Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe

PubMed Central

Jennings, Larissa; Bertrand, Jane; Rech, Dino; Harvey, Steven A.; Hatzold, Karin; Samkange, Christopher A.; Omondi Aduda, Dickens S.; Fimbo, Bennett; Cherutich, Peter; Perry, Linnea; Castor, Delivette; Njeuhmeli, Emmanuel

2014-01-01

Background The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria. Methods and Findings A comparative process evaluation was used to examine data from SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up, among health facilities providing VMMC across two years of program scale-up. Site-level assessments examined the availability of guidelines, supplies and equipment, infection control, and continuity of care services. Direct observation of VMMC surgeries were used to assess care quality. Two sample tests of proportions and t-tests were used to examine differences in the percent of facilities meeting requisite preparedness standards and the mean number of directly-observed surgical tasks performed correctly. Results showed that safe, high quality VMMC can be implemented and sustained at-scale, although substantial variability was observed over time. In some settings, facility preparedness and VMMC service quality improved as the number of VMMC facilities increased. Yet, lapses in high performance and expansion of considerably deficient services were also observed. Surgical tasks had the highest quality scores, with lower performance levels in infection control, pre-operative examinations, and post-operative patient monitoring and counseling. The range of scale-up models used across countries additionally underscored the complexity of delivering high quality VMMC. Conclusions Greater efforts are needed to integrate VMMC scale-up and quality improvement processes in sub-Saharan African settings. Monitoring of service quality, not just adverse events reporting, will be essential in realizing the full health impact of VMMC for HIV prevention. PMID:24801073

Critical loads and levels: Leveraging existing monitoring data

Treesearch

D. G. Fox; A. R. Riebau; R. Fisher

2006-01-01

A snapshot of current air quality in the National Parks and Wilderness areas of the US is presented based on data from the 165 site Interagency Monitoring of Protected Visual Environments, or IMPROVE program, and other relevant air quality monitoring programs. This snapshot is provided using the VIEWS web service, an on-line web-based data warehouse, analysis, and...

Quality of the ophthalmological service to outpatients of the public and private healthcare systems.

PubMed

Hercos, Benigno Vicente Santos; Berezovsky, Adriana

2017-01-01

To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

Review of Available Water-Quality Data for the Southern Colorado Plateau Network and Characterization of Water Quality in Five Selected Park Units in Arizona, Colorado, New Mexico, and Utah, 1925 to 2004

USGS Publications Warehouse

Brown, Juliane B.

2008-01-01

Historical water-quality data in the National Park Service Southern Colorado Plateau Network have been collected irregularly and with little followup interpretation, restricting the value of the data. To help address these issues, to inform future water-quality monitoring planning efforts, and to address relevant National Park Service Inventory and Monitoring Program objectives, the U.S. Geological Survey, in cooperation with the National Park Service, compiled, reviewed, and summarized available historical water-quality data for 19 park units in the Southern Colorado Plateau Network. The data are described in terms of availability by major water-quality classes, park unit, site type, and selected identified water sources. The report also describes the geology, water resources, water-quality issues, data gaps, and water-quality standard exceedances identified in five of the park units determined to be of high priority. The five park units are Bandelier National Monument in New Mexico, Canyon de Chelly National Monument in Arizona, Chaco Culture National Historical Park in New Mexico, Glen Canyon National Recreation Area in Arizona and Utah, and Mesa Verde National Park in Colorado. Statistical summaries of water-quality characteristics are presented and considerations for future water-quality monitoring are provided for these five park units.

[The telemedical service centre as an essential element of the conceptual approach for telemonitoring of cardiac patients : Requirements on the service, quality, and technical realization of telemonitoring].

PubMed

Helms, T M; Müller, A; Perings, C; Köhler, F; Leonhardt, V; Rybak, K; Sack, S; Stockburger, M

2017-09-01

Telemonitoring as part of a treatment strategy supports and facilitates the monitoring, disease management and education of patients with heart failure and cardiac arrhythmias. Therefore, telemonitoring affects quality and success of the therapy. Thus, meeting the needs of the patients and of the involved health care professionals is important for the success of the telemonitoring service. Moreover, a high quality of the service has to be ensured. The following article describes several configuration options for telemonitoring services considering technical as well as quality- and service-related aspects.

A Longitudinal Sociological Monitoring of Customers' Satisfaction with the Quality of Educational Services

ERIC Educational Resources Information Center

Gaidukova, G. N.

2014-01-01

Research data on levels of satisfaction with educational services in a Russian university show room for improvement in such areas as vocational guidance work; range of opportunities in the choice of specialization and optional disciplines; availability of academic and methodological literature; the quality of food services; and amount of practical…

Improving Reference Service: The Case for Using a Continuous Quality Improvement Method.

ERIC Educational Resources Information Center

Aluri, Rao

1993-01-01

Discusses the evaluation of library reference service; examines problems with past evaluations, including the lack of long-term planning and a systems perspective; and suggests a method for continuously monitoring and improving reference service using quality improvement tools such as checklists, cause and effect diagrams, Pareto charts, and…

42 CFR 418.58 - Condition of participation: Quality assessment and performance improvement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... collected to do the following: (i) Monitor the effectiveness and safety of services and quality of care. (ii... 42 Public Health 3 2010-10-01 2010-10-01 false Condition of participation: Quality assessment and performance improvement. 418.58 Section 418.58 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES...

CMEMS (Copernicus Marine Environment Monitoring Service) In Situ Thematic Assembly Centre: A service for operational Oceanography

NASA Astrophysics Data System (ADS)

Manzano Muñoz, Fernando; Pouliquen, Sylvie; Petit de la Villeon, Loic; Carval, Thierry; Loubrieu, Thomas; Wedhe, Henning; Sjur Ringheim, Lid; Hammarklint, Thomas; Tamm, Susanne; De Alfonso, Marta; Perivoliotis, Leonidas; Chalkiopoulos, Antonis; Marinova, Veselka; Tintore, Joaquin; Troupin, Charles

2016-04-01

Copernicus, previously known as GMES (Global Monitoring for Environment and Security), is the European Programme for the establishment of a European capacity for Earth Observation and Monitoring. Copernicus aims to provide a sustainable service for Ocean Monitoring and Forecasting validated and commissioned by users. From May 2015, the Copernicus Marine Environment Monitoring Service (CMEMS) is working on an operational mode through a contract with services engagement (result is regular data provision). Within CMEMS, the In Situ Thematic Assembly Centre (INSTAC) distributed service integrates in situ data from different sources for operational oceanography needs. CMEMS INSTAC is collecting and carrying out quality control in a homogeneous manner on data from providers outside Copernicus (national and international networks), to fit the needs of internal and external users. CMEMS INSTAC has been organized in 7 regional Dissemination Units (DUs) to rely on the EuroGOOS ROOSes. Each DU aggregates data and metadata provided by a series of Production Units (PUs) acting as an interface for providers. Homogeneity and standardization are key features to ensure coherent and efficient service. All DUs provide data in the OceanSITES NetCDF format 1.2 (based on NetCDF 3.6), which is CF compliant, relies on SeaDataNet vocabularies and is able to handle profile and time-series measurements. All the products, both near real-time (NRT) and multi-year (REP), are available online for every CMEMS registered user through an FTP service. On top of the FTP service, INSTAC products are available through Oceanotron, an open-source data server dedicated to marine observations dissemination. It provides services such as aggregation on spatio-temporal coordinates and observed parameters, and subsetting on observed parameters and metadata. The accuracy of the data is checked on various levels. Quality control procedures are applied for the validity of the data and correctness tests for the metadata of each NetCDF file. The quality control procedures for the data include different routines for NRT and REP products. Key Performance Indicators (KPI) for monitoring purposes are also used in Copernicus. They allow a periodic monitoring of the availability, quantity and quality of the INSTAC data integrated in the NRT products. Statistical reports are generated on quarterly and yearly basis to provide more visibility on the coverage in space and time of the INSTAC NRT and REP products, as well as information on their quality. These reports are generated using Java and Python procedures developed within the INSTAC group. One of the most critical tasks for the DUs is to generate NetCDF files compliant with the agreed format. Many tools and programming libraries have been developed for that purpose, for instance Unidata Java Library. These tools provide NetCDF data management capabilities including creation, reading and modification. Some DUs have also developed regional data portals which offer useful information for the users including data charts, platforms availability through interactive maps, KPI and statistical figures and direct access to the FTP service. The proposed presentation will detail Copernicus in situ data service and the monitoring tools that have been developed by the INSTAC group.

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.

Monitoring progress towards universal health coverage at country and global levels.

PubMed

Boerma, Ties; Eozenou, Patrick; Evans, David; Evans, Tim; Kieny, Marie-Paule; Wagstaff, Adam

2014-09-01

Universal health coverage (UHC) has been defined as the desired outcome of health system performance whereby all people who need health services (promotion, prevention, treatment, rehabilitation, and palliation) receive them, without undue financial hardship. UHC has two interrelated components: the full spectrum of good-quality, essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services. Both components should benefit the entire population. This paper summarizes the findings from 13 country case studies and five technical reviews, which were conducted as part of the development of a global framework for monitoring progress towards UHC. The case studies show the relevance and feasibility of focusing UHC monitoring on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity. These components link directly to the definition of UHC and measure the direct results of strategies and policies for UHC. The studies also show how UHC monitoring can be fully embedded in often existing, regular overall monitoring of health sector progress and performance. Several methodological and practical issues related to the monitoring of coverage of essential health services, financial protection, and equity, are highlighted. Addressing the gaps in the availability and quality of data required for monitoring progress towards UHC is critical in most countries.

Monitoring Progress towards Universal Health Coverage at Country and Global Levels

PubMed Central

Boerma, Ties; Eozenou, Patrick; Evans, David; Evans, Tim; Kieny, Marie-Paule; Wagstaff, Adam

2014-01-01

Universal health coverage (UHC) has been defined as the desired outcome of health system performance whereby all people who need health services (promotion, prevention, treatment, rehabilitation, and palliation) receive them, without undue financial hardship. UHC has two interrelated components: the full spectrum of good-quality, essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services. Both components should benefit the entire population. This paper summarizes the findings from 13 country case studies and five technical reviews, which were conducted as part of the development of a global framework for monitoring progress towards UHC. The case studies show the relevance and feasibility of focusing UHC monitoring on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity. These components link directly to the definition of UHC and measure the direct results of strategies and policies for UHC. The studies also show how UHC monitoring can be fully embedded in often existing, regular overall monitoring of health sector progress and performance. Several methodological and practical issues related to the monitoring of coverage of essential health services, financial protection, and equity, are highlighted. Addressing the gaps in the availability and quality of data required for monitoring progress towards UHC is critical in most countries. PMID:25243899

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.

Reliability and Utility of the Behaviour Support Plan Quality Evaluation Tool (BSP-QEII) for Auditing and Quality Development in Services for Adults with Intellectual Disability and Challenging Behaviour

ERIC Educational Resources Information Center

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

2013-01-01

Background: Having an objective means of evaluating the quality of behaviour support plans (BSPs) could assist service providers and statutory authorities to monitor and improve the quality of support provided to people with intellectual disability (ID) who exhibit challenging behaviour. The Behaviour Support Plan Quality Evaluation Guide II…

Near Real Time Operational Satellite Ocean Color Products From NOAA OSPO CoastWatch Okeanos System:: Status and Challenges

NASA Astrophysics Data System (ADS)

Banghua Yan, B.

2016-02-01

Near real-time (NRT) ocean color (OC) satellite operation products are generated and distributed in NOAA Okeanos Operational Product System, by using the CWAPS including the Multi-Sensor Level (MSL) 12 and the chlorophyll-a frontal algorithms. Current OC operational products include daily chlorophyll concentration (anomaly), water turbidity, remote sensing reflectance and chlorophyll frontal products from Moderate-resolution Imaging Spectroradiometer (MODIS)/Aqua. The products have been widely applied to USA local and state ecosystem research, ecosystem observations, and fisheries managements for coastal and regional forecasting of ocean water quality, phytoplankton concentrations, and primary production. Users of the products have the National Ocean Service, National Marine Fisheries Service, National Weather Service, and Oceanic and Atmospheric Research. Recently, the OC products are being extended to S-NPP VIIRS to provide global NRT ocean color products to user community suh as National Weatrher Service for application for Global Data Assimilation System and Real-Time Ocean Forecast System. However, there remain some challenges in application of the products due to certain product quality and coverage issues. Recent efforts were made to provide a comprehensive web-based Quality Assurance (QA) tool for monitoring OC products quality in near real time mode, referring to http://www.ospo.noaa.gov/Products/ocean/color_new/color.htm. The new QA monitoring tool includes but not limited to the following advanced features applicable for MODIS/Aqua and NPP/VIIRS OC products: 1) Monitoring product quality in NRT mode; 2) Monitoring the availability and quality of OC products with time; 3) Detecting anomalous OC products due to low valid pixels and other quality issues. As an example, potential application and challenges of the ocean color products to oceanic oil spill detection are investigated. It is thus expected that the Okeanos ocean color operational system in combination with the new QA monitoring tool will more efficiently ensure availability and quality of satellite operational OC products from Okeanos system to the user community. The QA tool also will provide much useful information of OC products quality and statistics to the OC user community.

Effect of home care service on the quality of life in patients with gynecological cancer.

PubMed

Aktas, Demet; Terzioglu, Fusun

2015-01-01

The purpose of the research was to determine the effect of home care service on the quality of life in patients with gynecological cancer. This randomized case control study was carried out in a womans hospital between September 2011 and February 2012. Women undergoing gynecological cancer treatment were separated into intervention and control groups, of 35 patients each. The intervention group was provided with nursing care service through hospital and home visits (1st, 12th weeks) within the framework of a specifically developed nursing care plan. The control group was monitored without any intervention through the hospital routine protocols (1st, 12th weeks). Data were collected using An Interview Form, Home Visit Monitoring Form and Quality of Life Scale/Cancer Survivors. Effects of home care service on the quality of life in gynecological cancer patients were investigated using chi-square tests, McNemar's test, independent t-test and ANOVA. This study found that the intervention group receiving home care service had a moderately high quality of life (average mean: 6.01±0.64), while the control group had comparatively lower quality (average mean: 4.35±0.79) within the 12 week post- discharge period (p<0.05). This study found home care services to be efficient in improving the quality of life in patients with gynecological cancer.

Development and Monitoring the Key Performance Indicators of the Quality of Care for Patients with Cleft Lips/Palates at Srinagarind Hospital.

PubMed

Mongkhonthawornchai, Siriporn; Pradubwong, Suteera; Augsornwan, Darawan; Pathumwiwatana, Pornpen; Sroyhin, Waranya; Pongpagatip, Sumalee; Wongkham, Jamras; Wachirapakorn, Jantira; Lao-unka, Kesorn; Mucnamporn, Tippawan; Chowchuen, Bowornsilp

2015-08-01

Congenital deformities, such as cleft lips and/or cleft palates (CLP), have high incidences in the Northeast of Thailand. These birth defects can affect patient's quality of life. CLP patients need crucial and long-term treatments by a multidisciplinary team starting from prenatal stage to late adulthood. Patients and their families should involve in their own care, and their care objectives should correspond with healthcare providers. Besides the clinical outcome of interdisciplinary team, key performance indicators (KPIs) need to be developed in the hospital service unit in order to improve quality of care and treatment outcomes. 1) to establish KPIs in hospital service units, and 2) to develop the information system to collect, analysis and improve the quality of CLP care. A nurse coordinator was appointed in the Tawanchai Center to coordinate care. The three periods were conducted for the nurse coordinator to work with nine service units in Srinagarind Hospital for consensus on both qualitative and quantitative data to be used as service unit quality measurement. Thirty one KPIs from nine service units were established, collected and analyzed during a four-month period in 2014. The 20 KPIs achieved the unit targets. Two PKIs of the rates of complication with anesthesia during/after surgery in the first 24 hours and the rates of patient/caregiver's satisfaction in acquiring information from the officer were improving. There were 11 KPIs that did not achieve the targets. The coordinator nurse of the Tawanchai Center discussed with the service unit for the cause and how to improve the outcome. The monitoring KPIs will lead to improvement of outcome for better patient quality as well as benchmarking with other hospitals of Cleft Center. The KPIs from hospital service units with the monitoring and analysis of information by the nurse coordinator will enhance and lead to improvement of the quality of the patients and family centered care process.

[2011 after-service customer satisfaction survey of monitoring devices in Shanghai area].

PubMed

Wang, Lijun; Li, Bin; Qian, Jianguo; Cao, Shaoping; He, Dehua; Zheng, Yunxin

2013-01-01

In 2011, Shanghai Medical Equipment Management Quality Control Center launched the fifth after-sale service satisfaction survey for medical devices in Shanghai area. There are 8 classes medical devices involving in the survey. This paper demonstrates the investigation results of monitoring devices which are from different manufacturers.

Monitoring Trends in Educational Growth: A Partnership Service to Monitor the Educational Growth of Students in the Early to Middle Years of Schooling

ERIC Educational Resources Information Center

Australian Council for Educational Research, 2015

2015-01-01

Monitoring Trends in Educational Growth (MTEG) offers a flexible, collaborative approach to developing and implementing an assessment of learning outcomes that yields high-quality, nationally relevant data. MTEG is a service that involves ACER staff working closely with each country to develop an assessment program that meets the country's…

Water quality monitoring for high-priority water bodies in the Sonoran Desert network

Treesearch

Terry W. Sprouse; Robert M. Emanuel; Sara A. Strorrer

2005-01-01

This paper describes a network monitoring program for “high priority” water bodies in the Sonoran Desert Network of the National Park Service. Protocols were developed for monitoring selected waters for ten of the eleven parks in the Network. Park and network staff assisted in identifying potential locations of testing sites, local priorities, and how water quality...

Designing-and Redesigning-Information Services for Maximum Impact.

ERIC Educational Resources Information Center

Jones, Rebecca; Dysart, Jane

2002-01-01

Discusses innovative information services, including new services and the redesign of existing services. Describes the development process, including assessing the market and developing a marketing plan; and explains the implementation process, including monitoring client satisfaction and quality control. (LRW)

The Copernicus Atmosphere Monitoring Service: facilitating the prediction of air quality from global to local scales

NASA Astrophysics Data System (ADS)

Engelen, R. J.; Peuch, V. H.

2017-12-01

The European Copernicus Atmosphere Monitoring Service (CAMS) operationally provides daily forecasts of global atmospheric composition and regional air quality. The global forecasting system is using ECMWF's Integrated Forecasting System (IFS), which is used for numerical weather prediction and which has been extended with modules for atmospheric chemistry, aerosols and greenhouse gases. The regional forecasts are produced by an ensemble of seven operational European air quality models that take their boundary conditions from the global system and provide an ensemble median with ensemble spread as their main output. Both the global and regional forecasting systems are feeding their output into air quality models on a variety of scales in various parts of the world. We will introduce the CAMS service chain and provide illustrations of its use in downstream applications. Both the usage of the daily forecasts and the usage of global and regional reanalyses will be addressed.

Transforming Data into Practical Information: Using Consumer Input to Improve Home-Care Services

ERIC Educational Resources Information Center

Applebaum, Robert; Kunkel, Suzanne; Wilson, Ken

2007-01-01

Purpose: As funds have increased for the provision of in-home care, so too have concerns about the quality of services. In response, care management agencies and home-care providers have developed an array of monitoring activities designed to ensure the quality of services. In this article, we show how an area agency on aging both collected and…

Two-echelon logistics service supply chain decision game considering quality supervision

NASA Astrophysics Data System (ADS)

Shi, Jiaying

2017-10-01

Due to the increasing importance of supply chain logistics service, we established the Stackelberg game model between single integrator and single subcontractors under decentralized and centralized circumstances, and found that logistics services integrators as a leader prefer centralized decision-making but logistics service subcontractors tend to the decentralized decision-making. Then, we further analyzed why subcontractor chose to deceive and rebuilt a principal-agent game model to monitor the logistics services quality of them. Mixed Strategy Nash equilibrium and related parameters were discussed. The results show that strengthening the supervision and coordination can improve the quality level of logistics service supply chain.

Network Quality of Service Monitoring for IP Telephony.

ERIC Educational Resources Information Center

Ghita, B. V.; Furnell, S. M.; Lines, B. M.; Le-Foll, D.; Ifeachor, E. C.

2001-01-01

Discusses the development of real-time applications on the Internet for telecommunications and presents a non-intrusive way of determining network performance parameters for voice packet flows within a voice over IP (Internet Protocol), or Internet telephony call. Considers measurement of quality of service and describes results of a preliminary…

Delivery of nutrition services in health systems in sub-Saharan Africa: opportunities in Burkina Faso, Mozambique and Niger.

PubMed

Hampshire, Rachel D; Aguayo, Victor M; Harouna, Hamani; Roley, Julie A; Tarini, Ann; Baker, Shawn K

2004-12-01

In sub-Saharan Africa, underweight and micronutrient deficiencies account for an estimated 25% of the burden of disease. As the coverage of national health systems expands, increased opportunities exist to address the needs of children and women, the most vulnerable to these deficiencies, through high-quality nutrition services. To assess health providers' knowledge and practice with regard to essential nutrition services for women and children in Burkina Faso, Mozambique and Niger, in order to assist the development of a standard guide and tools to assess and monitor the quality of the nutrition services delivered through national health systems. The three surveys reveal the extent of missed opportunities to deliver nutrition services during routine prenatal, postnatal and child-care consultations for the prevention and treatment of highly prevalent nutritional deficiencies. A commitment to improving the quality of facility-based nutrition services is necessary to impact on the health outcomes of women and children 'covered' by national health systems. Rigorous assessment and monitoring of the quality of nutrition services should inform health programme and policy development. Building on the lessons learned in these three assessments, Helen Keller International has developed a standard Guide and Tools to assess the quality of the nutrition services delivered through national health systems. These tools can be adapted to assess ongoing nutrition services in health facilities, provide a framework for nutrition programming, inform the development of pre-service as well as in-service nutrition training curricula for providers, and evaluate the impact of nutrition training on providers' practices.

Gaining competitive advantage in personal dosimetry services through ISO 9001 certification.

PubMed

Noriah, M A

2007-01-01

This paper discusses the advantage of certification process in the quality assurance of individual dose monitoring in Malaysia. The demand by customers and the regulatory authority for a higher degree of quality service requires a switch in emphasis from a technically focused quality assurance program to a comprehensive quality management for service provision. Achieving the ISO 9001:2000 certification by an accredited third party demonstrates acceptable recognition and documents the fact that the methods used are capable of generating results that satisfy the performance criteria of the certification program. It also offers a proof of the commitment to quality and, as a benchmark, allows measurement of the progress for continual improvement of service performance.

42 CFR 480.131 - Access to medical records for the monitoring of QIOs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Disclosure of Confidential Information § 480.131 Access to medical records...

42 CFR 480.131 - Access to medical records for the monitoring of QIOs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Disclosure of Confidential Information § 480.131 Access to medical records...

42 CFR 480.131 - Access to medical records for the monitoring of QIOs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Disclosure of Confidential Information § 480.131 Access to medical records...

Developing a quality assurance program for online services.

PubMed Central

Humphries, A W; Naisawald, G V

1991-01-01

A quality assurance (QA) program provides not only a mechanism for establishing training and competency standards, but also a method for continuously monitoring current service practices to correct shortcomings. The typical QA cycle includes these basic steps: select subject for review, establish measurable standards, evaluate existing services using the standards, identify problems, implement solutions, and reevaluate services. The Claude Moore Health Sciences Library (CMHSL) developed a quality assurance program for online services designed to evaluate services against specific criteria identified by research studies as being important to customer satisfaction. These criteria include reliability, responsiveness, approachability, communication, and physical factors. The application of these criteria to the library's existing online services in the quality review process is discussed with specific examples of the problems identified in each service area, as well as the solutions implemented to correct deficiencies. The application of the QA cycle to an online services program serves as a model of possible interventions. The use of QA principles to enhance online service quality can be extended to other library service areas. PMID:1909197

Developing a quality assurance program for online services.

PubMed

Humphries, A W; Naisawald, G V

1991-07-01

A quality assurance (QA) program provides not only a mechanism for establishing training and competency standards, but also a method for continuously monitoring current service practices to correct shortcomings. The typical QA cycle includes these basic steps: select subject for review, establish measurable standards, evaluate existing services using the standards, identify problems, implement solutions, and reevaluate services. The Claude Moore Health Sciences Library (CMHSL) developed a quality assurance program for online services designed to evaluate services against specific criteria identified by research studies as being important to customer satisfaction. These criteria include reliability, responsiveness, approachability, communication, and physical factors. The application of these criteria to the library's existing online services in the quality review process is discussed with specific examples of the problems identified in each service area, as well as the solutions implemented to correct deficiencies. The application of the QA cycle to an online services program serves as a model of possible interventions. The use of QA principles to enhance online service quality can be extended to other library service areas.

[Ophthalmological service quality offered to outpatients of the Public Healthcare System].

PubMed

Santos Hercos, Benigno Vicente; Berezovsky, Adriana

2006-01-01

To identify the perception of the ophthalmic service quality provided for outpatients of the public healthcare system as well as to detect which actions should be considered necessary and priority in order to improve its quality. A quantitative descriptive study was carried out on 100 outpatients of the public healthcare system which were submitted to ophthalmic tests at Fundação Hilton Rocha--Belo Horizonte-MG, from July 1st-July 30th 2004. Individual interviews were carried out by giving the interviewees two structured questionnaires adapted from the modified SERVQUAL. This scale is in agreement with the reality of the studied institute. The adapted SERVQUAL scale was submitted to statistical validation and it showed a suitable internal consistency index. In general terms, a slight general dissatisfaction was detected regarding ophthalmological service quality. The interviewees cared more about safety and reliability. A higher degree of dissatisfaction was detected mainly concerning fulfillment of procedures at scheduled appointments related to the execution of services within due time-limits. The institute is supposed to plan as well as carry out actions which lead to a general improvement in the patient's satisfaction regarding service quality and mainly reliability. Service quality monitoring through periodic use of the SERVQUAL scale will not only make it possible to plan highly precise and effective intervention strategies in these and in other healthcare services but it will also allow monitoring the responses to these actions. All these actions will contribute to the improvement of the service in the system as a whole.

[Construction and implementation of two quality indicators in nursing services].

PubMed

de Moura, Gisela Maria Schebela Souto; Juchem, Beatriz Cavalcanti; Falk, Maria Lucia Rodrigues; de Magalhães, Ana Maria Muller; Suzuki, Lyliam Midori

2009-03-01

Indicators monitor the quality of services and improve the attention offered to the patients. Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil, has been developing strategies to assess its services according to its institutional management policy of quality The present study aims to report the experience at this university hospital with the construction and implementation of quality indicators in its nursing services. In 2006, four indicators were established: incidence of pressure ulcer, with a goal of < or = 10:1000 patients per day/month and incidence of falls from bed whose goal was established as < or = 2:1000 patients per day/month. Our challenge was to build and implement these indicators as management tools to assess the quality of nursing services, for this is a large hospital.

Development of a new Clinical Engineering Management Tool & Information System (CLE-MANTIS).

PubMed

Panousis, S G; Malataras, P; Patelodimou, C; Kolitsi, Z; Pallikarakis, N

1997-01-01

The evolution of the field of biomedical technology has led to the diffusion of an impressive number of medical devices into healthcare institutions. In this environment, Clinical Engineering Departments (CEDs) are expanding their role in healthcare technology management, by changing their structure and introducing quality systems in order to improve their services and monitor the outcomes. In the framework of the national project BIOTECHNET II, a software tool for the management of biomedical technology, named CLE-MANTIS, has been developed, with the aim to assist CEDs in their tasks. CLE-MANTIS functions include the upkeep of an inventory, the support and monitoring of scheduled maintenance, corrective maintenance, vigilance, equipment acquisition and replacement, service contract management and user training. The system offers clinical engineers the possibility to monitor and evaluate the quality and cost-effectiveness of their departments through the monitoring of quality and cost indicators. This paper presents the main features and functions of the system.

42 CFR 480.131 - Access to medical records for the monitoring of QIOs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Disclosure of Confidential Information § 480.131 Access to medical records...

42 CFR 480.131 - Access to medical records for the monitoring of QIOs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Disclosure of Confidential Information § 480.131 Access to medical records...

Guide to Improving Parenting Education in Even Start Family Literacy Programs.

ERIC Educational Resources Information Center

Powell, Douglas R.; D'Angelo, Diane

This guide provides a framework and suggestions for strengthening the quality and impact of parenting education services in Even Start. It is aimed at Even Start state coordinators and local program administrators responsible for supporting and monitoring the quality of parenting education services in Even Start, and at local program staff…

Continuous water-quality monitoring to improve lake management at Lake Mattamuskeet National Wildlife Refuge

Treesearch

Michelle Moorman; Tom Augspurger

2016-01-01

The U.S. Fish and Wildlife Service has partnered with U.S. Geological Survey to establish 2 continuous water-quality monitoring stations at Lake Mattamuskeet. Stations on the east and west side of the lake measure water level, clarity, dissolved oxygen, pH, temperature, salinity, and conductivity.

Information for mental health systems: an instrument for policy-making and system service quality.

PubMed

Lora, A; Lesage, A; Pathare, S; Levav, I

2017-08-01

Information is crucial in mental healthcare, yet it remains undervalued by stakeholders. Its absence undermines rationality in planning, makes it difficult to monitor service quality improvement, impedes accountability and human rights monitoring. For international organizations (e.g., WHO, OECD), information is indispensable for achieving better outcomes in mental health policies, services and programs. This article reviews the importance of developing system level information with reference to inputs, processes and outputs, analyzes available tools for collecting and summarizing information, highlights the various goals of information gathering, discusses implementation issues and charts the way forward. Relevant publications and research were consulted, including WHO studies that purport to promote the use of information systems to upgrade mental health care in high- and low-middle income countries. Studies have shown that once information has been collected by relevant systems and analyzed through indicator schemes, it can be put to many uses. Monitoring mental health services, represents a first step in using information. In addition, studies have noted that information is a prime resource in many other areas such as evaluation of quality of care against evidence based standards of care. Services data may support health services research where it is possible to link mental health data with other health and non-health databases. Information systems are required to carefully monitor involuntary admissions, restrain and seclusion, to reduce human rights violations in care facilities. Information has been also found useful for policy makers, to monitor the implementation of policies, to evaluate their impact, to rationally allocate funding and to create new financing models. Despite its manifold applications, Information systems currently face many problems such as incomplete recording, poor data quality, lack of timely reporting and feedback, and limited application of information. Corrective action is needed to upgrade data collection in outpatient facilities, to improve data quality, to establish clear rules and norms, to access adequate information technology equipment and to train health care personnel in data collection. Moreover, it is necessary to shift from mere administrative data collection to analysis, dissemination and use by relevant stakeholders and to develop a "culture of information" to dismantle the culture of intuition and mere tradition. Clinical directors, mental health managers, patient and family representatives, as well as politicians should be educated to operate with information and not just intuition.

20 CFR 627.475 - Oversight and monitoring.

Code of Federal Regulations, 2010 CFR

2010-04-01

... monitoring. (a) The Secretary may monitor all recipients and subrecipients of financial assistance pursuant... program quality and outcomes meet the objectives of the Act and regulations promulgated thereunder; (2... Coordination and Special Services Plan (GCSSP). (e)(1) The PIC, pursuant to standards established by the...

Lichens as bioindicators of air quality. Forest Service general technical report (Final)

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

Stolte, K.; Doty, R.; Mangis, D.

1993-03-01

The report is the result of a workshop held in Denver, Colorado on April 9-11, 1991. It summarizes the current literature and techniques for using lichens to monitor air quality. Experts in lichenology and ecology contributed information on lichen floristics, characterization of monitoring sites, lichen species and communities, identifying lichen species sensitive to pollutants, active monitoring with transplants, chemical analysis of lichens, and case studies as examples of lichen biomonitoring scenarios.

Ubiquitous Computing for Remote Cardiac Patient Monitoring: A Survey

PubMed Central

Kumar, Sunil; Kambhatla, Kashyap; Hu, Fei; Lifson, Mark; Xiao, Yang

2008-01-01

New wireless technologies, such as wireless LAN and sensor networks, for telecardiology purposes give new possibilities for monitoring vital parameters with wearable biomedical sensors, and give patients the freedom to be mobile and still be under continuous monitoring and thereby better quality of patient care. This paper will detail the architecture and quality-of-service (QoS) characteristics in integrated wireless telecardiology platforms. It will also discuss the current promising hardware/software platforms for wireless cardiac monitoring. The design methodology and challenges are provided for realistic implementation. PMID:18604301

Ubiquitous computing for remote cardiac patient monitoring: a survey.

PubMed

Kumar, Sunil; Kambhatla, Kashyap; Hu, Fei; Lifson, Mark; Xiao, Yang

2008-01-01

New wireless technologies, such as wireless LAN and sensor networks, for telecardiology purposes give new possibilities for monitoring vital parameters with wearable biomedical sensors, and give patients the freedom to be mobile and still be under continuous monitoring and thereby better quality of patient care. This paper will detail the architecture and quality-of-service (QoS) characteristics in integrated wireless telecardiology platforms. It will also discuss the current promising hardware/software platforms for wireless cardiac monitoring. The design methodology and challenges are provided for realistic implementation.

Chapter 9. Data Management, Storage, and Reporting

Treesearch

Linda A. Spencer; Mary M. Manning; Bryce Rickel

2013-01-01

Data collected for a habitat monitoring program must be managed and stored to be accessible for current and future use inside and outside the Forest Service. Information maintenance and dissemination are important to the Forest Service; they are part of the U.S. Department of Agriculture (USDA) guidelines for information quality (USDA 2002) under the Data Quality Act...

Satisfaction monitoring for quality control in campground management

Treesearch

Wilbur F. LaPage; Malcolm I. Bevins

1981-01-01

A 4-year study of camper satisfaction indicates that satisfaction monitoring is a useful tool for campground managers to assess their performance and achieve a high level of quality control in their service to the public. An indication of camper satisfaction with campground management is gained from a report card on which a small sample of visitors rates 14 elements of...

National pilot audit of intermediate care.

PubMed

Hutchinson, Tom; Young, John; Forsyth, Duncan

2011-04-01

The National Service Framework for Older People resulted in the widespread introduction of intermediate care (IC) services. However, although these services have shared common aims, there has been considerable diversity in their staffing, organisation and delivery. Concerns have been raised regarding the clinical governance of IC with a paucity of data to evaluate the effectiveness, quality and safety of these services. This paper presents the results of a national pilot audit of IC services focusing particularly on clinical governance issues. The results confirm these concerns and provide support for a larger scale national audit of IC services to monitor and improve care quality.

Gaining customer knowledge: obtaining and using customer judgments for hospitalwide quality improvement.

PubMed

Nelson, E C; Caldwell, C; Quinn, D; Rose, R

1991-03-01

Customer knowledge is an essential feature of hospitalwide quality improvement. All systems and processes have customers. The aim is to use customer knowledge and voice of the customer measurement to plan, design, improve, and monitor these systems and processes continuously. In this way, the hospital stands the best chance of meeting customers' needs and, hopefully, delivering services that are so outstanding that customers will be surprised and delighted. There are many methods, both soft and hard, that can be used to increase customer knowledge. One useful strategy is to use a family of quality measures that reflect the voice of the customer. These measures can generate practical and powerful customer knowledge information that is essential to performing strategic planning, deploying quality policy, designing new services, finding targets for improvements, and monitoring those continuous improvements based on customers' judgments.

Real-time dissemination of air quality information using data streams and Web technologies: linking air quality to health risks in urban areas.

PubMed

Davila, Silvije; Ilić, Jadranka Pečar; Bešlić, Ivan

2015-06-01

This article presents a new, original application of modern information and communication technology to provide effective real-time dissemination of air quality information and related health risks to the general public. Our on-line subsystem for urban real-time air quality monitoring is a crucial component of a more comprehensive integrated information system, which has been developed by the Institute for Medical Research and Occupational Health. It relies on a StreamInsight data stream management system and service-oriented architecture to process data streamed from seven monitoring stations across Zagreb. Parameters that are monitored include gases (NO, NO2, CO, O3, H2S, SO2, benzene, NH3), particulate matter (PM10 and PM2.5), and meteorological data (wind speed and direction, temperature and pressure). Streamed data are processed in real-time using complex continuous queries. They first go through automated validation, then hourly air quality index is calculated for every station, and a report sent to the Croatian Environment Agency. If the parameter values exceed the corresponding regulation limits for three consecutive hours, the web service generates an alert for population groups at risk. Coupled with the Common Air Quality Index model, our web application brings air pollution information closer to the general population and raises awareness about environmental and health issues. Soon we intend to expand the service to a mobile application that is being developed.

Monitoring and root cause analysis of clinical biochemistry turn around time at an academic hospital.

PubMed

Chauhan, Kiran P; Trivedi, Amit P; Patel, Dharmik; Gami, Bhakti; Haridas, N

2014-10-01

Quality can be defined as the ability of a product or service to satisfy the needs and expectations of the customer. Laboratories are more focusing on technical and analytical quality for reliability and accuracy of test results. Patients and clinicians however are interested in rapid, reliable and efficient service from laboratory. Turn around time (TAT), the timeliness with which laboratory personnel deliver test results, is one of the most noticeable signs of laboratory service and is often used as a key performance indicator of laboratory performance. This study is aims to provide clue for laboratory TAT monitoring and root cause analysis. In a 2 year period a total of 75,499 specimens of outdoor patient department were monitor, of this a total of 4,142 specimens exceeded TAT. With consistent efforts to monitor, root cause analysis and corrective measures, we are able to decreased the specimens exceeding TAT from 7-8 to 3.7 %. Though it is difficult task to monitor TAT with the help of laboratory information system, real time documentation and authentic data retrievable, along with identification of causes for delays and its remedial measures, improve laboratory TAT and thus patient satisfaction.

Identifying perceived barriers to monitoring service quality among substance abuse treatment providers in South Africa

PubMed Central

2014-01-01

Background A performance measurement system is planned for South African substance abuse treatment services. Provider-level barriers to implementing these systems have been identified in the United States, but little is known about the nature of these barriers in South Africa. This study explored the willingness of South African substance abuse treatment providers’ to adopt a performance measurement system and perceived barriers to monitoring service quality that would need to be addressed during system development. Methods Three focus group discussions were held with treatment providers from two of the nine provinces in South Africa. These providers represented the diverse spread of substance abuse treatment services available in the country. The final sample comprised 21 representatives from 12 treatment facilities: eight treatment centres in the Western Cape and four in KwaZulu-Natal. Content analysis was used to extract core themes from these discussions. Results Participants identified barriers to the monitoring of service quality that included outdated modes of collecting data, personnel who were already burdened by paperwork, lack of time to collect data, and limited skills to analyse and interpret data. Participants recommended that developers engage with service providers in a participatory manner to ensure that service providers are invested in the proposed performance measurement system. Conclusion Findings show that substance abuse treatment providers are willing to adopt a performance measurement system and highlight several barriers that need to be addressed during system development in order to enhance the likelihood that this system will be successfully implemented. PMID:24499037

The art of customer service.

PubMed

Williams, Jeni

2007-10-01

Strategies for improving the consumer service skills of finance staff include: Hire employees who have a customer service background. Work with your human resources department to provide customer service training. Monitor new hires extensively. Offer front-end employees scripted language for situations they may face on the job. Measure the quality of customer service provided. Provide incentives for performance.

Continuous Hydrologic and Water Quality Monitoring of Vernal Ponds.

PubMed

Mina, Odette; Gall, Heather E; Chandler, Joseph W; Harper, Jeremy; Taylor, Malcolm

2017-11-13

Vernal ponds, also referred to as vernal pools, provide critical ecosystem services and habitat for a variety of threatened and endangered species. However, they are vulnerable parts of the landscapes that are often poorly understood and understudied. Land use and management practices, as well as climate change are thought to be a contribution to the global amphibian decline. However, more research is needed to understand the extent of these impacts. Here, we present methodology for characterizing a vernal pond's morphology and detail a monitoring station that can be used to collect water quantity and quality data over the duration of a vernal pond's hydroperiod. We provide methodology for how to conduct field surveys to characterize the morphology and develop stage-storage curves for a vernal pond. Additionally, we provide methodology for monitoring the water level, temperature, pH, oxidation-reduction potential, dissolved oxygen, and electrical conductivity of water in a vernal pond, as well as monitoring rainfall data. This information can be used to better quantify the ecosystem services that vernal ponds provide and the impacts of anthropogenic activities on their ability to provide these services.

Methods developed to elucidate nursing related adverse events in Japan.

PubMed

Yamagishi, Manaho; Kanda, Katsuya; Takemura, Yukie

2003-05-01

Financial resources for quality assurance in Japanese hospitals are limited and few hospitals have quality monitoring systems of nursing service systems. However, recently its necessity has been recognized. This study has cost effectively used adverse event occurrence rates as indicators of the quality of nursing service, and audited methods of collecting data on adverse events to elucidate their approximate true numbers. Data collection was conducted in July, August and November 2000 at a hospital in Tokyo that administered both primary and secondary health care services (281 beds, six wards, average length of stay 23 days). We collected adverse events through incident reports, logs, check-lists, nurse interviews, medication error questionnaires, urine leucocyte tests, patient interviews and medical records. Adverse events included the unplanned removals of invasive lines, medication errors, falls, pressure sores, skin deficiencies, physical restraints, and nosocomial infections. After evaluating the time and useful outcomes of each source, it soon became clear that we could elucidate adverse events most consistently and cost-effectively through incident reports, check lists, nurse interviews, urine leucocyte tests and medication error questionnaires. This study suggests that many hospitals in Japan could monitor the quality of the nursing service using these sources.

Comparison of NASA OMI and MLS Ozone Products with US Forest Service Ground-based Ozone Monitoring Data for US Forest Service Air Quality / Forest Management Decision Support

NASA Astrophysics Data System (ADS)

Barrett, S.; Brooks, A.; Moussa, Y.; Spencer, T.; Thompson, J.

2013-12-01

Tropospheric ozone, formed when nitrogen oxides (NOx) and volatile organic compounds (VOCs) react with sunlight, is a significant threat to the health of US National Forests. Approximately one third of ozone is absorbed by plants during the uptake of carbon dioxide. This increases the vegetation's susceptibility to drought, beetle infestation, and wildfire. Currently the US Forest Service has ground monitoring stations sparsely located across the country. This project looks specifically at the area surrounding several Class I Wilderness Areas in the Appalachian region. These areas are the highest priority for protection from air pollutants. The Forest Service must interpolate ozone concentrations for areas between these monitoring stations. Class I Wilderness Areas are designated by the Forest Service and are defined as a total 5000 acres or greater when the Clean Air Act was passed in 1977. This Act mandated that the EPA create national ambient air quality standards (NAAQS) for six major air pollutants including ground-level ozone. This project assessed the feasibility of incorporating NASA ozone data into Forest Service ozone monitoring in an effort to enhance the accuracy and precision of ozone exposure measurements in Class I Wilderness Areas and other federally managed lands in order to aid in complying with the Clean Air Act of 1977. This was accomplished by establishing a method of comparison between a preliminary data product produced at the Goddard Space Flight Center that uses OMI/MLS data to derive global tropospheric ozone measurements and Forest Service ozone monitoring station measurements. Once a methodology for comparison was established, statistical comparisons of these data were performed to assess the quantitative differences.

R2 Water Quality Portal Monitoring Stations

EPA Pesticide Factsheets

The Water Quality Data Portal (WQP) provides an easy way to access data stored in various large water quality databases. The WQP provides various input parameters on the form including location, site, sampling, and date parameters to filter and customize the returned results. The The Water Quality Portal (WQP) is a cooperative service sponsored by the United States Geological Survey (USGS), the Environmental Protection Agency (EPA) and the National Water Quality Monitoring Council (NWQMC) that integrates publicly available water quality data from the USGS National Water Information System (NWIS) the EPA STOrage and RETrieval (STORET) Data Warehouse, and the USDA ARS Sustaining The Earth??s Watersheds - Agricultural Research Database System (STEWARDS).

Factors affecting mobile diabetes monitoring adoption among physicians: questionnaire study and path model.

PubMed

Okazaki, Shintaro; Castañeda, José Alberto; Sanz, Silvia; Henseler, Jörg

2012-12-21

Patients with type 1 and type 2 diabetes often find it difficult to control their blood glucose level on a daily basis because of distance or physical incapacity. With the increase in Internet-enabled smartphone use, this problem can be resolved by adopting a mobile diabetes monitoring system. Most existing studies have focused on patients' usability perceptions, whereas little attention has been paid to physicians' intentions to adopt this technology. The aim of the study was to evaluate the perceptions and user acceptance of mobile diabetes monitoring among Japanese physicians. A questionnaire survey of physicians was conducted in Japan. The structured questionnaire was prepared in a context of a mobile diabetes monitoring system that controls blood glucose, weight, physical activity, diet, insulin and medication, and blood pressure. Following a thorough description of mobile diabetes monitoring with a graphical image, questions were asked relating to system quality, information quality, service quality, health improvement, ubiquitous control, privacy and security concerns, perceived value, subjective norms, and intention to use mobile diabetes monitoring. The data were analyzed by partial least squares (PLS) path modeling. In total, 471 physicians participated from 47 prefectures across Japan, of whom 134 were specialized in internal and gastrointestinal medicine. Nine hypotheses were tested with both the total sample and the specialist subsample; results were similar for both samples in terms of statistical significance and the strength of path coefficients. We found that system quality, information quality, and service quality significantly affect overall quality. Overall quality determines the extent to which physicians perceive the value of mobile health monitoring. However, in contrast to our initial predictions, overall quality does not have a significant direct effect on the intention to use mobile diabetes monitoring. With regard to net benefits, both ubiquitous control and health improvement are significant predictors. Net benefits in turn significantly motivate physicians to use mobile health monitoring, and has a strong influence on perceived value. Perceived value and subjective norms are predictors of intention to use. In our sample, concerns over privacy and security risk have no significant effects on intention to use mobile diabetes monitoring. Among the 3 control variables, only age significantly affected intention to use mobile diabetes monitoring, whereas experience and gender were not significant predictors of intention. Physicians consider perceived value and net benefits as the most important motivators to use mobile diabetes monitoring. Overall quality assessment does affect their intention to use this technology, but only indirectly through perceived value. Net benefits seem to be a strong driver in both a direct and indirect manner, implying that physicians may perceive health improvement with ubiquitous control as a true utility by enhancing cost-effective monitoring, and simultaneously recognize it as a way to create value for their clinical practices.

76 FR 36539 - Scientific Information Request on Insulin Delivery and Glucose Monitoring Devices for Diabetes...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-22

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Scientific... for Healthcare Research and Quality (AHRQ), HHS. ACTION: Request for scientific information submissions. SUMMARY: The Agency for Healthcare Research and Quality (AHRQ) is seeking scientific information...

Asan medical information system for healthcare quality improvement.

PubMed

Ryu, Hyeon Jeong; Kim, Woo Sung; Lee, Jae Ho; Min, Sung Woo; Kim, Sun Ja; Lee, Yong Su; Lee, Young Ha; Nam, Sang Woo; Eo, Gi Seung; Seo, Sook Gyoung; Nam, Mi Hyun

2010-09-01

This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. AMIS CONSISTED OF SEVERAL DISTINCTIVE SYSTEMS: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.

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

PubMed

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

2013-08-01

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

A design of wireless sensor networks for a power quality monitoring system.

PubMed

Lim, Yujin; Kim, Hak-Man; Kang, Sanggil

2010-01-01

Power grids deal with the business of generation, transmission, and distribution of electric power. Recently, interest in power quality in electrical distribution systems has increased rapidly. In Korea, the communication network to deliver voltage, current, and temperature measurements gathered from pole transformers to remote monitoring centers employs cellular mobile technology. Due to high cost of the cellular mobile technology, power quality monitoring measurements are limited and data gathering intervals are large. This causes difficulties in providing the power quality monitoring service. To alleviate the problems, in this paper we present a communication infrastructure to provide low cost, reliable data delivery. The communication infrastructure consists of wired connections between substations and monitoring centers, and wireless connections between pole transformers and substations. For the wireless connection, we employ a wireless sensor network and design its corresponding data forwarding protocol to improve the quality of data delivery. For the design, we adopt a tree-based data forwarding protocol in order to customize the distribution pattern of the power quality information. We verify the performance of the proposed data forwarding protocol quantitatively using the NS-2 network simulator.

Are we doing enough? Evaluation of the Polio Eradication Initiative in a district of Pakistan's Punjab province: a LQAS study

PubMed Central

2010-01-01

Background The success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. The aim of the study was to establish valid and reliable estimate for: routine oral polio vaccine (OPV) coverage, logistics management and the quality of monitoring systems in health facilities, NIDs OPV coverage, the quality of NIDs service delivery in static centers and mobile teams, and to ultimately provide scientific evidence for tailoring future interventions. Methods A cross-sectional study using lot quality assessment sampling was conducted in the District Nankana Sahib of Pakistan's Punjab province. Twenty primary health centers and their catchment areas were selected randomly as 'lots'. The study involved the evaluation of 1080 children aged 12-23 months for routine OPV coverage, 20 health centers for logistics management and quality of monitoring systems, 420 households for NIDs OPV coverage, 20 static centers and 20 mobile teams for quality of NIDs service delivery. Study instruments were designed according to WHO guidelines. Results Five out of twenty lots were rejected for unacceptably low routine immunization coverage. The validity of coverage was questionable to extent that all lots were rejected. Among the 54.1% who were able to present immunization cards, only 74.0% had valid immunization. Routine coverage was significantly associated with card availability and socioeconomic factors. The main reasons for routine immunization failure were absence of a vaccinator and unawareness of need for immunization. Health workers (96.9%) were a major source of information. All of the 20 lots were rejected for poor compliance in logistics management and quality of monitoring systems. Mean compliance score and compliance percentage for logistics management were 5.4 ± 2.0 (scale 0-9) and 59.4% while those for quality of monitoring systems were 3.3 ± 1.2 (scale 0-6) and 54.2%. The 15 out of 20 lots were rejected for unacceptably low NIDs coverage by finger-mark. All of the 20 lots were rejected for poor NIDs service delivery (mean compliance score = 11.7 ± 2.1 [scale 0-16]; compliance percentage = 72.8%). Conclusion Low coverage, both routine and during NIDs, and poor quality of logistics management, monitoring systems and NIDs service delivery were highlighted as major constraints in polio eradication and these should be considered in prioritizing future strategies. PMID:20144212

Are we doing enough? Evaluation of the Polio Eradication Initiative in a district of Pakistan's Punjab province: a LQAS study.

PubMed

Mushtaq, Muhammad Umair; Majrooh, Muhammad Ashraf; Ullah, Mohsin Zia Sana; Akram, Javed; Siddiqui, Arif Mahmood; Shad, Mushtaq Ahmad; Waqas, Muhammad; Abdullah, Hussain Muhammad; Ahmad, Waqar; Shahid, Ubeera; Khurshid, Usman

2010-02-09

The success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. The aim of the study was to establish valid and reliable estimate for: routine oral polio vaccine (OPV) coverage, logistics management and the quality of monitoring systems in health facilities, NIDs OPV coverage, the quality of NIDs service delivery in static centers and mobile teams, and to ultimately provide scientific evidence for tailoring future interventions. A cross-sectional study using lot quality assessment sampling was conducted in the District Nankana Sahib of Pakistan's Punjab province. Twenty primary health centers and their catchment areas were selected randomly as 'lots'. The study involved the evaluation of 1080 children aged 12-23 months for routine OPV coverage, 20 health centers for logistics management and quality of monitoring systems, 420 households for NIDs OPV coverage, 20 static centers and 20 mobile teams for quality of NIDs service delivery. Study instruments were designed according to WHO guidelines. Five out of twenty lots were rejected for unacceptably low routine immunization coverage. The validity of coverage was questionable to extent that all lots were rejected. Among the 54.1% who were able to present immunization cards, only 74.0% had valid immunization. Routine coverage was significantly associated with card availability and socioeconomic factors. The main reasons for routine immunization failure were absence of a vaccinator and unawareness of need for immunization. Health workers (96.9%) were a major source of information. All of the 20 lots were rejected for poor compliance in logistics management and quality of monitoring systems. Mean compliance score and compliance percentage for logistics management were 5.4 +/- 2.0 (scale 0-9) and 59.4% while those for quality of monitoring systems were 3.3 +/- 1.2 (scale 0-6) and 54.2%. The 15 out of 20 lots were rejected for unacceptably low NIDs coverage by finger-mark. All of the 20 lots were rejected for poor NIDs service delivery (mean compliance score = 11.7 +/- 2.1 [scale 0-16]; compliance percentage = 72.8%). Low coverage, both routine and during NIDs, and poor quality of logistics management, monitoring systems and NIDs service delivery were highlighted as major constraints in polio eradication and these should be considered in prioritizing future strategies.

Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update

DTIC Science & Technology

2011-08-01

of information, including suggestions for reducing this burden, to Washington Headquarters Services , Directorate for Information Operations and...Infectious Disease Service (MCHE-MDI),3851 Roger Brooke Drive,Fort Sam Houston,TX,78234 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING...Guidelines TABLE 1. GRADE* Systematic Weighting of the Quality of Evidence and Grading of Recommendations Strength of Recommendation and Quality of

Quality Assurance Through Quality Improvement and Professional Development in the National Breast and Cervical Cancer Early Detection Program

PubMed Central

Siegl, Elvira J.; Miller, Jacqueline W.; Khan, Kris; Harris, Susan E.

2015-01-01

Quality assurance (QA) is the process of providing evidence that the outcome meets the established standards. Quality improvement (QI), by contrast, is the act of methodically developing ways to meet acceptable quality standards and evaluating current processes to improve overall performance. In the case of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), the desired outcome is the delivery of quality health care services to program clients. The NBCCEDP provides professional development to ensure that participating providers have current knowledge of evidence-based clinical standards regarding breast and cervical cancer screening and diagnosis and are monitoring women with abnormal screening results for timely follow-up. To assess the quality of clinical care provided to NBCCEDP clients, performance data are collected by NBCCEDP grantees and compared against predetermined Centers for Disease Control and Prevention (CDC) benchmarks known as Data Quality Indicator Guides. In this article, the authors describe 1) the development and use of indicators for QI in the NBCCEDP and 2) the professional development activities implemented to improve clinical outcomes. QA identifies problems, whereas QI systematically corrects them. The quality of service delivery and improved patient outcomes among NBCCEDP grantees has enhanced significantly because of continuous monitoring of performance and professional development. By using QA, NBCCEDP grantees can maximize the quality of patient screening, diagnostic services, and follow-up. Examples of grantee activities to maintain quality of care are also described in this report. PMID:25099901

Economic evaluations of pharmacist-managed services in people with diabetes mellitus: a systematic review.

PubMed

Wang, Y; Yeo, Q Q; Ko, Y

2016-04-01

To review and evaluate the most recent literature on the economic outcomes of pharmacist-managed services in people with diabetes. The global prevalence of diabetes is increasing. Although pharmacist-managed services have been shown to improve people's health outcomes, the economic impact of these programmes remains unclear. A systematic review was conducted of six databases. Study inclusion criteria were: (1) original research; (2) evaluation of pharmacist-managed services in people with diabetes; (3) an economic evaluation; (4) English-language publication; and (5) full-text, published between January 2006 and December 2014. The quality of the full economic evaluations reviewed was evaluated using the Consolidated Health Economic Evaluation Reporting Standards checklist. A total of 2204 articles were screened and 25 studies were selected. These studies were conducted in a community pharmacy (n = 10), a clinic- /hospital-based outpatient facility (n = 8), or others. Pharmacist-managed services included targeted education (n = 24), general pharmacotherapeutic monitoring (n = 21), health screening or laboratory testing services (n = 9), immunization services (n = 2) and pharmacokinetic monitoring (n = 1). Compared with usual care, pharmacist-managed services resulted in cost savings that varied from $7 to $65,000 ($8 to $85,000 in 2014 US dollars) per person per year, and generated higher quality-adjusted life years with lower costs. Benefit-to-cost ratios ranged from 1:1 to 8.5:1. Among the 25 studies reviewed, 11 were full economic evaluations of moderate quality. Pharmacist-managed services had a positive return in terms of economic viability. With the expanding role of pharmacists in the healthcare sector, alongside increasing health expenditure, future economic studies of high quality are needed to investigate the cost-effectiveness of these services. © 2015 Diabetes UK.

The influence of road salts on water quality in a restored urban stream (Columbus, OH)

EPA Science Inventory

Understanding the connection between road salts and water quality is essential to assess the implications for human health and ecosystem services. To assess the effects of the restoration on water quality, surface and ground water have been monitored at Minebank Run, MD since 20...

The importance of continuing education for transplant coordination staff.

PubMed

Tokalak, Ibrahim; Emiroğlu, Remzi; Karakayali, Hamdi; Bilgin, Nevzat; Haberal, Mehmet

2005-06-01

Continuous quality improvement activities are necessary to achieve excellence at any institution. The Başkent University Hospitals have implemented continuous in-service training programs to improve all health services provided. Also, continuing medical education programs are being instituted in organ procurement and transplantation centers. In addition to receiving basic orientation and training upon hiring, transplant coordination staff complete forms that detail their current training status, further job training needed, and other courses of interest. The information is used to monitor skill levels, to determine the success of educational programs, and to identify further education that is needed. Our aim is to improve the quality of transplant coordination activities and increase organ donation at the hospitals in our network through effective monitoring and evaluation of continuous in-service training. These training programs enhance staff members' understanding of and participation in procedures related to transplantation and improves the total quality of the transplantation process. In the near future, this training model may be used to improve the donor hospital education program in Turkey.

A comprehensive health service evaluation and monitoring framework.

PubMed

Reeve, Carole; Humphreys, John; Wakerman, John

2015-12-01

To develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services. A targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders. The framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable. Data collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

PubMed Central

2012-01-01

The Walt Disney Company has never lost sight of its founder's edict: “Give the public everything you can give them.” From this simple statement, everyone at Disney strives to exceed customer expectations every day. For more than 80 years this singular pursuit of excellence in delivering consistent quality service has earned the Disney organization a world-renowned reputation and ongoing business success. Uncover some of the secrets behind the Disney service culture and processes. In this session, you will examine the time-tested model for delivering world-class Guest service and discover how attention to detail creates a consistent, successful environment for both employees and customers. You can then use these ideas to transform and improve your own organization's delivery of quality service. You will learn how to: Develop an organizational culture that supports consistent delivery of quality service.Evaluate the Disney approach and tailor it to your business.Design quality service standards and processes to raise the level of customer satisfaction.Create metrics to gauge the needs, perceptions and expectations of your customers.Enable employees, settings and processes to convey your quality service commitment.Implement a strategic plan for monitoring the delivery of seamless customer experiences.

ISO 9001 in a neonatal intensive care unit (NICU).

PubMed

Vitner, Gad; Nadir, Erez; Feldman, Michael; Yurman, Shmuel

2011-01-01

The aim of this paper is to present the process for approving and certifying a neonatal intensive care unit to ISO 9001 standards. The process started with the department head's decision to improve services quality before deciding to achieve ISO 9001 certification. Department processes were mapped and quality management mechanisms were developed. Process control and performance measurements were defined and implemented to monitor the daily work. A service satisfaction review was conducted to get feedback from families. In total, 28 processes and related work instructions were defined. Process yields showed service improvements. Family satisfaction improved. The paper is based on preparing only one neonatal intensive care unit to the ISO 9001 standard. The case study should act as an incentive for hospital managers aiming to improve service quality based on the ISO 9001 standard. ISO 9001 is becoming a recommended tool to improve clinical service quality.

Quality of antenatal care in Zambia: a national assessment

PubMed Central

2012-01-01

Background Antenatal care (ANC) is one of the recommended interventions to reduce maternal and neonatal mortality. Yet in most Sub-Saharan African countries, high rates of ANC coverage coexist with high maternal and neonatal mortality. This disconnect has fueled calls to focus on the quality of ANC services. However, little conceptual or empirical work exists on the measurement of ANC quality at health facilities in low-income countries. We developed a classification tool and assessed the level of ANC service provision at health facilities in Zambia on a national scale and compared this to the quality of ANC received by expectant mothers. Methods We analysed two national datasets with detailed antenatal provider and user information, the 2005 Zambia Health Facility Census and the 2007 Zambia Demographic and Health Survey (DHS), to describe the level of ANC service provision at 1,299 antenatal facilities in 2005 and the quality of ANC received by 4,148 mothers between 2002 and 2007. Results We found that only 45 antenatal facilities (3%) fulfilled our developed criteria for optimum ANC service, while 47% of facilities provided adequate service, and the remaining 50% offered inadequate service. Although 94% of mothers reported at least one ANC visit with a skilled health worker and 60% attended at least four visits, only 29% of mothers received good quality ANC, and only 8% of mothers received good quality ANC and attended in the first trimester. Conclusions DHS data can be used to monitor “effective ANC coverage” which can be far below ANC coverage as estimated by current indicators. This “quality gap” indicates missed opportunities at ANC for delivering effective interventions. Evaluating the level of ANC provision at health facilities is an efficient way to detect where deficiencies are located in the system and could serve as a monitoring tool to evaluate country progress. PMID:23237601

Multileaf collimator performance monitoring and improvement using semiautomated quality control testing and statistical process control.

PubMed

Létourneau, Daniel; Wang, An; Amin, Md Nurul; Pearce, Jim; McNiven, Andrea; Keller, Harald; Norrlinger, Bernhard; Jaffray, David A

2014-12-01

High-quality radiation therapy using highly conformal dose distributions and image-guided techniques requires optimum machine delivery performance. In this work, a monitoring system for multileaf collimator (MLC) performance, integrating semiautomated MLC quality control (QC) tests and statistical process control tools, was developed. The MLC performance monitoring system was used for almost a year on two commercially available MLC models. Control charts were used to establish MLC performance and assess test frequency required to achieve a given level of performance. MLC-related interlocks and servicing events were recorded during the monitoring period and were investigated as indicators of MLC performance variations. The QC test developed as part of the MLC performance monitoring system uses 2D megavoltage images (acquired using an electronic portal imaging device) of 23 fields to determine the location of the leaves with respect to the radiation isocenter. The precision of the MLC performance monitoring QC test and the MLC itself was assessed by detecting the MLC leaf positions on 127 megavoltage images of a static field. After initial calibration, the MLC performance monitoring QC test was performed 3-4 times/week over a period of 10-11 months to monitor positional accuracy of individual leaves for two different MLC models. Analysis of test results was performed using individuals control charts per leaf with control limits computed based on the measurements as well as two sets of specifications of ± 0.5 and ± 1 mm. Out-of-specification and out-of-control leaves were automatically flagged by the monitoring system and reviewed monthly by physicists. MLC-related interlocks reported by the linear accelerator and servicing events were recorded to help identify potential causes of nonrandom MLC leaf positioning variations. The precision of the MLC performance monitoring QC test and the MLC itself was within ± 0.22 mm for most MLC leaves and the majority of the apparent leaf motion was attributed to beam spot displacements between irradiations. The MLC QC test was performed 193 and 162 times over the monitoring period for the studied units and recalibration had to be repeated up to three times on one of these units. For both units, rate of MLC interlocks was moderately associated with MLC servicing events. The strongest association with the MLC performance was observed between the MLC servicing events and the total number of out-of-control leaves. The average elapsed time for which the number of out-of-specification or out-of-control leaves was within a given performance threshold was computed and used to assess adequacy of MLC test frequency. A MLC performance monitoring system has been developed and implemented to acquire high-quality QC data at high frequency. This is enabled by the relatively short acquisition time for the images and automatic image analysis. The monitoring system was also used to record and track the rate of MLC-related interlocks and servicing events. MLC performances for two commercially available MLC models have been assessed and the results support monthly test frequency for widely accepted ± 1 mm specifications. Higher QC test frequency is however required to maintain tighter specification and in-control behavior.

A Wireless Sensor Network-Based Approach with Decision Support for Monitoring Lake Water Quality.

PubMed

Huang, Xiaoci; Yi, Jianjun; Chen, Shaoli; Zhu, Xiaomin

2015-11-19

Online monitoring and water quality analysis of lakes are urgently needed. A feasible and effective approach is to use a Wireless Sensor Network (WSN). Lake water environments, like other real world environments, present many changing and unpredictable situations. To ensure flexibility in such an environment, the WSN node has to be prepared to deal with varying situations. This paper presents a WSN self-configuration approach for lake water quality monitoring. The approach is based on the integration of a semantic framework, where a reasoner can make decisions on the configuration of WSN services. We present a WSN ontology and the relevant water quality monitoring context information, which considers its suitability in a pervasive computing environment. We also propose a rule-based reasoning engine that is used to conduct decision support through reasoning techniques and context-awareness. To evaluate the approach, we conduct usability experiments and performance benchmarks.

[Analytical quality in biological monitoring of workers exposed to chemicals: experience of the Prevention and Safety at the Workplace Service in Modena].

PubMed

Alpaca, R I Paredes; Migliore, A; Di Rico, R; Canali, Claudia; Rota, Cristina; Trenti, T; Cariani, Elisabetta

2010-01-01

The quality of laboratory data is one of the main factors in guaranteeing efficacy of biological monitoring. To analyze the quality of laboratory data used for biological monitoring of exposed workers. A survey involving 18 companies employing 945 workers in the area of Modena, Italy, was carried out in 2008. Most of the 9 private laboratories receiving biological samples did not perform directly part or all of the laboratory assessments requested, but this was not indicated in the final report. Major problems were observed in the application of internal quality control, and only one laboratory participated in external quality assessment for blood lead measurements. Our results raise major concerns on the traceability and reliability of laboratory assessments performed for biomonitoring of exposed workers. Systematic evaluation of the quality of analytical data would be highly recommendable.

Monitoring game-based motor rehabilitation of patients at home for better plans of care and quality of life.

PubMed

Ponte, S; Gabrielli, S; Jonsdottir, J; Morando, M; Dellepiane, S

2015-01-01

This paper describes the biomedical, remote monitoring infrastructure developed and currently tested in the EU REHAB@HOME project to support home rehabilitation of the upper extremity of persons post-stroke and in persons with other neurological disorders, such as Multiple Sclerosis patients, in order to track their progress over therapy and improve their Quality of Life. The paper will specifically focus on describing the initial testing of the tele-rehabilitation system's components for patients' biomedical monitoring over therapy, which support the delivery and monitoring of more personalized, engaging plans of care by rehabilitation centers and services.

Outcomes sensitive to nursing service quality in ambulatory cancer chemotherapy: Systematic scoping review.

PubMed

Griffiths, Peter; Richardson, Alison; Blackwell, Rebecca

2012-07-01

There is long standing interest in identifying patient outcomes that are sensitive to nursing care and an increasing number of systems that include outcomes in order to demonstrate or monitor the quality of nursing care. We undertook scoping reviews of the literature in order to identify patient outcomes sensitive to the quality of nursing services in ambulatory cancer chemotherapy settings to guide the development of an outcomes-based quality measurement system. A 2-stage scoping review to identify potential outcome areas which were subsequently assessed for their sensitivity to nursing was carried out. Data sources included the Cochrane Library, Medline, Embase, the British Nursing Index, Google and Google scholar. We identified a broad range of outcomes potentially sensitive to nursing. Individual trials support many nursing interventions but we found relatively little clear evidence of effect on outcomes derived from systematic reviews and no evidence associating characteristics of nursing services with outcomes. The purpose of identifying a set of outcomes as specifically nurse-sensitive for quality measurement is to give clear responsibility and create an expectation of strong clinical leadership by nurses in terms of monitoring and acting on results. It is important to select those outcomes that nurses have most impact upon. Patient experience, nausea, vomiting, mucositis and safe medication administration were outcome areas most likely to yield sensitive measures of nursing service quality in ambulatory cancer chemotherapy. Copyright © 2011 Elsevier Ltd. All rights reserved.

Designing and implementing a trust-wide quality assurance programme.

PubMed

Coope, Sally-Ann

2018-04-02

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

42 CFR 418.58 - Condition of participation: Quality assessment and performance improvement.

Code of Federal Regulations, 2011 CFR

2011-10-01

... collected to do the following: (i) Monitor the effectiveness and safety of services and quality of care. (ii..., patient safety, and quality of care. (2) Performance improvement activities must track adverse patient... care and patient safety, and that all improvement actions are evaluated for effectiveness. (3) That one...

Factors Affecting Mobile Diabetes Monitoring Adoption Among Physicians: Questionnaire Study and Path Model

PubMed Central

Castañeda, José Alberto; Sanz, Silvia; Henseler, Jörg

2012-01-01

Background Patients with type 1 and type 2 diabetes often find it difficult to control their blood glucose level on a daily basis because of distance or physical incapacity. With the increase in Internet-enabled smartphone use, this problem can be resolved by adopting a mobile diabetes monitoring system. Most existing studies have focused on patients’ usability perceptions, whereas little attention has been paid to physicians’ intentions to adopt this technology. Objective The aim of the study was to evaluate the perceptions and user acceptance of mobile diabetes monitoring among Japanese physicians. Methods A questionnaire survey of physicians was conducted in Japan. The structured questionnaire was prepared in a context of a mobile diabetes monitoring system that controls blood glucose, weight, physical activity, diet, insulin and medication, and blood pressure. Following a thorough description of mobile diabetes monitoring with a graphical image, questions were asked relating to system quality, information quality, service quality, health improvement, ubiquitous control, privacy and security concerns, perceived value, subjective norms, and intention to use mobile diabetes monitoring. The data were analyzed by partial least squares (PLS) path modeling. Results In total, 471 physicians participated from 47 prefectures across Japan, of whom 134 were specialized in internal and gastrointestinal medicine. Nine hypotheses were tested with both the total sample and the specialist subsample; results were similar for both samples in terms of statistical significance and the strength of path coefficients. We found that system quality, information quality, and service quality significantly affect overall quality. Overall quality determines the extent to which physicians perceive the value of mobile health monitoring. However, in contrast to our initial predictions, overall quality does not have a significant direct effect on the intention to use mobile diabetes monitoring. With regard to net benefits, both ubiquitous control and health improvement are significant predictors. Net benefits in turn significantly motivate physicians to use mobile health monitoring, and has a strong influence on perceived value. Perceived value and subjective norms are predictors of intention to use. In our sample, concerns over privacy and security risk have no significant effects on intention to use mobile diabetes monitoring. Among the 3 control variables, only age significantly affected intention to use mobile diabetes monitoring, whereas experience and gender were not significant predictors of intention. Conclusions Physicians consider perceived value and net benefits as the most important motivators to use mobile diabetes monitoring. Overall quality assessment does affect their intention to use this technology, but only indirectly through perceived value. Net benefits seem to be a strong driver in both a direct and indirect manner, implying that physicians may perceive health improvement with ubiquitous control as a true utility by enhancing cost-effective monitoring, and simultaneously recognize it as a way to create value for their clinical practices. PMID:23257115

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

PubMed

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

2007-01-01

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

An Interoperable Architecture for Air Pollution Early Warning System Based on Sensor Web

NASA Astrophysics Data System (ADS)

Samadzadegan, F.; Zahmatkesh, H.; Saber, M.; Ghazi khanlou, H. J.

2013-09-01

Environmental monitoring systems deal with time-sensitive issues which require quick responses in emergency situations. Handling the sensor observations in near real-time and obtaining valuable information is challenging issues in these systems from a technical and scientific point of view. The ever-increasing population growth in urban areas has caused certain problems in developing countries, which has direct or indirect impact on human life. One of applicable solution for controlling and managing air quality by considering real time and update air quality information gathered by spatially distributed sensors in mega cities, using sensor web technology for developing monitoring and early warning systems. Urban air quality monitoring systems using functionalities of geospatial information system as a platform for analysing, processing, and visualization of data in combination with Sensor Web for supporting decision support systems in disaster management and emergency situations. This system uses Sensor Web Enablement (SWE) framework of the Open Geospatial Consortium (OGC), which offers a standard framework that allows the integration of sensors and sensor data into spatial data infrastructures. SWE framework introduces standards for services to access sensor data and discover events from sensor data streams as well as definition set of standards for the description of sensors and the encoding of measurements. The presented system provides capabilities to collect, transfer, share, process air quality sensor data and disseminate air quality status in real-time. It is possible to overcome interoperability challenges by using standard framework. In a routine scenario, air quality data measured by in-situ sensors are communicated to central station where data is analysed and processed. The extracted air quality status is processed for discovering emergency situations, and if necessary air quality reports are sent to the authorities. This research proposed an architecture to represent how integrate air quality sensor data stream into geospatial data infrastructure to present an interoperable air quality monitoring system for supporting disaster management systems by real time information. Developed system tested on Tehran air pollution sensors for calculating Air Quality Index (AQI) for CO pollutant and subsequently notifying registered users in emergency cases by sending warning E-mails. Air quality monitoring portal used to retrieving and visualize sensor observation through interoperable framework. This system provides capabilities to retrieve SOS observation using WPS in a cascaded service chaining pattern for monitoring trend of timely sensor observation.

Physical soil quality indicators for monitoring British soils

NASA Astrophysics Data System (ADS)

Corstanje, Ron; Mercer, Theresa G.; Rickson, Jane R.; Deeks, Lynda K.; Newell-Price, Paul; Holman, Ian; Kechavarsi, Cedric; Waine, Toby W.

2017-09-01

Soil condition or quality determines its ability to deliver a range of functions that support ecosystem services, human health and wellbeing. The increasing policy imperative to implement successful soil monitoring programmes has resulted in the demand for reliable soil quality indicators (SQIs) for physical, biological and chemical soil properties. The selection of these indicators needs to ensure that they are sensitive and responsive to pressure and change, e.g. they change across space and time in relation to natural perturbations and land management practices. Using a logical sieve approach based on key policy-related soil functions, this research assessed whether physical soil properties can be used to indicate the quality of British soils in terms of their capacity to deliver ecosystem goods and services. The resultant prioritised list of physical SQIs was tested for robustness, spatial and temporal variability, and expected rate of change using statistical analysis and modelling. Seven SQIs were prioritised: soil packing density, soil water retention characteristics, aggregate stability, rate of soil erosion, depth of soil, soil structure (assessed by visual soil evaluation) and soil sealing. These all have direct relevance to current and likely future soil and environmental policy and are appropriate for implementation in soil monitoring programmes.

Deming, quality and the small medical group administrator.

PubMed

Noll, D C

1992-01-01

As administrators, writes Douglas Noll, we can coordinate and implement quality measures affecting our practices and which impact the patient's total medical experience. Unfortunately, many smaller groups cannot hire an outside consultant or single employee whose sole purpose would be to monitor quality. Noll offers several simple practices that administrators can use to improve the quality of service in their groups.

A Context-Aware Indoor Air Quality System for Sudden Infant Death Syndrome Prevention

PubMed Central

De Paz, Juan F.; Barriuso, Alberto L.

2018-01-01

Context-aware monitoring systems designed for e-Health solutions and ambient assisted living (AAL) play an important role in today’s personalized health-care services. The majority of these systems are intended for the monitoring of patients’ vital signs by means of bio-sensors. At present, there are very few systems that monitor environmental conditions and air quality in the homes of users. A home’s environmental conditions can have a significant influence on the state of the health of its residents. Monitoring the environment is the key to preventing possible diseases caused by conditions that do not favor health. This paper presents a context-aware system that monitors air quality to prevent a specific health problem at home. The aim of this system is to reduce the incidence of the Sudden Infant Death Syndrome, which is triggered mainly by environmental factors. In the conducted case study, the system monitored the state of the neonate and the quality of air while it was asleep. The designed proposal is characterized by its low cost and non-intrusive nature. The results are promising. PMID:29498653

A Context-Aware Indoor Air Quality System for Sudden Infant Death Syndrome Prevention.

PubMed

De La Iglesia, Daniel H; De Paz, Juan F; Villarrubia González, Gabriel; Barriuso, Alberto L; Bajo, Javier

2018-03-02

Context-aware monitoring systems designed for e-Health solutions and ambient assisted living (AAL) play an important role in today's personalized health-care services. The majority of these systems are intended for the monitoring of patients' vital signs by means of bio-sensors. At present, there are very few systems that monitor environmental conditions and air quality in the homes of users. A home's environmental conditions can have a significant influence on the state of the health of its residents. Monitoring the environment is the key to preventing possible diseases caused by conditions that do not favor health. This paper presents a context-aware system that monitors air quality to prevent a specific health problem at home. The aim of this system is to reduce the incidence of the Sudden Infant Death Syndrome, which is triggered mainly by environmental factors. In the conducted case study, the system monitored the state of the neonate and the quality of air while it was asleep. The designed proposal is characterized by its low cost and non-intrusive nature. The results are promising.

Measuring quality in services for children with an intellectual disability.

PubMed

Koornneef, Erik

2006-01-01

To evaluate the application of one particular quality measurement tool, the SERVQUAL instrument, as a potential mechanism to measure quality in services for children with disabilities Staff and family of children with an intellectual disability in two organisations providing specialist therapy and day completed an adapted SERVQUAL questionnaire. A total of 81 SERVQUAL questionnaires were distributed and 59 questionnaires were returned (response rate of 73 per cent). The SERVQUAL instrument can be considered as a useful diagnostic tool to identify particular strengths and areas for improvement in services for people with disabilities as the instrument lends itself for the monitoring of the effectiveness of quality improvement initiatives over time. The findings also showed relatively high customer expectations and the organisations involved in this research are currently not meeting all of these high expectations as significant quality gaps were found in the areas of reliability and responsiveness. The sample size was relatively small and the measurement of quality using the SERVQUAL instrument remains a challenge, due to the conceptual and empirical difficulties. The SERVQUAL instrument is probably most be attractive to service managers and funding organisations because of its ability to identify gaps in the quality of the service. The tool had been used to measure quality in services for people with disabilities and the research has shown that this tool might be an important additional quality measurement tool for services.

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

PubMed

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

2017-10-27

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

A Guide to Monitoring Residential Settings.

ERIC Educational Resources Information Center

Taylor, Steven J.

The guide provides some basic strategies and tools for monitoring residential settings--both institutions and community residences--for the quality of services provided to persons with developmental disabilities. An introductory chapter explains the purpose and layout of the document. Chapter II describes how to find and understand public…

Practice management/role of the medical director.

PubMed

Merrill, Douglas G

2014-06-01

Although the nature of ambulatory surgery has changed over the years, the ideal role of the medical director mirrors its earliest iterations, focusing on excellent customer service and high quality of care. These efforts are supported by 3 modern methods of quality management borrowed from industry: intentional process improvement, standard care pathways, and monitoring outcomes to determine the efficacy of each. These methods are critical to master in order to lead the facility and providers to the highest quality of care and service. Copyright © 2014 Elsevier Inc. All rights reserved.

Global Monitoring of Water Supply and Sanitation: History, Methods and Future Challenges

PubMed Central

Bartram, Jamie; Brocklehurst, Clarissa; Fisher, Michael B.; Luyendijk, Rolf; Hossain, Rifat; Wardlaw, Tessa; Gordon, Bruce

2014-01-01

International monitoring of drinking water and sanitation shapes awareness of countries’ needs and informs policy, implementation and research efforts to extend and improve services. The Millennium Development Goals established global targets for drinking water and sanitation access; progress towards these targets, facilitated by international monitoring, has contributed to reducing the global disease burden and increasing quality of life. The experiences of the MDG period generated important lessons about the strengths and limitations of current approaches to defining and monitoring access to drinking water and sanitation. The methods by which the Joint Monitoring Programme (JMP) of WHO and UNICEF tracks access and progress are based on analysis of data from household surveys and linear regression modelling of these results over time. These methods provide nationally-representative and internationally-comparable insights into the drinking water and sanitation facilities used by populations worldwide, but also have substantial limitations: current methods do not address water quality, equity of access, or extra-household services. Improved statistical methods are needed to better model temporal trends. This article describes and critically reviews JMP methods in detail for the first time. It also explores the impact of, and future directions for, international monitoring of drinking water and sanitation. PMID:25116635

[Quality of service provided to heart surgery patients of the Unified Health System-SUS].

PubMed

Borges, Juliana Bassalobre Carvalho; Carvalho, Sebastião Marcos Ribeiro de; Silva, Marcos Augusto de Moraes

2010-01-01

To evaluate the service quality provided to heart surgery patients during their hospital stay, identifying the patient's expectations and perceptions. To associate service quality with: gender, age and the use of extracorporeal circulation. We studied 82 elective heart surgery patients (52.4% females and 47.6% males), operated by midsternal thoracotomy, age: 31 to 83 years (60.4 +/- 13.2 years); period: March to September 2006. Service quality was evaluated in two instances: the expectations at pre-operative and the perceptions of the service received on the 6th post-operative; through the application of the modified SERVQUAL scale (SERVQUAL-Card). The result was obtained by the difference of the sum of the scores on perception minus those of the expectations, and through statistical analysis. The SERVQUAL-Card scale was statistically validated, showing adequate level of internal consistency. We found a higher frequency of myocardial revascularization 55 (67.0%); first heart surgery 72 (87.8%) and the use of ECC 69 (84.1%). We noticed high mean values for expectations and perceptions with significant results (P<0.05). We observed a significant relationship between the quality of service with: gender, in empathy (P= 0.04) and age, in reliability (P = 0.02). There was no significant association between ECC and quality of service. Service quality was satisfactory. The patient demonstrated a high expectation to hospital medical service. Women present a higher perception of quality in empathy and younger people in reliability. The use of ECC is not related to service quality in this sample. The data obtained in this study suggest that the quality of this health service can be monitored through the periodical application of the SERVQUAL scale.

7 CFR 225.7 - Program monitoring and assistance.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., food service management company representatives, auditors, and health inspectors who will participate... adequately for the Program. (c) Food specifications and meal quality standards. With the assistance of the... and model meal quality standards which shall become part of all contracts between vended sponsors and...

Evaluation Model of Plate Waste to Monitor Food Consumption in Two Different Catering Settings

PubMed Central

Scognamiglio, Umberto; Moroni, Catia; Marani, Alessandra; Calcaterra, Veronica; Amendola, Mariano; Civitelli, Giulia; Cattaruzza, Maria Sofia; Ermenegildi, Arianna; Morena, Valeria

2014-01-01

An increasing number of people regularly eats lunch away from home, using catering services. In this context, therefore, it is extremely important to improve the meals’ quality, remaining faithful to the principles of hygiene, nutritional and organoleptic quality and proper food handling. At the same time, it is necessary to promote food choices, nutritionally correct, by evaluations of appropriateness of menus. The study of food waste allows an evaluation of the nutritional habits of consumers and an important economic consideration of the costs incurred for the implementation of the service. This becomes even more important in some particularly sensitive groups, such as children and elderly. The purpose of this work is to test a model of semi-quantitative evaluation of waste to monitor food consumption in two different catering contexts (educational and business), in order to improve the service for school students and other consumers. PMID:27800337

Evaluation Model of Plate Waste to Monitor Food Consumption in Two Different Catering Settings.

PubMed

Saccares, Stefano; Scognamiglio, Umberto; Moroni, Catia; Marani, Alessandra; Calcaterra, Veronica; Amendola, Mariano; Civitelli, Giulia; Cattaruzza, Maria Sofia; Ermenegildi, Arianna; Morena, Valeria

2014-04-17

An increasing number of people regularly eats lunch away from home, using catering services. In this context, therefore, it is extremely important to improve the meals' quality, remaining faithful to the principles of hygiene, nutritional and organoleptic quality and proper food handling. At the same time, it is necessary to promote food choices, nutritionally correct, by evaluations of appropriateness of menus. The study of food waste allows an evaluation of the nutritional habits of consumers and an important economic consideration of the costs incurred for the implementation of the service. This becomes even more important in some particularly sensitive groups, such as children and elderly. The purpose of this work is to test a model of semi-quantitative evaluation of waste to monitor food consumption in two different catering contexts (educational and business), in order to improve the service for school students and other consumers.

A rapid review of the impact of commissioning on service use, quality, outcomes and value for money: implications for Australian policy.

PubMed

Gardner, Karen; Davies, G Powell; Edwards, Karen; McDonald, Julie; Findlay, Terry; Kearns, Rachael; Joshi, Chandni; Harris, Mark

2016-01-01

The aim of this systematic review was to assess evidence of the impact of commissioning on health service use, quality, outcomes and value for money and to consider findings in the Australian context. Systematic searches of the literature identified 444 papers and, after exclusions, 36 were subject to full review. The commissioning cycle (planning, contracting, monitoring) formed a framework for analysis and impacts were assessed at individual, subpopulation and population levels. Little evidence of the effectiveness of commissioning at any level was available and observed impacts were highly context-dependent. There was insufficient evidence to identify a preferred model. Lack of skills and capacity were cited as major barriers to the implementation of commissioning. Successful commissioning requires a clear policy framework of national and regional priorities that define agreed targets for commissioning agencies. Engagement of consumers and providers, especially physicians, was considered to be critically important but is time consuming and has proven difficult to sustain. Adequate information on the cost, volume and quality of healthcare services is critically important for setting priorities, and for contracting and monitoring performance. Lack of information resulted in serious problems. High-quality nationally standardised performance measures and data requirements need to be built into contracts and ongoing monitoring and evaluation. In Australia, there is significant work to be done in areas of policy and governance, funding systems and incentives, patient enrolment or registration, information systems, individual and organisational capacity, community engagement and experience in commissioning.

78 FR 18323 - Notice of Availability of a Draft Programmatic Environmental Assessment of the Proposed United...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

... Proposed United States Regional Climate Reference Network (USRCRN) AGENCY: National Weather Service (NWS..., is proposing to implement, operate, and manage a USRCRN. With other climate monitoring efforts..., high-quality climate data for use in climate-monitoring activities and for placing current climate...

Guidance for Habitat Restoration Monitoring: Framework for Monitoring Plan Development and Implementation (User’s Guide)

DTIC Science & Technology

2004-08-01

release; distribution is unlimited. ENGINEERING SERVICE CENTER Port Hueneme, California 93043-4370 (This page intentionally blank.) REPORT DOCUMENTATION...responses. For example, an extended period of drought may greatly retard, set back, or even prevent establishment of a desired plant species or...Categories of Potential Chemical Monitoring Dataa Monitoring Variable Habitat Type Water Quality pH REDOX DO Salinity Freshwater wetlands S−M S–M M S–M

Development and implementation of a comprehensive quality assurance program at a community endoscopy facility.

PubMed

Hilsden, Robert Jay; Rostom, Alaa; Dubé, Catherine; Pontifex, Darlene; McGregor, S Elizabeth; Bridges, Ronald J

2011-10-01

Quality assurance (QA) is a process that includes the systematic evaluation of a service, institution of improvements and ongoing evaluation to ensure that effective changes were made. QA is a fundamental component of any organized colorectal cancer screening program. However, it should play an equally important role in opportunistic screening. Establishing the processes and procedures for a comprehensive QA program can be a daunting proposition for an endoscopy unit. The present article describes the steps taken to establish a QA program at the Forzani & MacPhail Colon Cancer Screening Centre (Calgary, Alberta) - a colorectal cancer screening centre and nonhospital endoscopy unit that is dedicated to providing colorectal cancer screening-related colonoscopies. Lessons drawn from the authors' experience may help others develop their own initiatives. The Global Rating Scale, a quality assessment and improvement tool developed for the gastrointestinal endoscopy services of the United Kingdom's National Health Service, was used as the framework to develop the QA program. QA activities include monitoring the patient experience through surveys, creating endoscopist report cards on colonoscopy performance, tracking and evaluating adverse events and monitoring wait times.

Multileaf collimator performance monitoring and improvement using semiautomated quality control testing and statistical process control

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

Létourneau, Daniel, E-mail: daniel.letourneau@rmp.uh.on.ca; McNiven, Andrea; Keller, Harald

2014-12-15

Purpose: High-quality radiation therapy using highly conformal dose distributions and image-guided techniques requires optimum machine delivery performance. In this work, a monitoring system for multileaf collimator (MLC) performance, integrating semiautomated MLC quality control (QC) tests and statistical process control tools, was developed. The MLC performance monitoring system was used for almost a year on two commercially available MLC models. Control charts were used to establish MLC performance and assess test frequency required to achieve a given level of performance. MLC-related interlocks and servicing events were recorded during the monitoring period and were investigated as indicators of MLC performance variations. Methods:more » The QC test developed as part of the MLC performance monitoring system uses 2D megavoltage images (acquired using an electronic portal imaging device) of 23 fields to determine the location of the leaves with respect to the radiation isocenter. The precision of the MLC performance monitoring QC test and the MLC itself was assessed by detecting the MLC leaf positions on 127 megavoltage images of a static field. After initial calibration, the MLC performance monitoring QC test was performed 3–4 times/week over a period of 10–11 months to monitor positional accuracy of individual leaves for two different MLC models. Analysis of test results was performed using individuals control charts per leaf with control limits computed based on the measurements as well as two sets of specifications of ±0.5 and ±1 mm. Out-of-specification and out-of-control leaves were automatically flagged by the monitoring system and reviewed monthly by physicists. MLC-related interlocks reported by the linear accelerator and servicing events were recorded to help identify potential causes of nonrandom MLC leaf positioning variations. Results: The precision of the MLC performance monitoring QC test and the MLC itself was within ±0.22 mm for most MLC leaves and the majority of the apparent leaf motion was attributed to beam spot displacements between irradiations. The MLC QC test was performed 193 and 162 times over the monitoring period for the studied units and recalibration had to be repeated up to three times on one of these units. For both units, rate of MLC interlocks was moderately associated with MLC servicing events. The strongest association with the MLC performance was observed between the MLC servicing events and the total number of out-of-control leaves. The average elapsed time for which the number of out-of-specification or out-of-control leaves was within a given performance threshold was computed and used to assess adequacy of MLC test frequency. Conclusions: A MLC performance monitoring system has been developed and implemented to acquire high-quality QC data at high frequency. This is enabled by the relatively short acquisition time for the images and automatic image analysis. The monitoring system was also used to record and track the rate of MLC-related interlocks and servicing events. MLC performances for two commercially available MLC models have been assessed and the results support monthly test frequency for widely accepted ±1 mm specifications. Higher QC test frequency is however required to maintain tighter specification and in-control behavior.« less

The keys to CERN conference rooms - Managing local collaboration facilities in large organisations

NASA Astrophysics Data System (ADS)

Baron, T.; Domaracky, M.; Duran, G.; Fernandes, J.; Ferreira, P.; Gonzalez Lopez, J. B.; Jouberjean, F.; Lavrut, L.; Tarocco, N.

2014-06-01

For a long time HEP has been ahead of the curve in its usage of remote collaboration tools, like videoconference and webcast, while the local CERN collaboration facilities were somewhat behind the expected quality standards for various reasons. This time is now over with the creation by the CERN IT department in 2012 of an integrated conference room service which provides guidance and installation services for new rooms (either equipped for videoconference or not), as well as maintenance and local support. Managing now nearly half of the 246 meeting rooms available on the CERN sites, this service has been built to cope with the management of all CERN rooms with limited human resources. This has been made possible by the intensive use of professional software to manage and monitor all the room equipment, maintenance and activity. This paper focuses on presenting these packages, either off-the-shelf commercial products (asset and maintenance management tool, remote audio-visual equipment monitoring systems, local automation devices, new generation touch screen interfaces for interacting with the room) when available or locally developed integration and operational layers (generic audio-visual control and monitoring framework) and how they help overcoming the challenges presented by such a service. The aim is to minimise local human interventions while preserving the highest service quality and placing the end user back in the centre of this collaboration platform.

Portable water quality monitoring system

NASA Astrophysics Data System (ADS)

Nizar, N. B.; Ong, N. R.; Aziz, M. H. A.; Alcain, J. B.; Haimi, W. M. W. N.; Sauli, Z.

2017-09-01

Portable water quality monitoring system was a developed system that tested varied samples of water by using different sensors and provided the specific readings to the user via short message service (SMS) based on the conditions of the water itself. In this water quality monitoring system, the processing part was based on a microcontroller instead of Lead and Copper Rule (LCR) machines to receive the results. By using four main sensors, this system obtained the readings based on the detection of the sensors, respectively. Therefore, users can receive the readings through SMS because there was a connection between Arduino Uno and GSM Module. This system was designed to be portable so that it would be convenient for users to carry it anywhere and everywhere they wanted to since the processor used is smaller in size compared to the LCR machines. It was also developed to ease the user to monitor and control the water quality. However, the ranges of the sensors' detection still a limitation in this study.

Twelve Months of Air Quality Monitoring at Ash Meadows National Wildlife Refuge, Southwestern Rural Nevada, U.S.A (EMSI April 2007)

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

Engelbrecht, Johann P; Shafer, David S; Campbell, Dave

The one year of air quality monitoring data collected at the Ash Meadows National Wildlife Refuge (NWR) was the final part of the air quality "Scoping Studies" for the Environmental Monitoring Systems Initiative (EMSI) in southern and central Nevada. The objective of monitoring at Ash Meadows was to examine aerosol and meteorological data, seasonal trends in aerosol and meteorological parameters as well as to examine evidence for long distance transport of some constituents. The 9,307 hectare refuge supports more than 50 springs and 24 endemic species, including the only population of the federally listed endangered Devil’s Hole pupfish (Cyprinodon diabolis)more » (U.S. Fish and Wildlife Service, 1990). Ash Meadows NWR is located in a Class II air quality area, and the aerosol measurements collected with this study are compared to those of Interagency Monitoring of Protected Visual Environments (IMPROVE) sites. Measurements taken at Ash Meadows NWR over a period of 12 months provide new baseline air quality and meteorological information for rural southwestern Nevada, specifically Nye County and the Amargosa Valley.« less

System-level change in mental health services in North Wales: An observational study using systems thinking.

PubMed

Evans, S; Huxley, P J; Maxwell, N; Huxley, K L S

2014-06-01

To describe changes to mental health services using systems thinking. Structured standardized quality of life assessment (Manchester Short Quality of Life Assessment: MANSA) was used to establish service user priorities for changes to service provision (part of a process known as check in systems thinking). Current service performance in these priority areas was identified, and changes to service arrangements were planned, implemented and monitored by task and finish (T&F) groups (making use of a process known as flow in systems thinking). 81 MANSA assessments were completed at the check stage (by NM). Work finances and leisure activities emerged as service user priority areas for change, and T&F groups were established with representation of all sectors and service users. Ways to make improvements were observed, planned and implemented by T&F groups (the flow stage). The systems approach reveals how services and quality of life have been changed for patients in Wrexham. Further generalizable research is needed into the potential benefits of using systems thinking in mental health service evaluation. © The Author(s) 2013.

Drug prescribing in rural health facilities in China: implications for service quality and cost.

PubMed

Zhan, S K; Tang, S L; Guo, Y D; Bloom, G

1998-01-01

Overuse of drugs in rural areas of China has led to a growing concern regarding service quality and cost. The study found evidence of high levels of drug use in some rural health facilities in comparison with a number of other developing countries. Such a result was significantly associated with the government policy of financing health care, regulation and monitoring of health services, and users' attitudes and behaviour. It underlines the need for measures to be taken in China to improve drug use in order to allow its population access to effective care at reasonable cost.

Quality of trauma care and trauma registries.

PubMed

Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F

2015-03-01

Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

21 CFR 866.5910 - Quality control material for cystic fibrosis nucleic acid assays.

Code of Federal Regulations, 2010 CFR

2010-04-01

... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES IMMUNOLOGY AND MICROBIOLOGY DEVICES Immunological Test Systems § 866.5910 Quality control material for cystic fibrosis nucleic acid assays. (a... cystic fibrosis nucleic acid assays is a device intended to help monitor reliability of a test system by...

Communication of the monitoring and evaluation process through the use of storyboards and story notebooks.

PubMed

Lewis, L C; Honea, S H; Kanter, D F; Haney, P E

1993-10-01

In preparation for the 1993 Joint Commission on Accreditation of Health Care Organizations (JCAHO) survey, Audie L. Murphy Memorial Veterans Hospital Nursing Service was faced with determining the best approach to presenting their Total Quality Improvement/Total Quality Management (TQI/TQM) process. Nursing Service management and staff, Quality Improvement Clinicians, and medical staff used the Storyboard concept and the accompanying Story Notebooks to organize and to communicate their TQI/TQM process and findings. This concept was extremely beneficial, enabling staff to successfully present the multidisciplinary TQI/TQM data to the JCAHO surveyors.

An Investigation of Techniques for Detecting Data Anomalies in Earned Value Management Data

DTIC Science & Technology

2011-12-01

Management Studio Harte Hanks Trillium Software Trillium Software System IBM Info Sphere Foundation Tools Informatica Data Explorer Informatica ...Analyst Informatica Developer Informatica Administrator Pitney Bowes Business Insight Spectrum SAP BusinessObjects Data Quality Management DataFlux...menting quality monitoring efforts and tracking data quality improvements Informatica http://www.informatica.com/products_services/Pages/index.aspx

[Monitoring of nursing service context factors: first descriptive results of a cross-sectional Swiss study prior the introduction of SwissDRG].

PubMed

Kleinknecht-Dolf, Michael; Spichiger, Elisabeth; Frei, Irena Anna; Müller, Marianne; Martin, Jacqueline S; Spirig, Rebecca

2015-04-01

The adoption of DRG-based payment systems has narrowed hospitals' financial margins, necessitating streamlining and process optimization. The experience of other countries shows that this restructuring can influence context factors essential to the delivery of nursing care. As a result, nursing care quality and patient safety may be impacted. The Sinergia Project aims to develop a monitoring model and related instruments to continuously monitor the impact of DRG-based reimbursement on central nursing service context factors. The descriptive, quantitative results were collected within the framework of a study with a mixed methods design by means of an online survey in which nurses from five hospitals participated. The results show that the nursing service context factors examined (nursing care complexity, quality of the work environment, management, moral distress and job satisfaction), have relevance in all practice areas as regards practice setting and nursing care delivery. Patterns can be recognized that are consistent with those found in the literature and which could be an indication of the relationships between the context factors above, as was hypothesized in the model. The study has provided the participating hospitals with useful data upon which to base discussions on ensuring quality of nursing care and practice development, in addition to information important to the further development of the model and the instruments employed.

Exploring the Use of Participatory Information to Improve Monitoring, Mapping and Assessment of Aquatic Ecosystem Services at Landascape Scales

EPA Science Inventory

Traditionally, the EPA has monitored aquatic ecosystems using statistically rigorous sample designs and intensive field efforts which provide high quality datasets. But by their nature they leave many aquatic systems unsampled, follow a top down approach, have a long lag between ...

US EPA 2012 Air Quality Fused Surface for the Conterminous U.S. Map Service

EPA Pesticide Factsheets

This web service contains a polygon layer that depicts fused air quality predictions for 2012 for census tracts in the conterminous United States. Fused air quality predictions (for ozone and PM2.5) are modeled using a Bayesian space-time downscaling fusion model approach described in a series of three published journal papers: 1) (Berrocal, V., Gelfand, A. E. and Holland, D. M. (2012). Space-time fusion under error in computer model output: an application to modeling air quality. Biometrics 68, 837-848; 2) Berrocal, V., Gelfand, A. E. and Holland, D. M. (2010). A bivariate space-time downscaler under space and time misalignment. The Annals of Applied Statistics 4, 1942-1975; and 3) Berrocal, V., Gelfand, A. E., and Holland, D. M. (2010). A spatio-temporal downscaler for output from numerical models. J. of Agricultural, Biological,and Environmental Statistics 15, 176-197) is used to provide daily, predictive PM2.5 (daily average) and O3 (daily 8-hr maximum) surfaces for 2012. Summer (O3) and annual (PM2.5) means calculated and published. The downscaling fusion model uses both air quality monitoring data from the National Air Monitoring Stations/State and Local Air Monitoring Stations (NAMS/SLAMS) and numerical output from the Models-3/Community Multiscale Air Quality (CMAQ). Currently, predictions at the US census tract centroid locations within the 12 km CMAQ domain are archived. Predictions at the CMAQ grid cell centroids, or any desired set of locations co

National Forest Health Monitoring Program, Monitoring Urban Forests in Indiana: Pilot Study 2002, Part 2: Statewide Estimates Using the UFORE Model

Treesearch

David Nowak; Anne Buckelew Cumming; Daniel Twardus; Robert Hoehn; Manfred Mielke

2007-01-01

Trees in cities can improve environmental quality and human health. Unfortunately, little is known about the urban forest resource and what and how it contributes to local, regional, and national societies and economies. To better understand the urban forest resource and its value, the Forest Service, U.S. Department of Agriculture, Forest Health Monitoring Program...

Preliminary benefits study for a public service communications satellite system: Task order 2

NASA Technical Reports Server (NTRS)

1978-01-01

The economic and social benefits to accrue from an operational public service communications satellite system are estimated for the following applications: teleradiology, emergency medical services, teleconferencing for both civilian and defense agencies, data transfer, remote cardiac monitoring, teleconsultation, continuing education for professionals, and severe storm warning. The potential impact of improved communication on the cost and quality of services are assessed for various agencies, professions, and industries.

Comparison of 2008-2009 water years and historical water-quality data, upper Gunnison River Basin, Colorado

USGS Publications Warehouse

Solberg, Patricia A.; Moore, Bryan; Blacklock, Ty D.

2012-01-01

Population growth and changes in land use have the potential to affect water quality and quantity in the upper Gunnison River Basin. In 1995, the U.S. Geological Survey (USGS), in cooperation with the Bureau of Land Management, City of Gunnison, Colorado River Water Conservation District, Crested Butte South Metropolitan District, Gunnison County, Hinsdale County, Mount Crested Butte Water and Sanitation District, National Park Service, Town of Crested Butte, U.S. Forest Service, Upper Gunnison River Water Conservancy District, and Western State College, established a water-quality monitoring program in the upper Gunnison River Basin to characterize current water-quality conditions and to assess the effects of increased urban development and other land-use changes on water quality. The monitoring network has evolved into two groups of sites: (1) sites that are considered long term and (2) sites that are considered rotational. Data from the long-term sites assist in defining temporal changes in water quality (how conditions may change over time). The rotational sites assist in the spatial definition of water-quality conditions (how conditions differ throughout the basin) and address local and short-term concerns. Biannual summaries of the water-quality data from the monitoring network provide a point of reference for stakeholder discussions regarding the location and purpose of water-quality monitoring sites in the upper Gunnison River Basin. This report compares and summarizes the data collected during water years 2008 and 2009 to the historical data available at these sites. The introduction provides a map of the sampling sites, definitions of terms, and a one-page summary of selected water-quality conditions at the network sites. The remainder of the report is organized around the data collected at individual sites. Data collected during water years 2008 and 2009 are compared to historical data, State water-quality standards, and Federal water-quality guidelines. A seasonal Kendall test for trend analysis is completed when there is sufficient data (typically >5 years) at the station. Data were collected following USGS protocols.

Service Quality Of Diagnostic Fine Needle Aspiration Cytology In A Tertiary Care Hospital Of Lahore (Process Measure As Patient's Perspective).

PubMed

Rizvi, Zainab; Usmani, Rabia Arshed; Rizvi, Amna; Wazir, Salim; Zahra, Taskeen; Rasool, Hafza

2017-01-01

Quality of any service is the most important aspect for the manufacturer as well as the consumer. The primary objective of any nation's health system is to provide supreme quality health care services to its patients. The objective of this study was to assess the quality of diagnostic fine needle aspiration cytology service in a tertiary care hospital. As Patient's perspectives provide valuable information on quality of process, therefore, patient's perception in terms of satisfaction with the service was measured. In this cross sectional analytical study, 291 patients undergoing fine needle aspiration cytology in Mayo Hospital were selected by systematic sampling technique. Information regarding satisfaction of patients with four dimensions of service quality process, namely "procedure, sterilization, conduct and competency of doctor" was collected through interview on questionnaire. The questionnaire was developed on SERVQUAL model, a measurement tool, for quality assessment of services provided to patients. All items were assessed on 2- point likert scale (0=dissatisfied, 1=satisfied). Frequencies and percentages of satisfied and dissatisfied patients were recorded for each item and all items in each dimension were scored. If the percentage of sum of all item scores of a dimension was ≥60, the dimension was 'good quality'. Whereas <60% was 'poor quality' dimension. Data was analysed using epi-info-3.5.1. Fisher test was applied to check statistical significance. (p-value <0.05). Out of the 4 dimensions of service quality process, Procedure (48.8%), Sterilization (51.5%) and practitioner conduct (50.9%) were perceived as 'poor' by the patients. Only practitioner competency (67.4%) was perceived as 'good'. Comparison of dimensions of service quality scoring with overall level of patient satisfaction revealed that all 4 dimensions were significantly related to patient dissatisfaction (p<.05). The study suggests that service quality of therapeutic and diagnostic procedures in public hospitals should be routinely monitored from the patients' point of view as most aspects of service quality in public hospitals of Pakistan, require improvements. In this manner patient's satisfaction regarding use of services in public hospitals can be made better.

Hanford Internal Dosimetry Project manual. Revision 1

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

Carbaugh, E.H.; Bihl, D.E.; MacLellan, J.A.

1994-07-01

This document describes the Hanford Internal Dosimetry Project, as it is administered by Pacific Northwest Laboratory (PNL) in support of the US Department of Energy and its Hanford contractors. Project services include administrating the bioassay monitoring program, evaluating and documenting assessment of potential intakes and internal dose, ensuring that analytical laboratories conform to requirements, selecting and applying appropriate models and procedures for evaluating radionuclide deposition and the resulting dose, and technically guiding and supporting Hanford contractors in matters regarding internal dosimetry. Specific chapters deal with the following subjects: practices of the project, including interpretation of applicable DOE Orders, regulations, andmore » guidance into criteria for assessment, documentation, and reporting of doses; assessment of internal dose, including summary explanations of when and how assessments are performed; recording and reporting practices for internal dose; selection of workers for bioassay monitoring and establishment of type and frequency of bioassay measurements; capability and scheduling of bioassay monitoring services; recommended dosimetry response to potential internal exposure incidents; quality control and quality assurance provisions of the program.« less

On-Line Water Quality Parameters as Indicators of Distribution System Contamination

EPA Science Inventory

At a time when the safety and security of services we have typically taken for granted are under question, a real-time or near real-time method of monitoring changes in water quality parameters could provide a critical line of defense in protecting public health. This study was u...

Quality of care in reproductive health programmes: education for quality improvement.

PubMed

Kwast, B E

1998-09-01

The provision of high quality maternity care will make the difference between life and death or lifelong maiming for millions of pregnant women. Barriers preventing access to affordable, appropriate, acceptable and effective services, and lack of facilities providing high quality obstetric care result in about 1600 maternal deaths every day. Education in its broadest sense is required at all levels and sectors of society to enhance policy formulation that will strengthen programme commitment, improve services with a culturally sensitive approach and ensure appropriate delegation of responsibility to health staff at peripheral levels. This paper is the second in series of three which addresses quality of care. The first (Kwast 1998) contains an overview of concepts, assessments, barriers and improvements of quality of care. The third article will describe selected aspects of monitoring and evaluation of quality of care.

Spatial-temporal distortion metric for in-service quality monitoring of any digital video system

NASA Astrophysics Data System (ADS)

Wolf, Stephen; Pinson, Margaret H.

1999-11-01

Many organizations have focused on developing digital video quality metrics which produce results that accurately emulate subjective responses. However, to be widely applicable a metric must also work over a wide range of quality, and be useful for in-service quality monitoring. The Institute for Telecommunication Sciences (ITS) has developed spatial-temporal distortion metrics that meet all of these requirements. These objective metrics are described in detail and have a number of interesting properties, including utilization of (1) spatial activity filters which emphasize long edges on the order of 10 arc min while simultaneously performing large amounts of noise suppression, (2) the angular direction of the spatial gradient, (3) spatial-temporal compression factors of at least 384:1 (spatial compression of at least 64:1 and temporal compression of at least 6:1, and 4) simple perceptibility thresholds and spatial-temporal masking functions. Results are presented that compare the objective metric values with mean opinion scores from a wide range of subjective data bases spanning many different scenes, systems, bit-rates, and applications.

Using soil quality indicators for monitoring sustainable forest management

Treesearch

James A. Burger; Garland Gray; D. Andrew Scott

2010-01-01

Most private and public forest land owners and managers are compelled to manage their forests sustainably, which means management that is economically viable,environmentally sound, and socially acceptable. To meet this mandate, the USDA Forest Service protects the productivity of our nation’s forest soils by monitoring and evaluating management activities to ensure...

National Forest Health Monitoring Program, Urban Forests Of Wisconsin: Pilot Monitoring Project 2002

Treesearch

Anne Buckelew Cumming; David Nowak; Daniel Twardus; Robert Hoehn; Manfred Mielke; Richard Rideout

2007-01-01

Trees in cities can contribute significantly to human health and environmental quality. Unfortunately, little is known about the urban forest resource and what it contributes locally, regionally, and nationally in terms of ecology, economy, and social well-being. To better understand this resource and its values, the Forest Service, U.S. Department of Agriculture,...

Quality of asthma care under different primary care models in Canada: a population-based study.

PubMed

To, Teresa; Guan, Jun; Zhu, Jingqin; Lougheed, M Diane; Kaplan, Alan; Tamari, Itamar; Stanbrook, Matthew B; Simatovic, Jacqueline; Feldman, Laura; Gershon, Andrea S

2015-02-14

Previous research has shown variations in quality of care and patient outcomes under different primary care models. The objective of this study was to use previously validated, evidence-based performance indicators to measure quality of asthma care over time and to compare quality of care between different primary care models. Data were obtained for years 2006 to 2010 from the Ontario Asthma Surveillance Information System, which uses health administrative databases to track individuals with asthma living in the province of Ontario, Canada. Individuals with asthma (n=1,813,922) were divided into groups based on the practice model of their primary care provider (i.e., fee-for-service, blended fee-for-service, blended capitation). Quality of asthma care was measured using six validated, evidence-based asthma care performance indicators. All of the asthma performance indicators improved over time within each of the primary care models. Compared to the traditional fee-for-service model, the blended fee-for-service and blended capitation models had higher use of spirometry for asthma diagnosis and monitoring, higher rates of inhaled corticosteroid prescription, and lower outpatient claims. Emergency department visits were lowest in the blended fee-for-service group. Quality of asthma care improved over time within each of the primary care models. However, the amount by which they improved differed between the models. The newer primary care models (i.e., blended fee-for-service, blended capitation) appear to provide better quality of asthma care compared to the traditional fee-for-service model.

Dynamic composition of medical support services in the ICU: Platform and algorithm design details.

PubMed

Hristoskova, Anna; Moeyersoon, Dieter; Van Hoecke, Sofie; Verstichel, Stijn; Decruyenaere, Johan; De Turck, Filip

2010-12-01

The Intensive Care Unit (ICU) is an extremely data-intensive environment where each patient needs to be monitored 24/7. Bedside monitors continuously register vital patient values (such as serum creatinine, systolic blood pressure) which are recorded frequently in the hospital database (e.g. every 2 min in the ICU of the Ghent University Hospital), laboratories generate hundreds of results of blood and urine samples, and nurses measure blood pressure and temperature up to 4 times an hour. The processing of such large amount of data requires an automated system to support the physicians' daily work. The Intensive Care Service Platform (ICSP) offers the needed support through the development of medical support services for processing and monitoring patients' data. With an increased deployment of these medical support services, reusing existing services as building blocks to create new services offers flexibility to the developer and accelerates the design process. This paper presents a new addition to the ICSP, the Dynamic Composer for Web services. Based on a semantic description of the medical support services, this Composer enables a service to be executed by creating a composition of medical services that provide the needed calculations. The composition is achieved using various algorithms satisfying certain quality of service (QoS) constraints and requirements. In addition to the automatic composition the paper also proposes a recovery mechanism in case of unavailable services. When executing the composition of medical services, unavailable services are dynamically replaced by equivalent services or a new composition achieving the same result. The presented platform and QoS algorithms are put through extensive performance and scalability tests for typical ICU scenarios, in which basic medical services are composed to a complex patient monitoring service. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

[National health resources for highly specialised medicine].

PubMed

Bratlid, Dag; Rasmussen, Knut

2005-11-03

In order to monitor quality and efficiency in the use of health resources for highly specialised medicine, a National Professional Council has since 1990 advised the Norwegian health authorities on the establishing and localisation of such services. A comprehensive review of both the quality, economy and the geographical distribution of patients in each specialised service has been carried out. 33 defined national programmes were centralised to one hospital only and distributed among seven university hospitals. Eight multiregional programmes were centralised to two hospitals only and included four university hospitals. In 2001, a total of 2711 new patients were treated in these programmes. The system seems to have secured a sufficient patient flow to each programme so as to maintain quality. However, a geographically skewed distribution of patients was noted, particularly in some of the national programmes. In a small country like Norway, with 4.5 million inhabitants, a centralised monitoring of highly specialised medicine seems both rational and successful. By the same logic, however, international cooperation should probably be sought for the smallest patient groups.

Linking quality and performance. Quality orientation can be a competitive strategy for health care providers.

PubMed

Rapert, M I; Babakus, E

1996-01-01

Many organizations are not convinced a quality orientation pays off and are looking for ways to link quality with performance. The authors' exploratory study found that a quality orientation is a differentiating factor between low-performing and high-performing general service hospitals. They also developed a quality scale to assess the performance implications of quality-based strategies in the health care industry. Successful health care organizations (1) develop a strategic quality orientation at the management level, (2) support the pursuit of quality at the contact level, and (3) monitor external customers' perceptions of quality.

LISTENing to healthcare students: the impact of new library facilities on the quality of services.

PubMed

Haldane, Graham C

2003-06-01

Following a low assessment of 'Learning resources' provision by the Quality Assurance Agency, the librarian of Homerton College, School of Health Studies commenced the LISTEN Project, a long-term study to monitor the effects of planned interventions on the quality of library provision. Surveys of entry-to-register student nurses & midwives were conducted in 1999 and 2001 by extensive questionnaires, inviting Likert-scaled and free text responses. Following a college relocation, students made greater than expected use of a new health studies library in Cambridge, and significantly less use of the local teaching hospital library. Using both a satisfaction index and a non-parametric test of mean scores, student evaluation of library services in Cambridge significantly improved following relocation. The physical accommodation and location of library services remain important to healthcare students. Identifiable improvements to the quality of services, however, will overcome initial resistance to change. Education providers must ensure the best mix of physical and electronic services for students who spend much of their time on clinical placement.

Source Water Quality Monitoring Networks

EPA Science Inventory

Harmful Algal Blooms (HABs) are increasingly impacting aquatic systems, reducing provided ecological services and requiring expensive engineered solutions. HABs, particularly those dominated by cyanobacteria (cyanoHABs) are a public health, ecologic, and economic concern. Charac...

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 Service-Learning Project in Chemistry: Environmental Monitoring of a Nature Preserve

ERIC Educational Resources Information Center

Kammler, David C.; Truong, Triet M.; VanNess, Garrett; McGowin, Audrey E.

2012-01-01

A collaborative environmental service-learning project was implemented between upper-level undergraduate science majors and graduate chemistry students at a large state school and first-year students at a small private liberal arts college. Students analyzed the water quality in a nature preserve by determining the quantities of 12 trace metals,…

Soil Disturbance Monitoring in the USDA Forest Service, Pacific Northwest Region

Treesearch

Steven W. Howes

2006-01-01

In order to make reasoned decisions, USDA Forest Service managers must understand how changes in specific indicators of soil quality resulting from project implementation affect long-term forest productivity and watershed health. They must also be able to efficiently and economically assess the degree and extent of such changes across specified areas and adjust...

Health Monitoring and Management for Manufacturing Workers in Adverse Working Conditions.

PubMed

Xu, Xiaoya; Zhong, Miao; Wan, Jiafu; Yi, Minglun; Gao, Tiancheng

2016-10-01

In adverse working conditions, environmental parameters such as metallic dust, noise, and environmental temperature, directly affect the health condition of manufacturing workers. It is therefore important to implement health monitoring and management based on important physiological parameters (e.g., heart rate, blood pressure, and body temperature). In recent years, new technologies, such as body area networks, cloud computing, and smart clothing, have allowed the improvement of the quality of services. In this article, we first give five-layer architecture for health monitoring and management of manufacturing workers. Then, we analyze the system implementation process, including environmental data processing, physical condition monitoring and system services and management, and present the corresponding algorithms. Finally, we carry out an evaluation and analysis from the perspective of insurance and compensation for manufacturing workers in adverse working conditions. The proposed scheme will contribute to the improvement of workplace conditions, realize health monitoring and management, and protect the interests of manufacturing workers.

Improving the quality of physical health monitoring in CAMHS for children and adolescents prescribed medication for ADHD.

PubMed

Oxley, Cristal; Moghraby, Omer S; Samuel, Rani; Joyce, Dan W

2018-01-01

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterised by a persistent, pervasive pattern of inattention, impulsivity and hyperactivity. Stimulant medication such as methylphenidate has an established evidence base in the treatment of children and adolescents with ADHD. However, it is also associated with a risk of side effects which may include decreased appetite, increased blood pressure and possible reduced growth. Monitoring physical health in children and adolescents prescribed medication for ADHD is a key clinical responsibility and includes a number of parameters as outlined in the National Institute for Health and Care Excellence Guidelines. Ascertaining the centiles of physical observations is essential to put these into developmental context and accurately inform treatment decisions. This quality improvement project aimed to improve physical health monitoring in children and adolescents prescribed stimulant medication for ADHD within a large specialist urban inner-city Child and Adolescent Mental Health Service (CAMHS) in South London and Maudsley NHS Foundation Trust. Baseline data were obtained to establish the quality of physical monitoring including blood pressure, height, weight and centiles. Targeted interventions included the development of a novel web-based application designed to calculate and record centiles. We report an improvement in total proportion compliance with physical health monitoring from 24% to 75%. The frequency of recording baseline blood pressure centiles increased from 0% to 62%; recording baseline height centiles increased from 37% to 81% and recording baseline weight centiles increased from 37% to 81%. Improvement in the delivery of high-quality care was achieved and sustained through close collaboration with clinicians involved in the treatment pathway in order to elicit and respond effectively to feedback for improvement and codevelop interventions which were highly effective within the clinical system. We believe this model to be replicable in other CAMHS services and ADHD clinics to improve the delivery of high-quality clinical care.

Perspectives for Web Service Intermediaries: How Influence on Quality Makes the Difference

NASA Astrophysics Data System (ADS)

Scholten, Ulrich; Fischer, Robin; Zirpins, Christian

In the service-oriented computing paradigm and the Web service architecture, the broker role is a key facilitator to leverage technical capabilities of loose coupling to achieve organizational capabilities of dynamic customer-provider-relationships. In practice, this role has quickly evolved into a variety of intermediary concepts that refine and extend the basic functionality of service brokerage with respect to various forms of added value like platform or market mechanisms. While this has initially led to a rich variety of Web service intermediaries, many of these are now going through a phase of stagnation or even decline in customer acceptance. In this paper we present a comparative study on insufficient service quality that is arguably one of the key reasons for this phenomenon. In search of a differentiation with respect to quality monitoring and management patterns, we categorize intermediaries into Infomediaries, e-Hubs, e-Markets and Integrators. A mapping of quality factors and control mechanisms to these categories depicts their respective strengths and weaknesses. The results show that Integrators have the highest overall performance, followed by e-Markets, e-Hubs and lastly Infomediaries. A comparative market survey confirms the conceptual findings.

Improving consistency and quality of service delivery: implications for the addiction treatment field.

PubMed

Knott, Anne Marie; Corredoira, Rafael; Kimberly, John

2008-09-01

Addiction treatment providers face serious problems in delivering consistent, high-quality services over time. Among those providers with multiple treatment sites, there is also intersite variability. This is a serious problem in the addiction field, likely to be made worse as new technologies are introduced and/or as there is industry consolidation (Corredoira, R., Kimberly, J. (2006) Industry evolution through consolidation: Implications for addiction treatment. Journal of Substance Abuse Treatment 31, 255-265.). Although serious, these problems in managing and monitoring to assure consistent service quality have been faced by many other industries. Here, we review evidence from research in other industries regarding three different forms of management (vertical integration, franchising, and licensing) across a chain of individual service providers. We show how each management form affects the level, consistency, and improvement of service delivery over time. In addition, we discuss how such performance advantages affect customer demand as well as regulatory endorsement of the consolidated firm and its approach.

Factors affecting satisfaction level with the food services in a military hospital.

PubMed

Sahin, Bayram; Demir, Cesim; Celik, Yusuf; Teke, A Kadir

2006-10-01

To determine the factors affecting general satisfaction level of patients with the food services in a military hospital in Turkey. The study was carried out in a military hospital providing tertiary health care services with the capacity of 1000 hospital bed. A questionnaire was used as data collection tool on measuring satisfaction of the patients with the food services. The results showed that of 374 patients 51.3% evaluated food service quality adequate, 32.4% said that the food quality was inadequate, and 16.3% stated that they were uncertain. A logistic regression model was estimated in determining the most important and statistically significant factors affecting patient satisfaction with hospital foods and food services. The results showed that patient-specific demographic characteristics were insignificant in explaining satisfaction level with food services, but the variables of taste (OR = 9.853, p = 0.000) and appearance (OR = 2.687, p = 0.014) of the food were statistically significant and important determinants of patient satisfaction with the foods served at the hospital. The results of this study would be helpful in making decision on increasing the level of satisfaction of patients with the food services for hospital managers and the food (nutrition) departments. On the other hand, the results can also be used in benchmarking the hospital's food services quality with other hospitals, and in monitoring improvements in food services quality in the future.

Bridging existing governance gaps: five evidence-based actions that boards can take to pursue high quality care.

PubMed

Leggat, Sandra G; Balding, Cathy

2017-11-13

Objective To explore the impact of the organisational quality systems on quality of care in Victorian health services. Methods During 2015 a total of 55 focus groups were conducted with more than 350 managers, clinical staff and board members in eight Victorian health services to explore the effectiveness of health service quality systems. A review of the quality and safety goals and strategies outlined in the strategic and operating plans of the participating health services was also undertaken. Results This paper focuses on the data related to the leadership role of health service boards in ensuring safe, high-quality care. The findings suggest that health service boards are not fully meeting their governance accountability to ensure consistently high-quality care. The data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety and the implementation of these expectations at point of care. These gaps were further compounded by quality system confusion, over-reliance on compliance, and inadequate staff engagement. Conclusion Based on the existing evidence we propose five specific actions boards can take to close the gaps, thereby supporting improved care for all consumers. What is known about this topic? Effective governance is essential for high-quality healthcare delivery. Boards are required to play an active role in their organisation's pursuit of high quality care. What does this paper add? Recent government reports suggest that Australian health service boards are not fully meeting their governance requirements for high quality, safe care delivery, and our research pinpoints key governance gaps. What are the implications for practitioners? Based on our research findings we outline five evidence-based actions for boards to improve their governance of quality care delivery. These actions focus on an organisational strategy for high-quality care, with the chief executive officer held accountable for successful implementation, which is actively guided and monitored by the board.

Comparison of Water Years 2004-05 and Historical Water-Quality Data, Upper Gunnison River Basin, Colorado

USGS Publications Warehouse

Spahr, Norman E.; Hartle, David M.; Diaz, Paul

2008-01-01

Population growth and changes in land use have the potential to affect water quality and quantity in the upper Gunnison River Basin. In 1995, the U.S. Geological Survey (USGS), in cooperation with the Bureau of Land Management, City of Gunnison, Colorado River Water Conservation District, Crested Butte South Metropolitan District, Gunnison County, Hinsdale County, Mount Crested Butte Water and Sanitation District, National Park Service, Town of Crested Butte, Upper Gunnison River Water Conservancy District, and Western State College, established a water-quality monitoring program in the upper Gunnison River Basin to characterize current water-quality conditions and to assess the effects of increased urban development and other land-use changes on water quality. The monitoring network has evolved into two groups of stations - stations that are considered long term and stations that are considered rotational. The long-term stations are monitored to assist in defining temporal changes in water quality (how conditions may change over time). The rotational stations are monitored to assist in the spatial definition of water-quality conditions (how conditions differ throughout the basin) and to address local and short-term concerns. Some stations in the rotational group were changed beginning in water year 2007. Annual summaries of the water-quality data from the monitoring network provide a point of reference for discussions regarding water-quality monitoring in the upper Gunnison River Basin. This summary includes data collected during water years 2004 and 2005. The introduction provides a map of the sampling sites, definitions of terms, and a one-page summary of selected water-quality conditions at the network stations. The remainder of the summary is organized around the data collected at individual stations. Data collected during water years 2004 and 2005 are compared to historical data, State water-quality standards, and Federal water-quality guidelines. Data were collected following USGS protocols.

Comparison of 2006-2007 Water Years and Historical Water-Quality Data, Upper Gunnison River Basin, Colorado

USGS Publications Warehouse

Solberg, P.A.; Moore, Bryan; Smits, Dennis

2009-01-01

Population growth and changes in land use have the potential to affect water quality and quantity in the upper Gunnison River basin. In 1995, the U.S. Geological Survey (USGS), in cooperation with the Bureau of Land Management, City of Gunnison, Colorado River Water Conservation District, Crested Butte South Metropolitan District, Gunnison County, Hinsdale County, Mount Crested Butte Water and Sanitation District, National Park Service, Town of Crested Butte, Upper Gunnison River Water Conservancy District, and Western State College established a water-quality monitoring program in the upper Gunnison River basin to characterize current water-quality conditions and to assess the effects of increased urban development and other land-use changes on water quality. The monitoring network has evolved into two groups of stations - stations that are considered long term and stations that are considered rotational. The long-term stations are monitored to assist in defining temporal changes in water quality (how conditions may change over time). The rotational stations are monitored to assist in the spatial definition of water-quality conditions (how conditions differ throughout the basin) and to address local and short-term concerns. Some stations in the rotational group were changed beginning in water year 2007. Annual summaries of the water-quality data from the monitoring network provide a point of reference for discussions regarding water-quality monitoring in the upper Gunnison River basin. This summary includes data collected during water years 2006 and 2007. The introduction provides a map of the sampling sites, definitions of terms, and a one-page summary of selected water-quality conditions at the network stations. The remainder of the summary is organized around the data collected at individual stations. Data collected during water years 2006 and 2007 are compared to historical data, State water-quality standards, and Federal water-quality guidelines. Data were collected following USGS protocols (U.S. Geological Survey, variously dated).

Sources and summaries of water-quality information for the Rapid Creek basin, western South Dakota

USGS Publications Warehouse

Zogorski, John S.; Zogorski, E.M.; McKallip, T.E.

1990-01-01

This report provides a compilation of water quality information for the Rapid Creek basin in western South Dakota. Two types of information are included: First, past and current water quality monitoring data collected by the South Dakota Department of Water and Natural Resources, U.S. Forest Service, U.S. Geological Survey, and others are described. Second, a summary is included for all past water quality reports, publications, and theses that could be located during this study. A total of 62 documents were abstracted and included journal articles, abstracts, Federal agency reports and publications, university and State agency reports, local agency reports, and graduate theses. The report should be valuable to water resources managers, regulators, and others contemplating water quality research, monitoring, and regulatory programs in the Rapid Creek basin. (USGS)

Monitoring techniques and alarm procedures for CMS services and sites in WLCG

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

Molina-Perez, J.; Bonacorsi, D.; Gutsche, O.

2012-01-01

The CMS offline computing system is composed of roughly 80 sites (including most experienced T3s) and a number of central services to distribute, process and analyze data worldwide. A high level of stability and reliability is required from the underlying infrastructure and services, partially covered by local or automated monitoring and alarming systems such as Lemon and SLS, the former collects metrics from sensors installed on computing nodes and triggers alarms when values are out of range, the latter measures the quality of service and warns managers when service is affected. CMS has established computing shift procedures with personnel operatingmore » worldwide from remote Computing Centers, under the supervision of the Computing Run Coordinator at CERN. This dedicated 24/7 computing shift personnel is contributing to detect and react timely on any unexpected error and hence ensure that CMS workflows are carried out efficiently and in a sustained manner. Synergy among all the involved actors is exploited to ensure the 24/7 monitoring, alarming and troubleshooting of the CMS computing sites and services. We review the deployment of the monitoring and alarming procedures, and report on the experience gained throughout the first two years of LHC operation. We describe the efficiency of the communication tools employed, the coherent monitoring framework, the proactive alarming systems and the proficient troubleshooting procedures that helped the CMS Computing facilities and infrastructure to operate at high reliability levels.« less

Internet-Based Recording Service Solves Maintenance Reporting Problems.

ERIC Educational Resources Information Center

Noah, Marilyn

2001-01-01

Details the response to a health threat caused by illegal wastewater disposal in Wisconsin. Traces the identification of the problem, ordinances and policies adopted to guide the remedy, and subsequent monitoring of environmental quality. (DDR)

Effective Documentation Tools

NASA Technical Reports Server (NTRS)

Sleboda, Claire

1997-01-01

Quality assurance programs provide a very effective means to monitor and evaluate medical care. Quality assurance involves: (1) Identify a problem; (2) Determine the source and nature of the problem; (3) Develop policies and methods to effect improvement; (4) Implement those polices; (5) Monitor the methods applied; and (6) Evaluate their effectiveness. Because this definition of quality assurance so closely resembles the Nursing Process, the health unit staff was able to use their knowledge of the nursing process to develop many forms which improve the quality of patient care. These forms include the NASA DFRC Service Report, the occupational injury form (Incident Report), the patient survey (Pre-hospital Evaluation/Care Report), the Laboratory Log Sheet, the 911 Run Sheet, and the Patient Assessment Stamp. Examples and steps which are followed to generate these reports are described.

Quality of surface water in Missouri, water year 2011

USGS Publications Warehouse

Barr, Miya N.

2012-01-01

The U.S. Geological Survey, in cooperation with the Missouri Department of Natural Resources, designed and operates a series of monitoring stations on streams throughout Missouri known as the Ambient Water-Quality Monitoring Network. During the 2011 water year (October 1, 2010, through September 30, 2011), data were collected at 75 stations—72 Ambient Water-Quality Monitoring Network stations, 2 U.S. Geological Survey National Stream Quality Accounting Network stations, and 1 spring sampled in cooperation with the U.S. Forest Service. Dissolved oxygen, specific conductance, water temperature, suspended solids, suspended sediment, fecal coliform bacteria, Escherichia coli bacteria, dissolved nitrate plus nitrite, total phosphorus, dissolved and total recoverable lead and zinc, and select pesticide compound summaries are presented for 72 of these stations. The stations primarily have been classified into groups corresponding to the physiography of the State, primary land use, or unique station types. In addition, a summary of hydrologic conditions in the State including peak discharges, monthly mean discharges, and 7-day low flow is presented.

Quality of surface water in Missouri, water year 2010

USGS Publications Warehouse

Barr, Miya N.

2011-01-01

The U.S. Geological Survey, in cooperation with the Missouri Department of Natural Resources, designs and operates a series of monitoring stations on streams throughout Missouri known as the Ambient Water-Quality Monitoring Network. During the 2010 water year (October 1, 2009 through September 30, 2010), data were collected at 75 stations-72 Ambient Water-Quality Monitoring Network stations, 2 U.S. Geological Survey National Stream Quality Accounting Network stations, and 1 spring sampled in cooperation with the U.S. Forest Service. Dissolved oxygen, specific conductance, water temperature, suspended solids, suspended sediment, fecal coliform bacteria, Escherichia coli bacteria, dissolved nitrate plus nitrite, total phosphorus, dissolved and total recoverable lead and zinc, and select pesticide compound summaries are presented for 72 of these stations. The stations primarily have been classified into groups corresponding to the physiography of the State, primary land use, or unique station types. In addition, a summary of hydrologic conditions in the State including peak discharges, monthly mean discharges, and 7-day low flow is presented.

Effectiveness of presence of physician and midwife in quantity and quality of family planning services in health care centers.

PubMed

Jabbari, Hossein; Bakhshian, Fariba; Velayati, Atefeh; Mehrabi, Esmat; Allahverdizadeh, Shirin; Alikhah, Hossein; Maleki, Ahdieh; Ahadi, Hamid-Reza; Ghorbaniyan, Maryam; Naghavi-Behzad, Mohammad

2014-01-01

Iran's health sector has been engaging the services of physicians and midwives in healthcare centers since 2005, with the hope of improving the quantity and quality of family planning services. The aim of this study was to assess the effect of serving physicians and midwives on the quantity and quality of family planning services in the healthcare centers of Iran. The present cross-sectional study (Jan 2010 until Sep 2011) was carried out on 600 eligible families who were clients of healthcare centers of Tabriz, Azarshahr and Osku, cities of Northwest Iran from 2006 until 2011, in two groups (before and after). Some of the characteristics of the participants and the data on the quality and quantity of family planning services provided were grouped in a checklist of 16 variables by comparing the patients' past medical histories. In comparison with 3 years prior to engaging physician and midwife services in health care centers, the Couple Year Protection (CYP) and the quantity of family planning service indexes significantly increased among eligible families. The family size of participants declined significantly after family physicians and midwives became available in the healthcare centers (P < 0.005). Our findings showed some improvement in the quantity of services without any noticeable changes in the quality of services provided as a consequence of this huge intervention. Therefore, it is suggested that there should be proper oversight of the duties of the health team in order to keep a close watch on primary healthcare, design of proper mechanisms for collecting and maintaining performance reports and statistics, and continuously monitor and control the quality of services.

[Quality of mental health services: a self audit in the South Verona mental health service].

PubMed

Allevi, Liliana; Salvi, Giovanni; Ruggeri, Mirella

2006-01-01

To start a process of Continuous Quality Improvement (CQI) in an Italian Community Mental Health Service by using a quality assurance questionnaire in a self audit exercise. The questionnaire was administered to 14 key workers and clinical managers with different roles and seniority. One senior manager's evaluation was used as a benchmark for all the others. Changes were introduced in the service practice according to what emerged from the evaluation. Meetings were scheduled to monitor those changes and renew the CQI process. There was a wide difference in the key workers' answers. Overall, the senior manager's evaluation was on the 60th percentile of the distribution of the other evaluations. Those areas that required prompt intervention were risk management, personnel development, and CQI. The CQI process was followed up for one year: some interventions were carried out to change the practice of the service. A self audit exercise in Community Mental Health Services was both feasible and useful. The CQI process was easier to start than to carry on over the long term.

Tweets about hospital quality: a mixed methods study

PubMed Central

Greaves, Felix; Laverty, Antony A; Cano, Daniel Ramirez; Moilanen, Karo; Pulman, Stephen; Darzi, Ara; Millett, Christopher

2014-01-01

Background Twitter is increasingly being used by patients to comment on their experience of healthcare. This may provide information for understanding the quality of healthcare providers and improving services. Objective To examine whether tweets sent to hospitals in the English National Health Service contain information about quality of care. To compare sentiment on Twitter about hospitals with established survey measures of patient experience and standardised mortality rates. Design A mixed methods study including a quantitative analysis of all 198 499 tweets sent to English hospitals over a year and a qualitative directed content analysis of 1000 random tweets. Twitter sentiment and conventional quality metrics were compared using Spearman's rank correlation coefficient. Key results 11% of tweets to hospitals contained information about care quality, with the most frequent topic being patient experience (8%). Comments on effectiveness or safety of care were present, but less common (3%). 77% of tweets about care quality were positive in tone. Other topics mentioned in tweets included messages of support to patients, fundraising activity, self-promotion and dissemination of health information. No associations were observed between Twitter sentiment and conventional quality metrics. Conclusions Only a small proportion of tweets directed at hospitals discuss quality of care and there was no clear relationship between Twitter sentiment and other measures of quality, potentially limiting Twitter as a medium for quality monitoring. However, tweets did contain information useful to target quality improvement activity. Recent enthusiasm by policy makers to use social media as a quality monitoring and improvement tool needs to be carefully considered and subjected to formal evaluation. PMID:24748372

Quality site seasonal report: Army Air Force Exchange Service Headquarters Building, SFBP 1343, August 1984 through May 1985

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

Pollock, E.O. Jr.

1987-10-15

The active solar Domestic Hot Water (DHW) system at the HQ Army-Air Force Exchange Service (AAFES) Building was designed and constructed as part of the Solar in Federal Buildings Programs (SFBP). This retrofitted system is one of eight of the systems in the SFBP selected for quality monitoring. The purpose of this monitoring effort is to document the performance of quality state-of-the-art solar systems in large federal building applications. The six-story HQ AAFES Building houses a cafeteria, officer's mess and club and office space for 2400 employees. The siphon-return drainback system uses 1147 ft/sup 2/ of Aircraftsman flat-plate collectors tomore » collect solar energy which is used to preheat domestic hot water. Solar energy is stored in a 1329-gallon tank and transferred to the hot water load through a heat exchanger located in the 356-gallon DHW preheat tank. Auxiliary energy is supplied by two gas fired boilers which boost the temperature to 130/sup 0/F before it is distributed to the load. Highlights of the performance of the HQ AAFES Building solar system during the monitoring period from August 1984 through May 1985 are presented in this report.« less

Assessing impacts of payments for watershed services on sustainability in coupled human and natural systems

Treesearch

Heidi Asbjornsen; Alex S. Mayer; Kelly W. Jones; Theresa Selfa; Leonardo Saenz; Randall K. Kolka; Kathleen E. Halvorsen

2015-01-01

Payments for watershed services (PWS) as a policy tool for enhancing water quality and supply have gained momentum in recent years, but their ability to lead to sustainable watershed outcomes is uncertain. Consequently, the demand for effective monitoring and evaluation (M&E) of PWS impacts on coupled human and natural systems (CHANS) and their implications for...

Assessment of Historical Water-Quality Data for National Park Units in the Rocky Mountain Network, Colorado and Montana, through 2004

USGS Publications Warehouse

Mast, M. Alisa

2007-01-01

This report summarizes historical water-quality data for six National Park units that compose the Rocky Mountain Network. The park units in Colorado are Florissant Fossil Beds National Monument, Great Sand Dunes National Park and Preserve, and Rocky Mountain National Park; and in Montana, they are Glacier National Park, Grant-Kohrs Ranch National Historic Site, and Little Bighorn Battlefield National Monument. This study was conducted in cooperation with the Inventory and Monitoring Program of the National Park Service to aid in the design of an effective and efficient water-quality monitoring plan for each park. Data were retrieved from a number of sources for the period of record through 2004 and compiled into a relational database. Descriptions of the environmental setting of each park and an overview of the park's water resources are presented. Statistical summaries of water-quality constituents are presented and compared to aquatic-life and drinking-water standards. Spatial, seasonal, and temporal patterns in constituent concentrations also are described and suggestions for future water-quality monitoring are provided.

Reliability in individual monitoring service.

PubMed

Mod Ali, N

2011-03-01

As a laboratory certified to ISO 9001:2008 and accredited to ISO/IEC 17025, the Secondary Standard Dosimetry Laboratory (SSDL)-Nuclear Malaysia has incorporated an overall comprehensive system for technical and quality management in promoting a reliable individual monitoring service (IMS). Faster identification and resolution of issues regarding dosemeter preparation and issuing of reports, personnel enhancement, improved customer satisfaction and overall efficiency of laboratory activities are all results of the implementation of an effective quality system. Review of these measures and responses to observed trends provide continuous improvement of the system. By having these mechanisms, reliability of the IMS can be assured in the promotion of safe behaviour at all levels of the workforce utilising ionising radiation facilities. Upgradation of in the reporting program through a web-based e-SSDL marks a major improvement in Nuclear Malaysia's IMS reliability on the whole. The system is a vital step in providing a user friendly and effective occupational exposure evaluation program in the country. It provides a higher level of confidence in the results generated for occupational dose monitoring of the IMS, thus, enhances the status of the radiation protection framework of the country.

Parental monitoring as a moderator of the effect of family sexual communication on sexual risk behavior among adolescents in psychiatric care.

PubMed

Nappi, Carla M; Thakral, Charu; Kapungu, Chisina; Donenberg, Geri R; DiClemente, Ralph; Brown, Larry

2009-10-01

Authors examined if parental monitoring moderated effects of family sexual communication on sexual risk behavior among adolescents in psychiatric care. Seven hundred and eighteen parents reported upon quality of family discussions about sex-related topics and degree to which they monitor teen behavior. Adolescents reported the frequency of their own safe sex practices. Parental monitoring moderated the family communication quality-sexual risk behavior relationship among African American families. African American parents who perceived themselves as capable of open family sexual communication and frequent monitoring had adolescents who reported decreased sexual risk behavior. The moderator model was not supported among Caucasian and Hispanic families and findings did not depend upon gender. For African Americans, findings support the influential role of family processes in development of teen sexual risk behavior and suggest, for parents of teens receiving mental health services, learning communication and monitoring skills may be critical to their adolescent's sexual health.

Who Is for Children?

ERIC Educational Resources Information Center

Edelman, Marian Wright

1981-01-01

Psychologists must help to create a national atmosphere that would facilitate progress on critical issues affecting children and families by monitoring the quality and outreach of child services and serving as advocates for children in the political arena. (Author/GC)

Monitoring Changes in Soil Quality from Post-fire Logging in the Inland Northwest

Treesearch

Deborah Page-Dumroese; Martin Jurgensen; Ann Abbott; Tom Rice; Joanne Tirocke; Sue Farley; Sharon DeHart

2006-01-01

The wildland fires of 2000, 2002, and 2003 created many opportunities to conduct post-fire logging operations in the Inland Northwest. Relatively little information is available on the impact of post-fire logging on long-term soil productivity or on the best method for monitoring these changes. We present a USDA Forest Service Northern Region study of post-fire logged...

An Analysis of Undersea Glider Architectures and an Assessment of Undersea Glider Integration into Undersea Applications

DTIC Science & Technology

2012-09-01

Marine Mammal Survey • Inspection and Security • Environmental Monitoring Launch & Recovery • Man Portable (1-2 people) Features • Length: 2.2 m...Oceanography & Science • Pollution Detection • Water Quality Monitoring • Rapid Environment Assessment • Marine Mammals Assessment Launch & Recovery...Figure 29. Slocum Electric Launch from Surface Ship Guide Rails from (Quest Marine Services, 2007

Lichen bioindication of biodiversity, air quality, and climate: baseline results from monitoring in Washington, Oregon, and California.

Treesearch

Sarah Jovan

2008-01-01

Lichens are highly valued ecological indicators known for their sensitivity to a wide variety of environmental stressors like air quality and climate change. This report summarizes baseline results from the U.S. Department of Agriculture, Forest Service, Forest Inventory and Analysis (FIA) Lichen Community Indicator covering the first full cycle of data collection (...

Quality assurance for respiratory care services: a computer-assisted program.

PubMed

Elliott, C G

1993-01-01

At present, the principal advantage of computer-assisted quality assurance is the acquisition of quality assurance date without resource-consuming chart reviews. A surveillance program like the medical director's alert may reduce morbidity and mortality. Previous research suggests that inadequate oxygen therapy or failures in airway management are important causes of preventable deaths in hospitals. Furthermore, preventable deaths tend to occur among patients who have lower severity-of-illness scores and who are not in ICUs. Thus, surveillance of the entire hospital, as performed by the HIS medical director's alert, may significantly impact hospital mortality related to respiratory care. Future research should critically examine the potential of such computerized systems to favorably change the morbidity and mortality of hospitalized patients. The departments of respiratory care and medical informatics at LDS Hospital have developed a computer-assisted approach to quality assurance monitoring of respiratory care services. This system provides frequent and consistent samples of a variety of respiratory care data. The immediate needs of patients are addressed through a daily surveillance system (medical director's alert). The departmental quality assurance program utilizes a separate program that monitors clinical indicators of staff performance in terms of stated departmental policies and procedures (rate-based clinical indicators). The availability of an integrated patient database allows these functions to be performed without labor-intensive chart audits.

Monitoring Quality Across Home Visiting Models: A Field Test of Michigan's Home Visiting Quality Assurance System.

PubMed

Heany, Julia; Torres, Jennifer; Zagar, Cynthia; Kostelec, Tiffany

2018-06-05

Introduction In order to achieve the positive outcomes with parents and children demonstrated by many home visiting models, home visiting services must be well implemented. The Michigan Home Visiting Initiative developed a tool and procedure for monitoring implementation quality across models referred to as Michigan's Home Visiting Quality Assurance System (MHVQAS). This study field tested the MHVQAS. This article focuses on one of the study's evaluation questions: Can the MHVQAS be applied across models? Methods Eight local implementing agencies (LIAs) from four home visiting models (Healthy Families America, Early Head Start-Home Based, Parents as Teachers, Maternal Infant Health Program) and five reviewers participated in the study by completing site visits, tracking their time and costs, and completing surveys about the process. LIAs also submitted their most recent review by their model developer. The researchers conducted participant observation of the review process. Results Ratings on the MHVQAS were not significantly different between models. There were some differences in interrater reliability and perceived reliability between models. There were no significant differences between models in perceived validity, satisfaction with the review process, or cost to participate. Observational data suggested that cross-model applicability could be improved by assisting sites in relating the requirements of the tool to the specifics of their model. Discussion The MHVQAS shows promise as a tool and process to monitor implementation quality of home visiting services across models. The results of the study will be used to make improvements before the MHVQAS is used in practice.

[A monitor for the emergency psychiatric service chain].

PubMed

Salden, M E F H; van Kemenade, J F L M; van Dam, A; Mulder, C L

2014-01-01

Many organisations are involved in the delivery of psychiatric emergency care to patients in crisis. We therefore refer to these organisations as the Psychiatric Emergency Chain (PEC). The quality of the PEC determines the quality of the psychiatric emergency care in a region. In order to measure the quality of this type of care a monitor has been developed in collaboration with the main stakeholders in the region Western North Brabant (WNB). To develop a monitor to measure the quality of a PEC in a region, identify weak spots in the chain and feed back the results to the chain. By searching the literature, studying the primary process in the chain and by having interviews with stakeholders we compiled a questionnaire for monitoring the pec. The monitor was tested in the WNB region and adjusted on the basis of experiences with the respondents. Then the monitor was generalised and tested in another region (Eindhoven and the Kempen) in order to find out whether this instrument might also be applicable to other pecs in the Netherlands. The monitor provided the PEC with a common language for evaluating the chain. The monitor was able to pinpoint particular weak spots and collaboration problems such as the response time required to reach the emergency, communication between and within organisations and domain discussions between different stakeholders. Chain partners used the results of the monitor to negotiate better collaborative agreements and to improve their care. The monitor is able to pinpoint problem areas in the PEC and subsequently to generate feedback to its stakeholders. This creates opportunities for improvement in the PEC. Therefore the monitor is a useful instrument for evaluating a local PEC periodically.

The network of Shanghai Stroke Service System (4S): A public health-care web-based database using automatic extraction of electronic medical records.

PubMed

Dong, Yi; Fang, Kun; Wang, Xin; Chen, Shengdi; Liu, Xueyuan; Zhao, Yuwu; Guan, Yangtai; Cai, Dingfang; Li, Gang; Liu, Jianmin; Liu, Jianren; Zhuang, Jianhua; Wang, Panshi; Chen, Xin; Shen, Haipeng; Wang, David Z; Xian, Ying; Feng, Wuwei; Campbell, Bruce Cv; Parsons, Mark; Dong, Qiang

2018-07-01

Background Several stroke outcome and quality control projects have demonstrated the success in stroke care quality improvement through structured process. However, Chinese health-care systems are challenged with its overwhelming numbers of patients, limited resources, and large regional disparities. Aim To improve quality of stroke care to address regional disparities through process improvement. Method and design The Shanghai Stroke Service System (4S) is established as a regional network for stroke care quality improvement in the Shanghai metropolitan area. The 4S registry uses a web-based database that automatically extracts data from structured electronic medical records. Site-specific education and training program will be designed and administrated according to their baseline characteristics. Both acute reperfusion therapies including thrombectomy and thrombolysis in the acute phase and subsequent care were measured and monitored with feedback. Primary outcome is to evaluate the differences in quality metrics between baseline characteristics (including rate of thrombolysis in acute stroke and key performance indicators in secondary prevention) and post-intervention. Conclusions The 4S system is a regional stroke network that monitors the ongoing stroke care quality in Shanghai. This project will provide the opportunity to evaluate the spectrum of acute stroke care and design quality improvement processes for better stroke care. A regional stroke network model for quality improvement will be explored and might be expanded to other large cities in China. Clinical Trial Registration-URL http://www.clinicaltrials.gov . Unique identifier: NCT02735226.

Temporal Informative Analysis in Smart-ICU Monitoring: M-HealthCare Perspective.

PubMed

Bhatia, Munish; Sood, Sandeep K

2016-08-01

The rapid introduction of Internet of Things (IoT) Technology has boosted the service deliverance aspects of health sector in terms of m-health, and remote patient monitoring. IoT Technology is not only capable of sensing the acute details of sensitive events from wider perspectives, but it also provides a means to deliver services in time sensitive and efficient manner. Henceforth, IoT Technology has been efficiently adopted in different fields of the healthcare domain. In this paper, a framework for IoT based patient monitoring in Intensive Care Unit (ICU) is presented to enhance the deliverance of curative services. Though ICUs remained a center of attraction for high quality care among researchers, still number of studies have depicted the vulnerability to a patient's life during ICU stay. The work presented in this study addresses such concerns in terms of efficient monitoring of various events (and anomalies) with temporal associations, followed by time sensitive alert generation procedure. In order to validate the system, it was deployed in 3 ICU room facilities for 30 days in which nearly 81 patients were monitored during their ICU stay. The results obtained after implementation depicts that IoT equipped ICUs are more efficient in monitoring sensitive events as compared to manual monitoring and traditional Tele-ICU monitoring. Moreover, the adopted methodology for alert generation with information presentation further enhances the utility of the system.

The Use of Data Analytics to Build an Australian Context-Sensitive Health Informatics Framework for Consumer-Directed Community Aged Care.

PubMed

Georgiou, Andrew; Jorgensen, Mikaela; Siette, Joyce; Westbrook, Johanna I

2017-01-01

The challenge of providing services that meet the growing needs of an ageing population is one confronted by communities across Australia and internationally. The aim of this study was to: a) undertake semi-structured interviews and focus groups across a sample of service and technical staff to identify the interconnection between communication, information, work practices and performance; and b) carry out a comprehensive review of existing data sources to identify the data linkages required to identify and monitor performance across different dimensions of the quality of aged care spectrum. The results from this study provided empirical evidence of the interconnection between communication, information, work practices and performance; and highlighted numerous potential data linkages which can be used to monitor performance across different dimensions of aged care. These included: the uptake and utilisation of community care services, community aged care client interactions and transitions (with hospitals and other health care providers), and quality of life measures (e.g., health and safety status, symptoms of depression and anxiety, social integration and mortality rates).

Development of indoor environmental index: Air quality index and thermal comfort index

NASA Astrophysics Data System (ADS)

Saad, S. M.; Shakaff, A. Y. M.; Saad, A. R. M.; Yusof, A. M.; Andrew, A. M.; Zakaria, A.; Adom, A. H.

2017-03-01

In this paper, index for indoor air quality (also known as IAQI) and thermal comfort index (TCI) have been developed. The IAQI was actually modified from previous outdoor air quality index (AQI) designed by the United States Environmental Protection Agency (US EPA). In order to measure the index, a real-time monitoring system to monitor indoor air quality level was developed. The proposed system consists of three parts: sensor module cloud, base station and service-oriented client. The sensor module cloud (SMC) contains collections of sensor modules that measures the air quality data and transmit the captured data to base station through wireless. Each sensor modules includes an integrated sensor array that can measure indoor air parameters like Carbon Dioxide, Carbon Monoxide, Ozone, Nitrogen Dioxide, Oxygen, Volatile Organic Compound and Particulate Matter. Temperature and humidity were also being measured in order to determine comfort condition in indoor environment. The result from several experiments show that the system is able to measure the air quality presented in IAQI and TCI in many indoor environment settings like air-conditioner, chemical present and cigarette smoke that may impact the air quality. It also shows that the air quality are changing dramatically, thus real-time monitoring system is essential.

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).

Classifying Sources Influencing Indoor Air Quality (IAQ) Using Artificial Neural Network (ANN)

PubMed Central

Mad Saad, Shaharil; Melvin Andrew, Allan; Md Shakaff, Ali Yeon; Mohd Saad, Abdul Rahman; Muhamad Yusof @ Kamarudin, Azman; Zakaria, Ammar

2015-01-01

Monitoring indoor air quality (IAQ) is deemed important nowadays. A sophisticated IAQ monitoring system which could classify the source influencing the IAQ is definitely going to be very helpful to the users. Therefore, in this paper, an IAQ monitoring system has been proposed with a newly added feature which enables the system to identify the sources influencing the level of IAQ. In order to achieve this, the data collected has been trained with artificial neural network or ANN—a proven method for pattern recognition. Basically, the proposed system consists of sensor module cloud (SMC), base station and service-oriented client. The SMC contain collections of sensor modules that measure the air quality data and transmit the captured data to base station through wireless network. The IAQ monitoring system is also equipped with IAQ Index and thermal comfort index which could tell the users about the room’s conditions. The results showed that the system is able to measure the level of air quality and successfully classify the sources influencing IAQ in various environments like ambient air, chemical presence, fragrance presence, foods and beverages and human activity. PMID:26007724

Water-resources data network evaluation for Monterey County, California; Phase 2, northern and coastal areas of Monterey County

USGS Publications Warehouse

Templin, W.E.; Smith, P.E.; DeBortoli, M.L.; Schluter, R.C.

1995-01-01

This report presents an evaluation of water- resources data-collection networks in the northern and coastal areas of Monterey County, California. This evaluation was done by the U.S. Geological Survey in cooperation with the Monterey County Flood Control and Water Conservation District to evaluate precipitation, surface water, and ground water monitoring networks. This report describes existing monitoring networks in the study areas and areas where possible additional data-collection is needed. During this study, 106 precipitation-quantity gages were identified, of which 84 were active; however, no precipitation-quality gages were identified in the study areas. The precipitaion-quantity gages were concentrated in the Monterey Peninsula and the northern part of the county. If the number of gages in these areas were reduced, coverage would still be adequate to meet most objectives; however, additional gages could improve coverage in the Tularcitos Creek basin and in the coastal areas south of Carmel to the county boundary. If collection of precipitation data were expanded to include monitoring precipitation quality, this expanded monitoring also could include monitoring precipitation for acid rain and pesticides. Eleven continuous streamflow-gaging stations were identified during this study, of which seven were active. To meet the objectives of the streamflow networks outlined in this report, the seven active stations would need to be continued, four stations would need to be reactivated, and an additional six streamflow-gaging stations would need to be added. Eleven stations that routinely were sampled for chemical constituents were identified in the study areas. Surface water in the lower Big Sur River basin was sampled annually for total coli- form and fecal coliform bacteria, and the Big Sur River was sampled monthly at 16 stations for these bacteria. Routine sampling for chemical constituents also was done in the Big Sur River basin. The Monterey County Flood Control and Water Conservation District maintained three networks in the study areas to measure ground-water levels: (1) the summer network, (2) the monthly network, and (3) the annual autumn network. The California American Water Company also did some ground-water-level monitoring in these areas. Well coverage for ground-water monitoring was dense in the seawater-intrusion area north of Moss Landing (possibly because of multiple overlying aquifers), but sparse in other parts of the study areas. During the study, 44 sections were identified as not monitored for ground-water levels. In an ideal ground-water-level network, wells would be evenly spaced, except where local conditions or correlations of wells make monitoring unnecessary. A total of 384 wells that monitor ground-water levels and/or ground-water quality were identified during this study. The Monterey County Flood Control and Water Conservation District sampled ground-water quality monthly during the irrigation season to monitor seawater intrusion. Once each year (during the summer), the wells in this network were monitored for chlorides, specific conductance, and nitrates. Additional samples were collected from each well once every 5 years for complete mineral analysis. The California Department of Health Services, the California American Water Company, the U.S. Army Health Service at Ford Ord, and the Monterey Peninsula Water Management District also monitored ground-water quality in wells in the study areas. Well coverage for the ground-water- quality networks was dense in the seawater- intrusion area north of Moss Landing, but sparse in the rest of the study areas. During this study, 54 sections were identified as not monitored for water quality.

[Outsourcing: theory and practice at a clinical hospital in Szczecin exemplified by medical waste transport and treatment service].

PubMed

Kotlega, Dariusz; Nowacki, Przemysław; Lewiński, Dariusz; Chmurowicz, Ryszard; Ciećwiez, Sylwester

2011-01-01

Outsourcing proves to be a useful tool in the difficult process of improving the financial result of hospitals. Outsourcing means separation of some functions and services in one entity and their transfer to another. The aim of this study was to analyze the use of outsourcing at the Second Independent Public University Hospital of the Pomeranian Medical University (SPSK 2 PUM) in Szczecin. We studied the transport and treatment of medical waste. Outsourcing of waste treatment services led to financial savings. The cost of treatment of one kilogram of waste by an external company was PLN 2.53. The same service provided by the hospital would cost approximately PLN 7 per kilogram. Appropriate attention should be paid to the quality of services. It seems useful to have appropriate tools for quality control and monitoring. SPSK 2 PUM can serve as a good example of effective use of outsourcing.

Integrating a project monitoring system into a public health network: experiences from Alive & Thrive Vietnam.

PubMed

Tuan, Nguyen Thanh; Alayon, Silvia; Do, Tran Thanh; Ngan, Tran Thi; Hajeebhoy, Nemat

2015-01-01

Little information is available about how to build a monitoring system to measure the output of preventive nutrition interventions, such as counselling on infant and young child feeding. This paper describes the Alive & Thrive Vietnam (A&T) project experience in nesting a large-scale project monitoring system into the existing public health information system (e.g. using the system and resources), and in using monitoring data to strengthen service delivery in 15 provinces with A&T franchises. From January 2012 to April 2014, the 780 A&T franchises provided 1,700,000 counselling contacts (~3/4 by commune franchises). In commune franchises in April 2014, 80% of mothers who were pregnant or with children under two years old had been to the counselling service at least one time, and 87% of clients had been to the service earlier. Monitoring data are used to track the progress of the project, make decisions, provide background for a costing study and advocate for the integration of nutrition counselling indicators into the health information system nationwide. With careful attention to the needs of stakeholders at multiple levels, clear data quality assurance measures and strategic feedback mechanisms, it is feasible to monitor the scale-up of nutrition programmes through the existing routine health information system.

Development of a multi-ensemble Prediction Model for China

NASA Astrophysics Data System (ADS)

Brasseur, G. P.; Bouarar, I.; Petersen, A. K.

2016-12-01

As part of the EU-sponsored Panda and MarcoPolo Projects, a multi-model prediction system including 7 models has been developed. Most regional models use global air quality predictions provided by the Copernicus Atmospheric Monitoring Service and downscale the forecast at relatively high spatial resolution in eastern China. The paper will describe the forecast system and show examples of forecasts produced for several Chinese urban areas and displayed on a web site developed by the Dutch Meteorological service. A discussion on the accuracy of the predictions based on a detailed validation process using surface measurements from the Chinese monitoring network will be presented.

In-service communication channel sensing based on reflectometry for TWDM-PON systems

NASA Astrophysics Data System (ADS)

Iida, Daisuke; Kuwano, Shigeru; Terada, Jun

2014-05-01

Many base stations are accommodated in TWDM-PON based mobile backhaul and fronthaul networks for future radio access, and failed connections in an optical network unit (ONU) wavelength channel severely degrade system performance. A cost effective in-service ONU wavelength channel monitor is essential to ensure proper system operation without failed connections. To address this issue we propose a reflectometry-based remote sensing method that provides wavelength channel information with the optical line terminal (OLT)-ONU distance. The method realizes real-time monitoring of ONU wavelength channels without signal quality degradation. Experimental results show it achieves wavelength channel distinction with high distance resolution.

Real-time GIS data model and sensor web service platform for environmental data management.

PubMed

Gong, Jianya; Geng, Jing; Chen, Zeqiang

2015-01-09

Effective environmental data management is meaningful for human health. In the past, environmental data management involved developing a specific environmental data management system, but this method often lacks real-time data retrieving and sharing/interoperating capability. With the development of information technology, a Geospatial Service Web method is proposed that can be employed for environmental data management. The purpose of this study is to determine a method to realize environmental data management under the Geospatial Service Web framework. A real-time GIS (Geographic Information System) data model and a Sensor Web service platform to realize environmental data management under the Geospatial Service Web framework are proposed in this study. The real-time GIS data model manages real-time data. The Sensor Web service platform is applied to support the realization of the real-time GIS data model based on the Sensor Web technologies. To support the realization of the proposed real-time GIS data model, a Sensor Web service platform is implemented. Real-time environmental data, such as meteorological data, air quality data, soil moisture data, soil temperature data, and landslide data, are managed in the Sensor Web service platform. In addition, two use cases of real-time air quality monitoring and real-time soil moisture monitoring based on the real-time GIS data model in the Sensor Web service platform are realized and demonstrated. The total time efficiency of the two experiments is 3.7 s and 9.2 s. The experimental results show that the method integrating real-time GIS data model and Sensor Web Service Platform is an effective way to manage environmental data under the Geospatial Service Web framework.

Comparison of 2002 Water Year and Historical Water-Quality Data, Upper Gunnison River Basin, Colorado

USGS Publications Warehouse

Spahr, N.E.

2003-01-01

Introduction: Population growth and changes in land-use practices have the potential to affect water quality and quantity in the upper Gunnison River basin. In 1995, the U.S. Geological Survey (USGS), in cooperation with local sponsors, City of Gunnison, Colorado River Water Conservation District, Crested Butte South Metropolitan District, Gunnison County, Mount Crested Butte Water and Sanitation District, National Park Service, Town of Crested Butte, and Upper Gunnison River Water Conservancy District, established a water-quality monitoring program in the upper Gunnison River basin to characterize current water-quality conditions and to assess the effects of increased urban development and other land-use changes on water quality. The monitoring network has evolved into two groups of stations, stations that are considered as long term and stations that are rotational. The long-term stations are monitored to assist in defining temporal changes in water quality (how conditions have changed over time). The rotational stations are monitored to assist in the spatial definition of water-quality conditions (how conditions differ throughout the basin) and to address local and short term concerns. Another group of stations (rotational group 2) will be chosen and sampled beginning in water year 2004. Annual summaries of the water-quality data from the monitoring network provide a point of reference for discussions regarding water-quality sampling in the upper Gunnison River basin. This summary includes data collected during water year 2002. The introduction provides a map of the sampling locations, definitions of terms, and a one-page summary of selected water-quality conditions at the network stations. The remainder of the summary is organized around the data collected at individual stations. Data collected during water year 2002 are compared to historical data (data collected for this network since 1995), state water-quality standards, and federal water-quality guidelines. Data were collected during water year 2002 following USGS protocols (U.S. Geological Survey, variously dated).

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

PubMed Central

Zweifler, John

2007-01-01

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

A Review of Quality Assurance Methods to Assist Professional Record Keeping: Implications for Providers of Interpersonal Violence Treatment

PubMed Central

Bradshaw, Kelsey M.; Donohue, Brad; Wilks, Chelsey

2014-01-01

Errors have been found to frequently occur in the management of case records within mental health service systems. In cases involving interpersonal violence, such errors have been found to negatively impact service implementation and lead to significant trauma and fatalities. In an effort to ensure adherence to specified standards of care, quality assurance programs (QA) have been developed to monitor and enhance service implementation. These programs have generally been successful in facilitating record management. However, these systems are rarely disseminated, and not well integrated. Therefore, within the context of interpersonal violence, we provide an extensive review of evidence supported record keeping practices, and methods to assist in assuring these practices are implemented with adherence. PMID:24976786

Performance Analysis of IIUM Wireless Campus Network

NASA Astrophysics Data System (ADS)

Abd Latif, Suhaimi; Masud, Mosharrof H.; Anwar, Farhat

2013-12-01

International Islamic University Malaysia (IIUM) is one of the leading universities in the world in terms of quality of education that has been achieved due to providing numerous facilities including wireless services to every enrolled student. The quality of this wireless service is controlled and monitored by Information Technology Division (ITD), an ISO standardized organization under the university. This paper aims to investigate the constraints of wireless campus network of IIUM. It evaluates the performance of the IIUM wireless campus network in terms of delay, throughput and jitter. QualNet 5.2 simulator tool has employed to measure these performances of IIUM wireless campus network. The observation from the simulation result could be one of the influencing factors in improving wireless services for ITD and further improvement.

CURRENT STATUS OF INDIVIDUAL DOSIMETRIC MONITORING IN UKRAINE.

PubMed

Chumak, V; Deniachenko, N; Makarovska, O; Mihailescu, L-C; Prykhodko, A; Voloskyi, V; Vanhavere, F

2016-09-01

About 50 000 workers are being occupationally exposed to radiation in Ukraine. Individual dosimetric monitoring (IDM) is provided by 77 dosimetry services and laboratories of very different scale with a number of monitored workers ranging from several persons to ∼9000. In the present work, the current status of personal dosimetry in Ukraine was studied. The First National Intercomparison (FNI) of the IDM labs was accompanied by a survey of the laboratory operation in terms of coverage, types of dosimetry provided, instrumentation and methodologies used, metrological support, data recording, etc. Totally, 34 laboratories responded to the FNI call, and 18 services with 19 different personal dosimetry systems took part in the intercomparison exercise providing 24 dosimeters each for blind irradiation to photons of 6 different qualities (ISO N-series X-rays, S-Cs and S-Co sources) in a dose range of 5-60 mSv. Performance of the dosimetry labs was evaluated according to ISO 14146 criteria of matching trumpet curves with H0 = 0.2 mSv. The test revealed that 8 of the 19 systems meet ISO 14146 criteria in full, 5 other labs show marginal performance and 6 laboratories demonstrated catastrophic quality of dosimetric results. Altogether, 18 participating labs provide dosimetric monitoring to 37 477 workers (about three-fourths of all occupationally exposed workers), usually on monthly (nuclear industry) or quarterly (rest of applications) basis. Of this number, 20 664 persons (55 %) receive completely adequate individual monitoring, and the number of personnel receiving IDM of inadequate quality counts 3054 persons. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Methods for Monitoring Fish Communities of Buffalo National River and Ozark National Scenic Riverways in the Ozark Plateaus of Arkansas and Missouri: Version 1.0

USGS Publications Warehouse

Petersen, James C.; Justus, B.G.; Dodd, H.R.; Bowles, D.E.; Morrison, L.W.; Williams, M.H.; Rowell, G.A.

2008-01-01

Buffalo National River located in north-central Arkansas, and Ozark National Scenic Riverways, located in southeastern Missouri, are the two largest units of the National Park Service in the Ozark Plateaus physiographic province. The purpose of this report is to provide a protocol that will be used by the National Park Service to sample fish communities and collect related water-quality, habitat, and stream discharge data of Buffalo National River and Ozark National Scenic Riverways to meet inventory and long-term monitoring objectives. The protocol includes (1) a protocol narrative, (2) several standard operating procedures, and (3) supplemental information helpful for implementation of the protocol. The protocol narrative provides background information about the protocol such as the rationale of why a particular resource or resource issue was selected for monitoring, information concerning the resource or resource issue of interest, a description of how monitoring results will inform management decisions, and a discussion of the linkages between this and other monitoring projects. The standard operating procedures cover preparation, training, reach selection, water-quality sampling, fish community sampling, physical habitat collection, measuring stream discharge, equipment maintenance and storage, data management and analysis, reporting, and protocol revision procedures. Much of the information in the standard operating procedures was gathered from existing protocols of the U.S. Geological Survey National Water Quality Assessment program or other sources. Supplemental information that would be helpful for implementing the protocol is included. This information includes information on fish species known or suspected to occur in the parks, sample sites, sample design, fish species traits, index of biotic integrity metrics, sampling equipment, and field forms.

Assessing the influence of component processing and donor characteristics on quality of red cell concentrates using quality control data.

PubMed

Jordan, A; Chen, D; Yi, Q-L; Kanias, T; Gladwin, M T; Acker, J P

2016-07-01

Quality control (QC) data collected by blood services are used to monitor production and to ensure compliance with regulatory standards. We demonstrate how analysis of quality control data can be used to highlight the sources of variability within red cell concentrates (RCCs). We merged Canadian Blood Services QC data with manufacturing and donor records for 28 227 RCC between June 2011 and October 2014. Units were categorized based on processing method, bag manufacturer, donor age and donor sex, then assessed based on product characteristics: haemolysis and haemoglobin levels, unit volume, leucocyte count and haematocrit. Buffy-coat method (top/bottom)-processed units exhibited lower haemolysis than units processed using the whole-blood filtration method (top/top). Units from female donors exhibited lower haemolysis than male donations. Processing method influenced unit volume and the ratio of additive solution to residual plasma. Stored red blood cell characteristics are influenced by prestorage processing and donor factors. Understanding the relationship between processing, donors and RCC quality will help blood services to ensure the safety of transfused products. © 2016 International Society of Blood Transfusion.

Why do water quality monitoring programs succeed or fail? A qualitative comparative analysis of regulated testing systems in sub-Saharan Africa.

PubMed

Peletz, Rachel; Kisiangani, Joyce; Bonham, Mateyo; Ronoh, Patrick; Delaire, Caroline; Kumpel, Emily; Marks, Sara; Khush, Ranjiv

2018-05-31

Water quality testing is critical for guiding water safety management and ensuring public health. In many settings, however, water suppliers and surveillance agencies do not meet regulatory requirements for testing frequencies. This study examines the conditions that promote successful water quality monitoring in Africa, with the goal of providing evidence for strengthening regulated water quality testing programs. We compared monitoring programs among 26 regulated water suppliers and surveillance agencies across six African countries. These institutions submitted monthly water quality testing results over 18 months. We also collected qualitative data on the conditions that influenced testing performance via approximately 821 h of semi-structured interviews and observations. Based on our qualitative data, we developed the Water Capacity Rating Diagnostic (WaterCaRD) to establish a scoring framework for evaluating the effects of the following conditions on testing performance: accountability, staffing, program structure, finances, and equipment & services. We summarized the qualitative data into case studies for each of the 26 institutions and then used the case studies to score the institutions against the conditions captured in WaterCaRD. Subsequently, we applied fuzzy-set Qualitative Comparative Analysis (fsQCA) to compare these scores against performance outcomes for water quality testing. We defined the performance outcomes as the proportion of testing Targets Achieved (outcome 1) and Testing Consistency (outcome 2) based on the monthly number of microbial water quality tests conducted by each institution. Our analysis identified motivation & leadership, knowledge, staff retention, and transport as institutional conditions that were necessary for achieving monitoring targets. In addition, equipment, procurement, infrastructure, and enforcement contributed to the pathways that resulted in strong monitoring performance. Our identification of institutional commitment, comprising motivation & leadership, knowledge, and staff retention, as a key driver of monitoring performance was not surprising: in weak regulatory environments, individuals and their motivations take-on greater importance in determining institutional and programmatic outcomes. Nevertheless, efforts to build data collection capacity in low-resource settings largely focus on supply-side interventions: the provision of infrastructure, equipment, and training sessions. Our results indicate that these interventions will continue to have limited long-term impacts and sustainability without complementary strategies for motivating or incentivizing water supply and surveillance agency managers to achieve testing goals. More broadly, our research demonstrates both an experimental approach for diagnosing the systems that underlie service provision and an analytical strategy for identifying appropriate interventions. Copyright © 2018 The Authors. Published by Elsevier GmbH.. All rights reserved.

Pursuing scale and quality in STI interventions with sex workers: initial results from Avahan India AIDS Initiative

PubMed Central

Steen, R; Mogasale, V; Wi, T; Singh, A K; Das, A; Daly, C; George, B; Neilsen, G; Loo, V; Dallabetta, G

2006-01-01

Background Migration, population mobility, and sex work continue to drive sexually transmitted epidemics in India. Yet interventions targeting high incidence networks are rarely implemented at sufficient scale to have impact. India AIDS Initiative (Avahan), funded by the Bill and Melinda Gates Foundation, is scaling up interventions with sex workers (SWs) and other high risk populations in India's six highest HIV prevalence states. Methods Avahan resources are channelled through state level partners (SLPs) to local level non‐governmental organisations (NGOs) who organise outreach, community mobilisation, and dedicated clinics for SWs. These clinics provide services for sexually transmitted infections (STIs) including Condom Promotion, syndromic case management, regular check‐ups, and treatment of asymptomatic infections. SWs take an active role in service delivery. STI capacity building support functions on three levels. A central capacity building team developed guidelines and standards, trains state level STI coordinators, monitors outcomes, and conducts operations research. Standards are documented in an Avahan‐wide manual. State level STI coordinators train NGO clinic staff and conduct supervision of clinics based on these standards and related quality monitoring tools. Clinic and outreach staff report on indicators that guide additional capacity building inputs. Results In 2 years, clinics with community outreach for SWs have been established in 274 settings covering 77 districts. Mapping and size estimation have identified 187 000 SWs. In a subset of four large states covered by six SLPs (183 000 estimated SWs, 65 districts), 128 326 (70%) of the SWs have been contacted through peer outreach and 74 265 (41%) have attended the clinic at least once. A total of 127 630 clinic visits have been reported, an increasing proportion for recommended routine check ups. Supervision and monitoring facilitate standardisation of services across sites. Conclusion Targeted HIV/STI interventions can be brought to scale and standardised given adequate capacity building support. Intervention coverage, service utilisation, and quality are key parameters that should be monitored and progressively improved with active involvement of SWs themselves. PMID:17012513

Implementation of a clinical quality control program in a mammography screening service of Brazil.

PubMed

DE Souza Sabino, Silvia Maria Prioli; Silva, Thiago Buosi; Watanabe, Anapaula Hidemi Uema; Syrjänen, Kari; Carvalho, André Lopes; Mauad, Edmundo Carvalho

2014-09-01

To evaluate the effect of a clinical quality control program on the final quality of a mammography screening service. We conducted retrospective assessment of the clinical quality of 5,000 mammograms taken in a Mammography Screening Program between November 2010 and September 2011, following the implementation of a Clinical Quality Control Program based on the European Guidelines. Among the 105,000 evaluated quality items, there were 8,588 failures (8.2%) - 1.7 failures per examination. Altogether, 89% of the failures were associated with positioning. The recall rate due to a technical error reached a maximum of 0.5% in the early phase of the observation period and subsequently stabilized (0.09%). The ongoing education and monitoring combined with personalized training increased the critical thinking of the involved professionals, reducing the technical failures and unnecessary exposure of patients to radiation, with substantial improvement in the final quality of mammography. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Substitution of Assisted Living Services by Assistive Technology - Experts Opinions and Technical Feasibility.

PubMed

Schwartze, Jonas; Prekazi, Arianit; Schrom, Harald; Marschollek, Michael

2017-01-01

Ambient assisted living (AAL) may support ageing in place but is primarily driven by technology. The aim of this work is, to identifying reasons to move into assisted living institutions, their range of service and possible substitutability. We did semi-structured interviews with five experts from assisted living institutions and used results to design and implement assistive technologies in an AAL environment using BASIS, a cross domain bus system for smart buildings. Reasons for moving to assisted living institutions are expected benefits for chronic health problems, safety, social isolation and carefree living. We implemented six application systems for inactivity monitoring, stove shutdown, air quality monitoring, medication and appointment reminders, detection of unwanted situations before leaving and optical ringing of the doorbell. Substitution of selected assisted living services is feasible and has potential to delay necessity to move into assisted living institution if complement social services are installed.

Governance of quality of care: a qualitative study of health service boards in Victoria, Australia

PubMed Central

Bismark, Marie M; Studdert, David M

2014-01-01

Objectives To describe the engagement of health service boards with quality-of-care issues and to identify factors that influence boards’ activities in this area. Methods We conducted semistructured interviews with 35 board members and executives from 13 public health services in Victoria, Australia. Interviews focused on the role currently played by boards in overseeing quality of care. We also elicited interviewees’ perceptions of factors that have influenced their current approach to governance in this area. Thematic analysis was used to identify key themes from interview transcripts. Results Virtually all interviewees believed boards had substantial opportunities to influence the quality of care delivered within the service, chiefly through setting priorities, monitoring progress, holding staff to account and shaping culture. Perceived barriers to leveraging this influence included insufficient resources, gaps in skills and experience among board members, inadequate information on performance and regulatory requirements that miss the mark. Interviewees converged on four enablers of more effective quality governance: stronger regional collaborations; more tailored board training on quality issues; smarter use of reporting and accreditation requirements; and better access to data that was reliable, longitudinal and allowed for benchmarking against peer organisations. Conclusions Although health service boards are eager to establish quality of care as a governance priority, several obstacles are blocking progress. The result is a gap between the rhetoric of quality governance and the reality of month-to-month activities at the board level. The imperative for effective board-level engagement in this area cannot be met until these barriers are addressed. PMID:24327735

Gaps in monitoring systems for Implanon NXT services in South Africa: An assessment of 12 facilities in two districts

PubMed

Pillay, D; Morroni, C; Pleaner, M; Adeogba, O; Chersich, M; Naidoo, N; Mullick, S; Rees, H

2017-10-01

Background. Implanon NXT, a long-acting subdermal contraceptive implant, was introduced in South Africa (SA) in early 2014 as part of an expanded contraceptive method mix. After initial high levels of uptake, reports emerged of frequent early removals and declines in use. Monitoring of progress and challenges in implant service delivery could identify aspects of the programme that require strengthening. Objectives. To assess data management and record keeping within implant services at primary care facilities. Methods. We developed a checklist to assess the tools used for monitoring implant services and data reporting to district offices. The checklist was piloted in seven facilities. An additional six high-volume and six low-volume implant insertion clinics in the City of Johannesburg (CoJ), Gauteng Province, and the Dr Kenneth Kaunda District, North West Province, were selected for assessment. Results. All 12 facilities completed a Daily Head Count Register, which tallied the number of clients attending the clinic, but not information about implant use. A more detailed Tick Register recorded services that clinic attendees received, with nine documenting number of implant insertions and six implant removals. A more specific tool, an Insertion Checklist, collected data on insertion procedures and client characteristics, but was only used in CoJ (five of six facilities). Other registers, which were developed de novo by staff at individual facilities, captured more detailed information about insertions and removals, including reasons. Five of six low-volume insertion facilities used these registers, but only three of six high-volume facilities. No facilities used the form specifically developed by the National Department of Health for implant pharmacovigilance. Nine of 12 clinics reported data on numbers of insertions to the district office, six reported removals and none provided data on reasons for removals. Conclusion. For data to inform effective decision-making and quality improvement in implant services in SA, standardised reporting guidelines and data collection tools are needed, reinforced by staff training and quality assessment of data collection. Staff often took the initiative to fill gaps in reporting systems. Current systems are unable to accurately monitor uptake or discontinuation, or identify aspects of services requiring strengthening. Lack of pharmacovigilance data is especially concerning. Deficiencies noted in these monitoring systems may be common to family planning services more broadly, which warrants investigation. Creative Commons Attribution - NonCommercial Works License (CC BY-NC 4.0)

Evaluating the Impact of Modern Copper Mining on Ecosystem Services in Southern Arizona

NASA Astrophysics Data System (ADS)

Virgone, K.; Brusseau, M. L.; Ramirez-Andreotta, M.; Coeurdray, M.; Poupeau, F.

2014-12-01

Historic mining practices were conducted with little environmental forethought, and hence generated a legacy of environmental and human-health impacts. However, an awareness and understanding of the impacts of mining on ecosystem services has developed over the past few decades. Ecosystem services are defined as benefits that humans obtain from ecosystems, and upon which they are fundamentally dependent for their survival. Ecosystem services are divided into four categories including provisioning services (i.e., food, water, timber, and fiber); regulating services (i.e., climate, floods, disease, wastes, and water quality); supporting services (i.e., soil formation, photosynthesis, and nutrient cycling) and cultural services (i.e., recreational, aesthetic, and spiritual benefits) (Millennium Ecosystem Assessment, 2005). Sustainable mining practices have been and are being developed in an effort to protect and preserve ecosystem services. This and related efforts constitute a new generation of "modern" mines, which are defined as those that are designed and permitted under contemporary environmental legislation. The objective of this study is to develop a framework to monitor and assess the impact of modern mining practices and sustainable mineral development on ecosystem services. Using the sustainability performance indicators from the Global Reporting Initiative (GRI) as a starting point, we develop a framework that is reflective of and adaptive to specific local conditions. Impacts on surface and groundwater water quality and quantity are anticipated to be of most importance to the southern Arizona region, which is struggling to meet urban and environmental water demands due to population growth and climate change. We seek to build a more comprehensive and effective assessment framework by incorporating socio-economic aspects via community engaged research, including economic valuations, community-initiated environmental monitoring, and environmental human-health education programs.

Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.

PubMed

Kakyo, Tracy Alexis; Xiao, Lily Dongxia

2017-06-01

Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention. © 2017 John Wiley & Sons Australia, Ltd.

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.

Project officer's perspective: quality assurance as a management tool.

PubMed

Heiby, J

1993-06-01

Advances in the management of health programs in less developed countries (LDC) have not kept pace with the progress of the technology used. The US Agency for International Development mandated the Quality Assurance Project (QAP) to provide quality improvement technical assistance to primary health care systems in LDCs while developing appropriate quality assurance (QA) strategies. The quality of health care in recent years in the US and Europe focused on the introduction of management techniques developed for industry into health systems. The experience of the QAP and its predecessor, the PRICOR Project, shows that quality improvement techniques facilitate measurement of quality of care. A recently developed WHO model for the management of the sick child provides scientifically based standards for actual care. Since 1988, outside investigators measuring how LDC clinicians perform have revealed serious deficiencies in quality compared with the program's own standards. This prompted developed of new QA management initiatives: 1) communicating standards clearly to the program staff; 2) actively monitoring actual performance corresponds to these standards; and 3) taking action to improve performance. QA means that managers are expected to monitor service delivery, undertake problem solving, and set specific targets for quality improvement. Quality improvement methods strengthen supervision as supervisors can objectively assess health worker performance. QA strengthens the management functions that support service delivery, e.g., training, records management, finance, logistics, and supervision. Attention to quality can contribute to improved health worker motivation and effective incentive programs by recognition for a job well done and opportunities for learning new skills. These standards can also address patient satisfaction. QA challenges managers to aim for the optimal level of care attainable.

Quality-based purchasing in health care.

PubMed

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

2004-01-01

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

Quality of surface water in Missouri, water year 2009

USGS Publications Warehouse

Barr, Miya N.

2010-01-01

The U.S. Geological Survey, in cooperation with the Missouri Department of Natural Resources, designs and operates a series of monitoring stations on streams throughout Missouri known as the Ambient Water-Quality Monitoring Network. During the 2009 water year (October 1, 2008, through September 30, 2009), data were collected at 75 stations-69 Ambient Water-Quality Monitoring Network stations, 2 U.S. Geological Survey National Stream Quality Accounting Network stations, 1 spring sampled in cooperation with the U.S. Forest Service, and 3 stations sampled in cooperation with the Elk River Watershed Improvement Association. Dissolved oxygen, specific conductance, water temperature, suspended solids, suspended sediment, fecal coliform bacteria, Escherichia coli bacteria, dissolved nitrate plus nitrite, total phosphorus, dissolved and total recoverable lead and zinc, and select pesticide compound summaries are presented for 72 of these stations. The stations primarily have been classified into groups corresponding to the physiography of the State, primary land use, or unique station types. In addition, a summary of hydrologic conditions in the State including peak discharges, monthly mean discharges, and seven-day low flow is presented.

Distributed intelligent monitoring and reporting facilities

NASA Astrophysics Data System (ADS)

Pavlou, George; Mykoniatis, George; Sanchez-P, Jorge-A.

1996-06-01

Distributed intelligent monitoring and reporting facilities are of paramount importance in both service and network management as they provide the capability to monitor quality of service and utilization parameters and notify degradation so that corrective action can be taken. By intelligent, we refer to the capability of performing the monitoring tasks in a way that has the smallest possible impact on the managed network, facilitates the observation and summarization of information according to a number of criteria and in its most advanced form and permits the specification of these criteria dynamically to suit the particular policy in hand. In addition, intelligent monitoring facilities should minimize the design and implementation effort involved in such activities. The ISO/ITU Metric, Summarization and Performance management functions provide models that only partially satisfy the above requirements. This paper describes our extensions to the proposed models to support further capabilities, with the intention to eventually lead to fully dynamically defined monitoring policies. The concept of distributing intelligence is also discussed, including the consideration of security issues and the applicability of the model in ODP-based distributed processing environments.

How to implement quality indicators successfully in palliative care services: perceptions of team members about facilitators of and barriers to implementation.

PubMed

Leemans, Kathleen; Van den Block, Lieve; Vander Stichele, Robert; Francke, Anneke L; Deliens, Luc; Cohen, Joachim

2015-12-01

There is an increasing demand for the use of quality indicators in palliative care. With previous research about implementation in this field lacking, we aimed to evaluate the barriers to and facilitators of implementation. Three focus group interviews were organized with 21 caregivers from 18 different specialized palliative care services in Belgium. Four had already worked with the indicators during a pilot study. The focus group discussions were transcribed verbatim and analyzed using the thematic framework approach. The caregivers anticipated that a positive attitude by the team towards quality improvement, the presence of a good leader, and the possible link between quality indicators and reimbursement might facilitate the implementation of quality indicators in specialized palliative care services. Other facilitators concerned the presence of a need to demonstrate quality of care, to perform improvement actions, and to learn from other caregivers and services in the field. A negative attitude by caregivers towards quality measurement and a lack of skills, time, and staff were mentioned as barriers to successful implementation. Palliative caregivers anticipate a number of opportunities and problems when implementing quality indicators. These relate to the attitudes of the team regarding quality measurement; the attitudes, knowledge, and skills of the individual caregivers within the team; and the organizational context and the economic and political context. Training in the advantages of quality indicators and how to use them is indispensable, as are structural changes in the policy concerning palliative care, in order to progress towards systematic quality monitoring.

The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures.

PubMed

Rutter, Matthew D; Senore, Carlo; Bisschops, Raf; Domagk, Dirk; Valori, Roland; Kaminski, Michal F; Spada, Cristiano; Bretthauer, Michael; Bennett, Cathy; Bellisario, Cristina; Minozzi, Silvia; Hassan, Cesare; Rees, Colin; Dinis-Ribeiro, Mário; Hucl, Tomas; Ponchon, Thierry; Aabakken, Lars; Fockens, Paul

2016-02-01

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision. ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients.

Flame quality monitor system for fixed firing rate oil burners

DOEpatents

Butcher, Thomas A.; Cerniglia, Philip

1992-01-01

A method and apparatus for determining and indicating the flame quality, or efficiency of the air-fuel ratio, in a fixed firing rate heating unit, such as an oil burning furnace, is provided. When the flame brightness falls outside a preset range, the flame quality, or excess air, has changed to the point that the unit should be serviced. The flame quality indicator output is in the form of lights mounted on the front of the unit. A green light indicates that the flame is about in the same condition as when the burner was last serviced. A red light indicates a flame which is either too rich or too lean, and that servicing of the burner is required. At the end of each firing cycle, the flame quality indicator goes into a hold mode which is in effect during the period that the burner remains off. A yellow or amber light indicates that the burner is in the hold mode. In this mode, the flame quality lights indicate the flame condition immediately before the burner turned off. Thus the unit can be viewed when it is off, and the flame condition at the end of the previous firing cycle can be observed.

[Reorganizing the management of specialist uro-andrologic ultrasound health-care service: impact on professional quality].

PubMed

Dell'Atti, Lucio; Russo, Gian Rosario

2011-01-01

The process of organizing a ultrasound service nowadays can be improved by properly managing the user's request, the speed of response and safety, the standardization of methods and skills. The outpatients at our uro-andrologic ultrasound clinic (O.U. of Urology in Ferrara) received a questionnaire each; we administered a total of 640 questionnaires. The number of questionnaires collected was 532. Patients were asked to give an assessment of services using a qualitative method according to a 4-parameter response scale: very satisfied, satisfied, dissatisfied, very dissatisfied. The identification of indicators to be monitored by the user's perceived quality was accomplished by establishing the correlation coefficient between different parameters of analysis and an overall rating of the sample. Some of these parameters were: the relationship with the practitioner, the availability of doctors, the ability of doctors for reassurance, the completeness of information and facilities hygiene conditions. When these parameters vary, positively or negatively, also the citizen's overall opinion changes. The customer satisfaction is an important component of the quality of care, it represents both an indicator of the effectiveness of health intervention and the ability to meet quality requirements of the health service organization. The objective of an ultrasound service should be to provide, within a reasonable timeframe, the supply of high quality with qualified personnel, with adequate tools and procedures.

Setting standards and monitoring quality in the NHS 1999-2013: a classic case of goal conflict.

PubMed

Littlejohns, Peter; Knight, Alec; Littlejohns, Anna; Poole, Tara-Lynn; Kieslich, Katharina

2017-04-01

2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high-quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross-sectional, in-depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio-political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman-Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

Setting standards and monitoring quality in the NHS 1999–2013: a classic case of goal conflict

PubMed Central

Knight, Alec; Littlejohns, Anna; Poole, Tara‐Lynn; Kieslich, Katharina

2016-01-01

Abstract 2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high‐quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross‐sectional, in‐depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio‐political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman–Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. PMID:27435020

Do America's Schools Need a "Dow Jones Index"?

ERIC Educational Resources Information Center

Guthrie, James W.

1993-01-01

Education may be only major social activity lacking publicly accepted composite indicator. A national education index could incorporate dimensions such as student performance, public support for education, children's conditions, and quality of educational service. Such a system might monitor progress, foster accountability, facilitate…

UTILITY OF GENETIC INDICATORS FOR MONITORING ECOLOGICAL CONDITION

EPA Science Inventory

It is evident that Earth's ecosystems have been steadily deteriorating due to relatively recent human activities. Since quality of life depends upon the ecosystem services, the impacts of deterioration of ecosystems on human health and on wild life populations has been amply de...

Wilsonline.

ERIC Educational Resources Information Center

Nitecki, Danuta A.

1985-01-01

Observations on impact of WILSONLINE (online access to H. W. Wilson's indexes) on the industry, library services, and end users are drawn from interviews with reference librarians, H. W. Wilson administrative staff, and monitors of database industry. Issues addressed include quality, thoroughness, ease of use, and marketing (demand, pricing,…

Walnut creek watershed monitoring project, Iowa: Monitoring water quality in response to prairie restoration

USGS Publications Warehouse

Schilling, K.E.; Thompson, C.A.

2000-01-01

Land use and surface water data for nitrogen and pesticides (1995 to 1997) are reported for the Walnut Creek Watershed Monitoring Project, Jasper County Iowa. The Walnut Creek project was established in 1995 as a nonpoint source monitoring program in relation to watershed habitat restoration and agricultural management changes implemented at the Neal Smith National Wildlife Refuge by the U.S. Fish and Wildlife Service. The monitoring project utilizes a paired-watershed approach (Walnut and Squaw creeks) as well as upstream/downstream comparisons on Walnut for analysis and tracking of trends. From 1992 to 1997, 13.4 percent of the watershed was converted from row crop to native prairie in the Walnut Creek watershed. Including another 6 percent of watershed farmed on a cash-rent basis, land use changes have been implemented on 19.4 percent of the watershed by the USFWS. Nitrogen and pesticide applications were reduced an estimated 18 percent and 28 percent in the watershed from land use changes. Atrazine was detected most often in surface water with frequencies of detection ranging from 76-86 percent. No significant differences were noted in atrazine concentrations between Walnut and Squaw Creek. Nitrate-N concentrations measured in both watersheds were similar; both basins showed a similar pattern of detection and an overall reduction in nitrate-N concentrations from upstream to downstream monitoring sites. Water quality improvements are suggested by nitrate-N and chloride ratios less than one in the Walnut Creek watershed and low nitrate-N concentrations measured in the subbasin of Walnut Creek containing the greatest amount of land use changes. Atrazine and nitrate-N concentrations from the lower portion of the Walnut Creek watershed (including the prairie restoration area) may be decreasing in relation to the upstream untreated component of the watershed. The frequencies of pesticide detections and mean nitrate-N concentrations appear related to the percentage of row crop in the basins and subbasins. Although some results are encouraging, definitive water quality improvements have not been observed during the first three years of monitoring. Possible reasons include: (1) more time is needed to adequately detect changes; (2) the size of the watershed is too large to detect improvements; (3) land use changes are not located in the area of the watershed where they would have greatest effect; or (4) water quality improvements have occurred but have been missed by the project monitoring design. Longer-term monitoring will allow better evaluation of the impact of restoration activities on water quality.An overview is given on the Walnut Creek Watershed Monitoring Project established as a nonpoint source monitoring program in relation to watershed habitat restoration and agricultural management changes implemented at the Neal Smith National Wildlife Refuge by the U.S. Fish and Wildlife Services. Focus is on land use and surface water data for nitrogen and pesticides. Initial results obtained for the first three years of monitoring are discussed.

Development of a Personal Integrated Environmental Monitoring System

PubMed Central

Wong, Man Sing; Yip, Tsan Pong; Mok, Esmond

2014-01-01

Environmental pollution in the urban areas of Hong Kong has become a serious public issue but most urban inhabitants have no means of judging their own living environment in terms of dangerous threshold and overall livability. Currently there exist many low-cost sensors such as ultra-violet, temperature and air quality sensors that provide reasonably accurate data quality. In this paper, the development and evaluation of Integrated Environmental Monitoring System (IEMS) are illustrated. This system consists of three components: (i) position determination and sensor data collection for real-time geospatial-based environmental monitoring; (ii) on-site data communication and visualization with the aid of an Android-based application; and (iii) data analysis on a web server. This system has shown to be working well during field tests in a bus journey and a construction site. It provides an effective service platform for collecting environmental data in near real-time, and raises the public awareness of environmental quality in micro-environments. PMID:25420154

Cancer control in developing countries: using health data and health services research to measure and improve access, quality and efficiency.

PubMed

Hanna, Timothy P; Kangolle, Alfred C T

2010-10-13

Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1) Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2) PROCESS: enabling follow-up, knowledge translation, patient safety and quality assurance. (3) OUTCOME: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1) Capacity building in oncology health services research, policy and planning relevant to developing countries. (2) Development of high-quality health data sources. (3) More oncology-related economic evaluations in developing countries. (4) Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and international collaboration as well as political leadership. Horizontal integration with programs for other diseases will be important.

Regional input to joint European space weather service

NASA Astrophysics Data System (ADS)

Stanislawska, I.; Belehaki, A.; Jansen, F.; Heynderickx, D.; Lilensten, J.; Candidi, M.

The basis for elaborating within COST 724 Action Developing the scientific basis for monitoring modeling and predicting Space Weather European space weather service is rich by many national and international activities which provide instruments and tools for global as well as regional monitoring and modeling COST 724 stimulates coordinates and supports Europe s goals of development and global cooperation by providing standards for timely and high quality information and knowledge in space weather Existing local capabilities are taken into account to develop synergies and avoid duplication The enhancement of environment monitoring networks and associated instruments technology yields mutual advantages for European service and regional services specialized for local users needs It structurally increases the integration of limited-area services generates a platform employing the same approach to each task differing mostly in input and output data In doing so it also provides complementary description of the environmental state within issued information A general scheme of regional services concept within COST 724 activity can be the processing chain from measurements trough algorithms to operational knowledge It provides the platform for interaction among the local end users who define what kind of information they need system providers who elaborate tools necessary to obtain required information and local service providers who do the actual processing of data and tailor it to specific user s needs Such initiative creates a unique possibility for small

A pervasive health monitoring service system based on ubiquitous network technology.

PubMed

Lin, Chung-Chih; Lee, Ren-Guey; Hsiao, Chun-Chieh

2008-07-01

The phenomenon of aging society has derived problems such as shortage of medical resources and reduction of quality in healthcare services. This paper presents a system infrastructure for pervasive and long-term healthcare applications, i.e. a ubiquitous network composed of wireless local area network (WLAN) and cable television (CATV) network serving as a platform for monitoring physiological signals. Users can record vital signs including heart rate, blood pressure, and body temperature anytime either at home or at frequently visited public places in order to create a personal health file. The whole system was formally implemented in December 2004. Analysis of 2000 questionnaires indicates that 85% of users were satisfied with the provided community-wide healthcare services. Among the services provided by our system, health consultation services offered by family doctors was rated the most important service by 17.9% of respondents, and was followed by control of one's own health condition (16.4% of respondents). Convenience of data access was rated most important by roughly 14.3% of respondents. We proposed and implemented a long-term healthcare system integrating WLAN and CATV networks in the form of a ubiquitous network providing a service platform for physiological monitoring. This system can classify the health levels of the resident according to the variation tendency of his or her physiological signal for important reference of health management.

Economic constraints and quality assurance in mental health services: sensitive indicators.

PubMed

el-Guebaly, N; Papineau, D

1984-03-01

Clinicians in the field of mental health are met with the dual challenge of increased accountability and shrinking resources. Funds are often allocated through the use of crude administrative monitors. This is of little solace to the clinician faced with unmet patients' wants and needs. A set of clinical monitors is outlined requiring the practitioner's cooperation. The presentation of an accurate composite picture is a must in the process of resource allocation. Such clinical monitors include the analysis of characteristics of patients such as the repeaters at emergency, "the revolving door" pool of patients and those falling in between networks. Reviews of waiting lists and lengths of stay, an evaluation of nursing care variables, the auditing of the choice of therapeutic modalities and the use of restraints are other suggested contributors to the assessment of service needs.

Introducing quality improvement management methods into primary health care services in Uganda.

PubMed

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

1996-01-01

Uganda's National Quality Assurance Program was established in 1994 to monitor the process of decentralization of primary health care services. Guidelines were developed to address problems (e.g., in obtaining health funds channeled through local government) identified at district meetings. Bringing together District Health Teams with local administrators and political leaders to share responsibility for strengthening health services has been a significant program achievement. A smoother functioning referral system from health units to district hospitals has resulted. The response to a measles outbreak in the Arua district in 1993-94 confirmed the utility of the quality management approach. Weaknesses in the district cold chain, problems with diagnostic accuracy, and a poorly functioning information system were identified as key causative factors, and corrective action in these areas led to a subsequent decline in measles cases. Patient dissatisfaction with long waiting times at Masaka Hospital was another concern addressed through the quality assurance approach. Five salient areas were identified for action: low health worker morale, supply shortages, inadequate supervision by hospital management, poor patient flow, and inefficient drug dispensing. As a result, long delays were eliminated and utilization of hospital outpatient services increased by 28%.

CIEMAT EXTERNAL DOSIMETRY SERVICE: ISO/IEC 17025 ACCREDITATION AND 3 Y OF OPERATIONAL EXPERIENCE AS AN ACCREDITED LABORATORY.

PubMed

Romero, A M; Rodríguez, R; López, J L; Martín, R; Benavente, J F

2016-09-01

In 2008, the CIEMAT Radiation Dosimetry Service decided to implement a quality management system, in accordance with established requirements, in order to achieve ISO/IEC 17025 accreditation. Although the Service comprises the approved individual monitoring services of both external and internal radiation, this paper is specific to the actions taken by the External Dosimetry Service, including personal and environmental dosimetry laboratories, to gain accreditation and the reflections of 3 y of operational experience as an accredited laboratory. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Negotiation and Monitoring of Service Level Agreements

NASA Astrophysics Data System (ADS)

Quillinan, Thomas B.; Clark, Kassidy P.; Warnier, Martijn; Brazier, Frances M. T.; Rana, Omer

Service level agreements (SLAs) provide a means to define specific Quality of Service (QoS) guarantees between providers and consumers of services. Negotiation and definition of these QoS characteristics is an area of significant research. However, defining the actions that take place when an agreement is violated is a topic of more recent focus. This paper discusses recent advances in this field and propose some additional features that can help both consumers and producers during the enactment of services. These features include the ability to (re)negotiate penalties in an agreement, and specifically focuses on the renegotiation of penalties during enactment to reflect ongoing violations.

FTIR Monitoring Of Curing Of Composites

NASA Technical Reports Server (NTRS)

Druy, Mark A.; Stevenson, William A.; Young, Philip R.

1990-01-01

Infrared-sensing optical fiber system developed to monitor principal infrared absorption bands resulting from vibrations of atoms and molecules as chemical bonds form when resin cured. System monitors resin chemistry more directly. Used to obtain Fourier transform infrared (FTIR) spectrum from graphite fiber/polyimide matrix resin prepreg. Embedded fiber optic FTIR sensor used to indicate state of cure of thermosetting composite material. Developed primarily to improve quality of advanced composites, many additional potential applications exist because principal of operation applicable to all organic materials and most inorganic gases. Includes monitoring integrities of composite materials in service, remote sensing of hazardous materials, and examination of processes in industrial reactors and furnaces.

Measuring the performance of maintenance service outsourcing.

PubMed

Cruz, Antonio Miguel; Rincon, Adriana Maria Rios; Haugan, Gregory L

2013-01-01

The aims of this paper are (1) to identify the characteristics of maintenance service providers that directly impact maintenance service quality, using 18 independent covariables; (2) to quantify the change in risk these covariables present to service quality, measured in terms of equipment turnaround time (TAT). A survey was applied to every maintenance service provider (n = 19) for characterization purposes. The equipment inventory was characterized, and the TAT variable recorded and monitored for every work order of each service provider (N = 1,025). Finally, the research team conducted a statistical analysis to accomplish the research objectives. The results of this study offer strong empirical evidence that the most influential variables affecting the quality of maintenance service performance are the following: type of maintenance, availability of spare parts in the country, user training, technological complexity of the equipment, distance between the company and the hospital, and the number of maintenance visits performed by the company. The strength of the results obtained by the Cox model built are supported by the measure of the Rp,e(2) = 0.57 with a value of Rp,e= 0.75. Thus, the model explained 57% of the variation in equipment TAT, with moderate high positive correlation between the dependent variable (TAT) and independent variables.

Are We Monitoring the Quality of Cataract Surgery Services? A Qualitative Situation Analysis of Attitudes and Practices in a Large City in South Africa

PubMed Central

Haastrup, Oluwatosin O. O.; Buchan, John C.; Cassels-Brown, Andy; Cook, Colin

2015-01-01

Purpose: To evaluate the current quality “assurance” and “improvement” mechanisms, the knowledge, attitudes and practices of cataract surgeons in a large South African city. Methodology: A total of 17 in-depth semi-structured interviews were conducted with ophthalmologists in June 2012 at 2 tertiary institutions in the Republic of South Africa. Recruitment of the purposive sample was supplemented by snowball sampling. The study participants were 5 general ophthalmologists and 2 pediatric ophthalmologists; 4 senior and 4 junior registrars and a medical officer. Participants were interviewed by a trained qualitative interviewer. The interview lasted between 20 and 60 min. The interviews were recorded, transcribed verbatim and analyzed for thematic content. Results: Mechanisms for quality assurance were trainee logbooks and subjective senior staff observation. Clinicians were encouraged, but not obliged to self-audit. Quality improvement is incentivized by personal integrity and ambition. Poorly performing departments are inconspicuous, especially nationally, and ophthalmologists rely on the impression to gauge the quality of service provided by colleagues. Currently, word of mouth is the method for determining the better cataract surgical centers. Conclusion: The quality assurance mechanisms were dependent on insight and integrity of the individual surgeons. No structures were described that would ensure the detection of surgeons with higher than expected complication rates. Currently, audits are not enforced, and surgical outcomes are not well monitored due to concerns that this may lead to lack of openness among ophthalmologists. PMID:25949081

Are we monitoring the quality of cataract surgery services? A qualitative situation analysis of attitudes and practices in a large city in South Africa.

PubMed

Haastrup, Oluwatosin O O; Buchan, John C; Cassels-Brown, Andy; Cook, Colin

2015-01-01

To evaluate the current quality "assurance" and "improvement" mechanisms, the knowledge, attitudes and practices of cataract surgeons in a large South African city. A total of 17 in-depth semi-structured interviews were conducted with ophthalmologists in June 2012 at 2 tertiary institutions in the Republic of South Africa. Recruitment of the purposive sample was supplemented by snowball sampling. The study participants were 5 general ophthalmologists and 2 pediatric ophthalmologists; 4 senior and 4 junior registrars and a medical officer. Participants were interviewed by a trained qualitative interviewer. The interview lasted between 20 and 60 min. The interviews were recorded, transcribed verbatim and analyzed for thematic content. Mechanisms for quality assurance were trainee logbooks and subjective senior staff observation. Clinicians were encouraged, but not obliged to self-audit. Quality improvement is incentivized by personal integrity and ambition. Poorly performing departments are inconspicuous, especially nationally, and ophthalmologists rely on the impression to gauge the quality of service provided by colleagues. Currently, word of mouth is the method for determining the better cataract surgical centers. The quality assurance mechanisms were dependent on insight and integrity of the individual surgeons. No structures were described that would ensure the detection of surgeons with higher than expected complication rates. Currently, audits are not enforced, and surgical outcomes are not well monitored due to concerns that this may lead to lack of openness among ophthalmologists.

The use of patient feedback by hospital boards of directors: a qualitative study of two NHS hospitals in England

PubMed Central

Lee, Robert; Baeza, Juan I; Fulop, Naomi J

2018-01-01

Background Although previous research suggests that different kinds of patient feedback are used in different ways to help improve the quality of hospital care, there have been no studies of the ways in which hospital boards of directors use feedback for this purpose. Objectives To examine whether and how boards of directors of hospitals use feedback from patients to formulate strategy and to assure and improve the quality of care. Methods We undertook an in-depth qualitative study in two acute hospital National Health Service foundation trusts in England, purposively selected as contrasting examples of the collection of different kinds of patient feedback. We collected and analysed data from interviews with directors and other managers, from observation of board meetings, and from board papers and other documents. Results The two boards used in-depth qualitative feedback and quantitative feedback from surveys in different ways to help develop strategies, set targets for quality improvement and design specific quality improvement initiatives; but both boards made less subsequent use of any kinds of feedback to monitor their strategies or explicitly to assure the quality of services. Discussion and conclusions We have identified limitations in the uses of patient feedback by hospital boards that suggest that boards should review their current practice to ensure that they use the different kinds of patient feedback that are available to them more effectively to improve, monitor and assure the quality of care. PMID:28754814

Effective coverage of primary care services in eight high-mortality countries

PubMed Central

Malata, Address; Ndiaye, Youssoupha; Kruk, Margaret E

2017-01-01

Introduction Measurement of effective coverage (quality-corrected coverage) of essential health services is critical to monitoring progress towards the Sustainable Development Goal for health. We combine facility and household surveys from eight low-income and middle-income countries to examine effective coverage of maternal and child health services. Methods We developed indices of essential clinical actions for antenatal care, family planning and care for sick children from existing guidelines and used data from direct observations of clinical visits conducted in Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania and Uganda between 2007 and 2015 to measure quality of care delivered. We calculated healthcare coverage for each service from nationally representative household surveys and combined quality with utilisation estimates at the subnational level to quantify effective coverage. Results Health facility and household surveys yielded over 40 000 direct clinical observations and over 100 000 individual reports of healthcare utilisation. Coverage varied between services, with much greater use of any antenatal care than family planning or sick-child care, as well as within countries. Quality of care was poor, with few regions demonstrating more than 60% average performance of basic clinical practices in any service. Effective coverage across all eight countries averaged 28% for antenatal care, 26% for family planning and 21% for sick-child care. Coverage and quality were not strongly correlated at the subnational level; effective coverage varied by as much as 20% between regions within a country. Conclusion Effective coverage of three primary care services for women and children in eight countries was substantially lower than crude service coverage due to major deficiencies in care quality. Better performing regions can serve as examples for improvement. Systematic increases in the quality of care delivered—not just utilisation gains—will be necessary to progress towards truly beneficial universal health coverage. PMID:29632704

Quality of requests for serum digoxin concentrations: experience from an Australian regional health service.

PubMed

Ellington, Chris; Grgurinovich, Nick; Miners, John O; Mangoni, Arduino A

2007-05-01

* Therapeutic drug monitoring of serum digoxin concentrations (SDC) is considered useful in enhancing the therapeutic benefits of digoxin and minimizing the incidence of adverse drug reactions. * The quality of requests for SDC has been reported to be generally unsatisfactory. However, studies have focused on few information parameters. * A better knowledge of these issues might be useful to target appropriate areas of weakness within heathcare systems. * The poor quality of the information in SDC requests involves a wide range of codes from the contact details of the requester to the time interval between the last dose of digoxin and blood sampling. * Misuse of the therapeutic drug monitoring service is common across different specialties and healthcare settings. To assess the quality of the information provided with serum digoxin concentration (SDC) requests received by a therapeutic drug monitoring service in a regional health service. We conducted a retrospective audit of a consecutive series of 685 SDC requests during a 7-month period. Information regarding (i) contact details, (ii) reasons for request, (iii) dose, (iv) route of administration, (v) concurrent therapy, (vi) treatment duration and (vii) time interval between the last dose and sampling was reviewed and coded as appropriate or inappropriate/missing. Data were analysed according to the origin of request, i.e. from different specialties/wards (emergency department and critical care, cardiology and coronary care unit, medicine and aged care, surgery, and general/private practice) and healthcare settings (teaching hospital, geriatric hospital and general/private practice). The quality of SDC requests was generally poor across different specialties and healthcare settings. The information provided for the coded parameters was appropriate only in 19.1% (i), 6.4% (ii), 54.7% (iii), 45.8% (iv), 12.8% (v), 32.9% (vi) and 47.1% (vii) of cases. No SDC request was complete in all the information codes. SDC requests from general/private practice lacked more often details regarding the dose (information provided in 46.7% of requests, P = 0.007 vs. other specialties; P = 0.02 vs. other settings) and the route of administration (20.0%, P < 0.001 vs. other specialties and vs. other settings). SDC requests from the emergency department and critical care unit lacked more often details regarding the treatment duration (22.6%, P < 0.001 vs. other specialties) and the time interval between the last dose and blood sampling (40.1%, P = 0.01 vs. other specialties). The quality of the information in SDC requests is poor across different specialties and healthcare settings. Educational strategies to ensure the appropriate use of this service are urgently needed.

Quality of requests for serum digoxin concentrations: experience from an Australian Regional Health Service

PubMed Central

Ellington, Chris; Grgurinovich, Nick; Miners, John O; Mangoni, Arduino A

2007-01-01

What is already known about this subject Therapeutic drug monitoring of serum digoxin concentrations (SDC) is considered useful in enhancing the therapeutic benefits of digoxin and minimizing the incidence of adverse drug reactions. The quality of requests for SDC has been reported to be generally unsatisfactory. However, studies have focused on few information parameters. A better knowledge of these issues might be useful to target appropriate areas of weakness within heathcare systems. What this study adds The poor quality of the information in SDC requests involves a wide range of codes from the contact details of the requester to the time interval between the last dose of digoxin and blood sampling. Misuse of the therapeutic drug monitoring service is common across different specialties and healthcare settings. Aims To assess the quality of the information provided with serum digoxin concentration (SDC) requests received by a therapeutic drug monitoring service in a regional health service. Methods We conducted a retrospective audit of a consecutive series of 685 SDC requests during a 7-month period. Information regarding (i) contact details, (ii) reasons for request, (iii) dose, (iv) route of administration, (v) concurrent therapy, (vi) treatment duration and (vii) time interval between the last dose and sampling was reviewed and coded as appropriate or inappropriate/missing. Data were analysed according to the origin of request, i.e. from different specialties/wards (emergency department and critical care, cardiology and coronary care unit, medicine and aged care, surgery, and general/private practice) and healthcare settings (teaching hospital, geriatric hospital and general/private practice). Results The quality of SDC requests was generally poor across different specialties and healthcare settings. The information provided for the coded parameters was appropriate only in 19.1% (i), 6.4% (ii), 54.7% (iii), 45.8% (iv), 12.8% (v), 32.9% (vi) and 47.1% (vii) of cases. No SDC request was complete in all the information codes. SDC requests from general/private practice lacked more often details regarding the dose (information provided in 46.7% of requests, P = 0.007 vs. other specialties; P = 0.02 vs. other settings) and the route of administration (20.0%, P < 0.001 vs. other specialties and vs. other settings). SDC requests from the emergency department and critical care unit lacked more often details regarding the treatment duration (22.6%, P < 0.001 vs. other specialties) and the time interval between the last dose and blood sampling (40.1%, P = 0.01 vs. other specialties). Conclusions The quality of the information in SDC requests is poor across different specialties and healthcare settings. Educational strategies to ensure the appropriate use of this service are urgently needed. PMID:17073890

Northern Great Plains Network water quality monitoring design for tributaries to the Missouri National Recreational River

USGS Publications Warehouse

Rowe, Barbara L.; Wilson, Stephen K.; Yager, Lisa; Wilson, Marcia H.

2013-01-01

The National Park Service (NPS) organized more than 270 parks with important natural resources into 32 ecoregional networks to conduct Inventory and Monitoring (I&M) activities for assessment of natural resources within park units. The Missouri National Recreational River (NRR) is among the 13 parks in the NPS Northern Great Plain Network (NGPN). Park managers and NGPN staff identified surface water resources as a high priority vital sign to monitor in park units. The objectives for the Missouri NRR water quality sampling design are to (1) assess the current status and long-term trends of select water quality parameters; and (2) document trends in streamflow at high-priority stream systems. Due to the large size of the Missouri River main stem, the NGPN water quality design for the Missouri NRR focuses on wadeable tributaries within the park unit. To correlate with the NGPN water quality protocols, monitoring of the Missouri NRR consists of measurement of field core parameters including dissolved oxygen, pH, specific conductance, and temperature; and streamflow. The purpose of this document is to discuss factors examined for selection of water quality monitoring on segments of the Missouri River tributaries within the Missouri NRR.Awareness of the complex history of the Missouri NRR aids in the current understanding and direction for designing a monitoring plan. Historical and current monitoring data from agencies and entities were examined to assess potential NGPN monitoring sites. In addition, the U.S. Environmental Protection Agency 303(d) list was examined for the impaired segments on tributaries to the Missouri River main stem. Because major tributaries integrate water quality effects from complex combinations of land use and environmental settings within contributing areas, a 20-mile buffer of the Missouri NRR was used to establish environmental settings that may impact the water quality of tributaries that feed the Missouri River main stem. For selection of monitoring sites, anthropogenic and natural influences to water quality were assessed for Missouri NRR tributaries. Factors that were examined include the size and contributions of tributaries within watersheds to the main stem; population density; and land use such as urban development and agricultural practices including concentrated animal feeding operations. Based on examination of these data in addition to the park’s legislation and management considerations, two sites were selected for monitoring water quality on Missouri NRR tributaries for the ice-free season (mid-May to mid-October) on a rotational basis every third year. Bow Creek at St. James was selected for water quality monitoring based on lack of long-term water quality monitoring, current recreational use, and proximity of the tributary to intense agricultural practices. In addition, land within the Bow Creek watershed is owned by the NPS. The Niobrara River at Verdel was selected for monitoring due to high use for public recreational activities, adjacent agricultural land use, and documented impairments for designated beneficial uses. Both sites will have access to real-time streamgages that will aid in a greater understanding of water quality.

Monitoring tree mortality in mature Douglas-fir forests: size and species matter

EPA Science Inventory

Background/Question/MethodsA regional increase in tree mortality rates associated with climate change will influence forest health and ecosystem services, including water quality and quantity. In recent decades, accelerated tree mortality has occurred in some, but not all, fores...

Hybrid monitoring scheme for end-to-end performance enhancement of multicast-based real-time media

NASA Astrophysics Data System (ADS)

Park, Ju-Won; Kim, JongWon

2004-10-01

As real-time media applications based on IP multicast networks spread widely, end-to-end QoS (quality of service) provisioning for these applications have become very important. To guarantee the end-to-end QoS of multi-party media applications, it is essential to monitor the time-varying status of both network metrics (i.e., delay, jitter and loss) and system metrics (i.e., CPU and memory utilization). In this paper, targeting the multicast-enabled AG (Access Grid) a next-generation group collaboration tool based on multi-party media services, the applicability of hybrid monitoring scheme that combines active and passive monitoring is investigated. The active monitoring measures network-layer metrics (i.e., network condition) with probe packets while the passive monitoring checks both application-layer metrics (i.e., user traffic condition by analyzing RTCP packets) and system metrics. By comparing these hybrid results, we attempt to pinpoint the causes of performance degradation and explore corresponding reactions to improve the end-to-end performance. The experimental results show that the proposed hybrid monitoring can provide useful information to coordinate the performance improvement of multi-party real-time media applications.

Data quality through a web-based QA/QC system: implementation for atmospheric mercury data from the global mercury observation system.

PubMed

D'Amore, Francesco; Bencardino, Mariantonia; Cinnirella, Sergio; Sprovieri, Francesca; Pirrone, Nicola

2015-08-01

The overall goal of the on-going Global Mercury Observation System (GMOS) project is to develop a coordinated global monitoring network for mercury, including ground-based, high altitude and sea level stations. In order to ensure data reliability and comparability, a significant effort has been made to implement a centralized system, which is designed to quality assure and quality control atmospheric mercury datasets. This system, GMOS-Data Quality Management (G-DQM), uses a web-based approach with real-time adaptive monitoring procedures aimed at preventing the production of poor-quality data. G-DQM is plugged on a cyberinfrastructure and deployed as a service. Atmospheric mercury datasets, produced during the first-three years of the GMOS project, are used as the input to demonstrate the application of the G-DQM and how it identifies a number of key issues concerning data quality. The major issues influencing data quality are presented and discussed for the GMOS stations under study. Atmospheric mercury data collected at the Longobucco (Italy) station is used as a detailed case study.

Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises.

PubMed

Schlein, Karen; De La Cruz, Anna York; Gopalakrishnan, Tisha; Montagu, Dominic

2013-01-03

Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs. The study included three data sources and levels of investigation: 1) Self-reported program data; 2) Scoping telephone interviews; and 3) In-depth field interviews and clinic visits. Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback. These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance becomes a part of the organizational culture, and the components of a quality assurance system that are most correlated with improved quality of clinical care for patients.

Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises

PubMed Central

2013-01-01

Background Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs. Methods The study included three data sources and levels of investigation: 1) Self-reported program data; 2) Scoping telephone interviews; and 3) In-depth field interviews and clinic visits. Results Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback. Conclusions These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance becomes a part of the organizational culture, and the components of a quality assurance system that are most correlated with improved quality of clinical care for patients. PMID:23286899

MINERVA: An INSAR Monitoring Service for Volcanic Hazard

NASA Astrophysics Data System (ADS)

Tampellini, M. L.; Sansosti, E.; Usai, S.; Lanari, R.; Borgstrom, S.; van Persie, M.; Ricciardi, G. P.; Maddalena, V.; Cicero, L.; Pepe, A.

2004-06-01

MINERVA (Monitoring by Interferometric SAR of Environmental Risk in Volcanic Areas) is a small scale service demonstration project financed by ESA in the Data User Programme framework. The objective of the project is the design, development and assessment of a demonstrative information service based on the interferometric processing of images acquired from either the ASAR instrument on board ENVISAT-I or SAR instruments on board ERS1/2. The system is based on a new approach for the processing of INSAR data, which allows to optimize the quality of interferograms spanning from 35 days up to several years, and to merge them to generate a single solution describing the temporal evolution of the ground deformations in the examined risk area. The system allows to update this solution each time a new SAR image is available, and constitutes therefore an innovative tool for monitoring of the ground displacements in risk areas. The system has been implemented and demonstrated at Osservatorio Vesuviano (Naples, Italy), which is the institution responsible for monitoring the volcanic phenomena in the Neapolitan volcanic district, and for alerting the Italian civil authorities (''Protezione Civile'') in case such monitoring activity reveals signals of imminent eruptions. In particular, the MINERVA system has been used to monitor the ground deformations at the Phlegrean Fields, a densely populated, high-hazard zone which is subject to alternate phases of uplift and subsidence, accompanied often by seismic activity.

Quality assurance report - Loch Vale Watershed, 1999-2002

USGS Publications Warehouse

Botte, Jorin A.; Baron, Jill S.

2004-01-01

The National Park Service initiated the Loch Vale Watershed (LVWS) project in 1980 with funding from the Aquatic Effects Research Program of the National Acid Precipitation Assessment Program. Long-term ecological research and monitoring address watershed-scale ecosystem processes, particularly as they respond to atmospheric deposition and climate variability. Monitoring of meteorological, hydrologic, precipitation chemistry, and surface water quality parameters enable us to use long-term trends to distinguish natural from human-caused disturbances. Research into snow distribution, hydrologic flowpaths, vegetation responses to N deposition, isotopic transformations of N by forest and soil processes, trace metals, and aquatic ecological responses to disturbance enable us to understand processes that influence high elevation ecosystems.

Quality Indicators for the Total Testing Process.

PubMed

Plebani, Mario; Sciacovelli, Laura; Aita, Ada

2017-03-01

ISO 15189:2012 requires the use of quality indicators (QIs) to monitor and evaluate all steps of the total testing process, but several difficulties dissuade laboratories from effective and continuous use of QIs in routine practice. An International Federation of Clinical Chemistry and Laboratory Medicine working group addressed this problem and implemented a project to develop a model of QIs to be used in clinical laboratories worldwide to monitor and evaluate all steps of the total testing process, and decrease error rates and improve patient services in laboratory testing. All laboratories are invited, at no cost, to enroll in the project and contribute to harmonized management at the international level. Copyright © 2016 Elsevier Inc. All rights reserved.

Governance of quality of care: a qualitative study of health service boards in Victoria, Australia.

PubMed

Bismark, Marie M; Studdert, David M

2014-06-01

To describe the engagement of health service boards with quality-of-care issues and to identify factors that influence boards' activities in this area. We conducted semistructured interviews with 35 board members and executives from 13 public health services in Victoria, Australia. Interviews focused on the role currently played by boards in overseeing quality of care. We also elicited interviewees' perceptions of factors that have influenced their current approach to governance in this area. Thematic analysis was used to identify key themes from interview transcripts. Virtually all interviewees believed boards had substantial opportunities to influence the quality of care delivered within the service, chiefly through setting priorities, monitoring progress, holding staff to account and shaping culture. Perceived barriers to leveraging this influence included insufficient resources, gaps in skills and experience among board members, inadequate information on performance and regulatory requirements that miss the mark. Interviewees converged on four enablers of more effective quality governance: stronger regional collaborations; more tailored board training on quality issues; smarter use of reporting and accreditation requirements; and better access to data that was reliable, longitudinal and allowed for benchmarking against peer organisations. Although health service boards are eager to establish quality of care as a governance priority, several obstacles are blocking progress. The result is a gap between the rhetoric of quality governance and the reality of month-to-month activities at the board level. The imperative for effective board-level engagement in this area cannot be met until these barriers are addressed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Characterizing the Quality Workforce in Private U.S. Child and Family Behavioral Health Agencies.

PubMed

McMillen, J Curtis; Raffol, Matthew

2016-09-01

Behavioral health agencies have been encouraged to monitor performance and improve service quality. This paper characterizes the workforce charged with these tasks through a national survey of 238 behavioral health quality professionals. A latent class analysis suggests only 30 % of these workers report skills in both basic research and quality-specific skills. Respondents wanted to learn a variety of research and data analytic skills. The results call into question the quality of data collected in behavioral health agencies and the conclusions agencies are drawing from their data. Professional school and continuing education programs are needed to prepare this workforce.

Using internal communication as a marketing strategy: gaining physician commitment.

PubMed

Heine, R P

1990-01-01

In the ambulatory care industry, increased competition and promotional costs are pressuring managers to design more creative and effective marketing strategies. One largely overlooked strategy is careful monitoring of the daily communication between physicians and ambulatory care staff providing physician services. Satisfying physician communication needs is the key to increasing physician commitment and referrals. This article outlines the steps necessary to first monitor, then improve the quality of all communication provided to physicians by ambulatory care personnel.

Performance Evaluation of Resource Management in Cloud Computing Environments.

PubMed

Batista, Bruno Guazzelli; Estrella, Julio Cezar; Ferreira, Carlos Henrique Gomes; Filho, Dionisio Machado Leite; Nakamura, Luis Hideo Vasconcelos; Reiff-Marganiec, Stephan; Santana, Marcos José; Santana, Regina Helena Carlucci

2015-01-01

Cloud computing is a computational model in which resource providers can offer on-demand services to clients in a transparent way. However, to be able to guarantee quality of service without limiting the number of accepted requests, providers must be able to dynamically manage the available resources so that they can be optimized. This dynamic resource management is not a trivial task, since it involves meeting several challenges related to workload modeling, virtualization, performance modeling, deployment and monitoring of applications on virtualized resources. This paper carries out a performance evaluation of a module for resource management in a cloud environment that includes handling available resources during execution time and ensuring the quality of service defined in the service level agreement. An analysis was conducted of different resource configurations to define which dimension of resource scaling has a real influence on client requests. The results were used to model and implement a simulated cloud system, in which the allocated resource can be changed on-the-fly, with a corresponding change in price. In this way, the proposed module seeks to satisfy both the client by ensuring quality of service, and the provider by ensuring the best use of resources at a fair price.

Performance Evaluation of Resource Management in Cloud Computing Environments

PubMed Central

Batista, Bruno Guazzelli; Estrella, Julio Cezar; Ferreira, Carlos Henrique Gomes; Filho, Dionisio Machado Leite; Nakamura, Luis Hideo Vasconcelos; Reiff-Marganiec, Stephan; Santana, Marcos José; Santana, Regina Helena Carlucci

2015-01-01

Cloud computing is a computational model in which resource providers can offer on-demand services to clients in a transparent way. However, to be able to guarantee quality of service without limiting the number of accepted requests, providers must be able to dynamically manage the available resources so that they can be optimized. This dynamic resource management is not a trivial task, since it involves meeting several challenges related to workload modeling, virtualization, performance modeling, deployment and monitoring of applications on virtualized resources. This paper carries out a performance evaluation of a module for resource management in a cloud environment that includes handling available resources during execution time and ensuring the quality of service defined in the service level agreement. An analysis was conducted of different resource configurations to define which dimension of resource scaling has a real influence on client requests. The results were used to model and implement a simulated cloud system, in which the allocated resource can be changed on-the-fly, with a corresponding change in price. In this way, the proposed module seeks to satisfy both the client by ensuring quality of service, and the provider by ensuring the best use of resources at a fair price. PMID:26555730

Urban Air Quality Modelling with AURORA: Prague and Bratislava

NASA Astrophysics Data System (ADS)

Veldeman, N.; Viaene, P.; De Ridder, K.; Peelaerts, W.; Lauwaet, D.; Muhammad, N.; Blyth, L.

2012-04-01

The European Commission, in its strategy to protect the health of the European citizens, states that in order to assess the impact of air pollution on public health, information on long-term exposure to air pollution should be available. Currently, indicators of air quality are often being generated using measured pollutant concentrations. While air quality monitoring stations data provide accurate time series information at specific locations, air quality models have the advantage of being able to assess the spatial variability of air quality (for different resolutions) and predict air quality in the future based on different scenarios. When running such air quality models at a high spatial and temporal resolution, one can simulate the actual situation as closely as possible, allowing for a detailed assessment of the risk of exposure to citizens from different pollutants. AURORA (Air quality modelling in Urban Regions using an Optimal Resolution Approach), a prognostic 3-dimensional Eulerian chemistry-transport model, is designed to simulate urban- to regional-scale atmospheric pollutant concentration and exposure fields. The AURORA model also allows to calculate the impact of changes in land use (e.g. planting of trees) or of emission reduction scenario's on air quality. AURORA is currently being applied within the ESA atmospheric GMES service, PASODOBLE (http://www.myair-eu.org), that delivers information on air quality, greenhouse gases, stratospheric ozone, … At present there are two operational AURORA services within PASODOBLE. Within the "Air quality forecast service" VITO delivers daily air quality forecasts for Belgium at a resolution of 5 km and for the major Belgian cities: Brussels, Ghent, Antwerp, Liege and Charleroi. Furthermore forecast services are provided for Prague, Czech Republic and Bratislava, Slovakia, both at a resolution of 1 km. The "Urban/regional air quality assessment service" provides urban- and regional-scale maps (hourly resolution) for air pollution and human exposure statistics for an entire year. So far we concentrated on Brussels, Belgium and the Rotterdam harbour area, The Netherlands. In this contribution we focus on the operational forecast services. Reference Lefebvre W. et al. (2011) Validation of the MIMOSA-AURORA-IFDM model chain for policy support: Modeling concentrations of elemental carbon in Flanders, Atmospheric Environment 45, 6705-6713

When Are Mobile Phones Useful for Water Quality Data Collection? An Analysis of Data Flows and ICT Applications among Regulated Monitoring Institutions in Sub-Saharan Africa

PubMed Central

Kumpel, Emily; Peletz, Rachel; Bonham, Mateyo; Fay, Annette; Cock-Esteb, Alicea; Khush, Ranjiv

2015-01-01

Water quality monitoring is important for identifying public health risks and ensuring water safety. However, even when water sources are tested, many institutions struggle to access data for immediate action or long-term decision-making. We analyzed water testing structures among 26 regulated water suppliers and public health surveillance agencies across six African countries and identified four water quality data management typologies. Within each typology, we then analyzed the potential for information and communication technology (ICT) tools to facilitate water quality information flows. A consistent feature of all four typologies was that testing activities occurred in laboratories or offices, not at water sources; therefore, mobile phone-based data management may be most beneficial for institutions that collect data from multiple remote laboratories. We implemented a mobile phone application to facilitate water quality data collection within the national public health agency in Senegal, Service National de l’Hygiène. Our results indicate that using the phones to transmit more than just water quality data will likely improve the effectiveness and sustainability of this type of intervention. We conclude that an assessment of program structure, particularly its data flows, provides a sound starting point for understanding the extent to which ICTs might strengthen water quality monitoring efforts. PMID:26404343

When Are Mobile Phones Useful for Water Quality Data Collection? An Analysis of Data Flows and ICT Applications among Regulated Monitoring Institutions in Sub-Saharan Africa.

PubMed

Kumpel, Emily; Peletz, Rachel; Bonham, Mateyo; Fay, Annette; Cock-Esteb, Alicea; Khush, Ranjiv

2015-09-02

Water quality monitoring is important for identifying public health risks and ensuring water safety. However, even when water sources are tested, many institutions struggle to access data for immediate action or long-term decision-making. We analyzed water testing structures among 26 regulated water suppliers and public health surveillance agencies across six African countries and identified four water quality data management typologies. Within each typology, we then analyzed the potential for information and communication technology (ICT) tools to facilitate water quality information flows. A consistent feature of all four typologies was that testing activities occurred in laboratories or offices, not at water sources; therefore, mobile phone-based data management may be most beneficial for institutions that collect data from multiple remote laboratories. We implemented a mobile phone application to facilitate water quality data collection within the national public health agency in Senegal, Service National de l'Hygiène. Our results indicate that using the phones to transmit more than just water quality data will likely improve the effectiveness and sustainability of this type of intervention. We conclude that an assessment of program structure, particularly its data flows, provides a sound starting point for understanding the extent to which ICTs might strengthen water quality monitoring efforts.

Measures To Monitor Developmental Disabilities Quality Assurance: A Study of Reliability.

ERIC Educational Resources Information Center

Dodder, Richard A.; Foster, Luann H.; Bolin, Brien L.

1999-01-01

This study examined the reliability of an instrument used to evaluate services for people with developmental disabilities. Seven types of variables were analyzed: demographic data, residential arrangements, medical needs, adaptive behavior, severity of challenging behavior, frequency of challenging behavior, and the perception that disabled…

50 CFR 660.373 - Pacific whiting (whiting) fishery management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Sustainable Fisheries Division, 7600 Sand Point Way NE, Seattle, WA 98115, or via email to [email protected] quality and resolving monitoring issues. Requests may be submitted to: Attn: Frank Lockhart, National Marine Fisheries Service, Northwest Region Sustainable Fisheries Division, 7600 Sand Point Way NE...

[Satisfaction survey of CatSalut-PLAENSA(©). Strategies to incorporate citizens' perception of the quality of the service in health policies].

PubMed

Aguado-Blázquez, Hortensia; Cerdà-Calafat, Ismael; Argimon-Pallàs, Josep Maria; Murillo-Fort, Carles; Canela-Soler, Jaume

2011-12-01

The aim of this work is to present the strategies, activities and results of satisfaction surveys Plan CatSalut- PLAENSA(©) 2003-2010 that are making progress in improving the quality of health services. Since 2003, CatSalut has at its disposal the plan known as PLAENSA(©) Satisfaction Surveys, a tool for assessment and improvement proposals addressed to the insurance services provided by contracted public entities. The plan follows 3 key strategies: systematic and objective policyholders' satisfaction measurement, related to the services received; release of improvement proposals according to a standardized model, including standardized monitoring, and promotion of equity through propagation among health centres and territories. Current assessment provided by the insured about most health services has been already collected, leading to more tan 2,500 projects of improvement which are being developed by the providers of the 7 health regions of Catalonia. Copyright © 2011 Elsevier España S.L. All rights reserved.

Essential tips for measuring levels of consumer satisfaction with rural health service quality.

PubMed

Smith, Karly B; Humphreys, John S; Jones, Judith A

2006-01-01

Quality of health services is a matter of increasing importance to health authorities. Monitoring consumer satisfaction of health care is an important input to improving the quality of health services. This article highlights a number of important considerations learned from rural consumer studies relevant to ensuring the valid measurement of consumer satisfaction with rural health services, as a means of contributing to quality improvements. This article compares two methods of analysing rural consumers' satisfaction with healthcare services. In one study of three rural communities in western New South Wales (NSW) and eight communities in north-west Victoria, residents were asked to rate their satisfaction with five key aspects of local health services (availability, geographical accessibility, choice, continuity, economic accessibility as measured by affordability) using a 5 point Likert scale from: one = very satisfied to five = very dissatisfied. An alternative method of assessing levels of consumer satisfaction was undertaken in the survey of eight rural communities in north-west Victoria by investigating consumers' experiences with actual and potential complaints in relation to health services. Both the NSW and Victorian respondents reported generally high levels of satisfaction with the five indicators of quality of health care. At the same time, 11% of Victorian study respondents reported having made a complaint about a health service in the previous 12 months, and one-third of the Victorian respondents reported experiences with their health services about which they wanted to complain but did not, over the same period. Interpretation of apparent consumer satisfaction with their health services must take particular account of the measures and research methods used. In assessing consumer satisfaction with health services in rural areas, specific attention should be given to maximising the engagement of rural consumers in order to ensure representativeness of findings, and to minimise possible biases in satisfaction ratings associated with the use of particular tools.

Managing data quality in an existing medical data warehouse using business intelligence technologies.

PubMed

Eaton, Scott; Ostrander, Michael; Santangelo, Jennifer; Kamal, Jyoti

2008-11-06

The Ohio State University Medical Center (OSUMC) Information Warehouse (IW) is a comprehensive data warehousing facility that provides providing data integration, management, mining, training, and development services to a diversity of customers across the clinical, education, and research sectors of the OSUMC. Providing accurate and complete data is a must for these purposes. In order to monitor the data quality of targeted data sets, an online scorecard has been developed to allow visualization of the critical measures of data quality in the Information Warehouse.

Disaster Monitoring and Emergency Response Services in China

NASA Astrophysics Data System (ADS)

Wu, J.; Han, X.; Zhou, Y.; Yue, P.; Wang, X.; Lu, J.; Jiang, W.; Li, J.; Tang, H.; Wang, F.; Li, X.; Fan, J.

2018-04-01

The Disaster Monitoring and Emergency Response Service(DIMERS) project was kicked off in 2017 in China, with the purpose to improve timely responsive service of the institutions involved in the management of natural disasters and man-made emergency situations with the timely and high-quality products derived from Space-based, Air-based and the in-situ Earth observation. The project team brought together a group of top universities and research institutions in the field of Earth observations as well as the operational institute in typical disaster services at national level. The project will bridge the scientific research and the response services of massive catastrophe in order to improve the emergency response capability of China and provide scientific and technological support for the implementation of the national emergency response strategy. In response to the call for proposal of "Earth Observation and Navigation" of 2017 National Key R&D Program of China, Professor Wu Jianjun, the deputy chairman of Faculty of Geographical Science of Beijing Normal University, submitted the Disaster Monitoring and Emergency Response Service (DIMERS) project, jointly with the experts and scholars from Institute of Remote Sensing and Digital Earth, Chinese Academy of Sciences, Wuhan University, China Institute of Earthquake Forecasting of China Earthquake Administration and China Institute of Water Resources and Hydropower Science. After two round evaluations, the proposal was funded by Ministry of Science and Technology of China.

Improving public health information: a data quality intervention in KwaZulu-Natal, South Africa.

PubMed

Mphatswe, W; Mate, K S; Bennett, B; Ngidi, H; Reddy, J; Barker, P M; Rollins, N

2012-03-01

To evaluate the effect of an intervention to improve the quality of data used to monitor the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus in South Africa. The study involved 58 antenatal clinics and 20 delivery wards (37 urban, 21 rural and 20 semi-urban) in KwaZulu-Natal province that provided PMTCT services and reported data to the District Health Information System. The data improvement intervention, which was implemented between May 2008 and March 2009, involved training on data collection and feedback for health information personnel and programme managers, monthly data reviews and data audits at health-care facilities. Data on six data elements used to monitor PMTCT services and recorded in the information system were compared with source data from health facility registers before, during and after the intervention. Data completeness (i.e. their presence in the system) and accuracy (i.e. being within 10% of their true value) were evaluated. The level of data completeness increased from 26% before to 64% after the intervention. Similarly, the proportion of data in the information system considered accurate increased from 37% to 65% (P < 0.0001). Moreover, the correlation between data in the information system and those from facility registers rose from 0.54 to 0.92. A simple, practical data improvement intervention significantly increased the completeness and accuracy of the data used to monitor PMTCT services in South Africa.

Health laboratories in the Tanga region of Tanzania: the quality of diagnostic services for malaria and other communicable diseases.

PubMed

Ishengoma, D R S; Rwegoshora, R T; Mdira, K Y; Kamugisha, M L; Anga, E O; Bygbjerg, I C; Rønn, A M; Magesa, S M

2009-07-01

Although critical for good case management and the monitoring of health interventions, the health-laboratory services in sub-Saharan Africa are grossly compromised by poor infrastructures and a lack of trained personnel, essential reagents and other supplies. The availability and quality of diagnostic services in 37 health laboratories in three districts of the Tanga region of Tanzania have recently been assessed. The results of the survey, which involved interviews with health workers, observations and a documentary review, revealed that malaria accounted for >50% of admissions and out-patient visits. Most (92%) of the laboratories were carrying out malaria diagnosis and 89% were measuring haemoglobin concentrations but only one (3%) was conducting culture and sensitivity tests, and those only on urine and pus samples. Only 14 (17%) of the 84 people found working in the visited laboratories were laboratory technologists with a diploma certificate or higher qualification. Sixteen (43%) of the study laboratories each had five or fewer types of equipment and only seven (19%) had more than 11 types each. Although 11 (30%) of the laboratories reported that they conducted internal quality control, none had standard operating procedures (SOP) on display or evidence of such quality assurance. Although malaria was the main health problem, diagnostic services for malaria and other diseases were inadequate and of poor quality because of the limited human resources, poor equipment and shortage of supplies. If the health services in Tanga are not to be overwhelmed by the progressively increasing burden of HIV/AIDS, malaria, tuberculosis and other emerging and re-emerging diseases, more funding and appropriate policies to improve the availability and quality of the area's diagnostic services will clearly be required.

The Ozone Monitoring Instrument (OMI): towards a 14 Year Data Record and Applications in the Air Quality and Climate Domain

NASA Astrophysics Data System (ADS)

Levelt, P.; Joiner, J.; Tamminen, J.; Veefkind, P.; Bhartia, P. K.; Court, A. J.; Vlemmix, T.

2017-12-01

Keywords: emission monitoring, air quality, climate, atmospheric composition The Ozone Monitoring Instrument (OMI), launched on board of NASA's EOS-Aura spacecraft on July 15, 2004, provides unique contributions to the monitoring of the ozone layer, air quality and climate from space. With a data record of 13 years, OMI provides the longest NO2 and SO2 record from space, which is essential to understand the changes to emissions globally. The combination of urban scale resolution (13 x 24 km2 in nadir) and daily global coverage proved to be key features for the air quality community. Due to the operational Very Fast Delivery (VFD / direct readout) and Near Real Time (NRT) availability of the data, OMI also plays an important role in the early developments of operational services in the atmospheric chemistry domain. For example, OMI data is currently used operationally for improving air quality forecasts, for inverting high-resolution emission maps, the UV forecast and for volcanic plume warning systems for aviation. An overview of air quality applications, emission inventory inversions and trend analyses based on the OMI data record will be presented. An outlook will be given on the potentials of augmenting this record with the high resolution air quality measurements of TROPOMI (3,5 x 7 km2) and new satellite instrumentation entering the imaging domain, such as the TROPOLITE instrument ( 1 x 1 km2). Potential of imaging type of NO2 measurements in the the climate and air quality domain will be given, most notably on the use of high resolution NO2 measurements for pin-pointing anthropogenic CO2 emissions.

Radiation levels and image quality in patients undergoing chest X-ray examinations

NASA Astrophysics Data System (ADS)

de Oliveira, Paulo Márcio Campos; do Carmo Santana, Priscila; de Sousa Lacerda, Marco Aurélio; da Silva, Teógenes Augusto

2017-11-01

Patient dose monitoring for different radiographic procedures has been used as a parameter to evaluate the performance of radiology services; skin entrance absorbed dose values for each type of examination were internationally established and recommended aiming patient protection. In this work, a methodology for dose evaluation was applied to three diagnostic services: one with a conventional film and two with digital computerized radiography processing techniques. The x-ray beam parameters were selected and "doses" (specifically the entrance surface and incident air kerma) were evaluated based on images approved in European criteria during postero-anterior (PA) and lateral (LAT) incidences. Data were collected from 200 patients related to 200 PA and 100 LAT incidences. Results showed that doses distributions in the three diagnostic services were very different; the best relation between dose and image quality was found in the institution with the chemical film processing. This work contributed for disseminating the radiation protection culture by emphasizing the need of a continuous dose reduction without losing the quality of the diagnostic image.

The association of market competition with hospital charges, length of stay, and quality outcomes for patients with joint diseases: a longitudinal study in Korea.

PubMed

Kim, Sun Jung; Park, Eun-Cheol; Yoo, Ki-Bong; Kwon, Jeoung A; Kim, Tae Hyun

2015-03-01

This study investigated the association of market competition with hospital charges, length of stay, and quality outcomes. A total of 279,847 patients from 851 hospitals were analyzed. The Herfindahl-Hirschman Index was used as a measure of hospital market competition level. Our results suggest that hospitals in less competitive markets charged more on charge per admission, possibly by increasing the length of stays, however, hospitals in more competitive markets charged more for daily services by providing more intensive services while reducing the length of stays, thereby reducing the overall charge per admission. Quality outcomes measured by mortality within 30 days of admission and readmission within 30 days of discharge were better for surgical procedures within competitive areas. Continued government monitoring of hospital response to market competition level is recommended in order to determine whether changes in hospitals' strategies influence the long-term outcomes of services performance and health care spending. © 2014 APJPH.

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.

Development of a new quality fair access best value performance indicator (BVPI) for recycling services.

PubMed

Harder, M K; Stantzos, N; Woodard, R; Read, A

2008-01-01

Recycling schemes are being used worldwide to reduce the impact of municipal waste. Those using public funds are usually obliged to set performance indicators by which the standards of such schemes can be measured. In the UK, a set of statutory Best Value Performance Indicators (BVPI) must be reported annually, such as the Quality of Fair Access, which monitors the public's access to recycling facilities within 1000 m (known as BVPI 91). This work shows that BVPI 91, and performance indicators like it, quantify only very basic recycling services. A much more sensitive performance indicator is developed in this paper, labelled as the Maximum Practicable Recycling Rate Provision (MPRRP) achievable by a local authority. It indicates the percentage of local waste that could be reasonably recycled using the services provided, calculated on the basis of the average composition of the local waste, the local population coverage for collection of any materials, and nationally provided information stating how much of each material stream is generally suitable (practical) for recycling. Evidence for the usefulness of this new quantity is presented. Although this paper refers a particular performance indicator in the UK, its findings are applicable to all urban areas worldwide needing to monitor recycling service. Furthermore, the MPRRP could be used for planning purposes, and for determining the level of performance of an existing service, by comparing its predicted recycling rate to that actually obtained. Further work is now being carried out on this.

An investigation of the effects of a nonprofit agency's investigations on quality of care in nursing homes.

PubMed

Lorentz, Madeline; Finnegan, Brittany

2013-01-01

This study examined whether an agency's investigation of complaints in 40 nursing homes is positively correlated with the quality of nursing home care. A quantitative methodology design using quantitative and qualitative data was used to assess the relationship between Agency X's investigation of consumers' nursing home complaints and the quality of nursing home care. Results showed fewer violations after the agency's interventions, indicating improvement in the nursing care. Analysis showed on average 0.14 fewer violations. This decrease is statistically significant (p = .015), indicating that this agency's intervention improved nursing home care. Additional studies are needed to further explore the quality of care given in nursing homes. Nurses may propose to the Centers for Medicare & Medicaid Services to establish a new innovative system for ensuring high quality nursing home care by requiring the establishment of outside agencies, such as Agency X, to monitor care in addition to the annual surveys conducted by the Department of Health and Human Services. © 2013 Wiley Periodicals, Inc.

Implementation of clinical governance in hospitals: challenges and the keys for success.

PubMed

Mousavi, Seyed Mohammad Hadi; Agharahimi, Zahra; Daryabeigi, Maede; Rezaei, Nima

2014-01-01

There is a number of models and strategies for improving the quality of care such as total quality management, continuous quality improvement and clinical governance. The policy of clinical governance is part of the governments overall strategy for monitoring, assuring and improving in the national health services organization. Clinical governance has been introduced as a bridge between managerial and clinical approaches to quality. For successful implementing of clinical governance, it is necessary to pay attention to firm foundations of the structure, including equipment, staffing arrangement, supporting specialties, and staff training. Therefore, as clinical governance improves safety and quality in health care services, the current situation in hospitals should be evaluated before any intervention while barriers and blocks on structure and process should be determined to select a method for changing them. Considering these points could guarantee success in implementation of clinical governance; otherwise there would be a little chance to achieve the desired results despite consumption of plenty of time and huge paper works.

A ten-year history: the Cancer Quality Council of Ontario.

PubMed

Anas, Rebecca; Bell, Robert; Brown, Adalsteinn; Evans, William; Sawka, Carol

2012-01-01

One of the longest-established quality oversight organizations in Canadian healthcare, the Cancer Quality Council of Ontario (CQCO) is an advisory group formed in 2002 by the Ministry of Health and Long-Term Care. Although quasi-independent from Cancer Care Ontario (CCO), the council was established to provide advice to CCO and the ministry in their efforts to improve the quality of cancer care in the province. The council is composed of a multidisciplinary group of healthcare providers, cancer survivors and experts in the areas of oncology, health system policy and administration, governance, performance measurement and health services research. Its mandate is to monitor and report publicly on the performance of the Ontario cancer system and to motivate improvement through national and international benchmarking. Since its formation, the council has played an evolving role in improving the quality of care received by Ontario cancer patients. This article will briefly describe the origins and founding principles of the CQCO, its changing role in monitoring quality and its relationship with CCO. Copyright © 2012 Longwoods Publishing.

Key Performance Indicators in Radiology: You Can't Manage What You Can't Measure.

PubMed

Harvey, H Benjamin; Hassanzadeh, Elmira; Aran, Shima; Rosenthal, Daniel I; Thrall, James H; Abujudeh, Hani H

2016-01-01

Quality assurance (QA) is a fundamental component of every successful radiology operation. A radiology QA program must be able to efficiently and effectively monitor and respond to quality problems. However, as radiology QA has expanded into the depths of radiology operations, the task of defining and measuring quality has become more difficult. Key performance indicators (KPIs) are highly valuable data points and measurement tools that can be used to monitor and evaluate the quality of services provided by a radiology operation. As such, KPIs empower a radiology QA program to bridge normative understandings of health care quality with on-the-ground quality management. This review introduces the importance of KPIs in health care QA, a framework for structuring KPIs, a method to identify and tailor KPIs, and strategies to analyze and communicate KPI data that would drive process improvement. Adopting a KPI-driven QA program is both good for patient care and allows a radiology operation to demonstrate measurable value to other health care stakeholders. Copyright © 2015 Mosby, Inc. All rights reserved.

Integrated software system for improving medical equipment management.

PubMed

Bliznakov, Z; Pappous, G; Bliznakova, K; Pallikarakis, N

2003-01-01

The evolution of biomedical technology has led to an extraordinary use of medical devices in health care delivery. During the last decade, clinical engineering departments (CEDs) turned toward computerization and application of specific software systems for medical equipment management in order to improve their services and monitor outcomes. Recently, much emphasis has been given to patient safety. Through its Medical Device Directives, the European Union has required all member nations to use a vigilance system to prevent the reoccurrence of adverse events that could lead to injuries or death of patients or personnel as a result of equipment malfunction or improper use. The World Health Organization also has made this issue a high priority and has prepared a number of actions and recommendations. In the present workplace, a new integrated, Windows-oriented system is proposed, addressing all tasks of CEDs but also offering a global approach to their management needs, including vigilance. The system architecture is based on a star model, consisting of a central core module and peripheral units. Its development has been based on the integration of 3 software modules, each one addressing specific predefined tasks. The main features of this system include equipment acquisition and replacement management, inventory archiving and monitoring, follow up on scheduled maintenance, corrective maintenance, user training, data analysis, and reports. It also incorporates vigilance monitoring and information exchange for adverse events, together with a specific application for quality-control procedures. The system offers clinical engineers the ability to monitor and evaluate the quality and cost-effectiveness of the service provided by means of quality and cost indicators. Particular emphasis has been placed on the use of harmonized standards with regard to medical device nomenclature and classification. The system's practical applications have been demonstrated through a pilot evaluation trial.

Estuarine water quality in parks of the Northeast Coastal and Barrier Network: vital signs estuarine nutrient-enrichment monitoring, 2006-11

USGS Publications Warehouse

Caldwell, James M.; Nixon, Matthew E.; Neckles, Hilary A.; Pooler, Penelope S.

2015-01-01

This report summarizes results of water-quality monitoring within estuaries of the National Park Service Northeast Coastal and Barrier Network (NCBN) from 2006 through 2011. Data collection formed part of the NCBN Vital Signs Monitoring Program implemented to detect threats of estuarine nutrient enrichment. Data included here were collected from six parks at predetermined intervals: Cape Cod National Seashore, Massachusetts (2007, 2008, 2009, 2010, 2011); Fire Island National Seashore, New York (2009, 2011); Gateway National Recreation Area, New York and New Jersey (2010); Assateague Island National Seashore, Maryland and Virginia (2006, 2008, 2010); George Washington Birthplace National Monument, Virginia (2009, 2011); and Colonial National Historic Park, Virginia (2008, 2010). Monitoring variables consisted of dissolved-oxygen concentration, chlorophyll a concentration, attenuation of downwelling photosynthetically available radiation (PAR), turbidity, water temperature, and salinity. All monitoring was conducted during four-week summer index periods. The monitoring design incorporated data collection at multiple, complementary spatial and temporal scales. Within each park, a spatial survey was conducted once during the index period following a probability design using a grid of tessellated hexagons as the basis for sample site selection. The spatial survey was supplemented with weekly measurements at a subset of sites and continuous monitoring at a single reference site. Within parks, data were reported as area-weighted water-quality conditions during each index period, the location and extent of estuarine area within condition categories, and spatial and temporal trends. In addition, we used a repeated measures analysis of variance to determine the extent to which variability in three water quality metrics (chlorophyll a in surface water, dissolved oxygen in bottom water, and water clarity expressed by PAR attenuation) was explained by year to year changes in each park's respective estuary. 

Usage of Wireless Sensor Networks in a service based spatial data infrastructure for Landslide Monitoring and Early Warning

NASA Astrophysics Data System (ADS)

Arnhardt, C.; Fernandez-Steeger, T. M.; Walter, K.; Kallash, A.; Niemeyer, F.; Azzam, R.; Bill, R.

2007-12-01

The joint project Sensor based Landslide Early Warning System (SLEWS) aims at a systematic development of a prototyping alarm- and early warning system for the detection of mass movements by application of an ad hoc wireless sensor network (WSN). Next to the development of suitable sensor setups, sensor fusion and network fusion are applied to enhance data quality and reduce false alarm rates. Of special interest is the data retrieval, processing and visualization in GI-Systems. Therefore a suitable serviced based Spatial Data Infrastructure (SDI) will be developed with respect to existing and upcoming Open Geospatial Consortium (OGC) standards.The application of WSN provides a cheap and easy to set up solution for special monitoring and data gathering in large areas. Measurement data from different low-cost transducers for deformation observation (acceleration, displacement, tilting) is collected by distributed sensor nodes (motes), which interact separately and connect each other in a self-organizing manner. Data are collected and aggregated at the beacon (transmission station) and further operations like data pre-processing and compression can be performed. The WSN concept provides next to energy efficiency, miniaturization, real-time monitoring and remote operation, but also new monitoring strategies like sensor and network fusion. Since not only single sensors can be integrated at single motes either cross-validation or redundant sensor setups are possible to enhance data quality. The planned monitoring and information system will include a mobile infrastructure (information technologies and communication components) as well as methods and models to estimate surface deformation parameters (positioning systems). The measurements result in heterogeneous observation sets that have to be integrated in a common adjustment and filtering approach. Reliable real-time information will be obtained using a range of sensor input and algorithms, from which early warnings and prognosis may be derived. Implementation of sensor algorithms is an important task to form the business logic. This will be represented in self-contained web-based processing services (WPS). In the future different types of sensor networks can communicate via an infrastructure of OGC services using an interoperable way by standardized protocols as the Sensor Markup Language (SensorML) and Observations & Measurements Schema (O&M). Synchronous and asynchronous information services as the Sensor Alert Service (SAS) and the Web Notification Services (WNS) will provide defined users and user groups with time-critical readings from the observation site. Techniques using services for visualizing mapping data (WMS), meta data (CSW), vector (WFS) and raster data (WCS) will range from high detailed expert based output to fuzzy graphical warning elements.The expected results will be an advancement regarding classical alarm and early warning systems as the WSN are free scalable, extensible and easy to install.

IMS: a new technology to develop a telemedicine system.

PubMed

Uceda, J D; Elena, M; Blasco, S; Tarrida, C L; Quero, J M

2008-01-01

The emergent IMS (Internet Protocol Multimedia Subsystem) technology appears to improve the current communication technologies. Its characteristics, such as Quality of Service (QoS), make it an advantageous system for innovative applications. Providing integrated services to users is one of the main reasons for the existence of IMS. Operators provide the technology as an open source, to be able to use services developed by researchers. Combining and integrating them, users will receive completely new services. Our proposal of use for IMS is the development of a telemedicine platform, designed to support not only remote biological signal monitoring, but value-added services for diagnosis and medical care, both of these working in real time.

The Satellite based Monitoring Initiative for Regional Air quality (SAMIRA): Project summary and first results

NASA Astrophysics Data System (ADS)

Schneider, Philipp; Stebel, Kerstin; Ajtai, Nicolae; Diamandi, Andrei; Horalek, Jan; Nemuc, Anca; Stachlewska, Iwona; Zehner, Claus

2017-04-01

We present a summary and some first results of a new ESA-funded project entitled Satellite based Monitoring Initiative for Regional Air quality (SAMIRA), which aims at improving regional and local air quality monitoring through synergetic use of data from present and upcoming satellite instruments, traditionally used in situ air quality monitoring networks and output from chemical transport models. Through collaborative efforts in four countries, namely Romania, Poland, the Czech Republic and Norway, all with existing air quality problems, SAMIRA intends to support the involved institutions and associated users in their national monitoring and reporting mandates as well as to generate novel research in this area. The primary goal of SAMIRA is to demonstrate the usefulness of existing and future satellite products of air quality for improving monitoring and mapping of air pollution at the regional scale. A total of six core activities are being carried out in order to achieve this goal: Firstly, the project is developing and optimizing algorithms for the retrieval of hourly aerosol optical depth (AOD) maps from the Spinning Enhanced Visible and InfraRed Imager (SEVIRI) onboard of Meteosat Second Generation. As a second activity, SAMIRA aims to derive particulate matter (PM2.5) estimates from AOD data by developing robust algorithms for AOD-to-PM conversion with the support from model- and Lidar data. In a third activity, we evaluate the added value of satellite products of atmospheric composition for operational European-scale air quality mapping using geostatistics and auxiliary datasets. The additional benefit of satellite-based monitoring over existing monitoring techniques (in situ, models) is tested by combining these datasets using geostatistical methods and demonstrated for nitrogen dioxide (NO2), sulphur dioxide (SO2), and aerosol optical depth/particulate matter. As a fourth activity, the project is developing novel algorithms for downscaling coarse-resolution satellite products of air quality with the help of high-resolution model information. This will add value to existing earth observation products of air quality by bringing them to spatial scales that are more in line with what is generally required for studying urban and regional scale air quality. In a fifth activity, we implement robust and independent validation schemes for evaluating the quality of the generated products. Finally, in a sixth activity the consortium is working towards a pre-operational system for improved PM forecasts using observational (in situ and satellite) data assimilation. SAMIRA aims to maximize project benefits by liaison with national and regional environmental protection agencies and health institutions, as well as related ESA and European initiatives such as the Copernicus Atmosphere Monitoring Service (CAMS).

The European Society of Gastrointestinal Endoscopy Quality Improvement Initiative: developing performance measures.

PubMed

Rutter, Matthew D; Senore, Carlo; Bisschops, Raf; Domagk, Dirk; Valori, Roland; Kaminski, Michal F; Spada, Cristiano; Bretthauer, Michael; Bennett, Cathy; Bellisario, Cristina; Minozzi, Silvia; Hassan, Cesare; Rees, Colin; Dinis-Ribeiro, Mário; Hucl, Tomas; Ponchon, Thierry; Aabakken, Lars; Fockens, Paul

2016-01-01

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology (UEG) have a vision to create a thriving community of endoscopy services across Europe, collaborating with each other to provide high quality, safe, accurate, patient-centered and accessible endoscopic care. Whilst the boundaries of what can be achieved by advanced endoscopy are continually expanding, we believe that one of the most fundamental steps to achieving our goal is to raise the quality of everyday endoscopy. The development of robust, consensus- and evidence-based key performance measures is the first step in this vision.ESGE and UEG have identified quality of endoscopy as a major priority. This paper explains the rationale behind the ESGE Quality Improvement Initiative and describes the processes that were followed. We recommend that all units develop mechanisms for audit and feedback of endoscopist and service performance using the ESGE performance measures that will be published in future issues of this journal over the next year. We urge all endoscopists and endoscopy services to prioritize quality and to ensure that these performance measures are implemented and monitored at a local level, so that we can provide the highest possible care for our patients. © Georg Thieme Verlag KG Stuttgart · New York.

The Role of International Accreditation in Promoting Academic and Professional Preparation in School Psychology

ERIC Educational Resources Information Center

Farrell, Peter; McFarland, Max; Gonzalez, Ruth; Hass, Michael; Stiles, Deborah A.

2014-01-01

The development of rigorous and universally respected quality assurance procedures that monitor and recognize the delivery of effective and ethically responsible public services has become increasingly evident in many countries. However, within professional psychology, these developments generally are located in individual countries. With a few…

Applications for remotely sensed evapotranspiration data in monitoring water quality, water use, and water security

USDA-ARS?s Scientific Manuscript database

Across the globe there are ever-increasing and competing demands for freshwater resources in support of food production, ecosystems services and human/industrial consumption. Recent studies using the GRACE satellite have identified severely stressed aquifers that are being unsustainably depleted du...

Agricultural applications for remotely sensed evapotranspiration data in monitoring water use, water quality, and water security

USDA-ARS?s Scientific Manuscript database

Across the U.S. and globally there are ever increasing and competing demands for freshwater resources in support of food production, ecosystems services and human/industrial consumption. Recent studies using the GRACE satellite have identified severely stressed aquifers globally, which are being un...

Quality Assurance Project Plan: Suitability of Leak Detection Technology for Use In Ethanol-Blended Fuel Service

EPA Science Inventory

Oversight of this investigation will be provided by the U.S. Environmental Protection Agency through the Environmental Technology Verification (ETV) Program. This project will be performed by Battelle, which manages the ETV Advanced Monitoring Systems (AMS) Center through a coop...

Feasibility of antiretroviral treatment monitoring in the era of decentralized HIV care: a systematic review.

PubMed

Pham, Minh D; Romero, Lorena; Parnell, Bruce; Anderson, David A; Crowe, Suzanne M; Luchters, Stanley

2017-01-19

Regular monitoring of HIV patients who are receiving antiretroviral therapy (ART) is required to ensure patient benefits and the long-term effectiveness and sustainability of ART programs. Prompted by WHO recommendations for expansion and decentralization of HIV treatment and care in low and middle income countries, we conducted a systematic review to assess the feasibility of treatment monitoring in these settings. A comprehensive search strategy was developed using a combination of MeSH and free text terms relevant to HIV treatment and care, health service delivery, health service accessibility, decentralization and other relevant terms. Five electronic databases and two conference websites were searched to identify relevant studies conducted in LMICs, published in English between Jan 2006 and Dec 2015. Outcomes of interest included the proportion of patients who received treatment monitoring and health system factors related to monitoring of patients on ART under decentralized HIV service delivery models. From 5363 records retrieved, twenty studies were included in the review; all but one was conducted in sub-Saharan African countries. The majority of studies (15/20) had relatively short follow-up duration (≤24 months), and only two studies were specifically designed to assess treatment monitoring practices. The most frequently studied follow-up period was 12 months and a wide range of treatment monitoring coverage was observed. The reported proportions of patients on ART who received CD4 monitoring ranged from very low (6%; N = 2145) to very high (95%; N = 488). The median uptake of viral load monitoring was 86% with studies in program settings reporting coverage as low as 14%. Overall, the longer the follow-up period, the lower the proportion of patients who received regular monitoring tests; and programs in rural areas reported low coverage of laboratory monitoring. Moreover, uptake in the context of research had significantly better where monitoring was done by dedicated research staff. In the absence of point of care (POC) testing, the limited capacity for blood sample transportation between clinic and laboratory and poor quality of nursing staff were identified as a major barrier for treatment monitoring practice. There is a paucity of data on the uptake of treatment monitoring, particularly with longer-term follow-up. Wide variation in access to both virological and immunological regular monitoring was observed, with some clinics in well-resourced settings supported by external donors achieving high coverage. The feasibility of treatment monitoring, particularly in decentralized settings of HIV treatment and care may thus be of concern and requires further study. Significant investment in POC diagnostic technologies and, improving the quality of and training for nursing staff is required to ensure effective scale up of ART programs towards the targets of 90-90-90 by the year 2020.

Lot quality assurance sampling for monitoring coverage and quality of a targeted condom social marketing programme in traditional and non-traditional outlets in India

PubMed Central

Piot, Bram; Navin, Deepa; Krishnan, Nattu; Bhardwaj, Ashish; Sharma, Vivek; Marjara, Pritpal

2010-01-01

Objectives This study reports on the results of a large-scale targeted condom social marketing campaign in and around areas where female sex workers are present. The paper also describes the method that was used for the routine monitoring of condom availability in these sites. Methods The lot quality assurance sampling (LQAS) method was used for the assessment of the geographical coverage and quality of coverage of condoms in target areas in four states and along selected national highways in India, as part of Avahan, the India AIDS initiative. Results A significant general increase in condom availability was observed in the intervention area between 2005 and 2008. High coverage rates were gradually achieved through an extensive network of pharmacies and particularly of non-traditional outlets, whereas traditional outlets were instrumental in providing large volumes of condoms. Conclusion LQAS is seen as a valuable tool for the routine monitoring of the geographical coverage and of the quality of delivery systems of condoms and of health products and services in general. With a relatively small sample size, easy data collection procedures and simple analytical methods, it was possible to inform decision-makers regularly on progress towards coverage targets. PMID:20167732

Lot quality assurance sampling for monitoring coverage and quality of a targeted condom social marketing programme in traditional and non-traditional outlets in India.

PubMed

Piot, Bram; Mukherjee, Amajit; Navin, Deepa; Krishnan, Nattu; Bhardwaj, Ashish; Sharma, Vivek; Marjara, Pritpal

2010-02-01

This study reports on the results of a large-scale targeted condom social marketing campaign in and around areas where female sex workers are present. The paper also describes the method that was used for the routine monitoring of condom availability in these sites. The lot quality assurance sampling (LQAS) method was used for the assessment of the geographical coverage and quality of coverage of condoms in target areas in four states and along selected national highways in India, as part of Avahan, the India AIDS initiative. A significant general increase in condom availability was observed in the intervention area between 2005 and 2008. High coverage rates were gradually achieved through an extensive network of pharmacies and particularly of non-traditional outlets, whereas traditional outlets were instrumental in providing large volumes of condoms. LQAS is seen as a valuable tool for the routine monitoring of the geographical coverage and of the quality of delivery systems of condoms and of health products and services in general. With a relatively small sample size, easy data collection procedures and simple analytical methods, it was possible to inform decision-makers regularly on progress towards coverage targets.

SAMIRA - SAtellite based Monitoring Initiative for Regional Air quality

NASA Astrophysics Data System (ADS)

Schneider, Philipp; Stebel, Kerstin; Ajtai, Nicolae; Diamandi, Andrei; Horalek, Jan; Nicolae, Doina; Stachlewska, Iwona; Zehner, Claus

2016-04-01

Here, we present a new ESA-funded project entitled Satellite based Monitoring Initiative for Regional Air quality (SAMIRA), which aims at improving regional and local air quality monitoring through synergetic use of data from present and upcoming satellites, traditionally used in situ air quality monitoring networks and output from chemical transport models. Through collaborative efforts in four countries, namely Romania, Poland, the Czech Republic and Norway, all with existing air quality problems, SAMIRA intends to support the involved institutions and associated users in their national monitoring and reporting mandates as well as to generate novel research in this area. Despite considerable improvements in the past decades, Europe is still far from achieving levels of air quality that do not pose unacceptable hazards to humans and the environment. Main concerns in Europe are exceedances of particulate matter (PM), ground-level ozone, benzo(a)pyrene (BaP) and nitrogen dioxide (NO2). While overall sulfur dioxide (SO2) emissions have decreased in recent years, regional concentrations can still be high in some areas. The objectives of SAMIRA are to improve algorithms for the retrieval of hourly aerosol optical depth (AOD) maps from SEVIRI, and to develop robust methods for deriving column- and near-surface PM maps for the study area by combining satellite AOD with information from regional models. The benefit to existing monitoring networks (in situ, models, satellite) by combining these datasets using data fusion methods will be tested for satellite-based NO2, SO2, and PM/AOD. Furthermore, SAMIRA will test and apply techniques for downscaling air quality-related EO products to a spatial resolution that is more in line with what is generally required for studying urban and regional scale air quality. This will be demonstrated for a set of study sites that include the capitals of the four countries and the highly polluted areas along the border of Poland and the Czech Republic, and the Gorj County in Romania. All data products shall undergo a quality control, i.e. robust and independent validation. The SAMIRA consortium will further work towards a pre-operational system for improved PM10 forecasts using observational (in situ and satellite) data assimilation. SAMIRA aims to maximize project benefits by liaison with national and regional environmental protection agencies and health institutions, as well as related ESA and European initiatives such as the Copernicus Atmospheric Monitoring Services (CAMS).

Secure and Efficient Reactive Video Surveillance for Patient Monitoring.

PubMed

Braeken, An; Porambage, Pawani; Gurtov, Andrei; Ylianttila, Mika

2016-01-02

Video surveillance is widely deployed for many kinds of monitoring applications in healthcare and assisted living systems. Security and privacy are two promising factors that align the quality and validity of video surveillance systems with the caliber of patient monitoring applications. In this paper, we propose a symmetric key-based security framework for the reactive video surveillance of patients based on the inputs coming from data measured by a wireless body area network attached to the human body. Only authenticated patients are able to activate the video cameras, whereas the patient and authorized people can consult the video data. User and location privacy are at each moment guaranteed for the patient. A tradeoff between security and quality of service is defined in order to ensure that the surveillance system gets activated even in emergency situations. In addition, the solution includes resistance against tampering with the device on the patient's side.

Secure and Efficient Reactive Video Surveillance for Patient Monitoring

PubMed Central

Braeken, An; Porambage, Pawani; Gurtov, Andrei; Ylianttila, Mika

2016-01-01

Video surveillance is widely deployed for many kinds of monitoring applications in healthcare and assisted living systems. Security and privacy are two promising factors that align the quality and validity of video surveillance systems with the caliber of patient monitoring applications. In this paper, we propose a symmetric key-based security framework for the reactive video surveillance of patients based on the inputs coming from data measured by a wireless body area network attached to the human body. Only authenticated patients are able to activate the video cameras, whereas the patient and authorized people can consult the video data. User and location privacy are at each moment guaranteed for the patient. A tradeoff between security and quality of service is defined in order to ensure that the surveillance system gets activated even in emergency situations. In addition, the solution includes resistance against tampering with the device on the patient’s side. PMID:26729130

Chronic kidney-disease screening service quality: questionnaire survey research evidence from Taichung City.

PubMed

Lin, Deng-Juin; Li, Ya-Hsin; Pai, Jar-Yuan; Sheu, Ing-Cheau; Glen, Robert; Chou, Ming-Jen; Lee, Ching-Yi

2009-12-19

Chronic kidney disease (CKD) is a serious public health problem in Taiwan and the world. The most effective, affordable treatments involve early prevention/detection/intervention, requiring screening. Successfully implementing CKD programs requires good patient participation, affected by patient perceptions of screening service quality. Service quality improvements can help make such programs more successful. Thus, good tools for assessing service quality perceptions are important. to investigate using a modified SERVQUAL questionnaire in assessing patient expectations, perceptions, and loyalty towards kidney disease screening service quality. 1595 kidney disease screening program patients in Taichung City were requested to complete and return a modified kidney disease screening SERVQUAL questionnaire. 1187 returned them. Incomplete ones (102) were culled and 1085 were chosen as effective for use. Paired t-tests, correlation tests, ANOVA, LSD test, and factor analysis identified the characteristics and factors of service quality. The paired t-test tested expectation score and perception score gaps. A structural equation modeling system examined satisfaction-based components' relationships. The effective response rate was 91.4%. Several methods verified validity. Cronbach's alpha on internal reliability was above 0.902. On patient satisfaction, expectation scores are high: 6.50 (0.82), but perception scores are significantly lower 6.14 (1.02). Older patients' perception scores are lower than younger patients'. Expectation and perception scores for patients with different types of jobs are significantly different. Patients higher on education have lower scores for expectation (r = -0.09) and perception (r = -0.26). Factor analysis identified three factors in the 22 item SERVQUAL form, which account for 80.8% of the total variance for the expectation scores and 86.9% of the total variance for the satisfaction scores. Expectation and perception score gaps in all 22 items are significant. The goodness-of-fit summary of the SEM results indicates that expectations and perceptions are positively correlated, perceptions and loyalty are positively correlated, but expectations and loyalty are not positively correlated. The results of this research suggest that the SERVQUAL instrument is a useful measurement tool in assessing and monitoring service quality in kidney disease screening services, enabling the staff to identify where service improvements are needed from the patients' perspectives.

In Vivo Monitoring Program Manual, PNL-MA-574

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

Lynch, Timothy P.

2010-07-01

An overview of the administration for the In Vivo Monitoring Program (IVMP) for Hanford. This includes organizational structure and program responsibilities; coordination of in vivo measurements; scheduling measurements; performing measurements; reporting results; and quality assurance. Overall responsibility for the management of the IVMP rests with the Program Manager (PM). The PM is responsible for providing the required in vivo counting services for Hanford Site contractor employees in accordance with Department of Energy (DOE) requirements and the specific statements of work.

Web technologies for rapid assessment of pollution of the atmosphere of the industrial city

NASA Astrophysics Data System (ADS)

Shaparev, N.; Tokarev, A.; Yakubailik, O.; Soldatov, A.

2018-05-01

The functionality, architectural features, the user interface of the geoinformation web-system of environmental monitoring of Krasnoyarsk is discussed. This system is created in service-oriented architecture. Data collection from the automated stations to monitor the state of atmospheric air has been implemented. An original device to measure the level of contamination of the atmosphere by fine dust PM2.5 has developed. Assessment of the level of air pollution is based on the quality index AQI atmosphere.

Action Monitoring for Equity and Gender in Health

PubMed Central

Bhuiya, Abbas; Hanifi, S.M.A.; Mahmood, Shehrin Shaila

2008-01-01

Equity and gender, despite being universal concerns for all health programmes in Bangladesh, are often missing in many of the health agenda. The health programmes fail to address these important dimensions unless these are specifically included in the planning stage of a programme and are continually monitored for progress. This paper presents the situation of equity in health in Bangladesh, innovations in monitoring equity in the use of health services in general and by the poor in particular, and impact of targeted non-health interventions on health outcomes of the poor. It was argued that an equitable use of health services might also result in enhanced overall coverage of the services. The findings show that government services at the upazila level are used by the poor proportionately more than they are in the community, while at the private facilities, the situation is reverse. Commonly-used monitoring tools, at times, are not very useful for the programme managers to know how well they are doing in reaching the poor. Use of benefit-incidence ratio may provide a quick feedback to the health facility managers about their extent of serving the poor. Similarly, Lot Quality Assurance Sampling can be an easy-to-use tool for monitoring coverage at the community level requiring a very small sample size. Although health problems are biomedical phenomena, their solutions may include actions beyond the biomedical framework. Studies have shown that non-health interventions targeted towards the poor improve the use of health services and reduce mortality among children in poor households. The study on equity and health deals with various interlocking issues, and the examples and views presented in this paper intend to introduce their importance in designing and managing health and development programmes. PMID:18831232

Action monitoring for equity and gender in health.

PubMed

Bhuiya, Abbas; Hanifi, S M A; Mahmood, Shehrin Shaila

2008-09-01

Equity and gender, despite being universal concerns for all health programmes in Bangladesh, are often missing in many of the health agenda. The health programmes fail to address these important dimensions unless these are specifically included in the planning stage of a programme and are continually monitored for progress. This paper presents the situation of equity in health in Bangladesh, innovations in monitoring equity in the use of health services in general and by the poor in particular, and impact of targeted non-health interventions on health outcomes of the poor. It was argued that an equitable use of health services might also result in enhanced overall coverage of the services. The findings show that government services at the upazila level are used by the poor proportionately more than they are in the community, while at the private facilities, the situation is reverse. Commonly-used monitoring tools, at times, are not very useful for the programme managers to know how well they are doing in reaching the poor. Use of benefit-incidence ratio may provide a quick feedback to the health facility managers about their extent of serving the poor. Similarly, Lot Quality Assurance Sampling can be an easy-to-use tool for monitoring coverage at the community level requiring a very small sample size. Although health problems are biomedical phenomena, their solutions may include actions beyond the biomedical framework. Studies have shown that non-health interventions targeted towards the poor improve the use of health services and reduce mortality among children in poor households. The study on equity and health deals with various interlocking issues, and the examples and views presented in this paper intend to introduce their importance in designing and managing health and development programmes.

System Proposal for Mass Transit Service Quality Control Based on GPS Data

PubMed Central

Padrón, Gabino; Cristóbal, Teresa; Alayón, Francisco; Quesada-Arencibia, Alexis; García, Carmelo R.

2017-01-01

Quality is an essential aspect of public transport. In the case of regular public passenger transport by road, punctuality and regularity are criteria used to assess quality of service. Calculating metrics related to these criteria continuously over time and comprehensively across the entire transport network requires the handling of large amounts of data. This article describes a system for continuously and comprehensively monitoring punctuality and regularity. The system uses location data acquired continuously in the vehicles and automatically transferred for analysis. These data are processed intelligently by elements that are commonly used by transport operators: GPS-based tracking system, onboard computer and wireless networks for mobile data communications. The system was tested on a transport company, for which we measured the punctuality of one of the routes that it operates; the results are presented in this article. PMID:28621745

System Proposal for Mass Transit Service Quality Control Based on GPS Data.

PubMed

Padrón, Gabino; Cristóbal, Teresa; Alayón, Francisco; Quesada-Arencibia, Alexis; García, Carmelo R

2017-06-16

Quality is an essential aspect of public transport. In the case of regular public passenger transport by road, punctuality and regularity are criteria used to assess quality of service. Calculating metrics related to these criteria continuously over time and comprehensively across the entire transport network requires the handling of large amounts of data. This article describes a system for continuously and comprehensively monitoring punctuality and regularity. The system uses location data acquired continuously in the vehicles and automatically transferred for analysis. These data are processed intelligently by elements that are commonly used by transport operators: GPS-based tracking system, onboard computer and wireless networks for mobile data communications. The system was tested on a transport company, for which we measured the punctuality of one of the routes that it operates; the results are presented in this article.

Toward of a highly integrated probe for improving wireless network quality

NASA Astrophysics Data System (ADS)

Ding, Fei; Song, Aiguo; Wu, Zhenyang; Pan, Zhiwen; You, Xiaohu

2016-10-01

Quality of service and customer perception is the focus of the telecommunications industry. This paper proposes a low-cost approach to the acquisition of terminal data, collected from LTE networks with the application of a soft probe, based on the Java language. The soft probe includes support for fast call in the form of a referenced library, and can be integrated into various Android-based applications to automatically monitor any exception event in the network. Soft probe-based acquisition of terminal data has the advantages of low cost and can be applied on large scale. Experiment shows that a soft probe can efficiently obtain terminal network data. With this method, the quality of service of LTE networks can be determined from acquired wireless data. This work contributes to efficient network optimization, and the analysis of abnormal network events.

How to achieve optimal organization of primary care service delivery at system level: lessons from Europe.

PubMed

Pelone, Ferruccio; Kringos, Dionne S; Spreeuwenberg, Peter; De Belvis, Antonio G; Groenewegen, Peter P

2013-09-01

To measure the relative efficiency of primary care (PC) in turning their structures into services delivery and turning their services delivery into quality outcomes. Cross-sectional study based on the dataset of the Primary Healthcare Activity Monitor for Europe project. Two Data Envelopment models were run to compare the relative technical efficiency. A sensitivity analysis of the resulting efficiency scores was performed. PC systems in 22 European countries in 2009/2010. Model 1 included data on PC governance, workforce development and economic conditions as inputs and access, coordination, continuity and comprehensiveness of care as outputs. Model 2 included the previous process dimensions as inputs and quality indicators as outputs. There is relatively reasonable efficiency in all countries at delivering as many as possible PC processes at a given level of PC structure. It is particularly important to invest in economic conditions to achieve an efficient structure-process balance. Only five countries have fully efficient PC systems in turning their services delivery into high quality outcomes, using a similar combination of access, continuity and comprehensiveness, although they differ on the adoption of coordination of services. There is a large variation in efficiency levels obtained by countries with inefficient PC in turning their services delivery into quality outcomes. Maximizing the individual functions of PC without taking into account the coherence within the health-care system is not sufficient from a policymaker's point of view when aiming to achieve efficiency.

An assessment of quality of home-based HIV counseling and testing performed by lay counselors in a rural sub-district of KwaZulu-Natal, South Africa.

PubMed

Magasana, Vuyolwethu; Zembe, Wanga; Tabana, Hanani; Naik, Reshma; Jackson, Debra; Swanevelder, Sonja; Doherty, Tanya

2016-12-01

HIV counseling and testing (HCT) has been prioritized as one of the prevention strategies for HIV/AIDS, and promoted as an essential tool in scaling up and improving access to treatment, care and support especially in community settings. Home-based HCT (HBHCT) is a model that has consistently been found to be highly acceptable and has improved HCT coverage and uptake in low- and middle-income countries since 2002. It involves trained lay counselors going door-to-door offering pre-test counseling and providing HCT services to consenting eligible household members. Currently, there are few studies reporting on the quality of HBHCT services offered by lay counselors especially in Sub-Saharan Africa, including South Africa. This is a quantitative descriptive sub-study of a community randomized trial (Good Start HBHCT trial) which describes the quality of HBHCT provided by lay counselors. Quality of HBHCT was measured as scores comparing observed practice to prescribed protocols using direct observation. Data were collected through periodic observations of HCT sessions and exit interviews with clients. Counselor quality scores for pre-test counseling and post-test counseling sessions were created to determine the level of quality. For the client exit interviews a continuous score was created to assess how satisfied the clients were with the counseling session. A total of 196 (3%) observational assessments and 406 (6%) client exit interviews were completed. Overall, median scores for quality of counseling and testing were high for both HIV-negative and HIV-positive clients. For exit interviews all 406 (100%) clients had overall satisfaction with the counseling and testing services they received, however 11% were concerned about the counselor keeping their discussion confidential. Of all 406 clients, 393 (96.8%) intended to recommend the service to other people. In ensuring good quality HCT services, ongoing quality assessments are important to monitor quality of HCT after training.

Harmonisation Initiatives of Copernicus Data Quality Control

NASA Astrophysics Data System (ADS)

Vescovi, F. D.; Lankester, T.; Coleman, E.; Ottavianelli, G.

2015-04-01

The Copernicus Space Component Data Access system (CSCDA) incorporates data contributions from a wide range of satellite missions. Through EO data handling and distribution, CSCDA serves a set of Copernicus Services related to Land, Marine and Atmosphere Monitoring, Emergency Management and Security and Climate Change. The quality of the delivered EO products is the responsibility of each contributing mission, and the Copernicus data Quality Control (CQC) service supports and complements such data quality control activities. The mission of the CQC is to provide a service of quality assessment on the provided imagery, to support the investigation related to product quality anomalies, and to guarantee harmonisation and traceability of the quality information. In terms of product quality control, the CQC carries out analysis of representative sample products for each contributing mission as well as coordinating data quality investigation related to issues found or raised by Copernicus users. Results from the product analysis are systematically collected and the derived quality reports stored in a searchable database. The CQC service can be seen as a privileged focal point with unique comparison capacities over the data providers. The comparison among products from different missions suggests the need for a strong, common effort of harmonisation. Technical terms, definitions, metadata, file formats, processing levels, algorithms, cal/val procedures etc. are far from being homogeneous, and this may generate inconsistencies and confusion among users of EO data. The CSCDA CQC team plays a significant role in promoting harmonisation initiatives across the numerous contributing missions, so that a common effort can achieve optimal complementarity and compatibility among the EO data from multiple data providers. This effort is done in coordination with important initiatives already working towards these goals (e.g. INSPIRE directive, CEOS initiatives, OGC standards, QA4EO etc.). This paper describes the main actions being undertaken by CQC to encourage harmonisation among space-based EO systems currently in service.

Developing a set of consensus indicators to support maternity service quality improvement: using Core Outcome Set methodology including a Delphi process.

PubMed

Bunch, K J; Allin, B; Jolly, M; Hardie, T; Knight, M

2018-05-16

To develop a core metric set to monitor the quality of maternity care. Delphi process followed by a face-to-face consensus meeting. English maternity units. Three representative expert panels: service designers, providers and users. Maternity care metrics judged important by participants. Participants were asked to complete a two-phase Delphi process, scoring metrics from existing local maternity dashboards. A consensus meeting discussed the results and re-scored the metrics. In all, 125 distinct metrics across six domains were identified from existing dashboards. Following the consensus meeting, 14 metrics met the inclusion criteria for the final core set: smoking rate at booking; rate of birth without intervention; caesarean section delivery rate in Robson group 1 women; caesarean section delivery rate in Robson group 2 women; caesarean section delivery rate in Robson group 5 women; third- and fourth-degree tear rate among women delivering vaginally; rate of postpartum haemorrhage of ≥1500 ml; rate of successful vaginal birth after a single previous caesarean section; smoking rate at delivery; proportion of babies born at term with an Apgar score <7 at 5 minutes; proportion of babies born at term admitted to the neonatal intensive care unit; proportion of babies readmitted to hospital at <30 days of age; breastfeeding initiation rate; and breastfeeding rate at 6-8 weeks. Core outcome set methodology can be used to incorporate the views of key stakeholders in developing a core metric set to monitor the quality of care in maternity units, thus enabling improvement. Achieving consensus on core metrics for monitoring the quality of maternity care. © 2018 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

Responses of Massachusetts hospitals to a state mandate to collect race, ethnicity and language data from patients: a qualitative study.

PubMed

Jorgensen, Selena; Thorlby, Ruth; Weinick, Robin M; Ayanian, John Z

2010-12-31

A Massachusetts regulation implemented in 2007 has required all acute care hospitals to report patients' race, ethnicity and preferred language using standardized methodology based on self-reported information from patients. This study assessed implementation of the regulation and its impact on the use of race and ethnicity data in performance monitoring and quality improvement within hospitals. Thematic analysis of semi-structured interviews with executives from a representative sample of 28 Massachusetts hospitals in 2009. The number of hospitals using race, ethnicity and language data internally beyond refining interpreter services increased substantially from 11 to 21 after the regulation. Thirteen of these hospitals were utilizing patient race and ethnicity data to identify disparities in quality performance measures for a variety of clinical processes and outcomes, while 16 had developed patient services and community outreach programs based on findings from these data. Commonly reported barriers to data utilization include small numbers within categories, insufficient resources, information system requirements, and lack of direction from the state. The responses of Massachusetts hospitals to this new state regulation indicate that requiring the collection of race, ethnicity and language data can be an effective method to promote performance monitoring and quality improvement, thereby setting the stage for federal standards and incentive programs to eliminate racial and ethnic disparities in the quality of health care.

Three methods to monitor utilization of healthcare services by the poor

PubMed Central

Bhuiya, Abbas; Hanifi, SMA; Urni, Farhana; Mahmood, Shehrin Shaila

2009-01-01

Background Achieving equity by way of improving the condition of the economically poor or otherwise disadvantaged is among the core goals of contemporary development paradigm. This places importance on monitoring outcome indicators among the poor. National surveys allow disaggregation of outcomes by socioeconomic status at national level and do not have statistical adequacy to provide estimates for lower level administrative units. This limits the utility of these data for programme managers to know how well particular services are reaching the poor at the lowest level. Managers are thus left without a tool for monitoring results for the poor at lower levels. This paper demonstrates that with some extra efforts community and facility based data at the lower level can be used to monitor utilization of healthcare services by the poor. Methods Data used in this paper came from two sources- Chakaria Health and Demographic Surveillance System (HDSS) of ICDDR,B and from a special study conducted during 2006 among patients attending the public and private health facilities in Chakaria, Bangladesh. The outcome variables included use of skilled attendants for delivery and use of facilities. Rate-ratio, rate-difference, concentration index, benefit incidence ratio, sequential sampling, and Lot Quality Assurance Sampling were used to assess how pro-poor is the use of skilled attendants for delivery and healthcare facilities. Findings Poor are using skilled attendants for delivery far less than the better offs. Government health service facilities are used more than the private facilities by the poor. Benefit incidence analysis and sequential sampling techniques could assess the situation realistically which can be used for monitoring utilization of services by poor. The visual display of the findings makes both these methods attractive. LQAS, on the other hand, requires small fixed sample and always enables decision making. Conclusion With some extra efforts monitoring of the utilization of healthcare services by the poor at the facilities can be done reliably. If monitored, the findings can guide the programme and facility managers to act in a timely fashion to improve the effectiveness of the programme in reaching the poor. PMID:19650938

Excerpts from Managing CQI in Radiology and Diagnostic Imaging Services: A CQI Handbook.

PubMed

Joseph, E D; Lesher, C; Zage, R

1994-01-01

Continuous quality improvement (CQI) is currently the most popular and influential quality management program used in healthcare organizations. It is an effective methodology for identifying and acting on opportunities to improve the efficiency, effectiveness and value of services provided to customers. CQI implementation can be broken down into four components: (1) achievement objectives and goal identification, (2) system process analysis, (3) action planning and implementation, and (4) performance measurement and follow-up. As the project team establishes goals, it should consider customer and staff needs, what constitutes "quality," existing guidelines and regulations, and how results will be measured. Many techniques can be used to analyze the procedure or function targeted for improvement, including charts and diagrams, formal monitoring, data collection and statistical analysis. After the project team has identified potential service improvements, they develop an action plan, which may include education, recruitment, reassignment or equipment acquisition. The team must consider the impact of proposed changes and the financial and logistical feasibility of various proposals. The dynamic challenges of radiology and diagnostic imaging cannot be addressed through single, isolated actions; efforts to improve quality should be continuous. Accordingly, the project team should measure and analyze results of the action plan, reappraise goals and look for opportunities to further improve service.

The use of patient feedback by hospital boards of directors: a qualitative study of two NHS hospitals in England.

PubMed

Lee, Robert; Baeza, Juan I; Fulop, Naomi J

2018-02-01

Although previous research suggests that different kinds of patient feedback are used in different ways to help improve the quality of hospital care, there have been no studies of the ways in which hospital boards of directors use feedback for this purpose. To examine whether and how boards of directors of hospitals use feedback from patients to formulate strategy and to assure and improve the quality of care. We undertook an in-depth qualitative study in two acute hospital National Health Service foundation trusts in England, purposively selected as contrasting examples of the collection of different kinds of patient feedback. We collected and analysed data from interviews with directors and other managers, from observation of board meetings, and from board papers and other documents. The two boards used in-depth qualitative feedback and quantitative feedback from surveys in different ways to help develop strategies, set targets for quality improvement and design specific quality improvement initiatives; but both boards made less subsequent use of any kinds of feedback to monitor their strategies or explicitly to assure the quality of services. We have identified limitations in the uses of patient feedback by hospital boards that suggest that boards should review their current practice to ensure that they use the different kinds of patient feedback that are available to them more effectively to improve, monitor and assure the quality of care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Improving the quality of healthcare for children: implementing the results of the AHSR research agenda conference.

PubMed Central

Halfon, N; Schuster, M; Valentine, W; McGlynn, E

1998-01-01

OBJECTIVE: To describe the rationale, development, content, and results of the AHSR-sponsored conference on developing a research agenda focused on improving the quality of care for children. DATA SOURCES AND METHODS: Planning documents, background papers, and conference proceedings. PRINCIPAL FINDINGS: The conference developed the research agenda focused on (1) monitoring the health of children; (2) evaluating the efficacy and effectiveness of health services for children; (3) assessing the quality of healthcare provided to children; (4) improving the quality of healthcare within health systems; (5) assessing the performance of community systems for children; (6) exploring the impact of different financial incentives on the provision of pediatric healthcare; and (7) developing and disseminating clinical practice guidelines and other information to physicians, families, and consumers. Specific issues and research questions in each area are also presented. Strategies for implementing the research agenda are presented and include: (1) expanding the child health services research workforce; (2) developing child healthcare quality improvement research centers; (3) conducting research in specific high-priority areas; (4) focusing research on improving the health of vulnerable populations; (5) improving child health data and collection systems at the national level; (6) developing better community health monitoring for children; (7) building and supporting research networks and a consortium of research users; and (8) developing a coordinated interagency federal effort to advance this agenda and to provide accountability for its completion. CONCLUSION: The proposed research agenda should be a national priority so that all Americans can be assured that children are receiving the best quality of care that the United States can provide. PMID:9776945

Client Satisfaction And Decision Making Amongst Females Visiting Family Planning Clinics In Hyderabad, Pakistan.

PubMed

Memon, Arbia; Hamid, Saima; Kumar, Ramesh

2017-01-01

Family Planning is the basic right of the human being. It involves decision regarding the number of children and desired space between children by the couple themselves. Quality services involving multiple dimensions build the confidence of the clients and lack of quality is one of the constraints behind incomplete coverage of family planning. Objectives of the current study were to determine the client satisfaction, decision-making process and various influences on clients in adopting family planning methods. This cross-sectional study was conducted at Family Planning Centre of Liaquat University Hospital, Hyderabad in 2016. Quality of the family planning services and satisfaction with the services were assessed through responses obtained from women selected purposively and visiting family planning centre through exit interviews with structured pretested and reliable questionnaire after taking the written consent. Access to Family Planning Centre was not an issue in 92% cases but only 31% respondents were appropriately greeted, 77% faced blank expression and 13% received sufficient privacy. Health problems and socioeconomic conditions were inquired by 41% and18% providers respectively, while motivating force for service use was mother in law in most 35% cases. Health workers were successful in clarifying misinformation (86%) and explaining side effects (71%) but only 21% respondents were satisfied with services. Respondents are influenced by family and health care providers while making decision and type of influence was considered positive by 83% respondents. Training and monitoring system be strengthened at family planning centres to improve quality of services while important influencing relations be focused for family planning education to improve utilization of services.

MEDNET: A Multi-State Policymaker/Researcher Collaboration to Improve Prescribing Practices

PubMed Central

Finnerty, Molly; Neese-Todd, Sheree; Bilder, Scott; Olfson, Mark; Crystal, Stephen

2015-01-01

States face new federal requirements to monitor psychotropic prescribing practices for children and adults in Medicaid. Effective use of quality measurement and quality improvement strategies hold the promise of improved outcomes for public mental health systems. The Medicaid/Mental Health Network for Evidence Based Treatment (MEDNET) is an AHRQ funded multi-state Medicaid quality collaborative with the Rutgers University Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes. We review the development, infrastructure, challenges, and early evidence of success of this public-academic partnership, the first multi-state Medicaid quality improvement collaborative to focus on psychotropic medications. PMID:25756882

A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center

PubMed Central

Sindhwani, Geetika; Gupta, Monica; Arora, Sweta; Mishra, Arpita; Bhatt, Jayesh; Arora, Manali; Gehani, Anisha

2017-01-01

Introduction An organization’s transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. Aim To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. Materials and Methods To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP’s), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis. Results A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. Conclusion Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety. PMID:28969238

mHealthMon: toward energy-efficient and distributed mobile health monitoring using parallel offloading.

PubMed

Ahnn, Jong Hoon; Potkonjak, Miodrag

2013-10-01

Although mobile health monitoring where mobile sensors continuously gather, process, and update sensor readings (e.g. vital signals) from patient's sensors is emerging, little effort has been investigated in an energy-efficient management of sensor information gathering and processing. Mobile health monitoring with the focus of energy consumption may instead be holistically analyzed and systematically designed as a global solution to optimization subproblems. This paper presents an attempt to decompose the very complex mobile health monitoring system whose layer in the system corresponds to decomposed subproblems, and interfaces between them are quantified as functions of the optimization variables in order to orchestrate the subproblems. We propose a distributed and energy-saving mobile health platform, called mHealthMon where mobile users publish/access sensor data via a cloud computing-based distributed P2P overlay network. The key objective is to satisfy the mobile health monitoring application's quality of service requirements by modeling each subsystem: mobile clients with medical sensors, wireless network medium, and distributed cloud services. By simulations based on experimental data, we present the proposed system can achieve up to 10.1 times more energy-efficient and 20.2 times faster compared to a standalone mobile health monitoring application, in various mobile health monitoring scenarios applying a realistic mobility model.

Quality of Surface Water in Missouri, Water Year 2007

USGS Publications Warehouse

Otero-Benitez, William; Davis, Jerri V.

2009-01-01

The U.S. Geological Survey, in cooperation with the Missouri Department of Natural Resources, designed and operates a series of monitoring stations on streams throughout Missouri known as the Ambient Water-Quality Monitoring Network. During the 2007 water year (October 1, 2006 through September 30, 2007), data were collected at 67 stations including two U.S. Geological Survey National Stream Quality Accounting Network stations and one spring sampled in cooperation with the U.S. Forest Service. Dissolved oxygen, specific conductance, water temperature, suspended solids, suspended sediment, fecal coliform bacteria, dissolved nitrite plus nitrte, total phosphorus, dissolved and total recoverable lead and zinc, and selected pesticide data summaries are presented for 64 of these stations, which primarily have been classified in groups corresponding to the physiography of the State, main land use, or unique station types. In addition, a summary of hydrologic conditions in the State during water year 2007 is presented.

Process auditing in long term care facilities.

PubMed

Hewitt, S M; LeSage, J; Roberts, K L; Ellor, J R

1985-01-01

The ECC tool development and audit experiences indicated that there is promise in developing a process audit tool to monitor quality of care in nursing homes; moreover, the tool selected required only one hour per resident. Focusing on the care process and resident needs provided useful information for care providers at the unit level as well as for administrative personnel. Besides incorporating a more interdisciplinary focus, the revised tool needs to define support services most appropriate for nursing homes, includes items related to discharge planning and increases measurement of significant others' involvement in the care process. Future emphasis at the ECC will focus on developing intervention plans to maintain strengths and correct deficiencies identified in the audits. Various strategies to bring about desired changes in the quality of care will be evaluated through regular, periodic monitoring. Having a valid and reliable measure of quality of care as a tool will be an important step forward for LTC facilities.

From Computer-interpretable Guidelines to Computer-interpretable Quality Indicators: A Case for an Ontology.

PubMed

White, Pam; Roudsari, Abdul

2014-01-01

In the United Kingdom's National Health Service, quality indicators are generally measured electronically by using queries and data extraction, resulting in overlap and duplication of query components. Electronic measurement of health care quality indicators could be improved through an ontology intended to reduce duplication of effort during healthcare quality monitoring. While much research has been published on ontologies for computer-interpretable guidelines, quality indicators have lagged behind. We aimed to determine progress on the use of ontologies to facilitate computer-interpretable healthcare quality indicators. We assessed potential for improvements to computer-interpretable healthcare quality indicators in England. We concluded that an ontology for a large, diverse set of healthcare quality indicators could benefit the NHS and reduce workload, with potential lessons for other countries.

[Cleaning and disinfection of surfaces in hospitals: Data on structure, process and result in the Frankfurt/Main Metropolitan Area].

PubMed

Hausemann, A; Hofmann, H; Otto, U; Heudorf, Ursel

2015-06-01

In addition to hand hygiene and reprocessing of medical products, cleaning and disinfection of surfaces is also an important issue in the prevention of germ transmission and by implication infections. Therefore, in 2014, the quality of the structure, process and result of surface preparation of all hospitals in Frankfurt am Main, Germany, was monitored. All 17 hospitals transferred information on the quality of structure. Process quality was obtained through direct observation during cleaning and disinfection of rooms and their plumbing units. Result quality was gained using the fluorescent method, i.e. marking surfaces with a fluorescent liquid and testing if this mark has been sufficiently removed by cleaning. Structure quality: in all hospitals the employees were trained regularly. In 12 of them, the foremen had the required qualifications, in 6 hospitals unclarity as to the intersection of the cleaning and care services remained. In 14 hospitals only visible contamination was cleaned on the weekends, whereas complete cleaning was reported to take place in 12 hospitals on Saturdays and in 2 hospitals on Sundays. The contractually stipulated cleaning (observations specified in brackets) averaged 178 m(2)/h (148 m(2)/h) per patient room and 69 m(2)/h (33 m(2)/h) for bathrooms. Process quality: during process monitoring, various hand contact surfaces were prepared insufficiently. Result quality: 63 % of fluorescent markings were appropriately removed. The need for improvement is given especially in the area of the qualification of the foremen and a in a clear definition of the intersection between cleaning and care services, as well as in the regulations for weekends and public holidays.

Quality in laboratory medicine: 50years on.

PubMed

Plebani, Mario

2017-02-01

The last 50years have seen substantial changes in the landscape of laboratory medicine: its role in modern medicine is in evolution and the quality of laboratory services is changing. The need to control and improve quality in clinical laboratories has grown hand in hand with the growth in technological developments leading to an impressive reduction of analytical errors over time. An essential cause of this impressive improvement has been the introduction and monitoring of quality indicators (QIs) such as the analytical performance specifications (in particular bias and imprecision) based on well-established goals. The evolving landscape of quality and errors in clinical laboratories moved first from analytical errors to all errors performed within the laboratory walls, subsequently to errors in laboratory medicine (including errors in test requesting and result interpretation), and finally, to a focus on errors more frequently associated with adverse events (laboratory-associated errors). After decades in which clinical laboratories have focused on monitoring and improving internal indicators of analytical quality, efficiency and productivity, it is time to shift toward indicators of total quality, clinical effectiveness and patient outcomes. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Deformation integrity monitoring for GNSS positioning services including local, regional and large scale hazard monitoring - the Karlsruhe approach and software(MONIKA)

NASA Astrophysics Data System (ADS)

Jaeger, R.

2007-05-01

GNSS-positioning services like SAPOS/ascos in Germany and many others in Europe, America and worldwide, usually yield in a short time their interdisciplinary and country-wide use for precise geo-referencing, replacing traditional low order geodetic networks. So it becomes necessary that possible changes of the reference stations' coordinates are detected ad hoc. The GNSS-reference-station MONitoring by the KArlsruhe approach and software (MONIKA) are designed for that task. The developments at Karlsruhe University of Applied Sciences in cooperation with the State Survey of Baden-Württemberg are further motivated by a the official resolution of the German state survey departments' association (Arbeitsgemeinschaft der Vermessungsverwaltungen Deutschland (AdV)) 2006 on coordinate monitoring as a quality-control duty of the GNSS-positioning service provider. The presented approach can - besides the coordinate control of GNSS-positioning services - also be used to set up any GNSS-service for the tasks of an area-wide geodynamical and natural disaster-prevention service. The mathematical model of approach, which enables a multivariate and multi-epochal design approach, is based on the GNSS-observations input of the RINEX-data of the GNSS service, followed by fully automatic processing of baselines and/or session, and a near-online setting up of epoch-state vectors and their covariance-matrices in a rigorous 3D network adjustment. In case of large scale and long-term monitoring situations, geodynamical standard trends (datum-drift, plate-movements etc.) are accordingly considered and included in the mathematical model of MONIKA. The coordinate-based deformation monitoring approach, as third step of the stepwise adjustments, is based on the above epoch-state vectors, and - splitting off geodynamics trends - hereby on a multivariate and multi-epochal congruency testing. So far, that no other information exists, all points are assumed as being stable and congruent reference points. Stations, which a priori assumed as moving - in that way local monitoring areas can be included- are to be monitored and analyzed in reference to the stable reference points. In that way, a high sensitivity for the detection of GNSS station displacements, both for assumed stable points, as well as for a priori moving points, can be achieved. The results for the concept are shown at the example of a monitoring using the MONINKA-software in the 300 x 300 km area of the state of Baden-Württemberg, Germany.

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.

Effects of an Asthma Training and Monitoring Program on Children’s Disease Management and Quality of Life

PubMed Central

Ekici, Behice; Cimete, Güler

2015-01-01

OBJECTIVES To determine the effects of an asthma training and monitoring program on children’s disease management and quality of life. MATERIAL AND METHODS The sample consisted of 120 children and their parents. Data were collected during, at the beginning, and at the end of the 3-month monitoring period using four forms and a quality of life scale. After an initial evaluation, approaches to control symptoms and asthma triggers and measures that might be taken for them were taught to the children and parents. The children recorded the conditions of trigger exposure, experience of disease symptoms, their effects on daily activities, and therapeutic implementations on a daily basis. RESULTS During the 3-month monitoring period, the number of days when the children were exposed to triggers (p=0.000) and experienced disease symptoms decreased to a statistically significant level (p=0.006). Majority of domestic triggers disappeared, but those stemming from the structure of the house and non-domestic triggers indicated no change (p>0.05). Moreover, 30.8% of the children applied to a physician/hospital/emergency service, 4.2% of the children were hospitalized, and 30% of them could not go to school. The number of times when the children applied to a physician/hospital/emergency (p=0.013), the number of times they used medicines (p=0.050), and the number of days they could not go to school (p=0.002) decreased at a statistically significant level, and their quality of life increased (p=0.001). CONCLUSION Asthma training and monitoring program decreased children’s rate of experiencing asthma symptoms and implementations of therapeutic purposes and increased their life quality. PMID:29404097

Cancer control in developing countries: using health data and health services research to measure and improve access, quality and efficiency

PubMed Central

2010-01-01

Background Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. Discussion This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1) Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2) Process: enabling follow-up, knowledge translation, patient safety and quality assurance. (3) Outcome: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. Summary There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1) Capacity building in oncology health services research, policy and planning relevant to developing countries. (2) Development of high-quality health data sources. (3) More oncology-related economic evaluations in developing countries. (4) Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and international collaboration as well as political leadership. Horizontal integration with programs for other diseases will be important. PMID:20942937

Clustering techniques: measuring the performance of contract service providers.

PubMed

Cruz, Antonio Miguel; Perilla, Sandra Patricia Usaquén; Pabón, Nidia Nelly Vanegas

2010-01-01

This paper investigates the use of clustering technique to characterize the providers of maintenance services in a health-care institution according to their performance. A characterization of the inventory of equipment from seven pilot areas was carried out first (including 264 medical devices). The characterization study concluded that the inventory on a whole is old [exploitation time (ET)/useful life (UL) average is 0.78] and has high maintenance service costs relative to the original cost of acquisition (service cost /acquisition cost average 8.61%). A monitoring of the performance of maintenance service providers was then conducted. The variables monitored were response time (RT), service time (ST), availability, and turnaround time (TAT). Finally, the study grouped maintenance service providers into clusters according to performance. The study grouped maintenance service providers into the following clusters. Cluster 0: Identified with the best performance, the lowest values of TAT, RT, and ST, with an average TAT value of 1.46 days; Clusters 1 and 2: Identified with the poorest performance, highest values of TAT, RT, and ST, and an average TAT value of 9.79 days; and Cluster 3: Identified by medium-quality performance, intermediate values of TAT, RT, and ST, and an average TAT value of 2.56 days.

Improving access to services and interactions with clients in Guatemala: the value of distance learning.

PubMed

Brambila, Carlos; Lopez, Felipe; Garcia-Colindres, Julio; Donis, Marco Vinicio

2005-04-01

To develop and test a distance-learning programme to improve the quality and efficiency of family planning services in Guatemala. The setting was rural family planning services in Guatemala. The study design was quasi-experimental with one intervention and one control group and with pre- and post-intervention measures. Two staff members from each of 20 randomly selected health districts were trained as leaders of the training programme. In turn, the 40 trainers trained a total of 240 service providers, under the supervision of four health area facilitators. The results were compared with 20 randomly selected control health districts. The intervention was a distance-learning programme including 40 in-class hours followed by 120 inservice practice hours spread over a 4-month period. Distinctively, the programme used a cascade approach to training, intensive supervision, and close monitoring and evaluation. Patient flow analysis was used to determine number of contacts, waiting times, and the interaction time between service providers and clients. Consultation observations were used to assess the quality and completeness of reproductive health information and services received by clients. The intervention showed a positive impact on reducing the number of contacts before the consultation and client waiting times. More complete services and better quality services were provided at intervention clinics. Some, but not all, of the study objectives were attained. The long-term impact of the intervention is as yet unknown. Distance-learning programmes are an effective methodology for training health professionals in rural areas.

Indicators and protocols for monitoring impacts of formal and informal trails in protected areas

USGS Publications Warehouse

Marion, Jeffrey L.; Leung, Yu-Fai

2011-01-01

Trails are a common recreation infrastructure in protected areas and their conditions affect the quality of natural resources and visitor experiences. Various trail impact indicators and assessment protocols have been developed in support of monitoring programs, which are often used for management decision-making or as part of visitor capacity management frameworks. This paper reviews common indicators and assessment protocols for three types of trails, surfaced formal trails, unsurfaced formal trails, and informal (visitor-created) trails. Monitoring methods and selected data from three U.S. National Park Service units are presented to illustrate some common trail impact indicators and assessment options.

Good laboratory practices for biochemical genetic testing and newborn screening for inherited metabolic disorders.

PubMed

2012-04-06

Biochemical genetic testing and newborn screening are essential laboratory services for the screening, detection, diagnosis, and monitoring of inborn errors of metabolism or inherited metabolic disorders. Under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations, laboratory testing is categorized on the basis of the level of testing complexity as either waived (i.e., from routine regulatory oversight) or nonwaived testing (which includes tests of moderate and high complexity). Laboratories that perform biochemical genetic testing are required by CLIA regulations to meet the general quality systems requirements for nonwaived testing and the personnel requirements for high-complexity testing. Laboratories that perform public health newborn screening are subject to the same CLIA regulations and applicable state requirements. As the number of inherited metabolic diseases that are included in state-based newborn screening programs continues to increase, ensuring the quality of performance and delivery of testing services remains a continuous challenge not only for public health laboratories and other newborn screening facilities but also for biochemical genetic testing laboratories. To help ensure the quality of laboratory testing, CDC collaborated with the Centers for Medicare & Medicaid Services, the Food and Drug Administration, the Health Resources and Services Administration, and the National Institutes of Health to develop guidelines for laboratories to meet CLIA requirements and apply additional quality assurance measures for these areas of genetic testing. This report provides recommendations for good laboratory practices that were developed based on recommendations from the Clinical Laboratory Improvement Advisory Committee, with additional input from the Secretary's Advisory Committee on Genetics, Health, and Society; the Secretary's Advisory Committee on Heritable Disorders in Newborns and Children; and representatives of newborn screening laboratories. The recommended practices address the benefits of using a quality management system approach, factors to consider before introducing new tests, establishment and verification of test performance specifications, the total laboratory testing process (which consists of the preanalytic, analytic, and postanalytic phases), confidentiality of patient information and test results, and personnel qualifications and responsibilities for laboratory testing for inherited metabolic diseases. These recommendations are intended for laboratories that perform biochemical genetic testing to improve the quality of laboratory services and for newborn screening laboratories to ensure the quality of laboratory practices for inherited metabolic disorders. These recommendations also are intended as a resource for medical and public health professionals who evaluate laboratory practices, for users of laboratory services to facilitate their collaboration with newborn screening systems and use of biochemical genetic tests, and for standard-setting organizations and professional societies in developing future laboratory quality standards and practice recommendations. This report complements Good Laboratory Practices for Molecular Genetic Testing for Heritable Diseases and Conditions (CDC. Good laboratory practices for molecular genetic testing for heritable diseases and conditions. MMWR 2009;58 [No. RR-6]) to provide guidance for ensuring and improving the quality of genetic laboratory services and public health outcomes. Future recommendations for additional areas of genetic testing will be considered on the basis of continued monitoring and evaluation of laboratory practices, technology advancements, and the development of laboratory standards and guidelines.

Can the Mentoring and Socialization of Pre-Service Teachers Improve Teacher Education?

ERIC Educational Resources Information Center

Vumilia, Philbert L.; Semali, Ladislaus M.

2016-01-01

The goal of this study was to determine whether the processes of mentoring and socialization that take place during block teaching practice (BTP) in Tanzania can improve the quality of teacher education. In this essay, "mentoring" refers to all activities geared toward guiding, counseling, monitoring, supervising, and supporting teacher…

Outcomes Program in a Small, Rural Community College.

ERIC Educational Resources Information Center

Carlson, Dale R.; Fleming, Donald

Student educational outcomes and the quality of instruction are now being monitored by several programs at Worthington Community College (WCC) in southwest Minnesota. WCC, one of the 20 community colleges in the Minnesota Community College system, currently serves 875 students, and has been intensifying its efforts to serve the whole service area…

GIS as a Tool in Interdisciplinary Environmental Studies: Student, Teacher, and Community Perspectives.

ERIC Educational Resources Information Center

Alibrandi, Marsha

1998-01-01

Describes an application of Geographic Information Systems (GIS) technology as a tool in an environmental community-service project in which students and adult community members participated in water-quality monitoring and biological assessment. Discusses issues and problems associated with technology in education and recommends a balance of…

Urban Forest Health Monitoring in the United States

Treesearch

David J. Nowak; Robert Hoehn; Jeffrey T. Walton; Daniel E. Crane; Jack C. Stevens; Daniel Twardus; Anne Cumming; Manfred Mielke; Bill Smith

2006-01-01

Trees in cities can contribute significantly to human health and environmental quality. Unfortunately, little is known about the urban forest resource and what it contributes to the local, regional, and national societal and economic interests. To help better understand the urban forest resource and its numerous values, the USDA Forest Service has initiated a pilot...

Medicare program; standards for quality of water used in dialysis and revised guidelines on reuse of hemodialysis filters for end-stage renal disease (ESRD) patients--HCFA. Final rule.

PubMed

1995-09-18

This final rule revises the Medicare conditions for coverage of suppliers of end-stage renal disease services. The revisions remove general language in the regulations regarding water quality; incorporate by reference standards for monitoring the quality of water used in dialysis as published by the Association for the Advancement of Medical Instrumentation (AAMI) in its document, "Hemodialysis Systems" (second edition); and update existing regulations to incorporate by reference the second edition of AAMI's voluntary guidelines on "Reuse of Hemodialyzers."

The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study.

PubMed

Grant, Suzanne; Huby, Guro; Watkins, Francis; Checkland, Kath; McDonald, Ruth; Davies, Huw; Guthrie, Bruce

2009-03-01

The 2004 new General Medical Services (nGMS) contract exemplifies trends across the public services towards increased definition, measurement and regulation of professional work, with general practice income now largely dependent on the quality of care provided across a range of clinical and organisational indicators known collectively as the 'Quality and Outcomes Framework' (QOF). This paper reports an ethnographically based study of the impact of the new contract and the financial incentives contained within it on professional boundaries in UK general practice. The distribution of clinical and administrative work has changed significantly and there has been a new concentration of authority, with QOF decision making and monitoring being led by an internal QOF team of clinical and managerial staff who make the major practice-level decisions about QOF, monitor progress against targets, and intervene to resolve areas or indicators at risk of missing targets. General practitioners and nurses, however, appear to have accommodated these changes by re-creating long established narratives on professional boundaries and clinical hierarchies. This paper is concerned with the impact of these new arrangements on existing clinical hierarchies.

Governance and Purchasing Function under Social Health Insurance in Nepal: Looking Back and Moving Forward.

PubMed

Sapkota, V P; Bhusal, U P

2017-01-01

Nepal is pursuing Social Health Insurance as a way of mobilizing revenues to achieve Universal Health Coverage. The Social Health Insurance governance encourages service providers to maintain quality and efficiency in services provision by practicing strategic purchasing. Social Health Security Programme is a social protection program which aspires to achieve the goals of Social Health Insurance. Social Health Security Development Committee needs to consider following experiences to function as a strategic purchaser. The Social Health Security Development Committee need to be an independent body instead of falling under Ministry of Health. Similarly, purchasing of health services needs to be made strategic, i.e., Social Health Security Development Committee should use its financial power to guide the provider behavior that will eventually contribute to achieving the goals of quality and efficiency in service provision. The other social health security funds should be merged with Social Health Security Development Committee and develop a single national fund. Finally, the state has to regulate and monitor the performance of the SHI agency.

An audit of the quality of inpatient care for adults with learning disability in the UK.

PubMed

Sheehan, Rory; Gandesha, Aarti; Hassiotis, Angela; Gallagher, Pamela; Burnell, Matthew; Jones, Glyn; Kerr, Michael; Hall, Ian; Chaplin, Robert; Crawford, Michael J

2016-04-18

To audit patient hospital records to evaluate the performance of acute general and mental health services in delivering inpatient care to people with learning disability and explore the influence of organisational factors on the quality of care they deliver. Nine acute general hospital Trusts and six mental health services. Adults with learning disability who received inpatient hospital care between May 2013 and April 2014. Data on seven key indicators of high-quality care were collected from 176 patients. These covered physical health/monitoring, communication and meeting needs, capacity and decision-making, discharge planning and carer involvement. The impact of services having an electronic system for flagging patients with learning disability and employing a learning disability liaison nurse was assessed. Indicators of physical healthcare (body mass index, swallowing assessment, epilepsy risk assessment) were poorly recorded in acute general and mental health inpatient settings. Overall, only 34 (19.3%) patients received any assessment of swallowing and 12 of the 57 with epilepsy (21.1%) had an epilepsy risk assessment. For most quality indicators, there was a non-statistically significant trend for improved performance in services with a learning disability liaison nurse. The presence of an electronic flagging system showed less evidence of benefit. Inpatient care for people with learning disability needs to be improved. The work gives tentative support to the role of a learning disability liaison nurse in acute general and mental health services, but further work is needed to confirm these benefits and to trial other interventions that might improve the quality and safety of care for this high-need group. 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/

The politics of assessment: water and sanitation MDGs in the Middle East.

PubMed

Zawahri, Neda; Sowers, Jeannie; Weinthal, Erika

2011-01-01

The Middle East and North Africa (MENA) is generally considered to be making adequate progress towards meeting Target 10 of the Millennium Development Goals (MDGs), which calls for halving the proportion of the population with inadequate access to drinking water and sanitation. Progress towards achieving Target 10 is evaluated by the Joint Monitoring Programme (JMP), run by UNICEF and WHO. This article shows that the assessment methodologies employed by the JMP significantly overstate coverage rates in the drinking water and sanitation sectors, by overlooking and ‘not counting’ problems of access, affordability, quality of service and pollution. The authors show that states in MENA often fail to provide safe drinking water and adequate sanitation services, particularly in densely populated informal settlements, and that many centralized water and sanitation infrastructures contribute to water pollution and contamination. Despite the glaring gap between the MDG statistics and the evidence available from national and local reports, exclusionary political regimes in the region have had few incentives to adopt more accurate assessments and improve the quality of service. While international organizations have proposed some reforms, they too lack incentives to employ adequate measures that gauge access, quality and affordability of drinking water and sanitation services.

Voluntary Noise Mapping for Smart City

NASA Astrophysics Data System (ADS)

Poslončec-Petrić, V.; Vuković, V.; Frangeš, S.; Bačić, Ž.

2016-09-01

One of the main concept objectives of smart cities is to create a quality living environment that is long-term sustainable and economically justified. In that context, modern cities are aware of the exposure to various forms of physical and non-physical pollution that needs to be remediated, eliminated or reduced. To achieve that it is necessary to quality determine the sources and reasons of each pollution. The most prominent examples of physical pollution that affects the quality of life of citizens in cities are light and noise pollution. Noise pollution or noise, is mostly the consequence of road and rail traffic in cities and it directly affects the health of citizens. Traffic control, reduction of peak congestion, dispersion and traffic redirection or building protective barriers, are ways that cities use to reduce the amount of noise or its effects. To make these measures efficient it is necessary to obtain the information related to the level of noise in certain areas, streets, cities. To achieve this, smart cities use noise mapping. The city of Zagreb since 2012, participates in the i-SCOPE project (interoperable Smart City services trough Open Platform for urban Ecosystems). i-SCOPE delivers an open platform on top of which it develops, three "smart city" services: optimization of energy consumption through a service for accurate assessment of solar energy potential and energy loss at building level, environmental monitoring through a real-time environmental noise mapping service leveraging citizen's involvement will who act as distributed sensors city-wide measuring noise levels through an application on their mobile phones and improved inclusion and personal mobility of aging and diversely able citizens through an accurate personal routing service. The students of Faculty of Geodesy University of Zagreb, who enrolled in the course Thematic Cartography, were actively involved in the voluntary data acquisition in order to monitor the noise in real time. In this paper are presented the voluntary acquisitioned data of noise level measurement in Zagreb through a mobile application named Noise Tube, which were used as the basis for creating the dynamic noise map. The paper describes how citizens through voluntarily collected geoinformation can directly influence decision-making in their community, which certainly affects the quality of life.

Barriers in the Delivery of Emergency Obstetric and Neonatal Care in Post-Conflict Africa: Qualitative Case Studies of Burundi and Northern Uganda

PubMed Central

Chi, Primus Che; Bulage, Patience; Urdal, Henrik; Sundby, Johanne

2015-01-01

Objectives Maternal and neonatal mortality and morbidity rates are particularly grim in conflict, post-conflict and other crisis settings, a situation partly blamed on non-availability and/or poor quality of emergency obstetric and neonatal care (EmONC) services. The aim of this study was to explore the barriers to effective delivery of EmONC services in post-conflict Burundi and Northern Uganda, in order to provide policy makers and other relevant stakeholders context-relevant data on improving the delivery of these lifesaving services. Methods This was a qualitative comparative case study that used 42 face-to-face semi-structured in-depth interviews and 4 focus group discussions for data collection. Participants were 32 local health providers and 37 staff of NGOs working in the area of maternal health. Data was analysed using the framework approach. Results The availability, quality and distribution of EmONC services were major challenges across the sites. The barriers in the delivery of quality EmONC services were categorised into two major themes; human resources-related challenges, and systemic and institutional failures. While some of the barriers were similar, others were unique to specific sites. The common barriers included shortage of qualified staff; lack of essential installations, supplies and medications; increasing workload, burn-out and turnover; and poor data collection and monitoring systems. Barriers unique to Northern Uganda were demoralised personnel and lack of recognition; poor referral system; inefficient drug supply system; staff absenteeism in rural areas; and poor coordination among key personnel. In Burundi, weak curriculum; poor harmonisation and coordination of training; and inefficient allocation of resources were the unique challenges. To improve the situation across the sites, efforts are ongoing to improve the training and recruitment of more staff; harmonise and strengthen the curriculum and training; increase the number of EmONC facilities; and improve staff supervision, monitoring and support. Conclusions Post-conflict health systems face different challenges in the delivery of EmONC services and as such require context-specific interventions to improve the delivery of these services. PMID:26405800

Barriers in the Delivery of Emergency Obstetric and Neonatal Care in Post-Conflict Africa: Qualitative Case Studies of Burundi and Northern Uganda.

PubMed

Chi, Primus Che; Bulage, Patience; Urdal, Henrik; Sundby, Johanne

2015-01-01

Maternal and neonatal mortality and morbidity rates are particularly grim in conflict, post-conflict and other crisis settings, a situation partly blamed on non-availability and/or poor quality of emergency obstetric and neonatal care (EmONC) services. The aim of this study was to explore the barriers to effective delivery of EmONC services in post-conflict Burundi and Northern Uganda, in order to provide policy makers and other relevant stakeholders context-relevant data on improving the delivery of these lifesaving services. This was a qualitative comparative case study that used 42 face-to-face semi-structured in-depth interviews and 4 focus group discussions for data collection. Participants were 32 local health providers and 37 staff of NGOs working in the area of maternal health. Data was analysed using the framework approach. The availability, quality and distribution of EmONC services were major challenges across the sites. The barriers in the delivery of quality EmONC services were categorised into two major themes; human resources-related challenges, and systemic and institutional failures. While some of the barriers were similar, others were unique to specific sites. The common barriers included shortage of qualified staff; lack of essential installations, supplies and medications; increasing workload, burn-out and turnover; and poor data collection and monitoring systems. Barriers unique to Northern Uganda were demoralised personnel and lack of recognition; poor referral system; inefficient drug supply system; staff absenteeism in rural areas; and poor coordination among key personnel. In Burundi, weak curriculum; poor harmonisation and coordination of training; and inefficient allocation of resources were the unique challenges. To improve the situation across the sites, efforts are ongoing to improve the training and recruitment of more staff; harmonise and strengthen the curriculum and training; increase the number of EmONC facilities; and improve staff supervision, monitoring and support. Post-conflict health systems face different challenges in the delivery of EmONC services and as such require context-specific interventions to improve the delivery of these services.

Health equity issues at the local level: socio-geography, access, and health outcomes in the service area of the Hôpital Albert Schweitzer-Haiti.

PubMed

Perry, Henry B; King-Schultz, Leslie W; Aftab, Asma S; Bryant, John H

2007-08-01

Although health equity issues at regional, national and international levels are receiving increasing attention, health equity issues at the local level have been virtually overlooked. Here, we describe here a comprehensive equity assessment carried out by the Hôpital Albert Schweitzer-Haiti (HAS) in 2003. HAS has been operating health and development programs in the Artibonite Valley of Haiti for 50 years. We reviewed all available information arising from a comprehensive evaluation of the programs of HAS carried out in 1999 and 2000. As part of this evaluation, two demographic and health surveys were carried out. We carried out exit interviews with clients receiving primary health care, observations within health facilities, interviews with households related to quality of care, and focus group discussions with community-based health workers. A special study was carried out in 2003 to assess factors determining the use of prenatal care services. Finally, selected findings were obtained from the HAS information system. We found markedly reduced access to health services in the peripheral mountainous areas compared to the central plains. The quality of services was more deficient and the coverage of key services was lower in the mountains. Finally, health status, as measured by under-five mortality rates and levels of childhood malnutrition, was also worse in the mountains. These findings indicate that local health programs need to give attention to monitoring the health status as well as the quality and coverage of basic services among marginalized groups within the program service area. Health inequities will not be overcome until such monitoring occurs and leaders of health programs ensure that inequities identified are addressed in the local programming of activities. It is quite likely that, within relatively small geographic areas in resource-poor settings around the world, similar, if not even greater, levels of health inequities exist. These inequities need to be measured and addressed in order for health programs to achieve equity and maximum improvement in health status within the population.

Race and psychiatric services in post-apartheid South Africa: a preliminary study of psychiatrists' perceptions.

PubMed

Kohn, Robert; Szabo, Christopher P; Gordon, Alan; Allwood, Clifford W

2004-03-01

The primary objective of this study was to examine the perception of the quality of psychiatric services five years after apartheid, and specifically whether care for black patients had improved. A survey was distributed to South African psychiatrists during a national congress and by mail. The questionnaire focused on the quality of psychiatric care in general, for black and white patients, the racial composition of each respondent's psychiatric practice currently, and the racial composition of the psychiatric practice during apartheid. Psychiatric services in South Africa were viewed as deteriorating. The end of apartheid has done little to improve the quality of psychiatric care for both black and white patients. Although less pronounced, racial inequality in psychiatric care continues to exist. Psychiatric practices continue to be overrepresented with white patients. There remains a differential in quality of psychiatric care and further monitoring should continue. Continued efforts to improve racial equality and the need for greater awareness of cultural issues need to be addressed. Limitations of this study included possible social desirability bias, use of subjective rather than objective measures, and a survey that was limited in scope.

Effects of an Integrated Care System on quality of care and satisfaction for children with special health care needs.

PubMed

Knapp, Caprice; Madden, Vanessa; Sloyer, Phyllis; Shenkman, Elizabeth

2012-04-01

To assess the effects of an Integrated Care System (ICS) on parent-reported quality of care and satisfaction for Children with Special Health Care Needs (CSHCN). In 2006 Florida reformed its Medicaid program in Broward and Duval counties. Children's Medical Services Network (CMSN) chose to participate in the reform and developed an ICS for CSHCN. The ICS ushered in several changes such as more prior approval requirements and closing of the provider network. Telephone surveys were conducted with CMSN parents whose children reside in the reform counties and parents whose children reside outside of the reform counties in 2006 and 2007 (n = 1,727). Results from multivariate quasi-experimental models show that one component of parent-report quality of care, customer service, increased. Following implementation of the ICS, customer service increased by 0.22 points. After implementation of the ICS, parent-reported quality and satisfaction were generally unaffected. Although significant increases were not seen in the majority of the quality and satisfaction domains, it is nonetheless encouraging that parents did not report negative experiences with the ICS. It is important to present these interim findings so that progress can be monitored and decision-makers can begin to consider if the program should be expanded statewide.

Performance indicators for quality in surgical and laboratory services at Muhimbili National Hospital (MNH) in Tanzania.

PubMed

Mbembati, Naboth A; Mwangu, Mugwira; Muhondwa, Eustace P Y; Leshabari, Melkizedek M

2008-04-01

Muhimbili National Hospital (MNH), a teaching and national referral hospital, is undergoing major reforms to improve the quality of health care. We performed a retrospective descriptive study using a set of performance indicators for the surgical and laboratory services of MNH in years 2001 and 2002, to help monitor and evaluate the impact of reforms on the quality of health care during and after the reform process. Hospital records were reviewed and information recorded for planned and postponed operations, laboratory equipment, reagents, laboratory tests and quality assurance programmes. In the year 2001 a total of 4332 non-emergency operations were planned, 3313 operations were performed and 1019 (23.5%) operations were postponed. In the year 2002, 4301 non-emergency operations were planned, 3046 were performed and 1255 (29%) were postponed. The most common reasons for operation postponement were "time-barred", interference by emergency operations, no show of patients and inoperable anaesthetic machines. Equipment problems and supply and staff shortages together accounted for one quarter of postponements. In the laboratory, a lack of equipment prevented some tests, but quality assurance was performed for most tests. Current surgical services at MNH are inadequate; operating theatres require modern, functioning equipment and adequate supplies of consumables to provide satisfactory care.

Multimedia telehomecare system using standard TV set.

PubMed

Guillén, S; Arredondo, M T; Traver, V; García, J M; Fernández, C

2002-12-01

Nowadays, there are a very large number of patients that need specific health support at home. The deployment of broadband communication networks is making feasible the provision of home care services with a proper quality of service. This paper presents a telehomecare multimedia platform that runs over integrated services digital network and internet protocol using videoconferencing standards H.320 and H.323, and standard TV set for patient interaction. This platform allows online remote monitoring: ECG, heart sound, blood pressure. Usability, affordability, and interoperability were considered for the design and development of its hardware and software components. A first evaluation of technical and usability aspects were carried forward with 52 patients of a private clinic and 10 students in the University. Results show a high rate (mean = 4.33, standard deviation--SD = 1.63 in a five-points Likert scale) in the global perception of users on the quality of images, voice, and feeling of virtual presence.

Towards a personalized environmental health information service using low-cost sensors and crowdsourcing

NASA Astrophysics Data System (ADS)

Castell, Nuria; Liu, Hai-Ying; Schneider, Philipp; Cole-Hunter, Tom; Lahoz, William; Bartonova, Alena

2015-04-01

Most European cities exceed the air quality guidelines established by the WHO to protect human health. As such, citizens are exposed to potentially harmful pollutant levels. Some cities have services (e.g., web pages, mobile apps, etc.) which provide timely air quality information to the public. However, air quality data at individual level is currently scarce or non-existent. Making this information directly useful to individuals poses a challenge. For instance, if a user is informed that the air quality is "poor", what does that mean for him/her, and how can this information be acted upon? Despite individuals having a unique relationship with their environment, the information on the state of atmospheric components and related hazards is currently mostly generic, and seldom personally relevant. This undermines citizens' interest in their environment, and consequently limits their ability to recognize and change both their contribution and their exposure to air pollution. In Oslo, two EU founded projects, CITI-SENSE (Engelken-Jorge et al., 2014) and Citi-Sense-MOB (Castell et al., 2014), are trying to establish a dialogue with citizens by providing them with the possibility of getting personalized air quality information on their smartphones. The users are able to check the air quality in their immediate surroundings and track their individual exposure while moving through the urban environment (Castell et al., 2014). In this way, they may be able to reduce their exposure such as by changing transport modes or routes, for example by selecting less polluted streets to walk or cycle through. Using a smartphone application, citizens are engaged in collecting and sharing environmental data generated by low-cost air quality sensors, and in reporting their individual perception (turning citizens into sensors themselves). The highly spatially resolved data on air quality and perception is geo-located. This allows for simultaneous visualization of both kinds of the sensor information on a map. These field experiences will allow us to evaluate the ability of crowdsourcing and low-cost sensor technologies to enhance existing air quality monitoring systems. They will also test to what extent this approach enables citizens to engage in more active environmental monitoring. Challenges include precision and accuracy of the measurements, scientific understanding of these novel data and provision of added value for the participants (Liu et al., 2014). References: Castell et al. 2014. Mobile technologies and services for environmental monitoring: The Citi-Sense-MOB approach. Urban Climate. http://dx.doi.org/10.1016/j.uclim.2014.08.002 Engelken-Jorge M, Moreno J, Keune H, Verheyden W, Bartonova A, CITI-SENSE Consortium. 2014. Developing citizens' observatories for environmental monitoring and citizen empowerment: challenges and future scenarios. In Proceedings of the Conference for EDemocracy and Open Governement (CeDEM14): 21-23 May 2014; Danube University Krems, Austria. Edited by Parycek P, Edelmann N. 2014:49-60. Liu H.-Y., Kobernus M., Broday D., Bartonova A. 2014. A conceptual approach to a citizens' observatory - supporting community-based environmental governance. Environmental Health. 13:107. doi:10.1186/1476-069X-13-107.

An early warning and control system for urban, drinking water quality protection: China's experience.

PubMed

Hou, Dibo; Song, Xiaoxuan; Zhang, Guangxin; Zhang, Hongjian; Loaiciga, Hugo

2013-07-01

An event-driven, urban, drinking water quality early warning and control system (DEWS) is proposed to cope with China's urgent need for protecting its urban drinking water. The DEWS has a web service structure and provides users with water quality monitoring functions, water quality early warning functions, and water quality accident decision-making functions. The DEWS functionality is guided by the principles of control theory and risk assessment as applied to the feedback control of urban water supply systems. The DEWS has been deployed in several large Chinese cities and found to perform well insofar as water quality early warning and emergency decision-making is concerned. This paper describes a DEWS for urban water quality protection that has been developed in China.

Voice of the customer---a roadmap for service improvement.

PubMed

Uberoi, Ravinder S; Nayak, Yogamaya; Sachdeva, Pritindira; Sibal, Anupam

2013-01-01

Patient satisfaction surveys help a great deal in identifying ways of improving a hospital's services. Ultimately, that translates into better care and happier patients. Moreover, it shows the staff and the community that the hospital is serious about quality and is looking for ways to improve. This article describes how the Voice of the Customer (VOC) Survey can be used as a tool for improving services. Regular monitoring of VOC scores is essential for minimizing the gaps between service delivery and patient expectations. The present study showcases the various initiatives undertaken to improve the VOC scores from an original 4.40 to 4.77 (on a 5 point scale) at the hospital under study.

Colonoscopy in the office setting is safe, and financially sound ... for now.

PubMed

Luchtefeld, Martin A; Kim, Donald G

2006-03-01

In 2000, the Centers for Medicare & Medicaid Services announced a plan to allow for enhanced reimbursement for office endoscopy. This change in reimbursement was phased in during three years. The purpose of this study was to evaluate the fiscal outcomes and quality measures in the first two and a one-half years of performing endoscopy in an office setting under the new Centers for Medicare & Medicaid Services guidelines. The following financial parameters were gathered: number of endoscopies, expenses (divided into salaries and operational), net revenue, and margin for endoscopies performed in the office compared with the hospital. All endoscopies were performed by endoscopists with advanced training (gastroenterology fellowship or colon and rectal surgery residency). Monitoring equipment included continuous SaO2 and automated blood pressure in all patients and continuous electrocardiographic monitors in selected patients. Quality/safety data have been tracked in a prospective manner and include number of transfers to the hospital, perforations, bleeding requiring transfusion or hospitalization, and cardiorespiratory arrest. The financial outcomes are as follows: 13,285 endoscopies performed from the opening of the unit through December 2003; net revenue per case $504 per case; expense per case has dropped from $205 per case to $145 per case; the overall financial benefit of performing endoscopy in the office compared with the hospital was an additional $28 to $143 per case depending on the insurance carrier. The quality outcomes since inception of the unit include the following: 13,285 endoscopies; 0 hospital transfers, 0 cardiorespiratory arrests; 0 perforations; and 1 bleeding episode that required hospitalization. Endoscopy performed in the office setting is safe when done with appropriate monitoring and in the proper patient population. At the time of this study, office endoscopy also is financially rewarding but changes in Centers for Medicare & Medicaid Services reimbursement threaten the ability to retain any financial benefit.

[Development of medical tourism in Georgia. Problems and prospectiv (review)].

PubMed

Gerzmava, O; Lomtadze, L; Kitovani, D; Kadjrishvili, M

2011-10-01

Medical tourism is the movement of patients through a global network of health services. Medical tourists seek affordable healthcare on a timely basis in a variety of destination nations. The expansion of global medical services has sparked immense economic growth in developing nations and has created a new market for advertising access to care. Beyond offering a unique untapped market of services, medical tourism has invited a host of liability, malpractice and ethical concerns. The explosion of off-shore "mini-surgical" vacations will surely incite global unification and increased access, quality and affordability of care. Medical tourism is a dynamic subset of global health care that incorporates a variety of services, procedures and venues of care. Health insurance coverage, the impact on domestic and global markets, and the use of international standards of care will be examined in combination with quality, access and cost parameters. The global nature of medical tourism invites a variety of legal and ethical issues and calls for an organizational body to monitor this new phenomenon. Finally, the future implications of the globalization of health services and systems will be discussed.

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders.

PubMed

Mashamba-Thompson, Tivani P; Jama, Ngcwalisa A; Sartorius, Benn; Drain, Paul K; Thompson, Rowan M

2017-01-08

Key stakeholders' involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients' needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

PubMed Central

Mashamba-Thompson, Tivani P.; Jama, Ngcwalisa A.; Sartorius, Benn; Drain, Paul K.; Thompson, Rowan M.

2017-01-01

Introduction: Key stakeholders’ involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. Method: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. Results: 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients’ needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Conclusions: Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics. PMID:28075337

Developing satellite communications for public service: Prospects in four service areas

NASA Technical Reports Server (NTRS)

1977-01-01

The Public Service Satellite Consortium evaluated prospects for satellite telecommunications in four areas of the public service: the U.S. health care system, elementary and secondary education, American libraries, and that sector of the public service which is concerned with the provision of continuing education to health professionals. Three important conclusions were reached. First, throughout the public service there are three recurring needs: improved access, cost containment, and maintenance of quality. Appropriate application of communication satellite systems could ameliorate each of these concerns. Second, there appears to be an enormous latent demand for data communication services throughout the public service. The potential demand in 1982 to support requirements in hospital administration, library services and other information-retrieval activities, equipment maintenance, and environmental monitoring may be in excess of $300 million a year. Third, administrative applications of data communication networks show particular promise, especially in rural areas.

Toward the application of ecological concepts in EU coastal water management.

PubMed

de Jonge, Victor N

2007-01-01

The EU Water Framework Directive demands the protection of the functioning and the structure of our aquatic ecosystems. The defined means to realize this goal are: (1) optimization of the habitat providing conditions and (2) optimizing the water quality. The effects of the measures on the structure and functioning of the aquatic ecosystems then has to be assessed and judged. The available tool to do this is 'monitoring'. The present monitoring activities in The Netherlands cover target monitoring and trend monitoring. This is insufficient to meet the requirements of the EU. It is, given the EU demands, the ongoing budget reductions in The Netherlands and an increasing flow of unused new ecological concepts and theories (e.g. new theoretical insights related to resource competition theory, intermediate disturbance hypothesis and tools to judge the system quality like ecological network analysis) suggested to reconsider the present monitoring tasks among governmental services (final responsibility for the program and logistic support) and the academia (data analyses, data interpretation and development of concepts suitable for ecosystem modelling and tools to judge the quality of our ecosystems). This will lead to intensified co-operation between both arena's and consequently increased exchange of knowledge and ideas. Suggestions are done to extend the Dutch monitoring by surveillance monitoring and to change the focus from 'station oriented' to 'area oriented' without changing the operational aspects and its costs. The extended data sets will allow proper calibration and validation of developed dynamic ecosystem models which is not possible now. The described 'cost-effective' change in the environmental monitoring will also let biological and ecological theories play the pivotal role they should play in future integrated environmental management.

Rheticus Displacement: an Automatic Geo-Information Service Platform for Ground Instabilities Detection and Monitoring

NASA Astrophysics Data System (ADS)

Chiaradia, M. T.; Samarelli, S.; Agrimano, L.; Lorusso, A. P.; Nutricato, R.; Nitti, D. O.; Morea, A.; Tijani, K.

2016-12-01

Rheticus® is an innovative cloud-based data and services hub able to deliver Earth Observation added-value products through automatic complex processes and a minimum interaction with human operators. This target is achieved by means of programmable components working as different software layers in a modern enterprise system which relies on SOA (service-oriented-architecture) model. Due to its architecture, where every functionality is well defined and encapsulated in a standalone component, Rheticus is potentially highly scalable and distributable allowing different configurations depending on the user needs. Rheticus offers a portfolio of services, ranging from the detection and monitoring of geohazards and infrastructural instabilities, to marine water quality monitoring, wildfires detection or land cover monitoring. In this work, we outline the overall cloud-based platform and focus on the "Rheticus Displacement" service, aimed at providing accurate information to monitor movements occurring across landslide features or structural instabilities that could affect buildings or infrastructures. Using Sentinel-1 (S1) open data images and Multi-Temporal SAR Interferometry techniques (i.e., SPINUA), the service is complementary to traditional survey methods, providing a long-term solution to slope instability monitoring. Rheticus automatically browses and accesses (on a weekly basis) the products of the rolling archive of ESA S1 Scientific Data Hub; S1 data are then handled by a mature running processing chain, which is responsible of producing displacement maps immediately usable to measure with sub-centimetric precision movements of coherent points. Examples are provided, concerning the automatic displacement map generation process, as well as the integration of point and distributed scatterers, the integration of multi-sensors displacement maps (e.g., Sentinel-1 IW and COSMO-SkyMed HIMAGE), the combination of displacement rate maps acquired along both ascending and descending passes. ACK: Study carried out in the framework of the FAST4MAP project and co-funded by the Italian Space Agency (Contract n. 2015-020-R.0). Sentinel-1A products provided by ESA. CSK® Products, ASI, provided by ASI under a license to use. Rheticus® is a registered trademark of Planetek Italia srl.

Emergency medical services key performance measurement in Asian cities.

PubMed

Rahman, Nik Hisamuddin; Tanaka, Hideharu; Shin, Sang Do; Ng, Yih Yng; Piyasuwankul, Thammapad; Lin, Chih-Hao; Ong, Marcus Eng Hock

2015-01-01

One of the key principles in the recommended standards is that emergency medical service (EMS) providers should continuously monitor the quality and safety of their services. This requires service providers to implement performance monitoring using appropriate and relevant measures including key performance indicators. In Asia, EMS systems are at different developmental phases and maturity. This will create difficultly in benchmarking or assessing the quality of EMS performance across the region. An attempt was made to compare the EMS performance index based on the structure, process, and outcome analysis. The data was collected from the Pan-Asian Resuscitation Outcome Study (PAROS) data among few Asian cities, namely, Tokyo, Osaka, Singapore, Bangkok, Kuala Lumpur, Taipei, and Seoul. The parameters of inclusions were broadly divided into structure, process, and outcome measurements. The data was collected by the site investigators from each city and keyed into the electronic web-based data form which is secured strictly by username and passwords. Generally, there seems to be a more uniformity for EMS performance parameters among the more developed EMS systems. The major problem with the EMS agencies in the cities of developing countries like Bangkok and Kuala Lumpur is inadequate or unavailable data pertaining to EMS performance. There is non-uniformity in the EMS performance measurement across the Asian cities. This creates difficulty for EMS performance index comparison and benchmarking. Hopefully, in the future, collaborative efforts such as the PAROS networking group will further enhance the standardization in EMS performance reporting across the region.

Evaluation of Calendar Year 1997 Groundwater and Surface Water Quality Data For The Chestnut Ridge Hydrogeologic Regime At The U.S. Department of Energy Y-12 Plant, Oak Ridge, Tennessee

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

Jones, S.B.

1998-09-01

This report presents an evaluation of the groundwater monitoring data obtained in the Chestnut Ridge Hydrogeologic Regime (Chestnut Ridge Regime) during calendar year (CY) 1997. The Chestnut Ridge Regime encompasses a section of Chestnut Ridge bordered by the U.S. Department of Energy (DOE) Y-12 Plant in Bear Creek Valley (BCV) to the north, Scarboro Road to the eas~ Bethel Valley Road to the south, and an unnamed drainage basin southwest of the Y-12 Plant (Figure 1). Groundwater quality monitoring is performed at hazardous and nonhazardous waste management facilities in the regime under the auspices of the Y-12 Plant Groundwater Protectionmore » Program (GWPP). The CY 1997 monitoring data are presented in Calendar Year 1997 Annual Groundwater Monitoring Report for the Chestnut Ridge Hydrogeolo~"c Regime at the US. Department of Energy Y-12 Plant, Oak Ridge, Tennessee (MA Technical Services, Inc. 1998), which also presents results of site-specific monitoring data evaluations required under the Resource Conservation and Recovery Act (RCIL4) post-closure permit (PCP) for the Chestnut Ridge Regime« less

Molecular genetics external quality assessment pilot scheme for KRAS analysis in metastatic colorectal cancer.

PubMed

Deans, Zandra C; Tull, Justyna; Beighton, Gemma; Abbs, Stephen; Robinson, David O; Butler, Rachel

2011-11-01

Laboratories are increasingly required to perform molecular tests for the detection of mutations in the KRAS gene in metastatic colorectal cancers to allow better clinical management and more effective treatment for these patients. KRAS mutation status predicts a patient's likely response to the monoclonal antibody cetuximab. To provide a high standard of service, these laboratories require external quality assessment (EQA) to monitor the level of laboratory output and measure the performance of the laboratory against other service providers. National External Quality Assurance Services for Molecular Genetics provided a pilot EQA scheme for KRAS molecular analysis in metastatic colorectal cancers during 2009. Very few genotyping errors were reported by participating laboratories; however, the reporting nomenclature of the genotyping results varied considerably between laboratories. The pilot EQA scheme highlighted the need for continuing EQA in this field which will assess the laboratories' ability not only to obtain accurate, reliable results but also to interpret them safely and correctly ensuring that the referring clinician has the correct information to make the best clinical therapeutic decision for their patient.

A Crowdsensing Based Analytical Framework for Perceptional Degradation of OTT Web Browsing.

PubMed

Li, Ke; Wang, Hai; Xu, Xiaolong; Du, Yu; Liu, Yuansheng; Ahmad, M Omair

2018-05-15

Service perception analysis is crucial for understanding both user experiences and network quality as well as for maintaining and optimizing of mobile networks. Given the rapid development of mobile Internet and over-the-top (OTT) services, the conventional network-centric mode of network operation and maintenance is no longer effective. Therefore, developing an approach to evaluate and optimizing users' service perceptions has become increasingly important. Meanwhile, the development of a new sensing paradigm, mobile crowdsensing (MCS), makes it possible to evaluate and analyze the user's OTT service perception from end-user's point of view other than from the network side. In this paper, the key factors that impact users' end-to-end OTT web browsing service perception are analyzed by monitoring crowdsourced user perceptions. The intrinsic relationships among the key factors and the interactions between key quality indicators (KQI) are evaluated from several perspectives. Moreover, an analytical framework of perceptional degradation and a detailed algorithm are proposed whose goal is to identify the major factors that impact the perceptional degradation of web browsing service as well as their significance of contribution. Finally, a case study is presented to show the effectiveness of the proposed method using a dataset crowdsensed from a large number of smartphone users in a real mobile network. The proposed analytical framework forms a valuable solution for mobile network maintenance and optimization and can help improve web browsing service perception and network quality.

Clinical governance in pre-hospital care.

PubMed Central

Robertson-Steel, I; Edwards, S; Gough, M

2001-01-01

This article seeks to discover and recognize the importance of clinical governance within a new and emerging quality National Health Service (NHS) system. It evaluates the present state of prehospital care and recommends how change, via clinical governance, can ensure a paradigm shift from its currently fragmented state to a seamless ongoing patient care episode. Furthermore, it identifies the drivers of a quality revolution, examines the monitoring and supervision of quality care, and evaluates the role of evidence-based practice. A frank and open view of immediate care doctors is presented, with recommendations to improve the quality of skill delivery and reduce the disparity that exists. Finally, it reviews the current problems with pre-hospital care and projects a future course for quality and patient care excellence. PMID:11383428

Operational use of open satellite data for marine water quality monitoring

NASA Astrophysics Data System (ADS)

Symeonidis, Panagiotis; Vakkas, Theodoros

2017-09-01

The purpose of this study was to develop an operational platform for marine water quality monitoring using near real time satellite data. The developed platform utilizes free and open satellite data available from different data sources like COPERNICUS, the European Earth Observation Initiative, or NASA, from different satellites and instruments. The quality of the marine environment is operationally evaluated using parameters like chlorophyll-a concentration, water color and Sea Surface Temperature (SST). For each parameter, there are more than one dataset available, from different data sources or satellites, to allow users to select the most appropriate dataset for their area or time of interest. The above datasets are automatically downloaded from the data provider's services and ingested to the central, spatial engine. The spatial data platform uses the Postgresql database with the PostGIS extension for spatial data storage and Geoserver for the provision of the spatial data services. The system provides daily, 10 days and monthly maps and time series of the above parameters. The information is provided using a web client which is based on the GET SDI PORTAL, an easy to use and feature rich geospatial visualization and analysis platform. The users can examine the temporal variation of the parameters using a simple time animation tool. In addition, with just one click on the map, the system provides an interactive time series chart for any of the parameters of the available datasets. The platform can be offered as Software as a Service (SaaS) to any area in the Mediterranean region.

Measuring NO, NO2, CO2 and O3 with low-cost sensors

NASA Astrophysics Data System (ADS)

Müller, Michael; Graf, Peter; Hüglin, Christoph

2017-04-01

Inexpensive sensors measuring ambient gas concentrations can be integrated in sensor units forming dense sensor networks. The utilized sensors have to be sufficiently accurate as the value of such networks directly depends on the information they provide. Thus, thorough testing of sensors before bringing them into service and the application of effective strategies for performance monitoring and adjustments during service are key elements for operating the low-cost sensors that are currently available on the market. We integrated several types of low-cost sensors into sensor units (Alphasense NO2 B4/B42F/B43F, Alphasense NO B4, SensAir CO2 LP8, Aeroqual O3 SM50), run them in the field next to instruments of air quality monitoring stations and performed tests in the laboratory. The poster summarizes our findings regarding the achieved sensor accuracy, methods to improve sensor performance as well as strategies to monitor the current state of the sensor (drifts, sensitivity) within a sensor network.

Rural and remote care

PubMed Central

Marciniuk, Darcy

2016-01-01

The challenges of providing quality respiratory care to persons living in rural or remote communities can be daunting. These populations are often vulnerable in terms of both health status and access to care, highlighting the need for innovation in service delivery. The rapidly expanding options available using telehealthcare technologies have the capacity to allow patients in rural and remote communities to connect with providers at distant sites and to facilitate the provision of diagnostic, monitoring, and therapeutic services. Successful implementation of telehealthcare programs in rural and remote settings is, however, contingent upon accounting for key technical, organizational, social, and legal considerations at the individual, community, and system levels. This review article discusses five types of telehealthcare delivery that can facilitate respiratory care for residents of rural or remote communities: remote monitoring (including wearable and ambient systems; remote consultations (between providers and between patients and providers), remote pulmonary rehabilitation, telepharmacy, and remote sleep monitoring. Current and future challenges related to telehealthcare are discussed. PMID:26902542

The implementation of a quality assurance procedure for the Veterinary Services of France.

PubMed

Gerster, F; Guerson, N; Moreau, V; Mulnet, O; Provot, S; Salabert, C

2003-08-01

Due to the increasing complexity of food production systems and the concerns that these systems raise, there has been increasing demand from the general public for more State control of these processes. In France, it is the official Veterinary Services who are responsible for food safety and who must respond to these demands. The Veterinary Service is formulating a quality assurance procedure in accordance with standard EN 45004-ISO 17020, which determines the requirements that inspection bodies must follow to be recognised, at national, European and international level, as competent and reliable. As part of this procedure, the Veterinary Service will review requirements in terms of organisation, functions, qualifications and resources. The progress of inspection service orders, from their conception by the Central Administration, to their implementation by decentralised services, must be carefully managed. It is essential that service orders be implemented effectively and systematically by using recognised methods and issuing adequate inspection reports. The training and qualifications of inspectors are very important: their skills must remain up-to-date so that there is always a network of qualified staff, that is, staff who have an understanding of production processes and who have recognised competences in terms of initial training, continuous professional development and adequate experience. The quality systems implemented will only meet expectations if they are continuously monitored by means of regular evaluations. For this reason, both internal and external audits are performed. These new practices contribute to establishing a basis for the improvement of internal evaluation. In order to facilitate the implementation of a quality assurance procedure for inspection services, several tools, that are linked with the information system of the government department responsible for food, are, or will be, at the disposal of the decentralised Veterinary Services, i.e. a national database, mail and service order processing software, and inspection procedures.

Chronic kidney-disease screening service quality: questionnaire survey research evidence from Taichung city

PubMed Central

2009-01-01

Background Chronic kidney disease (CKD) is a serious public health problem in Taiwan and the world. The most effective, affordable treatments involve early prevention/detection/intervention, requiring screening. Successfully implementing CKD programs requires good patient participation, affected by patient perceptions of screening service quality. Service quality improvements can help make such programs more successful. Thus, good tools for assessing service quality perceptions are important. Aim: to investigate using a modified SERVQUAL questionnaire in assessing patient expectations, perceptions, and loyalty towards kidney disease screening service quality. Method 1595 kidney disease screening program patients in Taichung City were requested to complete and return a modified kidney disease screening SERVQUAL questionnaire. 1187 returned them. Incomplete ones (102) were culled and 1085 were chosen as effective for use. Paired t-tests, correlation tests, ANOVA, LSD test, and factor analysis identified the characteristics and factors of service quality. The paired t-test tested expectation score and perception score gaps. A structural equation modeling system examined satisfaction-based components' relationships. Results The effective response rate was 91.4%. Several methods verified validity. Cronbach's alpha on internal reliability was above 0.902. On patient satisfaction, expectation scores are high: 6.50 (0.82), but perception scores are significantly lower 6.14 (1.02). Older patients' perception scores are lower than younger patients'. Expectation and perception scores for patients with different types of jobs are significantly different. Patients higher on education have lower scores for expectation (r = -0.09) and perception (r = -0.26). Factor analysis identified three factors in the 22 item SERVQUAL form, which account for 80.8% of the total variance for the expectation scores and 86.9% of the total variance for the satisfaction scores. Expectation and perception score gaps in all 22 items are significant. The goodness-of-fit summary of the SEM results indicates that expectations and perceptions are positively correlated, perceptions and loyalty are positively correlated, but expectations and loyalty are not positively correlated. Conclusions The results of this research suggest that the SERVQUAL instrument is a useful measurement tool in assessing and monitoring service quality in kidney disease screening services, enabling the staff to identify where service improvements are needed from the patients' perspectives. PMID:20021684

Telerehabilitation Technologies: Accessibility and Usability

PubMed Central

Pramuka, Michael; van Roosmalen, Linda

2009-01-01

In the fields of telehealth and telemedicine, phone and/or video technologies are key to the successful provision of services such as remote monitoring and visits. How do these technologies affect service accessibility, effectiveness, quality, and usefulness when applied to rehabilitation services in the field of telerehabilitation? To answer this question, we provide a overview of the complex network of available technologies and discuss how they link to rehabilitation applications, services, and practices as well as to the telerehabilitation end-user. This white paper will first present the numerous professional considerations that shape the use of technology in telerehabilitation service and set it somewhat apart from telemedicine. It will then provide an overview of concepts essential to usability analysis; present a summary of various telerehabilitation technologies and their strengths and limitations, and consider how the technologies interface with end users’ clinical needs for service accessibility, effectiveness, quality, and usefulness. The paper will highlight a conceptual framework (including task analyses and usability issues) that underlies a functional match between telerehabilitation technologies, clinical applications, and end-user capabilities for telerehabilitation purposes. Finally, we will discuss pragmatic issues related to user integration of telerehabilitation technology versus traditional face-to-face approaches. PMID:25945165

An optimization approach to selecting research natural areas in National Forests

Treesearch

Stephanie A. Snyder; Lucy E. Tyrrell; Robert G. Haight

1999-01-01

The USDA Forest Service has a long-established program to identify areas in national forests for designation as protected Research Natural Areas (RNAs). One of the goals is to protect high quality examples of regional ecosystems for the purposes of maintaining biological diversity, conducting nonmanipulative research and monitoring, and fostering education. When RNA...

S-Cube: Enabling the Next Generation of Software Services

NASA Astrophysics Data System (ADS)

Metzger, Andreas; Pohl, Klaus

The Service Oriented Architecture (SOA) paradigm is increasingly adopted by industry for building distributed software systems. However, when designing, developing and operating innovative software services and servicebased systems, several challenges exist. Those challenges include how to manage the complexity of those systems, how to establish, monitor and enforce Quality of Service (QoS) and Service Level Agreements (SLAs), as well as how to build those systems such that they can proactively adapt to dynamically changing requirements and context conditions. Developing foundational solutions for those challenges requires joint efforts of different research communities such as Business Process Management, Grid Computing, Service Oriented Computing and Software Engineering. This paper provides an overview of S-Cube, the European Network of Excellence on Software Services and Systems. S-Cube brings together researchers from leading research institutions across Europe, who join their competences to develop foundations, theories as well as methods and tools for future service-based systems.

Quality assurance: Importance of systems and standard operating procedures

PubMed Central

Manghani, Kishu

2011-01-01

It is mandatory for sponsors of clinical trials and contract research organizations alike to establish, manage and monitor their quality control and quality assurance systems and their integral standard operating procedures and other quality documents to provide high-quality products and services to fully satisfy customer needs and expectations. Quality control and quality assurance systems together constitute the key quality systems. Quality control and quality assurance are parts of quality management. Quality control is focused on fulfilling quality requirements, whereas quality assurance is focused on providing confidence that quality requirements are fulfilled. The quality systems must be commensurate with the Company business objectives and business model. Top management commitment and its active involvement are critical in order to ensure at all times the adequacy, suitability, effectiveness and efficiency of the quality systems. Effective and efficient quality systems can promote timely registration of drugs by eliminating waste and the need for rework with overall financial and social benefits to the Company. PMID:21584180

Quality assurance: Importance of systems and standard operating procedures.

PubMed

Manghani, Kishu

2011-01-01

It is mandatory for sponsors of clinical trials and contract research organizations alike to establish, manage and monitor their quality control and quality assurance systems and their integral standard operating procedures and other quality documents to provide high-quality products and services to fully satisfy customer needs and expectations. Quality control and quality assurance systems together constitute the key quality systems. Quality control and quality assurance are parts of quality management. Quality control is focused on fulfilling quality requirements, whereas quality assurance is focused on providing confidence that quality requirements are fulfilled. The quality systems must be commensurate with the Company business objectives and business model. Top management commitment and its active involvement are critical in order to ensure at all times the adequacy, suitability, effectiveness and efficiency of the quality systems. Effective and efficient quality systems can promote timely registration of drugs by eliminating waste and the need for rework with overall financial and social benefits to the Company.

LandSense: A Citizen Observatory and Innovation Marketplace for Land Use and Land Cover Monitoring

NASA Astrophysics Data System (ADS)

Moorthy, Inian; Fritz, Steffen; See, Linda; McCallum, Ian

2017-04-01

Currently within the EU's Earth Observation (EO) monitoring framework, there is a need for low-cost methods for acquiring high quality in-situ data to create accurate and well-validated environmental monitoring products. To help address this need, a new four year Horizon 2020 project entitled LandSense will link remote sensing data with modern participatory data collection methods that involve citizen scientists. This paper will describe the citizen science activities within the LandSense Observatory that aim to deliver concrete, measurable and quality-assured ground-based data that will complement existing satellite monitoring systems. LandSense will deploy advanced tools, services and resources to mobilize and engage citizens to collect in-situ observations (i.e. ground-based data and visual interpretations of EO imagery). Integrating these citizen-driven in-situ data collections with established authoritative and open access data sources will help reduce costs, extend GEOSS and Copernicus capacities, and support comprehensive environmental monitoring systems. Policy-relevant campaigns will be implemented in close collaboration with multiple stakeholders to ensure that citizen observations address user requirements and contribute to EU-wide environmental governance and decision-making. Campaigns for addressing local and regional Land Use and Land Cover (LULC) issues are planned for select areas in Austria, France, Germany, Spain, Slovenia and Serbia. Novel LandSense services (LandSense Campaigner, FarmLand Support, Change Detector and Quality Assurance & Control) will be deployed and tested in these areas to address critical LULC issues (i.e. urbanization, agricultural land use and forest/habitat monitoring). For example, local residents in the cities of Vienna, Tulln, and Heidelberg will help cooperatively detect and map changes in land cover and green space to address key issues of urban sprawl, land take and flooding. Such campaigns are facilitated through numerous pathways of citizen empowerment via the LandSense Engagement Platform, i.e. tools for discussion, online voting collaborative mapping, as well as events linked to public consultation and cooperative planning. In addition to creating tools for data collection, quality assurance, and interaction with the public, the project aims to drive innovation through collaboration with the private sector. LandSense will build an innovation marketplace to attract a vast community of users across numerous disciplines and sectors and boost Europe's role in the business of ground-based monitoring. The anticipated outcomes of LandSense have considerable potential to lower expenditure costs on ground-based data collection and greatly extend the current sources of such data, thereby realizing citizen-powered innovations in the processing chain of LULC monitoring activities both within and beyond Europe.

Network challenges for cyber physical systems with tiny wireless devices: a case study on reliable pipeline condition monitoring.

PubMed

Ali, Salman; Qaisar, Saad Bin; Saeed, Husnain; Khan, Muhammad Farhan; Naeem, Muhammad; Anpalagan, Alagan

2015-03-25

The synergy of computational and physical network components leading to the Internet of Things, Data and Services has been made feasible by the use of Cyber Physical Systems (CPSs). CPS engineering promises to impact system condition monitoring for a diverse range of fields from healthcare, manufacturing, and transportation to aerospace and warfare. CPS for environment monitoring applications completely transforms human-to-human, human-to-machine and machine-to-machine interactions with the use of Internet Cloud. A recent trend is to gain assistance from mergers between virtual networking and physical actuation to reliably perform all conventional and complex sensing and communication tasks. Oil and gas pipeline monitoring provides a novel example of the benefits of CPS, providing a reliable remote monitoring platform to leverage environment, strategic and economic benefits. In this paper, we evaluate the applications and technical requirements for seamlessly integrating CPS with sensor network plane from a reliability perspective and review the strategies for communicating information between remote monitoring sites and the widely deployed sensor nodes. Related challenges and issues in network architecture design and relevant protocols are also provided with classification. This is supported by a case study on implementing reliable monitoring of oil and gas pipeline installations. Network parameters like node-discovery, node-mobility, data security, link connectivity, data aggregation, information knowledge discovery and quality of service provisioning have been reviewed.

Network Challenges for Cyber Physical Systems with Tiny Wireless Devices: A Case Study on Reliable Pipeline Condition Monitoring

PubMed Central

Ali, Salman; Qaisar, Saad Bin; Saeed, Husnain; Farhan Khan, Muhammad; Naeem, Muhammad; Anpalagan, Alagan

2015-01-01

The synergy of computational and physical network components leading to the Internet of Things, Data and Services has been made feasible by the use of Cyber Physical Systems (CPSs). CPS engineering promises to impact system condition monitoring for a diverse range of fields from healthcare, manufacturing, and transportation to aerospace and warfare. CPS for environment monitoring applications completely transforms human-to-human, human-to-machine and machine-to-machine interactions with the use of Internet Cloud. A recent trend is to gain assistance from mergers between virtual networking and physical actuation to reliably perform all conventional and complex sensing and communication tasks. Oil and gas pipeline monitoring provides a novel example of the benefits of CPS, providing a reliable remote monitoring platform to leverage environment, strategic and economic benefits. In this paper, we evaluate the applications and technical requirements for seamlessly integrating CPS with sensor network plane from a reliability perspective and review the strategies for communicating information between remote monitoring sites and the widely deployed sensor nodes. Related challenges and issues in network architecture design and relevant protocols are also provided with classification. This is supported by a case study on implementing reliable monitoring of oil and gas pipeline installations. Network parameters like node-discovery, node-mobility, data security, link connectivity, data aggregation, information knowledge discovery and quality of service provisioning have been reviewed. PMID:25815444

Quality of HIV Testing Data Before and After the Implementation of a National Data Quality Assessment and Feedback System.

PubMed

Beltrami, John; Wang, Guoshen; Usman, Hussain R; Lin, Lillian S

In 2010, the Centers for Disease Control and Prevention (CDC) implemented a national data quality assessment and feedback system for CDC-funded HIV testing program data. Our objective was to analyze data quality before and after feedback. Coinciding with required quarterly data submissions to CDC, each health department received data quality feedback reports and a call with CDC to discuss the reports. Data from 2008 to 2011 were analyzed. Fifty-nine state and local health departments that were funded for comprehensive HIV prevention services. Data collected by a service provider in conjunction with a client receiving HIV testing. National data quality assessment and feedback system. Before and after intervention implementation, quality was assessed through the number of new test records reported and the percentage of data values that were neither missing nor invalid. Generalized estimating equations were used to assess the effect of feedback in improving the completeness of variables. Data were included from 44 health departments. The average number of new records per submission period increased from 197 907 before feedback implementation to 497 753 afterward. Completeness was high before and after feedback for race/ethnicity (99.3% vs 99.3%), current test results (99.1% vs 99.7%), prior testing and results (97.4% vs 97.7%), and receipt of results (91.4% vs 91.2%). Completeness improved for HIV risk (83.6% vs 89.5%), linkage to HIV care (56.0% vs 64.0%), referral to HIV partner services (58.9% vs 62.8%), and referral to HIV prevention services (55.3% vs 63.9%). Calls as part of feedback were associated with improved completeness for HIV risk (adjusted odds ratio [AOR] = 2.28; 95% confidence interval [CI], 1.75-2.96), linkage to HIV care (AOR = 1.60; 95% CI, 1.31-1.96), referral to HIV partner services (AOR = 1.73; 95% CI, 1.43-2.09), and referral to HIV prevention services (AOR = 1.74; 95% CI, 1.43-2.10). Feedback contributed to increased data quality. CDC and health departments should continue monitoring the data and implement measures to improve variables of low completeness.

A method for developing outcome measures in the clinical laboratory.

PubMed

Jones, J

1996-01-01

Measuring and reporting outcomes in health care is becoming more important for quality assessment, utilization assessment, accreditation standards, and negotiating contracts in managed care. How does one develop an outcome measure for the laboratory to assess the value of the services? A method is described which outlines seven steps in developing outcome measures for a laboratory service or process. These steps include the following: 1. Identify the process or service to be monitored for performance and outcome assessment. 2. If necessary, form an multidisciplinary team of laboratory staff, other department staff, physicians, and pathologists. 3. State the purpose of the test or service including a review of published data for the clinical pathological correlation. 4. Prepare a process cause and effect diagram including steps critical to the outcome. 5. Identify key process variables that contribute to positive or negative outcomes. 6. Identify outcome measures that are not process measures. 7. Develop an operational definition, identify data sources, and collect data. Examples, including a process cause and effect diagram, process variables, and outcome measures, are given using the Therapeutic Drug Monitoring service (TDM). A summary of conclusions and precautions for outcome measurement is then provided.

Screening for Hypertension and Lowering Blood Pressure for Prevention of Cardiovascular Disease Events.

PubMed

Viera, Anthony J

2017-07-01

Hypertension affects 1 in 3 American adults. Blood pressure (BP)-lowering therapy reduces the risk of cardiovascular disease. The United States Preventive Services Task Force recommends all adults be screened for hypertension. Most patients whose office BP is elevated should have out-of-office monitoring to confirm the diagnosis. Ambulatory BP monitoring is preferred for out-of-office measurement, but home BP monitoring is a reasonable alternative. Guidelines for treatment are stratified by age (<60 vs >60 years) and include cutoffs for recommended treatment BPs and target BP goals. Quality of hypertension care is improved by incorporating population health management using registries and medication titration. Copyright © 2017 Elsevier Inc. All rights reserved.

Real-time monitoring implementation in a remote-pumped WDM PON

NASA Astrophysics Data System (ADS)

Liaw, S.-K.; Hong, K.-L.; Shei, Y.-S.

2008-08-01

We report on an improved configuration to monitor a passive optical network with high quality in service. This proposed system comprises fiber-Bragg gratings, a 1 × 4 optical switch, and an optical time-domain reflectometry to diagnose the broken point in real time. It could simultaneously detect multioptical network units in a WDM PON. The remote-pump integrated residual pumping reused function is implemented. Broken points in different optical paths can be detected simultaneously even when the distances to the central office are identical. The bit-error rate testing is verified with a small power penalty, making it an ideal solution for the real-time monitoring in a WDM PON.

Measurement results obtained from air quality monitoring system

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

Turzanski, P.K.; Beres, R.

1995-12-31

An automatic system of air pollution monitoring operates in Cracow since 1991. The organization, assembling and start-up of the network is a result of joint efforts of the US Environmental Protection Agency and the Cracow environmental protection service. At present the automatic monitoring network is operated by the Provincial Inspection of Environmental Protection. There are in total seven stationary stations situated in Cracow to measure air pollution. These stations are supported continuously by one semi-mobile (transportable) station. It allows to modify periodically the area under investigation and therefore the 3-dimensional picture of creation and distribution of air pollutants within Cracowmore » area could be more intelligible.« less

Country watch: South-East Asia.

PubMed

Bagasao, T M

1996-01-01

Nongovernmental organizations (NGO) and community-based groups working on HIV/AIDS in Thailand, Sri Lanka, the Philippines, Malaysia, and other countries participated in a February 1991 workshop during which they recognized that human rights are inextricably linked with HIV prevention, the provision of services, and improving the quality of life of people living with HIV/AIDS and other vulnerable, marginalized groups. They also noted how rarely environments were supportive with respect to either legal structures or sociocultural norms. The groups resolved to act as a watchdog, an advocacy and lobbying group to monitor legislation, provide public information, and empower people with HIV/AIDS as visible and active partners. Meeting again in 1993 to assess progress, the groups found few gains in addressing human rights violations such as the denial of medical services to people with HIV/AIDS and the deportation of HIV-positive migrant workers. The Asia Pacific Council of AIDS Service Organizations (APCASO) responded by developing a pilot documentation, monitoring, and reporting system in the region to record HIV-related human rights violations. That system is described.

RESTful M2M Gateway for Remote Wireless Monitoring for District Central Heating Networks

PubMed Central

Cheng, Bo; Wei, Zesan

2014-01-01

In recent years, the increased interest in energy conservation and environmental protection, combined with the development of modern communication and computer technology, has resulted in the replacement of distributed heating by central heating in urban areas. This paper proposes a Representational State Transfer (REST) Machine-to-Machine (M2M) gateway for wireless remote monitoring for a district central heating network. In particular, we focus on the resource-oriented RESTful M2M gateway architecture, and present an uniform devices abstraction approach based on Open Service Gateway Initiative (OSGi) technology, and implement the resource mapping mechanism between resource address mapping mechanism between RESTful resources and the physical sensor devices, and present the buffer queue combined with polling method to implement the data scheduling and Quality of Service (QoS) guarantee, and also give the RESTful M2M gateway open service Application Programming Interface (API) set. The performance has been measured and analyzed. Finally, the conclusions and future work are presented. PMID:25436650

RESTful M2M gateway for remote wireless monitoring for district central heating networks.

PubMed

Cheng, Bo; Wei, Zesan

2014-11-27

In recent years, the increased interest in energy conservation and environmental protection, combined with the development of modern communication and computer technology, has resulted in the replacement of distributed heating by central heating in urban areas. This paper proposes a Representational State Transfer (REST) Machine-to-Machine (M2M) gateway for wireless remote monitoring for a district central heating network. In particular, we focus on the resource-oriented RESTful M2M gateway architecture, and present an uniform devices abstraction approach based on Open Service Gateway Initiative (OSGi) technology, and implement the resource mapping mechanism between resource address mapping mechanism between RESTful resources and the physical sensor devices, and present the buffer queue combined with polling method to implement the data scheduling and Quality of Service (QoS) guarantee, and also give the RESTful M2M gateway open service Application Programming Interface (API) set. The performance has been measured and analyzed. Finally, the conclusions and future work are presented.

WIWS: a protein structure bioinformatics Web service collection.

PubMed

Hekkelman, M L; Te Beek, T A H; Pettifer, S R; Thorne, D; Attwood, T K; Vriend, G

2010-07-01

The WHAT IF molecular-modelling and drug design program is widely distributed in the world of protein structure bioinformatics. Although originally designed as an interactive application, its highly modular design and inbuilt control language have recently enabled its deployment as a collection of programmatically accessible web services. We report here a collection of WHAT IF-based protein structure bioinformatics web services: these relate to structure quality, the use of symmetry in crystal structures, structure correction and optimization, adding hydrogens and optimizing hydrogen bonds and a series of geometric calculations. The freely accessible web services are based on the industry standard WS-I profile and the EMBRACE technical guidelines, and are available via both REST and SOAP paradigms. The web services run on a dedicated computational cluster; their function and availability is monitored daily.

Developing a national framework of quality indicators for public hospitals.

PubMed

Simou, Effie; Pliatsika, Paraskevi; Koutsogeorgou, Eleni; Roumeliotou, Anastasia

2014-01-01

The current study describes the development of a preliminary set of quality indicators for public Greek National Health System (GNHS) hospitals, which were used in the "Health Monitoring Indicators System: Health Map" (Ygeionomikos Chartis) project, with the purpose that these quality indicators would assess the quality of all the aspects relevant to public hospital healthcare workforce and services provided. A literature review was conducted in the MEDLINE database to identify articles referring to international and national hospital quality assessment projects, together with an online search for relevant projects. Studies were included if they were published in English, from 1980 to 2010. A consensus panel took place afterwards with 40 experts in the field and tele-voting procedure. Twenty relevant projects and their 1698 indicators were selected through the literature search, and after the consensus panel process, a list of 67 indicators were selected to be implemented for the assessment of the public hospitals categorized under six distinct dimensions: Quality, Responsiveness, Efficiency, Utilization, Timeliness, and Resources and Capacity. Data gathered and analyzed in this manner provided a novel evaluation and monitoring system for Greece, which can assist decision-makers, healthcare professionals, and patients in Greece to retrieve relevant information, with the long-term goal to improve quality in care in the GNHS hospital sector. Copyright © 2014 John Wiley & Sons, Ltd.

The challenge of documenting water quality benefits of conservation practices: a review of USDA-ARS's conservation effects assessment project watershed studies.

PubMed

Tomer, M D; Locke, M A

2011-01-01

The Conservation Effects Assessment Project was established to quantify water quality benefits of conservation practices supported by the U.S. Department of Agriculture (USDA). In 2004, watershed assessment studies were begun in fourteen agricultural watersheds with varying cropping systems, landscapes, climate, and water quality concerns. This paper reviews USDA Agricultural Research Service 'Benchmark' watershed studies and the challenge of identifying water quality benefits in watersheds. Study goals included modeling and field research to assess practices, and evaluation of practice placement in watersheds. Not all goals were met within five years but important lessons were learned. While practices improved water quality, problems persisted in larger watersheds. This dissociation between practice-focused and watershed-scale assessments occurred because: (1) Conservation practices were not targeted at critical sources/pathways of contaminants; (2) Sediment in streams originated more from channel and bank erosion than from soil erosion; (3) Timing lags, historical legacies, and shifting climate combined to mask effects of practice implementation; and (4) Water quality management strategies addressed single contaminants with little regard for trade-offs among contaminants. These lessons could help improve conservation strategies and set water quality goals with realistic timelines. Continued research on agricultural water quality could better integrate modeling and monitoring capabilities, and address ecosystem services.

Safe and effective error rate monitors for SS7 signaling links

NASA Astrophysics Data System (ADS)

Schmidt, Douglas C.

1994-04-01

This paper describes SS7 error monitor characteristics, discusses the existing SUERM (Signal Unit Error Rate Monitor), and develops the recently proposed EIM (Error Interval Monitor) for higher speed SS7 links. A SS7 error monitor is considered safe if it ensures acceptable link quality and is considered effective if it is tolerant to short-term phenomena. Formal criteria for safe and effective error monitors are formulated in this paper. This paper develops models of changeover transients, the unstable component of queue length resulting from errors. These models are in the form of recursive digital filters. Time is divided into sequential intervals. The filter's input is the number of errors which have occurred in each interval. The output is the corresponding change in transmit queue length. Engineered EIM's are constructed by comparing an estimated changeover transient with a threshold T using a transient model modified to enforce SS7 standards. When this estimate exceeds T, a changeover will be initiated and the link will be removed from service. EIM's can be differentiated from SUERM by the fact that EIM's monitor errors over an interval while SUERM's count errored messages. EIM's offer several advantages over SUERM's, including the fact that they are safe and effective, impose uniform standards in link quality, are easily implemented, and make minimal use of real-time resources.

An audit of the quality of inpatient care for adults with learning disability in the UK

PubMed Central

Sheehan, Rory; Gandesha, Aarti; Hassiotis, Angela; Gallagher, Pamela; Burnell, Matthew; Jones, Glyn; Kerr, Michael; Hall, Ian; Chaplin, Robert; Crawford, Michael J

2016-01-01

Objectives To audit patient hospital records to evaluate the performance of acute general and mental health services in delivering inpatient care to people with learning disability and explore the influence of organisational factors on the quality of care they deliver. Setting Nine acute general hospital Trusts and six mental health services. Participants Adults with learning disability who received inpatient hospital care between May 2013 and April 2014. Primary and secondary outcome measures Data on seven key indicators of high-quality care were collected from 176 patients. These covered physical health/monitoring, communication and meeting needs, capacity and decision-making, discharge planning and carer involvement. The impact of services having an electronic system for flagging patients with learning disability and employing a learning disability liaison nurse was assessed. Results Indicators of physical healthcare (body mass index, swallowing assessment, epilepsy risk assessment) were poorly recorded in acute general and mental health inpatient settings. Overall, only 34 (19.3%) patients received any assessment of swallowing and 12 of the 57 with epilepsy (21.1%) had an epilepsy risk assessment. For most quality indicators, there was a non-statistically significant trend for improved performance in services with a learning disability liaison nurse. The presence of an electronic flagging system showed less evidence of benefit. Conclusions Inpatient care for people with learning disability needs to be improved. The work gives tentative support to the role of a learning disability liaison nurse in acute general and mental health services, but further work is needed to confirm these benefits and to trial other interventions that might improve the quality and safety of care for this high-need group. PMID:27091821

A multi-agent approach to intelligent monitoring in smart grids

NASA Astrophysics Data System (ADS)

Vallejo, D.; Albusac, J.; Glez-Morcillo, C.; Castro-Schez, J. J.; Jiménez, L.

2014-04-01

In this paper, we propose a scalable multi-agent architecture to give support to smart grids, paying special attention to the intelligent monitoring of distribution substations. The data gathered by multiple sensors are used by software agents that are responsible for monitoring different aspects or events of interest, such as normal voltage values or unbalanced intensity values that can end up blowing fuses and decreasing the quality of service of end consumers. The knowledge bases of these agents have been built by means of a formal model for normality analysis that has been successfully used in other surveillance domains. The architecture facilitates the integration of new agents and can be easily configured and deployed to monitor different environments. The experiments have been conducted over a power distribution network.

Electronic symptom reporting between patient and provider for improved health care service quality: a systematic review of randomized controlled trials. part 1: state of the art.

PubMed

Johansen, Monika Alise; Henriksen, Eva; Horsch, Alexander; Schuster, Tibor; Berntsen, Gro K Rosvold

2012-10-03

Over the last two decades, the number of studies on electronic symptom reporting has increased greatly. However, the field is very heterogeneous: the choices of patient groups, health service innovations, and research targets seem to involve a broad range of foci. To move the field forward, it is necessary to build on work that has been done and direct further research to the areas holding most promise. Therefore, we conducted a comprehensive review of randomized controlled trials (RCTs) focusing on electronic communication between patient and provider to improve health care service quality, presented in two parts. Part 2 investigates the methodological quality and effects of the RCTs, and demonstrates some promising benefits of electronic symptom reporting. To give a comprehensive overview of the most mature part of this emerging field regarding (1) patient groups, (2) health service innovations, and (3) research targets relevant to electronic symptom reporting. We searched Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore for original studies presented in English-language articles published from 1990 to November 2011. Inclusion criteria were RCTs of interventions where patients or parents reported health information electronically to the health care system for health care purposes and were given feedback. Of 642 records identified, we included 32 articles representing 29 studies. The included articles were published from 2002, with 24 published during the last 5 years. The following five patient groups were represented: respiratory and lung diseases (12 studies), cancer (6), psychiatry (6), cardiovascular (3), and diabetes (1). In addition to these, 1 study had a mix of three groups. All included studies, except 1, focused on long-term conditions. We identified four categories of health service innovations: consultation support (7 studies), monitoring with clinician support (12), self-management with clinician support (9), and therapy (1). Most of the research (21/29, 72%) was conducted within four combinations: consultation support innovation in the cancer group (5/29, 17%), monitoring innovation in the respiratory and lung diseases group (8/29, 28%), and self-management innovations in psychiatry (4/29, 14%) and in the respiratory and lung diseases group (4/29, 14%). Research targets in the consultation support studies focused on increased patient centeredness, while monitoring and self-management mainly aimed at documenting health benefits. All except 1 study aiming for reduced health care costs were in the monitoring group. RCT-based research on electronic symptom reporting has developed enormously since 2002. Research including additional patient groups or new combinations of patient groups with the four identified health service innovations can be expected in the near future. We suggest that developing a generic model (not diagnosis specific) for electronic patient symptom reporting for long-term conditions may benefit the field.

Electronic Symptom Reporting Between Patient and Provider for Improved Health Care Service Quality: A Systematic Review of Randomized Controlled Trials. Part 1: State of the Art

PubMed Central

Henriksen, Eva; Horsch, Alexander; Schuster, Tibor; Berntsen, Gro K Rosvold

2012-01-01

Background Over the last two decades, the number of studies on electronic symptom reporting has increased greatly. However, the field is very heterogeneous: the choices of patient groups, health service innovations, and research targets seem to involve a broad range of foci. To move the field forward, it is necessary to build on work that has been done and direct further research to the areas holding most promise. Therefore, we conducted a comprehensive review of randomized controlled trials (RCTs) focusing on electronic communication between patient and provider to improve health care service quality, presented in two parts. Part 2 investigates the methodological quality and effects of the RCTs, and demonstrates some promising benefits of electronic symptom reporting. Objective To give a comprehensive overview of the most mature part of this emerging field regarding (1) patient groups, (2) health service innovations, and (3) research targets relevant to electronic symptom reporting. Methods We searched Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore for original studies presented in English-language articles published from 1990 to November 2011. Inclusion criteria were RCTs of interventions where patients or parents reported health information electronically to the health care system for health care purposes and were given feedback. Results Of 642 records identified, we included 32 articles representing 29 studies. The included articles were published from 2002, with 24 published during the last 5 years. The following five patient groups were represented: respiratory and lung diseases (12 studies), cancer (6), psychiatry (6), cardiovascular (3), and diabetes (1). In addition to these, 1 study had a mix of three groups. All included studies, except 1, focused on long-term conditions. We identified four categories of health service innovations: consultation support (7 studies), monitoring with clinician support (12), self-management with clinician support (9), and therapy (1). Most of the research (21/29, 72%) was conducted within four combinations: consultation support innovation in the cancer group (5/29, 17%), monitoring innovation in the respiratory and lung diseases group (8/29, 28%), and self-management innovations in psychiatry (4/29, 14%) and in the respiratory and lung diseases group (4/29, 14%). Research targets in the consultation support studies focused on increased patient centeredness, while monitoring and self-management mainly aimed at documenting health benefits. All except 1 study aiming for reduced health care costs were in the monitoring group. Conclusion RCT-based research on electronic symptom reporting has developed enormously since 2002. Research including additional patient groups or new combinations of patient groups with the four identified health service innovations can be expected in the near future. We suggest that developing a generic model (not diagnosis specific) for electronic patient symptom reporting for long-term conditions may benefit the field. PMID:23032300

The EVER-EST portal as support for the Sea Monitoring Virtual Research Community, through the sharing of resources, enabling dynamic collaboration and promoting community engagement

NASA Astrophysics Data System (ADS)

Foglini, Federica; Grande, Valentina; De Leo, Francesco; Mantovani, Simone; Ferraresi, Sergio

2017-04-01

EVER-EST offers a framework based on advanced services delivered both at the e-infrastructure and domain-specific level, with the objective of supporting each phase of the Earth Science Research and Information Lifecycle. It provides innovative e-research services to Earth Science user communities for communication, cross-validation and the sharing of knowledge and science outputs. The project follows a user-centric approach: real use cases taken from pre-selected Virtual Research Communities (VRC) covering different Earth Science research scenarios drive the implementation of the Virtual Research Environment (VRE) services and capabilities. The Sea Monitoring community is involved in the evaluation of the EVER-EST infrastructure. The community of potential users is wide and heterogeneous including both multi-disciplinary scientists and national/international agencies and authorities (e.g. MPAs directors, technicians from regional agencies like ARPA in Italy, the technicians working for the Ministry of the Environment) dealing with the adoption of a better way of measuring the quality of the environment. The scientific community has the main role of assessing the best criteria and indicators for defining the Good Environmental Status (GES) in their own sub regions, and implementing methods, protocols and tools for monitoring the GES descriptors. According to the Marine Strategy Framework Directive (MSFD), the environmental status of marine waters is defined by 11 descriptors, and forms a proposed set of 29 associated criteria and 56 different indicators. The objective of the Sea Monitoring VRC is to provide useful and applicable contributions to the evaluation of the descriptors: D1.Biodiversity, D2.Non-indigenous species and D6.Seafloor Integrity (http://ec.europa.eu/environment/marine/good-environmental-status/index_en.htm). The main challenges for the community members are: 1. discovery of existing data and products distributed among different infrastructures; 2. sharing methodologies about the GES evaluation and monitoring; 3. working on the same workflows and data; 4. adopting shared powerful tools for data processing (e.g. software and servers). The Sea Monitoring portal provides the VRC users with tools and services aimed at enhancing their ability to interoperate and share knowledge, experience and methods for GES assessment and monitoring, such as: •digital information services for data management, exploitation and preservation (accessibility of heterogeneous data sources including associated documentation); •e-collaboration services to communicate and share knowledge, ideas, protocols and workflows; •e-learning services to facilitate the use of common workflows for assessing GES indicators; •e-research services for workflow management, validation and verification, as well as visualization and interactive services. The current study is co-financed by the European Union's Horizon 2020 research and innovation programme under the EVER-EST project (Grant Agreement No. 674907).

Primary Healthcare-based Diabetes Registry in Puducherry: Design and Methods

PubMed Central

Lakshminarayanan, Subitha; Kar, Sitanshu Sekhar; Gupta, Rajeev; Xavier, Denis; Bhaskar Reddy, S. Vijaya

2017-01-01

Background: Diabetes registries monitor the population prevalence and incidence of diabetes, monitor diabetes control program, provide information of quality of care to health service providers, and provide a sampling frame for interventional studies. This study documents the process of establishing a prospective diabetes registry in a primary health-care setting in Puducherry. Methods: This is a facility-based prospective registry conducted in six randomly selected urban health centers in Puducherry, with enrollment of all known patients with diabetes attending chronic disease clinics. Administrative approvals were obtained from Government Health Services. Manuals for training of medical officers, health-care workers, and case report forms were developed. Diabetes registry was prepared using Epi Info software. Results: In the first phase, demographic characteristics, risk factors, complications, coexisting chronic conditions, lifestyle and medical management, and clinical outcomes were recorded. Around 2177 patients with diabetes have been registered in six Primary Health Centres out of a total of 2948 participants seeking care from chronic disease clinic. Registration coverage ranges from 61% to 105% in these centers. Conclusion: This study has documented methodological details, and learning experiences gained while developing a diabetes registry at the primary health care level and the scope for upscaling to a Management Information System for Diabetes and a State-wide Registry. Improvement in patient care through needs assessment and quality assurance in service delivery is an important theme envisioned by this registry. PMID:28553589

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

PubMed

Korop, Oleg A; Lenskykh, Sergiy V

2018-01-01

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

Adapting the balanced scorecard for mental health and addictions: an inpatient example.

PubMed

Lin, Elizabeth; Durbin, Janet

2008-05-01

The Balanced Scorecard (BSC) is a performance-monitoring framework that originated in the business sector but has more recently been applied to health services. The province of Ontario is using the BSC approach to monitor quality of inpatient care in five service areas. Feasibility of the scorecard framework for each area has been assessed using a standard approach. This paper reports results of the feasibility study for the mental health sector, focusing on three issues: framework relevance, underlying strategic goals and indicator selection. Based on a literature review and extensive stakeholder input, the BSC quadrant structure was recommended with some modifications, and indicators were selected that aligned with provincial mental health reform policy goals. The mental health report has completed two cycles of reporting, and has received good support from the field. Copyright © 2008 Longwoods Publishing.

The AirQuality SenseBox

NASA Astrophysics Data System (ADS)

Demuth, Dustin; Nuest, Daniel; Bröring, Arne; Pebesma, Edzer

2013-04-01

In the past year, a group of open hardware enthusiasts and citizen scientists had large success in the crowd-funding of an open hardware-based sensor platform for air quality monitoring, called the Air Quality Egg. Via the kickstarter platform, the group was able to collect triple the amount of money than needed to fulfill their goals. Data generated by the Air Quality Egg is pushed to the data logging platform cosm.com, which makes the devices a part of the Internet of Things. The project aims at increasing the participation of citizens in the collection of data, the development of sensors, the operation of sensor stations, and, as data on cosm is publicly available, the sharing, visualization and analysis of data. Air Quality Eggs can measure NO2 and CO concentrations, as well as relative humidity and temperature. The chosen sensors are low-cost and have limited precision and accurracy. The Air Quality Egg consists of a stationary outdoor and a stationary indoor unit. Each outdoor unit will wirelessly transmit air quality measurements to the indoor unit, which forwards the data to cosm. Most recent versions of the Air Quality Egg allow a rough calibration of the gas sensors and on-the-fly conversion from raw sensor readings (impedance) to meaningful air quality data expressed in units of parts per billion. Data generated by these low-cost platforms are not intended to replace well-calibrated official monitoring stations, but rather augment the density of the total monitoring network with citizen sensors. To improve the usability of the Air Quality Egg, we present a new and more advanced concept, called the AirQuality SenseBox. We made the outdoor platform more autonomous and location-aware by adding solarpanels and rechargeable batteries as a power source. The AirQuality SenseBox knows its own position from a GPS device attached to the platform. As a mobile sensor platform, it can for instance be attached to vehicles. A low-cost and low-power wireless chipset reads the sensors and broadcasts the data. The data is received by gateways that convert the data and forward it to services. Although cosm is still supported, we also use services that are more common in the scientific domain, in particular the OGC Sensor Observation Service. In contrast to the ``One Sender - One Receiver'' (pair) setup proposed by the platform developers, we follow a ``Many Senders - Many Receivers'' (mesh) solution. As data is broadcasted by the platforms, it can be received and processed by any gateway, and, as the sender is not bound to the receiver, applications different from the gateways can receive and evaluate the data measured by the platform. Advantages of our solution are: (i) prepared gateways, which have more precise data at hand, can send calibration instructions to the mobile sensor platforms when those are in proximity; (ii) redundancy is obtained by adding additional gateways, to avoid the loss of data if a gateway fails; (iii) autonomous stations can be ubiquitous, are robust, do not require frequent maintenance, and can be placed at arbitrary locations; (iv) the standardized interface is vendor-independent and allows direct integration into existing analysis software.

WHO Better Outcomes in Labour Difficulty (BOLD) project: innovating to improve quality of care around the time of childbirth.

PubMed

Oladapo, Olufemi T; Souza, João Paulo; Bohren, Meghan A; Tunçalp, Özge; Vogel, Joshua P; Fawole, Bukola; Mugerwa, Kidza; Gülmezoglu, A Metin

2015-05-26

As most pregnancy-related deaths and morbidities are clustered around the time of childbirth, quality of care during this period is critical to the survival of pregnant women and their babies. Despite the wide acceptance of partograph as the central tool to optimize labour outcomes for over 40 years, its use has not successfully improved outcomes in many settings for several reasons. There are also increasing questions about the validity and applicability of its central feature - "the alert line" - to all women regardless of their labour characteristics. Apart from the known deficiencies in labour care, attempts to improve quality of care in low resource settings have also failed to address and integrate women's birth experience into quality improvement processes. It was against this background that the World Health Organization (WHO) embarked on the Better Outcomes in Labour Difficulty (BOLD) project to improve the quality of intrapartum care in low- and middle-income countries. The main goal of the BOLD project is to reduce intrapartum-related stillbirths, maternal and newborn mortalities and morbidities by addressing the critical barriers to the process of good quality intrapartum care and enhancing the connection between health systems and communities. The project seeks to achieve this goal by (1) developing an evidence-based, easy to use, labour monitoring-to-action decision-support tool (currently termed Simplified, Effective, Labour Monitoring-to-Action - SELMA); and (2) by developing innovative service prototypes/tools, co-designed with users of health services (women, their families and communities) and health providers, to promote access to respectful, dignified and emotionally supportive care for pregnant women and their companions at the time of birth ("Passport to Safer Birth"). This two-pronged approach is expected to positively impact on important domains of quality of care relating to both provision and experience of care. In this paper, we briefly describe the rationale for innovative thinking in relation to improving quality of care around the time of childbirth and introduce WHO current plans to improve care through research, design and implementation of innovative tools and services in the post-2015 era.Please see related articles ' http://dx.doi.org/10.1186/s12978-015-0029-4 ' and ' http://dx.doi.org/10.1186/s12978-015-0028-5 '.

Quality of oral anticoagulation with phenprocoumon in regular medical care and its potential for improvement in a telemedicine-based coagulation service--results from the prospective, multi-center, observational cohort study thrombEVAL.

PubMed

Prochaska, Jürgen H; Göbel, Sebastian; Keller, Karsten; Coldewey, Meike; Ullmann, Alexander; Lamparter, Heidrun; Jünger, Claus; Al-Bayati, Zaid; Baer, Christina; Walter, Ulrich; Bickel, Christoph; ten Cate, Hugo; Münzel, Thomas; Wild, Philipp S

2015-01-23

The majority of studies on quality of oral anticoagulation (OAC) therapy with vitamin K-antagonists are performed with short-acting warfarin. Data on long-acting phenprocoumon, which is frequently used in Europe for OAC therapy and is considered to enable more stable therapy adjustment, are scarce. In this study, we aimed to assess quality of OAC therapy with phenprocoumon in regular medical care and to evaluate its potential for optimization in a telemedicine-based coagulation service. In the prospective observational cohort study program thrombEVAL we investigated 2,011 patients from regular medical care in a multi-center cohort study and 760 patients from a telemedicine-based coagulation service in a single-center cohort study. Data were obtained from self-reported data, computer-assisted personal interviews, and laboratory measurements according to standard operating procedures with detailed quality control. Time in therapeutic range (TTR) was calculated by linear interpolation method to assess quality of OAC therapy. Study monitoring was carried out by an independent institution. Overall, 15,377 treatment years and 48,955 international normalized ratio (INR) measurements were analyzed. Quality of anticoagulation, as measured by median TTR, was 66.3% (interquartile range (IQR) 47.8/81.9) in regular medical care and 75.5% (IQR 64.2/84.4) in the coagulation service (P <0.001). Stable anticoagulation control within therapeutic range was achieved in 63.8% of patients in regular medical care with TTR at 72.1% (IQR 58.3/84.7) as compared to 96.4% of patients in the coagulation service with TTR at 76.2% [(IQR 65.6/84.7); P = 0.001)]. Prospective follow-up of coagulation service patients with pretreatment in regular medical care showed an improvement of the TTR from 66.2% (IQR 49.0/83.6) to 74.5% (IQR 62.9/84.2; P <0.0001) in the coagulation service. Treatment in the coagulation service contributed to an optimization of the profile of time outside therapeutic range, a 2.2-fold increase of stabile INR adjustment and a significant decrease in TTR variability by 36% (P <0.001). Quality of anticoagulation with phenprocoumon was comparably high in this real-world sample of regular medical care. Treatment in a telemedicine-based coagulation service substantially improved quality of OAC therapy with regard to TTR level, frequency of stable anticoagulation control, and TTR variability. ClinicalTrials.gov, unique identifier NCT01809015, March 8, 2013.

The quality of free antenatal and delivery services in Northern Sierra Leone.

PubMed

Koroma, Manso M; Kamara, Samuel S; Bangura, Evelyn A; Kamara, Mohamed A; Lokossou, Virgil; Keita, Namoudou

2017-07-12

The number of maternal deaths in sub-Saharan Africa continues to be overwhelmingly high. In West Africa, Sierra Leone leads the list, with the highest maternal mortality ratio. In 2010, financial barriers were removed as an incentive for more women to use available antenatal, delivery and postnatal services. Few published studies have examined the quality of free antenatal services and access to emergency obstetric care in Sierra Leone. A cross-sectional survey was conducted in 2014 in all 97 peripheral health facilities and three hospitals in Bombali District, Northern Region. One hundred antenatal care providers were interviewed, 276 observations were made and 486 pregnant women were interviewed. We assessed the adequacy of antenatal and delivery services provided using national standards. The distance was calculated between each facility providing delivery services and the nearest comprehensive emergency obstetric care (CEOC) facility, and the proportion of facilities in a chiefdom within 15 km of each CEOC facility was also calculated. A thematic map was developed to show inequities. The quality of services was poor. Based on national standards, only 27% of women were examined, 2% were screened on their first antenatal visit and 47% received interventions as recommended. Although 94% of facilities provided delivery services, a minority had delivery rooms (40%), delivery kits (42%) or portable water (46%). Skilled attendants supervised 35% of deliveries, and in only 35% of these were processes adequately documented. None of the five basic emergency obstetric care facilities were fully compliant with national standards, and the central and northernmost parts of the district had the least access to comprehensive emergency obstetric care. The health sector needs to monitor the quality of antenatal interventions in addition to measuring coverage. The quality of delivery services is compromised by poor infrastructure, inadequate skilled staff, stock-outs of consumables, non-functional basic emergency obstetric care facilities, and geographic inequities in access to CEOC facilities. These findings suggest that the health sector needs to urgently investigate continuing inequities adversely influencing the uptake of these services, and explore more sustainable funding mechanisms. Without this, the country is unlikely to achieve its goal of reducing maternal deaths.

Level I water-quality inventory and monitoring, Richmond National Battlefield Park, Virginia

USGS Publications Warehouse

Moberg, Roger M.; Rice, Karen C.

2002-01-01

The U.S. Geological Survey conducted a Level I Water-Quality Inventory and Monitoring (WAQIM) data-collection effort for Richmond National Battlefield Park (Richmond NBP) from August 2001 through April 2002. The primary objective of the WAQIM program was to provide the National Park Service (NPS) and Richmond NBP with at least a nominal inventory of its natural resources and to provide those data in a data-management system consistent with park management needs. Water-quality inventory data (physical, chemical, and biological) were collected from "key" water bodies within the boundaries of Richmond NBP. The key water bodies are those waters within park boundaries that are essential to the central cultural, historical or natural resources management themes of the parks or provide habitats to threatened or endangered plants and animals. Data were collected during the fall, winter, spring, and summer over a range of hydrologic conditions. Because of the drought conditions that persisted during the study period, variations in flow between seasons were less pronounced than during normal hydrologic conditions.

Quality of Surface Water in Missouri, Water Year 2008

USGS Publications Warehouse

Otero-Benitez, William; Davis, Jerri V.

2009-01-01

The U.S. Geological Survey, in cooperation with the Missouri Department of Natural Resources, designed and operates a series of monitoring stations on streams throughout Missouri known as the Ambient Water-Quality Monitoring Network. During the 2008 water year (October 1, 2007, through September 30, 2008), data were collected at 67 stations, including two U.S. Geological Survey National Stream Quality Accounting Network stations and one spring sampled in cooperation with the U.S. Forest Service. Dissolved oxygen, specific conductance, water temperature, suspended solids, suspended sediment, fecal coliform bacteria, Escherichia coli bacteria, dissolved nitrate plus nitrite, total phosphorus, dissolved and total recoverable lead and zinc, and selected pesticide data summaries are presented for 64 of these stations. The stations primarily have been classified into groups corresponding to the physiography of the State, primary land use, or unique station types. In addition, a summary of hydrologic conditions in the State including peak discharges, monthly mean discharges, and seven-day low flow is presented.

Physician satisfaction with clinical laboratory services: a College of American Pathologists Q-probes study of 138 institutions.

PubMed

Jones, Bruce A; Bekeris, Leonas G; Nakhleh, Raouf E; Walsh, Molly K; Valenstein, Paul N

2009-01-01

Monitoring customer satisfaction is a valuable component of a laboratory quality improvement program. To survey the level of physician satisfaction with hospital clinical laboratory services. Participating institutions provided demographic and practice information and survey results of physician satisfaction with defined aspects of clinical laboratory services, rated on a scale of 1 (poor) to 5 (excellent). One hundred thirty-eight institutions participated in this study and submitted a total of 4329 physician surveys. The overall satisfaction score for all institutions ranged from 2.9 to 5.0. The median overall score for all participants was 4.1 (10th percentile, 3.6; 90th percentile, 4.5). Physicians were most satisfied with the quality/reliability of results and staff courtesy, with median values of excellent or good ratings of 89.9%. Of the 5 service categories that received the lowest percentage values of excellent/good ratings (combined scores of 4 and 5), 4 were related to turnaround time for inpatient stat, outpatient stat, routine, and esoteric tests. Surveys from half of the participating laboratories reported that 96% to 100% of physicians would recommend the laboratory to other physicians. The category most frequently selected as the most important category of laboratory services was quality/reliability of results (31.7%). There continues to be a high level of physician satisfaction and loyalty with clinical laboratory services. Test turnaround times are persistent categories of dissatisfaction and present opportunities for improvement.

Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges.

PubMed

Bajorek, Beata; Lemay, Kate S; Magin, Parker; Roberts, Christopher; Krass, Ines; Armour, Carol L

2016-01-01

Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control - usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context.

Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

PubMed Central

2016-01-01

Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control – usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Results: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. Conclusion: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context. PMID:27382427

Monitoring quality of care at dialysis facilities: a case for regulatory parsimony--and beyond.

PubMed

Stivelman, John C

2012-10-01

With the issuance of the new Conditions for Coverage in 2008 and the implementation of the Prospective Payment System in 2011, the Centers for Medicare & Medicaid Services has fundamentally altered the regulatory landscape of quality in the ESRD program. Although these changes-largely through use of tools comparing individual facility performance to regional and national quality expectations-have increased facility accountability for the quality of patient care in many quarters, they have also complicated both substance and process of facility adherence to quality rules in that component of the program. This editorial critically assesses the main quality tools now in use for dialysis facilities and reviews the issues arising from their conjoint use. A scheme for improving the effectiveness of each quality tool is proposed, and an assessment of their future value and effectiveness in quality improvement is offered.

Stormwater Management Effects on Ecosystem Services: A Literature Review

NASA Astrophysics Data System (ADS)

Prudencio, L.; Null, S. E.

2016-12-01

Managing stormwater provides benefits for enhancing water supplies while reducing urban runoff. Yet, there has been little research focused on understanding how stormwater management affects ecosystem services, the benefits that ecosystems provide to humans. Garnering more knowledge of the changes to ecosystem services from stormwater management will ultimately improve management and decision-making. The objective of this research is to review and synthesize published literature on 1) ecosystem services and stormwater management and 2) changes in ecosystem services from anthropogenic impacts and climate warming, to establish a foundation for research at the intersection of ecosystems services, stormwater management, and global environmental change. We outline four research areas for ecosystem services and stormwater management that should be further explored. These four areas, named after the four types of ecosystem services, highlight context-specific research questions and human and climate change effects. We conclude that effective and sustainable stormwater management requires incorporating engineering, social, and environmental criteria to quantify benefits of provisioning, regulating, cultural, and supporting ecosystem services. Lastly, improved current and potential stormwater management policy may better support sustainable stormwater methods at the institutional level. Stormwater quality and monitoring could be improved through the use of the Clean Water Act (e.g. Total Maximum Daily Loads), the Endangered Species Act, and public health measures. Additional policies regulating groundwater quantity and quality have been and may continue to be implemented by states, encouraging sustainable and cleaner stormwater practices.

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.

Research on Clinical Preventive Services for Adolescents and Young Adults: Where Are We and Where Do We Need to Go?

PubMed Central

Harris, Sion K.; Aalsma, Matthew C.; Weitzman, Elissa R.; Garcia-Huidobro, Diego; Wong, Charlene; Hadland, Scott E.; Santelli, John; Park, M. Jane; Ozer, Elizabeth M.

2017-01-01

We reviewed research regarding system- and visit-level strategies to enhance clinical preventive service delivery and quality for adolescents and young adults. Despite professional consensus on recommended services for adolescents, a strong evidence base for services for young adults, and improved financial access to services with the Affordable Care Act’s provisions, receipt of preventive services remains suboptimal. Further research that builds off successful models of linking traditional and community clinics is needed to improve access to care for all youth. To optimize the clinical encounter, promising clinician-focused strategies to improve delivery of preventive services include screening and decision support tools, particularly when integrated into electronic medical record systems and supported by training and feedback. Although results have been mixed, interventions have moved beyond increasing service delivery to demonstrating behavior change. Research on emerging technology—such as gaming platforms, mobile phone applications, and wearable devices—suggests opportunities to expand clinicians’ reach; however, existing research is based on limited clinical settings and populations. Improved monitoring systems and further research are needed to examine preventive services facilitators and ensure that interventions are effective across the range of clinical settings where youth receive preventive care, across multiple populations, including young adults, and for more vulnerable populations with less access to quality care. PMID:28011064

Research on Clinical Preventive Services for Adolescents and Young Adults: Where Are We and Where Do We Need to Go?

PubMed

Harris, Sion K; Aalsma, Matthew C; Weitzman, Elissa R; Garcia-Huidobro, Diego; Wong, Charlene; Hadland, Scott E; Santelli, John; Park, M Jane; Ozer, Elizabeth M

2017-03-01

We reviewed research regarding system- and visit-level strategies to enhance clinical preventive service delivery and quality for adolescents and young adults. Despite professional consensus on recommended services for adolescents, a strong evidence base for services for young adults, and improved financial access to services with the Affordable Care Act's provisions, receipt of preventive services remains suboptimal. Further research that builds off successful models of linking traditional and community clinics is needed to improve access to care for all youth. To optimize the clinical encounter, promising clinician-focused strategies to improve delivery of preventive services include screening and decision support tools, particularly when integrated into electronic medical record systems and supported by training and feedback. Although results have been mixed, interventions have moved beyond increasing service delivery to demonstrating behavior change. Research on emerging technology-such as gaming platforms, mobile phone applications, and wearable devices-suggests opportunities to expand clinicians' reach; however, existing research is based on limited clinical settings and populations. Improved monitoring systems and further research are needed to examine preventive services facilitators and ensure that interventions are effective across the range of clinical settings where youth receive preventive care, across multiple populations, including young adults, and for more vulnerable populations with less access to quality care. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

A systematic review of the cost of data collection for performance monitoring in hospitals.

PubMed

Jones, Cheryl; Gannon, Brenda; Wakai, Abel; O'Sullivan, Ronan

2015-04-01

Key performance indicators (KPIs) are used to identify where organisational performance is meeting desired standards and where performance requires improvement. Valid and reliable KPIs depend on the availability of high-quality data, specifically the relevant minimum data set ((MDS) the core data identified as the minimum required to measure performance for a KPI) elements. However, the feasibility of collecting the relevant MDS elements is always a limitation of performance monitoring using KPIs. Preferably, data should be integrated into service delivery, and, where additional data are required that are not currently collected as part of routine service delivery, there should be an economic evaluation to determine the cost of data collection. The aim of this systematic review was to synthesise the evidence base concerning the costs of data collection in hospitals for performance monitoring using KPI, and to identify hospital data collection systems that have proven to be cost minimising. We searched MEDLINE (1946 to May week 4 2014), Embase (1974 to May week 2 2014), and CINAHL (1937 to date). The database searches were supplemented by searching for grey literature through the OpenGrey database. Data was extracted, tabulated, and summarised as part of a narrative synthesis. The searches yielded a total of 1,135 publications. After assessing each identified study against specific inclusion exclusion criteria only eight studies were deemed as relevant for this review. The studies attempt to evaluate different types of data collection interventions including the installation of information communication technology (ICT), improvements to current ICT systems, and how different analysis techniques may be used to monitor performance. The evaluation methods used to measure the costs and benefits of data collection interventions are inconsistent across the identified literature. Overall, the results weakly indicate that collection of hospital data and improvements in data recording can be cost-saving. Given the limitations of this systematic review, it is difficult to conclude whether improvements in data collection systems can save money, increase quality of care, and assist performance monitoring of hospitals. With that said, the results are positive and suggest that data collection improvements may lead to cost savings and aid quality of care. PROSPERO CRD42014007450 .

Quality management systems for your in vitro fertilization clinic's laboratory: Why bother?

PubMed

Olofsson, Jan I; Banker, Manish R; Sjoblom, Late Peter

2013-01-01

Several countries have in recent years introduced prescribed requirements for treatment and monitoring of outcomes, as well as a licensing or accreditation requirement for in vitro fertilization (IVF) clinics and their laboratories. It is commonplace for Assisted Reproductive Technology (ART) laboratories to be required to have a quality control system. However, more effective Total Quality Management systems are now being implemented by an increasing number of ART clinics. In India, it is now a requirement to have a quality management system in order to be accredited and to help meet customer demand for improved delivery of ART services. This review contains the proceedings a quality management session at the Indian Fertility Experts Meet (IFEM) 2010 and focuses on the creation of a patient-oriented best-in-class IVF laboratory.

Quality management systems for your in vitro fertilization clinic's laboratory: Why bother?

PubMed Central

Olofsson, Jan I; Banker, Manish R; Sjoblom, Late Peter

2013-01-01

Several countries have in recent years introduced prescribed requirements for treatment and monitoring of outcomes, as well as a licensing or accreditation requirement for in vitro fertilization (IVF) clinics and their laboratories. It is commonplace for Assisted Reproductive Technology (ART) laboratories to be required to have a quality control system. However, more effective Total Quality Management systems are now being implemented by an increasing number of ART clinics. In India, it is now a requirement to have a quality management system in order to be accredited and to help meet customer demand for improved delivery of ART services. This review contains the proceedings a quality management session at the Indian Fertility Experts Meet (IFEM) 2010 and focuses on the creation of a patient-oriented best-in-class IVF laboratory. PMID:23869142

The integrated management for renal replacement therapy in Portugal.

PubMed

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

2014-01-01

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

QoS and energy aware cooperative routing protocol for wildfire monitoring wireless sensor networks.

PubMed

Maalej, Mohamed; Cherif, Sofiane; Besbes, Hichem

2013-01-01

Wireless sensor networks (WSN) are presented as proper solution for wildfire monitoring. However, this application requires a design of WSN taking into account the network lifetime and the shadowing effect generated by the trees in the forest environment. Cooperative communication is a promising solution for WSN which uses, at each hop, the resources of multiple nodes to transmit its data. Thus, by sharing resources between nodes, the transmission quality is enhanced. In this paper, we use the technique of reinforcement learning by opponent modeling, optimizing a cooperative communication protocol based on RSSI and node energy consumption in a competitive context (RSSI/energy-CC), that is, an energy and quality-of-service aware-based cooperative communication routing protocol. Simulation results show that the proposed algorithm performs well in terms of network lifetime, packet delay, and energy consumption.

Response of consumer and research grade indoor air quality monitors to residential sources of fine particles.

PubMed

Singer, B C; Delp, W W

2018-04-23

The ability to inexpensively monitor PM 2.5 to identify sources and enable controls would advance residential indoor air quality (IAQ) management. Consumer IAQ monitors incorporating low-cost optical particle sensors and connections with smart home platforms could provide this service if they reliably detect PM 2.5 in homes. In this study, particles from typical residential sources were generated in a 120 m 3 laboratory and time-concentration profiles were measured with 7 consumer monitors (2-3 units each), 2 research monitors (Thermo pDR-1500, MetOne BT-645), a Grimm Mini Wide-Range Aerosol Spectrometer (GRM), and a Tapered Element Oscillating Microbalance with Filter Dynamic Measurement System (FDMS), a Federal Equivalent Method for PM 2.5 . Sources included recreational combustion (candles, cigarettes, incense), cooking activities, an unfiltered ultrasonic humidifier, and dust. FDMS measurements, filter samples, and known densities were used to adjust the GRM to obtain time-resolved mass concentrations. Data from the research monitors and 4 of the consumer monitors-AirBeam, AirVisual, Foobot, Purple Air-were time correlated and within a factor of 2 of the estimated mass concentrations for most sources. All 7 of the consumer and both research monitors substantially under-reported or missed events for which the emitted mass was comprised of particles smaller than 0.3 μm diameter. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Measurement repeatability of a large-scale inventory of forest fuels

Treesearch

J.A. Westfall; C.W. Woodall

2007-01-01

An efficient and accurate inventory of forest fuels at large scales is critical for assessment of forest fire hazards across landscapes. The Forest Inventory and Analysis (FIA) program of the USDA Forest Service conducts a national inventory of fuels along with blind remeasurement of a portion of inventory plots to monitor and improve data quality. The goal of this...

The Alliance for Innovation in Maternal Health Care: A Way Forward.

PubMed

Mahoney, Jeanne

2018-06-01

The Alliance for Innovation in Maternal Health is a program supported by the Health Services Resource Administration to reduce maternal mortality and severe maternal morbidity in the United States. This program develops bundles of evidence based action steps for birth facilities to adapt. Progress is monitored at the facility, state and national levels to foster data-driven quality improvement efforts.

Land-use change and new houses on forestland: contrasting trends over 30 years in Oregon and Washington

Treesearch

Andrew N. Gray; Joel L. Thompson; Gary J. Lettman

2015-01-01

Conversion of forest, range, and agricultural resource lands to residential and commercial uses affects the available land base, management practices on remaining resource lands, habitat quality, and ecosystem services. The Forest Inventory and Analysis program (FIA) mandate includes monitoring changes in the land area in forest use, and this has proved valuable for...

77 FR 7584 - Draft Guidance for Industry on Heparin for Drug and Medical Device Use; Monitoring Crude Heparin...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-13

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-D-0083... Quality; Availability AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and... contamination. DATES: Although you can comment on any guidance at any time (see 21 CFR 10.115(g)(5)), to ensure...

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

NASA Astrophysics Data System (ADS)

Crosthwaite Eyre, Charles

2010-12-01

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

Implementation of the National Breast and Cervical Cancer Early Detection Program

PubMed Central

Lee, Nancy C.; Wong, Faye L.; Jamison, Patricia M.; Jones, Sandra F.; Galaska, Louise; Brady, Kevin T.; Wethers, Barbara; Stokes-Townsend, George-Ann

2015-01-01

In 1990, Congress passed the Breast and Cervical Cancer Mortality Prevention Act because of increases in the number of low-income and uninsured women being diagnosed with breast cancer. This act authorized the Centers for Disease Control and Prevention (CDC) to establish the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to provide high-quality and timely breast and cervical cancer screening and diagnostic services to low-income, uninsured women. The program started in 1991, and, in 1993, Congress amended the act to allow the CDC to fund American Indian and Alaska Native tribes and tribal organizations. By 1996, the program was providing cancer screening across the United States. To ensure appropriate delivery and monitoring of services, the program adopted detailed policies on program management, evidence-based guidelines for clinical services, a systematized clinical data system to track service quality, and key partnerships that expand the program’s reach. The NBCCEDP currently funds 67 programs, including all 50 states, the District of Columbia, 5 US territories, and 11 tribes or tribal organizations. PMID:25099896

Transfer of European Approach to Groundwater Monitoring in China

NASA Astrophysics Data System (ADS)

Zhou, Y.

2007-12-01

Major groundwater development in North China has been a key factor in the huge economic growth and the achievement of self sufficiency in food production. Groundwater accounts for more than 70 percent of urban water supply and provides important source of irrigation water during dry period. This has however caused continuous groundwater level decline and many associated problems: hundreds of thousands of dry wells, dry river beds, land subsidence, seawater intrusion and groundwater quality deterioration. Groundwater levels in the shallow unconfined aquifers have fallen 10m up to 50m, at an average rate of 1m/year. In the deep confined aquifers groundwater levels have commonly fallen 30m up to 90m, at an average rate of 3 to 5m/year. Furthermore, elevated nitrate concentrations have been found in shallow groundwater in large scale. Pesticides have been detected in vulnerable aquifers. Urgent actions are necessary for aquifer recovery and mitigating groundwater pollution. Groundwater quantity and quality monitoring plays a very important role in formulating cost-effective groundwater protection strategies. In 2000 European Union initiated a Water Framework Directive (2000/60/EC) to protect all waters in Europe. The objective is to achieve good water and ecological status by 2015 cross all member states. The Directive requires monitoring surface and groundwater in all river basins. A guidance document for monitoring was developed and published in 2003. Groundwater monitoring programs are distinguished into groundwater level monitoring and groundwater quality monitoring. Groundwater quality monitoring is further divided into surveillance monitoring and operational monitoring. The monitoring guidance specifies key principles for the design and operation of monitoring networks. A Sino-Dutch cooperation project was developed to transfer European approach to groundwater monitoring in China. The project aims at building a China Groundwater Information Centre. Case studies in 3 pilot areas have been conducted to build research capacities of the central and provincial groundwater information centers in providing groundwater information services to decision makers and public. Groundwater regime zoning and pollution risk maps were used to lay-out groundwater quantity and quality monitoring networks, respectively. Automatic groundwater recorders were installed in selected observation wells. ArcGIS based regional groundwater information systems were constructed and used to create groundwater regime zoning and pollution risk maps. Steady state groundwater models have been constructed and calibrated. Transient groundwater models are under calibration. Groundwater resources development scenarios were formulated. The model will be used to predict what will be consequences in next 20 years if current situation continues as business as usual. Possibilities of reducing groundwater abstraction and opportunities of artificially enhanced groundwater recharge will be analyzed. Combination of decreasing abstraction and increasing recharge may lead to a sustainable plan of future groundwater resources development.

Highly survivable bed pressure mat remote patient monitoring system for mHealth.

PubMed

Joshi, Vilas; Holtzman, Megan; Arcelus, Amaya; Goubran, Rafik; Knoefel, Frank

2012-01-01

The high speed mobile networks like 4G and beyond are making a ubiquitous remote patient monitoring (RPM) system using multiple sensors and wireless sensor networks a realistic possibility. The high speed wireless RPM system will be an integral part of the mobile health (mHealth) paradigm reducing cost and providing better service to the patients. While the high speed wireless RPM system will allow clinicians to monitor various chronic and acute medical conditions, the reliability of such system will depend on the network Quality of Service (QoS). The RPM system needs to be resilient to temporary reduced network QoS. This paper presents a highly survivable bed pressure mat RPM system design using an adaptive information content management methodology for the monitored sensor data. The proposed design improves the resiliency of the RPM system under adverse network conditions like congestion and/or temporary loss of connectivity. It also shows how the proposed RPM system can reduce the information rate and correspondingly reduce the data transfer rate by a factor of 5.5 and 144 to address temporary network congestion. The RPM system data rate reduction results in a lower specificity and sensitivity for the features being monitored but increases the survivability of the system from 1 second to 2.4 minutes making it highly robust.

Utilizing a Homecare Platform for Remote Monitoring of Patients with Idiopathic Pulmonary Fibrosis.

PubMed

Panagopoulos, Christos; Malli, Foteini; Menychtas, Andreas; Smyrli, Efstathia-Petrina; Georgountzou, Aikaterini; Daniil, Zoe; Gourgoulianis, Konstantinos I; Tsanakas, Panayiotis; Maglogiannis, Ilias

2017-01-01

Homecare and home telemonitoring are a focal point of emerging healthcare schemes, with proven benefits for both patients, caregivers and providers, including reduction of healthcare costs and improved patients' quality of life, especially in the case of chronic disease management. Studies have evaluated solutions for remote monitoring of chronic patients based on technologies that allow daily symptom and vital signs monitoring, tailored to the needs of specific diseases. In this work, we present an affordable home telemonitoring system for patients with idiopathic pulmonary fibrosis (IPF), based on an application for mobile devices and Bluetooth-enabled sensors for pulse oximetry and blood pressure measurements. Besides monitoring of vital signs, the system incorporates communication via videoconferencing and emergency response, with support from a helpdesk service. A pilot study was conducted, in order to verify the proposed solution's feasibility. The results support the utilization of the system for effective monitoring of patients with IPF.

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.

Monitoring the Microgravity Environment Quality On-Board the International Space Station Using Soft Computing Techniques

NASA Technical Reports Server (NTRS)

Jules, Kenol; Lin, Paul P.

2001-01-01

This paper presents an artificial intelligence monitoring system developed by the NASA Glenn Principal Investigator Microgravity Services project to help the principal investigator teams identify the primary vibratory disturbance sources that are active, at any moment in time, on-board the International Space Station, which might impact the microgravity environment their experiments are exposed to. From the Principal Investigator Microgravity Services' web site, the principal investigator teams can monitor via a graphical display, in near real time, which event(s) is/are on, such as crew activities, pumps, fans, centrifuges, compressor, crew exercise, platform structural modes, etc., and decide whether or not to run their experiments based on the acceleration environment associated with a specific event. This monitoring system is focused primarily on detecting the vibratory disturbance sources, but could be used as well to detect some of the transient disturbance sources, depending on the events duration. The system has built-in capability to detect both known and unknown vibratory disturbance sources. Several soft computing techniques such as Kohonen's Self-Organizing Feature Map, Learning Vector Quantization, Back-Propagation Neural Networks, and Fuzzy Logic were used to design the system.

Concepts for VLBI Station Control as Part of NEXPReS

NASA Astrophysics Data System (ADS)

Ettl, M.; Neidhardt, A.; Schönberger, M.; Alef, W.; Himwich, E.; Beaudoin, C.; Plötz, C.; Lovell, J.; Hase, H.

2012-12-01

In the Novel EXploration Pushing Robust e-VLBI Services-project (NEXPReS) the Technische Universität München (TUM) realizes concepts for continuous quality monitoring and station remote control in cooperation with the Max-Planck-Institute for Radio Astronomy, Bonn. NEXPReS is a three-year project, funded within the European Seventh Framework program. It is aimed to develop e-VLBI services for the European VLBI Network (EVN), which can also support the IVS observations (VLBI2010). Within this project, the TUM focuses on developments of an operational remote control system (e-RemoteCtrl) with authentication and authorization. It includes an appropriate role management with different remote access states for future observation strategies. To allow a flexible control of different systems in parallel, sophisticated graphical user interfaces are designed and realized. The software is currently under test in the new AuScope network, Australia/New Zealand. Additional system parameters and information are collected with a new system monitoring (SysMon) for a higher degree of automation, which is currently under preparation for standardization within the IVS Monitoring and Control Infrastructure (MCI) Collaboration Group. The whole system for monitoring and control is fully compatible with the NASA Field System and extends it.

Finding the gap: revealing local disparities in coverage of maternal, newborn and child health services in South Sudan using lot quality assurance sampling.

PubMed

Valadez, Joseph J; Berendes, Sima; Lako, Richard; Gould, Simon; Vargas, William; Milner, Susan

2015-12-01

We adapted a rapid monitoring method to South Sudan, a new nation with one of the world's highest maternal and child mortality rates, aiming to assess coverage of maternal, neonatal and child health (MNCH) services at the time of independence, and introducing a monitoring and evaluation system (M&E) for equity-sensitive tracking of progress related to Millennium Development Goals (MDG) 4 and 5 at national, state and county levels to detect local variability. We conducted a national cross-sectional household survey among women from six client populations in all, but six of South Sudan's 79 counties. We used lot quality assurance sampling (LQAS) to measure coverage with diverse MNCH indicators to obtain information for national-, state- and county-level health system management decision-making. National coverage of MNCH services was low for all maternal and neonatal care, child immunisation, and child care indicators. However, results varied across states and counties. Central Equatoria State (CES), where the capital is located, showed the highest coverage for most indicators (e.g. ≥4 antenatal care visits range: 4.5% in Jonglei to 40.1% in CES). Urban counties often outperformed rural ones. This adaptation of LQAS to South Sudan demonstrates how it can be used in the future as an M&E system to track progress of MDGs at national, state and county levels to detect local disparities. Overall, our data reveal a desperate need for improving MNCH service coverage in all states. © 2015 The Authors.Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Evaluation of Immunization Knowledge, Practices, and Service-delivery in the Private Sector in Cambodia

PubMed Central

Soeung, Sann Chan; Grundy, John; Morn, Cheng; Samnang, Chham

2008-01-01

A study of private-sector immunization services was undertaken to assess scope of practice and quality of care and to identify opportunities for the development of models of collaboration between the public and the private health sector. A questionnaire survey was conducted with health providers at 127 private facilities; clinical practices were directly observed; and a policy forum was held for government representatives, private healthcare providers, and international partners. In terms of prevalence of private-sector provision of immunization services, 93% of the private inpatient clinics surveyed provided immunization services. The private sector demonstrated a lack of quality of care and management in terms of health workers’ knowledge of immunization schedules, waste and vaccine management practices, and exchange of health information with the public sector. Policy and operational guidelines are required for private-sector immunization practices that address critical subject areas, such as setting of standards, capacity-building, public-sector monitoring, and exchange of health information between the public and the private sector. Such public/private collaborations will keep pace with the trends towards the development of private-sector provision of health services in developing countries. PMID:18637533

Evaluation of Calendar Year 1997 Groundwater and Surface Water Quality Data For The Upper East Fork Poplar Creek Hydrogeologic Regime At The U.S. Department of Energy Y-12 Plant, Oak Ridge, Tennessee

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

Jones, S.B.

1998-09-01

1 1.0 INTRODUCTION This report presents an evaluation of the groundwater quality monitoring data reported in: Calendar Year 1997 Annual Groundwatw Monitoring Report for the Upper East Fork Poplar Creek Hydrogeologtc Rep-meat the US. Department of Energy Y-12 Plant, Oak Ridge, Tennessee (AJA Technical Services, Inc. 1998), which is hereafter referenced as the Annual Monitoring Report. Section 2.0 presents background information for the Upper East Fork Poplar Creek Hydrogeologic Regime (East Fork Regime) that is relevant to data evaluation, including brief descriptions of the geology, the groundwater flow system, the contaminant source areas, and the extent of groundwater contamination inmore » the regime. Section 3.0 provides an overview of the groundwater sampling and analysis activities petiormed during calendar year (CY) 1997, including monitoring well locations, sampling frequency and methods, and laboratory analyses. Evaluation and interpretation of the monitoring da% described in Section 4.0, is generally focused on an overview of data quality assurance/quality control (QA/QC), long-term concentration trends for selected inorganic, organic, and radiological contaminants, and consistency with applicable site-specific conceptual contaminant transport models described in: Report on the Remedial Investigation of the Upper East Fork Poplar Creek Characterization Area at the Oak Ridge Y-12 Plant, Oak Ridge, Tennessee (U.S. Department of Energy 1998), which is referenced hereafter as the Remedial Investigation @I) Report. Findings of the data evaluations are summarized :in Section 5.0 and a list of technical reports and regulatory documents cited for more detailed irdormation (Section 6.0) concludes the report. All of the illustrations (maps and trend graphs) and data summary tables referenced in the text are presented in Appendm A and Appendix B, respectively. Appendix C provides a summary of the analytical results that meet applicable data quality objectives (DQOS) of the Y-12 Plant Groundwater Protection Program.« less

A mobile health technology platform for quality assurance and quality improvement of malaria diagnosis by community health workers.

PubMed

Laktabai, Jeremiah; Platt, Alyssa; Menya, Diana; Turner, Elizabeth L; Aswa, Daniel; Kinoti, Stephen; O'Meara, Wendy Prudhomme

2018-01-01

Community health workers (CHWs) play an important role in improving access to services in areas with limited health infrastructure or workforce. Supervision of CHWs by qualified health professionals is the main link between this lay workforce and the formal health system. The quality of services provided by lay health workers is dependent on adequate supportive supervision. It is however one of the weakest links in CHW programs due to logistical and resource constraints, especially in large scale programs. Interventions such as point of care testing using malaria rapid diagnostic tests (RDTs) require real time monitoring to ensure diagnostic accuracy. In this study, we evaluated the utility of a mobile health technology platform to remotely monitor malaria RDT (mRDT) testing by CHWs for quality improvement. As part of a large implementation trial involving mRDT testing by CHWs, we introduced the Fionet system composed of a mobile device (Deki Reader, DR) to assist in processing and automated interpretation of mRDTs, which connects to a cloud-based database which captures reports from the field in real time, displaying results in a custom dashboard of key performance indicators. A random sample of 100 CHWs were trained and provided with the Deki Readers and instructed to use it on 10 successive patients. The CHWs interpretation was compared with the Deki Reader's automatic interpretation, with the errors in processing and interpreting the RDTs recorded. After the CHW entered their interpretation on the DR, the DR provided immediate, automated feedback and interpretation based on its reading of the same cassette. The study team monitored the CHW performance remotely and provided additional support. A total of 1251 primary and 113 repeat tests were performed by the 97 CHWs who used the DR. 91.6% of the tests had agreement between the DR and the CHWs. There were 61 (4.9%) processing and 52 (4.2%) interpretation errors among the primary tests. There was a tendency towards lower odds of errors with increasing number and frequency of tests, though not statistically significant. Of the 62 tests that were repeated due to errors, 79% achieved concordance between the CHW and the DR. Satisfaction with the use of the DR by the CHWs was high. Use of innovative mHealth strategies for monitoring and quality control can ensure quality within a large scale implementation of community level testing by lay health workers.

Quality of care in reproductive health programmes: monitoring and evaluation of quality improvement.

PubMed

Kwast, B E

1998-12-01

As 200 million women become pregnant every year, at least 30 million will develop life-threatening complications requiring emergency treatment at any level of society where they live. But it is a basic human right that pregnancy be made safe for all women as complications are mostly unpredictable. This requires reproductive health programmes which are responsive to women's and their families' needs and expectations on the one hand and enhancement of community participation, high quality obstetric services, and both provider collaboration and satisfaction on the other. Monitoring and evaluation of these facets need to be an integral part of any safe motherhood programme, not only to assess progress, but also to use this information for subsequent planning and implementation cycles of national programmes. Lessons learned from ten years' implementation of Safe Motherhood programmes indicate that process and outcome indicators are more feasible for short-term evaluation purposes than impact indicators, such as maternal mortality reduction. The former are described in this paper with relevant country examples. This is the third, and last, article in a series on quality of care in reproductive health programmes. The first (Kwast 1998a) contains an overview of concepts, assessments, barriers and improvements of quality of care. The second (Kwast 1998b) addresses education issues for quality improvement.

Increasing Access to Family Planning Choices Through Public-Sector Social Franchising: The Experience of Marie Stopes International in Mali

PubMed Central

Gold, Judy; Burke, Eva; Cissé, Boubacar; Mackay, Anna; Eva, Gillian; Hayes, Brendan

2017-01-01

Background: Mali has one of the world's lowest contraceptive use rates and a high rate of unmet need for family planning. In order to increase access to and choice of quality family planning services, Marie Stopes International (MSI) Mali introduced social franchising in public-sector community health centers (referred to as CSCOMs in Mali) in 3 regions under the MSI brand BlueStar. Program Description: Potential franchisees are generally identified from CSCOMs who have worked with MSI outreach teams; once accredited as franchisees, CSCOMs receive training, supervision, family planning consumables and commodities, and support for awareness raising and demand creation. To ensure availability and affordability of services, franchisees are committed to providing a wide range of contraceptive methods at low fixed prices. Methods and Results: The performance of the BlueStar network from inception in March 2012 until December 2015 was examined using information from routine monitoring data, clinical quality audits, and client exit interviews. During this period, the network grew from 70 to 135 franchisees; an estimated 123,428 clients received voluntary family planning services, most commonly long-acting reversible methods of contraception. Franchisee efficiency and clinical quality of services increased over time, and client satisfaction with services remained high. One-quarter of clients in 2015 were under 20 years old, and three-quarters were adopters of family planning (that is, they had not been using a modern method during the 3 months prior to their visit). Conclusion: Applying a social franchising support package, originally developed for for-profit private-sector providers, to public-sector facilities in Mali has increased access, choice, and use of family planning in 3 regions of Mali. The experience of BlueStar Mali suggests that interventions that support quality supply of services, while simultaneously addressing demand-side barriers such as service pricing, can successfully create demand for a broad range of family planning services, even in settings with low contraceptive prevalence. PMID:28655803

Increasing Access to Family Planning Choices Through Public-Sector Social Franchising: The Experience of Marie Stopes International in Mali.

PubMed

Gold, Judy; Burke, Eva; Cissé, Boubacar; Mackay, Anna; Eva, Gillian; Hayes, Brendan

2017-06-27

Mali has one of the world's lowest contraceptive use rates and a high rate of unmet need for family planning. In order to increase access to and choice of quality family planning services, Marie Stopes International (MSI) Mali introduced social franchising in public-sector community health centers (referred to as CSCOMs in Mali) in 3 regions under the MSI brand BlueStar. Potential franchisees are generally identified from CSCOMs who have worked with MSI outreach teams; once accredited as franchisees, CSCOMs receive training, supervision, family planning consumables and commodities, and support for awareness raising and demand creation. To ensure availability and affordability of services, franchisees are committed to providing a wide range of contraceptive methods at low fixed prices. The performance of the BlueStar network from inception in March 2012 until December 2015 was examined using information from routine monitoring data, clinical quality audits, and client exit interviews. During this period, the network grew from 70 to 135 franchisees; an estimated 123,428 clients received voluntary family planning services, most commonly long-acting reversible methods of contraception. Franchisee efficiency and clinical quality of services increased over time, and client satisfaction with services remained high. One-quarter of clients in 2015 were under 20 years old, and three-quarters were adopters of family planning (that is, they had not been using a modern method during the 3 months prior to their visit). Applying a social franchising support package, originally developed for for-profit private-sector providers, to public-sector facilities in Mali has increased access, choice, and use of family planning in 3 regions of Mali. The experience of BlueStar Mali suggests that interventions that support quality supply of services, while simultaneously addressing demand-side barriers such as service pricing, can successfully create demand for a broad range of family planning services, even in settings with low contraceptive prevalence. © Gold et al.

International GPS Service for Geodynamics

NASA Technical Reports Server (NTRS)

Zumberge, J. F. (Editor); Urban, M. P. (Editor); Liu, R. (Editor); Neilan, R. E. (Editor)

1996-01-01

This 1995 annual report of the IGS International GPS (Global Positioning System) Service for Geodynamics - describes the second operational year of the service. It provides the many IGS contributing agencies and the rapidly growing user community with essential information on current organizational and technical matters promoting the IGS standards and products (including organizational framework, data processing strategies, and statistics showing the remarkable expansion of the GPS monitoring network, the improvement of IGS performance, and product quality). It also introduces important practical concepts for network densification by integration of regional stations and the combination of station coordinate solutions. There are groups of articles describing general aspects of the IGS, the Associate Analysis Centers (AACs), Data Centers, and IGS stations.

Automated Developmental Disabilities Out-Patient Treatment Review System (ADDOPTRS)—Development and Automation of a Microcomputer Based Case Management System

PubMed Central

Fisch, Clifford B.; Fisch, Martin L.

1979-01-01

The Stanley S. Lamm Institute for Developmental Disabilities of The Long Island College Hospital, in conjunction with Micro-Med Systems has developed a low cost micro-computer based information system (ADDOP TRS) which monitors quality of care in outpatient settings rendering services to the developmentally disabled population. The process of conversion from paper record keeping systems to direct key-to-disk data capture at the point of service delivery is described. Data elements of the information system including identifying patient information, coded and English-grammar entry procedures for tracking elements of service as well as their delivery status are described. Project evaluation criteria are defined including improved quality of care, improved productivity for clerical and professional staff and enhanced decision making capability. These criteria are achieved in a cost effective manner as a function of more efficient information flow. Administrative applications including staff/budgeting procedures, submissions for third party reimbursement and case reporting to utilization review committees are considered.

Organizational boundaries of medical practice: the case of physician ownership of ancillary services

PubMed Central

2012-01-01

Physician ownership of in-office ancillary services (IOASs) has come under increasing scrutiny. Advocates of argue that IOASs allow physicians to supervise the quality and coordination of care. Critics have argued that IOASs create financial incentives for physicians to increase ancillary service volume. In this paper we develop a conceptual framework to evaluate the tradeoffs associated with physician ownership of IOASs. There is some evidence supporting the existence of scope and transaction economies in IOASs. Improvement in flow and continuity of care are likely to generate scope economies and improvements in quality monitoring and reductions in consumer transaction costs are likely to generate transaction economies. Other factors include the capture of upstream and downstream profits, but these incentives are likely to be small compared to scope and transaction economies. Policy debates on the merits of IOASs should include an explicit assessment of these tradeoffs. This research was supported in part by funding from the American Association of Orthopaedic Surgeons (AAOS). PMID:22828324

Boundary-Layer & health

NASA Astrophysics Data System (ADS)

Costigliola, V.

2010-09-01

It has long been known that specific atmospheric processes, such as weather and longer-term climatic fluctuations, affect human health. The biometeorological literature refers to this relationship as meteorotropism, defined as a change in an organism that is correlated with a change in atmospheric conditions. Plenty of (patho)physiological functions are affected by those conditions - like the respiratory diseases - and currently it is difficult to put any limits for pathologies developed in reply. Nowadays the importance of atmospheric boundary layer and health is increasingly recognised. A number of epidemiologic studies have reported associations between ambient concentrations of air pollution, specifically particulate pollution, and adverse health effects, even at the relatively low concentrations of pollution found. Since 1995 there have been over twenty-one studies from four continents that have explicitly examined the association between ambient air pollutant mixes and daily mortality. Statistically significant and positive associations have been reported in data from various locations around the world, all with varying air pollutant concentrations, weather conditions, population characteristics and public health policies. Particular role has been given to atmospheric boundary layer processes, the impact of which for specific patient-cohort is, however, not well understood till now. Assessing and monitoring air quality are thus fundamental to improve Europe's welfare. One of current projects run by the "European Medical Association" - PASODOBLE will develop and demonstrate user-driven downstream information services for the regional and local air quality sectors by combining space-based and in-situ data with models in 4 thematic service lines: - Health community support for hospitals, pharmacies, doctors and people at risk - Public information for regions, cities, tourist industry and sporting event organizers - Compliance monitoring support on particulate matter for regional environmental agencies - Local forecast model evaluation support for local authorities and city bodies. Giving value to the above listed aspects, PASODOBLE objectives are following: - Evolution of existing and development of new sustainable air quality services for Europe on regional and local scales - Development and testing of a generic service framework for coordinated input data acquisition and customizable user-friendly access to services - Utilization of multiple cycles of delivery, use and assessment versus requirements and market planning in cooperation with users - Promotion and harmonisation of best practise tools for air quality communities. Further European multidisciplinary projects should be created to better understand the most prevalent atmospheric factors to be impacted in predictive, preventive and personalised medicine considered as the central concept for future medicine.

Patient care delivery and integration: stimulating advancement of ambulatory care pharmacy practice in an era of healthcare reform.

PubMed

Epplen, Kelly T

2014-08-15

This article discusses how to plan and implement an ambulatory care pharmacist service, how to integrate a hospital- or health-system-based service with the mission and operations of the institution, and how to help the institution meet its challenges related to quality improvement, continuity of care, and financial sustainability. The steps in implementing an ambulatory care pharmacist service include (1) conducting a needs assessment, (2) aligning plans for the service with the mission and goals of the parent institution, (3) collaborating with patients and physicians, (4) standardizing the patient care process, (5) proposing the service, (6) attaining the necessary resources, (7) identifying stakeholders, (8) identifying applicable quality standards, (9) defining competency standards, (10) planning for service payment, and (11) monitoring outcomes. Ambulatory care pharmacists have current opportunities to become engaged with patient-centered medical homes, accountable care organizations, preventive and wellness programs, and continuity of care initiatives. Common barriers to the advancement of ambulatory care pharmacist services include lack of complete access to patient information, inadequate information technology, and lack of payment. Ambulatory care pharmacy practitioners must assertively promote appropriate medication use, provide patient-centered care, pursue integration with the patient care team, and seek appropriate recognition and compensation for the services they provide. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Quality assurance and quality improvement in U.S. clinical molecular genetic laboratories.

PubMed

Chen, Bin; Richards, C Sue; Wilson, Jean Amos; Lyon, Elaine

2011-04-01

A robust quality-assurance program is essential for laboratories that perform molecular genetic testing to maintain high-quality testing and be able to address challenges associated with performance or delivery of testing services as the use of molecular genetic tests continues to expand in clinical and public health practice. This unit discusses quality-assurance and quality-improvement considerations that are critical for molecular genetic testing performed for heritable diseases and conditions. Specific discussion is provided on applying regulatory standards and best practices in establishing/verifying test performance, ensuring quality of the total testing process, monitoring and maintaining personnel competency, and continuing quality improvement. The unit provides a practical reference for laboratory professionals to use in recognizing and addressing essential quality-assurance issues in human molecular genetic testing. It should also provide useful information for genetics researchers, trainees, and fellows in human genetics training programs, as well as others who are interested in quality assurance and quality improvement for molecular genetic testing. 2011 by John Wiley & Sons, Inc.

What do we really know about UK paediatric dental general anaesthesia services?

PubMed

Robertson, S; Ní Chaollaí, A; Dyer, T A

2012-02-24

Dental general anaesthesia (DGA) is only permitted within a hospital setting where critical care facilities are available. Recently, concern has been expressed about the number of hospital admissions for the dental care of children following the publication of a high profile paper which highlighted an apparent increase in children being admitted for extractions due to caries under DGA. Coincidentally new best practice standards for paediatric DGA services have been published. An evaluation of DGA services in Yorkshire and the Humber suggested that existing monitoring was inadequate and is unlikely to represent true levels of activity and that any apparent increase may reflect the method of remuneration for services. In fact, recent changes in service structure and changes to improve quality have reduced DGA activity in some areas. In addition, the evaluation revealed that many services were not meeting standards of best practice.

Use of antenatal services and delivery care in Entebbe, Uganda: a community survey.

PubMed

Tann, Carolyn J; Kizza, Moses; Morison, Linda; Mabey, David; Muwanga, Moses; Grosskurth, Heiner; Elliott, Alison M

2007-10-11

Disparities in perinatal health care occur worldwide. If the UN Millennium Development Goals in maternal and child health are to be met, this needs to be addressed. This study was conducted to facilitate our understanding of the changing use of maternity care services in a semi-urban community in Entebbe Uganda and to examine the range of antenatal and delivery services received in health care facilities and at home. We conducted a retrospective community survey among women using structured questionnaires to describe the use of antenatal services and delivery care. In total 413 women reported on their most recent pregnancy. Antenatal care attendance was high with 96% attending once, and 69% the recommended four times. Blood pressure monitoring (95%) and tetanus vaccination (91%) were the services most frequently reported and HIV testing (47%), haematinics (58%) and presumptive treatment for malaria (66%) least frequently. Hospital clinics significantly outperformed public clinics in the quality of antenatal service. A significant improvement in the reported quality of antenatal services received was observed by year (p < 0.001). Improvement in the range and consistency of services at Entebbe Hospital over time was associated with an increase in the numbers who sought care there (p = 0.038). Although 63% delivered their newborn at a local hospital, 11% still delivered at home with no skilled assistance and just under half of these women reported financial/transportation difficulties as the primary reason. Less educated, poorer mothers were more likely to have unskilled/no assistance. Simple newborn care practices were commonly neglected. Only 35% of newborns were breastfed within the first hour and delayed wrapping of newborn infants occurred after 27% of deliveries. Although antenatal services were well utilised, the quality of services varied. Women were able and willing to travel to a facility providing a good service. Access to essential skilled birth attendants remains difficult especially for less educated, poorer women, commonly mediated by financial and transport difficulties and several simple post delivery practices were commonly neglected. These factors need to be addressed to ensure that high quality care reaches the most vulnerable women and infants.

Defining Quality of Life in the Children of Parents with Severe Mental Illness: A Preliminary Stakeholder-Led Model

PubMed Central

Bee, Penny; Berzins, Kathryn; Calam, Rachel; Pryjmachuk, Steven; Abel, Kathryn M.

2013-01-01

Severe parental mental illness poses a challenge to quality of life (QoL) in a substantial number of children and adolescents, and improving the lives of these children is of urgent political and public health concern. This study used a bottom-up qualitative approach to develop a new stakeholder-led model of quality of life relevant to this population. Qualitative data were collected from 19 individuals participating in focus groups or individual interviews. Participants comprised 8 clinical academics, health and social care professionals or voluntary agency representatives; 5 parents and 6 young people (aged 13–18 yrs) with lived experience of severe parental mental illness. Data underwent inductive thematic analysis for the purposes of informing a population-specific quality of life model. Fifty nine individual themes were identified and grouped into 11 key ‘meta-themes’. Mapping each meta-theme against existing child-centred quality of life concepts revealed a multi-dimensional model that endorsed, to a greater or lesser degree, the core domains of generic quality of life models. Three new population-specific priorities were also observed: i) the alleviation of parental mental health symptoms, ii) improved problem-based coping skills and iii) increased mental health literacy. The identification of these priorities raises questions regarding the validity of generic quality of life measures to monitor the effectiveness of services for families and children affected by severe mental illness. New, age-appropriate instruments that better reflect the life priorities and unique challenges faced by the children of parents with severe mental illness may need to be developed. Challenges then remain in augmenting and adapting service design and delivery mechanisms better to meet these needs. Future child and adult mental health services need to work seamlessly alongside statutory education and social care services and a growing number of relevant third sector providers to address fully the quality of life priorities of these vulnerable families. PMID:24040050

Defining quality of life in the children of parents with severe mental illness: a preliminary stakeholder-led model.

PubMed

Bee, Penny; Berzins, Kathryn; Calam, Rachel; Pryjmachuk, Steven; Abel, Kathryn M

2013-01-01

Severe parental mental illness poses a challenge to quality of life (QoL) in a substantial number of children and adolescents, and improving the lives of these children is of urgent political and public health concern. This study used a bottom-up qualitative approach to develop a new stakeholder-led model of quality of life relevant to this population. Qualitative data were collected from 19 individuals participating in focus groups or individual interviews. Participants comprised 8 clinical academics, health and social care professionals or voluntary agency representatives; 5 parents and 6 young people (aged 13-18 yrs) with lived experience of severe parental mental illness. Data underwent inductive thematic analysis for the purposes of informing a population-specific quality of life model. Fifty nine individual themes were identified and grouped into 11 key 'meta-themes'. Mapping each meta-theme against existing child-centred quality of life concepts revealed a multi-dimensional model that endorsed, to a greater or lesser degree, the core domains of generic quality of life models. Three new population-specific priorities were also observed: i) the alleviation of parental mental health symptoms, ii) improved problem-based coping skills and iii) increased mental health literacy. The identification of these priorities raises questions regarding the validity of generic quality of life measures to monitor the effectiveness of services for families and children affected by severe mental illness. New, age-appropriate instruments that better reflect the life priorities and unique challenges faced by the children of parents with severe mental illness may need to be developed. Challenges then remain in augmenting and adapting service design and delivery mechanisms better to meet these needs. Future child and adult mental health services need to work seamlessly alongside statutory education and social care services and a growing number of relevant third sector providers to address fully the quality of life priorities of these vulnerable families.

Quality control of CT systems by automated monitoring of key performance indicators: a two-year study.

PubMed

Nowik, Patrik; Bujila, Robert; Poludniowski, Gavin; Fransson, Annette

2015-07-08

The purpose of this study was to develop a method of performing routine periodical quality controls (QC) of CT systems by automatically analyzing key performance indicators (KPIs), obtainable from images of manufacturers' quality assurance (QA) phantoms. A KPI pertains to a measurable or determinable QC parameter that is influenced by other underlying fundamental QC parameters. The established KPIs are based on relationships between existing QC parameters used in the annual testing program of CT scanners at the Karolinska University Hospital in Stockholm, Sweden. The KPIs include positioning, image noise, uniformity, homogeneity, the CT number of water, and the CT number of air. An application (MonitorCT) was developed to automatically evaluate phantom images in terms of the established KPIs. The developed methodology has been used for two years in clinical routine, where CT technologists perform daily scans of the manufacturer's QA phantom and automatically send the images to MonitorCT for KPI evaluation. In the cases where results were out of tolerance, actions could be initiated in less than 10 min. 900 QC scans from two CT scanners have been collected and analyzed over the two-year period that MonitorCT has been active. Two types of errors have been registered in this period: a ring artifact was discovered with the image noise test, and a calibration error was detected multiple times with the CT number test. In both cases, results were outside the tolerances defined for MonitorCT, as well as by the vendor. Automated monitoring of KPIs is a powerful tool that can be used to supplement established QC methodologies. Medical physicists and other professionals concerned with the performance of a CT system will, using such methods, have access to comprehensive data on the current and historical (trend) status of the system such that swift actions can be taken in order to ensure the quality of the CT examinations, patient safety, and minimal disruption of service.

Nurses' perceptions and experiences at daycare for elderly with stroke.

PubMed

Park, Yeon-Hwan; Han, Hae-Ra

2010-09-01

While adult daycare (ADC) is considered a culturally acceptable model of long-term care in countries with a tradition of family-oriented caregiving, Korea is struggling as soaring needs for ADC outpace qualified staff and regulatory systems. This study aimed to describe Korean daycare nurses' perceptions of key daycare services and their working experiences with stroke patients and their families. A mixed-method design was used. First, we conducted a cross-sectional descriptive survey to assess Korean nurses' perceptions about the importance of daycare services. Then focus group interviews were performed to explore the nurses' experiences at ADC. Seventy of a total of 96 nurses at ADC that specialized in the care of stroke patients responded to the survey (response rate 72.9%) and rated the importance of 11 key daycare service items on a visual analogue scale (0-10). Using a purposive sampling design, 16 eligible nurses were interviewed as a group. The qualitative data from focus group interviews were analyzed using thematic analysis to classify common themes into larger categories. Survey data revealed that the nurses perceived "skilled nursing services,"functional recovery," and "general health counseling" as the most important daycare service areas. Focus group data resulted in five themes: "Providing the same, standard care,"Lack of partnership with family caregivers,"Conflict with other staff: ambiguity of the roles and tasks,"Lack of proper education and training," and "Need for quality control and monitoring." Daycare nurses fully recognized the importance of direct nursing care services that are keys to adequate recovery and rehabilitation of older patients with stroke. However, they experienced substantial barriers to carrying out these services due to role confusion, insufficient number of qualified nursing staff, and lack of partnership with family caregivers. The results provide insight into changing healthcare policy to support daycare nurses in a country with limited resources and regulations. Strategies such as better quality control and monitoring of daycare services, provision of continuing education, and prioritizing key services should be considered as a way to address challenges experienced by daycare nurses.

Healthcare Reimbursement and Quality Improvement: Integration Using the Electronic Medical Record Comment on "Fee-for-Service Payment--an Evil Practice That Must Be Stamped Out?".

PubMed

Britton, John R

2015-05-08

Reimbursement for healthcare has utilized a variety of payment mechanisms with varying degrees of effectiveness. Whether these mechanisms are used singly or in combination, it is imperative that the resulting systems remunerate on the basis of the quantity, complexity, and quality of care provided. Expanding the role of the electronic medical record (EMR) to monitor provider practice, patient responsiveness, and functioning of the healthcare organization has the potential to not only enhance the accuracy and efficiency of reimbursement mechanisms but also to improve the quality of medical care. © 2015 by Kerman University of Medical Sciences.

Validation of reactive gases and aerosols in the MACC global analysis and forecast system

NASA Astrophysics Data System (ADS)

Eskes, H.; Huijnen, V.; Arola, A.; Benedictow, A.; Blechschmidt, A.-M.; Botek, E.; Boucher, O.; Bouarar, I.; Chabrillat, S.; Cuevas, E.; Engelen, R.; Flentje, H.; Gaudel, A.; Griesfeller, J.; Jones, L.; Kapsomenakis, J.; Katragkou, E.; Kinne, S.; Langerock, B.; Razinger, M.; Richter, A.; Schultz, M.; Schulz, M.; Sudarchikova, N.; Thouret, V.; Vrekoussis, M.; Wagner, A.; Zerefos, C.

2015-02-01

The European MACC (Monitoring Atmospheric Composition and Climate) project is preparing the operational Copernicus Atmosphere Monitoring Service (CAMS), one of the services of the European Copernicus Programme on Earth observation and environmental services. MACC uses data assimilation to combine in-situ and remote sensing observations with global and regional models of atmospheric reactive gases, aerosols and greenhouse gases, and is based on the Integrated Forecast System of the ECMWF. The global component of the MACC service has a dedicated validation activity to document the quality of the atmospheric composition products. In this paper we discuss the approach to validation that has been developed over the past three years. Topics discussed are the validation requirements, the operational aspects, the measurement data sets used, the structure of the validation reports, the models and assimilation systems validated, the procedure to introduce new upgrades, and the scoring methods. One specific target of the MACC system concerns forecasting special events with high pollution concentrations. Such events receive extra attention in the validation process. Finally, a summary is provided of the results from the validation of the latest set of daily global analysis and forecast products from the MACC system reported in November 2014.

Discharge communication from inpatient care: an audit of written medical discharge summary procedure against the new National Health Service Standard for clinical handover.

PubMed

Reid, Daniel Brooks; Parsons, Shaun R; Gill, Stephen D; Hughes, Andrew J

2015-04-01

To audit written medical discharge summary procedure and practice against Standard Six (clinical handover) of the Australian National Safety and Quality Health Service Standards at a major regional Victorian health service. Department heads were invited to complete a questionnaire about departmental discharge summary practices. Twenty-seven (82%) department heads completed the questionnaire. Seven (26%) departments had a documented discharge summary procedure. Fourteen (52%) departments monitored discharge summary completion and 13 (48%) departments monitored the timeliness of completion. Seven (26%) departments informed the patient of the content of the discharge summary and six (22%) departments provided the patient with a copy. Seven (26%) departments provided training for staff members on how to complete discharge summaries. Completing discharge summaries was usually delegated to the medical intern. The introduction of the National Service Standards prompted an organisation-wide audit of discharge summary practices against the external criterion. There was substantial variation in the organisation's practices. The Standards and the current audit results highlight an opportunity for the organisation to enhance and standardise discharge summary practices and improve communication with general practice.

Mental Health Commissions: making the critical difference to the development and reform of mental health services.

PubMed

Rosen, Alan; Goldbloom, David; McGeorge, Peter

2010-11-01

Several Mental Health Commissions (MHCs) have emerged in developed countries over recent years, often in connection with mental health reform strategies. It is timely to consider the types of MHC which exist in different countries, their characteristics which may contribute to making them more effective, and any possible limitations and concerns raised about them. The emerging literature on MHCs indicates, particularly with the wider types of MHCs, that they may contribute to the substantial enhancement of mental health resources and sustainability of services; mental health reform is much more likely to be implemented properly with an independent monitor such as a MHC which has official influence at the highest levels of government; and they can encourage, champion and monitor the transformation of services into more evidence-based, community-centred, recovery-oriented, consumer, family and human rights-focused mental health services. The advent of MHCs may enhance the resourcing, quality and consistency of distribution of effective clinical practices and crucial support services, and foster more relevant practice-based research. MHC variants can work in different countries and the model can be adapted to state jurisdictions, single state nations and federated systems of government, without duplicating bureaucracies. Achievements and possible limitations are considered.

Telemedicine and advances in urban and rural healthcare delivery in Africa.

PubMed

Mars, Maurice

2013-01-01

Telecardiology holds great promise for Africa, from tele-echocardiography and tele-ECG s, to home monitoring and text messaging for medication adherence monitoring. The burden of disease is great and there is an extreme shortage of health professionals. Telemedicine can provide access to scarce specialist care, improve the quality of care in rural areas and reduce the need for rural patients to travel to seek medical attention. International cross border service can alleviate the shortage of doctors. But telecardiology, and telemedicine uptake in general, has been poor in Africa. Legal and ethical issues around local and cross border telemedicine have not been resolved. The literature was reviewed and obstacles to telemedicine in Africa and current telemedicine activities in Africa, are described. There are few sustained telemedicine services in Africa with the exception of tele-education. There is an expectation that mobile phones will facilitate a range of telemedicine activities in Africa. Africa needs telemedicine. © 2013.

Developing human rights based indicators to support country monitoring of rehabilitation services and programmes for people with disabilities: a study protocol.

PubMed

Skempes, Dimitrios; Bickenbach, Jerome

2015-09-24

Rehabilitation care is fundamental to health and human dignity and a human right enshrined in the United Nations Convention on the Rights of Persons with Disabilities. The provision of rehabilitation is important for reducing the need for formal support and enabling persons with disabilities to lead an independent life. Increasingly scholars and advocacy groups voice concerns over the significant barriers facing people with disabilities in accessing appropriate and quality rehabilitation. A growing body of research highlights a "respond-need" gap in the provision of rehabilitation and assistive technologies and underscore the lack of indicators for assessing performance of rehabilitation systems and monitoring States compliance with human rights standards in rehabilitation service planning and programming. While research on human rights and health monitoring has increased exponentially over the last decade far too little attention has been paid to rehabilitation services. The proposed research aims to reduce this knowledge gap by developing a human rights based monitoring framework with indicators to support human rights accountability and performance assessment in rehabilitation. Concept mapping, a stakeholder-driven approach will be used as the core method to identify rights based indicators and develop the rehabilitation services monitoring framework. Concept mapping requires participants from various stakeholders groups to generate a list of the potential indicators through on line brainstorming, sort the indicators for conceptual similarity into clusters and rate them against predefined criteria. Multidimensional scaling and hierarchical cluster data analysis will be performed to develop the monitoring framework while bridging analysis will provide useful insights about patterns of agreement or disagreement among participants views on indicators. This study has the potential to influence future practices on data collection and measurement of compliance with human rights standards in rehabilitation service delivery and organization. The development of a valid and universally applicable set of indicators will have a profound impact on the design and implementation of evidence informed disability policies and programs as it can support countries in strengthening performance measurement through documentation of comparative information on rehabilitation care systems. Most importantly, the resulting indicators can be used by disabled people's organizations as well as national and international institutions to define a minimal standard for monitoring and reporting progress on the implementation of the Convention on the Rights of Persons with Disabilities in the area of rehabilitation.

Monitoring Users' Satisfactions of the NOAA NWS Climate Products and Services

NASA Astrophysics Data System (ADS)

Horsfall, F. M.; Timofeyeva, M. M.; Dixon, S.; Meyers, J. C.

2011-12-01

The NOAA's National Weather Service (NWS) Climate Services Division (CSD) ensures the relevance of NWS climate products and services. There are several ongoing efforts to identify the level of user satisfaction. One of these efforts includes periodical surveys conducted by Claes Fornell International (CFI) Group using the American Customer Satisfaction Index (ACSI), which is "the only uniform, national, cross-industry measure of satisfaction with the quality of goods and services available in the United States" (http://www.cfigroup.com/acsi/overview.asp). The CFI Group conducted NWS Climate Products and Services surveys in 2004 and 2009. In 2010, a prominent routine was established for a periodical assessment of the customer satisfaction. From 2010 onward, yearly surveys will cover major climate services products and services. An expanded suite of climate products will be surveyed every other year. Each survey evaluated customer satisfaction with a range of NWS climate services, data, and products, including Climate Prediction Center (CPC) outlooks, drought monitoring, and ENSO monitoring and forecasts, as well as NWS local climate data and forecast products and services. The survey results provide insight into the NWS climate customer base and their requirements for climate services. They also evaluate whether we are meeting the needs of customers and the ease of their understanding for routine climate services, forecasts, and outlooks. In addition, the evaluation of specific topics, such as NWS forecast product category names, probabilistic nature of climate products, interpretation issues, etc., were addressed to assess how our users interpret prediction terminology. This paper provides an analysis of the following products: hazards, extended-range, long-lead and drought outlooks, El Nino Southern Oscillation monitoring and predictions as well as local climate data products. Two key issues make comparing the different surveys challenging, including the inconsistent suite of characteristics measured and the different number of respondent collected for each survey. Regardless of these two factors contributing to uncertainty of the results, CSD observed general improvement in customer satisfaction. Although, all NWS climate products have competitive scores, the leading ACSIs are for NWS Drought products and climate surface observation products. Overall, the survey results identify requirements for improving existing NWS climate services and introducing new ones. To date, the 2011 survey results have not been evaluated, but will be included in the conference presentation. A key point out of the initial 2011 survey results was that the climate section captured the greatest interest (as measured by number of respondents) of the customers of NWS products and services.

Poverty and access to health care in developing countries.

PubMed

Peters, David H; Garg, Anu; Bloom, Gerry; Walker, Damian G; Brieger, William R; Rahman, M Hafizur

2008-01-01

People in poor countries tend to have less access to health services than those in better-off countries, and within countries, the poor have less access to health services. This article documents disparities in access to health services in low- and middle-income countries (LMICs), using a framework incorporating quality, geographic accessibility, availability, financial accessibility, and acceptability of services. Whereas the poor in LMICs are consistently at a disadvantage in each of the dimensions of access and their determinants, this need not be the case. Many different approaches are shown to improve access to the poor, using targeted or universal approaches, engaging government, nongovernmental, or commercial organizations, and pursuing a wide variety of strategies to finance and organize services. Key ingredients of success include concerted efforts to reach the poor, engaging communities and disadvantaged people, encouraging local adaptation, and careful monitoring of effects on the poor. Yet governments in LMICs rarely focus on the poor in their policies or the implementation or monitoring of health service strategies. There are also new innovations in financing, delivery, and regulation of health services that hold promise for improving access to the poor, such as the use of health equity funds, conditional cash transfers, and coproduction and regulation of health services. The challenge remains to find ways to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted for in ways that demonstrate improvements in access by the poor.

Monitoring the Urban Tree Cover for Urban Ecosystem Services - The Case of Leipzig, Germany

NASA Astrophysics Data System (ADS)

Banzhaf, E.; Kollai, H.

2015-04-01

Urban dynamics such as (extreme) growth and shrinkage bring about fundamental challenges for urban land use and related changes. In order to achieve a sustainable urban development, it is crucial to monitor urban green infrastructure at microscale level as it provides various urban ecosystem services in neighbourhoods, supporting quality of life and environmental health. We monitor urban trees by means of a multiple data set to get a detailed knowledge on its distribution and change over a decade for the entire city. We have digital orthophotos, a digital elevation model and a digital surface model. The refined knowledge on the absolute height above ground helps to differentiate tree tops. Grounded on an object-based image analysis scheme a detailed mapping of trees in an urbanized environment is processed. Results show high accuracy of tree detection and avoidance of misclassification due to shadows. The study area is the City of Leipzig, Germany. One of the leading German cities, it is home to contiguous community allotments that characterize the configuration of the city. Leipzig has one of the most well-preserved floodplain forests in Europe.

Ensuring Patient Safety by using Colored Petri Net Simulation in the Design of Heterogeneous, Multi-Vendor, Integrated, Life-Critical Wireless (802.x) Patient Care Device Networks.

PubMed

Sloane, Elliot; Gehlot, Vijay

2005-01-01

Hospitals and manufacturers are designing and deploying the IEEE 802.x wireless technologies in medical devices to promote patient mobility and flexible facility use. There is little information, however, on the reliability or ultimate safety of connecting multiple wireless life-critical medical devices from multiple vendors using commercial 802.11a, 802.11b, 802.11g or pre-802.11n devices. It is believed that 802.11-type devices can introduce unintended life-threatening risks unless delivery of critical patient alarms to central monitoring systems and/or clinical personnel is assured by proper use of 802.11e Quality of Service (QoS) methods. Petri net tools can be used to simulate all possible states and transitions between devices and/or systems in a wireless device network, and can identify failure modes in advance. Colored Petri Net (CPN) tools are ideal, in fact, as they allow tracking and controlling each message in a network based on pre-selected criteria. This paper describes a research project using CPN to simulate and validate alarm integrity in a small multi-modality wireless patient monitoring system. A 20-monitor wireless patient monitoring network is created in two versions: one with non-prioritized 802.x CSM protocols and the second with simulated Quality of Service (QoS) capabilities similar to 802.11e (i.e., the second network allows message priority management.) In the standard 802.x network, dangerous heart arrhythmia and pulse oximetry alarms could not be reliably and rapidly communicated, but the second network's QoS priority management reduced that risk significantly.

Response to Intervention A Systematic Process to Increase Learning Outcomes for All Students. Guidance Document for New Mexico Schools

ERIC Educational Resources Information Center

New Mexico Public Education Department, 2006

2006-01-01

Response to Intervention (RtI) is the practice of providing high-quality instruction and interventions to meet student needs and monitor progress in order to ensure effectiveness of instruction and/or interventions. RtI is an integrated service delivery approach for all students and should be applied to decisions in general, remedial, and special…

An Engineering Report in Civil Engineering and Management.

DTIC Science & Technology

1987-12-01

programs as the Apollo program and the Canaveral program. Progress in the late 70s and the 80s has seen advancements in the application of sophisticated...other forces in military operations; subsequent combat service support ashore and defense against overt or clandestine enemy attacks directed toward...construction execution plans; assigns construction projects to NCF units; monitors progress and assures adherence to quality standards: directs

Restoration of shallow peatlands on Exmoor (UK): initial effects on water quality

NASA Astrophysics Data System (ADS)

Grand-Clement, Emilie; Luscombe, David; Anderson, Karen; Gatis, Naomi; Ashe, Josie; Brazier, Richard

2014-05-01

Historical and recent anthropogenic pressure has had dramatic effects on peatlands throughout the UK. In the South West, drainage for agricultural reclamation and peat cutting since the 19th century has progressively altered the hydrological behaviour of the peatlands of Exmoor and Dartmoor National Parks. Lower water table levels have caused increased oxidation, erosion and vegetation change, further affecting the storage of carbon and the provision of other ecosystem services (i.e. supply of drinking water, biodiversity). Moreover, the location of these peatlands at the southernmost margin of the UK peatlands' geographical extent makes them extremely vulnerable to the predicted effects of climate change, i.e. increased temperature and change in rainfall pattern. An extensive programme of peatland restoration is currently underway on Exmoor. Drainage ditches were blocked to reinstate the hydrological behaviour, reduce the outflow of dissolved organic carbon and, in doing so, improve other ecosystem services delivered by peatlands. This paper will report on the water quality monitoring results from a small headwater catchment in Exmoor. We will show results comparing changes in Dissolved Organic Carbon (DOC) losses and colour pre- and post-restoration. Our experimental approach uses event-based water quality monitoring across three drainage ditches that are representative of the different scales of damage in the area. Samples were taken back to the laboratory and analysed for DOC and colour, using UV spectrophotometry and UV-vis spectrometry respectively. DOC loads were calculated using discharge for each drain. Overall, DOC concentrations ranged between 3 and 30mg/L. Both pre and post- restoration datasets presented high seasonal variability, with higher concentrations measured from June to September. No significant change in DOC concentrations was observed in the 6 months after restoration. It is hypothesised that the effects of restoration could be hidden by inter-annual variations in total and mean rainfall over the period monitored. However, significant changes in water quantity, such as a reduction in storm flow following restoration, means that, overall, DOC loads have decreased at the scale of the catchment. These results show the need for an integrated approach in catchment management, considering all trade-offs between ecosystem services before assessing the effects of restoration.

Air Quality Applications Based on Space Observations: The Role of the 11 Years OMI Data Record and the Potentials for TROPOMI

NASA Astrophysics Data System (ADS)

Levelt, P.; Veefkind, J. P.; Kleipool, Q.; Eskes, H.; A, R. V. D.; Mijling, B.; Tamminen, J.; Joiner, J.; Bhartia, P. K.

2015-12-01

In the last three decades the capabilities of measuring the atmospheric composition from space did grow tremendously with ESA's ENVISAT and NASA's Eos-Aura satellite programmes. The potential to operationally monitor the atmospheric composition, like the meteorological community is doing for the physical parameters, is now within reach. At the same time, the importance for society of operational environmental monitoring, related to the ozone layer, air quality and climate change, became apparent. The Ozone Monitoring Instrument (OMI), launched on board of NASA's EOS-Aura spacecraft in on July 15, 2004, provides unique contributions to air quality monitoring from Space. The combination of urban scale resolution (13 x 24 km2 in nadir) and daily global coverage proved to be key features for the air quality community. The OMI data is currently used for improving the air quality forecasts, for inverting high-resolution emission maps, for UV forecast and for volcanic plume warning systems for aviation. Due to its 11 year continuous operation OMI now provides the longest NO2 record from space, which is essential to understand the changes in emissions globally. In 2016 Tropospheric Monitoring Instrument (TROPOMI), will be launched on board ESA's Sentinel 5 Precursor satellite. TROPOMI will have a spatial resolution of 7x7 km2 in nadir; a more than 6 times improvement over OMI. The high spatial resolution serves two goals: (1) emissions sources can be detected with even better accuracy and (2) the number of cloud-free ground pixels will increase substantially. TROPOMI also adds additional spectral bands that allow for better cloud corrections, as well as the retrieval of carbon monoxide and methane. TROPOMI will be an important satellite mission for the Copernicus atmosphere service. TROPOMI will play a key role in the Air Quality Constellation, being the polar instruments that can link the 3 GEO UVN instruments, Sentinel 4, TEMPO and GEMS. Thus, TROPOMI can serve as a travelling standard that allows intercomparison of the calibration of the geostationary instruments. An overview of air quality applications, emission inversions and trend analyses will be presented, based on the 11 years of OMI data. An outlook will be presented on the potentials of TROPOMI, including its role in the Air Quality Constellation.

User-tailored seasonal forecasts for agriculture - creating socio-economic benefit through climate services in the Andes

NASA Astrophysics Data System (ADS)

De Ventura, Sara; Avalos, Grinia; Rossa, Andrea; Flubacher, Moritz; Gubler, Stefanie; Sedlmeier, Katrin; Dapozzo, Marlene; Garcia, Teresa; Quevedo, Karim; Liniger, Mark; Spirig, Christoph; Rosas, Gabriela; Schwierz, Cornelia

2017-04-01

The project Climandes is a twinning project between the Peruvian National Meteorological and Hydrological Service (SENAMHI) and the Federal Office of Meteorology and Climatology of Switzerland (MeteoSwiss) aiming at improving climate services for the Andean Region. It was launched in 2012 as a pilot project of the Global Framework for Climate Services (GFCS) of WMO. In 2016 a second phase of the project has started. Until now, Peru as all the Andean countries has had only a limited access to climate services, and the few instruments already in place have mostly not been developed in concordance with the user needs. Due to this mismatch, the opportunity to achieve veritable socio-economic benefits (SEB) has been overlooked so far. An additional difficulty is the lack of trained and experienced climatology and meteorology professionals able to develop and provide high quality climate services. Furthermore, the importance of climate information and its far-reaching benefits has not yet been fully acknowledged and embraced by the political decision-makers. The overall goals of the Climandes project are the following:. • Provision of user-tailored climate services for the Andean Region to improve socio- economic benefits for the agricultural sector and for society at large. • Improvement of the capacities of the meteorological service of Peru to generate user-tailored climate services in the agricultural sector. These goals are elaborated within three mutually dependent modules: The first one comprises user-tailored climate products for the agricultural sector in the Peruvian Andes. This includes drought and precipitation monitoring as well as the development of a prototype seasonal prediction system for the region including indices tailored to the agricultural sector. The second module focuses on capacity building, enabling climatology-related professionals and students to develop high-quality climate services for Peru and the Andean Region. Training courses as well as E-learning tools covering the knowledge needed for the elaboration and use of climate services (e.g. monitoring, seasonal prediction of precipitation) are developed and implemented. The third module aims at raising the awareness of political stakeholders of the SEB of SENAMHI's sector-specific climate services underpinned by a case study to quantify the SEB of drought and precipitation information platform for selected crops. This contribution will give an overview of the project and highlights some of the results of the first year of Climandes 2.

Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo

PubMed Central

2009-01-01

Background Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP). Methods Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities. Results None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC. Conclusions Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for health providers in RH and infection prevention; 4) improving referral systems to the hospitals; 5) advocating for changes in national RH policies and protocols; and 6) providing technical assistance for monitoring and evaluation of key RH indicators. Together, these initiatives will improve the quality and accessibility of RH services in the DRC - services which are urgently needed and to which Congolese women are entitled by international human rights law. PMID:20025757

Effectiveness of 'rehabilitation in the home' service.

PubMed

Bharadwaj, Sneha; Bruce, David

2014-11-01

Rehabilitation in the home (RITH) services increasingly provide hospital substitution services. This study examines clinical outcomes in a large metropolitan RITH service in Western Australia. The 2010 database of Fremantle Hospital RITH service was interrogated to identify the clinical profile of cases, length of stay (LOS) and clinical outcomes. Negative outcomes included death or unexpected hospital readmission. Multiple logistic regression modelling was used to explore associations with negative outcomes. This study was reviewed by the Institutional Review Board which deemed it not to require ethics approval. There were 1348 cases managed by RITH: 70.6% were aged≥65 years; elective joint replacement (29.7%), medical conditions (20%), stroke (13%), hip fractures (10%) were major contributors. The majority (93.3%) were discharged after a median of 9 days. Negative outcomes occurred in 90 cases (6.7%), including five deaths (0.4%) and 85 readmissions (6.3%). Independent associations with negative outcomes included older age (odds ratio (OR) (95% CI); 1.02, P=0.006), orthopaedic conditions (OR 1.91, P=0.004) and longer inpatient LOS (OR 1.96, P=0.003). Age above 80 years was independently associated with risk of negative outcome (OR 2.99, P=0.004). RITH had a low rate of negative outcomes. The database proved useful for monitoring quality of service provision. WHAT IS KNOWN ABOUT THE TOPIC?: Rehabilitation in the home environment has proven cost effective for multiple conditions, particularly stroke and elective joint surgery, among others, facilitating better quality of life, with reduced rates of delirium and mortality. Overall there are few negative outcomes and death is rare. WHAT DOES THIS PAPER ADD?: Although RITH services are widely utilised as bed substitution services, there is scant literature on clinical outcomes while within the service. This study focuses on frequency of good and poor clinical outcomes in a well-established RITH service in Western Australia, suggesting pattern recognition of an at-risk cohort by identifying potentially useful predictors of poor outcome. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: RITH services are a safe alternative for many, including older people. Health administration databases are useful tools to monitor clinical outcomes. Clinical indicators such as older age, long hospital stay and orthopaedic diagnoses may be useful predictors of poor outcomes in such services.

Establishment, Implementation, and Consolidation of Clinical Pharmacy Services in Community Pharmacies: Perceptions of a Group of Pharmacists.

PubMed

Dosea, Aline S; Brito, Giselle C; Santos, Lincoln M C; Marques, Tatiane C; Balisa-Rocha, Blície; Pimentel, Deborah; Bueno, Denise; Lyra, Divaldo P

2017-02-01

When pharmacists incorporate clinical practice into their routine, barriers and facilitators influence the implementation of patient care services. Three focus groups were conducted with 11 pharmacists who were working for the Farmácia Popular do Brasil program on the establishment, implementation, and consolidation of clinical pharmacy services. The perception of the pharmacists in Brazil about the program was that it facilitated access to health care and medication. The distance between neighboring cities made it difficult for patients to return for services. Lack of staff training created a lack of communication skills and knowledge. The pharmacists wanted to have increased technical support, skill development opportunities, and monitoring of researchers who assessed progress of the service. Pharmacists overcame many of their insecurities and felt more proactive and committed to quality service. Positive experiences in service implementations have shown that it is possible to develop a model of clinical services in community pharmacies.

[Cleaning and disinfection in nursing homes. Data on quality of structure, process and outcome in nursing homes in Frankfurt am Main, Germany, 2011].

PubMed

Heudorf, U; Gasteyer, S; Samoiski, Y; Voigt, K

2012-08-01

Due to the Infectious Disease Prevention Act, public health services in Germany are obliged to check the infection prevention in hospitals and other medical facilities as well as in nursing homes. In Frankfurt/Main, Germany, standardized control visits have been performed for many years. In 2011 focus was laid on cleaning and disinfection of surfaces. All 41 nursing homes were checked according to a standardized checklist covering quality of structure (i.e. staffing, hygiene concept), quality of process (observation of the cleaning processes in the homes) and quality of output, which was monitored by checking the cleaning of fluorescent marks which had been applied some days before and should have been removed via cleaning in the following days before the final check. In more than two thirds of the homes, cleaning personnel were salaried, in one third external personnel were hired. Of the homes 85% provided service clothing and all of them offered protective clothing. All homes had established hygiene and cleaning concepts, however, in 15% of the homes concepts for the handling of Norovirus and in 30% concepts for the handling of Clostridium difficile were missing. Regarding process quality only half of the processes observed, i.e. cleaning of hand contact surfaces, such as handrails, washing areas and bins, were correct. Only 44% of the cleaning controls were correct with enormous differences between the homes (0-100%). The correlation between quality of process and quality of output was significant. There was good quality of structure in the homes but regarding quality of process and outcome there was great need for improvement. This was especially due to faults in communication and coordination between cleaning personnel and nursing personnel. Quality outcome was neither associated with the number of the places for residents nor with staffing. Thus, not only quality of structure but also quality of process and outcome should be checked by the public health services.

Development of a Web-based tool to collect and display water system customer service areas for public health action.

PubMed

Wong, Michelle; Wolff, Craig; Collins, Natalie; Guo, Liang; Meltzer, Dan; English, Paul

2015-01-01

Significant illness is associated with biological contaminants in drinking water, but little is known about health effects from low levels of chemical contamination in drinking water. To examine these effects in epidemiological studies, the sources of drinking water of study populations need to be known. The California Environmental Health Tracking Program developed an online application that would collect data on the geographic location of public water system (PWS) customer service areas in California, which then could be linked to demographic and drinking water quality data. We deployed the Water Boundary Tool (WBT), a Web-based geospatial crowdsourcing application that can manage customer service boundary data for each PWS in California and can track changes over time. We also conducted a needs assessment for expansion to other states. The WBT was designed for water system operators, local and state regulatory agencies, and government entities. Since its public launch in 2012, the WBT has collected service area boundaries for about 2300 individual PWS, serving more than 90% of the California population. Results of the needs assessment suggest interest and utility for deploying such a tool among states lacking statewide PWS service area boundary data. Although the WBT data set is incomplete, it has already been used for a variety of applications, including fulfilling legislatively mandated reporting requirements and linking customer service areas to drinking water quality data to better understand local water quality issues. Development of this tool holds promise to assist with outbreak investigations and prevention, environmental health monitoring, and emergency preparedness and response.

An intelligent service matching method for mechanical equipment condition monitoring using the fibre Bragg grating sensor network

NASA Astrophysics Data System (ADS)

Zhang, Fan; Zhou, Zude; Liu, Quan; Xu, Wenjun

2017-02-01

Due to the advantages of being able to function under harsh environmental conditions and serving as a distributed condition information source in a networked monitoring system, the fibre Bragg grating (FBG) sensor network has attracted considerable attention for equipment online condition monitoring. To provide an overall conditional view of the mechanical equipment operation, a networked service-oriented condition monitoring framework based on FBG sensing is proposed, together with an intelligent matching method for supporting monitoring service management. In the novel framework, three classes of progressive service matching approaches, including service-chain knowledge database service matching, multi-objective constrained service matching and workflow-driven human-interactive service matching, are developed and integrated with an enhanced particle swarm optimisation (PSO) algorithm as well as a workflow-driven mechanism. Moreover, the manufacturing domain ontology, FBG sensor network structure and monitoring object are considered to facilitate the automatic matching of condition monitoring services to overcome the limitations of traditional service processing methods. The experimental results demonstrate that FBG monitoring services can be selected intelligently, and the developed condition monitoring system can be re-built rapidly as new equipment joins the framework. The effectiveness of the service matching method is also verified by implementing a prototype system together with its performance analysis.

DOI/GTN-P climate and active-layer data acquired in the National Petroleum Reserve-Alaska and the Arctic National Wildlife Refuge

USGS Publications Warehouse

Urban, Frank E.; Clow, Gary D.

2014-01-01

This report provides data collected by the climate monitoring array of the U.S. Department of the Interior on Federal lands in Arctic Alaska over the period August 1998 to July 2013; this array is part of the Global Terrestrial Network for Permafrost, (DOI/GTN-P). In addition to presenting data, this report also describes monitoring, data collection, and quality-control methods. This array of 16 monitoring stations spans lat 68.5°N. to 70.5°N. and long 142.5°W. to 161°W., an area of approximately 150,000 square kilometers. Climate summaries are presented along with quality-controlled data. Data collection is ongoing and includes the following climate- and permafrost-related variables: air temperature, wind speed and direction, ground temperature, soil moisture, snow depth, rainfall totals, up- and downwelling shortwave radiation, and atmospheric pressure. These data were collected by the U.S. Geological Survey in close collaboration with the Bureau of Land Management and the U.S. Fish and Wildlife Service.

DOI/GTN-P Climate and active-layer data acquired in the National Petroleum Reserve–Alaska and the Arctic National Wildlife Refuge, 1998–2014

USGS Publications Warehouse

Urban, Frank E.; Clow, Gary D.

2016-03-04

This report provides data collected by the climate monitoring array of the U.S. Department of the Interior on Federal lands in Arctic Alaska over the period August 1998 to July 2014; this array is part of the Global Terrestrial Network for Permafrost (DOI/GTN-P). In addition to presenting data, this report also describes monitoring, data collection, and quality-control methods. The array of 16 monitoring stations spans lat 68.5°N. to 70.5°N. and long 142.5°W. to 161°W., an area of approximately 150,000 square kilometers. Climate summaries are presented along with quality-controlled data. Data collection is ongoing and includes the following climate- and permafrost-related variables: air temperature, wind speed and direction, ground temperature, soil moisture, snow depth, rainfall totals, up- and downwelling shortwave radiation, and atmospheric pressure. These data were collected by the U.S. Geological Survey in close collaboration with the Bureau of Land Management and the U.S. Fish and Wildlife Service.

DOI/GTN-P Climate and active-layer data acquired in the National Petroleum Reserve–Alaska and the Arctic National Wildlife Refuge, 1998–2015

USGS Publications Warehouse

Urban, Frank E.; Clow, Gary D.

2017-02-06

This report provides data collected by the climate monitoring array of the U.S. Department of the Interior on Federal lands in Arctic Alaska over the period August 1998 to July 2015; this array is part of the Global Terrestrial Network for Permafrost (DOI/GTN-P). In addition to presenting data, this report also describes monitoring, data collection, and quality-control methods. The array of 16 monitoring stations spans lat 68.5°N. to 70.5°N. and long 142.5°W. to 161°W., an area of approximately 150,000 square kilometers. Climate summaries are presented along with quality-controlled data. Data collection is ongoing and includes the following climate- and permafrost-related variables: air temperature, wind speed and direction, ground temperature, soil moisture, snow depth, rainfall totals, up- and downwelling shortwave radiation, and atmospheric pressure. These data were collected by the U.S. Geological Survey in close collaboration with the Bureau of Land Management and the U.S. Fish and Wildlife Service.

DOI/GTN-P climate and active-layer data acquired in the National Petroleum Reserve: Alaska and the Arctic National Wildlife Refuge, 1998-2011

USGS Publications Warehouse

Urban, Frank E.; Clow, Gary D.

2014-01-01

This report provides data collected by the climate monitoring array of the U.S. Department of the Interior on Federal lands in Arctic Alaska over the period August 1998 to July 2011; this array is part of the Global Terrestrial Network for Permafrost, (DOI/GTN-P). In addition to presenting data, this report also describes monitoring, data collection, and quality-control methodology. This array of 16 monitoring stations spans lat 68.5°N. to 70.5°N. and long 142.5°W. to 161°W., an area of approximately 150,000 square kilometers. Climate summaries are presented along with quality-controlled data. Data collection is ongoing and includes the following climate- and permafrost-related variables: air temperature, wind speed and direction, ground temperature and soil moisture, snow depth, rainfall, up- and downwelling shortwave radiation, and atmospheric pressure. These data were collected by the U.S. Geological Survey in close collaboration with the Bureau of Land Management and the U.S. Fish and Wildlife Service.

Air temperature, wind speed, and wind direction in the National Petroleum Reserve—Alaska and the Arctic National Wildlife Refuge, 1998–2011

USGS Publications Warehouse

Urban, Frank E.; Clow, Gary D.

2013-01-01

This report provides air temperature, wind speed, and wind direction data collected on Federal lands in Arctic Alaska over the period August 1998 to July 2011 by the U.S. Department of the Interior's climate monitoring array, part of the Global Terrestrial Network for Permafrost. In addition to presenting data, this report also describes monitoring, data collection, and quality control methodology. This array of 16 monitoring stations spans 68.5°N to 70.5°N and 142.5°W to 161°W, an area of roughly 150,000 square kilometers. Climate summaries are presented along with provisional quality-controlled data. Data collection is ongoing and includes several additional climate variables to be released in subsequent reports, including ground temperature and soil moisture, snow depth, rainfall, up- and downwelling shortwave radiation, and atmospheric pressure. These data were collected by the U.S. Geological Survey in close collaboration with the Bureau of Land Management and the U.S. Fish and Wildlife Service.

COST Action ES1206: Advanced GNSS Tropospheric Products for Monitoring Severe Weather Events and Climate (GNSS4SWEC)

NASA Astrophysics Data System (ADS)

Jones, Jonathan; Guerova, Guergana; Dousa, Jan; Dick, Galina; de Haan, Siebren; Pottiaux, Eric; Bock, Olivier; Pacione, Rosa

2017-04-01

GNSS is a well established atmospheric observing technique which can accurately sense atmospheric water vapour, the most abundant greenhouse gas, accounting for up to 70% of atmospheric warming. Water vapour is typically under-sampled in modern operational meteorological observing systems and obtaining and exploiting additional high-quality humidity observations is essential to improve weather forecasting and climate monitoring. COST Action ES1206 is a 4-year project, running from 2013 to 2017, which is coordinating the research activities and improved capabilities from concurrent developments in the GNSS, meteorological and climate communities. For the first time, the synergy of multi-GNSS constellations is used to develop new, more advanced tropospheric products, exploiting the full potential of multi-GNSS on a wide range of temporal and spatial scales - from real-time products monitoring and forecasting severe weather, to the highest quality post-processed products suitable for climate research. The Action also promotes the use of meteorological data as an input to real-time GNSS services and is stimulating the transfer of knowledge and data throughout Europe and beyond.

Development and evaluation of an instantaneous atmospheric corrosion rate monitor

NASA Astrophysics Data System (ADS)

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

1985-06-01

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

Design and development of a tele-healthcare information system based on web services and HL7 standards.

PubMed

Huang, Ean-Wen; Hung, Rui-Suan; Chiou, Shwu-Fen; Liu, Fei-Ying; Liou, Der-Ming

2011-01-01

Information and communication technologies progress rapidly and many novel applications have been developed in many domains of human life. In recent years, the demand for healthcare services has been growing because of the increase in the elderly population. Consequently, a number of healthcare institutions have focused on creating technologies to reduce extraneous work and improve the quality of service. In this study, an information platform for tele- healthcare services was implemented. The architecture of the platform included a web-based application server and client system. The client system was able to retrieve the blood pressure and glucose levels of a patient stored in measurement instruments through Bluetooth wireless transmission. The web application server assisted the staffs and clients in analyzing the health conditions of patients. In addition, the server provided face-to-face communications and instructions through remote video devices. The platform deployed a service-oriented architecture, which consisted of HL7 standard messages and web service components. The platform could transfer health records into HL7 standard clinical document architecture for data exchange with other organizations. The prototyping system was pretested and evaluated in a homecare department of hospital and a community management center for chronic disease monitoring. Based on the results of this study, this system is expected to improve the quality of healthcare services.

Mapping online transportation service quality and multiclass classification problem solving priorities

NASA Astrophysics Data System (ADS)

Alamsyah, Andry; Rachmadiansyah, Imam

2018-03-01

Online transportation service is known for its accessibility, transparency, and tariff affordability. These points make online transportation have advantages over the existing conventional transportation service. Online transportation service is an example of disruptive technology that change the relationship between customers and companies. In Indonesia, there are high competition among online transportation provider, hence the companies must maintain and monitor their service level. To understand their position, we apply both sentiment analysis and multiclass classification to understand customer opinions. From negative sentiments, we can identify problems and establish problem-solving priorities. As a case study, we use the most popular online transportation provider in Indonesia: Gojek and Grab. Since many customers are actively give compliment and complain about company’s service level on Twitter, therefore we collect 61,721 tweets in Bahasa during one month observations. We apply Naive Bayes and Support Vector Machine methods to see which model perform best for our data. The result reveal Gojek has better service quality with 19.76% positive and 80.23% negative sentiments than Grab with 9.2% positive and 90.8% negative. The Gojek highest problem-solving priority is regarding application problems, while Grab is about unusable promos. The overall result shows general problems of both case study are related to accessibility dimension which indicate lack of capability to provide good digital access to the end users.

Developing effective feedback on quality of anaesthetic care: what are its most valuable characteristics from a clinical perspective?

PubMed

D'Lima, Danielle M; Moore, Joanna; Bottle, Alex; Brett, Stephen J; Arnold, Glenn M; Benn, Jonathan

2015-01-01

Research suggests that better feedback from quality and safety indicators leads to enhanced capability of clinicians and departments to improve care and change behaviour. The aim of the current study was to investigate the characteristics of feedback perceived by clinicians to be of most value. Data were collected using a survey designed as part of a wider evaluation of a data feedback initiative in anaesthesia. Eighty-nine consultant anaesthetists from two English NHS acute Trusts completed the survey. Multiple linear regression with hierarchical variable entry was used to investigate which characteristics of feedback predict its perceived usefulness for monitoring variation and improving care. The final model demonstrated that the relevance of the quality indicators to the specific service area (β=0.64, p=0.01) and the credibility of the data as coming from a trustworthy, unbiased source (β=0.55, p=0.01) were the significant predictors, having controlled for all other covariates. For clinicians to engage with effective quality monitoring and feedback, the perceived local relevance of indicators and trust in the credibility of the resulting data are paramount. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Evolving approaches to management of quality in clinical microbiology.

PubMed Central

Bartlett, R C; Mazens-Sullivan, M; Tetreault, J Z; Lobel, S; Nivard, J

1994-01-01

Quality management in clinical microbiology began in the 1960s. Both government and professional societies introduced programs for proficiency testing and laboratory inspection and accreditation. Many laboratory scientists and pathologists were independently active and creative in expanding efforts to monitor and improve practices. The initial emphasis was placed on intralaboratory process. Later, attention was shifted to physician ordering, specimen collection, reporting, and use of information. Quality management in the laboratory depends in large part on the monitoring of indicators that provide some evidence of how laboratory resources are being used and how the information benefits patient care. Continuous quality improvement should be introduced. This consists of a more thorough assessment of doing the right things versus the wrong things in terms of customer demand and satisfaction and studying the cumulative effect of error when responsibility is passed from one person to another. Prevention of error is accomplished more through effective training and continuing education than through surveillance. Also, this system will force more conscious attention to meeting the expectations of the many customers that must be satisfied by laboratory services, including patients, physicians, third-party payers, and managed-care organizations. PMID:8118791

How Can We Improve Outcomes for Patients and Families Under Palliative Care? Implementing Clinical Audit for Quality Improvement in Resource Limited Settings

PubMed Central

Selman, Lucy; Harding, Richard

2010-01-01

Palliative care in India has made enormous advances in providing better care for patients and families living with progressive disease, and many clinical services are well placed to begin quality improvement initiatives, including clinical audit. Clinical audit is recognized globally to be essential in all healthcare, as a way of monitoring and improving quality of care. However, it is not common in developing country settings, including India. Clinical audit is a cyclical activity involving: identification of areas of care in need of improvement, through data collection and analysis utilizing an appropriate questionnaire; setting measurable quality of care targets in specific areas; designing and implementing service improvement strategies; and then re-evaluating quality of care to assess progress towards meeting the targets. Outcome measurement is an important component of clinical audit that has additional advantages; for example, establishing an evidence base for the effectiveness of services. In resource limited contexts, outcome measurement in clinical audit is particularly important as it enables service development to be evidence-based and ensures resources are allocated effectively. Key success factors in conducting clinical audit are identified (shared ownership, training, managerial support, inclusion of all members of staff and a positive approach). The choice of outcome measurement tool is discussed, including the need for a culturally appropriate and validated measure which is brief and simple enough to incorporate into clinical practice and reflects the holistic nature of palliative care. Support for clinical audit is needed at a national level, and development and validation of an outcome measurement tool in the Indian context is a crucial next step. PMID:20859465

Country experience in organizing for quality: Niger.

PubMed

Marquez, L; Madubuike, C

1999-01-01

This article describes the efforts of Niger's Ministry of Health Tahoua Quality Assurance Project (QAP) since 1994. QAP aims to improve the delivery of critical primary health care (PHC) services by integrating and institutionalizing the QA approach in the PHC system in 1 demonstration site (Tahoua) and eventually, countrywide. The QAP selected 8 clinical interventions in its package of minimum services. The QAP project provided training, clarified and communicated clinical and management standards, and monitored and initiated a process for preventing and correcting problems. During 1994-96, QAP collaborated with BASICS to assist all 7 District Health Management Teams (DHMTs) in developing data collection tools for rapid performance assessments of the Integrated Management of Childhood Illnesses program. The pilot program proved that measurable gains in QA were possible, even with limited resources. DHMTs will have oversight of QA activities. A special unit within the MOH is not yet fully staffed. The central strategy has been to train teams of health staff at the regional and district level. A multilevel team developed manuals for norms and standards for vaccinations and for managerial operating procedures. The Quality Council redesigned the supervision system. Performance is monitored at quarterly regional and district meetings. A quarterly bulletin is the main dissemination tool. The loss of USAID support led to the loss of technical support from the QAP. The MOH is committed to QA and plans to institutionalize the process. The World Bank and UNICEF agreed to support QA projects in 1999.

A Multi Agent Based Approach for Prehospital Emergency Management.

PubMed

Safdari, Reza; Shoshtarian Malak, Jaleh; Mohammadzadeh, Niloofar; Danesh Shahraki, Azimeh

2017-07-01

To demonstrate an architecture to automate the prehospital emergency process to categorize the specialized care according to the situation at the right time for reducing the patient mortality and morbidity. Prehospital emergency process were analyzed using existing prehospital management systems, frameworks and the extracted process were modeled using sequence diagram in Rational Rose software. System main agents were identified and modeled via component diagram, considering the main system actors and by logically dividing business functionalities, finally the conceptual architecture for prehospital emergency management was proposed. The proposed architecture was simulated using Anylogic simulation software. Anylogic Agent Model, State Chart and Process Model were used to model the system. Multi agent systems (MAS) had a great success in distributed, complex and dynamic problem solving environments, and utilizing autonomous agents provides intelligent decision making capabilities.  The proposed architecture presents prehospital management operations. The main identified agents are: EMS Center, Ambulance, Traffic Station, Healthcare Provider, Patient, Consultation Center, National Medical Record System and quality of service monitoring agent. In a critical condition like prehospital emergency we are coping with sophisticated processes like ambulance navigation health care provider and service assignment, consultation, recalling patients past medical history through a centralized EHR system and monitoring healthcare quality in a real-time manner. The main advantage of our work has been the multi agent system utilization. Our Future work will include proposed architecture implementation and evaluation of its impact on patient quality care improvement.

A Multi Agent Based Approach for Prehospital Emergency Management

PubMed Central

Safdari, Reza; Shoshtarian Malak, Jaleh; Mohammadzadeh, Niloofar; Danesh Shahraki, Azimeh

2017-01-01

Objective: To demonstrate an architecture to automate the prehospital emergency process to categorize the specialized care according to the situation at the right time for reducing the patient mortality and morbidity. Methods: Prehospital emergency process were analyzed using existing prehospital management systems, frameworks and the extracted process were modeled using sequence diagram in Rational Rose software. System main agents were identified and modeled via component diagram, considering the main system actors and by logically dividing business functionalities, finally the conceptual architecture for prehospital emergency management was proposed. The proposed architecture was simulated using Anylogic simulation software. Anylogic Agent Model, State Chart and Process Model were used to model the system. Results: Multi agent systems (MAS) had a great success in distributed, complex and dynamic problem solving environments, and utilizing autonomous agents provides intelligent decision making capabilities.  The proposed architecture presents prehospital management operations. The main identified agents are: EMS Center, Ambulance, Traffic Station, Healthcare Provider, Patient, Consultation Center, National Medical Record System and quality of service monitoring agent. Conclusion: In a critical condition like prehospital emergency we are coping with sophisticated processes like ambulance navigation health care provider and service assignment, consultation, recalling patients past medical history through a centralized EHR system and monitoring healthcare quality in a real-time manner. The main advantage of our work has been the multi agent system utilization. Our Future work will include proposed architecture implementation and evaluation of its impact on patient quality care improvement. PMID:28795061

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.

BioCatalogue: a universal catalogue of web services for the life sciences

PubMed Central

Bhagat, Jiten; Tanoh, Franck; Nzuobontane, Eric; Laurent, Thomas; Orlowski, Jerzy; Roos, Marco; Wolstencroft, Katy; Aleksejevs, Sergejs; Stevens, Robert; Pettifer, Steve; Lopez, Rodrigo; Goble, Carole A.

2010-01-01

The use of Web Services to enable programmatic access to on-line bioinformatics is becoming increasingly important in the Life Sciences. However, their number, distribution and the variable quality of their documentation can make their discovery and subsequent use difficult. A Web Services registry with information on available services will help to bring together service providers and their users. The BioCatalogue (http://www.biocatalogue.org/) provides a common interface for registering, browsing and annotating Web Services to the Life Science community. Services in the BioCatalogue can be described and searched in multiple ways based upon their technical types, bioinformatics categories, user tags, service providers or data inputs and outputs. They are also subject to constant monitoring, allowing the identification of service problems and changes and the filtering-out of unavailable or unreliable resources. The system is accessible via a human-readable ‘Web 2.0’-style interface and a programmatic Web Service interface. The BioCatalogue follows a community approach in which all services can be registered, browsed and incrementally documented with annotations by any member of the scientific community. PMID:20484378

BioCatalogue: a universal catalogue of web services for the life sciences.

PubMed

Bhagat, Jiten; Tanoh, Franck; Nzuobontane, Eric; Laurent, Thomas; Orlowski, Jerzy; Roos, Marco; Wolstencroft, Katy; Aleksejevs, Sergejs; Stevens, Robert; Pettifer, Steve; Lopez, Rodrigo; Goble, Carole A

2010-07-01

The use of Web Services to enable programmatic access to on-line bioinformatics is becoming increasingly important in the Life Sciences. However, their number, distribution and the variable quality of their documentation can make their discovery and subsequent use difficult. A Web Services registry with information on available services will help to bring together service providers and their users. The BioCatalogue (http://www.biocatalogue.org/) provides a common interface for registering, browsing and annotating Web Services to the Life Science community. Services in the BioCatalogue can be described and searched in multiple ways based upon their technical types, bioinformatics categories, user tags, service providers or data inputs and outputs. They are also subject to constant monitoring, allowing the identification of service problems and changes and the filtering-out of unavailable or unreliable resources. The system is accessible via a human-readable 'Web 2.0'-style interface and a programmatic Web Service interface. The BioCatalogue follows a community approach in which all services can be registered, browsed and incrementally documented with annotations by any member of the scientific community.

The Icelandic volcanological data node and data service

NASA Astrophysics Data System (ADS)

Vogfjord, Kristin; Sigmundsson, Freysteinn; Futurevolc Team

2013-04-01

Through funding from the European FP7 programme, the International Civil Aviation Authority (ICAO), as well as the local Icelandic government and RANNÍS research fund, the establishment of the Icelandic volcano observatory (VO) as a cross-disciplinary, international volcanological data node and data service is starting to materialize. At the core of this entity is the close collaboration between the Icelandic Meteorological Office (IMO), a natural hazard monitoring and research institution, and researchers at the Earth Science Institute of the University of Iceland, ensuring long-term sustainable access to research quality data and products. Existing Icelandic Earth science monitoring and research infrastructures are being prepared for integration with the European EPOS infrastructure. Because the VO is located at a Met Office, this infrastructure also includes meteorological infrastructures relevant to volcanology. Furthermore, the FP7 supersite project, FUTUREVOLC cuts across disciplines to bring together European researchers from Earth science, atmospheric science, remote sensing and space science focussed on combined processing of the different data sources and results to generate a multiparametric volcano monitoring and early warning system. Integration with atmospheric and space science is to meet the need for better estimates of the volcanic eruption source term and dispersion, which depend not only on the magma flow rate and composition, but also on atmosphere-plume interaction and dispersion. This should lead to better estimates of distribution of ash in the atmosphere. FUTUREVOLC will significantly expand the existing Icelandic EPOS infrastructure to an even more multidisciplinary volcanological infrastructure. A central and sustainable part of the project is the establishment of a research-quality data centre at the VO. This data centre will be able to serve as a volcanological data node within EPOS, making multidisciplinary data accessible to scientists and stakeholders, and enabling the generation of products and services useful for civil protection, societal infrastructure and international aviation. The 2010 Eyjafjallajökull eruption demonstrated that eruption and dispersion of volcanic ash in the atmosphere can have far-reaching detrimental effects on aviation. The aviation community is therefore an important stakeholder in volcano monitoring, but interaction between the two communities is not well established. Traditionally Met Offices provide services vital to aviation safety and therefore have strong ties to the aviation community, with internationally established protocols for interaction. The co-habitation of a Met Office with a VO establishes a firm connection between these communities and allows adaptation of already established protocols to facilitate access to information and development of services for aviation, as well as sources of support for the VO.

Generic Sensor Data Fusion Services for Web-enabled Environmental Risk Management and Decision-Support Systems

NASA Astrophysics Data System (ADS)

Sabeur, Zoheir; Middleton, Stuart; Veres, Galina; Zlatev, Zlatko; Salvo, Nicola

2010-05-01

The advancement of smart sensor technology in the last few years has led to an increase in the deployment of affordable sensors for monitoring the environment around Europe. This is generating large amounts of sensor observation information and inevitably leading to problems about how to manage large volumes of data as well as making sense out the data for decision-making. In addition, the various European Directives (Water Framework Diectives, Bathing Water Directives, Habitat Directives, etc.. ) which regulate human activities in the environment and the INSPIRE Directive on spatial information management regulations have implicitely led the designated European Member States environment agencies and authorities to put in place new sensor monitoring infrastructure and share information about environmental regions under their statutory responsibilities. They will need to work cross border and collectively reach environmental quality standards. They will also need to regularly report to the EC on the quality of the environments of which they are responsible and make such information accessible to the members of the public. In recent years, early pioneering work on the design of service oriented architecture using sensor networks has been achieved. Information web-services infrastructure using existing data catalogues and web-GIS map services can now be enriched with the deployment of new sensor observation and data fusion and modelling services using OGC standards. The deployment of the new services which describe sensor observations and intelligent data-processing using data fusion techniques can now be implemented and provide added value information with spatial-temporal uncertainties to the next generation of decision support service systems. The new decision support service systems have become key to implement across Europe in order to comply with EU environmental regulations and INSPIRE. In this paper, data fusion services using OGC standards with sensor observation data streams are described in context of a geo-distributed service infrastructure specialising in multiple environmental risk management and decision-support. The sensor data fusion services are deployed and validated in two use cases. These are respectively concerned with: 1) Microbial risks forecast in bathing waters; and 2) Geohazards in urban zones during underground tunneling activities. This research was initiated in the SANY Integrated Project(www.sany-ip.org) and funded by the European Commission under the 6th Framework Programme.

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

PubMed

Stepenuck, Kristine F; Genskow, Kenneth D

2018-01-01

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

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

NASA Astrophysics Data System (ADS)

Stepenuck, Kristine F.; Genskow, Kenneth D.

2018-01-01

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

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

PubMed Central

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

2012-01-01

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

Quality of previous diabetes care among patients receiving services at ophthalmology hospitals in Mexico.

PubMed

Rodríguez-Saldana, Joel; Rosales-Campos, Andrea C; Rangel León, Carmen B; Vázquez-Rodríguez, Laura I; Martínez-Castro, Francisco; Piette, John D

2010-12-01

To survey a large sample of type 2 diabetes mellitus (T2DM) patients in Mexico City to determine if patient experience, access to basic services, treatment, and outcomes differed between those with social security coverage and those without. From 2001-2007 a total of 1 000 individuals with T2DM were surveyed in outpatient clinics of the three largest public ophthalmology hospitals in Mexico City. Patients reported information about their health status and receipt of basic diabetes services, such as laboratory glycemic monitoring and diabetes education. Rates were compared between those with (n = 461) and without (n = 539) social security. Almost half of the patients (46%) in these public facilities were social security patients that were unable to access other services and had to pay out-of-pocket for care. Half of respondents were originally identified as potentially diabetic based on symptom complaints (51%), including 11% with visual impairment. Most patients (87.9%) reported that their glycemic level was being monitored exclusively via fasting blood glucose testing or random capillary blood glucose tests; only 5.3% reported ever having a glycated hemoglobin test. While nearly all respondents reported an individual physician encounter ever, only 39% reported ever receiving nutrition counseling and only 21% reported attending one or more sessions of diabetes education in their lifetime. Processes of care and outcomes were no different in patients with and those without social security coverage. In Mexico, the quality of diabetes care is poor. Despite receiving social security, many patients still have to pay out-of-pocket to access needed care. Without policy changes that address these barriers to comprehensive diabetes management, scientific achievements in diagnosis and pharmacotherapy will have limited impact.

The Ozone Monitoring Instrument: overview of 14 years in space

NASA Astrophysics Data System (ADS)

Levelt, Pieternel F.; Joiner, Joanna; Tamminen, Johanna; Pepijn Veefkind, J.; Bhartia, Pawan K.; Stein Zweers, Deborah C.; Duncan, Bryan N.; Streets, David G.; Eskes, Henk; van der A, Ronald; McLinden, Chris; Fioletov, Vitali; Carn, Simon; de Laat, Jos; DeLand, Matthew; Marchenko, Sergey; McPeters, Richard; Ziemke, Jerald; Fu, Dejian; Liu, Xiong; Pickering, Kenneth; Apituley, Arnoud; González Abad, Gonzalo; Arola, Antti; Boersma, Folkert; Miller, Christopher Chan; Chance, Kelly; de Graaf, Martin; Hakkarainen, Janne; Hassinen, Seppo; Ialongo, Iolanda; Kleipool, Quintus; Krotkov, Nickolay; Li, Can; Lamsal, Lok; Newman, Paul; Nowlan, Caroline; Suleiman, Raid; Gijsbert Tilstra, Lieuwe; Torres, Omar; Wang, Huiqun; Wargan, Krzysztof

2018-04-01

This overview paper highlights the successes of the Ozone Monitoring Instrument (OMI) on board the Aura satellite spanning a period of nearly 14 years. Data from OMI has been used in a wide range of applications and research resulting in many new findings. Due to its unprecedented spatial resolution, in combination with daily global coverage, OMI plays a unique role in measuring trace gases important for the ozone layer, air quality, and climate change. With the operational very fast delivery (VFD; direct readout) and near real-time (NRT) availability of the data, OMI also plays an important role in the development of operational services in the atmospheric chemistry domain.

The Ozone Monitoring Instrument: overview of 14 years in space

NASA Technical Reports Server (NTRS)

Tamminen, Johanna; Veefkind, J. Pepijn; van der A, Ronald; Miller, Christopher Chan; Ialongo, Iolanda; Kleipool, Quintus; Lamsal, Lok N.; Wang, Huiqun; Bhartia, Pawan K.; Zweers, Deborah C. Stein;

Item generation in the development of an inpatient experience questionnaire: a qualitative study

PubMed Central

2013-01-01

Background Patient experience is a key feature of quality improvement in modern health-care delivery. Measuring patient experience is one of several tools used to assess and monitor the quality of health services. This study aims to develop a tool for assessing patient experience with inpatient care in public hospitals in Hong Kong. Methods Based on the General Inpatient Questionnaire (GIQ) framework of the Care Quality Commission as a discussion guide, a qualitative study involving focus group discussions and in-depth individual interviews with patients was employed to develop a tool for measuring inpatient experience in Hong Kong. Results All participants agreed that a patient satisfaction survey is an important platform for collecting patients’ views on improving the quality of health-care services. Findings of the focus group discussions and in-depth individual interviews identified nine key themes as important hospital quality indicators: prompt access, information provision, care and involvement in decision making, physical and emotional needs, coordination of care, respect and privacy, environment and facilities, handling of patient feedback, and overall care from health-care professionals and quality of care. Privacy, complaint mechanisms, patient involvement, and information provision were further highlighted as particularly important areas for item revision by the in-depth individual interviews. Thus, the initial version of the Hong Kong Inpatient Experience Questionnaire (HKIEQ), comprising 58 core items under nine themes, was developed. Conclusions A set of dimensions and core items of the HKIEQ was developed and the instrument will undergo validity and reliability tests through a validation survey. A valid and reliable tool is important in accurately assessing patient experience with care delivery in hospitals to improve the quality of health-care services. PMID:23835186

Implementation of quality management systems and progress towards accreditation of National Tuberculosis Reference Laboratories in Africa

PubMed Central

de Dieu Iragena, Jean; Kao, Kekeletso; Erni, Donatelle; Mekonen, Teferi

2017-01-01

Background Laboratory services are essential at all stages of the tuberculosis care cascade, from diagnosis and drug resistance testing to monitoring response to treatment. Enabling access to quality services is a challenge in low-resource settings. Implementation of a strong quality management system (QMS) and laboratory accreditation are key to improving patient care. Objectives The study objective was to determine the status of QMS implementation and progress towards accreditation of National Tuberculosis Reference Laboratories (NTRLs) in the African Region. Method An online questionnaire was administered to NTRL managers in 47 World Health Organization Regional Office for Africa member states in the region, between February and April 2015, regarding the knowledge of QMS tools and progress toward implementation to inform strategies for tuberculosis diagnostic services strengthening in the region. Results A total of 21 laboratories (43.0%) had received SLMTA/TB-SLMTA training, of which 10 had also used the Global Laboratory Initiative accreditation tool. However, only 36.7% of NTRLs had received a laboratory audit, a first step in quality improvement. Most NTRLs participated in acid-fast bacilli microscopy external quality assurance (95.8%), although external quality assurance for other techniques was lower (60.4% for first-line drug susceptibility testing, 25.0% for second-line drug susceptibility testing, and 22.9% for molecular testing). Barriers to accreditation included lack of training and accreditation programmes. Only 28.6% of NTRLs had developed strategic plans and budgets which included accreditation. Conclusion Good foundations are in place on the continent from which to scale up accreditation efforts. Laboratory audits should be conducted as a first step in developing quality improvement action plans. Political commitment and strong leadership are needed to drive accreditation efforts; advocacy will require clear evidence of patient impact and cost-benefit. PMID:28879161

Winter wheat quality monitoring and forecasting system based on remote sensing and environmental factors

NASA Astrophysics Data System (ADS)

Haiyang, Yu; Yanmei, Liu; Guijun, Yang; Xiaodong, Yang; Dong, Ren; Chenwei, Nie

2014-03-01

To achieve dynamic winter wheat quality monitoring and forecasting in larger scale regions, the objective of this study was to design and develop a winter wheat quality monitoring and forecasting system by using a remote sensing index and environmental factors. The winter wheat quality trend was forecasted before the harvest and quality was monitored after the harvest, respectively. The traditional quality-vegetation index from remote sensing monitoring and forecasting models were improved. Combining with latitude information, the vegetation index was used to estimate agronomy parameters which were related with winter wheat quality in the early stages for forecasting the quality trend. A combination of rainfall in May, temperature in May, illumination at later May, the soil available nitrogen content and other environmental factors established the quality monitoring model. Compared with a simple quality-vegetation index, the remote sensing monitoring and forecasting model used in this system get greatly improved accuracy. Winter wheat quality was monitored and forecasted based on the above models, and this system was completed based on WebGIS technology. Finally, in 2010 the operation process of winter wheat quality monitoring system was presented in Beijing, the monitoring and forecasting results was outputted as thematic maps.

Community drinking water quality monitoring data: utility for public health research and practice.

PubMed

Jones, Rachael M; Graber, Judith M; Anderson, Robert; Rockne, Karl; Turyk, Mary; Stayner, Leslie T

2014-01-01

Environmental Public Health Tracking (EPHT) tracks the occurrence and magnitude of environmental hazards and associated adverse health effects over time. The EPHT program has formally expanded its scope to include finished drinking water quality. Our objective was to describe the features, strengths, and limitations of using finished drinking water quality data from community water systems (CWSs) for EPHT applications, focusing on atrazine and nitrogen compounds in 8 Midwestern states. Water quality data were acquired after meeting with state partners and reviewed and merged for analysis. Data and the coding of variables, particularly with respect to censored results (nondetects), were not standardized between states. Monitoring frequency varied between CWSs and between atrazine and nitrates, but this was in line with regulatory requirements. Cumulative distributions of all contaminants were not the same in all states (Peto-Prentice test P < .001). Atrazine results were highly censored in all states (76.0%-99.3%); higher concentrations were associated with increased measurement frequency and surface water as the CWS source water type. Nitrate results showed substantial state-to-state variability in censoring (20.5%-100%) and in associations between concentrations and the CWS source water type. Statistical analyses of these data are challenging due to high rates of censoring and uncertainty about the appropriateness of parametric assumptions for time-series data. Although monitoring frequency was consistent with regulations, the magnitude of time gaps coupled with uncertainty about CWS service areas may limit linkage with health outcome data.

Why children are not vaccinated: a review of the grey literature.

PubMed

Favin, Michael; Steinglass, Robert; Fields, Rebecca; Banerjee, Kaushik; Sawhney, Monika

2012-12-01

In collaboration with WHO, IMMUNIZATION basics analyzed 126 documents from the global grey literature to identify reasons why eligible children had incomplete or no vaccinations. The main reasons for under-vaccination were related to immunization services and to parental knowledge and attitudes. The most frequently cited factors were: access to services, health staff attitudes and practices, reliability of services, false contraindications, parents' practical knowledge of vaccination, fear of side effects, conflicting priorities and parental beliefs. Some family demographic characteristics were strong, but underlying, risk factors for under-vaccination. Studies must be well designed to capture a complete picture of the simultaneous causes of under-vaccination and to avoid biased results. Although the grey literature contains studies of varying quality, it includes many well-designed studies. Every immunization program should strive to provide quality services that are accessible, convenient, reliable, friendly, affordable and acceptable, and should solicit feedback from families and community leaders. Every program should monitor missed and under-vaccinated children and assess and address the causes. Although global reviews, such as this one, can play a useful role in identifying key questions for local study, local enquiry and follow-up remain essential.

[Evaluation auditing of the quality of health care in accreditation of health facilities].

PubMed

Paim, Chennyfer da Rosa Paino; Zucchi, Paola

2011-01-01

This article shows how many health insurance companies operating in the Greater São Paulo have been performing auditing of the quality of their health care services, professionals, and which criteria are being employed to do so. Because of the legislation decreeing that health insurance companies have legal co-responsibility for the health care services and National Health Agency control the health services National Health Agency, auditing evaluations have been implemented since then. The survey was based on electronic forms e-mailed to all health insurance companies operating in the Greater São Paulo. The sample consisted of 125 health insurance companies; 29 confirmed that had monitoring and evaluation processes; 26 performed auditing of their services regularly; from those, 20 used some type of form or protocol for technical visits; all evaluation physical and administrative structure and 22 included functional structure. Regarding the professionals audited 21 were nurses, 13 administrative assistants; 04 managers and 02 doctors. Regarding criteria for accreditation the following were highlighted: region analysis (96%), localization (88.88%) and cost (36%). We conclude that this type of auditing evaluation is rather innovative and is being gradually implemented by the health insurance companies, but is not a systematic process.

Water quality in Atlantic rainforest mountain rivers (South America): quality indices assessment, nutrients distribution, and consumption effect.

PubMed

Avigliano, Esteban; Schenone, Nahuel

2016-08-01

The South American Atlantic rainforest is a one-of-a-kind ecosystem considered as a biodiversity hotspot; however, in the last decades, it was intensively reduced to 7 % of its original surface. Water resources and water quality are one of the main goods and services this system provides to people. For monitoring and management recommendations, the present study is focused on (1) determining the nutrient content (nitrate, nitrite, ammonium, and phosphate) and physiochemical parameters (temperature, pH, electrical conductivity, turbidity, dissolved oxygen, and total dissolved solids) in surface water from 24 rainforest mountain rivers in Argentina, (2) analyzing the human health risk, (3) assessing the environmental distribution of the determined pollutants, and (4) analyzing water quality indices (WQIobj and WQImin). In addition, for total coliform bacteria, a dataset was used from literature. Turbidity, total dissolved solids, and nitrite (NO2 (-)) exceeded the guideline value recommended by national or international guidelines in several sampling stations. The spatial distribution pattern was analyzed by Principal Component Analysis and Factor Analysis (PCA/FA) showing well-defined groups of rivers. Both WQI showed good adjustment (R (2) = 0.89) and rated water quality as good or excellent in all sampling sites (WQI > 71). Therefore, this study suggests the use of the WQImin for monitoring water quality in the region and also the water treatment of coliform, total dissolved solids, and turbidity.

Telehealth: seven strategies to successfully implement disruptive technology and transform health care.

PubMed

Schwamm, Lee H

2014-02-01

"Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.

[Quality of health care for diabetic and hypertensive patients in primary care settings servicing Mexican Seguro Popular].

PubMed

Ortiz-Domínguez, Maki E; Garrido-Latorre, Francisco; Orozco, Ricardo; Pineda-Pérez, Dayana; Rodríguez-Salgado, Marlenne

2011-01-01

To assess health care quality provided to type-2 diabetic and hypertensive patients in primary care settings from the Mexican Ministry of Health and to evaluate whether accredited clinics providing services to the Mexican Seguro Popular performed better in terms of metabolic control of those patients compared to the non-accredited. Cross-sectional study performed on 2008. Previous year clinical measures were obtained from 5 444 diabetic and 5 827 hypertensive patient's clinical records. Adequate metabolic control (glucose <110 mg/dl for diabetes and blood pressure <140/90 mmHg for hypertension) associated factors were assessed by multiple-multilevel logistic regression methods. Patients attending accredited clinics were more likely to be controlled, however, metabolic control was not constant over time of accreditation. Additional efforts are required to monitor accredited clinics' performance in order to maintain both metabolic control and clinical assessment of patients.

Soil Quality as an Indicator of Forest Health: an Overview and Initial Results from the USFS Forest Inventory and Analysis Soil Indicator Program

Treesearch

Katherine O' Neill; Michael Amacher; Craig Palmer; Barbara Conkling; Greg C. Liknes

2003-01-01

The Montreal Process was formed in 1994 to develop an internationally agreed upon set of criteria and indicators for the conservation and sustainable management of temperate and boreal forests. In response to this effort, the USDA Forest Service Forest Inventory and Analysis (FIA) and Forest Health Monitonhg (FHM) programs implemented a national soil monitoring program...

An exploration of multilevel modeling for estimating access to drinking-water and sanitation.

PubMed

Wolf, Jennyfer; Bonjour, Sophie; Prüss-Ustün, Annette

2013-03-01

Monitoring progress towards the targets for access to safe drinking-water and sanitation under the Millennium Development Goals (MDG) requires reliable estimates and indicators. We analyzed trends and reviewed current indicators used for those targets. We developed continuous time series for 1990 to 2015 for access to improved drinking-water sources and improved sanitation facilities by country using multilevel modeling (MLM). We show that MLM is a reliable and transparent tool with many advantages over alternative approaches to estimate access to facilities. Using current indicators, the MDG target for water would be met, but the target for sanitation missed considerably. The number of people without access to such services is still increasing in certain regions. Striking differences persist between urban and rural areas. Consideration of water quality and different classification of shared sanitation facilities would, however, alter estimates considerably. To achieve improved monitoring we propose: (1) considering the use of MLM as an alternative for estimating access to safe drinking-water and sanitation; (2) completing regular assessments of water quality and supporting the development of national regulatory frameworks as part of capacity development; (3) evaluating health impacts of shared sanitation; (4) using a more equitable presentation of countries' performances in providing improved services.

Advances in air quality prediction with the use of integrated systems

NASA Astrophysics Data System (ADS)

Dragani, R.; Benedetti, A.; Engelen, R. J.; Peuch, V. H.

2017-12-01

Recent years have seen the rise of global operational atmospheric composition forecasting systems for several applications including climate monitoring, provision of boundary conditions for regional air quality forecasting, energy sector applications, to mention a few. Typically, global forecasts are provided in the medium-range up to five days ahead and are initialized with an analysis based on satellite data. In this work we present the latest advances in data assimilation using the ECMWF's 4D-Var system extended to atmospheric composition which is currently operational under the Copernicus Atmosphere Monitoring Service of the European Commission. The service is based on acquisition of all relevant data available in near-real-time, the processing of these datasets in the assimilation and the subsequent dissemination of global forecasts at ECMWF. The global forecasts are used by the CAMS regional models as boundary conditions for the European forecasts based on a multi-model ensemble. The global forecasts are also used to provide boundary conditions for other parts of the world (e.g., China) and are freely available to all interested entities. Some of the regional models also perform assimilation of satellite and ground-based observations. All products are assessed, validated and made publicly available on https://atmosphere.copernicus.eu/.

Supporting graduate nurse transition to practice through a quality assurance feedback loop.

PubMed

Phillips, Craig; Kenny, Amanda; Esterman, Adrian

2017-11-01

This mixed-method study focused on new graduate nurses and their transition to practice. Transition to practice can be a time of heightened stress and anxiety, leaving many new graduates disillusioned and dissatisfied with their work. The study explored how satisfaction levels with transition may improve during their first year, using a unique approach of a continuous quality assurance feedback loop. This assurance framework is utilised in hospitality, automotive and supply chain logistics and in health, primarily to monitor patient outcomes. However, an association with graduate nurse satisfaction has not been previously reported. Graduate nurses from two health services completed a short survey questionnaire every four weeks for 12 months. De-identified aggregated data was sent to health service management, giving them an opportunity to integrate the findings with the objective of potentially increasing graduate satisfaction ratings. Quantitative findings showed no statistical significance of graduate nurse satisfaction scores between health services, however, one health service consistently outperformed the other. Qualitative findings drawn from a seminar and interviews confirmed that one health service took a more proactive stance with the monthly reports, communicating the results to ward managers. Outcomes reflected a greater commitment of support and an overall increase of satisfaction scores. Copyright © 2017 Elsevier Ltd. All rights reserved.

Fiber optics in composite materials: materials with nerves of glass

NASA Astrophysics Data System (ADS)

Measures, Raymond M.

1990-08-01

A Fiber Optic BasedSmart Structure wiipossess a structurally integrated optical microsensor system for determining its state. This built-in sensor system should, in real-time, be able to: evaluate the strain or deformation of a structure, monitor if its vibrating or subject to excessive loads, check its temperature and warn of the appearance of any hot spots. In addition a Smart Structure should maintain a vigilant survelliance over its structural integrity. The successful development of Smart StructureTechnolgy could lead to: aircraft that are safer, lighter, more efficient, easier to maintain and to service; pipelines, pressure vessels and storage tanks that constantly monitor their structuralintegrity and immediately issue an alert ifany problem is detected; space platforms that check forpressure leaks, unwanted vibration, excess thermal buildup, and deviation from some preassigned shape.This technology is particularly appropriate for composite materials where internal damage generated by: impacts, manufacturing flaws, excessive loading or fatigue could be detected and assessed. In service monitoring of structural loads, especially in regions like wing roots of aircraft, could be ofconsiderable benefit in helping to avoid structural overdesign and reduce weight. Structurally imbedded optical fibers sensors might also serve to monitor the cure state of composite thermosets during their fabrication and thereby contribute to improved quality control of these products.