of health facility factors in seeking healthcare for childhood illnesses in urban slums of Malawi. Caregivers of children under five years of age were presented with choice cards that depicted two hypothetical health facilities using six health facility attributes: availability of medicines and supplies, thoroughness of physical examination of the child, attitude of health workers, cost, distance, and waiting time. Caregivers were asked to indicate the health facility they would prefer to use. A mixed logit model was used to estimate the relative importance of and willingness to pay (WTP) for health facility attributes. Attributes with greatest influence on choice were: availability of medicines and supplies (β = 0.842, p<0.001) and thorough examination of the child (β = 0.479, p <0.001) with WTP of MK3698.32 ($11) (95% CI: $8-$13) and MK2049.13 ($6) (95% CI: $3-$9) respectively. Respondents were willing to pay 1.8 and 2.4 times more for medicine availability over thorough examination and positive attitude of health workers respectively. Therefore, strengthening health service delivery system through investment in sustained availability of essential medicines and supplies, sufficient and competent health workforce with positive attitude and clinical discipline to undertake thorough examination, and reductions in waiting times have the potential to improve child healthcare utilization in the urban slums.

Population Preferences for Health Care in Liberia: Insights for Rebuilding a Health System

PubMed Central

Kruk, Margaret E; Rockers, Peter C; Tornorlah Varpilah, S; Macauley, Rose

2011-01-01

Objective To quantify the influence of health system attributes, particularly quality of care, on preferences for health clinics in Liberia, a country with a high burden of disease that is rebuilding its health system after 14 years of civil war. Data Sources/Study Setting Informed by focus group discussions, a discrete choice experiment (DCE) was designed to assess preferences for structure and process of care at health clinics. The DCE was fielded in rural, northern Liberia as part of a 2008 population-based survey on health care utilization. Data Collection The survey response rate was 98 percent with DCE data available for 1,431 respondents. Mixed logit models were used to estimate the influence of six attributes on choice of hypothetical clinics for a future illness. Principal Findings Participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Respectful treatment and government (versus NGO) management marginally increased utility, whereas waiting time was not significant. Conclusions Liberians value technical quality of care over convenience, courtesy, and public management in selecting clinics for curative care. This suggests that investments in improved competence of providers and availability of medicines may increase population utilization of essential services as well as promote better clinical outcomes. PMID:21517835

Adults' Explanations for Intimate Partner Violence During Childhood and Associated Effects.

PubMed

Graham-Bermann, Sandra A; Cater, Åsa K; Miller-Graff, Laura E; Howell, Kathryn H

2017-06-01

Exposure to intimate partner violence (IPV) is known to challenge children's optimal development. This study sought to associate participants' beliefs about IPV held during childhood with their adjustment as adults, and to compare their beliefs from childhood to their beliefs in early adulthood. A nationally representative sample of 703 Swedish young adults reported on their past and present beliefs about the causes of their parents' IPV. Standardized measures assessed their mental health (anxiety, depression, and traumatic stress symptoms) and the quality of their relationships as adults. The most common explanations for IPV were that the perpetrator suffered from physical or mental illness, had relationship problems, or was distressed. Participants were less likely to blame themselves for IPV or to believe that the perpetrator was cruel when they were adults, compared to their reports of themselves as children. Women were more likely to attribute mental or physical illness as the cause of the perpetrator's IPV. Childhood beliefs that the perpetrator was debilitated (from mental illness or substance abuse) and cruel (took pleasure in violence and/or despised the child) were associated with greater mental health problems and poorer relationship quality in adulthood. Evaluation of children's harmful beliefs about IPV could be useful in adapting intervention services aimed at ameliorating negative personal causal attributions. © 2016 Wiley Periodicals, Inc.

Population preferences for health care in liberia: insights for rebuilding a health system.

PubMed

Kruk, Margaret E; Rockers, Peter C; Tornorlah Varpilah, S; Macauley, Rose

2011-12-01

OBJECTIVE. To quantify the influence of health system attributes, particularly quality of care, on preferences for health clinics in Liberia, a country with a high burden of disease that is rebuilding its health system after 14 years of civil war. DATA SOURCES/STUDY SETTING. Informed by focus group discussions, a discrete choice experiment (DCE) was designed to assess preferences for structure and process of care at health clinics. The DCE was fielded in rural, northern Liberia as part of a 2008 population-based survey on health care utilization. DATA COLLECTION. The survey response rate was 98 percent with DCE data available for 1,431 respondents. Mixed logit models were used to estimate the influence of six attributes on choice of hypothetical clinics for a future illness. PRINCIPAL FINDINGS. Participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Respectful treatment and government (versus NGO) management marginally increased utility, whereas waiting time was not significant. CONCLUSIONS. Liberians value technical quality of care over convenience, courtesy, and public management in selecting clinics for curative care. This suggests that investments in improved competence of providers and availability of medicines may increase population utilization of essential services as well as promote better clinical outcomes. © Health Research and Educational Trust.

[Causes of 72-hour return visits to hospital emergency departments].

PubMed

Jiménez-Puente, Alberto; Del Río-Mata, José; Arjona-Huertas, José Luis; Mora-Ordóñez, Begoña; Nieto-de Haro, Lourdes; Lara-Blanquer, Antonio; Martínez-Reina, Alfonso; Martínez Del Campo, Miguel

2015-10-01

The return-visit rate has been suggested as a measure of emergency department quality of care. We aimed to identify the reasons for emergency revisits and the percentage of returns related to problems with quality of care in the previous visit. Cross-sectional observational study of clinical records for a random sample of unscheduled returns within 72 hours of discharge from the emergency departments of 3 hospitals attending a population of nearly 3 million in the Spanish province of Malaga. The records were reviewed by 2 data collectors, who assigned a reason for revisits according to a standardized classification. A sample of 1075 emergency revisits were reviewed; 895 met the inclusion criteria. The most common reasons for revisits were the persistence or progression of disease (48.8%), an unrelated new problem (9.3%), and referral from a hospital that did not have the required specialized service (8.6%). Reasons attributable to the patient accounted for 14.5% of the revisits; 15.2% were attributable to health care staff errors, 9.2% to system organization, and 61.1% to the disease process. Most emergency department revisits are related to the progression of the disease that led to the first visit. Only a small percentage can be linked to diagnostic or treatment errors in the previous visit.

Identification of sensory attributes, instrumental and chemical measurements important for consumer acceptability of grilled lamb Longissimus lumborum.

PubMed

Oltra, O R; Farmer, L J; Gordon, A W; Moss, B W; Birnie, J; Devlin, D J; Tolland, E L C; Tollerton, I J; Beattie, A M; Kennedy, J T; Farrell, D

2015-02-01

In this study, important eating quality attributes that influence consumer liking for grilled lamb loin have been identified using preference mapping techniques. The eating quality attributes identified as driving the consumer liking of lamb loin steaks were “tenderness”, “sweet flavour”, “meaty aftertaste”, “roast lamb flavour” and “roast lamb aftertaste”. In contrast, the texture attribute “rubbery” and the flavour attributes “bitter flavour” and "bitter aftertaste" had a negative influence on consumer perceptions. Associations were observed between eating quality and a number of instrumental and chemical measurements. Warner Bratzler Shear Force showed an association with “rubbery” texture and a negative association with “tenderness” and consumer liking scores. The compounds, glucose, glucose-6-phosphate, inosine, inosine monophosphate and adenosine monophosphate were associated with the attributes, “sweet flavour”,“meaty aftertaste”, “roast lamb flavour”, “roast lamb aftertaste” and with consumer scores for liking of lamb which is probably caused by the role some of these compounds play as precursors of flavour and as taste compounds.

Consumer preferences for telemedicine devices and services in South Korea.

PubMed

Ahn, Joongha; Shin, Jungwoo; Lee, Jongsu; Shin, Kwangsoo; Park, Hayoung

2014-02-01

The scope of healthcare has been expanding from caring for sick people to keeping people from becoming sick, and telemedicine will play a significant role in this new healthcare paradigm. This study investigated consumer preferences and willingness to pay for attributes of telemedicine services in South Korea. A market simulation was conducted to examine the market shares of alternative services and their relationships to the perceived usefulness of service types and preferred device types. Using a conjoint survey, we collected data on consumer preferences for six telemedicine service attributes. Data analysis used the Bayesian mixed logit model. The market simulation estimated the probabilities of a specific service alternative being chosen using estimated model coefficients. Wearable devices were the most preferred, followed by smart-home and smartphone devices. Consumers perceived managing blood glucose to be the most useful telemedicine service, followed by monitoring oxygen saturation and blood pressure. The market simulation indicated that consumer preferences for device types were associated with the types of chronic diseases for which management through telemedicine services is perceived to be useful. As the focus of healthcare moves from treating patients to keeping individuals healthy, a key factor for the successful deployment of telemedicine services is understanding consumer perceptions and attitudes. The results of this study revealed the dynamics of consumer preferences with regard to service attributes.

Race, gender, and language concordance in the primary care setting.

PubMed

Martin, Brian C; Shi, Leiyu; Ward, Ryan D

2009-01-01

The purpose of this paper is to examine race, gender and language concordance in terms of importance to primary care. The 2003 Medical Expenditure Panel Survey Household Component (MEPS) was used. Four distinguishing primary care attributes and selected measures were operationalized primarily from a sample subset that identified a usual source of care (USC): accessibility to USC; interface between primary care and specialist services; treatment decisions; and preventive services received from the USC. Bivariate and multivariate results are reported. Adjusting for covariates, the following items remained statistically significant: race--choosing primary care physician as USC, USC having office hours, and going to USC for new health problems; gender--choosing primary care physician as USC and USC having office hours; and language--lack of difficulty contacting the USC after hours. However, these items appear to be isolated cases rather than indicators that concordance plays a key role in determining primary care quality. Language barriers/communication issues are the only areas where improvement appears warranted. While the study has strong accessibility and interpersonal relationship measures, service coordination and comprehensiveness indicators are limited. The analyses' cross-sectional nature also poses a problem in drawing causal relationships and conclusive findings. Finally, sample size limitations preclude stratified analyses across racial/ethnic groups, an important consideration as the relationships between concordance and quality may vary across groups. This study indicates that more research is needed in this area to determine future resource allocation and policy direction. The unique contribution of the study is to suggest that race and gender concordance may not accurately predict primary health care quality.

Scaling Down to Scale Up: A Health Economic Analysis of Integrating Point-of-Care Syphilis Testing into Antenatal Care in Zambia during Pilot and National Rollout Implementation

PubMed Central

Ncube, Alexander Tshaka; Sweeney, Sedona; Fleischer, Colette; Mumba, Grace Tembo; Gill, Michelle M.; Strasser, Susan; Peeling, Rosanna W.; Terris-Prestholt, Fern

2015-01-01

Maternal syphilis results in an estimated 500,000 stillbirths and neonatal deaths annually in Sub-Saharan Africa. Despite the existence of national guidelines for antenatal syphilis screening, syphilis testing is often limited by inadequate laboratory and staff services. Recent availability of inexpensive rapid point-of-care syphilis tests (RST) can improve access to antenatal syphilis screening. A 2010 pilot in Zambia explored the feasibility of integrating RST within prevention of mother-to-child-transmission of HIV services. Following successful demonstration, the Zambian Ministry of Health adopted RSTs into national policy in 2011. Cost data from the pilot and 2012 preliminary national rollout were extracted from project records, antenatal registers, clinic staff interviews, and facility observations, with the aim of assessing the cost and quality implications of scaling up a successful pilot into a national rollout. Start-up, capital, and recurrent cost inputs were collected, including costs of extensive supervision and quality monitoring during the pilot. Costs were analysed from a provider’s perspective, incremental to existing antenatal services. Total and unit costs were calculated and a multivariate sensitivity analysis was performed. Our accompanying qualitative study by Ansbro et al. (2015) elucidated quality assurance and supervisory system challenges experienced during rollout, which helped explain key cost drivers. The average unit cost per woman screened during rollout ($11.16) was more than triple the pilot unit cost ($3.19). While quality assurance costs were much lower during rollout, the increased unit costs can be attributed to several factors, including higher RST prices and lower RST coverage during rollout, which reduced economies of scale. Pilot and rollout cost drivers differed due to implementation decisions related to training, supervision, and quality assurance. This study explored the cost of integrating RST into antenatal care in pilot and national rollout settings, and highlighted important differences in costs that may be observed when moving from pilot to scale-up. PMID:25970443

Scaling Down to Scale Up: A Health Economic Analysis of Integrating Point-of-Care Syphilis Testing into Antenatal Care in Zambia during Pilot and National Rollout Implementation.

PubMed

Shelley, Katharine D; Ansbro, Éimhín M; Ncube, Alexander Tshaka; Sweeney, Sedona; Fleischer, Colette; Tembo Mumba, Grace; Gill, Michelle M; Strasser, Susan; Peeling, Rosanna W; Terris-Prestholt, Fern

2015-01-01

Maternal syphilis results in an estimated 500,000 stillbirths and neonatal deaths annually in Sub-Saharan Africa. Despite the existence of national guidelines for antenatal syphilis screening, syphilis testing is often limited by inadequate laboratory and staff services. Recent availability of inexpensive rapid point-of-care syphilis tests (RST) can improve access to antenatal syphilis screening. A 2010 pilot in Zambia explored the feasibility of integrating RST within prevention of mother-to-child-transmission of HIV services. Following successful demonstration, the Zambian Ministry of Health adopted RSTs into national policy in 2011. Cost data from the pilot and 2012 preliminary national rollout were extracted from project records, antenatal registers, clinic staff interviews, and facility observations, with the aim of assessing the cost and quality implications of scaling up a successful pilot into a national rollout. Start-up, capital, and recurrent cost inputs were collected, including costs of extensive supervision and quality monitoring during the pilot. Costs were analysed from a provider's perspective, incremental to existing antenatal services. Total and unit costs were calculated and a multivariate sensitivity analysis was performed. Our accompanying qualitative study by Ansbro et al. (2015) elucidated quality assurance and supervisory system challenges experienced during rollout, which helped explain key cost drivers. The average unit cost per woman screened during rollout ($11.16) was more than triple the pilot unit cost ($3.19). While quality assurance costs were much lower during rollout, the increased unit costs can be attributed to several factors, including higher RST prices and lower RST coverage during rollout, which reduced economies of scale. Pilot and rollout cost drivers differed due to implementation decisions related to training, supervision, and quality assurance. This study explored the cost of integrating RST into antenatal care in pilot and national rollout settings, and highlighted important differences in costs that may be observed when moving from pilot to scale-up.

Attributions for Poverty among College Students: The Impact of Service-Learning and Religiosity

ERIC Educational Resources Information Center

Davidson, Theresa C.

2009-01-01

This study examines service-learning participation and religiosity for their effect on structural and individualistic attributions for poverty. Research on these factors is either insufficient or nonexistent. The data for this study come from a random sample of college students in a Southeastern state. Results indicate that participation in a…

Comparative Job Attributes of Airmen and Civil Service Personnel Having Similar Job Types.

ERIC Educational Resources Information Center

Garza, Andrew T.; Carpenter, James B.

Military and civil service personnel having similar job types and from comparable accounting and finance career ladders were compared on several attributes. The data reveal certain distinct differences between the two populations with the magnitude of the differences being highly variable as functions of specific job types considered. Generally,…

[Computerization and the importance of information in health system, as in health care resources registry].

PubMed

Troselj, Mario; Fanton, Davor

2005-01-01

The possibilities of creating a health care resources registry and its operating in Croatia as well as the importance of information in health system are described. At the Croatian Institute of Public Health, monitoring of human resources is performed through the national Health Workers Registry. It also covers basic data on all health units, bed capacities of health facilities included. The initiated health care computerization has urged the idea of forming one more database on physical resources, i.e. on registered medical devices and equipment, more complete. Linking these databases on health resources would produce a single Health Care Resources Registry. The concept views Health Care Resources Registry as part of the overall health information system with centralized information on the health system. The planned development of segments of a single health information system is based on the implementation of the accepted international standards and common network services. Network services that are based on verified Internet technologies are used within a safe, reliable and closed health computer network, which makes up the health intranet (WAN--Wide Area Network). The resource registry is a software solution based on the relational database that monitors history, thus permitting the data collected over a longer period to be analyzed. Such a solution assumes the existence of a directory service, which would replace the current independent software for the Health Workers Registry. In the Health Care Resources Registry, the basic data set encompasses data objects and attributes from the directory service. The directory service is compatible with the LDAP protocol (Lightweight Directory Access Protocol), providing services uniformly to the current records on human and physical resources. Through the storage of attributes defined according to the HL7 (Health Level Seven) standard, directory service is accessible to all applications of the health information system. Directory service does not follow the history of attribute changes, and is optimized for a large number of authorizing inquiries. With it, one follows the following objects and attributes: persons, groups of people (patients, physicians, other personnel), roles (right of access and administrator permissions), organizational units, unit locations, devices and services (according to the list of services and procedures). One can add to the Health Care Resource Registry such attributes as are nonessential for inclusion in the directory service, but are of public health value. Authentication, authorization and digital signature are done by means of Smart Cards, which are used as protective elements against access to system functions, and simultaneously as a physical medium for the storage of the official certificate with which documents are signed digitally. As FINA (state financial control agency) has completed a system for certificate issuance and verification, the option of official digital signature is also available as a computer network service. Any changes taking place in the directory service are transferred by XML messages to a separate part of the Registry that reads them and automatically modifies records in the relational database. Because data input and data changes are made in health units, this makes the data updated and directly connected with health working operations. This avoids all one-time data collection campaigns using form filling about the devices and equipment in the future. As it is very difficult to monitor from a central standpoint how accurate and update the information is, it is necessary to delegate the permissions and duties associated with making changes to the directory service. By this organizational setup, the time needed to ensure data quality control is reduced. In the case described, the Health Care Resource Registry becomes an indicator of change, acquiring certain characteristics of an analytical system. An analysis of topical data renders possible proactive action and makes more effective the planning and utilization of available resources. Providing answers on the current data quickly could also be important to solution-seeking in emergencies. The present proposal to establish the Registry is intended to facilitate the future process of planning and striking a balance between investments in human and physical resources. For health expenditure control, having reliable information related to the use and purchase of new medical technology is particularly important. World Health Organization and European Union have also emphasized the need to develop new indicators in this area.

Broadening our understanding of clinical quality: from attribution error to situated cognition.

PubMed

Artino, A R; Durning, S J; Waechter, D M; Leary, K L; Gilliland, W R

2012-02-01

The tendency to overestimate the influence of personal characteristics on outcomes, and to underestimate the influence of situational factors, is known as the fundamental attribution error. We argue that medical-education researchers and policy makers may be guilty of this error in their quest to understand clinical quality. We suggest that to truly understand clinical quality, they must examine situational factors, which often have a strong influence on the quality of clinical encounters.

Evaluation of the structural, physicochemical, and biological characteristics of SB4, a biosimilar of etanercept

PubMed Central

Cho, Ick Hyun; Lee, Nayoung; Song, Dami; Jung, Seong Young; Bou-Assaf, George; Sosic, Zoran; Zhang, Wei; Lyubarskaya, Yelena

2016-01-01

ABSTRACT A biosimilar is a biological medicinal product that is comparable to a reference medicinal product in terms of quality, safety, and efficacy. SB4 was developed as a biosimilar to Enbrel® (etanercept) and was approved as Benepali®, the first biosimilar of etanercept licensed in the European Union (EU). The quality assessment of SB4 was performed in accordance with the ICH comparability guideline and the biosimilar guidelines of the European Medicines Agency and Food and Drug Administration. Extensive structural, physicochemical, and biological testing was performed with state-of-the-art technologies during a side-by-side comparison of the products. Similarity of critical quality attributes (CQAs) was evaluated on the basis of tolerance intervals established from quality data obtained from more than 60 lots of EU-sourced and US-sourced etanercept. Additional quality assessment was focused on a detailed investigation of immunogenicity-related quality attributes, including hydrophobic variants, high-molecular-weight (HMW) species, N-glycolylneuraminic acid (NGNA), and α-1,3-galactose. This comprehensive characterization study demonstrated that SB4 is highly similar to the reference product, Enbrel®, in structural, physicochemical, and biological quality attributes. In addition, the levels of potential immunogenicity-related quality attributes of SB4 such as hydrophobic variants, HMW aggregates, and α-1,3-galactose were less than those of the reference product. PMID:27246928

Transcriptomic analysis of apple fruit ripening and texture attributes

USDA-ARS?s Scientific Manuscript database

Molecular events regulating cultivar-specific apple fruit ripening and sensory quality are largely unknown. Such knowledge is essential for genomic-assisted apple breeding and postharvest quality management. The ripening behavior and texture attributes of two apple cultivars, ‘Pink Lady’ and ‘Honey...

Using ArchE in the Classroom: One Experience

DTIC Science & Technology

2007-09-01

The Architecture Expert (ArchE) tool serves as a software architecture design assistant. It embodies knowledge of quality attributes and the relation...between the achievement of quality attribute requirements and architecture design . This technical note describes the use of a pre-alpha release of

Simulation study to determine the impact of different design features on design efficiency in discrete choice experiments.

PubMed

Vanniyasingam, Thuva; Cunningham, Charles E; Foster, Gary; Thabane, Lehana

2016-07-19

Discrete choice experiments (DCEs) are routinely used to elicit patient preferences to improve health outcomes and healthcare services. While many fractional factorial designs can be created, some are more statistically optimal than others. The objective of this simulation study was to investigate how varying the number of (1) attributes, (2) levels within attributes, (3) alternatives and (4) choice tasks per survey will improve or compromise the statistical efficiency of an experimental design. A total of 3204 DCE designs were created to assess how relative design efficiency (d-efficiency) is influenced by varying the number of choice tasks (2-20), alternatives (2-5), attributes (2-20) and attribute levels (2-5) of a design. Choice tasks were created by randomly allocating attribute and attribute level combinations into alternatives. Relative d-efficiency was used to measure the optimality of each DCE design. DCE design complexity influenced statistical efficiency. Across all designs, relative d-efficiency decreased as the number of attributes and attribute levels increased. It increased for designs with more alternatives. Lastly, relative d-efficiency converges as the number of choice tasks increases, where convergence may not be at 100% statistical optimality. Achieving 100% d-efficiency is heavily dependent on the number of attributes, attribute levels, choice tasks and alternatives. Further exploration of overlaps and block sizes are needed. This study's results are widely applicable for researchers interested in creating optimal DCE designs to elicit individual preferences on health services, programmes, policies and products. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Factors Affecting Quality and Health Promoting Compounds during Growth and Postharvest Life of Sweet Cherry (Prunus avium L.)

PubMed Central

Correia, Sofia; Schouten, Rob; Silva, Ana P.; Gonçalves, Berta

2017-01-01

Sweet cherries are attractive fruits due to their taste, color, nutritional value, and beneficial health effects. Sweet cherry is a highly perishable fruit and all quality attributes and the level of health promoting compounds are affected by growth conditions, picking, packing, transport, and storage. During production, the correct combination of scion × rootstock will produce fruits with higher firmness, weight, sugars, vitamins, and phenolic compounds that boost the fruit antioxidant activity. Orchard management, such as applying drip irrigation and summer pruning, will increase fruit sugar levels and total phenolic content, while application of growth regulators can result in improved storability, increased red coloring, increased fruit size, and reduced cracking. Salicylic acid, oxalic acid, acetylsalicylic acid, and methyl salicylate are promising growth regulators as they also increase total phenolics, anthocyanins, and induce higher activity of antioxidant enzymes. These growth regulators are now also applied as fruit coatings that improve shelf-life with higher antioxidant enzyme activities and total phenolics. Optimizing storage and transport conditions, such as hydro cooling with added CaCl2, chain temperature and relative humidity control, are crucial for slowing down decay of quality attributes and increasing the antioxidant capacity. Application of controlled atmosphere during storage is successful in delaying quality attributes, but lowers ascorbic acid levels. The combination of low temperature storage in combination with modified atmosphere packaging (MAP) is successful in reducing the incidence of fruit decay, while preserving taste attributes and stem color with a higher antioxidant capacity. A new trend in MAP is the use of biodegradable films such as micro-perforated polylactic acid film that combine significant retention of quality attributes, high consumer acceptability, and a reduced environmental footprint. Another trend is to replace MAP with fruit edible coatings. Edible coatings, such as various lipid composite coatings, have advantages in retaining quality attributes and increasing the antioxidant activity (chitosan) and are regarded as approved food additives, although studies regarding consumer acceptance are needed. The recent publication of the sweet cherry genome will likely increase the identification of more candidate genes involved in growing and maintaining health related compounds and quality attributes. PMID:29312407

Classification of antecedents towards safety use of health information technology: A systematic review.

PubMed

Salahuddin, Lizawati; Ismail, Zuraini

2015-11-01

This paper provides a systematic review of safety use of health information technology (IT). The first objective is to identify the antecedents towards safety use of health IT by conducting systematic literature review (SLR). The second objective is to classify the identified antecedents based on the work system in Systems Engineering Initiative for Patient Safety (SEIPS) model and an extension of DeLone and McLean (D&M) information system (IS) success model. A systematic literature review (SLR) was conducted from peer-reviewed scholarly publications between January 2000 and July 2014. SLR was carried out and reported based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The related articles were identified by searching the articles published in Science Direct, Medline, EMBASE, and CINAHL databases. Data extracted from the resultant studies included are to be analysed based on the work system in Systems Engineering Initiative for Patient Safety (SEIPS) model, and also from the extended DeLone and McLean (D&M) information system (IS) success model. 55 articles delineated to be antecedents that influenced the safety use of health IT were included for review. Antecedents were identified and then classified into five key categories. The categories are (1) person, (2) technology, (3) tasks, (4) organization, and (5) environment. Specifically, person is attributed by competence while technology is associated to system quality, information quality, and service quality. Tasks are attributed by task-related stressor. Organisation is related to training, organisation resources, and teamwork. Lastly, environment is attributed by physical layout, and noise. This review provides evidence that the antecedents for safety use of health IT originated from both social and technical aspects. However, inappropriate health IT usage potentially increases the incidence of errors and produces new safety risks. The review cautions future implementation and adoption of health IT to carefully consider the complex interactions between social and technical elements propound in healthcare settings. Copyright © 2015. Published by Elsevier Ireland Ltd.

Composition of Web Services Using Markov Decision Processes and Dynamic Programming

PubMed Central

Uc-Cetina, Víctor; Moo-Mena, Francisco; Hernandez-Ucan, Rafael

2015-01-01

We propose a Markov decision process model for solving the Web service composition (WSC) problem. Iterative policy evaluation, value iteration, and policy iteration algorithms are used to experimentally validate our approach, with artificial and real data. The experimental results show the reliability of the model and the methods employed, with policy iteration being the best one in terms of the minimum number of iterations needed to estimate an optimal policy, with the highest Quality of Service attributes. Our experimental work shows how the solution of a WSC problem involving a set of 100,000 individual Web services and where a valid composition requiring the selection of 1,000 services from the available set can be computed in the worst case in less than 200 seconds, using an Intel Core i5 computer with 6 GB RAM. Moreover, a real WSC problem involving only 7 individual Web services requires less than 0.08 seconds, using the same computational power. Finally, a comparison with two popular reinforcement learning algorithms, sarsa and Q-learning, shows that these algorithms require one or two orders of magnitude and more time than policy iteration, iterative policy evaluation, and value iteration to handle WSC problems of the same complexity. PMID:25874247

NASA's Global Change Master Directory: Discover and Access Earth Science Data Sets, Related Data Services, and Climate Diagnostics

NASA Astrophysics Data System (ADS)

Aleman, A.; Olsen, L. M.; Ritz, S.; Stevens, T.; Morahan, M.; Grebas, S. K.

2011-12-01

NASA's Global Change Master Directory provides the scientific community with the ability to discover, access, and use Earth science data, data-related services, and climate diagnostics worldwide.The GCMD offers descriptions of Earth science data sets using the Directory Interchange Format (DIF) metadata standard; Earth science related data services are described using the Service Entry Resource Format (SERF); and climate visualizations are described using the Climate Diagnostic (CD) standard. The DIF, SERF and CD standards each capture data attributes used to determine whether a data set, service, or climate visualization is relevant to a user's needs.Metadata fields include: title, summary, science keywords, service keywords, data center, data set citation, personnel, instrument, platform, quality, related URL, temporal and spatial coverage, data resolution and distribution information.In addition, nine valuable sets of controlled vocabularies have been developed to assist users in normalizing the search for data descriptions. An update to the GCMD's search functionality is planned to further capitalize on the controlled vocabularies during database queries.By implementing a dynamic keyword "tree", users will have the ability to search for data sets by combining keywords in new ways.This will allow users to conduct more relevant and efficient database searches to support the free exchange and re-use of Earth science data.

A Consideration of Quality-Attribute-Property for Interoperability of Quality Data

NASA Astrophysics Data System (ADS)

Tarumi, Shinya; Kozaki, Kouji; Kitamura, Yoshinobu; Mizoguchi, Riichiro

Descriptions of attribute and quality are essential elements in ontology developments. Needless to say, science data are description of attributes of target things and it is an important role of ontology to support the validity of and interoperability between the description. Although some upper ontologies such as DOLCE, BFO, etc. are already developed and extensively used, a careful examination reveals some rooms for improvement of them. While each ontology covers quality and quantity, the mutual interchangeability among these ontologies is not considered because each has been designed intended to develop a ``correct'' ontology of quality and quantity. Furthermore, due to variety of ways of data description, no single ontology can cover all the existing scientific data. In this paper, we investigate ``quality'' and ``value'' from an ontological viewpoint and propose a conceptual framework to deal with attribute, property and quality appearing in existing data descriptions in the nanotechnology domain. This framework can be considered as a reference ontology for describing quality with existing upper ontology. Furthermore, on the basis of the results of the consideration, we evaluate and refine a conceptual hierarchy of materials functions which has been built by nanomaterials researchers. Through the evaluation process, we discuss an effect of the definition of a conceptual framework for building/refining ontology. Such conceptual consideration about quality and value is not only the problem in nanomaterials domain but also a first step toward advancement of an intelligent sharing of scientific data in e-Science.

A case study: application of statistical process control tool for determining process capability and sigma level.

PubMed

Chopra, Vikram; Bairagi, Mukesh; Trivedi, P; Nagar, Mona

2012-01-01

Statistical process control is the application of statistical methods to the measurement and analysis of variation process. Various regulatory authorities such as Validation Guidance for Industry (2011), International Conference on Harmonisation ICH Q10 (2009), the Health Canada guidelines (2009), Health Science Authority, Singapore: Guidance for Product Quality Review (2008), and International Organization for Standardization ISO-9000:2005 provide regulatory support for the application of statistical process control for better process control and understanding. In this study risk assessments, normal probability distributions, control charts, and capability charts are employed for selection of critical quality attributes, determination of normal probability distribution, statistical stability, and capability of production processes, respectively. The objective of this study is to determine tablet production process quality in the form of sigma process capability. By interpreting data and graph trends, forecasting of critical quality attributes, sigma process capability, and stability of process were studied. The overall study contributes to an assessment of process at the sigma level with respect to out-of-specification attributes produced. Finally, the study will point to an area where the application of quality improvement and quality risk assessment principles for achievement of six sigma-capable processes is possible. Statistical process control is the most advantageous tool for determination of the quality of any production process. This tool is new for the pharmaceutical tablet production process. In the case of pharmaceutical tablet production processes, the quality control parameters act as quality assessment parameters. Application of risk assessment provides selection of critical quality attributes among quality control parameters. Sequential application of normality distributions, control charts, and capability analyses provides a valid statistical process control study on process. Interpretation of such a study provides information about stability, process variability, changing of trends, and quantification of process ability against defective production. Comparative evaluation of critical quality attributes by Pareto charts provides the least capable and most variable process that is liable for improvement. Statistical process control thus proves to be an important tool for six sigma-capable process development and continuous quality improvement.

A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition.

PubMed

Ganle, John Kuumuori; Parker, Michael; Fitzpatrick, Raymond; Otupiri, Easmon

2014-12-21

To reduce financial barriers to access, and improve access to and use of skilled maternal and newborn healthcare services, the government of Ghana, in 2003, implemented a new maternal healthcare policy that provided free maternity care services in all public and mission healthcare facilities. Although supervised delivery in Ghana has increased from 47% in 2003 to 55% in 2010, strikingly high maternal mortality ratio and low percentage of skilled attendance are still recorded in many parts of the country. To explore health system factors that inhibit women's access to and use of skilled maternal and newborn healthcare services in Ghana despite these services being provided free. We conducted qualitative research with 185 expectant and lactating mothers and 20 healthcare providers in six communities in Ghana between November 2011 and May 2012. We used Attride-Stirling's thematic network analysis framework to analyze and present our data. We found that in addition to limited and unequal distribution of skilled maternity care services, women's experiences of intimidation in healthcare facilities, unfriendly healthcare providers, cultural insensitivity, long waiting time before care is received, limited birthing choices, poor care quality, lack of privacy at healthcare facilities, and difficulties relating to arranging suitable transportation were important health system barriers to increased and equitable access and use of services in Ghana. Our findings highlight how a focus on patient-side factors can conceal the fact that many health systems and maternity healthcare facilities in low-income settings such as Ghana are still chronically under-resourced and incapable of effectively providing an acceptable minimum quality of care in the event of serious obstetric complications. Efforts to encourage continued use of maternity care services, especially skilled assistance at delivery, should focus on addressing those negative attributes of the healthcare system that discourage access and use.

Determinants of farmers' choice for veterinary service providers in Nepal Mountains.

PubMed

Lamichhane, Dirga Kumar; Shrestha, Sabina

2012-08-01

This study was aimed to analyze factors that affect farmers' choice for major actors of veterinary service providers in village areas of Kaski district of Nepal, with the objective of identifying choice-specific attributes which could be addressed for improving the penetration of professional veterinary services in village areas. The information was obtained from 125 farmers using a structured questionnaire. A proportional hazard model was used for data analysis because of its ability to accommodate the attributes of both the chooser and the choice simultaneously. The results showed that village animal health workers (VAHWs) were the most preferred service providers followed by veterinarians and mid-level technicians. The farmers' age and education level had a significant but inverse relationship with the probability of choosing any of the three service providers. From our study, we found that the main choice-specific attributes with a significant impact on the choice probability was the distance to the preferred service provider. Since there was a high preference for VAHW, this suggests the possibility of poorly trained service providers dominating veterinary service market in village areas of Kaski district. Hence, the efforts put forward in the legalization of VAHW system in Nepal should first address the constraints that obstruct the accessibility of professional veterinary service providers in village areas.

On Robust Methodologies for Managing Public Health Care Systems

PubMed Central

Nimmagadda, Shastri L.; Dreher, Heinz V.

2014-01-01

Authors focus on ontology-based multidimensional data warehousing and mining methodologies, addressing various issues on organizing, reporting and documenting diabetic cases and their associated ailments, including causalities. Map and other diagnostic data views, depicting similarity and comparison of attributes, extracted from warehouses, are used for understanding the ailments, based on gender, age, geography, food-habits and other hereditary event attributes. In addition to rigor on data mining and visualization, an added focus is on values of interpretation of data views, from processed full-bodied diagnosis, subsequent prescription and appropriate medications. The proposed methodology, is a robust back-end application, for web-based patient-doctor consultations and e-Health care management systems through which, billions of dollars spent on medical services, can be saved, in addition to improving quality of life and average life span of a person. Government health departments and agencies, private and government medical practitioners including social welfare organizations are typical users of these systems. PMID:24445953

Enhancing marketing recruitment strategies: administrator tenure and nursing expenditures.

PubMed

Gunby, Norris White

2005-01-01

When recruiting nurses, long-term care facilities require an ability to identify salient organizational characteristics that are attractive to potential nursing services candidates vis-à-vis their competitors. The findings of this study suggest that information on administrative tenure can be utilized to attract applicants by appealing to criteria within their high-involvement job search activities. High-involvement applicants proactively seek recruitment content that provides essential job attributes that match their needs and skills and are more apt to be a higher quality candidate. Based upon the study's findings, managers are offered marketing strategy recommendations for tailoring recruiting messages that appeal to high-involvement job seekers.

Context Aware Systems, Methods and Trends in Smart Home Technology

NASA Astrophysics Data System (ADS)

Robles, Rosslin John; Kim, Tai-Hoon

Context aware applications respond and adapt to changes in the computing environment. It is the concept of leveraging information about the end user to improve the quality of the interaction. New technologies in context-enriched services will use location, presence, social attributes, and other environmental information to anticipate an end user's immediate needs, offering more-sophisticated, situation-aware and usable functions. Smart homes connect all the devices and appliances in your home so they can communicate with each other and with you. Context-awareness can be applied to Smart Home technology. In this paper, we discuss the context-aware tools for development of Smart Home Systems.

Genetic and cultural management solutions to improve potato storage quality

USDA-ARS?s Scientific Manuscript database

Potato storage quality is most easily described in terms of tuber attributes that maintain the value of the harvested crop. Among these attributes are attractive appearance, low shrink, low incidence of bruising and, for chip and fry processing varieties, specific gravity and reducing sugars appropr...

Measuring Website Quality: Asymmetric Effect of User Satisfaction

ERIC Educational Resources Information Center

Kincl, Tomas; Strach, Pavel

2012-01-01

Website quality measurement tools have been largely static and have struggled to determine relevant attributes of user satisfaction. This study compares and contrasts attributes of user satisfaction based on usability guidelines seeking to identify practical easy-to-administer measurement tools. The website users assessed business school homepages…

Patient preferences for community pharmacy asthma services: a discrete choice experiment.

PubMed

Naik-Panvelkar, Pradnya; Armour, Carol; Rose, John M; Saini, Bandana

2012-10-01

Specialized community pharmacy services, involving the provision of disease state management and care by pharmacists, have been developed and trialled and have demonstrated very good health outcomes. Most of these services have been developed from a healthcare professional perspective. However, for the future uptake and long-term sustainability of these services as well as for better and sustained health outcomes for patients, it is vital to gain an understanding of patients' preferences. We can then structure healthcare services to match these preferences and needs rather than around clinical viewpoints alone. The aim of this study was to elicit patient preferences for pharmacy-based specialized asthma services using a discrete choice experiment and to explore the value/importance that patients place on the different attributes of the asthma service. The existence of preference heterogeneity in the population was also investigated. The study was conducted with asthma patients who had recently experienced a specialized asthma management service at their pharmacy in New South Wales, Australia. Pharmacists delivering the asthma service mailed out the discrete choice questionnaires to participating patients at the end of 6 months of service provision. A latent class (LC) model was used to investigate each patient's strength of preference and preference heterogeneity for several key attributes related to asthma service provision: frequency of visits, access to pharmacist, interaction with pharmacy staff, availability of a private area for consultation, provision of lung function testing, type and depth of advice provision, number of days with asthma symptoms and cost of service. Eighty useable questionnaires (of 170 questionnaires sent out) were received (response rate 47.1%). The study identified various key elements of asthma services important to patients. Further, the LC analysis revealed three classes with differing patient preferences for levels of asthma service provision. Patients in the Minimalistic Model class valued provision of lung function testing and preferred more frequent service visits. Cost of service had a negative effect on service preference for patients in this class. Patients in the Partial Model class mainly derived utility from the provision of lung function testing and comprehensive advice at the pharmacy and also wanted more frequent service visits. The Holistic Model class patients considered all attributes of the service to be important when making a choice. While the majority of the service attributes had a positive effect on preference for patients in this class, cost of service and days with symptoms of asthma had a negative effect on service preference. These patients also preferred fewer service visits. The study identified various key attributes that are important to patients with respect to community pharmacy-based asthma services. The results also demonstrate the existence of preference heterogeneity in the population. Asthma service providers need to take these findings into consideration in the design and development of future service models so as to increase their uptake and ensure their long-term sustainability.

Valuing Attributes of Home Palliative Care With Service Users: A Pilot Discrete Choice Experiment.

PubMed

Gomes, Barbara; de Brito, Maja; Sarmento, Vera P; Yi, Deokhee; Soares, Duarte; Fernandes, Jacinta; Fonseca, Bruno; Gonçalves, Edna; Ferreira, Pedro L; Higginson, Irene J

2017-12-01

Discrete choice experiment (DCE) is a quantitative method that helps determine which service attributes are most valued by people and consequently improve their well-being. The objective of this study was to test a new DCE on home palliative care (HPC). Cross-sectional survey using the DCE method with adult patients and their family caregivers, users of three HPC services in Portugal. Service attributes were based on a Cochrane review, a meta-ethnography, and the few existing DCEs on HPC: 1) team's availability, 2) support for family caregivers, 3) homecare support, 4) information and planning, and 5) waiting time. The experimental design consisted in three blocks of eight choice sets where participants chose between two service alternatives that combined different levels of each attribute. We piloted the DCE using cognitive interviewing. Interviews were analyzed for difficulties using Tourangeau's model of information processing. The DCE was conducted with 21 participants of 37 eligible (10 patients with median Palliative Performance Scale score = 45, 11 caregivers). Most participants found the DCE easy (median 2 from 1 to 5), although two patients did not finish the exercise. Key difficulties related to comprehension (e.g., waiting time sometimes understood as response time for visit instead of time from referral to care start) and judgment (e.g., indecision due to similar service alternatives). The DCE method is feasible and acceptable but not all patients are able to participate. In the main study phase, we will give more attention to the explanation of the waiting time attribute. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Textural, nutritional and functional attributes in tomato genotypes for breeding better quality varieties.

PubMed

Saha, Supradip; Hedau, Nirmal K; Mahajan, Vinay; Singh, Gyanendra; Gupta, Hari S; Gahalain, Anita

2010-01-30

Screening of natural biodiversity for their better quality attributes is of prime importance for quality breeding programmes. A set of 53 tomato genotypes was measured for their textural [skin firmness, pericarp thickness, total soluble solids (TSS)], nutritional [phosphorus (P), potassium (K), iron (Fe), zinc (Zn), copper (Cu), manganese (Mn) and titrable acidity (TA)] and functional (beta-carotene, lycopene and ascorbic acid) quality attributes. Three sets of data (textural, nutritional and functional attributes) were obtained and analysed for their mutual relationships. Wide variations were observed in most of the measurements, e.g. skin firmness (coefficient of variability (CV) 269-612 g), pericarp thickness (CV 1.4-4.9 mm), potassium (CV 229-371 mg 100 g(-1)), iron (CV 611-1772 mg 100 g(-1)), ascorbic acid (CV 12-86 mg 100 g(-1)), suggesting that there are considerable levels of genetic diversity. Significant correlations (P < 0.05, 0.01) were also detected among different attributes of tomato genotypes, such as phosphorus and zinc with a correlation coefficient of 0.74, ascorbic acid and copper of 0.57, pericarp thickness and lycopene of - 0.52. However, there were no correlations between textural and nutritional attributes. Five factors were computed by principal component analysis that explained 66% of the variation in the attributes, among which all micronutrients other than iron, TSS, firmness and beta-carotene were most important. Functional attributes except beta-carotene played a less important role in explaining total variation. This knowledge could aid in the efficient conservation of important parts of the agricultural biodiversity of India. These results are also potentially useful for tomato breeders working on the development of new varieties. (c) 2009 Society of Chemical Industry.

Regional variations in health care intensity and physician perceptions of quality of care.

PubMed

Sirovich, Brenda E; Gottlieb, Daniel J; Welch, H Gilbert; Fisher, Elliott S

2006-05-02

Research has documented dramatic differences in health care utilization and spending across U.S. regions with similar levels of patient illness. Although patient outcomes and quality of care have been found to be no better in regions of high health care intensity, it is unknown whether physicians in these regions feel more capable of providing good patient care than those in low-intensity regions. To determine whether physicians in high-intensity regions feel better able to care for patients than physicians in low-intensity regions. Physician telephone survey. 51 metropolitan and 9 nonmetropolitan areas of the United States and a supplemental national sample. 10,577 physicians who provided care to adults in 1998 or 1999 were surveyed for the Community Tracking Study (response rate, 61%). The End-of-Life Expenditure Index, a measure of spending that reflects differences in the overall quantity of medical services provided rather than differences in illness or price, was used to determine health care intensity in the physicians' community. Outcomes included physicians' perceived availability of clinical services, ability to provide high-quality care to patients, and career satisfaction. Although the highest-intensity regions have substantially more hospital beds and specialists per capita, physicians in these regions reported more difficulty obtaining needed services for their patients. The proportion of physicians who felt able to obtain elective hospital admissions ranged from 50% in high-intensity regions to 64% in the lowest-intensity region (P < 0.001 for the relationship between intensity and perceived ability to obtain hospital admissions); the proportion of physicians who felt able to obtain high-quality specialist referrals ranged from 64% in high-intensity regions to 79% in low-intensity regions (P < 0.001). Compared with low-intensity regions, fewer physicians in high-intensity regions felt able to maintain good ongoing patient relationships (range, 62% to 70%; P < 0.001) or able to provide high-quality care (range, 72% to 77%; P = 0.009). In most cases, differences persisted but were attenuated in magnitude after adjustment for physician attributes, practice characteristics, and local market factors (for example, managed care penetration); the difference in perceived ability to provide high-quality care was no longer statistically significant (P = 0.099). The cross-sectional design prevented demonstration of a causal relationship between intensity and physician perceptions of quality. Despite more resources, physicians in regions of high health care intensity did not report greater ease in obtaining needed services or greater ability to provide high-quality care.

Service Oriented Architecture Security Risks and their Mitigation

DTIC Science & Technology

2012-10-01

this section can be mitigated by making use of suitable authentication , confidentiality, integrity, and authorisation standards such as Security...for authorisation . Machines/non-human users should be clearly identified and authenticated by the identity provision and authentication services... authentication , any security related attributes for the subject, and the authorisation decisions given based on the security and privilege attributes

Meaningful Learning with Mobile Devices: Pre-Service Class Teachers' Experiences of Mobile Learning in the Outdoors

ERIC Educational Resources Information Center

Kärki, Tomi; Keinänen, Heli; Tuominen, Anu; Hoikkala, Marianna; Matikainen, Eila; Maijala, Hanna

2018-01-01

The authors consider the use of mobile learning environment ActionTrack in teacher education. Pre-service class teachers' (N = 277) experiences of the mobile learning environment were measured with a 7-point Likert-scale questionnaire based on seven attributes of meaningful learning. Students' ratings for different attributes were analysed…

Attribute correlates of hospital outpatient satisfaction.

PubMed

Krueckeberg, H F; Hubbert, A

1995-01-01

Customer satisfaction (patient satisfaction) with hospital outpatient or ambulatory services is an important factor in influencing patient patronage and loyalty. Based on an empirical study, this article examines the attributes of the ambulatory care experience which were significantly associated with the level of satisfaction resulting from the most recent hospital ambulatory visit. This study focuses on identifying attributes of ambulatory services. This article brings to the health care marketing literature information on ambulatory satisfaction comparable to that which has been contributed to the literature regarding satisfaction with physician and hospital experiences.

Real-time product attribute control to manufacture antibodies with defined N-linked glycan levels.

PubMed

Zupke, Craig; Brady, Lowell J; Slade, Peter G; Clark, Philip; Caspary, R Guy; Livingston, Brittney; Taylor, Lisa; Bigham, Kyle; Morris, Arvia E; Bailey, Robert W

2015-01-01

Pressures for cost-effective new therapies and an increased emphasis on emerging markets require technological advancements and a flexible future manufacturing network for the production of biologic medicines. The safety and efficacy of a product is crucial, and consistent product quality is an essential feature of any therapeutic manufacturing process. The active control of product quality in a typical biologic process is challenging because of measurement lags and nonlinearities present in the system. The current study uses nonlinear model predictive control to maintain a critical product quality attribute at a predetermined value during pilot scale manufacturing operations. This approach to product quality control ensures a more consistent product for patients, enables greater manufacturing efficiency, and eliminates the need for extensive process characterization by providing direct measures of critical product quality attributes for real time release of drug product. © 2015 American Institute of Chemical Engineers.

Safety-net providers in some US communities have increasingly embraced coordinated care models.

PubMed

Cunningham, Peter; Felland, Laurie; Stark, Lucy

2012-08-01

Safety-net organizations, which provide health services to uninsured and low-income people, increasingly are looking for ways to coordinate services among providers to improve access to and quality of care and to reduce costs. In this analysis, a part of the Community Tracking Study, we examined trends in safety-net coordination activities from 2000 to 2010 within twelve communities in the United States and found a notable increase in such activities. Six of the twelve communities had made formal efforts to link uninsured people to medical homes and coordinate care with specialists in 2010, compared to only two communities in 2000. We also identified key attributes of safety-net coordinated care systems, such as reliance on a medical home for meeting patients' primary care needs, and lingering challenges to safety-net integration, such as competition among hospitals and community health centers for Medicaid patients.

Planning for progress, productivity, and performance.

PubMed

Benedict, J M

1983-10-01

A project is described for the interim renovation of a labor intensive existing foodservice facility. The renovated area will provide effective food management during the hospital's redevelopment period, including a new foodservice. Objectives of the interim project were to conserve labor while emphasizing control and centralization, provide economic foodservices with improved quality, and incorporate one tray distribution system throughout the hospital complex. Immediate measures were necessary in order to generate funds to proceed. Renovations had to occur without disrupting food-service to patients. The project was planned over a three year period and included an ingredient control area, two patient tray service centres, a renewed production kitchen and test kitchen facility. Each phase has been financed on the understanding that the costs of construction and equipment will be repaid within one fiscal year of operating the renovated facility. Positive results are being achieved, attributable to the support and encouragement received from staff during the change process.

CCSDS Mission Operations Action Service Core Capabilities

NASA Technical Reports Server (NTRS)

Reynolds, Walter F.; Lucord, Steven A.; Stevens, John E.

2009-01-01

This slide presentation reviews the operations concepts of the command (action) services. Since the consequences of sending the wrong command are unacceptable, the command system provides a collaborative and distributed work environment for flight controllers and operators. The system prescribes a review and approval process where each command is viewed by other individuals before being sent to the vehicle. The action service needs additional capabilities to support he operations concepts of manned space flight. These are : (1) Action Service methods (2) Action attributes (3) Action parameter/argument attributes (4 ) Support for dynamically maintained action data. (5) Publish subscri be capabilities.

Applying image quality in cell phone cameras: lens distortion

NASA Astrophysics Data System (ADS)

Baxter, Donald; Goma, Sergio R.; Aleksic, Milivoje

2009-01-01

This paper describes the framework used in one of the pilot studies run under the I3A CPIQ initiative to quantify overall image quality in cell-phone cameras. The framework is based on a multivariate formalism which tries to predict overall image quality from individual image quality attributes and was validated in a CPIQ pilot program. The pilot study focuses on image quality distortions introduced in the optical path of a cell-phone camera, which may or may not be corrected in the image processing path. The assumption is that the captured image used is JPEG compressed and the cellphone camera is set to 'auto' mode. As the used framework requires that the individual attributes to be relatively perceptually orthogonal, in the pilot study, the attributes used are lens geometric distortion (LGD) and lateral chromatic aberrations (LCA). The goal of this paper is to present the framework of this pilot project starting with the definition of the individual attributes, up to their quantification in JNDs of quality, a requirement of the multivariate formalism, therefore both objective and subjective evaluations were used. A major distinction in the objective part from the 'DSC imaging world' is that the LCA/LGD distortions found in cell-phone cameras, rarely exhibit radial behavior, therefore a radial mapping/modeling cannot be used in this case.

Defining Hardwood Veneer Log Quality Attributes

Treesearch

Jan Wiedenbeck; Michael Wiemann; Delton Alderman; John Baumgras; William Luppold

2004-01-01

This publication provides a broad spectrum of information on the hardwood veneer industry in North America. Veneer manufacturers and their customers impose guidelines in specifying wood quality attributes that are very discriminating but poorly defined (e.g., exceptional color, texture, and/or figure characteristics). To better understand and begin to define the most...

Biases in Quality Attribution to Mother-Child and Caregiver-Child Interaction.

ERIC Educational Resources Information Center

Shpancer, Noam; Britner, Preston A.

1995-01-01

Examined the possible existence, direction, and nature of subconscious, cognitive biases in participants' quality attributions to maternal and nonmaternal child-care interactions, the relationship of such biases to subject's background, and their attitudes toward child care and maternal employment. Potential explanations for the biases and the…

Monsters, Lovers and Former Friends: Exploring Relationships with Mathematics via Personification

ERIC Educational Resources Information Center

Zazkis, Dov

2015-01-01

Personification is the attribution of human qualities to non-human entities. The method of eliciting personification, which requires participants to attribute human qualities to non-human entities, takes advantage of a naturally occurring means through which (some) people discuss the emotional relationship they have with those entities. Eliciting…

Characterizing CO and NOy Sources and Relative Ambient Ratios in the Baltimore Area Using Ambient Measurements and Source Attribution Modeling

EPA Science Inventory

Modeled source attribution information from the Community Multiscale Air Quality model was coupled with ambient data from the 2011 Deriving Information on Surface conditions from Column and Vertically Resolved Observations Relevant to Air Quality Baltimore field study. We assess ...

The Role of Negative Affect in the Assessment of Quality of Life among Women with Type 1 Diabetes Mellitus

PubMed Central

Gawlik, Nicola R.

2018-01-01

Background The purpose of this study is to determine the impact of negative affect (defined in terms of lack of optimism, depressogenic attributional style, and hopelessness depression) on the quality of life of women with type 1 diabetes mellitus. Methods Participants (n=177) completed either an online or paper questionnaire made available to members of Australian diabetes support groups. Measures of optimism, attributional style, hopelessness depression, disease-specific data, and diabetes-related quality of life were sought. Bivariate correlations informed the construction of a structural equation model. Results Participants were 36.3±11.3 years old, with a disease duration of 18.4±11.2 years. Age and recent glycosylated hemoglobin readings were significant contextual variables in the model. All bivariate associations involving the components of negative affect were as hypothesized. That is, poorer quality of life was associated with a greater depressogenic attributional style, higher hopelessness depression, and lower optimism. The structural equation model demonstrated significant direct effects of depressogenic attributional style and hopelessness depression on quality of life, while (lack of) optimism contributed to quality of life indirectly by way of these variables. Conclusion The recognition of negative affect presentations among patients, and an understanding of its relevance to diabetes-related quality of life, is a valuable tool for the practitioner. PMID:29199406

Comprehensive model for predicting perceptual image quality of smart mobile devices.

PubMed

Gong, Rui; Xu, Haisong; Luo, M R; Li, Haifeng

2015-01-01

An image quality model for smart mobile devices was proposed based on visual assessments of several image quality attributes. A series of psychophysical experiments were carried out on two kinds of smart mobile devices, i.e., smart phones and tablet computers, in which naturalness, colorfulness, brightness, contrast, sharpness, clearness, and overall image quality were visually evaluated under three lighting environments via categorical judgment method for various application types of test images. On the basis of Pearson correlation coefficients and factor analysis, the overall image quality could first be predicted by its two constituent attributes with multiple linear regression functions for different types of images, respectively, and then the mathematical expressions were built to link the constituent image quality attributes with the physical parameters of smart mobile devices and image appearance factors. The procedure and algorithms were applicable to various smart mobile devices, different lighting conditions, and multiple types of images, and performance was verified by the visual data.

Establishing and Scaling-Up Clinical Social Franchise Networks: Lessons Learned From Marie Stopes International and Population Services International.

PubMed

Thurston, Sarah; Chakraborty, Nirali M; Hayes, Brendan; Mackay, Anna; Moon, Pierre

2015-06-17

In many low- and middle-income countries, a majority of people seek health care from the private sector. However, fragmentation, poor economies of scale, inadequate financing, political opposition, a bias toward curative services, and weak regulatory and quality control systems pose serious challenges for the private sector. Social franchising addresses a number of these challenges by organizing small, independent health care businesses into quality-assured networks. Global franchisors Marie Stopes International (MSI) and Population Services International (PSI) have rapidly scaled their family planning social franchising programs in recent years, jointly delivering over 10.8 million couple-years of protection (CYPs) in 2014-up 26% from 8.6 million CYPs just 1 year prior. Drawing on experience across MSI's 17 and PSI's 25 social franchise networks across Africa, Asia, and Latin America and the Caribbean, this article documents the organizations' operational approaches, challenges faced, and solutions implemented. The organizations provide intensive capacity building and support for private-sector providers, including clinical training, branding, monitoring quality of franchised services, and commodity support. In addition, franchising programs engage providers and clients through behavior change communication (BCC) and demand generation activities to raise awareness and to attract clients, and they implement initiatives to ensure services are affordable for the lowest-income clients. Social franchise programs offer the private sector a collective platform to better engage government in health policy advocacy and for integrating into new public health care financing and procurement mechanisms. The future of social franchising will require developing approaches to scale-up and sustain the model cost-effectively, selectively integrating other health services into the franchise package, and being responsive to evolving health care financing approaches with the potential to contribute to universal health coverage. © Thurston et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/

Effect of Frozen Storage Temperature on the Quality of Premium Ice Cream.

PubMed

Park, Sung Hee; Jo, Yeon-Ji; Chun, Ji-Yeon; Hong, Geun-Pyo; Davaatseren, Munkhtugs; Choi, Mi-Jung

2015-01-01

The market sales of premium ice cream have paralleled the growth in consumer desire for rich flavor and taste. Storage temperature is a major consideration in preserving the quality attributes of premium ice cream products for both the manufacturer and retailers during prolonged storage. We investigated the effect of storage temperature (-18℃, -30℃, -50℃, and -70℃) and storage times, up to 52 wk, on the quality attributes of premium ice cream. Quality attributes tested included ice crystal size, air cell size, melting resistance, and color. Ice crystal size increased from 40.3 μm to 100.1 μm after 52 wk of storage at -18℃. When ice cream samples were stored at -50℃ or -70℃, ice crystal size slightly increased from 40.3 μm to 57-58 μm. Initial air cell size increased from 37.1 μm to 87.7 μm after storage at -18℃ for 52 wk. However, for storage temperatures of -50℃ and -70℃, air cell size increased only slightly from 37.1 μm to 46-47 μm. Low storage temperature (-50℃ and -70℃) resulted in better melt resistance and minimized color changes in comparison to high temperature storage (-18℃ and -30℃). In our study, quality changes in premium ice cream were gradually minimized according to decrease in storage temperature up to-50℃. No significant beneficial effect of -70℃ storage was found in quality attributes. In the scope of our experiment, we recommend a storage temperature of -50℃ to preserve the quality attributes of premium ice cream.

Effect of Frozen Storage Temperature on the Quality of Premium Ice Cream

PubMed Central

Park, Sung Hee; Jo, Yeon-Ji; Chun, Ji-Yeon; Hong, Geun-Pyo

2015-01-01

The market sales of premium ice cream have paralleled the growth in consumer desire for rich flavor and taste. Storage temperature is a major consideration in preserving the quality attributes of premium ice cream products for both the manufacturer and retailers during prolonged storage. We investigated the effect of storage temperature (−18℃, −30℃, −50℃, and −70℃) and storage times, up to 52 wk, on the quality attributes of premium ice cream. Quality attributes tested included ice crystal size, air cell size, melting resistance, and color. Ice crystal size increased from 40.3 μm to 100.1 μm after 52 wk of storage at −18℃. When ice cream samples were stored at −50℃ or −70℃, ice crystal size slightly increased from 40.3 μm to 57-58 μm. Initial air cell size increased from 37.1 μm to 87.7 μm after storage at −18℃ for 52 wk. However, for storage temperatures of −50℃ and −70℃, air cell size increased only slightly from 37.1 μm to 46-47 μm. Low storage temperature (−50℃ and −70℃) resulted in better melt resistance and minimized color changes in comparison to high temperature storage (−18℃ and −30℃). In our study, quality changes in premium ice cream were gradually minimized according to decrease in storage temperature up to−50℃. No significant beneficial effect of −70℃ storage was found in quality attributes. In the scope of our experiment, we recommend a storage temperature of −50℃ to preserve the quality attributes of premium ice cream. PMID:26877639

Influence of raw material properties upon critical quality attributes of continuously produced granules and tablets.

PubMed

Fonteyne, Margot; Wickström, Henrika; Peeters, Elisabeth; Vercruysse, Jurgen; Ehlers, Henrik; Peters, Björn-Hendrik; Remon, Jean Paul; Vervaet, Chris; Ketolainen, Jarkko; Sandler, Niklas; Rantanen, Jukka; Naelapää, Kaisa; De Beer, Thomas

2014-07-01

Continuous manufacturing gains more and more interest within the pharmaceutical industry. The International Conference of Harmonisation (ICH) states in its Q8 'Pharmaceutical Development' guideline that the manufacturer of pharmaceuticals should have an enhanced knowledge of the product performance over a range of raw material attributes, manufacturing process options and process parameters. This fits further into the Process Analytical Technology (PAT) and Quality by Design (QbD) framework. The present study evaluates the effect of variation in critical raw material properties on the critical quality attributes of granules and tablets, produced by a continuous from-powder-to-tablet wet granulation line. The granulation process parameters were kept constant to examine the differences in the end product quality caused by the variability of the raw materials properties only. Theophylline-Lactose-PVP (30-67.5-2.5%) was used as model formulation. Seven different grades of theophylline were granulated. Afterward, the obtained granules were tableted. Both the characteristics of granules and tablets were determined. The results show that differences in raw material properties both affect their processability and several critical quality attributes of the resulting granules and tablets. Copyright © 2014 Elsevier B.V. All rights reserved.

Operational source receptor calculations for large agglomerations

NASA Astrophysics Data System (ADS)

Gauss, Michael; Shamsudheen, Semeena V.; Valdebenito, Alvaro; Pommier, Matthieu; Schulz, Michael

2016-04-01

For Air quality policy an important question is how much of the air pollution within an urbanized region can be attributed to local sources and how much of it is imported through long-range transport. This is critical information for a correct assessment of the effectiveness of potential emission measures. The ratio between indigenous and long-range transported air pollution for a given region depends on its geographic location, the size of its area, the strength and spatial distribution of emission sources, the time of the year, but also - very strongly - on the current meteorological conditions, which change from day to day and thus make it important to provide such calculations in near-real-time to support short-term legislation. Similarly, long-term analysis over longer periods (e.g. one year), or of specific air quality episodes in the past, can help to scientifically underpin multi-regional agreements and long-term legislation. Within the European MACC projects (Monitoring Atmospheric Composition and Climate) and the transition to the operational CAMS service (Copernicus Atmosphere Monitoring Service) the computationally efficient EMEP MSC-W air quality model has been applied with detailed emission data, comprehensive calculations of chemistry and microphysics, driven by high quality meteorological forecast data (up to 96-hour forecasts), to provide source-receptor calculations on a regular basis in forecast mode. In its current state, the product allows the user to choose among different regions and regulatory pollutants (e.g. ozone and PM) to assess the effectiveness of fictive emission reductions in air pollutant emissions that are implemented immediately, either within the agglomeration or outside. The effects are visualized as bar charts, showing resulting changes in air pollution levels within the agglomeration as a function of time (hourly resolution, 0 to 4 days into the future). The bar charts not only allow assessing the effects of emission reduction measures but they also indicate the relative importance of indigenous versus imported air pollution. The calculations are currently performed weekly by MET Norway for the Paris, London, Berlin, Oslo, Po Valley and Rhine-Ruhr regions and the results are provided free of charge at the MACC website (http://www.gmes-atmosphere.eu/services/aqac/policy_interface/regional_sr/). A proposal to extend this service to all EU capitals on a daily basis within the Copernicus Atmosphere Monitoring Service is currently under review. The tool is an important example illustrating the increased application of scientific tools to operational services that support Air Quality policy. This paper will describe this tool in more detail, focusing on the experimental setup, underlying assumptions, uncertainties, computational demand, and the usefulness for air quality for policy. Options to apply the tool for agglomerations outside the EU will also be discussed (making reference to, e.g., PANDA, which is a European-Chinese collaboration project).

Increasing access to sexual health care for rural and regional young people: Similarities and differences in the views of young people and service providers.

PubMed

Johnston, Karen; Harvey, Caroline; Matich, Paula; Page, Priscilla; Jukka, Clare; Hollins, Jane; Larkins, Sarah

2015-10-01

This study aims to describe the views of sexual health service providers on access issues for young people and consider them together with the views of young people themselves. A cross-sectional mixed-methods study design involving semi-structured interviews with health service providers and an electronic survey with young people. Four towns in rural and regional Queensland, Australia. A total of 32 service providers: 9 sexual health nurses, 8 general practitioners, 6 school-based youth health nurses, 5 sexual health educators, 2 Australian Aboriginal health workers and 2 youth workers. There were 391 young people who participated in the Young People's Survey. Themes generated from interviews with service providers and quantitative data from young people addressing access to sexual and reproductive health (SRH) services for rural and regional young people. Service providers frequently identified structural barriers, confidentiality and lack of awareness of SRH services as barriers for young people seeking SRH care. Young people also reported that structural factors such as transport, cost and service operating hours were important; however, they placed greater value on personal attributes of service providers, particularly welcoming and non-judgemental attitudes. Health service policy and training focused on attitudinal qualities of individual service providers may improve access to SRH services for young people. Selective staff recruitment and professional development are important to increase sensitivity to youth issues. Promotion of non-judgemental and confidential care may also improve access for youth. © 2015 National Rural Health Alliance Inc.

The Origin of Variation in Primary Care Process and Outcome Indicators: Patients, Professionals, Centers, and Health Districts.

PubMed

Orueta, Juan F; García-Alvarez, Arturo; Grandes, Gonzalo; Nuño-Solinís, Roberto

2015-08-01

Healthcare providers are often evaluated by studying variability in their indicators. However, the usefulness of this analysis may be limited if we do not distinguish the variability attributable to health professionals and organizations from that associated with their patients.Our objectives are to describe the main process and outcome indicators of primary healthcare services, analyzing the contribution to variability in these indicators from different levels: individual, health professional, health center, and health district.This is a cross-sectional study that includes all.All the individuals covered by the public Basque Health Service (children [age 0-13], n = 247,493; adults [≥14 years old], n = 1,959,682) over a 12-month period.We calculated the number of visits to primary care doctors, number of referrals, prescription costs, and potentially avoidable hospitalizations for ambulatory care sensitive conditions (ACSCs). Using multilevel analysis, we determined the percentage of variance attributable to each level.After adjusting for the characteristics of patients (demographic, socioeconomic, and morbidity), doctors (panel size), health center (size, staff satisfaction, demographic structure of the community), and health district, the variance in the indicators was mainly attributable to differences between patients, independently of the attending health professional, the center, or the healthcare organization, both in children (94.21% for visits to the doctor; 96.66% for referrals; 98.57% for prescription costs; 90.02% for potentially avoidable hospitalizations for ACSCs) and in adults (88.10%; 96.26%; 97.92%; and 93.77%, respectively).The limited contribution of health professionals and organizations to variability in indicators should be taken into account when performing evaluations and planning quality improvement strategies.

The Origin of Variation in Primary Care Process and Outcome Indicators

PubMed Central

Orueta, Juan F.; García-Alvarez, Arturo; Grandes, Gonzalo; Nuño-Solinís, Roberto

2015-01-01

Abstract Healthcare providers are often evaluated by studying variability in their indicators. However, the usefulness of this analysis may be limited if we do not distinguish the variability attributable to health professionals and organizations from that associated with their patients. Our objectives are to describe the main process and outcome indicators of primary healthcare services, analyzing the contribution to variability in these indicators from different levels: individual, health professional, health center, and health district. This is a cross-sectional study that includes all. All the individuals covered by the public Basque Health Service (children [age 0–13], n = 247,493; adults [≥14 years old], n = 1,959,682) over a 12-month period. We calculated the number of visits to primary care doctors, number of referrals, prescription costs, and potentially avoidable hospitalizations for ambulatory care sensitive conditions (ACSCs). Using multilevel analysis, we determined the percentage of variance attributable to each level. After adjusting for the characteristics of patients (demographic, socioeconomic, and morbidity), doctors (panel size), health center (size, staff satisfaction, demographic structure of the community), and health district, the variance in the indicators was mainly attributable to differences between patients, independently of the attending health professional, the center, or the healthcare organization, both in children (94.21% for visits to the doctor; 96.66% for referrals; 98.57% for prescription costs; 90.02% for potentially avoidable hospitalizations for ACSCs) and in adults (88.10%; 96.26%; 97.92%; and 93.77%, respectively). The limited contribution of health professionals and organizations to variability in indicators should be taken into account when performing evaluations and planning quality improvement strategies. PMID:26252315

Paying for Forest Ecosystem Services: Voluntary Versus Mandatory Payments.

PubMed

Roesch-McNally, Gabrielle E; Rabotyagov, Sergey S

2016-03-01

The emergence of new markets for forest ecosystem services can be a compelling opportunity for market diversification for private forest landowners, while increasing the provision of public goods from private lands. However, there is limited information available on the willingness-to-pay (WTP) for specific forest ecosystem services, particularly across different ecosystem market mechanisms. We utilize survey data from Oregon and Washington households to compare marginal WTP for forest ecosystem services and the total WTP for cost-effective bundles of forest ecosystem services obtained from a typical Pacific Northwest forest across two value elicitation formats representing two different ecosystem market mechanisms: an incentive-compatible choice experiment involving mandatory tax payments and a hypothetical private provision scenario modeled as eliciting contributions to the preferred forest management alternative via a provision point mechanism with a refund. A representative household's total WTP for the average forest management program was estimated at $217.59 per household/year under a mandatory tax mechanism and $160.44 per household/per year under a voluntary, crowdfunding-style, contribution mechanism; however, these estimates are not statistically different. Marginal WTP estimates were assessed for particular forest ecosystem service attributes including water quality, carbon storage, mature forest habitat, and public recreational access. This study finds that survey respondents place significant economic value on forest ecosystem services in both elicitation formats and that the distributions of the marginal WTP are not statistically significantly different.

Paying for Forest Ecosystem Services: Voluntary Versus Mandatory Payments

NASA Astrophysics Data System (ADS)

Roesch-McNally, Gabrielle E.; Rabotyagov, Sergey S.

2016-03-01

The emergence of new markets for forest ecosystem services can be a compelling opportunity for market diversification for private forest landowners, while increasing the provision of public goods from private lands. However, there is limited information available on the willingness-to-pay (WTP) for specific forest ecosystem services, particularly across different ecosystem market mechanisms. We utilize survey data from Oregon and Washington households to compare marginal WTP for forest ecosystem services and the total WTP for cost-effective bundles of forest ecosystem services obtained from a typical Pacific Northwest forest across two value elicitation formats representing two different ecosystem market mechanisms: an incentive-compatible choice experiment involving mandatory tax payments and a hypothetical private provision scenario modeled as eliciting contributions to the preferred forest management alternative via a provision point mechanism with a refund. A representative household's total WTP for the average forest management program was estimated at 217.59 per household/year under a mandatory tax mechanism and 160.44 per household/per year under a voluntary, crowdfunding-style, contribution mechanism; however, these estimates are not statistically different. Marginal WTP estimates were assessed for particular forest ecosystem service attributes including water quality, carbon storage, mature forest habitat, and public recreational access. This study finds that survey respondents place significant economic value on forest ecosystem services in both elicitation formats and that the distributions of the marginal WTP are not statistically significantly different.

Evaluation of Public Service Advertising Messages with Local and Non-Local Source Attribution: A Controlled Laboratory Experiment.

ERIC Educational Resources Information Center

Lynn, Jerry R.; Gagnard, Alice

A study was conducted to examine message evaluations of selected public service advertisements (PSAs) by a young adult population and to test whether local and nonlocal source attribution would influence those evaluations. In addition, the study investigated the extent to which audience characteristics such as fatalism (the degree to which a…

The Longitudinal Emergency Medical Technician (EMT) Attributes and Demographics Study (LEADS): The First 10 Years and a Look at Public Perception of Emergency Medical Services (EMS).

PubMed

Crowe, Remle P; Bentley, Melissa A; Levine, Roger

2016-12-01

Crowe RP , Bentley MA , Levine R . The Longitudinal Emergency Medical Technician (EMT) Attributes and Demographics Study (LEADS): the first 10 years and a look at public perception of Emergency Medical Services (EMS). Prehosp Disaster Med. 2016;31(Suppl. 1):s1-s6.

Global mortality attributable to aircraft cruise emissions.

PubMed

Barrett, Steven R H; Britter, Rex E; Waitz, Ian A

2010-10-01

Aircraft emissions impact human health though degradation of air quality. The majority of previous analyses of air quality impacts from aviation have considered only landing and takeoff emissions. We show that aircraft cruise emissions impact human health over a hemispheric scale and provide the first estimate of premature mortalities attributable to aircraft emissions globally. We estimate ∼8000 premature mortalities per year are attributable to aircraft cruise emissions. This represents ∼80% of the total impact of aviation (where the total includes the effects of landing and takeoff emissions), and ∼1% of air quality-related premature mortalities from all sources. However, we note that the impact of landing and takeoff emissions is likely to be under-resolved. Secondary H(2)SO(4)-HNO(3)-NH(3) aerosols are found to dominate mortality impacts. Due to the altitude and region of the atmosphere at which aircraft emissions are deposited, the extent of transboundary air pollution is particularly strong. For example, we describe how strong zonal westerly winds aloft, the mean meridional circulation around 30-60°N, interaction of aircraft-attributable aerosol precursors with background ammonia, and high population densities in combination give rise to an estimated ∼3500 premature mortalities per year in China and India combined, despite their relatively small current share of aircraft emissions. Subsidence of aviation-attributable aerosol and aerosol precursors occurs predominantly around the dry subtropical ridge, which results in reduced wet removal of aviation-attributable aerosol. It is also found that aircraft NO(x) emissions serve to increase oxidation of nonaviation SO(2), thereby further increasing the air quality impacts of aviation. We recommend that cruise emissions be explicitly considered in the development of policies, technologies and operational procedures designed to mitigate the air quality impacts of air transportation.

How the quality and processing attributes of commercial sweet sorghum hybrids and cultivar compare for biorefining

USDA-ARS?s Scientific Manuscript database

Quality and processing attributes of sweet sorghum (Sorghum bicolor L. Moench) biomass are critical to the development of a large-scale industry for the manufacture of bioproducts. Two commercial sweet sorghum hybrids 105 and 106, later and earlier maturing, respectively, were compared to inbred, l...

The Incorporation of Quality Attributes into Online Course Design in Higher Education

ERIC Educational Resources Information Center

Lenert, Kathleen Anne; Diane P. Janes

2017-01-01

A survey was designed incorporating questions on 28 attributes (compiled through a literature review) and considered to be quality features in online academic courses in higher education. This study sought to investigate the ongoing practice of instructional designers and instructors in the United States with respect to their incorporation of…

Hydrodynamic pressure processing: Impact on the quality attributes of fresh and further-processed meat products

USDA-ARS?s Scientific Manuscript database

This book chapter reviews hydrodynamic pressure processing (HDP) as an innovative, postharvest technology for enhancing the quality attributes of fresh and further-processed meat products. A variety of meat products have been tested for their response to the high pressure shockwaves of HDP. The st...

Evaluation of Communication about Groups: The Hydra Phenomenon.

ERIC Educational Resources Information Center

Desmond, Roger Jon; Bezzini, John

A study investigated how the attribution of a problem solution to an individual or group affects the consumer's perception of the solution's quality. Based on the tendency to support group decision-making (Hydra phenomenon) it was predicted that decisions attributed to groups would be perceived as higher in quality than those made by individuals,…

Clinic Design as Placebo—Using Design to Promote Healing and Support Treatments

PubMed Central

Schuster, Kai

2017-01-01

Analogously to the medical placebo effect, people seem to anticipate the quality of treatments based on external stimuli. In order to gain insights on the effect the built environment can have on a person’s judgments and behavior with a particular focus on health related issues, a quantitative survey (N = 851) with four groups before and after the renovation of a rehabilitation clinic has been conducted. In line with an overall modernization of the clinic, the entrance, the lobby, and some patient rooms have been changed. In the lobby, a service counter and coffee bar have been added as well as light colors and new flooring material to achieve a more modern and clean atmosphere in the sense of aesthetical appearance of the space. The outcome revealed that patients rate the intention to change their health behavior as well as the quality of food or significantly higher in a modernized clinic. These differences cannot be directly attributed solely to the changes in the building. Analogously to the medical placebo, an effect referred to as design placebo effect is, therefore, proposed to explain improved ratings of aspects that have not directly been changed due to the intervention. Other significant effects are attributable to winter and summer climate. During summer time, ratings for waiting area, atmosphere, patient rooms, as well as for staff were significantly higher. It is, therefore, assumed that aesthetic attributes, such as architectural design, or friendliness of the weather, exert their effects as perceptual placebos that directly influence judgment outcomes and behavioral intentions. Further research is needed to match certain design and general environmental features to their effects on patients and investigate their effect strength. PMID:29120378

Job preferences among clinical officers in public sector facilities in rural Kenya: a discrete choice experiment.

PubMed

Takemura, Toshio; Kielmann, Karina; Blaauw, Duane

2016-01-08

Clinical officers (COs), a mid-level cadre of health worker, are the backbone of healthcare provision in rural Kenya. However, the vacancy rate for COs in rural primary healthcare facilities is high. Little is known about factors motivating COs' preferences for rural postings. A discrete choice experiment (DCE) questionnaire was used with 57 COs at public health facilities in nine districts of Nyanza Province, Kenya. The questionnaire was developed on the basis of formative qualitative interviews with COs (n = 5) and examined how five selected job attributes influenced COs' preferences for working in rural areas. Conditional logit models were employed to examine the relative importance of different job attributes. Analysis of the qualitative data revealed five important job attributes influencing COs' preferences: quality of the facility, educational opportunities, housing, monthly salary and promotion. Analysis of the DCE indicated that a 1-year guaranteed study leave after 3 years of service would have the greatest impact on retention, followed by good quality health facility infrastructure and equipment and a 30% salary increase. Sub-group analysis shows that younger COs demonstrated a significantly stronger preference for study leave than older COs. Female COs placed significantly higher value on promotion than male COs. Although both financial incentives and non-financial incentives were effective in motivating COs to stay in post, the study leave intervention was shown to have the strongest impact on COs' retention in our study. Further research is required to examine appropriate interventions at each career stage that might boost COs' professional identity and status but without leading to larger deficits in the availability of generalist COs.

Clinic Design as Placebo-Using Design to Promote Healing and Support Treatments.

PubMed

Rehn, Jonas; Schuster, Kai

2017-11-09

Analogously to the medical placebo effect, people seem to anticipate the quality of treatments based on external stimuli. In order to gain insights on the effect the built environment can have on a person's judgments and behavior with a particular focus on health related issues, a quantitative survey ( N = 851) with four groups before and after the renovation of a rehabilitation clinic has been conducted. In line with an overall modernization of the clinic, the entrance, the lobby, and some patient rooms have been changed. In the lobby, a service counter and coffee bar have been added as well as light colors and new flooring material to achieve a more modern and clean atmosphere in the sense of aesthetical appearance of the space. The outcome revealed that patients rate the intention to change their health behavior as well as the quality of food or significantly higher in a modernized clinic. These differences cannot be directly attributed solely to the changes in the building. Analogously to the medical placebo, an effect referred to as design placebo effect is, therefore, proposed to explain improved ratings of aspects that have not directly been changed due to the intervention. Other significant effects are attributable to winter and summer climate. During summer time, ratings for waiting area, atmosphere, patient rooms, as well as for staff were significantly higher. It is, therefore, assumed that aesthetic attributes, such as architectural design, or friendliness of the weather, exert their effects as perceptual placebos that directly influence judgment outcomes and behavioral intentions. Further research is needed to match certain design and general environmental features to their effects on patients and investigate their effect strength.

Customer satisfaction survey to improve the European cystic fibrosis external quality assessment scheme.

PubMed

Berwouts, Sarah; Dequeker, Elisabeth

2011-08-01

The Cystic Fibrosis European Network, coordinated from within the Katholieke Universiteit Leuven, is the provider of the European cystic fibrosis external quality assessment (EQA) scheme. The network aimed to seek feedback from laboratories that participated in the cystic fibrosis scheme in order to improve services offered. In this study we analysed responses to an on-line customer satisfaction survey conducted between September and November 2009. The survey was sent to 213 laboratories that participated in the cystic fibrosis EQA scheme of 2008; 69 laboratories (32%) responded. Scores for importance and satisfaction were obtained from a five-point Likert scale for 24 attributes. A score of one corresponded to very dissatisfied/very unimportant and five corresponded to very satisfied/very important. Means were calculated and placed in a two-dimensional grid (importance-satisfaction analysis). Means were subtracted from each other to obtain gap values (gap-analysis). No attribute had a mean score below 3.63. The overall mean of satisfaction was 4.35. Opportunities for improvement enclosed clarity, usefulness and completeness of the general report and individual comments, and user-friendliness of the electronic datasheet. This type of customer satisfaction survey was a valuable instrument to identify opportunities to improve the cystic fibrosis EQA scheme. It should be conducted on a regular basis to reveal new opportunities in the future and to assess effectiveness of actions taken. Moreover, it could be a model for other EQA providers seeking feedback from participants. Overall, the customer satisfaction survey provided a powerful quality of care improvement tool.

Attributions of Mental Illness: An Ethnically Diverse Community Perspective.

PubMed

Bignall, Whitney J Raglin; Jacquez, Farrah; Vaughn, Lisa M

2015-07-01

Although the prevalence of mental illness is similar across ethnic groups, a large disparity exists in the utilization of services. Mental health attributions, causal beliefs regarding the etiology of mental illness, may contribute to this disparity. To understand mental health attributions across diverse ethnic backgrounds, we conducted focus groups with African American (n = 8; 24 %), Asian American (n = 6; 18 %), Latino/Hispanic (n = 9; 26 %), and White (n = 11; 32 %) participants. We solicited attributions about 19 mental health disorders, each representing major sub-categories of the DSM-IV. Using a grounded theory approach, participant responses were categorized into 12 themes: Biological, Normalization, Personal Characteristic, Personal Choice, Just World, Spiritual, Family, Social Other, Environment, Trauma, Stress, and Diagnosis. Results indicate that ethnic minorities are more likely than Whites to mention spirituality and normalization causes. Understanding ethnic minority mental health attributions is critical to promote treatment-seeking behaviors and inform culturally responsive community-based mental health services.

Reliability and Validity of a Measure of Preschool Teachers' Attributions for Disruptive Behavior

ERIC Educational Resources Information Center

Carter, Lauren M.; Williford, Amanda P.; LoCasale-Crouch, Jennifer

2014-01-01

Research Findings: This study examined the quality of teacher attributions for child disruptive behavior using a new measure, the Preschool Teaching Attributions measure. A sample of 153 early childhood teachers and 432 children participated. All teachers completed the behavior attributions measure, as well as measures regarding demographics,…

A Quadrupole Dalton-based multi-attribute method for product characterization, process development, and quality control of therapeutic proteins.

PubMed

Xu, Weichen; Jimenez, Rod Brian; Mowery, Rachel; Luo, Haibin; Cao, Mingyan; Agarwal, Nitin; Ramos, Irina; Wang, Xiangyang; Wang, Jihong

2017-10-01

During manufacturing and storage process, therapeutic proteins are subject to various post-translational modifications (PTMs), such as isomerization, deamidation, oxidation, disulfide bond modifications and glycosylation. Certain PTMs may affect bioactivity, stability or pharmacokinetics and pharmacodynamics profile and are therefore classified as potential critical quality attributes (pCQAs). Identifying, monitoring and controlling these PTMs are usually key elements of the Quality by Design (QbD) approach. Traditionally, multiple analytical methods are utilized for these purposes, which is time consuming and costly. In recent years, multi-attribute monitoring methods have been developed in the biopharmaceutical industry. However, these methods combine high-end mass spectrometry with complicated data analysis software, which could pose difficulty when implementing in a quality control (QC) environment. Here we report a multi-attribute method (MAM) using a Quadrupole Dalton (QDa) mass detector to selectively monitor and quantitate PTMs in a therapeutic monoclonal antibody. The result output from the QDa-based MAM is straightforward and automatic. Evaluation results indicate this method provides comparable results to the traditional assays. To ensure future application in the QC environment, this method was qualified according to the International Conference on Harmonization (ICH) guideline and applied in the characterization of drug substance and stability samples. The QDa-based MAM is shown to be an extremely useful tool for product and process characterization studies that facilitates facile understanding of process impact on multiple quality attributes, while being QC friendly and cost-effective.

Service quality in health care setting.

PubMed

Rashid, Wan Edura Wan; Jusoff, Hj Kamaruzaman

2009-01-01

This paper attempts to explore the concept of service quality in a health care setting. This paper probes the definition of service quality from technical and functional aspects for a better understanding on how consumers evaluate the quality of health care. It adopts the conceptual model of service quality frequently used by the most researchers in the health care sector. The paper also discusses several service quality dimensions and service quality problems in order to provide a more holistic conception of hospital service quality. The paper finds that service quality in health care is very complex as compared to other services because this sector highly involves risk. The paper adds a new perspective towards understanding how the concept of service quality is adopted in a health care setting.

Implications of a valuation study for ecological and social indicators associated with Everglades restoration.

PubMed

Seeteram, Nadia A; Engel, Victor; Mozumder, Pallab

2018-06-15

The Everglades of south Florida, although degraded, imparts vital ecosystem benefits, including contributions to high quality drinking water supplies and habitat for a number of threatened and endangered species. Restoration of the Everglades can improve the provision of these benefits but also may impose tradeoffs with competing societal demands. This study focuses on understanding public preferences for Everglades restoration and estimating the willingness to pay (WTP) values for restored ecosystem services (ES) through the implementation of a discrete choice experiment (DCE). We collected data from 2302 respondents from the general public from an online survey designed to elicit WTP values for selected ecological and social attributes associated with Everglades restoration scenarios. We compare the findings to results from earlier studies (Milon et al., 1999; Milon and Scrogin, 2005), which also estimated WTP values among Floridians for Everglades restoration. For some attributes, WTP for Everglades restoration appears to have slightly increased while for others WTP appears to have decreased. We estimated statewide aggregate WTP values for components of species population restoration up to $2B over 10 years. Several factors impeded a direct comparison of current and historical WTP values, including time elapsed, different samples and sampling methods- which may have implications for integrating ecosystem service valuation studies into water management decisions. Copyright © 2018 Elsevier B.V. All rights reserved.

Advanced networks and computing in healthcare

PubMed Central

Ackerman, Michael

2011-01-01

As computing and network capabilities continue to rise, it becomes increasingly important to understand the varied applications for using them to provide healthcare. The objective of this review is to identify key characteristics and attributes of healthcare applications involving the use of advanced computing and communication technologies, drawing upon 45 research and development projects in telemedicine and other aspects of healthcare funded by the National Library of Medicine over the past 12 years. Only projects publishing in the professional literature were included in the review. Four projects did not publish beyond their final reports. In addition, the authors drew on their first-hand experience as project officers, reviewers and monitors of the work. Major themes in the corpus of work were identified, characterizing key attributes of advanced computing and network applications in healthcare. Advanced computing and network applications are relevant to a range of healthcare settings and specialties, but they are most appropriate for solving a narrower range of problems in each. Healthcare projects undertaken primarily to explore potential have also demonstrated effectiveness and depend on the quality of network service as much as bandwidth. Many applications are enabling, making it possible to provide service or conduct research that previously was not possible or to achieve outcomes in addition to those for which projects were undertaken. Most notable are advances in imaging and visualization, collaboration and sense of presence, and mobility in communication and information-resource use. PMID:21486877

Temperature affects long-term productivity and quality attributes of day-neutral strawberry for a space life-support system

NASA Astrophysics Data System (ADS)

Massa, Gioia D.; Chase, Elaine; Santini, Judith B.; Mitchell, Cary A.

2015-04-01

Strawberry (Fragaria x ananassa L.) is a promising candidate crop for space life-support systems with desirable sensory quality and health attributes. Day-neutral cultivars such as 'Seascape' are adaptable to a range of photoperiods, including short days that would save considerable energy for crop lighting without reductions in productivity or yield. Since photoperiod and temperature interact to affect strawberry growth and development, several diurnal temperature regimes were tested under a short photoperiod of 10 h per day for effects on yield and quality attributes of 'Seascape' strawberry during production cycles longer than 270 days. The coolest day/night temperature regime, 16°/8 °C, tended to produce smaller numbers of larger fruit than did the intermediate temperature range of 18°/10 °C or the warmest regime, 20°/12 °C, both of which produced similar larger numbers of smaller fruit. The intermediate temperature regime produced the highest total fresh mass of berries over an entire production cycle. Independent experiments examined either organoleptic or physicochemical quality attributes. Organoleptic evaluation indicated that fruit grown under the coolest temperature regime tended to score the highest for both hedonic preference and descriptive evaluation of sensory attributes related to sweetness, texture, aftertaste, and overall approval. The physicochemical quality attributes Brix, pH, and sugar/acid ratio were highest for fruits harvested from the coolest temperature regime and lower for those from the warmer temperature regimes. The cool-regime fruits also were lowest in titratable acidity. The yield parameters fruit number and size oscillated over the course of a production cycle, with a gradual decline in fruit size under all three temperature regimes. Brix and titratable acidity both decreased over time for all three temperature treatments, but sugar/acid ratio remained highest for the cool temperature regime over the entire production period. Periodic rejuvenation or replacement of strawberry propagules may be needed to maintain both quality and quantity of strawberry yield in space.

Remote sensing of ecosystem health: opportunities, challenges, and future perspectives.

PubMed

Li, Zhaoqin; Xu, Dandan; Guo, Xulin

2014-11-07

Maintaining a healthy ecosystem is essential for maximizing sustainable ecological services of the best quality to human beings. Ecological and conservation research has provided a strong scientific background on identifying ecological health indicators and correspondingly making effective conservation plans. At the same time, ecologists have asserted a strong need for spatially explicit and temporally effective ecosystem health assessments based on remote sensing data. Currently, remote sensing of ecosystem health is only based on one ecosystem attribute: vigor, organization, or resilience. However, an effective ecosystem health assessment should be a comprehensive and dynamic measurement of the three attributes. This paper reviews opportunities of remote sensing, including optical, radar, and LiDAR, for directly estimating indicators of the three ecosystem attributes, discusses the main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system, and provides some future perspectives. The main challenges to develop a remote sensing-based spatially-explicit comprehensive ecosystem health system are: (1) scale issue; (2) transportability issue; (3) data availability; and (4) uncertainties in health indicators estimated from remote sensing data. However, the Radarsat-2 constellation, upcoming new optical sensors on Worldview-3 and Sentinel-2 satellites, and improved technologies for the acquisition and processing of hyperspectral, multi-angle optical, radar, and LiDAR data and multi-sensoral data fusion may partly address the current challenges.

Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE)

PubMed Central

Woldesenbet, Selamawit; Jackson, Debra; Lombard, Carl; Dinh, Thu-Ha; Puren, Adrian; Sherman, Gayle; Ramokolo, Vundli; Doherty, Tanya; Mogashoa, Mary; Bhardwaj, Sanjana; Chopra, Mickey; Shaffer, Nathan; Pillay, Yogan; Goga, Ameena

2015-01-01

Objectives We examined uptake of prevention of mother-to-child HIV transmission (PMTCT) services, predictors of missed opportunities, and infant HIV transmission attributable to missed opportunities along the PMTCT cascade across South Africa. Methods A cross-sectional survey was conducted among 4–8 week old infants receiving first immunisations in 580 nationally representative public health facilities in 2010. This included maternal interviews and testing infants’ dried blood spots for HIV. A weighted analysis was performed to assess uptake of antenatal and perinatal PMTCT services along the PMTCT cascade (namely: maternal HIV testing, CD4 count test/result, and receiving maternal and infant antiretroviral treatment) and predictors of dropout. The population attributable fraction associated with dropouts at each service point are estimated. Results Of 9,803 mothers included, 31.7% were HIV-positive as identified by reactive infant antibody tests. Of these 80.4% received some form of maternal and infant antiretroviral treatment. More than a third (34.9%) of mothers dropped out from one or more steps in the PMTCT service cascade. In a multivariable analysis, the following characteristics were associated with increased dropout from the PMTCT cascade: adolescent (<20 years) mothers, low socioeconomic score, low education level, primiparous mothers, delayed first antenatal visit, homebirth, and non-disclosure of HIV status. Adolescent mothers were twice (adjusted odds ratio: 2.2, 95% confidence interval: 1.5–3.3) as likely to be unaware of their HIV-positive status and had a significantly higher rate (85.2%) of unplanned pregnancies compared to adults aged ≥20 years (55.5%, p = 0.0001). A third (33.8%) of infant HIV infections were attributable to dropout in one or more steps in the cascade. Conclusion A third of transmissions attributable to missed opportunities of PMTCT services can be prevented by optimizing the uptake of PMTCT services. Identified risk factors for low PMTCT service uptake should be addressed through health facility and community-level interventions, including raising awareness, promoting women education, adolescent focused interventions, and strengthening linkages/referral-system between communities and health facilities. PMID:26147598

Service quality and clinical outcomes: an example from mental health rehabilitation services in England.

PubMed

Killaspy, Helen; Marston, Louise; Omar, Rumana Z; Green, Nicholas; Harrison, Isobel; Lean, Melanie; Holloway, Frank; Craig, Tom; Leavey, Gerard; King, Michael

2013-01-01

Current health policy assumes better quality services lead to better outcomes. To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes. Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes. A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life. Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.

Best Practices for Making Scientific Data Discoverable and Accessible through Integrated, Standards-Based Data Portals

NASA Astrophysics Data System (ADS)

Lucido, J. M.

2013-12-01

Scientists in the fields of hydrology, geophysics, and climatology are increasingly using the vast quantity of publicly-available data to address broadly-scoped scientific questions. For example, researchers studying contamination of nearshore waters could use a combination of radar indicated precipitation, modeled water currents, and various sources of in-situ monitoring data to predict water quality near a beach. In discovering, gathering, visualizing and analyzing potentially useful data sets, data portals have become invaluable tools. The most effective data portals often aggregate distributed data sets seamlessly and allow multiple avenues for accessing the underlying data, facilitated by the use of open standards. Additionally, adequate metadata are necessary for attribution, documentation of provenance and relating data sets to one another. Metadata also enable thematic, geospatial and temporal indexing of data sets and entities. Furthermore, effective portals make use of common vocabularies for scientific methods, units of measure, geologic features, chemical, and biological constituents as they allow investigators to correctly interpret and utilize data from external sources. One application that employs these principles is the National Ground Water Monitoring Network (NGWMN) Data Portal (http://cida.usgs.gov/ngwmn), which makes groundwater data from distributed data providers available through a single, publicly accessible web application by mediating and aggregating native data exposed via web services on-the-fly into Open Geospatial Consortium (OGC) compliant service output. That output may be accessed either through the map-based user interface or through the aforementioned OGC web services. Furthermore, the Geo Data Portal (http://cida.usgs.gov/climate/gdp/), which is a system that provides users with data access, subsetting and geospatial processing of large and complex climate and land use data, exemplifies the application of International Standards Organization (ISO) metadata records to enhance data discovery for both human and machine interpretation. Lastly, the Water Quality Portal (http://www.waterqualitydata.us/) achieves interoperable dissemination of water quality data by referencing a vocabulary service for mapping constituents and methods between the USGS and USEPA. The NGWMN Data Portal, Geo Data Portal and Water Quality Portal are three examples of best practices when implementing data portals that provide distributed scientific data in an integrated, standards-based approach.

Quality of Maternal and Neonatal Care in Albania, Turkmenistan and Kazakhstan: A Systematic, Standard-Based, Participatory Assessment

PubMed Central

Tamburlini, Giorgio; Siupsinskas, Gelmius; Bacci, Alberta

2011-01-01

Background Progress in maternal and neonatal mortality has been slow in many countries despite increasing access to institutional births, suggesting deficiencies in the quality of care. We carried out a systematic assessment of the quality of maternal and newborn care in three CEE/CIS countries, using an innovative approach to identify priority issues and promote action. Methods A standard-based tool, covering over 400 items grouped in 13 main areas ranging from support services to case management, was used to assess a sample of ten maternity hospitals in Albania, Kazakhstan and Turkmenistan. Sources of information were visit to services, medical records, observation of cases, and interviews with staff and mothers. A score (range 0 to 3) was attributed to each item and area of care. The assessment was carried out by a multidisciplinary team of international and national professionals. Local managers and staff provided the necessary information and were involved in discussing the findings and the priority actions. Results Quality of care was found to be substandard in all 13 areas. The lowest scores (between one and two) were obtained by: management of normal labour, delivery, obstetric complications and sick babies; infection prevention; use of guidelines and audits; monitoring and follow-up. Neonatal care as a whole scored better than obstetric care. Interviewed mothers identified lack of information, insufficient support during labour and lack of companionship as main issues. Actions to improve quality of care were identified at facility as well as at central level and framed according to main health system functions. Conclusions Quality of care is a key issue to improve maternal and neonatal outcomes, particularly in countries such as CEE/CIS where access to institutional births is nearly universal. Approaches that involve health professionals and managers in comprehensive, action-oriented assessments of quality of care are promising and should be further supported. PMID:22216110

Private-Sector Social Franchising to Accelerate Family Planning Access, Choice, and Quality: Results From Marie Stopes International.

PubMed

Munroe, Erik; Hayes, Brendan; Taft, Julia

2015-06-17

To achieve the global Family Planning 2020 (FP2020) goal of reaching 120 million more women with voluntary family planning services, rapid scale-up of services is needed. Clinical social franchising, a service delivery approach used by Marie Stopes International (MSI) in which small, independent health care businesses are organized into quality-assured networks, provides an opportunity to engage the private sector in improving access to family planning and other health services. We analyzed MSI's social franchising program against the 4 intended outputs of access, efficiency, quality, and equity. The analysis used routine service data from social franchising programs in 17 African and Asian countries (2008-2014) to estimate number of clients reached, couple-years of protection (CYPs) provided, and efficiency of services; clinical quality audits of 636 social franchisees from a subset of the 17 countries (2011-2014); and exit interviews with 4,844 clients in 14 countries (2013) to examine client satisfaction, demographics (age and poverty), and prior contraceptive use. The MSI "Impact 2" model was used to estimate population-level outcomes by converting service data into estimated health outcomes. Between 2008 and 2014, an estimated 3,753,065 women cumulatively received voluntary family planning services via 17 national social franchise programs, with a sizable 68% choosing long-acting reversible contraceptives (LARCs). While the number of social franchisee outlets increased over time, efficiency also significantly improved over time, with each outlet delivering, on average, 178 CYPs in 2008 compared with 941 CYPs in 2014 (P = .02). Clinical quality audit scores also significantly improved; 39.8% of social franchisee outlets scored over 80% in 2011 compared with 84.1% in 2014. In 2013, 40.7% of the clients reported they had not been using a modern method during the 3 months prior to their visit (95% CI = 37.4, 44.0), with 46.1% (95% CI = 40.9, 51.2) of them reporting having never previously used family planning at all. Analysis of age and poverty levels of clients indicate mixed results in bridging equity gaps: 57.4% of clients lived on under US$2.50/day in 2013 (95% CI = 54.9, 60.0) and 26.1% were 15-24 years old (95% CI = 23.8, 28.4), but only 15.1% lived on less than $1.25/day (95% CI = 13.8, 16.4) and 5.0% were 15-19 years old (95% CI = 3.9, 6.1). The services provided via social franchising are estimated to avert 4,958,000 unintended pregnancies and 7,150 maternal deaths. Social franchising through the existing private sector has the ability to rapidly scale-up access to high-quality family planning services, including LARCs, for the general population as well as young women and the poor, providing a promising model to help achieve the global FP2020 goal. © Munroe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/

Modernization of software quality assurance

NASA Technical Reports Server (NTRS)

Bhaumik, Gokul

1988-01-01

The customers satisfaction depends not only on functional performance, it also depends on the quality characteristics of the software products. An examination of this quality aspect of software products will provide a clear, well defined framework for quality assurance functions, which improve the life-cycle activities of software development. Software developers must be aware of the following aspects which have been expressed by many quality experts: quality cannot be added on; the level of quality built into a program is a function of the quality attributes employed during the development process; and finally, quality must be managed. These concepts have guided our development of the following definition for a Software Quality Assurance function: Software Quality Assurance is a formal, planned approach of actions designed to evaluate the degree of an identifiable set of quality attributes present in all software systems and their products. This paper is an explanation of how this definition was developed and how it is used.

Demand assessment and price-elasticity estimation of quality-improved primary health care in Palestine: a contribution from the contingent valuation method.

PubMed

Mataria, Awad; Luchini, Stéphane; Daoud, Yousef; Moatti, Jean-Paul

2007-10-01

This paper proposes a new methodology to assess demand and price-elasticity for health care, based on patients' stated willingness to pay (WTP) values for certain aspects of health care quality improvements. A conceptual analysis of how respondents consider contingent valuation (CV) questions allowed us to specify a probability density function of stated WTP values, and consequently, to model a demand function for quality-improved health care, using a parametric survival approach. The model was empirically estimated using a CV study intended to assess patients' values for improving the quality of primary health care (PHC) services in Palestine. A random sample of 499 individuals was interviewed following medical consultation in four PHC centers. Quality was assessed using a multi-attribute approach; and respondents valued seven specific quality improvements using a decomposed valuation scenario and a payment card elicitation technique. Our results suggest an inelastic demand at low user fees levels, and when the price-increase is accompanied with substantial quality-improvements. Nevertheless, demand becomes more and more elastic if user fees continue to rise. On the other hand, patients' reactions to price-increase turn out to depend on their level of income. Our results can be used to design successful health care financing strategies that include a consideration of patients' preferences and financial capacities. John Wiley & Sons, Ltd.

Quality effort decision in service supply chain with quality preference based on quantum game

NASA Astrophysics Data System (ADS)

Zhang, Cuihua; Xing, Peng; Wang, Jianwei

2015-04-01

Service quality preference behaviors of both members are considered in service supply chain (SSC) including a service integrator and a service provider with stochastic demand. Through analysis of service quality cost and revenue, the utility functions are established on service quality effort degree and service quality preference level in integrated and decentralized SSC. Nash equilibrium and quantum game are used to optimize the models. By comparing the different solutions, the optimal strategies are obtained in SSC with quality preference. Then some numerical examples are studied and the changing trend of service quality effort is further analyzed by the influence of the entanglement operator and quality preferences.

Probiotic supplementation and fast freezing to improve quality attributes and oxidation stability of frozen chicken breast muscle

USDA-ARS?s Scientific Manuscript database

The objective of this study was to determine the effects of probiotic supplementation and fast freezing on quality attributes and oxidation stability of frozen/thawed chicken breast meat. Broilers were fed with a basal diet or the basal diet plus 250 ppm Sporulin (three strains of Bacillus subtilis)...

Comparison of optimal wavelengths selection methods for visible/near-infrared prediction of apple firmness and soluble solids content

USDA-ARS?s Scientific Manuscript database

Visible and near-infrared (Vis-NIR) spectroscopy is now being used for nondestructive quality measurement of fruits and other food products. To implement the technology, it is necessary to develop an effective calibration model relating the acquired spectral data to the quality attribute(s) of inter...

Song and Male Quality in Prairie Warblers

Treesearch

Bruce E. Byers; Michael E. Akresh; David I. King; W. Koenig

2016-01-01

To determine if the songs of male prairie warblers could potentially reveal to female listeners information about the quality of singers, we compared various aspects of prairie warbler song structure and performance to attributes that might reflect a male singer's potential to enhance the fitness of his mate. We found that all the tested male attributes—arrival...

Relating instrumental texture, determined relating instrumental texture, determined attachments, to sensory analysis of rainbow trout, Oncorhynchus mykiss, fillets

USDA-ARS?s Scientific Manuscript database

Texture is one of the most important quality attributes of fish fillets, and accurate assessment of variation in this attribute, as affected by storage and handling, is critical in providing consistent quality product. Trout fillets received 4 treatments: 3-d refrigeration (R3), 7-d refrigeration (R...

Quality Management: An "Essential Attributes" Approach. A Case Study towards a Sustainable Model of Course Effectiveness Evaluation

ERIC Educational Resources Information Center

Murphy, Francis S.

2005-01-01

Education of potential professional engineers should take account of the type of employment that they will eventually obtain. The quality of an engineering degree course can be judged by assessing whether the correct balance of "essential attributes" has been effectively obtained. This case study is concerned with assessing the balance…

Emerging markets for imported beef in China: Results from a consumer choice experiment in Beijing.

PubMed

Ortega, David L; Hong, Soo Jeong; Wang, H Holly; Wu, Laping

2016-11-01

The purpose of this study is to explore emerging markets for imported beef in China by assessing Beijing consumer demand for quality attributes. This study utilizes data from an in-store choice experiment to evaluate consumer willingness-to-pay for select food quality attributes (food safety, animal welfare, Green Food and Organic certification) taking into account country-of-origin information. Our results show that Beijing consumers value food safety information the most, and are willing to pay more for Australian beef products than for US or domestic (Chinese) beef. We explore the various relationships between the quality attributes, find evidence of preference heterogeneity and discuss agribusiness and marketing implications of our findings. Copyright © 2016 Elsevier Ltd. All rights reserved.

Exploratory sensory profiling of three culinary preparations of potatoes (Solanum tuberosum L.).

PubMed

Seefeldt, Helene F; Tønning, Erik; Thybo, Anette K

2011-01-15

A consumer-oriented description of potato quality with regard to culinary preparation could increase potato consumption. The aim of this study was to investigate the sensory attributes in 11 potato varieties grown at two locations and used for three culinary preparations. Sensory evaluation of the potatoes served either as boiled, oven-fried or mashed were performed using 15-19 descriptors for appearance, flavour and texture attributes. A principal component analysis revealed that 45% of the variation in the sensory data was related to variety differences, which was ascribed to variation in appearance, dry matter content and texture. Growing location also significantly affected appearance and texture. The sensory panel judged the sensory attributes 'yellowness', 'hardness', 'adhesiveness' and 'moistness' to be important quality descriptors in all three culinary preparations. Internal references showed the high reproducibility of the sensory evaluations. The potatoes grown in a sandy location had higher content of dry matter compared to those grown in a clay location, affecting the quality. This study showed that it was possible to do reliable and reproducible sensory profiles in a potato material with a large span in quality. Sensory information based on few attributes can be used to describe culinary quality of potato varieties. Copyright © 2010 Society of Chemical Industry.

Valuing river characteristics using combined site choice and participation travel cost models.

PubMed

Johnstone, C; Markandya, A

2006-08-01

This paper presents new welfare measures for marginal changes in river quality in selected English rivers. The river quality indicators used include chemical, biological and habitat-level attributes. Economic values for recreational use of three types of river-upland, lowland and chalk-are presented. A survey of anglers was carried out and using these data, two travel cost models were estimated, one to predict the numbers of trips and the other to predict angling site choice. These models were then linked to estimate the welfare associated with marginal changes in river quality using the participation levels as estimated in the trip prediction model. The model results showed that higher flow rates, biological quality and nutrient pollution levels affect site choice and influence the likelihood of a fishing trip. Consumer surplus values per trip for a 10% change in river attributes range from pound 0.04 to pound 3.93 ( pound 2001) depending on the attribute.

Meeting ecological and societal needs for freshwater

USGS Publications Warehouse

Baron, Jill S.; Poff, N.L.; Angermeier, P.L.; Dahm, Clifford N.; Gleick, P.H.; Hairston, N.G.; Jackson, R.B.; Johnston, C.A.; Richter, B.D.; Steinman, A.D.

2002-01-01

Human society has used freshwater from rivers, lakes, groundwater, and wetlands for many different urban, agricultural, and industrial activities, but in doing so has overlooked its value in supporting ecosystems. Freshwater is vital to human life and societal well-being, and thus its utilization for consumption, irrigation, and transport has long taken precedence over other commodities and services provided by freshwater ecosystems. However, there is growing recognition that functionally intact and biologically complex aquatic ecosystems provide many economically valuable services and long-term benefits to society. The short-term benefits include ecosystem goods and services, such as food supply, flood control, purification of human and industrial wastes, and habitat for plant and animal life—and these are costly, if not impossible, to replace. Long-term benefits include the sustained provision of those goods and services, as well as the adaptive capacity of aquatic ecosystems to respond to future environmental alterations, such as climate change. Thus, maintenance of the processes and properties that support freshwater ecosystem integrity should be included in debates over sustainable water resource allocation.The purpose of this report is to explain how the integrity of freshwater ecosystems depends upon adequate quantity, quality, timing, and temporal variability of water flow. Defining these requirements in a comprehensive but general manner provides a better foundation for their inclusion in current and future debates about allocation of water resources. In this way the needs of freshwater ecosystems can be legitimately recognized and addressed. We also recommend ways in which freshwater ecosystems can be protected, maintained, and restored.Freshwater ecosystem structure and function are tightly linked to the watershed or catchment of which they are a part. Because riverine networks, lakes, wetlands, and their connecting groundwaters, are literally the “sinks” into which landscapes drain, they are greatly influenced by terrestrial processes, including many human uses or modifications of land and water. Freshwater ecosystems, whether lakes, wetlands, or rivers, have specific requirements in terms of quantity, quality, and seasonality of their water supplies. Sustainability normally requires these systems to fluctuate within a natural range of variation. Flow regime, sediment and organic matter inputs, thermal and light characteristics, chemical and nutrient characteristics, and biotic assemblages are fundamental defining attributes of freshwater ecosystems. These attributes impart relatively unique characteristics of productivity and biodiversity to each ecosystem. The natural range of variation in each of these attributes is critical to maintaining the integrity and dynamic potential of aquatic ecosystems; therefore, management should allow for dynamic change. Piecemeal approaches cannot solve the problems confronting freshwater ecosystems.Scientific definitions of the requirements to protect and maintain aquatic ecosystems are necessary but insufficient for establishing the appropriate distribution between societal and ecosystem water needs. For scientific knowledge to be implemented science must be connected to a political agenda for sustainable development. We offer these recommendations as a beginning to redress how water is viewed and managed in the United States: (1) Frame national and regional water management policies to explicitly incorporate freshwater ecosystem needs, particularly those related to naturally variable flow regimes and to the linking of water quality with water quantity; (2) Define water resources to include watersheds, so that freshwaters are viewed within a landscape, or systems context; (3) Increase communication and education across disciplines, especially among engineers, hydrologists, economists, and ecologists to facilitate an integrated view of freshwater resources; (4) Increase restoration efforts, using well-grounded ecological principles as guidelines; (5) Maintain and protect the remaining freshwater ecosystems that have high integrity; and (6) Recognize the dependence of human society on naturally functioning ecosystems.

NASA's Global Change Master Directory: Discover and Access Earth Science Data Sets, Related Data Services, and Climate Diagnostics

NASA Technical Reports Server (NTRS)

Aleman, Alicia; Olsen, Lola; Ritz, Scott; Morahan, Michael; Cepero, Laurel; Stevens, Tyler

2011-01-01

NASA's Global Change Master Directory provides the scientific community with the ability to discover, access, and use Earth science data, data-related services, and climate diagnostics worldwide. The GCMD offers descriptions of Earth science data sets using the Directory Interchange Format (DIF) metadata standard; Earth science related data services are described using the Service Entry Resource Format (SERF); and climate visualizations are described using the Climate Diagnostic (CD) standard. The DIF, SERF and CD standards each capture data attributes used to determine whether a data set, service, or climate visualization is relevant to a user's needs. Metadata fields include: title, summary, science keywords, service keywords, data center, data set citation, personnel, instrument, platform, quality, related URL, temporal and spatial coverage, data resolution and distribution information. In addition, nine valuable sets of controlled vocabularies have been developed to assist users in normalizing the search for data descriptions. An update to the GCMD's search functionality is planned to further capitalize on the controlled vocabularies during database queries. By implementing a dynamic keyword "tree", users will have the ability to search for data sets by combining keywords in new ways. This will allow users to conduct more relevant and efficient database searches to support the free exchange and re-use of Earth science data. http://gcmd.nasa.gov/

Social, moral, and temporal qualities: Pre-service teachers' considerations of evolution and creation

NASA Astrophysics Data System (ADS)

Hahn, Deirdre

The introduction of the theories of evolution into public education has created a history of misinterpretation and uncertainty about its application to understanding deep time and human origins. Conceptions about negative social and moral outcomes of evolution itself along with cognitive temporal constraints may be difficult for many individuals to uncouple from the scientific theory, serving to provoke the ongoing debate about the treatment of evolution in science education. This debate about teaching evolution is strongly influenced by groups who strive to add creationism to the science curriculum for a balanced treatment of human origins and to mediate implied negative social and moral outcomes of evolution. Individual conceptualization of evolution and creation may influence the choice of college students to teach science. This study is designed to examine if pre-service teachers' conceptualize an evolutionary and creationist process of human development using certain social, moral or temporal patterns; and if the patterns follow a negative conceptual theme. The pilot study explored 21 pre-service teachers' conceptual representation of an evolutionary process through personal narratives. Participants tended to link evolutionary changes with negative social and moral consequences and seemed to have difficulty envisioning change over time. The pilot study was expanded to include a quantitative examination of attribute patterns of an evolutionary and creationist developmental process. Seventy-three pre-service teachers participated in the second experiment and tended to fall evenly along a continuum of creationist and evolutionist beliefs about life. Using a chi-square and principle components analysis, participants were found to map concepts of evolution and creation onto each other using troubling attributes of development to distinguish negative change over time. A strong negative social and moral pattern of human development was found in the creation condition, though only a vague negative human developmental process was found for the evolution condition. Based on these results, pre-service teachers may not use evolution as a viable explanation of human origins, which may serve to contribute to evolution theory debates and discourage pre-service teachers' choice of being science instructors.

Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana

PubMed Central

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Ogink, Alice; van Ostenberg, Paul; Rinke de Wit, Tobias F.

2015-01-01

Background Patient safety and quality care remain major challenges to Ghana’s healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed. Purpose This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities. Methods A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities. Findings Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community groups that were gender balanced, religious/faith-based, and had structured leadership appeared to be better options for effective SCE in healthcare quality assessment. Conclusion Community engagement in healthcare quality assessment is a feasible client-centered quality improvement option that should be discussed for possible scale-up in Ghana and other resource poor countries in Africa. PMID:26619143

Effect of Community Engagement Interventions on Patient Safety and Risk Reduction Efforts in Primary Health Facilities: Evidence from Ghana.

PubMed

Alhassan, Robert Kaba; Nketiah-Amponsah, Edward; Spieker, Nicole; Arhinful, Daniel Kojo; Ogink, Alice; van Ostenberg, Paul; Rinke de Wit, Tobias F

2015-01-01

Patient safety and quality care remain major challenges to Ghana's healthcare system. Like many health systems in Africa, this is largely because demand for healthcare is outstripping available human and material resource capacity of healthcare facilities and new investment is insufficient. In the light of these demand and supply constraints, systematic community engagement (SCE) in healthcare quality assessment can be a feasible and cost effective option to augment existing quality improvement interventions. SCE entails structured use of existing community groups to assess healthcare quality in health facilities. Identified quality gaps are discussed with healthcare providers, improvements identified and rewards provided if the quality gaps are closed. This paper evaluates whether or not SCE, through the assessment of health service quality, improves patient safety and risk reduction efforts by staff in healthcare facilities. A randomized control trail was conducted in 64 primary healthcare facilities in the Greater Accra and Western regions of Ghana. Patient risk assessments were conducted in 32 randomly assigned intervention and control facilities. Multivariate multiple regression test was used to determine effect of the SCE interventions on staff efforts towards reducing patient risk. Spearman correlation test was used to ascertain associations between types of community groups engaged and risk assessment scores of healthcare facilities. Clinic staff efforts towards increasing patient safety and reducing risk improved significantly in intervention facilities especially in the areas of leadership/accountability (Coef. = 10.4, p<0.05) and staff competencies (Coef. = 7.1, p<0.05). Improvement in service utilization and health resources could not be attributed to the interventions because these were outside the control of the study and might have been influenced by institutional or national level developments between the baseline and follow-up period. Community groups that were gender balanced, religious/faith-based, and had structured leadership appeared to be better options for effective SCE in healthcare quality assessment. Community engagement in healthcare quality assessment is a feasible client-centered quality improvement option that should be discussed for possible scale-up in Ghana and other resource poor countries in Africa.

Lean Six Sigma in health care and the challenge of implementation of Six Sigma methodologies at a Veterans Affairs Medical Center.

PubMed

Pocha, Christine

2010-01-01

Six Sigma and Lean Thinking are quality initiatives initially deployed in industry to improve operational efficiency leading to better quality and subsequent cost savings. The financial rationale for embarking on this quality journey is clear; applying it to today's health care remains challenging. The cost of medical care is increasing at an alarming rate; most of these cost increases are attributed to an aging population and technological advances; therefore, largely beyond control. Furthermore, health care cost increases are caused by unnecessary operational inefficiency associated with the direct medical service delivery process. This article describes the challenging journey of implementing Six Sigma methodology at a tertiary care medical center. Many lessons were learned; however, of utmost importance were team approach, "buy in" of the stakeholders, and the willingness of team members to change daily practice and to adapt new and innovative ways how health care can be delivered. Six Sigma incorporated as part of the "company's or hospital's culture" would be most desirable but the learning curve will be steep.

An exploration of parents' preferences for foot care in juvenile idiopathic arthritis: a possible role for the discrete choice experiment.

PubMed

Hendry, Gordon J; Turner, Debbie E; Gardner-Medwin, Janet; Lorgelly, Paula K; Woodburn, James

2014-02-06

An increased awareness of patients' and parents' care preferences regarding foot care is desirable from a clinical perspective as such information may be utilised to optimise care delivery. The aim of this study was to examine parents' preferences for, and valuations of foot care and foot-related outcomes in juvenile idiopathic arthritis (JIA). A discrete choice experiment (DCE) incorporating willingness-to-pay (WTP) questions was conducted by surveying 42 parents of children with JIA who were enrolled in a randomised-controlled trial of multidisciplinary foot care at a single UK paediatric rheumatology outpatients department. Attributes explored were: levels of pain; mobility; ability to perform activities of daily living (ADL); waiting time; referral route; and footwear. The DCE was administered at trial baseline. DCE data were analysed using a multinomial-logit-regression model to estimate preferences and relative importance of attributes of foot care. A stated-preference WTP question was presented to estimate parents' monetary valuation of health and service improvements. Every attribute in the DCE was statistically significant (p < 0.01) except that of cost (p = 0.118), suggesting that all attributes, except cost, have an impact on parents' preferences for foot care for their child. The magnitudes of the coefficients indicate that the strength of preference for each attribute was (in descending order): improved ability to perform ADL, reductions in foot pain, improved mobility, improved ability to wear desired footwear, multidisciplinary foot care route, and reduced waiting time. Parents' estimated mean annual WTP for a multidisciplinary foot care service was £1,119.05. In terms of foot care service provision for children with JIA, parents appear to prefer improvements in health outcomes over non-health outcomes and service process attributes. Cost was relatively less important than other attributes suggesting that it does not appear to impact on parents' preferences.

An exploration of parents’ preferences for foot care in juvenile idiopathic arthritis: a possible role for the discrete choice experiment

PubMed Central

2014-01-01

Background An increased awareness of patients’ and parents’ care preferences regarding foot care is desirable from a clinical perspective as such information may be utilised to optimise care delivery. The aim of this study was to examine parents’ preferences for, and valuations of foot care and foot-related outcomes in juvenile idiopathic arthritis (JIA). Methods A discrete choice experiment (DCE) incorporating willingness-to-pay (WTP) questions was conducted by surveying 42 parents of children with JIA who were enrolled in a randomised-controlled trial of multidisciplinary foot care at a single UK paediatric rheumatology outpatients department. Attributes explored were: levels of pain; mobility; ability to perform activities of daily living (ADL); waiting time; referral route; and footwear. The DCE was administered at trial baseline. DCE data were analysed using a multinomial-logit-regression model to estimate preferences and relative importance of attributes of foot care. A stated-preference WTP question was presented to estimate parents’ monetary valuation of health and service improvements. Results Every attribute in the DCE was statistically significant (p < 0.01) except that of cost (p = 0.118), suggesting that all attributes, except cost, have an impact on parents’ preferences for foot care for their child. The magnitudes of the coefficients indicate that the strength of preference for each attribute was (in descending order): improved ability to perform ADL, reductions in foot pain, improved mobility, improved ability to wear desired footwear, multidisciplinary foot care route, and reduced waiting time. Parents’ estimated mean annual WTP for a multidisciplinary foot care service was £1,119.05. Conclusions In terms of foot care service provision for children with JIA, parents appear to prefer improvements in health outcomes over non-health outcomes and service process attributes. Cost was relatively less important than other attributes suggesting that it does not appear to impact on parents’ preferences. PMID:24502508

Plant-pollinator interactions over 120 years: loss of species, co-occurrence, and function.

PubMed

Burkle, Laura A; Marlin, John C; Knight, Tiffany M

2013-03-29

Using historic data sets, we quantified the degree to which global change over 120 years disrupted plant-pollinator interactions in a temperate forest understory community in Illinois, USA. We found degradation of interaction network structure and function and extirpation of 50% of bee species. Network changes can be attributed to shifts in forb and bee phenologies resulting in temporal mismatches, nonrandom species extinctions, and loss of spatial co-occurrences between extant species in modified landscapes. Quantity and quality of pollination services have declined through time. The historic network showed flexibility in response to disturbance; however, our data suggest that networks will be less resilient to future changes.

Quality Attribute Techniques Framework

NASA Astrophysics Data System (ADS)

Chiam, Yin Kia; Zhu, Liming; Staples, Mark

The quality of software is achieved during its development. Development teams use various techniques to investigate, evaluate and control potential quality problems in their systems. These “Quality Attribute Techniques” target specific product qualities such as safety or security. This paper proposes a framework to capture important characteristics of these techniques. The framework is intended to support process tailoring, by facilitating the selection of techniques for inclusion into process models that target specific product qualities. We use risk management as a theory to accommodate techniques for many product qualities and lifecycle phases. Safety techniques have motivated the framework, and safety and performance techniques have been used to evaluate the framework. The evaluation demonstrates the ability of quality risk management to cover the development lifecycle and to accommodate two different product qualities. We identify advantages and limitations of the framework, and discuss future research on the framework.

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.

A software quality model and metrics for risk assessment

NASA Technical Reports Server (NTRS)

Hyatt, L.; Rosenberg, L.

1996-01-01

A software quality model and its associated attributes are defined and used as the model for the basis for a discussion on risk. Specific quality goals and attributes are selected based on their importance to a software development project and their ability to be quantified. Risks that can be determined by the model's metrics are identified. A core set of metrics relating to the software development process and its products is defined. Measurements for each metric and their usability and applicability are discussed.

Factor selection for service quality evaluation: a hospital case study.

PubMed

Ameryoun, Ahmad; Najafi, Seyedvahid; Nejati-Zarnaqi, Bayram; Khalilifar, Seyed Omid; Ajam, Mahdi; Ansarimoghadam, Ahmad

2017-02-13

Purpose The purpose of this paper is to develop a systematic approach to predict service quality dimension's influence on service quality using a novel analysis based on data envelopment and SERVQUAL. Design/methodology/approach To assess hospital service quality in Tehran, expectation and perception of those who received the services were evaluated using SERVQUAL. The hospital service quality dimensions were found by exploratory factor analysis (EFA). To compare customer expectation and perception, perceived service quality index (PSQI) was measured using a new method based on common weights. A novel sensitivity approach was used to test the service quality factor's impact on the PSQI. Findings A new service quality dimension named "trust in services" was found using EFA, which is not an original SERVQUAL factor. The approach was applied to assess the hospital's service quality. Since the PSQI value was 0.76 it showed that improvements are needed to meet customer expectations. The results showed the factor order that affect PSQI. "Trust in services" has the strongest influence on PSQI followed by "tangibles," "assurance," "empathy," and "responsiveness," respectively. Practical implications This work gives managers insight into service quality by following a systematic method; i.e., measuring perceived service quality from the customer viewpoint and service factors' impact on customer perception. Originality/value The procedure helps managers to select the required service quality dimensions which need improvement and predict their effects on customer perception.

Preferences for Early Intervention Mental Health Services: A Discrete-Choice Conjoint Experiment.

PubMed

Becker, Mackenzie P E; Christensen, Bruce K; Cunningham, Charles E; Furimsky, Ivana; Rimas, Heather; Wilson, Fiona; Jeffs, Lisa; Bieling, Peter J; Madsen, Victoria; Chen, Yvonne Y S; Mielko, Stephanie; Zipursky, Robert B

2016-02-01

Early intervention services (EISs) for mental illness may improve outcomes, although treatment engagement is often a problem. Incorporating patients' preferences in the design of interventions improves engagement. A discrete-choice conjoint experiment was conducted in Canada to identify EIS attributes that encourage treatment initiation. Sixteen four-level attributes were formalized into a conjoint survey, completed by patients, family members, and mental health professionals (N=562). Participants were asked which EIS option people with mental illness would contact. Latent-class analysis identified respondent classes characterized by shared preferences. Randomized first-choice simulations predicted which hypothetical options, based on attributes, would result in maximum utilization. Participants in the conventional-service class (N=241, 43%) predicted that individuals would contact traditional services (for example, hospital location and staffed by psychologists or psychiatrists). Membership was associated with being a patient or family member and being male. Participants in the convenient-service class (N=321, 57%) predicted that people would contact services promoting easy access (for example, self-referral and access from home). Membership was associated with being a professional. Both classes predicted that people would contact services that included short wait times, direct contact with professionals, patient autonomy, and psychological treatment information. The convenient-service class predicted that people would use an e-health model, whereas the conventional-service class predicted that people would use a primary care or clinic-hospital model. Provision of a range of services may maximize EIS use. Professionals may be more apt to adopt EISs in line with their beliefs regarding patient preferences. Considering several perspectives is important for service design.

Quality of services and quality of life from service providers' perspectives: analysis with focus groups.

PubMed

Jenaro, C; Vega, V; Flores, N; Cruz, M

2013-06-01

Concepts such as support, quality of life and quality of services are customary in services for people with intellectual disabilities. The identification of the different ways of conceiving, prioritising and implementing these concepts by service providers can help to drive changes to achieve better personal outcomes for this population. The current study aims to identify service providers' perceptions regarding the quality of life of their clients and the quality of services they provide. It also aims to identify similarities and differences of appraisals among professionals, and to identify associations between supports, quality of life and quality of services. Data were collected from 22 service providers who attended three focus groups (professionals, direct support staff, and managers) from whom 424 comments were analysed. Service providers were asked about the required support for users, the meaning of quality of life for those users, and about features that should characterise quality services. Thematic analysis was employed and transcripts of the sessions were coded according to the dimensions of models on supports, quality of life and quality of services. Chi-squared tests were utilised to test for potential differences among groups. Each professional group has its own priorities concerning required supports. Among the organisation different and potentially conflicting perceptions regarding the meaning of experiencing quality of life coexist. Concerning quality of services, only managers mentioned personal outcomes. Finally, institutionalisation has a negative impact on supports, quality of life and quality of services. It is necessary to move beyond a shared awareness of the negative impact of institutionalisation towards the transformation of services in search of personal quality outcomes. © 2012 The Authors. Journal of Intellectual Disability Research © 2012 John Wiley & Sons Ltd, MENCAP & IASSID.

Service employees give as they get: internal service as a moderator of the service climate-service outcomes link.

PubMed

Ehrhart, Karen Holcombe; Witt, L A; Schneider, Benjamin; Perry, Sara Jansen

2011-03-01

We lend theoretical insight to the service climate literature by exploring the joint effects of branch service climate and the internal service provided to the branch (the service received from corporate units to support external service delivery) on customer-rated service quality. We hypothesized that service climate is related to service quality most strongly when the internal service quality received is high, providing front-line employees with the capability to deliver what the service climate motivates them to do. We studied 619 employees and 1,973 customers in 36 retail branches of a bank. We aggregated employee perceptions of the internal service quality received from corporate units and the local service climate and external customer perceptions of service quality to the branch level of analysis. Findings were consistent with the hypothesis that high-quality internal service is necessary for branch service climate to yield superior external customer service quality. PsycINFO Database Record (c) 2011 APA, all rights reserved.

The effect of cryogenic grinding and hammer milling on the flavour quality of ground pepper (Piper nigrum L.).

PubMed

Liu, Hong; Zeng, Fankui; Wang, Qinghuang; Ou, Shiyi; Tan, Lehe; Gu, Fenglin

2013-12-15

In this study, we compared the effects of cryogenic grinding and hammer milling on the flavour attributes of black, white, and green pepper. The flavour attributes were analysed using headspace solid-phase micro-extraction (HS-SPME) and gas chromatography-mass spectrometry (GC/MS), sensory evaluation and electronic nose (e-nose) analysis. Cryogenic grinding resulted in minimal damage to the colour, flavour, and sensory attributes of the spices. Cryogenic grinding was also better than hammer milling at preserving the main potent aroma constituents, but the concentrations of the main aroma constituents were dramatically reduced after storing the samples at 4 °C for 6 months. Pattern matching performed by the e-nose further supported our sensory and instrumental findings. Overall, cryogenic grinding was superior to hammer milling for preserving the sensory properties and flavour attributes of pepper without significantly affecting its quality. However, we found that the flavour quality of ground pepper was reduced during storage. Copyright © 2013 Elsevier Ltd. All rights reserved.

Effect of node attributes on the temporal dynamics of network structure

NASA Astrophysics Data System (ADS)

Momeni, Naghmeh; Fotouhi, Babak

2017-03-01

Many natural and social networks evolve in time and their structures are dynamic. In most networks, nodes are heterogeneous, and their roles in the evolution of structure differ. This paper focuses on the role of individual attributes on the temporal dynamics of network structure. We focus on a basic model for growing networks that incorporates node attributes (which we call "quality"), and we focus on the problem of forecasting the structural properties of the network in arbitrary times for an arbitrary initial network. That is, we address the following question: If we are given a certain initial network with given arbitrary structure and known node attributes, then how does the structure change in time as new nodes with given distribution of attributes join the network? We solve the model analytically and obtain the quality-degree joint distribution and degree correlations. We characterize the role of individual attributes in the position of individual nodes in the hierarchy of connections. We confirm the theoretical findings with Monte Carlo simulations.

Twenty-five years of accomplishments of the College of American Pathologists Q-probes program for clinical pathology.

PubMed

Howanitz, Peter J; Perrotta, Peter L; Bashleben, Christine P; Meier, Frederick A; Ramsey, Glenn E; Massie, Larry W; Zimmerman, Roberta L; Karcher, Donald S

2014-09-01

During the past 25 years, the College of American Pathologists' (CAP) Q-Probes program has been available as a subscription program to teach laboratorians how to improve the quality of clinical laboratory services. To determine the accomplishments of the CAP Q-Probes program. We reviewed Q-Probes participant information, study data and conclusions, author information, and program accomplishments. During this time 117 Q-Probes clinical pathology studies were conducted by 54 authors and coauthors, 42,899 laboratories enrolled from 24 countries, 98 peer-reviewed publications occurred and were cited more than 1600 times, and the studies were featured 59 times in CAP Today. The most frequent studies (19) focused on turnaround times for results or products at specific locations (emergency department, operating room, inpatients, outpatients), specific diseases (acute myocardial infarction, urinary tract), availability for specific events such as morning rounds or surgery, a specific result (positive blood cultures), and a method on how to use data for improvement (stat test outliers). Percentile ranking of study participants with better performance provided benchmarks for each study with attributes statistically defined that influenced improved performance. Other programs, such as an ongoing quality improvement program (Q-Tracks), a laboratory competency assessment program, a pathologist certification program, and an ongoing physician practice evaluation program (Evalumetrics), have been developed from Q-Probes studies. The CAP's Q-Probes program has made significant contributions to the medical literature and has developed a worldwide reputation for improving the quality of clinical pathology services worldwide.

Consumer preferences for food product quality attributes from Swedish agriculture.

PubMed

Carlsson, Fredrik; Frykblom, Peter; Lagerkvist, Carl Johan

2005-06-01

This paper employs a choice experiment to obtain consumer preferences and willingness to pay for food product quality attributes currently not available in Sweden. Data were obtained from a large mail survey and estimated with a random parameter logit model. We found evidence for intraproduct differences in consumer preferences for identical attributes, as well as interproduct discrepancies in ranking of attributes. Furthermore, we found evidence of a market failure relating to the potential use of genetically modified animal fodder. Finally, we found support for the idea that a cheap-talk script can alleviate problems of external validity of choice experiments. Our results are useful in forming product differentiation strategies within the food industry, as well as for the formation of food policy.

Quality assurance and reliability in the Japanese electronics industry

NASA Astrophysics Data System (ADS)

Pecht, Michael; Boulton, William R.

1995-02-01

Quality and reliability are two attributes required for all Japanese products, although the JTEC panel found these attributes to be secondary to customer cost requirements. While our Japanese hosts gave presentations on the challenges of technology, cost, and miniaturization, quality and reliability were infrequently the focus of our discussions. Quality and reliability were assumed to be sufficient to meet customer needs. Fujitsu's slogan, 'quality built-in, with cost and performance as prime consideration,' illustrates this point. Sony's definition of a next-generation product is 'one that is going to be half the size and half the price at the same performance of the existing one'. Quality and reliability are so integral to Japan's electronics industry that they need no new emphasis.

Quality assurance and reliability in the Japanese electronics industry

NASA Technical Reports Server (NTRS)

Pecht, Michael; Boulton, William R.

1995-01-01

Quality and reliability are two attributes required for all Japanese products, although the JTEC panel found these attributes to be secondary to customer cost requirements. While our Japanese hosts gave presentations on the challenges of technology, cost, and miniaturization, quality and reliability were infrequently the focus of our discussions. Quality and reliability were assumed to be sufficient to meet customer needs. Fujitsu's slogan, 'quality built-in, with cost and performance as prime consideration,' illustrates this point. Sony's definition of a next-generation product is 'one that is going to be half the size and half the price at the same performance of the existing one'. Quality and reliability are so integral to Japan's electronics industry that they need no new emphasis.

Work-Family Conflict within the Family: Crossover Effects, Perceived Parent-Child Interaction Quality, Parental Self-Efficacy, and Life Role Attributions

ERIC Educational Resources Information Center

Cinamon, Rachel Gali; Weisel, Amatzia; Tzuk, Kineret

2007-01-01

To better understand the work-family interface within the family domain, this study investigated crossover effects of two types of work-family conflict among 120 participants (60 married couples), these conflicts' relations with parental self-efficacy and perceived quality of parent-child interaction, and the contribution of attributions of…

Development of a Premium Quality Plasma-derived IVIg (IQYMUNE®) Utilizing the Principles of Quality by Design-A Worked-through Case Study.

PubMed

Paolantonacci, Philippe; Appourchaux, Philippe; Claudel, Béatrice; Ollivier, Monique; Dennett, Richard; Siret, Laurent

2018-01-01

Polyvalent human normal immunoglobulins for intravenous use (IVIg), indicated for rare and often severe diseases, are complex plasma-derived protein preparations. A quality by design approach has been used to develop the Laboratoire Français du Fractionnement et des Biotechnologies new-generation IVIg, targeting a high level of purity to generate an enhanced safety profile while maintaining a high level of efficacy. A modular approach of quality by design was implemented consisting of five consecutive steps to cover all the stages from the product design to the final product control strategy.A well-defined target product profile was translated into 27 product quality attributes that formed the basis of the process design. In parallel, a product risk analysis was conducted and identified 19 critical quality attributes among the product quality attributes. Process risk analysis was carried out to establish the links between process parameters and critical quality attributes. Twelve critical steps were identified, and for each of these steps a risk mitigation plan was established.Among the different process risk mitigation exercises, five process robustness studies were conducted at qualified small scale with a design of experiment approach. For each process step, critical process parameters were identified and, for each critical process parameter, proven acceptable ranges were established. The quality risk management and risk mitigation outputs, including verification of proven acceptable ranges, were used to design the process verification exercise at industrial scale.Finally, the control strategy was established using a mix, or hybrid, of the traditional approach plus elements of the quality by design enhanced approach, as illustrated, to more robustly assign material and process controls and in order to securely meet product specifications.The advantages of this quality by design approach were improved process knowledge for industrial design and process validation and a clear justification of the process and product specifications as a basis for control strategy and future comparability exercises. © PDA, Inc. 2018.

Understanding Consistency Maintenance in Service Discovery Architectures during Communication Failure

DTIC Science & Technology

2002-07-01

our general model include: (1) service user (SU), (2) service manager (SM), and (3) service cache manager ( SCM ), where the SCM is an optional...maintained by SMs that satisfy specific requirements. Where employed, the SCM operates as an intermediary, matching advertised SDs of SMs to...Directory Service Agent (optional) not applicableLookup ServiceService Cache Manager ( SCM ) Service URL Service Type Service Attributes Template URL

Fuzzy Logic-based expert system for evaluating cake quality of freeze-dried formulations.

PubMed

Trnka, Hjalte; Wu, Jian X; Van De Weert, Marco; Grohganz, Holger; Rantanen, Jukka

2013-12-01

Freeze-drying of peptide and protein-based pharmaceuticals is an increasingly important field of research. The diverse nature of these compounds, limited understanding of excipient functionality, and difficult-to-analyze quality attributes together with the increasing importance of the biosimilarity concept complicate the development phase of safe and cost-effective drug products. To streamline the development phase and to make high-throughput formulation screening possible, efficient solutions for analyzing critical quality attributes such as cake quality with minimal material consumption are needed. The aim of this study was to develop a fuzzy logic system based on image analysis (IA) for analyzing cake quality. Freeze-dried samples with different visual quality attributes were prepared in well plates. Imaging solutions together with image analytical routines were developed for extracting critical visual features such as the degree of cake collapse, glassiness, and color uniformity. On the basis of the IA outputs, a fuzzy logic system for analysis of these freeze-dried cakes was constructed. After this development phase, the system was tested with a new screening well plate. The developed fuzzy logic-based system was found to give comparable quality scores with visual evaluation, making high-throughput classification of cake quality possible. © 2013 Wiley Periodicals, Inc. and the American Pharmacists Association.

PA.NET International Quality Certification Protocol for blood pressure monitors.

PubMed

Omboni, Stefano; Costantini, Carlo; Pini, Claudio; Bulegato, Roberto; Manfellotto, Dario; Rizzoni, Damiano; Palatini, Paolo; O'brien, Eoin; Parati, Gianfranco

2008-10-01

Although standard validation protocols provide assurance of the accuracy of blood pressure monitors (BPMs), there is no guidance for the consumer as to the overall quality of a device. The PA.NET International Quality Certification Protocol, developed by the Association for Research and Development of Biomedical Technologies and for Continuing Medical Education (ARSMED), a nonprofit organization, with the support of the Italian Society of Hypertension-Italian Hypertension League, and the dabl Educational Trust denotes additional criteria of quality for BPMs that fulfilled basic validation criteria, published in full in peer-reviewed medical journals. The certification is characterized by three phases: (i) to determine that the device fulfilled standard validation criteria; (ii) to determine the technical and functional characteristics of the device (e.g. operativity, display dimension, accessory functions, memory availability, etc.) and (iii) to determine the commercial characteristics (e.g. price-quality ratio, after-sale service, guarantee, etc.). At the end of the certification process, ARSMED attributes a quality index to the device, based on a scale ranging from 1 to 100, and a quality seal with four different grades (bronze, silver, gold and diamond) according to the achieved score. The seal is identified by a unique alphanumeric code. The quality seal may be used on the packaging of the appliance or in advertising. A quality certification is released to the manufacturer and published on www.pressionearteriosa.net and www.dableducational.org. The PA.NET International Quality Certification Protocol represents the first attempt to provide health care personnel and consumers with an independent and objective assessment of BPMs based on their quality.

Optimizing conservation strategies for Mexican freetailed bats: a population viability and ecosystem services approach

USGS Publications Warehouse

Wiederholt, Ruscena; Lopez-Hoffman, Laura; Svancara, Colleen; McCracken, Gary; Thogmartin, Wayne E.; Diffendorfer, James E.; Mattson, Brady; Bagstad, Kenneth J.; Cryan, Paul; Russell, Amy; Semmens, Darius J.; Rodrigo A. Medellín,

2015-01-01

Conservation planning can be challenging due to the need to balance biological concerns about population viability with social concerns about the benefits biodiversity provide to society, often while operating under a limited budget. Methods and tools that help prioritize conservation actions are critical for the management of at-risk species. Here, we use a multi-attribute utility function to assess the optimal maternity roosts to conserve for maintaining the population viability and the ecosystem services of a single species, the Mexican free-tailed bat (Tadarida brasiliensis mexicana). Mexican free-tailed bats provide ecosystem services such as insect pest-suppression in agricultural areas and recreational viewing opportunities, and may be threatened by climate change and development of wind energy. We evaluated each roost based on five attributes: the maternity roost’s contribution to population viability, the pest suppression ecosystem services to the surrounding area provided by the bats residing in the roost, the ecotourism value of the roost, the risks posed to each roost structure, and the risks posed to the population of bats residing in each roost. We compared several scenarios that prioritized these attributes differently, hypothesizing that the set of roosts with the highest rankings would vary according to the conservation scenario. Our results indicate that placing higher values on different roost attributes (e.g. population importance over ecosystem service value) altered the roost rankings. We determined that the values placed on various conservation objectives are an important determinant of habitat planning.

Perceptions and home management practices of malaria in some rural communities in Abeokuta, Nigeria.

PubMed

Idowu, O A; Mafiana, C F; Luwoye, I J; Adehanloye, O

2008-07-01

A survey was carried out in five rural communities that enjoy agricultural extension services from the University of Agriculture Abeokuta. Questionnaires and focus group discussions (FGDs) were used to assess perceptions and home management practices of malaria infection. The inhabitants considered malaria (which they refer to as "Iba Otutu") has the least dangerous of other types of common fever such as yellow fever and typhoid fever. A vast majority of the respondents (73%) attributed malaria infection to doing of strenuous jobs in the hot sun, while only 11.7% attributed it to mosquito bites. Hunger, eating or drinking of contaminated food or water were other sources of malaria infection mentioned by the respondent. During the FGDs, another source of infection of malaria identified was excessive exposure to heat of fire used in frying cassava (garri), therefore those frying garri and those spreading cassava flakes in the sun were identified as most vulnerable to malaria infection. During the FGD, high level of malaria infection in children was attributed to children playful activities in the sun. It is believed that malaria infection will occur even without mosquito bites but with exposure to these other factors especially the intense heat of the sun. Respondents showed good knowledge of malaria symptoms even in infants and children. However, in the event of malaria infection consumption of herbal preparations is the first line of treatment. Drug hawkers that sell modern drugs in the communities were mainly consulted for malaria treatment. The antimalarial drugs bought were often wrongly used and none of the respondents were aware of the current trend in malaria management with modern drugs. Hospital visitation is usually after many days of persistent illness without improvement despite all forms of self medication. The main measure used against malaria vectors was insecticide coils (74.6%). None of the respondents used insecticide treated net (ITN). Distance, cost and poor quality of hospital treatment were reasons for refusal to seek proper medical care. Health education and improved health care services are recommended for these farmers in order for them to be able to translate extension services provided into maximum agricultural yields.

Utilizing Mushrooms to Reduce Overall Sodium in Taco Filling Using Physical and Sensory Evaluation.

PubMed

Wong, Kristin M; Decker, Eric A; Autio, Wesley R; Toong, Ken; DiStefano, Garett; Kinchla, Amanda J

2017-10-01

This project investigated the use of integrating mushrooms into beef taco filling as a means to reduce overall sodium for food service applications. Initial product development used physical characterization analysis (moisture, yield, color, and texture) to determine initial threshold of mushroom inclusion with minimal differences against an all-meat control. Increasing mushroom inclusion increased moisture and yield before draining but decreased yield after draining, lightness, redness, and texture. Results showed that inclusion under 50% by weight minimized physical attribute deviation from an all-meat control. Additional physical analysis investigated a variety of other factors (mushroom type, blanching, and particle size) to determine if other attributing mushroom characteristics would yield statistical similarity to the all-meat control. Results showed that a formulation containing up to 45% mushrooms can be integrated into beef fillings using un-blanched, white button mushrooms with small grind (1 to 5 mm), which maximized mushroom usage while minimizing differences from the all-meat control. Additional sodium analysis showed that varying salt level in formulations did not affect physical characteristics and mushroom inclusion could not significantly reduce overall sodium level. Optimized mushroom samples were then fielded in a hedonic sensory study to untrained consumers to evaluate product liking attributes (overall liking, aroma, color, flavor, juiciness, saltiness, and texture). Samples with overall liking scores that closely matched the control were then fielded in a paired-preference test to determine acceptance. Consumers preferred a 45% mushroom with reduced sodium taco filling compared to its full sodium counterpart in a food service fielded paired-preference sensory test. Although diet can significantly reduce the risk of heart disease, American consumers continue to eat detrimental diets high in fat and sodium. Products need to be made that decrease fat and sodium intake while still delivering acceptable taste. Mushroom substitution into meat-based products can be a strategy to develop products that can decrease fat and sodium consumption while increasing vegetable intake without compromising the quality and taste consumers demand. This research shows how consumers can accept meat-based products containing mushrooms with potential for direct food service application. © 2017 Institute of Food Technologists®.

The effect of texture granularity on texture synthesis quality

NASA Astrophysics Data System (ADS)

Golestaneh, S. Alireza; Subedar, Mahesh M.; Karam, Lina J.

2015-09-01

Natural and artificial textures occur frequently in images and in video sequences. Image/video coding systems based on texture synthesis can make use of a reliable texture synthesis quality assessment method in order to improve the compression performance in terms of perceived quality and bit-rate. Existing objective visual quality assessment methods do not perform satisfactorily when predicting the synthesized texture quality. In our previous work, we showed that texture regularity can be used as an attribute for estimating the quality of synthesized textures. In this paper, we study the effect of another texture attribute, namely texture granularity, on the quality of synthesized textures. For this purpose, subjective studies are conducted to assess the quality of synthesized textures with different levels (low, medium, high) of perceived texture granularity using different types of texture synthesis methods.

Which Way Do You Want To Serve Your Customers?

ERIC Educational Resources Information Center

Gupta, Dinesh K.; Jambheykar, Ashok

2002-01-01

Discusses the need to focus on customer service in libraries. Topics include motivating factors, including the value of library services as judged by the users; attributes of customer service; categories of customer service; identifying users; and questions to ask library staff to help evaluate their customer service. (LRW)

Understanding HIV-positive patients' preferences for healthcare services: a protocol for a discrete choice experiment

PubMed Central

Youssef, Elaney; Cooper, Vanessa; Miners, Alec; Llewellyn, Carrie; Pollard, Alex; Lagarde, Mylene; Sachikonye, Memory; Sabin, Caroline; Foreman, Claire; Perry, Nicky; Nixon, Eileen; Fisher, Martin

2016-01-01

Introduction While the care of HIV-positive patients, including the detection and management of comorbidities, has historically been provided in HIV specialist outpatient clinics, recent years have seen a greater involvement of non-HIV specialists and general practitioners (GPs). The aim of this study is to determine whether patients would prefer to see their GP or HIV physician given general symptoms, and to understand what aspects of care influence their preferences. Methods/analysis We have developed and piloted a discrete choice experiment (DCE) to better understand patients' preferences for care of non-HIV-related acute symptoms. The design of the DCE was informed by our exploratory research, including the findings of a systematic literature review and a qualitative study. Additional questionnaire items have been included to measure demographics, service use and experience of non-HIV illnesses and quality of life (EQ5D). We plan to recruit 1000 patients from 14 HIV clinics across South East England. Data will be analysed using random-effects logistic regression and latent class analysis. ORs and 95% CIs will be used to estimate the relative importance of each of the attribute levels. Latent class analysis will identify whether particular groups of people value the service attribute levels differently. Ethics/dissemination Ethical approval for this study was obtained from the Newcastle and North Tyneside Research Ethics Committee (reference number 14/NE/1193). The results will be disseminated at national and international conferences and peer-reviewed publications. A study report, written in plain English, will be made available to all participants. The Patient Advisory Group will develop a strategy for wider dissemination of the findings to patients and the public. PMID:27431895

Algal Attributes: An Autecological Classification of Algal Taxa Collected by the National Water-Quality Assessment Program

USGS Publications Warehouse

Porter, Stephen D.

2008-01-01

Algae are excellent indicators of water-quality conditions, notably nutrient and organic enrichment, and also are indicators of major ion, dissolved oxygen, and pH concentrations and stream microhabitat conditions. The autecology, or physiological optima and tolerance, of algal species for various water-quality contaminants and conditions is relatively well understood for certain groups of freshwater algae, notably diatoms. However, applications of autecological information for water-quality assessments have been limited because of challenges associated with compiling autecological literature from disparate sources, tracking name changes for a large number of algal species, and creating an autecological data base from which algal-indicator metrics can be calculated. A comprehensive summary of algal autecological attributes for North American streams and rivers does not exist. This report describes a large, digital data file containing 28,182 records for 5,939 algal taxa, generally species or variety, collected by the U.S. Geological Survey?s National Water-Quality Assessment (NAWQA) Program. The data file includes 37 algal attributes classified by over 100 algal-indicator codes or metrics that can be calculated easily with readily available software. Algal attributes include qualitative classifications based on European and North American autecological literature, and semi-quantitative, weighted-average regression approaches for estimating optima using regional and national NAWQA data. Applications of algal metrics in water-quality assessments are discussed and national quartile distributions of metric scores are shown for selected indicator metrics.

Can consumer choice replace trust in the National Health Service in England? Towards developing an affective psychosocial conception of trust in health care.

PubMed

Fotaki, Marianna

2014-11-01

Trust has long been regarded as a vitally important aspect of the relationship between health service providers and patients. Recently, consumer choice has been increasingly advocated as a means of improving the quality and effectiveness of health service provision. However, it is uncertain how the increase of information necessary to allow users of health services to exercise choice, and the simultaneous introduction of markets in public health systems, will affect various dimensions of trust, and how changing relations of trust will impact upon patients and services. This article employs a theory-driven approach to investigate conceptual and material links between choice, trust and markets in health care in the context of the National Health Service in England. It also examines the implications of patient choice on systemic, organisational and interpersonal trust. The article is divided into two parts. The first argues that the shift to marketisation in public health services might lead to an over-reliance on rational-calculative aspects of trust at the expense of embodied, relational and social attributes. The second develops an alternative psychosocial conception of trust: it focuses on the central role of affect and accounts for the material and symbolic links between choice, trust and markets in health care. © 2014 The Author. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Talent identification and recruitment in youth soccer: Recruiter's perceptions of the key attributes for player recruitment.

PubMed

Larkin, Paul; O'Connor, Donna

2017-01-01

Using the modified Delphi method, we aimed to understand the attributes youth coaches and recruiters perceive as important when identifying skilled youth performance at the entry level of representative soccer in Australia (i.e., Under 13 years). Furthermore, we also aimed to describe the current methods youth coaches and recruiters use to assess and identify these attributes in youth players. Australian regional youth technical directors and coaches (n = 20) completed a three stage process, including an initial interview and two subsequent questionnaires, whereby attributes and qualities associated with talent identification were rated and justified according to the importance for youth player performance and talent identification. Results indicate a hierarchy of attributes recruiters perceive as important for Under 13 soccer performance, including technical (i.e., first touch, striking the ball, one-versus-one ability, and technical ability under pressure), tactical (i.e., decision-making ability) and psychological attributes (i.e., coachability and positive attitude). In addition, the findings indicated attributes and qualities not emphasised within the talent identification process including, physiological, anthropometrical, sociological and several psychological attributes. It is suggested talent recruiters apply a holistic multidisciplinary approach to talent identification, with the current findings potentially providing initial evidence to suggest recruiters do consider numerous attributes when selecting and identifying youth players.

Talent identification and recruitment in youth soccer: Recruiter’s perceptions of the key attributes for player recruitment

PubMed Central

2017-01-01

Using the modified Delphi method, we aimed to understand the attributes youth coaches and recruiters perceive as important when identifying skilled youth performance at the entry level of representative soccer in Australia (i.e., Under 13 years). Furthermore, we also aimed to describe the current methods youth coaches and recruiters use to assess and identify these attributes in youth players. Australian regional youth technical directors and coaches (n = 20) completed a three stage process, including an initial interview and two subsequent questionnaires, whereby attributes and qualities associated with talent identification were rated and justified according to the importance for youth player performance and talent identification. Results indicate a hierarchy of attributes recruiters perceive as important for Under 13 soccer performance, including technical (i.e., first touch, striking the ball, one-versus-one ability, and technical ability under pressure), tactical (i.e., decision-making ability) and psychological attributes (i.e., coachability and positive attitude). In addition, the findings indicated attributes and qualities not emphasised within the talent identification process including, physiological, anthropometrical, sociological and several psychological attributes. It is suggested talent recruiters apply a holistic multidisciplinary approach to talent identification, with the current findings potentially providing initial evidence to suggest recruiters do consider numerous attributes when selecting and identifying youth players. PMID:28419175

The economics of health care quality and medical errors.

PubMed

Andel, Charles; Davidow, Stephen L; Hollander, Mark; Moreno, David A

2012-01-01

Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical errors cost the United States $19.5 billion. About 87 percent or $17 billion were directly associated with additional medical cost, including: ancillary services, prescription drug services, and inpatient and outpatient care, according to a study sponsored by the Society for Actuaries and conducted by Milliman in 2010. Additional costs of $1.4 billion were attributed to increased mortality rates with $1.1 billion or 10 million days of lost productivity from missed work based on short-term disability claims. The authors estimate that the economic impact is much higher, perhaps nearly $1 trillion annually when quality-adjusted life years (QALYs) are applied to those that die. Using the Institute of Medicine's (IOM) estimate of 98,000 deaths due to preventable medical errors annually in its 1998 report, To Err Is Human, and an average of ten lost years of life at $75,000 to $100,000 per year, there is a loss of $73.5 billion to $98 billion in QALYs for those deaths--conservatively. These numbers are much greater than those we cite from studies that explore the direct costs of medical errors. And if the estimate of a recent Health Affairs article is correct-preventable death being ten times the IOM estimate-the cost is $735 billion to $980 billion. Quality care is less expensive care. It is better, more efficient, and by definition, less wasteful. It is the right care, at the right time, every time. It should mean that far fewer patients are harmed or injured. Obviously, quality care is not being delivered consistently throughout U.S. hospitals. Whatever the measure, poor quality is costing payers and society a great deal. However, health care leaders and professionals are focusing on quality and patient safety in ways they never have before because the economics of quality have changed substantially.

PKI-based secure mobile access to electronic health services and data.

PubMed

Kambourakis, G; Maglogiannis, I; Rouskas, A

2005-01-01

Recent research works examine the potential employment of public-key cryptography schemes in e-health environments. In such systems, where a Public Key Infrastructure (PKI) is established beforehand, Attribute Certificates (ACs) and public key enabled protocols like TLS, can provide the appropriate mechanisms to effectively support authentication, authorization and confidentiality services. In other words, mutual trust and secure communications between all the stakeholders, namely physicians, patients and e-health service providers, can be successfully established and maintained. Furthermore, as the recently introduced mobile devices with access to computer-based patient record systems are expanding, the need of physicians and nurses to interact increasingly with such systems arises. Considering public key infrastructure requirements for mobile online health networks, this paper discusses the potential use of Attribute Certificates (ACs) in an anticipated trust model. Typical trust interactions among doctors, patients and e-health providers are presented, indicating that resourceful security mechanisms and trust control can be obtained and implemented. The application of attribute certificates to support medical mobile service provision along with the utilization of the de-facto TLS protocol to offer competent confidentiality and authorization services is also presented and evaluated through experimentation, using both the 802.11 WLAN and General Packet Radio Service (GPRS) networks.

Global Budgets and Technology-Intensive Medical Services.

PubMed

Song, Zirui; Fendrick, A Mark; Safran, Dana Gelb; Landon, Bruce; Chernew, Michael E

2013-06-01

In 2009-2010, Blue Cross Blue Shield of Massachusetts entered into global payment contracts (the Alternative Quality contract, AQC) with 11 provider organizations. We evaluated the impact of the AQC on spending and utilization of several categories of medical technologies, including one considered high value (colonoscopies) and three that include services that may be overused in some situations (cardiovascular, imaging, and orthopedic services). Approximately 420,000 unique enrollees in 2009 and 180,000 in 2010 were linked to primary care physicians whose organizations joined the AQC. Using three years of pre-intervention data and a large control group, we analyzed changes in utilization and spending associated with the AQC with a propensity-weighted difference-in-differences approach adjusting for enrollee demographics, health status, secular trends, and cost-sharing. In the 2009 AQC cohort, total volume of colonoscopies increased 5.2 percent (p=0.04) in the first two years of the contract relative to control. The contract was associated with varied changes in volume for cardiovascular and imaging services, but total spending on cardiovascular services in the first two years decreased by 7.4% (p=0.02) while total spending on imaging services decreased by 6.1% (p<0.001) relative to control. In addition to lower utilization of higher-priced services, these decreases were also attributable to shifting care to lower-priced providers. No effect was found in orthopedics. As one example of a large-scale global payment initiative, the AQC was associated with higher use of colonoscopies. Among several categories of services whose value may be controversial, the contract generally shifted volume to lower-priced facilities or services.

[Study on the optimization of monitoring indicators of drinking water quality during health supervision].

PubMed

Ye, Bixiong; E, Xueli; Zhang, Lan

2015-01-01

To optimize non-regular drinking water quality indices (except Giardia and Cryptosporidium) of urban drinking water. Several methods including drinking water quality exceed the standard, the risk of exceeding standard, the frequency of detecting concentrations below the detection limit, water quality comprehensive index evaluation method, and attribute reduction algorithm of rough set theory were applied, redundancy factor of water quality indicators were eliminated, control factors that play a leading role in drinking water safety were found. Optimization results showed in 62 unconventional water quality monitoring indicators of urban drinking water, 42 water quality indicators could be optimized reduction by comprehensively evaluation combined with attribute reduction of rough set. Optimization of the water quality monitoring indicators and reduction of monitoring indicators and monitoring frequency could ensure the safety of drinking water quality while lowering monitoring costs and reducing monitoring pressure of the sanitation supervision departments.

Proposed DoD (Department of Defense) Internet Protocol Standard.

DTIC Science & Technology

1982-07-06

parameters fall into two categories: service quality parameters and service options. Service quality parameters influence the transmission service provided...Corporation 6 July 1982 -7- TM-7172/481/OO o Service Quality Parameters - Precedence : attempts preferential treatment for high importance datagrams...select the transmission quality. IP passes the type of service (TOS) command set for service quality to the SNP where it is mapped into subnetwork

The antecedents, attributes and consequences of trust among nurses and nurse managers: a concept analysis.

PubMed

McCabe, T J; Sambrook, Sally

2014-05-01

Although trust has been investigated in the health context, limited research explores nurse and nurse manager perceptions of trust. To explore the concept of trust amongst nurses and nurse managers at individual, interpersonal and organisational levels. Our paper reports the findings from an interpretivist study conducted within the British National Health Service, involving thirty-nine semi-structured interviews with nurses and nurse managers. Large acute and small community organisation within the British National Health Service. 28 nurses and 11 nurse managers working within an Acute and a Community sector organisation - 20 and 19 in each organisation. Participants were selected through a process of purposive sampling, reflecting variations in terms of age, grade, ward and tenure. We utilise a concept analysis framework in exploring the antecedents, attributes and consequences of trust amongst nurses and nurse managers at individual, interpersonal and organisational levels. Key findings suggest that trust is formed within the immediate ward environment, and is significantly influenced by the role of line manager. Other positively influencing factors include professionalism and commitment to the nursing profession. These form the basis for the teamwork, delegation, support, open communication systems, confidentiality and discretion essential to delivering quality patient care. Negatively influencing factors include new management concepts, practices and styles overseen by managers recruited from the private sector. New management concepts were associated with reductions in the number of qualified nurses and increasing numbers of untrained nursing staff, reduced direct patient contact, less opportunities for professional training and development and deteriorating terms and conditions of employment. Our findings offer insight for managers, nurses and human resource practitioners to help build high trust relationships in a health care context. Of particular import is the need for managers to communicate more effectively organisational and financial constraints, in a manner that does not 'alienate' nurses and nurse managers, by highlighting their value and acknowledging their role in delivering high quality patient care. Copyright © 2013 Elsevier Ltd. All rights reserved.

Understanding HIV-positive patients' preferences for healthcare services: a protocol for a discrete choice experiment.

PubMed

Youssef, Elaney; Cooper, Vanessa; Miners, Alec; Llewellyn, Carrie; Pollard, Alex; Lagarde, Mylene; Sachikonye, Memory; Sabin, Caroline; Foreman, Claire; Perry, Nicky; Nixon, Eileen; Fisher, Martin

2016-07-18

While the care of HIV-positive patients, including the detection and management of comorbidities, has historically been provided in HIV specialist outpatient clinics, recent years have seen a greater involvement of non-HIV specialists and general practitioners (GPs). The aim of this study is to determine whether patients would prefer to see their GP or HIV physician given general symptoms, and to understand what aspects of care influence their preferences. We have developed and piloted a discrete choice experiment (DCE) to better understand patients' preferences for care of non-HIV-related acute symptoms. The design of the DCE was informed by our exploratory research, including the findings of a systematic literature review and a qualitative study. Additional questionnaire items have been included to measure demographics, service use and experience of non-HIV illnesses and quality of life (EQ5D). We plan to recruit 1000 patients from 14 HIV clinics across South East England. Data will be analysed using random-effects logistic regression and latent class analysis. ORs and 95% CIs will be used to estimate the relative importance of each of the attribute levels. Latent class analysis will identify whether particular groups of people value the service attribute levels differently. Ethical approval for this study was obtained from the Newcastle and North Tyneside Research Ethics Committee (reference number 14/NE/1193). The results will be disseminated at national and international conferences and peer-reviewed publications. A study report, written in plain English, will be made available to all participants. The Patient Advisory Group will develop a strategy for wider dissemination of the findings to patients and the public. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Modeling organizational justice improvements in a pediatric health service : a discrete-choice conjoint experiment.

PubMed

Cunningham, Charles E; Kostrzewa, Linda; Rimas, Heather; Chen, Yvonne; Deal, Ken; Blatz, Susan; Bowman, Alida; Buchanan, Don H; Calvert, Randy; Jennings, Barbara

2013-01-01

Patients value health service teams that function effectively. Organizational justice is linked to the performance, health, and emotional adjustment of the members of these teams. We used a discrete-choice conjoint experiment to study the organizational justice improvement preferences of pediatric health service providers. Using themes from a focus group with 22 staff, we composed 14 four-level organizational justice improvement attributes. A sample of 652 staff (76 % return) completed 30 choice tasks, each presenting three hospitals defined by experimentally varying the attribute levels. Latent class analysis yielded three segments. Procedural justice attributes were more important to the Decision Sensitive segment, 50.6 % of the sample. They preferred to contribute to and understand how all decisions were made and expected management to act promptly on more staff suggestions. Interactional justice attributes were more important to the Conduct Sensitive segment (38.5 %). A universal code of respectful conduct, consequences encouraging respectful interaction, and management's response when staff disagreed with them were more important to this segment. Distributive justice attributes were more important to the Benefit Sensitive segment, 10.9 % of the sample. Simulations predicted that, while Decision Sensitive (74.9 %) participants preferred procedural justice improvements, Conduct (74.6 %) and Benefit Sensitive (50.3 %) participants preferred interactional justice improvements. Overall, 97.4 % of participants would prefer an approach combining procedural and interactional justice improvements. Efforts to create the health service environments that patients value need to be comprehensive enough to address the preferences of segments of staff who are sensitive to different dimensions of organizational justice.

The Effect of Service Quality on Patient loyalty: a Study of Private Hospitals in Tehran, Iran.

PubMed

Arab, M; Tabatabaei, Sm Ghazi; Rashidian, A; Forushani, A Rahimi; Zarei, E

2012-01-01

Service quality is perceived as an important factor for developing patient's loyalty. The aim of this study was to determine the hospital service quality from the patients' viewpoints and the relative importance of quality dimensions in predicting the patient's loyalty. A cross-sectional study was conducted in 2010. The study sample was composed of 943 patients selected from eight private general hospitals in Tehran. The survey instrument was a questionnaire included 24 items about the service quality and 3 items about the patient's loyalty. Exploratory factor analysis was employed to extracting the dimensions of service quality. Also, regression analysis was performed to determining the relative importance of the service quality dimensions in predicting the patient's loyalty. The mean score of service quality and patient's loyalty was 3.99 and 4.16 out of 5, respectively. About 29% of the loyalty variance was explained by the service quality dimensions. Four quality dimensions (Costing, Process Quality, Interaction Quality and Environment Quality) were found to be key determinants of the patient's loyalty in the private hospitals of Tehran. The patients' experience in relation to the private hospitals' services has strong impact on the outcome variables like willingness to return to the same hospital and reuse its services or recommend them to others. The relationship between the service quality and patient's loyalty proves the strategic importance of improving the service quality for dragging and retaining patients and expanding the market share.

Efficacy of Sweet Potato Powder and Added Water as Fat Replacer on the Quality Attributes of Low-fat Pork Patties.

PubMed

Verma, Akhilesh K; Chatli, Manish Kumar; Kumar, Devendra; Kumar, Pavan; Mehta, Nitin

2015-02-01

The present study was conducted to investigate the efficacy of sweet potato powder (SPP) and water as a fat replacer in low-fat pork patties. Low-fat pork patties were developed by replacing the added fat with combinations of SPP and chilled water. Three different levels of SPP/chilled water viz. 0.5/9.5% (T-1), 1.0/9.0% (T-2), and 1.5/8.5% (T-3) were compared with a control containing 10% animal fat. The quality of low-fat pork patties was evaluated for physico-chemical (pH, emulsion stability, cooking yield, aw), proximate, instrumental colour and textural profile, and sensory attributes. The cooking yield and emulsion stability improved (p<0.05) in all treatments over the control and were highest in T-2. Instrumental texture profile attributes and hardness decreased, whereas cohesiveness increased compared with control, irrespective of SPP level. Dimensional parameters (% gain in height and % decrease in diameter) were better maintained during cooking in the low-fat product than control. The sensory quality attributes juiciness, texture and overall acceptability of T-2 and T-3 were (p<0.05) higher than control. Results concluded that low-fat pork patties with acceptable sensory attributes, improved cooking yield and textural attributes can be successfully developed with the incorporation of a combination of 1.0% SPP and 9.0% chilled water.

Efficacy of Sweet Potato Powder and Added Water as Fat Replacer on the Quality Attributes of Low-fat Pork Patties

PubMed Central

Verma, Akhilesh K.; Chatli, Manish Kumar; Kumar, Devendra; Kumar, Pavan; Mehta, Nitin

2015-01-01

The present study was conducted to investigate the efficacy of sweet potato powder (SPP) and water as a fat replacer in low-fat pork patties. Low-fat pork patties were developed by replacing the added fat with combinations of SPP and chilled water. Three different levels of SPP/chilled water viz. 0.5/9.5% (T-1), 1.0/9.0% (T-2), and 1.5/8.5% (T-3) were compared with a control containing 10% animal fat. The quality of low-fat pork patties was evaluated for physico-chemical (pH, emulsion stability, cooking yield, aw), proximate, instrumental colour and textural profile, and sensory attributes. The cooking yield and emulsion stability improved (p<0.05) in all treatments over the control and were highest in T-2. Instrumental texture profile attributes and hardness decreased, whereas cohesiveness increased compared with control, irrespective of SPP level. Dimensional parameters (% gain in height and % decrease in diameter) were better maintained during cooking in the low-fat product than control. The sensory quality attributes juiciness, texture and overall acceptability of T-2 and T-3 were (p<0.05) higher than control. Results concluded that low-fat pork patties with acceptable sensory attributes, improved cooking yield and textural attributes can be successfully developed with the incorporation of a combination of 1.0% SPP and 9.0% chilled water. PMID:25557822

Antibody performance in ChIP-sequencing assays: From quality scores of public data sets to quantitative certification.

PubMed

Mendoza-Parra, Marco-Antonio; Saravaki, Vincent; Cholley, Pierre-Etienne; Blum, Matthias; Billoré, Benjamin; Gronemeyer, Hinrich

2016-01-01

We have established a certification system for antibodies to be used in chromatin immunoprecipitation assays coupled to massive parallel sequencing (ChIP-seq). This certification comprises a standardized ChIP procedure and the attribution of a numerical quality control indicator (QCi) to biological replicate experiments. The QCi computation is based on a universally applicable quality assessment that quantitates the global deviation of randomly sampled subsets of ChIP-seq dataset with the original genome-aligned sequence reads. Comparison with a QCi database for >28,000 ChIP-seq assays were used to attribute quality grades (ranging from 'AAA' to 'DDD') to a given dataset. In the present report we used the numerical QC system to assess the factors influencing the quality of ChIP-seq assays, including the nature of the target, the sequencing depth and the commercial source of the antibody.  We have used this approach specifically to certify mono and polyclonal antibodies obtained from Active Motif directed against the histone modification marks H3K4me3, H3K27ac and H3K9ac for ChIP-seq. The antibodies received the grades AAA to BBC ( www.ngs-qc.org). We propose to attribute such quantitative grading of all antibodies attributed with the label "ChIP-seq grade".

An Approach for Forest Inventory in Canada's Northern Boreal region, Northwest Territories

NASA Astrophysics Data System (ADS)

Mahoney, C.; Hopkinson, C.; Hall, R.; Filiatrault, M.

2017-12-01

The northern extent of Canada's northern boreal forest is largely inaccessible resulting in logistical, financial, and human challenges with respect to obtaining concise and accurate forest resource inventory (FRI) attributes such as stand height, aboveground biomass and forest carbon stocks. This challenge is further exacerbated by mandated government resource management and reporting of key attributes with respect to assessing impacts of natural disturbances, monitoring wildlife habitat and establishing policies to mitigate effects of climate change. This study presents a framework methodology utilized to inventory canopy height and crown closure over a 420,000 km2 area in Canada's Northwest Territories (NWT) by integrating field, LiDAR and satellite remote sensing data. Attributes are propagated from available field to coincident airborne LiDAR thru to satellite laser altimetry footprints. A quality controlled form of the latter are then submitted to a k-nearest neighbor (kNN) imputation algorithm to produce a continuous map of each attribute on a 30 m grid. The resultant kNN stand height (r=0.62, p=0.00) and crown closure (r=0.64, p=0.00) products were identified as statistically similar to a comprehensive independent airborne LiDAR source. Regional uncertainty can be produced with each attribute to identify areas of potential improvement through future strategic data acquisitions or the fine tuning of model parameters. This study's framework concept was developed to inform Natural Resources Canada - Canadian Forest Service's Multisource Vegetation Inventory and update vast regions of Canada's northern forest inventories, however, its applicability can be generalized to any environment. Not only can such a framework approach incorporate other data sources (such as Synthetic Aperture Radar) to potentially better characterize forest attributes, but it can also utilize future Earth observation mission data (for example ICESat-2) to monitor forest dynamics and the status, health and sustainability of Canada's northern boreal regions as areas where detailed inventory information is typically not available.

Cultural values and health service quality in China.

PubMed

Polsa, Pia; Fuxiang, Wei; Sääksjärvi, Maria; Shuyuan, Pei

2013-01-01

Several service quality studies show how cultural features may influence the way service quality is perceived. However, few studies specifically describe culture's influence on health service quality. Also, there are few studies that take into account patients' health service quality perceptions. This article seeks to present a first step to fill these gaps by examining patients' cultural values and their health service quality assessments. The study draws on published work and applies its ideas to Chinese healthcare settings. Data consist of hospital service perceptions in the People's Republic of China (PRC), a society that is socially, economically and culturally undergoing major changes. In total, 96 patients were surveyed. Data relationships were tested using partial least square (PLS) analysis. Findings show that Chinese patients' cultural values and their health service assessments are related and that the cultural values themselves seem to be changing. Additionally, further analyses provided interesting results pointing to which cultural values influenced service quality perceptions. The strongest service quality predictor was power distance. The sample is relatively small and collected from only one major hospital in China. Therefore, future research should extend the sample size and scope. Follow-up research could also include cross-cultural investigations of perceived health service quality to substantiate cultural influences on health service quality perceptions. In line with similar research in other contexts, the study confirms that power distance has a significant relationship with service quality perceptions. The study contributes to existing health service literature by offering patients' views on health service quality and by describing relationships between health service perceptions and cultural values--the study's main contribution.

26 CFR 1.671-3 - Attribution or inclusion of income, deductions, and credits against tax.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 8 2014-04-01 2014-04-01 false Attribution or inclusion of income, deductions, and credits against tax. 1.671-3 Section 1.671-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT... Treated As Substantial Owners § 1.671-3 Attribution or inclusion of income, deductions, and credits...

26 CFR 1.671-3 - Attribution or inclusion of income, deductions, and credits against tax.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 8 2013-04-01 2013-04-01 false Attribution or inclusion of income, deductions, and credits against tax. 1.671-3 Section 1.671-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT... Treated As Substantial Owners § 1.671-3 Attribution or inclusion of income, deductions, and credits...

26 CFR 1.671-3 - Attribution or inclusion of income, deductions, and credits against tax.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 8 2012-04-01 2012-04-01 false Attribution or inclusion of income, deductions, and credits against tax. 1.671-3 Section 1.671-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT... Treated As Substantial Owners § 1.671-3 Attribution or inclusion of income, deductions, and credits...

26 CFR 1.671-3 - Attribution or inclusion of income, deductions, and credits against tax.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Attribution or inclusion of income, deductions, and credits against tax. 1.671-3 Section 1.671-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT... Substantial Owners § 1.671-3 Attribution or inclusion of income, deductions, and credits against tax. (a) When...

26 CFR 1.671-3 - Attribution or inclusion of income, deductions, and credits against tax.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 8 2011-04-01 2011-04-01 false Attribution or inclusion of income, deductions, and credits against tax. 1.671-3 Section 1.671-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT... Treated As Substantial Owners § 1.671-3 Attribution or inclusion of income, deductions, and credits...

Stated Preference Methods for Valuation of Forest Attributes

Treesearch

Thomas P. Holmes; Kevin J. Boyle

2003-01-01

The valuation methods described in this chapter are based on the idea that forest ecosystems produce a wide variety of goods and services that are valued by people. Rather than focusing attention on the holistic value of forest ecosystems as is done in contingent valuation studies, attribute-based valuation methods (ABMs) focus attention on a set of attributes that...

Multiscale predictions of aviation-attributable PM2.5 for U.S. airports modeled using CMAQ with plume-in-grid and an aircraft-specific 1-D emission model

EPA Science Inventory

Aviation activities represent an important and unique mode of transportation, but also impact air quality. In this study, we aim to quantify the impact of aircraft on air quality, focusing on aviation-attributable PM2.5 at scales ranging from local (a few kilometers) to continent...

A Quality Process Approach to Electronic System Reliability: Supplier Quality Assessment Procedure. Volume 2

DTIC Science & Technology

1993-11-01

AND SUPPORT SERVICE QUALITY ....... 16 3.5.7 SUPPLIER QUALITY ............................................................................. 16 3.6...RESULTS ......................................................................................................... 16 3.6.1 PRODUCT AND SERVICE QUALITY RESULTS...10 5.6 Business Process and Support Service Quality 20 5.7 Supplier Quality 20 6.0 Results 180 6.1 Product and Service Quality Results 90 6.2 Business

Rice Grain Quality and Consumer Preferences: A Case Study of Two Rural Towns in the Philippines

PubMed Central

Velarde, Orlee; Demont, Matty

2016-01-01

Hedonic pricing analysis is conducted to determine the implicit values of various attributes in the market value of a good. In this study, hedonic pricing analysis was applied to measure the contribution of grain quality search and experience attributes to the price of rice in two rural towns in the Philippines. Rice samples from respondents underwent quantitative routine assessments of grain quality. In particular, gelatinization temperature and chalkiness, two parameters that are normally assessed through visual scores, were evaluated by purely quantitative means (differential scanning calorimetry and by digital image analysis). Results indicate that rice consumed by respondents had mainly similar physical and chemical grain quality attributes. The respondents’ revealed preferences were typical of what has been previously reported for Filipino rice consumers. Hedonic regression analyses showed that grain quality characteristics that affected price varied by income class. Some of the traits or socioeconomic factors that affected price were percent broken grains, gel consistency, and household per capita rice consumption. There is an income effect on rice price and the characteristics that affect price vary between income classes. PMID:26982587

Rice Grain Quality and Consumer Preferences: A Case Study of Two Rural Towns in the Philippines.

PubMed

Cuevas, Rosa Paula; Pede, Valerien O; McKinley, Justin; Velarde, Orlee; Demont, Matty

2016-01-01

Hedonic pricing analysis is conducted to determine the implicit values of various attributes in the market value of a good. In this study, hedonic pricing analysis was applied to measure the contribution of grain quality search and experience attributes to the price of rice in two rural towns in the Philippines. Rice samples from respondents underwent quantitative routine assessments of grain quality. In particular, gelatinization temperature and chalkiness, two parameters that are normally assessed through visual scores, were evaluated by purely quantitative means (differential scanning calorimetry and by digital image analysis). Results indicate that rice consumed by respondents had mainly similar physical and chemical grain quality attributes. The respondents' revealed preferences were typical of what has been previously reported for Filipino rice consumers. Hedonic regression analyses showed that grain quality characteristics that affected price varied by income class. Some of the traits or socioeconomic factors that affected price were percent broken grains, gel consistency, and household per capita rice consumption. There is an income effect on rice price and the characteristics that affect price vary between income classes.

Model‐based economic evaluations in smoking cessation and their transferability to new contexts: a systematic review

PubMed Central

Berg, Marrit L.; Cheung, Kei Long; Hiligsmann, Mickaël; Evers, Silvia; de Kinderen, Reina J. A.; Kulchaitanaroaj, Puttarin

2017-01-01

Abstract Aims To identify different types of models used in economic evaluations of smoking cessation, analyse the quality of the included models examining their attributes and ascertain their transferability to a new context. Methods A systematic review of the literature on the economic evaluation of smoking cessation interventions published between 1996 and April 2015, identified via Medline, EMBASE, National Health Service (NHS) Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA). The checklist‐based quality of the included studies and transferability scores was based on the European Network of Health Economic Evaluation Databases (EURONHEED) criteria. Studies that were not in smoking cessation, not original research, not a model‐based economic evaluation, that did not consider adult population and not from a high‐income country were excluded. Findings Among the 64 economic evaluations included in the review, the state‐transition Markov model was the most frequently used method (n = 30/64), with quality adjusted life years (QALY) being the most frequently used outcome measure in a life‐time horizon. A small number of the included studies (13 of 64) were eligible for EURONHEED transferability checklist. The overall transferability scores ranged from 0.50 to 0.97, with an average score of 0.75. The average score per section was 0.69 (range = 0.35–0.92). The relative transferability of the studies could not be established due to a limitation present in the EURONHEED method. Conclusion All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context. PMID:28060453

Model-based economic evaluations in smoking cessation and their transferability to new contexts: a systematic review.

PubMed

Berg, Marrit L; Cheung, Kei Long; Hiligsmann, Mickaël; Evers, Silvia; de Kinderen, Reina J A; Kulchaitanaroaj, Puttarin; Pokhrel, Subhash

2017-06-01

To identify different types of models used in economic evaluations of smoking cessation, analyse the quality of the included models examining their attributes and ascertain their transferability to a new context. A systematic review of the literature on the economic evaluation of smoking cessation interventions published between 1996 and April 2015, identified via Medline, EMBASE, National Health Service (NHS) Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA). The checklist-based quality of the included studies and transferability scores was based on the European Network of Health Economic Evaluation Databases (EURONHEED) criteria. Studies that were not in smoking cessation, not original research, not a model-based economic evaluation, that did not consider adult population and not from a high-income country were excluded. Among the 64 economic evaluations included in the review, the state-transition Markov model was the most frequently used method (n = 30/64), with quality adjusted life years (QALY) being the most frequently used outcome measure in a life-time horizon. A small number of the included studies (13 of 64) were eligible for EURONHEED transferability checklist. The overall transferability scores ranged from 0.50 to 0.97, with an average score of 0.75. The average score per section was 0.69 (range = 0.35-0.92). The relative transferability of the studies could not be established due to a limitation present in the EURONHEED method. All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context. © 2017 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Effects of Persuasive Appeals in Public Service Advertising

ERIC Educational Resources Information Center

Lynn, Jerry R.

1974-01-01

Concludes that of four message types perceived on the basis of persuasive appeal--emotional, logical, source-attribute, and fear--emotional appeal is the most effective and source-attribute the least effective method of advertising. (RB)

Quantitative comparison of measurements of urgent care service quality.

PubMed

Qin, Hong; Prybutok, Victor; Prybutok, Gayle

2016-01-01

Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.

Factors Affecting Medical Service Quality.

PubMed

Mosadeghrad, Ali Mohammad

2014-02-01

A better understanding of factors influencing quality of medical service can pinpoint better strategies for quality assurance in medical services. This study aimed to identify factors affecting the quality of medical services provided by Iranian physicians. Exploratory in-depth individual interviews were conducted with sixty-four physicians working in various medical institutions in Iran. Individual, organizational and environmental factors enhance or inhibit the quality of medical services. Quality of medical services depends on the personal factors of the physician and patient, and factors pertaining to the healthcare setting and the broader environment. Differences in internal and external factors such as availability of resources, patient cooperation and collaboration among providers affect the quality of medical services and patient outcomes. Supportive leadership, proper planning, education and training and effective management of resources and processes improve the quality of medical services. This article contributes to healthcare theory and practice by developing a conceptual framework for understanding factors that influence medical services quality.

EnviroAtlas - Tampa, FL - 51m Riparian Buffer Vegetated Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is vegetated. There is a potential for decreased water quality in areas where the riparian buffer is less vegetated. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

In situ biodeposition measurements on a Modiolus modiolus (horse mussel) reef provide insights into ecosystem services

NASA Astrophysics Data System (ADS)

Kent, Flora E. A.; Last, Kim S.; Harries, Daniel B.; Sanderson, William G.

2017-01-01

Horse mussel (Modiolus modiolus) shellfish reefs are a threatened and declining habitat in the North East Atlantic and support high levels of biodiversity. Shellfish can influence the surrounding water column and modify the quality of material that reaches the seabed by filtering water, actively depositing particles and changing the benthic boundary layer due to surface roughness. In the present study M. modiolus biodeposition was measured in a field location for the first time. The results show that M. modiolus enhance sedimentation and contribute to the downward flux of material to the seabed. Approximately 30% of the total sediment deposition was attributed to active filter feeding and overall, the presence of horse mussels enhanced deposition two fold. The results are discussed in terms of the potential for horse mussel reefs to provide ecosystem services to society, through functions such as benthopelagic coupling and sediment stabilisation. Highlighting the societal benefits supplied by marine habitats can help prioritise conservation efforts and feed into the sustainable management of coastal water bodies.

EnviroAtlas - Portland, OR - 51m Riparian Buffer Forest Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is forested. There is a potential for decreased water quality in areas where the riparian buffer is less forested. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area.This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (http:/www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Woodbine, Iowa - 51m Riparian Buffer Forest Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is forested. There is a potential for decreased water quality in areas where the riparian buffer is less forested. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area.This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Milwaukee, WI - 51m Riparian Buffer Forest Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is forested. There is a potential for decreased water quality in areas where the riparian buffer is less forested. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Fresno, CA - 51m Riparian Buffer Vegetated Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is vegetated. There is a potential for decreased water quality in areas where the riparian buffer is less vegetated. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Pittsburgh, PA - 51m Riparian Buffer Vegetated Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is vegetated. There is a potential for decreased water quality in areas where the riparian buffer is less vegetated. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Portland, OR - 51m Riparian Buffer Vegetated Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is vegetated. There is a potential for decreased water quality in areas where the riparian buffer is less vegetated. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (http:/www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Tampa, FL - 51m Riparian Buffer Forest Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is forested. There is a potential for decreased water quality in areas where the riparian buffer is less forested. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - New Bedford, MA - 51m Riparian Buffer Vegetated Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is vegetated. There is a potential for decreased water quality in areas where the riparian buffer is less vegetated. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Green Bay, WI - 51m Riparian Buffer Vegetated Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is vegetated. There is a potential for decreased water quality in areas where the riparian buffer is less vegetated. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets ).

EnviroAtlas - Durham, NC - 51m Riparian Buffer Forest Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is forested. There is a potential for decreased water quality in areas where the riparian buffer is less forested. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas ) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets ).

EnviroAtlas - Phoenix, AZ - 51m Riparian Buffer Forest Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is forested. There is a potential for decreased water quality in areas where the riparian buffer is less forested. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Green Bay, WI - 51m Riparian Buffer Forest Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is forested. There is a potential for decreased water quality in areas where the riparian buffer is less forested. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area.This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets ).

EnviroAtlas - New Bedford, MA - 51m Riparian Buffer Forest Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is forested. There is a potential for decreased water quality in areas where the riparian buffer is less forested. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Woodbine, IA - 51m Riparian Buffer Vegetated Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is vegetated. There is a potential for decreased water quality in areas where the riparian buffer is less vegetated. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Fresno, CA - 51m Riparian Buffer Forest Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is forested. There is a potential for decreased water quality in areas where the riparian buffer is less forested. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area.This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Phoenix, AZ - 51m Riparian Buffer Vegetated Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is vegetated. There is a potential for decreased water quality in areas where the riparian buffer is less vegetated. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Portland, ME - 51m Riparian Buffer Vegetated Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is vegetated. There is a potential for decreased water quality in areas where the riparian buffer is less vegetated. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Portland, Maine - 51m Riparian Buffer Forest Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is forested. There is a potential for decreased water quality in areas where the riparian buffer is less forested. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Pittsburgh, PA - 51m Riparian Buffer Forest Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is forested. There is a potential for decreased water quality in areas where the riparian buffer is less forested. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

EnviroAtlas - Durham, NC - 51m Riparian Buffer Vegetated Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is vegetated. There is a potential for decreased water quality in areas where the riparian buffer is less vegetated. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas ) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets ).

EnviroAtlas - Milwaukee, WI - 51m Riparian Buffer Vegetated Cover

EPA Pesticide Factsheets

This EnviroAtlas dataset describes the percentage of a 51-m riparian buffer that is vegetated. There is a potential for decreased water quality in areas where the riparian buffer is less vegetated. The displayed line represents the center of the analyzed riparian buffer. The water bodies analyzed include hydrologically connected streams, rivers, connectors, reservoirs, lakes/ponds, ice masses, washes, locks, and rapids within the Atlas Area. This dataset was produced by the US EPA to support research and online mapping activities related to EnviroAtlas. EnviroAtlas (https://www.epa.gov/enviroatlas) allows the user to interact with a web-based, easy-to-use, mapping application to view and analyze multiple ecosystem services for the contiguous United States. The dataset is available as downloadable data (https://edg.epa.gov/data/Public/ORD/EnviroAtlas) or as an EnviroAtlas map service. Additional descriptive information about each attribute in this dataset can be found in its associated EnviroAtlas Fact Sheet (https://www.epa.gov/enviroatlas/enviroatlas-fact-sheets).

Naturalness and interestingness of test images for visual quality evaluation

NASA Astrophysics Data System (ADS)

Halonen, Raisa; Westman, Stina; Oittinen, Pirkko

2011-01-01

Balanced and representative test images are needed to study perceived visual quality in various application domains. This study investigates naturalness and interestingness as image quality attributes in the context of test images. Taking a top-down approach we aim to find the dimensions which constitute naturalness and interestingness in test images and the relationship between these high-level quality attributes. We compare existing collections of test images (e.g. Sony sRGB images, ISO 12640 images, Kodak images, Nokia images and test images developed within our group) in an experiment combining quality sorting and structured interviews. Based on the data gathered we analyze the viewer-supplied criteria for naturalness and interestingness across image types, quality levels and judges. This study advances our understanding of subjective image quality criteria and enables the validation of current test images, furthering their development.

Does quality influence utilization of primary health care? Evidence from Haiti.

PubMed

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

(Not) getting political: indigenous women and preventing mother-to-child transmission of HIV in West Papua.

PubMed

Munro, Jenny; McIntyre, Lynn

2016-01-01

This paper builds on critiques that call for a more nuanced and contextualised understanding of conditions that affect HIV prevention by looking at West Papuan women's experiences of prevention of mother-to-child transmission services. Drawing on qualitative, ethnographic research with indigenous women and health workers, the paper demonstrates that women experience poor-quality HIV education and counselling, and that indigenous practices and concerns are largely not addressed by HIV services. We attribute this to a combination of national anti-indigenous and anti-separatist political concerns with donor-led interventions that result in limited localisation and reduced effectiveness of HIV prevention measures. In West Papua, services are needed that enhance cooperation and shared commitment, and that acknowledge and work to overcome existing inequalities, ethnic tensions and discrimination in the health system. Beyond Indonesia, donor-led HIV programmes and interventions need to balance avoidance of politically sensitive issues with complicity in perpetuating health inequalities. Translating global health interventions and donor priorities into locally compelling HIV prevention activities involves more than navigating local cultural and religious beliefs. Programme development and implementation strategies that entail confronting structural questions as well as social hierarchies, cleavages and silences are needed to render more effective services; strategies that are inherently political.