Simplified management of ATM traffic

NASA Astrophysics Data System (ADS)

Luoma, Marko; Ilvesmaeki, Mika

1997-10-01

ATM has been under a thorough standardization process for more than ten years. Looking at it now, what have we achieved during this time period? Originally ATM was meant to be an easy and efficient protocol enabling varying services over a single network. What it is turning to be it `yet another ISDN'--network full of hopes and promises but too difficult to implement and expensive to market. The fact is that more and more `nice features' are implemented on the cost of overloading network with hard management procedures. Therefore we need to adopt a new approach. This approach keeps a strong reminder on `what is necessary.' This paper presents starting points for an alternative approach to the traffic management. We refer to this approach as `the minimum management principle.' Choosing of the suitable service classes for the ATM network is made difficult by the fact that the more services one implements the more management he needs. This is especially true for the variable bit rate connections that are usually treated based on the stochastic models. Stochastic model, at its best, can only reveal momentary characteristics in the traffic stream not the long range behavior of it. Our assumption is that ATM will move towards Internet in the sense that strict values for quality make little or no sense in the future. Therefore stochastic modeling of variable bit rate connections seems to be useless. Nevertheless we see that some traffic needs to have strict guarantees and that the only economic way of doing so is to use PCR allocation.

Prospective, randomized, blinded evaluation of donor semen quality provided by seven commercial sperm banks.

PubMed

Carrell, Douglas T; Cartmill, Deborah; Jones, Kirtly P; Hatasaka, Harry H; Peterson, C Matthew

2002-07-01

To evaluate variability in donor semen quality between seven commercial donor sperm banks, within sperm banks, and between intracervical insemination and intrauterine insemination. Prospective, randomized, blind evaluation of commercially available donor semen samples. An academic andrology laboratory. Seventy-five cryopreserved donor semen samples were evaluated. Samples were coded, then blindly evaluated for semen quality. Standard semen quality parameters, including concentration, motility parameters, World Health Organization criteria morphology, and strict criteria morphology. Significant differences were observed between donor semen banks for most semen quality parameters analyzed in intracervical insemination samples. In general, the greatest variability observed between banks was in percentage progressive sperm motility (range, 8.8 +/- 5.8 to 42.4 +/- 5.5) and normal sperm morphology (strict criteria; range, 10.1 +/- 3.3 to 26.6 +/- 4.7). Coefficients of variation within sperm banks were generally high. These data demonstrate the variability of donor semen quality provided by commercial sperm banks, both between banks and within a given bank. No relationship was observed between the size or type of sperm bank and the degree of variability. The data demonstrate the lack of uniformity in the criteria used to screen potential semen donors and emphasize the need for more stringent screening criteria and strict quality control in processing samples.

Comminuted Laryngeal Fracture Following Blunt Trauma: A Need for Strict Legislation on Roads!

PubMed

Jain, Shraddha; Singh, Pragya; Gupta, Minal; Kamble, Bhavna; Phatak, Suresh S

2017-01-01

Laryngeal fracture is a rare condition with potential life-long implications related to airway patency, voice quality, and swallowing. Rarity of the condition leads to lack of consensus on the most suitable way to manage this injury. The mode of injury can be prevented by strict legislation on the roads. We report a case of a 28-year-old Indian male who sustained a comminuted displaced fracture of the thyroid cartilage with disruption of anterior commissure due to blunt trauma caused by the metallic side rod of a ladder projecting from the rear of a vehicle in front of the bike on which he was riding. He presented with breathing difficulty, change in voice, surgical emphysema, and pneumomediastinum, but without any skin changes over the neck. His airway could be restored due to early tracheostomy and open reduction with internal fixation with sutures along with laryngeal stenting. He has no significant swallowing or breathing problem and reasonably good voice 6 months after surgery. This case highlights the need for strict legislation on roads in India and the importance of high level of suspicion for laryngeal fracture in acute trauma patient. Early identification and timely internal fixation not only restore the airway but also improve long-term voice and airway outcomes.

Cryptococcal meningitis management in Tanzania with strict schedule of serial lumber punctures using intravenous tubing sets: an operational research study.

PubMed

Meda, John; Kalluvya, Samuel; Downs, Jennifer A; Chofle, Awilly A; Seni, Jeremiah; Kidenya, Benson; Fitzgerald, Daniel W; Peck, Robert N

2014-06-01

Cryptococcal meningitis (CM) has a mortality rate of ∼70% among HIV-infected adults in low-income countries. Controlling intracranial pressure (ICP) is essential in CM, but it is difficult in low-income countries because manometers and practical ICP management protocols are lacking. As part of a continuous quality improvement project, our Tanzanian hospital initiated a new protocol for ICP management for CM. All adult inpatients with CM are included in a prospective patient registry. At the time of analysis, this registry included data from 2 years before the initiation of this new ICP management protocol and for a 9-month period after. ICP was measured at baseline and at days 3, 7, and 14 by both manometer and intravenous (IV) tubing set. All patients were given IV fluconazole according to Tanzanian treatment guidelines and were followed until 30 days after admission. Among adult inpatients with CM, 32 of 35 patients (91%) had elevated ICP on admission. Cerebrospinal fluid pressure measurements using the improvised IV tubing set demonstrated excellent agreement (r = 0.96) with manometer measurements. Compared with historical controls, the new ICP management protocol was associated with a significant reduction in 30-day mortality (16/35 [46%] vs. 48/64 [75%] in historical controls; hazard ratio = 2.1 [95% CI: 1.1 to 3.8]; P = 0.018]. Increased ICP is almost universal among HIV-infected adults admitted with CM in Tanzania. Intensive ICP management with a strict schedule of serial lumbar punctures reduced in-hospital mortality compared with historical controls. ICP measurement with IV tubing sets may be a good alternative in resource-limited health facilities where manometers are not available.

Risk-based Process Development of Biosimilars as Part of the Quality by Design Paradigm.

PubMed

Zalai, Dénes; Dietzsch, Christian; Herwig, Christoph

2013-01-01

In the last few years, several quality by design (QbD) studies demonstrated the benefit of systematic approaches for biopharmaceutical development. However, only very few studies identified biosimilars as a special case of product development. The targeted quality profile of biosimilars is strictly defined by the originator's product characteristic. Moreover, the major source of prior knowledge is the experience with the originator product itself. Processing this information in biosimilar development has a major effect on risk management and process development strategies. The main objective of this contribution is to demonstrate how risk management can facilitate the implementation of QbD in early-stage product development with special emphasis on fitting the reported approaches to biosimilars. Risk assessments were highlighted as important tools to integrate prior knowledge in biosimilar development. The risk assessment process as suggested by the International Conference on Harmonization (ICH Q9) was reviewed and three elements were identified to play a key role in targeted risk assessment approaches: proper understanding of target linkage, risk assessment tool compliance, and criticality threshold value. Adjusting these steps to biosimilar applications helped to address some unique challenges of these products such as a strictly defined quality profile or a lack of process knowledge. This contribution demonstrates the need for tailored risk management approaches for the risk-based development of biosimilars and provides novel tools for the integration of additional knowledge available for these products. The pharmaceutical industry is facing challenges such as profit loss and price competition. Companies are forced to rationalize business models and to cut costs in development as well as manufacturing. These trends recently hinder the implementation of any concepts that do not offer certain financial benefit or promise a long return of investment. Quality by design (QbD) is a concept that is currently struggling for more acceptance from the side of the pharmaceutical industry. To achieve this, the major goals of QbD have to be revisited and QbD tools have to be subsequently developed. This contribution offers an example as to how implement risk management in early-stage biosimilar development as part of the QbD concept. The main goal was to go beyond the conventional QbD workflow and to adjust risk management to the challenges of biosimilar products. Accordingly, instead of using methods like failure mode and effects analysis, recommendations of the ICH Q9 guideline were reviewed and put into practice by creating tailored risk assessment tools. The novelty of this contribution is to report those tailored tools ready-to-use for early bioprocess development of biosimilars along QbD principles.

Health benefits from improved outdoor air quality and intervention in China.

PubMed

Li, Shanshan; Williams, Gail; Guo, Yuming

2016-07-01

China is at its most critical stage of outdoor air quality management. In order to prevent further deterioration of air quality and to protect human health, the Chinese government has made a series of attempts to reduce ambient air pollution. Unlike previous literature reviews on the widespread hazards of air pollution on health, this review article firstly summarized the existing evidence of human health benefits from intermittently improved outdoor air quality and intervention in China. Contents of this paper provide concrete and direct clue that improvement in outdoor air quality generates various health benefits in China, and confirm from a new perspective that it is worthwhile for China to shift its development strategy from economic growth to environmental economic sustainability. Greater emphasis on sustainable environment design, consistently strict regulatory enforcement, and specific monitoring actions should be regarded in China to decrease the health risks and to avoid long-term environmental threats. Copyright © 2016 Elsevier Ltd. All rights reserved.

Matrix Intensification Alters Avian Functional Group Composition in Adjacent Rainforest Fragments

PubMed Central

Deikumah, Justus P.; McAlpine, Clive A.; Maron, Martine

2013-01-01

Conversion of farmland land-use matrices to surface mining is an increasing threat to the habitat quality of forest remnants and their constituent biota, with consequences for ecosystem functionality. We evaluated the effects of matrix type on bird community composition and the abundance and evenness within avian functional groups in south-west Ghana. We hypothesized that surface mining near remnants may result in a shift in functional composition of avifaunal communities, potentially disrupting ecological processes within tropical forest ecosystems. Matrix intensification and proximity to the remnant edge strongly influenced the abundance of members of several functional guilds. Obligate frugivores, strict terrestrial insectivores, lower and upper strata birds, and insect gleaners were most negatively affected by adjacent mining matrices, suggesting certain ecosystem processes such as seed dispersal may be disrupted by landscape change in this region. Evenness of these functional guilds was also lower in remnants adjacent to surface mining, regardless of the distance from remnant edge, with the exception of strict terrestrial insectivores. These shifts suggest matrix intensification can influence avian functional group composition and related ecosystem-level processes in adjacent forest remnants. The management of matrix habitat quality near and within mine concessions is important for improving efforts to preserveavian biodiversity in landscapes undergoing intensification such as through increased surface mining. PMID:24058634

Matrix intensification alters avian functional group composition in adjacent rainforest fragments.

PubMed

Deikumah, Justus P; McAlpine, Clive A; Maron, Martine

2013-01-01

Conversion of farmland land-use matrices to surface mining is an increasing threat to the habitat quality of forest remnants and their constituent biota, with consequences for ecosystem functionality. We evaluated the effects of matrix type on bird community composition and the abundance and evenness within avian functional groups in south-west Ghana. We hypothesized that surface mining near remnants may result in a shift in functional composition of avifaunal communities, potentially disrupting ecological processes within tropical forest ecosystems. Matrix intensification and proximity to the remnant edge strongly influenced the abundance of members of several functional guilds. Obligate frugivores, strict terrestrial insectivores, lower and upper strata birds, and insect gleaners were most negatively affected by adjacent mining matrices, suggesting certain ecosystem processes such as seed dispersal may be disrupted by landscape change in this region. Evenness of these functional guilds was also lower in remnants adjacent to surface mining, regardless of the distance from remnant edge, with the exception of strict terrestrial insectivores. These shifts suggest matrix intensification can influence avian functional group composition and related ecosystem-level processes in adjacent forest remnants. The management of matrix habitat quality near and within mine concessions is important for improving efforts to preserveavian biodiversity in landscapes undergoing intensification such as through increased surface mining.

Performance-based contracting in home-care work in The Netherlands: professionalism under pressure?

PubMed

Oomkens, Rosanne; Hoogenboom, Marcel; Knijn, Trudie

2016-07-01

Our aim was to improve the understanding of the relationships between performance-based contracting, management supportiveness and professionalism in home care. Using path analysis, this article explores the relationships between home-care workers' perceptions of management support, implementation of performance-based contracting (i.e. use of strict time registration rules and cost-efficiency measures) and autonomy and intrinsic job satisfaction. We hypothesised that: use of strict time registration rules and cost-efficiency measures relates to lower levels of autonomy and intrinsic job satisfaction (H1); there is an indirect relationship between use of strict time registration rules and use of cost-efficiency measures and intrinsic job satisfaction via autonomy (H2); higher levels of management support relate to the use of looser time registration rules and less use of cost-efficiency measures (H3); and higher levels of management support relate to higher levels of autonomy and intrinsic job satisfaction (H4). We used data from a cross-sectional survey conducted in 2010 of a sample of Dutch home-care workers (N = 156, response rate = 34%). Overall, our study suggests that the consequences of performance-based contracting for professionalism are ambiguous. More specifically, using strict time registration rules is related to lower levels of autonomy, whereas using cost-efficiency measures does not seem to affect autonomy (H1). Performance-based contracting has no consequences for the level of fulfilment home-care workers find in their job, as neither of the two contracting dimensions measured was directly or indirectly related to intrinsic job satisfaction (H1, H2). The role of managers must be taken into account when studying performance-based contracting, because perceived higher management support is related to managers' less frequent use of both strict time registration rules and of cost-efficiency measures (H3). The insight we gained into the importance of supportive managers for both autonomy and job satisfaction (H4) can help home-care organisations improve the attractiveness of home-care work. © 2015 John Wiley & Sons Ltd.

Analysis of Online DBA Algorithm with Adaptive Sleep Cycle in WDM EPON

NASA Astrophysics Data System (ADS)

Pajčin, Bojan; Matavulj, Petar; Radivojević, Mirjana

2018-05-01

In order to manage Quality of Service (QoS) and energy efficiency in the optical access network, an online Dynamic Bandwidth Allocation (DBA) algorithm with adaptive sleep cycle is presented. This DBA algorithm has the ability to allocate an additional bandwidth to the end user within a single sleep cycle whose duration changes depending on the current buffers occupancy. The purpose of this DBA algorithm is to tune the duration of the sleep cycle depending on the network load in order to provide service to the end user without violating strict QoS requests in all network operating conditions.

TU-FG-201-10: Quality Management of Accelerated Partial Breast Irradiation (APBI) Plans

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

Ji, H; Lorio, V; Cernica, G

2016-06-15

Purpose: Since 2008, over 700 patients received high dose rate (HDR) APBI treatment at Virginia Hospital Center. The complexity involved in the planning process demonstrated a broad variation between patient geometry across all applicators, in relation to anatomical regions of interest. A quality management program instituting various metrics was implemented in March 2013 with the goal of ensuring an optimal plan is achieved for each patient. Methods: For each plan, an in-house complexity index, geometric conformity index, and plan quality index were defined. These indices were obtained for all patients treated. For patients treated after the implementation, the conformity indexmore » and quality index were maximized while other dosimetric limits, such as maximum skin and rib doses, were strictly kept. Subsequently, all evaluation parameters and applicator information were placed in a database for cross-evaluation with similar complexity. Results: Both the conformity and quality indices show good correlation with the complexity index. They decrease as complexity increases for all applicators. Multi lumen type balloon applicators demonstrate a minimal advantage over single lumen applicators in increasingly complex patient geometries, as compared to SAVI applicators which showed considerably greater advantage in these circumstances. After the implementation of the in-house planning protocol, there is a direct improvement of quality for SAVI plans. Conclusion: Due to their interstitial nature, SAVI devices show a better conformity in comparison to balloon-based devices regardless of the number of lumens, especially in complex cases. The quality management program focuses on optimizing indices by utilizing prior planning knowledge based on complexity levels. The database of indices assists in decision making and has subsequently aided in balancing the experience level among planners. This approach has made APBI planning more robust for patient care, with a measurable improvement in the plan quality.« less

Operation of International Monitoring System Network

NASA Astrophysics Data System (ADS)

Nikolova, Svetlana; Araujo, Fernando; Aktas, Kadircan; Malakhova, Marina; Otsuka, Riyo; Han, Dongmei; Assef, Thierry; Nava, Elisabetta; Mickevicius, Sigitas; Agrebi, Abdelouaheb

2015-04-01

The IMS is a globally distributed network of monitoring facilities using sensors from four technologies: seismic, hydroacoustic, infrasound and radionuclide. It is designed to detect the seismic and acoustic waves produced by nuclear test explosions and the subsequently released radioactive isotopes. Monitoring stations transmit their data to the IDC in Vienna, Austria, over a global private network known as the GCI. Since 2013, the data availability (DA) requirements for IMS stations account for quality of the data, meaning that in calculation of data availability data should be exclude if: - there is no input from sensor (SHI technology); - the signal consists of constant values (SHI technology); Even more strict are requirements for the DA of the radionuclide (particulate and noble gas) stations - received data have to be analyzed, reviewed and categorized by IDC analysts. In order to satisfy the strict data and network availability requirements of the IMS Network, the operation of the facilities and the GCI are managed by IDC Operations. Operations has following main functions: - to ensure proper operation and functioning of the stations; - to ensure proper operation and functioning of the GCI; - to ensure efficient management of the stations in IDC; - to provide network oversight and incident management. At the core of the IMS Network operations are a series of tools for: monitoring the stations' state of health and data quality, troubleshooting incidents, communicating with internal and external stakeholders, and reporting. The new requirements for data availability increased the importance of the raw data quality monitoring. This task is addressed by development of additional tools for easy and fast identifying problems in data acquisition, regular activities to check compliance of the station parameters with acquired data by scheduled calibration of the seismic network, review of the samples by certified radionuclide laboratories. The DA for the networks of different technologies in 2014 is: Primary seismic (PS) network - 95.70%, Infrasound network (IS) - 97.68%, Hydroacoustic network (HA) - 88.78%, Auxiliary Seismic - 86.07%; Radionuclide Particulate - 83.01% and Radionuclide Noble Gas -75.06%. IDC's strategy for further improving operations and management of the stations and meeting DA requirements is: - further development of tools and procedures to effectively identify and support troubleshooting of problems by the Station Operators; - effective support to the station operators to develop tailored Operation and Maintenance plans for their stations; - focus on early identification of the raw data quality problems at the station in order to support timely resolution; - extensive training programme for station operators (joined effort of IDC and IMS).

Clinical study of the Erlanger silver catheter--data management and biometry.

PubMed

Martus, P; Geis, C; Lugauer, S; Böswald, M; Guggenbichler, J P

1999-01-01

The clinical evaluation of venous catheters for catheter-induced infections must conform to a strict biometric methodology. The statistical planning of the study (target population, design, degree of blinding), data management (database design, definition of variables, coding), quality assurance (data inspection at several levels) and the biometric evaluation of the Erlanger silver catheter project are described. The three-step data flow included: 1) primary data from the hospital, 2) relational database, 3) files accessible for statistical evaluation. Two different statistical models were compared: analyzing the first catheter only of a patient in the analysis (independent data) and analyzing several catheters from the same patient (dependent data) by means of the generalized estimating equations (GEE) method. The main result of the study was based on the comparison of both statistical models.

A whole process quality control system for energy measuring instruments inspection based on IOT technology

NASA Astrophysics Data System (ADS)

Yin, Bo; Liu, Li; Wang, Jiahan; Li, Xiran; Liu, Zhenbo; Li, Dewei; Wang, Jun; Liu, Lu; Wu, Jun; Xu, Tingting; Cui, He

2017-10-01

Electric energy measurement as a basic work, an accurate measurements play a vital role for the economic interests of both parties of power supply, the standardized management of the measurement laboratory at all levels is a direct factor that directly affects the fairness of measurement. Currently, the management of metering laboratories generally uses one-dimensional bar code as the recognition object, advances the testing process by manual management, most of the test data requires human input to generate reports. There are many problems and potential risks in this process: Data cannot be saved completely, cannot trace the status of inspection, the inspection process isn't completely controllable and so on. For the provincial metrology center's actual requirements of the whole process management for the performance test of the power measuring appliances, using of large-capacity RF tags as a process management information media, we developed a set of general measurement experiment management system, formulated a standardized full performance test process, improved the raw data recording mode of experimental process, developed a storehouse automatic inventory device, established a strict test sample transfer and storage system, ensured that all the raw data of the inspection can be traced back, achieved full life-cycle control of the sample, significantly improved the quality control level and the effectiveness of inspection work.

State-of-the-art biosimilar erythropoietins in the management of renal anemia: lessons learned from Europe and implications for US nephrologists.

PubMed

Covic, Adrian; Abraham, Ivo

2015-09-01

The European Medicines Agency (EMA), under a strictly regulated pathway, has approved several biosimilar products since 2005, including biosimilar versions of the erythropoiesis-stimulating agent (ESA) epoetin alfa since 2007. Subsequent to these approvals, the use of biosimilar epoetin alfa in the management of renal anemia has grown steadily throughout Europe. With the enactment of the US Biologics Price Competition and Innovation Act of 2009, a US Food and Drug Administration regulatory approval process for biosimilars was legalized. Thus, biosimilar erythropoietin products are expected to be available for prescription in the USA by mid-decade, presumably at a price that is competitive with the originator brand-name reference products. In this paper, we describe the status of originator and biosimilar ESAs, review the clinical development and regulatory approval of biosimilar erythropoietins in Europe, and summarize relevant efficacy and safety information of biosimilar erythropoietins in relation to their reference products to provide a background for US nephrologists as they appraise biosimilar erythropoietins as treatment options for renal anemia. Key lessons learned from Europe are that (a) EMA-approved biosimilar erythropoietins have comparable efficacy and safety profiles to their reference product erythropoietin; (b) pharmacovigilance preapproval and postapproval are critical, especially with regard to immunogenicity and vascular thromboembolic events; (c) strict preapproval and postapproval requirements must guide the regulatory pathway for biosimilars; and (d) high-quality manufacturing and production processes must be established to ensure quality biosimilar products. The availability of biosimilar erythropoietins in the USA will provide nephrologists with alternative effective, and potentially more affordable, treatment options for patients with renal anemia.

Kaizen method for esophagectomy patients: improved quality control, outcomes, and decreased costs.

PubMed

Iannettoni, Mark D; Lynch, William R; Parekh, Kalpaj R; McLaughlin, Kelley A

2011-04-01

The majority of costs associated with esophagectomy are related to the initial 3 days of hospital stay requiring intensive care unit stays, ventilator support, and intraoperative time. Additional costs arise from hospital-based services. The major cost increases are related to complications associated with the procedure. We attempted to define these costs and identify expense management by streamlining care through strict adherence to patient care maps, operative standardization, and rapid discharge planning to reduce variability. Utilizing methods of Kaizen philosophy we evaluated all processes related to the entire experience of esophageal resection. This process has taken over 5 years to achieve, with quality and cost being tracked over this time period. Cost analysis included expenses related to intensive care unit, anesthesia, disposables, and hospital services. Quality improvement measures were related to intraoperative complications, in-hospital complications, and postoperative outcomes. The Institutional Review Board approved the use of anonymous data from standard clinical practice because no additional treatment was planned (observational study). Utilizing a continuous process improvement methodology, a 43% reduction in cost per case has been achieved with a significant increase in contribution margin for esophagectomy. The length of stay has been reduced from 14 days to 5. With intraoperative and postoperative standardization the leak rate has dropped from 12% to less than 3% to no leaks in our current Kaizen modification of care in our last 64 patients. Utilizing lean manufacturing techniques and continuous process evaluation we have attempted to eliminate variability, standardized the phases of care resulting in improved outcomes, decreased length of stay, and improved contribution margins. These Kaizen improvements require continuous interventions, strict adherence to care maps, and input from all levels for quality improvements. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Regulatory Organizations for Physicians’ Status and Administrative Sanctions on Physicians

PubMed Central

MORIOKA, Yasuhiko; HIGUCHI, Norio; KUROYANAGI, Tatsuo; NUDESHIMA, Jiro

2014-01-01

Society bestows professional privilege on physicians. At the same time, it expects physicians to strive constantly to improve their ethics and quality in medical expertise. In every nation, some level of government is responsible for certifying or licensing physicians and imposes strict management, including revoking licenses from inappropriate physicians or providing severe sanctions for misconduct or conduct unbecoming of a physician. In reality, however, it is difficult to reduce the number of inappropriate or indiscreet physicians, and each nation faces its own challenges. We conducted a questionnaire survey of 13 national medical associations, including some major Western countries, regarding the licensing of physicians, the organizations managing their medical practice status, and the data and grounds for administrative sanctioning of physicians. We then examined the circumstances in Japan based on the survey results and pointed out the domestic issues. PMID:25784827

Economics of power plant siting in southeastern New England. Final report

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

Gates, J.M.; Meade, N.F.; Sutinen, J.G.

1974-06-01

The four major topics are discussed, i.e. demand and supply of electrical energy in the SENE region; the economics of expanding supply of and managing demand for electrical energy in SENE; the economics of locating power plants; and the economic implications of fifteen alternative power plant sites. The major sources of demand in the SENE region are Boston and Providence. Fossil fuel expansions in these areas will have to contend with higher fuel prices in the future and strict air quality standards. This will create incentives for fossil fuel facilities in outlying communities and for coastal nuclear plants where adequatemore » cooling water exists. Considerations affecting the choice of sites are: public health and safety; environmental quality and zero emissions; resistance on the part of land owners to sell sites for power plants; and local regulations on transmission lines.« less

Psychotropic drugs in Nepal: perceptions on use and supply chain management.

PubMed

Upadhaya, Nawaraj; Jordans, Mark J D; Gurung, Dristy; Pokhrel, Ruja; Adhikari, Ramesh P; Komproe, Ivan H

2018-01-24

Psychotropic drugs play an important role in the treatment of mental, neurological and substance use disorders. Despite the advancement of the use of psycho-pharmaceuticals in the developed countries, the psychotropic drug production and supply chain management in low- and middle- income countries are still poorly developed. This study aims to explore the perceptions of stakeholders involved in all stages of the psychotropic drug supply chain about the need, quality, availability and effectiveness of psychotropic drugs, as well as barriers to their supply chain management. The study was conducted among 65 respondents from the Kathmandu, Chitwan and Pyuthan districts, grouped into four categories: producers, promoters and distributors (N = 22), policy makers and government actors (N = 8), service providers (N = 21) and service users/family members (N = 14). The respondents reported that psychotropic drugs, despite having side effects, are 1) needed, 2) available in major regional centers and 3) are effective for treating mental health problems. The stigma associated with mental illness, however, forces patients and family members to hide their use of psychotropic drugs. The study found that the process of psychotropic drug supply chain management is similar to other general drugs, with the exceptions of strict pre-approval process, quantity restriction (for production and import), and mandatory record keeping. Despite these regulatory provisions, respondents believed that the misuse of psychotropic drugs is widespread and companies are providing incentives to prescribers and retailers to retain their brand in the market. The production and supply chain management of psychotropic drugs is influenced by the vested interests of pharmaceutical companies, prescribers and pharmacists. In the context of the government of Nepal's policy of integrating mental health into primary health care and increased consumption of psychotropic drugs in Nepal, there is a need for massive education and awareness as well as strict monitoring and supervision to avoid the misuse of psychotropic drugs.

Methods and implementation of a central biosample and data management in a three-centre clinical study.

PubMed

Angelow, Aniela; Schmidt, Matthias; Weitmann, Kerstin; Schwedler, Susanne; Vogt, Hannes; Havemann, Christoph; Hoffmann, Wolfgang

2008-07-01

In our report we describe concept, strategies and implementation of a central biosample and data management (CSDM) system in the three-centre clinical study of the Transregional Collaborative Research Centre "Inflammatory Cardiomyopathy - Molecular Pathogenesis and Therapy" SFB/TR 19, Germany. Following the requirements of high system resource availability, data security, privacy protection and quality assurance, a web-based CSDM was developed based on Java 2 Enterprise Edition using an Oracle database. An efficient and reliable sample documentation system using bar code labelling, a partitioning storage algorithm and an online documentation software was implemented. An online electronic case report form is used to acquire patient-related data. Strict rules for access to the online applications and secure connections are used to account for privacy protection and data security. Challenges for the implementation of the CSDM resided at project, technical and organisational level as well as at staff level.

[The modern principles of management of intermittent claudication].

PubMed

Gamzatov, T H; Svetlikov, A V

2016-01-01

Number of patients with peripheral arterial disease, despite various national public health programs, remains high and has no steady downward trend over the past few decades. Despite recent advances in drug therapy, сonservative approach in the management of peripheral arterial disease is often neglected by vascular surgeons. However, vast majority of patients with intermittent claudication, who receive comprehensive conservative treatment, including risk factor modification, exercise and drug therapy, may get significant improvement in quality of life by partial or complete relief of symptoms related to the disease. Patients strictly adhering to medical recommendations has favorable prognosis and progression of disease to the stage of critical limb ischemia is very unlikely. Noncompliant patients and those who continue smoking in particular, often experience progression of symptoms related to the disease. That may result in the need for surgical intervention aiming to prevent or delay the onset of critical limb ischemia.

[Role and management of cancer clinical database in the application of gastric cancer precision medicine].

PubMed

Li, Yuanfang; Zhou, Zhiwei

2016-02-01

Precision medicine is a new medical concept and medical model, which is based on personalized medicine, rapid progress of genome sequencing technology and cross application of biological information and big data science. Precision medicine improves the diagnosis and treatment of gastric cancer to provide more convenience through more profound analyses of characteristics, pathogenesis and other core issues in gastric cancer. Cancer clinical database is important to promote the development of precision medicine. Therefore, it is necessary to pay close attention to the construction and management of the database. The clinical database of Sun Yat-sen University Cancer Center is composed of medical record database, blood specimen bank, tissue bank and medical imaging database. In order to ensure the good quality of the database, the design and management of the database should follow the strict standard operation procedure(SOP) model. Data sharing is an important way to improve medical research in the era of medical big data. The construction and management of clinical database must also be strengthened and innovated.

Managing Risk to Ensure a Successful Cassini/Huygens Saturn Orbit Insertion (SOI)

NASA Technical Reports Server (NTRS)

Witkowski, Mona M.; Huh, Shin M.; Burt, John B.; Webster, Julie L.

2004-01-01

I. Design: a) S/C designed to be largely single fault tolerant; b) Operate in flight demonstrated envelope, with margin; and c) Strict compliance with requirements & flight rules. II. Test: a) Baseline, fault & stress testing using flight system testbeds (H/W & S/W); b) In-flight checkout & demos to remove first time events. III. Failure Analysis: a) Critical event driven fault tree analysis; b) Risk mitigation & development of contingencies. IV) Residual Risks: a) Accepted pre-launch waivers to Single Point Failures; b) Unavoidable risks (e.g. natural disaster). V) Mission Assurance: a) Strict process for characterization of variances (ISAs, PFRs & Waivers; b) Full time Mission Assurance Manager reports to Program Manager: 1) Independent assessment of compliance with institutional standards; 2) Oversight & risk assessment of ISAs, PFRs & Waivers etc.; and 3) Risk Management Process facilitator.

Meteorological and urban landscape factors on severe air pollution in Beijing.

PubMed

Han, Lijian; Zhou, Weiqi; Li, Weifeng; Meshesha, Derege T; Li, Li; Zheng, Mingqing

2015-07-01

Air pollution gained special attention with the rapid development in Beijing. In January 2013, Beijing experienced extreme air pollution, which was not well examined. We thus examine the magnitude of air quality in the particular month by applying the air quality index (AQI), which is based on the newly upgraded Chinese environmental standard. Our finding revealed that (1) air quality has distinct spatial heterogeneity and relatively better air quality was observed in the northwest while worse quality happened in the southeast part of the city; (2) the wind speed is the main determinant of air quality in the city-when wind speed is greater than 4 m/sec, air quality can be significantly improved; and (3) urban impervious surface makes a contribution to the severity of air pollution-that is, with an increase in the fraction of impervious surface in a given area, air pollution is more severe. The results from our study demonstrated the severe pollution in Beijing and its meteorological and landscape factors. Also, the results of this work suggest that very strict air quality management should be conducted when wind speed less than 4 m/sec, especially at places with a large fraction of urban impervious surface. Prevention of air pollution is rare among methods with controls on meteorological and urban landscape conditions. We present research that utilizes the latest air quality index (AQI) to compare air pollution with meteorological and landscape conditions. We found that wind is the major meteorological factor that determines the air quality. For a given wind speed greater than 4 m/sec, the air quality improved significantly. Urban impervious surface also contributes to the severe air pollution: that is, when the fraction of impervious surface increases, there is more severe air pollution. These results suggest that air quality management should be conducted when wind speed is less than 4 m/sec, especially at places with a larger fraction of urban impervious surface.

Controlling inpatient psychiatric utilization through managed care.

PubMed

Wickizer, T M; Lessler, D; Travis, K M

1996-03-01

There is little current understanding of how managed care strategies affect hospital inpatient psychiatric care for mentally ill patients. This study examined one prominent form of managed care, utilization management, which reviews requests for psychiatric care and authorizes provision of care deemed appropriate and clinically necessary. The authors analyzed data on 2,265 utilization management reviews conducted during 1989-1992 for patients insured by a single large commercial insurance company. Three utilization management procedures were examined: preadmission review, continued-stay review, and case management. The performance indicators analyzed included percent of admission requests granted, number of days requested and approved, and number of treatment extensions granted. Utilization management initially approved inpatient psychiatric treatment for nearly all (98.8%) of the patients but authorized, on average, only one-third of the days requested (6.9 versus 19.0). On average, 23.5 (total) days of care were requested and 16.8 days were approved. Care for patients with alcohol or drug dependence diagnoses was more restricted than was care for other patients. These data suggest that managed care does restrict inpatient psychiatric care, primarily by managing length of stay. The fact that almost all patients were approved for the same initial length of stay implies adherence to strict treatment protocols that do not distinguish among different clinical or patient factors. There is a need for careful study of the effects of managed care on outcomes and quality of psychiatric care.

Consensus on the guidelines for the dietary management of classical galactosemia.

PubMed

Kerckhove, Kristel Vande; Diels, Marianne; Vanhaesebrouck, Sigrid; Luyten, Karin; Pyck, Nancy; De Meyer, An; Van Driessche, Marleen; Robert, Martine; Corthouts, Karen; Caris, Ariane; Duchateau, Emilie; Dassy, Martine; Bihet, Genevieve

2015-02-01

Worldwide there is scientific discussion about the dietary management of galactosemia. The dietary management is very different in several countries among Europe, the US and Canada. The main points of discussion are related to the fact that i) despite a strict diet some patients still have poor outcomes; ii) there is lack of scientific knowledge about the role of endogenous production of galactose on disease evolution, with or without diet. The aim of the current work was the creation of a Belgian consensus on dietary guidelines for the management of galactosemia. A step-wise approach was used to achieve a consensus, including: a workshop, a Delphi round, discussion groups and a round table of different Belgian experts. The consensus is an agreement between strict guidelines (strict limitation of fruits, vegetables and soybean products/French guidelines) and the more liberal guidelines (comparable with a diet free of lactose/guidelines of UK and the Netherlands). The consensus document consists of different modules, including the medical context, the theoretical background of dietary guidelines and the age-specific practical dietary guidelines. A Belgian consensus on the guidelines for the dietary management of classical galactosemia was developed despite the uncertainties of the efficacy and practical application of these guidelines. The final consensus is based on scientific knowledge and practical agreement among experts. In the future, regular revision of the guidelines is recommended and a uniform European guideline is desirable. Copyright © 2014 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

River pollution caused by natural stone industry

NASA Astrophysics Data System (ADS)

Oktriani, Ani; Darmajanti, Linda; Soesilo, Tri Edhi Budhi

2017-03-01

The natural stone industry is classified as small industry. Current wastewater treatment still causes pollution in the river. This thesis aims to analyze the performance of wastewater treatment in natural stones industry. The data was collected from water quality test (parameters: temperature, pH, DO, and TSS). The wastewater treatment performance was in a slightly higher position compared to the 2nd class quality standards of Government Regulation No. 82/2001. The parameter that exceeded quality standards was the concentration of TSS, which was up to 240.8 mg/l. The high concentration of TSS was affected by the absence of sludge management schedule, which resulted in non-optimal precipitation. Besides that, the design of sedimentation basin was still not adapted with wastewater debit. Referring to the results, this study suggests the government of Cirebon District to provide wastewater treatment development through the village staff. Furthermore, the government also needs to give strict punishment to business owner who does not treat waste correctly and does not have a business license. Moreover, the sale value of sludge as byproduct of wastewater treatment needs to be increased.

INTERIM EPA GUIDANCE FOR GEOSPATIAL-RELATED QUALITY ASSURANCE PROJECT PLANS

EPA Science Inventory

This guidance supplements EPA Guidance for Quality,Assurance Project Plans (EPA QA/G-5), in that the focus here is on collection and use of geospatial rather than other environmental data (e.g., strictly chemical or biological data), including unique aspects of data storage, retr...

The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD) in primary care

PubMed Central

de Lusignan, Simon; Gallagher, Hugh; Chan, Tom; Thomas, Nicki; van Vlymen, Jeremy; Nation, Michael; Jain, Neerja; Tahir, Aumran; du Bois, Elizabeth; Crinson, Iain; Hague, Nigel; Reid, Fiona; Harris, Kevin

2009-01-01

Background Chronic kidney disease (CKD) is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP) control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression Design Cluster randomised controlled trial (CRT) Methods This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices) powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small group of practices (n = 4) will take part in an in-depth process evaluation. We will use time series data to examine the natural history of CKD in the community. Finally, we will conduct an economic evaluation based on a comparison of the cost effectiveness of each intervention. Clinical Trials Registration ISRCTN56023731. ClinicalTrials.gov identifier. PMID:19602233

Quality of Liver and Kidney Function Tests among Public Medical Laboratories in Western Region of Amhara National Regional State of Ethiopia.

PubMed

Teka, Abaynesh; Kibatu, Girma

2012-03-01

Medical laboratories play essential roles in measurements of substances in body fluids for the purpose of diagnosis, treatment, prevention, and for greater understanding of the disease process. Thus, data generated from have to be reliable for which strict quality control, management and assurance are maintained. The aim of this study is to assess the accuracy and precision of clinical chemistry laboratories in western region of Amhara national regional state of Ethiopia in testing liver and kidney functions. Eight laboratories in hospitals and a Regional Health Research Laboratory Center participated in this study from February to March, 2011. Each participant was requested to measure six specimens for six chemistry tests from two control samples. Three hundred twenty four test results to be reported from all participant laboratories, if all measurements can be made, were designed to be collected and statistically evaluated. None of the study subject laboratories could deliver all the six tests for estimation of both liver and renal functions simultaneously during the study period. Only 213 values from the expected 324 values were reported and about 65 % of the 213 values reported fell outside of the allowable limits of errors for the chemistry tests of the control specimen used. This study finding showed that there were lack of accuracy and precision in chemistry measurements. A regular survey on medical laboratories should be conducted questioning the accuracy and precision of their analyses in order to sustain improvements in the quality of services provided by participating laboratories for the benefit of patients. Laboratory Quality Management Systems appreciate the need for regular quality control and quality assessment schemes in medical laboratories.

Going beyond "two-getherness": Nurse managers' experiences of working together in a leadership model where more than two share the same chair.

PubMed

Döös, Marianne; Vinell, Helene; von Knorring, Mia

2017-12-01

To explore nurse manager experiences of working in leadership constellations where more than two managers share leadership, and to compare this multilateral sharing form to what is known about experiences of working in joint leadership in pairs. A qualitative design based on semi-structured interviews with nurse managers in two multilaterally shared leadership constellations at two intensive care units at an emergency hospital in Sweden. Data were analysed using a thematic and comparative approach. The comparative analysis identified four aspects that differ decisively from the positive picture in the literature on joint pair leadership: the perception of mandate with reduced decision-making power and reduced access to forums, the way of working with a strict division of tasks and a rotating schedule, a need to cope with the increasing number of internal relations and a feeling of doubt concerning trust. Shared leadership between nurse managers has gone from being a tight collaboration based on a feeling of "two-getherness", to being an organisational solution multilateral in character. In this transformation, a weakening of leadership qualities has occurred. Further research is necessary on how this new organisational solution impacts the nurse managers, their staff and the care provided in healthcare organisations generally. Copyright © 2017 Elsevier Ltd. All rights reserved.

[The strict sense nursing postgraduation in Brazil: advances and perspectives].

PubMed

Scochi, Carmen Gracinda Silvan; Munari, Denize Bouttelet; Gelbcke, Francine Lima; Erdmann, Alacoque Lorenzini; de Gutiérrez, Maria Gaby Rivero; Rodrigues, Rosalina Aparecida Partezani

2013-09-01

Nursing is a specific field of knowledge and social practice that has been consolidated and strengthened as science. In Brazil, it has been developed due to the increase and qualification of strict sense post-graduate programs. This study aims to present a historical review of the strict sense post-graduate nursing courses in Brazil and to reflect on their evolution, progress, challenges and future perspectives. It explores the creation of strict sense post-graduate courses, highlighting the movement to build a culture of academic and professional post-graduation in nursing. The historical path of their consolidation, expansion, conquest of excellence and international visibility over four decades, and the challenges and future perspectives are showed. It is found that the post-graduate programs in the field has contributed to the advancement and consolidation of scientific, technological knowledge and innovation in nursing and health care, having as philosophy the respect for diversity and the free exchange of ideas, the improvement of quality of life and health, and the effectiveness of citizenship.

Comparison of bacterial counts in expressed breast milk following standard or strict infection control regimens in neonatal intensive care units: compliance of mothers does matter.

PubMed

Haiden, N; Pimpel, B; Assadian, O; Binder, C; Kreissl, A; Repa, A; Thanhäuser, M; Roberts, C D; Berger, A

2016-03-01

Bacterial counts in 1466 expressed breast milk (EBM) samples from women following one of two infection control regimens (standard vs strict) were investigated. Overall, 12% of samples yielded Gram-negative bacteria, with no significant differences between the standard [11.9% (94/788)] and strict [12.1% (82/678)] regimens (P = 0.92). Significantly more samples were contaminated when expressed at home (standard regimen home/hospital: 17.9% vs 6.1%; strict regimen home/hospital: 19.6% vs 3.4%; P < 0.001). Bacterial contamination of EBM was not associated with the regimen, but was associated with the location of breast milk expression. Attempts to improve personal hygiene during milk collection seem to be of limited value. Good hygiene of collection and storage equipment is likely to be the most important way to ensure the microbiological quality of EBM. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Lessons Learned during the Development of HumaPen® Memoir™, an Insulin Pen with a Memory Feature

PubMed Central

Breslin, Stuart D.; Ignaut, Debra A.; Boyd, Douglas E.

2010-01-01

Insulin pens are developed to address specific needs of diabetes patients for their pens, such as ease of use, portability, and discreetness. Like many consumer-based products, the development of insulin pens can pose significant challenges to the development team in that they must balance substantial accuracy requirements with aesthetic desires. The HumaPen® Memoir™ team learned valuable lessons throughout the development process that may be worth highlighting. A keen understanding of the unmet needs of the patient population and a skillfully planned product generation map are critical to successful device development. A development team must decide whether to use a Quality Functional Deployment or system engineering-based development plan and, additionally, recognize where proof of concept ends and product development begins to maintain a strict timeline for the project. A proficiency in understanding and managing technical risk is critical to ensure a timely and high-quality product launch to the marketplace. PMID:20513318

The report of Task Group 100 of the AAPM: Application of risk analysis methods to radiation therapy quality management

PubMed Central

Huq, M. Saiful; Fraass, Benedick A.; Dunscombe, Peter B.; Gibbons, John P.; Mundt, Arno J.; Mutic, Sasa; Palta, Jatinder R.; Rath, Frank; Thomadsen, Bruce R.; Williamson, Jeffrey F.; Yorke, Ellen D.

2016-01-01

The increasing complexity of modern radiation therapy planning and delivery challenges traditional prescriptive quality management (QM) methods, such as many of those included in guidelines published by organizations such as the AAPM, ASTRO, ACR, ESTRO, and IAEA. These prescriptive guidelines have traditionally focused on monitoring all aspects of the functional performance of radiotherapy (RT) equipment by comparing parameters against tolerances set at strict but achievable values. Many errors that occur in radiation oncology are not due to failures in devices and software; rather they are failures in workflow and process. A systematic understanding of the likelihood and clinical impact of possible failures throughout a course of radiotherapy is needed to direct limit QM resources efficiently to produce maximum safety and quality of patient care. Task Group 100 of the AAPM has taken a broad view of these issues and has developed a framework for designing QM activities, based on estimates of the probability of identified failures and their clinical outcome through the RT planning and delivery process. The Task Group has chosen a specific radiotherapy process required for “intensity modulated radiation therapy (IMRT)” as a case study. The goal of this work is to apply modern risk-based analysis techniques to this complex RT process in order to demonstrate to the RT community that such techniques may help identify more effective and efficient ways to enhance the safety and quality of our treatment processes. The task group generated by consensus an example quality management program strategy for the IMRT process performed at the institution of one of the authors. This report describes the methodology and nomenclature developed, presents the process maps, FMEAs, fault trees, and QM programs developed, and makes suggestions on how this information could be used in the clinic. The development and implementation of risk-assessment techniques will make radiation therapy safer and more efficient. PMID:27370140

The report of Task Group 100 of the AAPM: Application of risk analysis methods to radiation therapy quality management

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

Huq, M. Saiful, E-mail: HUQS@UPMC.EDU

The increasing complexity of modern radiation therapy planning and delivery challenges traditional prescriptive quality management (QM) methods, such as many of those included in guidelines published by organizations such as the AAPM, ASTRO, ACR, ESTRO, and IAEA. These prescriptive guidelines have traditionally focused on monitoring all aspects of the functional performance of radiotherapy (RT) equipment by comparing parameters against tolerances set at strict but achievable values. Many errors that occur in radiation oncology are not due to failures in devices and software; rather they are failures in workflow and process. A systematic understanding of the likelihood and clinical impact ofmore » possible failures throughout a course of radiotherapy is needed to direct limit QM resources efficiently to produce maximum safety and quality of patient care. Task Group 100 of the AAPM has taken a broad view of these issues and has developed a framework for designing QM activities, based on estimates of the probability of identified failures and their clinical outcome through the RT planning and delivery process. The Task Group has chosen a specific radiotherapy process required for “intensity modulated radiation therapy (IMRT)” as a case study. The goal of this work is to apply modern risk-based analysis techniques to this complex RT process in order to demonstrate to the RT community that such techniques may help identify more effective and efficient ways to enhance the safety and quality of our treatment processes. The task group generated by consensus an example quality management program strategy for the IMRT process performed at the institution of one of the authors. This report describes the methodology and nomenclature developed, presents the process maps, FMEAs, fault trees, and QM programs developed, and makes suggestions on how this information could be used in the clinic. The development and implementation of risk-assessment techniques will make radiation therapy safer and more efficient.« less

The report of Task Group 100 of the AAPM: Application of risk analysis methods to radiation therapy quality management.

PubMed

Huq, M Saiful; Fraass, Benedick A; Dunscombe, Peter B; Gibbons, John P; Ibbott, Geoffrey S; Mundt, Arno J; Mutic, Sasa; Palta, Jatinder R; Rath, Frank; Thomadsen, Bruce R; Williamson, Jeffrey F; Yorke, Ellen D

2016-07-01

The increasing complexity of modern radiation therapy planning and delivery challenges traditional prescriptive quality management (QM) methods, such as many of those included in guidelines published by organizations such as the AAPM, ASTRO, ACR, ESTRO, and IAEA. These prescriptive guidelines have traditionally focused on monitoring all aspects of the functional performance of radiotherapy (RT) equipment by comparing parameters against tolerances set at strict but achievable values. Many errors that occur in radiation oncology are not due to failures in devices and software; rather they are failures in workflow and process. A systematic understanding of the likelihood and clinical impact of possible failures throughout a course of radiotherapy is needed to direct limit QM resources efficiently to produce maximum safety and quality of patient care. Task Group 100 of the AAPM has taken a broad view of these issues and has developed a framework for designing QM activities, based on estimates of the probability of identified failures and their clinical outcome through the RT planning and delivery process. The Task Group has chosen a specific radiotherapy process required for "intensity modulated radiation therapy (IMRT)" as a case study. The goal of this work is to apply modern risk-based analysis techniques to this complex RT process in order to demonstrate to the RT community that such techniques may help identify more effective and efficient ways to enhance the safety and quality of our treatment processes. The task group generated by consensus an example quality management program strategy for the IMRT process performed at the institution of one of the authors. This report describes the methodology and nomenclature developed, presents the process maps, FMEAs, fault trees, and QM programs developed, and makes suggestions on how this information could be used in the clinic. The development and implementation of risk-assessment techniques will make radiation therapy safer and more efficient.

Quality management: reduction of waiting time and efficiency enhancement in an ENT-university outpatients' department

PubMed Central

Helbig, Matthias; Helbig, Silke; Kahla-Witzsch, Heike A; May, Angelika

2009-01-01

Background Public health systems are confronted with constantly rising costs. Furthermore, diagnostic as well as treatment services become more and more specialized. These are the reasons for an interdisciplinary project on the one hand aiming at simplification of planning and scheduling patient appointments, on the other hand at fulfilling all requirements of efficiency and treatment quality. Methods As to understanding procedure and problem solving activities, the responsible project group strictly proceeded with four methodical steps: actual state analysis, analysis of causes, correcting measures, and examination of effectiveness. Various methods of quality management, as for instance opinion polls, data collections, and several procedures of problem identification as well as of solution proposals were applied. All activities were realized according to the requirements of the clinic's ISO 9001:2000 certified quality management system. The development of this project is described step by step from planning phase to inauguration into the daily routine of the clinic and subsequent control of effectiveness. Results Five significant problem fields could be identified. After an analysis of causes the major remedial measures were: installation of a patient telephone hotline, standardization of appointment arrangements for all patients, modification of the appointments book considering the reason for coming in planning defined working periods for certain symptoms and treatments, improvement of telephonic counselling, and transition to flexible time planning by daily updates of the appointments book. After implementation of these changes into the clinic's routine success could be demonstrated by significantly reduced waiting times and resulting increased patient satisfaction. Conclusion Systematic scrutiny of the existing organizational structures of the outpatients' department of our clinic by means of actual state analysis and analysis of causes revealed the necessity of improvement. According to rules of quality management correcting measures and subsequent examination of effectiveness were performed. These changes resulted in higher satisfaction of patients, referring colleagues and clinic staff the like. Additionally the clinic is able to cope with an increasing demand for appointments in outpatients' departments, and the clinic's human resources are employed more effectively. PMID:19183496

Evaluation of a nurse-led disease management programme for chronic kidney disease: a randomized controlled trial.

PubMed

Wong, Frances Kam Yuet; Chow, Susan Ka Yee; Chan, Tony Moon Fai

2010-03-01

Patients with end stage renal failure require dialysis and strict adherence to treatment plans to sustain life. However, non-adherence is a common and serious problem among patients with chronic kidney disease. There is a scarcity of studies in examining the effects of disease management programmes on patients with chronic kidney disease. This paper examines whether the study group receiving the disease management programme have better improvement than the control group, comparing outcomes at baseline (O1), at 7 weeks at the completion of the programme (O2) and at 13 weeks (O3). This is a randomized controlled trial. The outcome measures were non-adherence in diet, fluid, dialysis and medication, quality of life, satisfaction, symptom control, complication control and health service utilisation. There was no significant difference between the control and study group for the baseline measures, except for sleep. Significant differences (p<0.05) were found between the control and study group at O2 in the outcome measures of diet degree non-adherence, sleep, symptom, staff encouragement, overall health and satisfaction. Sustained effects at O3 were noted in the outcome measures of continuous ambulatory peritoneal dialysis (CAPD) non-adherence degree, sleep, symptom, and effect of kidney disease. Many studies exploring chronic disease management have neglected the group with end stage renal failure and this study fills this gap. This study has employed an innovative model of skill mix using specialist and general nurses and demonstrated patient improvement in diet non-adherence, CAPD non-adherence, aspects of quality of life and satisfaction with care. Redesigning chronic disease management programmes helps to optimize the use of different levels of skills and resources to bring about positive outcomes. Copyright 2009 Elsevier Ltd. All rights reserved.

The Rare Disease Bank of Japan: establishment, current status and future challenges.

PubMed

Tada, Mayako; Hirata, Makoto; Sasaki, Mitsuho; Sakate, Ryuichi; Kohara, Arihiro; Takahashi, Ichiro; Kameoka, Yosuke; Masui, Toru; Matsuyama, Akifumi

2018-04-02

Research on rare diseases cannot be performed without appropriate samples from patients with such diseases. Due to the limited number of such patients, securing biosamples of sufficient quality for extensive research is a challenge and represents an important barrier to the advancement of research on rare diseases. To tackle this problem, the Rare Disease Bank (RDB) was established in 2009 at the National Institute of Biomedical Innovation (NIBIO; currently, the National Institutes of Biomedical Innovation, Health and Nutrition in Japan). Since then, the RDB has focused on three objectives: (1) emphasizing the importance of collecting biosamples from patients with rare diseases, together with appropriate clinical information, from various medical facilities nationwide; (2) maintaining strict high-quality sample management standards; and (3) sharing biosamples with research scientists across Japan for the advancement of research on rare diseases. As of August 2017, the bank has collected 4147 biosamples from patients with rare diseases, including DNA, serum, plasma, and cell samples from various university hospitals and other medical institutions across the country, and provided various research institutions with 13,686 biosample aliquots from 2850 cases. In addition, the management committee has successfully established a bank system that provides high-quality biosamples together with the results of human leukocyte antigen analysis. It is anticipated that the RDB, through the collection and sharing of biosamples with the medical research community, will enhance the understanding, prevention, and treatment of rare diseases in Japan and the world at large.

Introduction [Chapter 1

Treesearch

R. C. Musselman; D. G Fox; A. W. Schoettle; C. M. Regan

1994-01-01

Wilderness ecosystems in the United States are federally mandated and set aside by the Wilderness Act. They are managed to minimize human impact using methods that leave these systems, to the extent possible, in their natural state uninfluenced by manipulation or disruption by humans. Management often involves controlling or minimizing visual impact by enforcing strict...

Improved quality monitoring of multi-center acupuncture clinical trials in China

PubMed Central

2009-01-01

Background In 2007, the Chinese Science Division of the State Administration of Traditional Chinese Medicine(TCM) convened a special conference to discuss quality control for TCM clinical research. Control and assurance standards were established to guarantee the quality of clinical research. This paper provides practical guidelines for implementing strict and reproducible quality control for acupuncture randomized controlled trials (RCTs). Methods A standard quality control program (QCP) was established to monitor the quality of acupuncture trials. Case report forms were designed; qualified investigators, study personnel and data management personnel were trained. Monitors, who were directly appointed by the project leader, completed the quality control programs. They guaranteed data accuracy and prevented or detected protocol violations. Clinical centers and clinicians were audited, the randomization system of the centers was inspected, and the treatment processes were audited as well. In addition, the case report forms were reviewed for completeness and internal consistency, the eligibility and validity of the patients in the study was verified, and data was monitored for compliance and accuracy. Results and discussion The monitors complete their reports and submit it to quality assurance and the sponsors. Recommendations and suggestions are made for improving performance. By holding regular meetings to discuss improvements in monitoring standards, the monitors can improve quality and efficiency. Conclusions Supplementing and improving the existed guidelines for quality monitoring will ensure that large multi-centre acupuncture clinical trials will be considered as valid and scientifically stringent as pharmaceutical clinical trials. It will also develop academic excellence and further promote the international recognition of acupuncture. PMID:20035630

The Potato Cryobank at The International Potato Center (Cip): A Model for Long Term Conservation of Clonal Plant Genetic Resources Collections of the Future.

PubMed

Vollmer, R; Villagaray, R; Egusquiza, V; Espirilla, J; García, M; Torres, A; Rojas, E; Panta, A; Barkley, N A; Ellis, D

Cryobanks are a secure, efficient and low cost method for the long-term conservation of plant genetic resources for theoretically centuries or millennia with minimal maintenance. The present manuscript describes CIP's modified protocol for potato cryopreservation, its large-scale application, and the establishment of quality and operational standards, which included a viability reassessment of material entering the cryobank. In 2013, CIP established stricter quality and operational standards under which 1,028 potato accessions were cryopreserved with an improved PVS2-droplet protocol. In 2014 the viability of 114 accessions cryopreserved in 2013 accessions were reassessed. The average recovery rate (full plant recovery after LN exposure) of 1028 cryopreserved Solanum species ranged from 34 to 59%, and 70% of the processed accessions showed a minimum recovery rate of ≥20% and were considered as successfully cryopreserved. CIP has established a new high quality management system for cryobanking. Periodic viability reassessment, strict and clear recovery criteria and the monitoring of the percent of successful accessions meeting the criteria as well as contamination rates are metrics that need to be considered in cryobanks.

Three Myths About Dietary Supplements … and How Knowing the Right Answers Is Good for Your Integrative Medicine Practice.

PubMed

Israelsen, Loren; Lampe, Frank

2016-06-01

The use of safe and beneficial dietary supplements remains an important part of your patients' healthy lifestyle-and supplements are likely an important part of your integrative medicine practice. Although issues surrounding potency, ingredient identification, adulteration, and the enforcement of existing laws are legitimate concerns for medical professionals and consumers, the responsible industry is actively working to raise quality standards for its products through a number of self-regulatory measures. These include education about and adoption of additional quality assurance initiatives, such as GMPs for botanical ingredients; better supply-chain management; adoption of improved identification and testing methodologies; an industry-wide product registry; the use of accredited third-party certifications and seals; and initiatives to promote widespread membership in the industry's trade associations, which is a reliable indicator of a company's support of and adherence to strict quality guidelines. Also, industry support of appropriate enforcement actions against problem players and products from the US Food and Drug Administration (FDA), the Federal Trade Commission (FTC), and states' attorneys general continues in an effort to rid the market of unsafe and mislabeled products.

Three Myths About Dietary Supplements … and How Knowing the Right Answers Is Good for Your Integrative Medicine Practice

PubMed Central

Israelsen, Loren; Lampe, Frank

2016-01-01

The use of safe and beneficial dietary supplements remains an important part of your patients’ healthy lifestyle—and supplements are likely an important part of your integrative medicine practice. Although issues surrounding potency, ingredient identification, adulteration, and the enforcement of existing laws are legitimate concerns for medical professionals and consumers, the responsible industry is actively working to raise quality standards for its products through a number of self-regulatory measures. These include education about and adoption of additional quality assurance initiatives, such as GMPs for botanical ingredients; better supply-chain management; adoption of improved identification and testing methodologies; an industry-wide product registry; the use of accredited third-party certifications and seals; and initiatives to promote widespread membership in the industry’s trade associations, which is a reliable indicator of a company’s support of and adherence to strict quality guidelines. Also, industry support of appropriate enforcement actions against problem players and products from the US Food and Drug Administration (FDA), the Federal Trade Commission (FTC), and states’ attorneys general continues in an effort to rid the market of unsafe and mislabeled products. PMID:27547162

Using Collaborative Modeling to Inform Policy Decisions in the Bow River Basin

NASA Astrophysics Data System (ADS)

Sheer, A. S.; Sheer, D. P.; Hill, D.

2011-12-01

The Bow River in Alberta, Canada serves a wide range of municipal, agricultural, recreational, and industrial purposes in the province. In 2006, the basin was deemed over-allocation and closed to new licenses. The Calgary region, however, continues to expand. In the next 60 to 70 years, population levels are expected to reach 2.8 million (more than double the current 1.2 million) with 800,000 new jobs. This increasing pressure led several stakeholders to work together in the development of a new management model to improve the management of the system as an integrated watershed. The major previous model of the system allowed only limited flexibility in management, focusing instead on strict license based operations. Over a 6 month period, with numerous multi-party meetings, the group developed the Bow River Operations Model (BROM). Based in OASIS software, this model integrated input from the major water users in the region to emulate the real-life decisions that are actually made on a daily bases, even when technically in violation of the strict license agreements (e.x. junior licensees receiving water despite senior priority due to exceedingly low volume requirements). Using historical records as forecasts, and performance measures developed with the best available science through expert opinion, participants jointly developed a new reservoir operation strategy. Even with such a short timeframe, the BROM exercise showed that there was substantial room for improvement. Utilizing a "Water Bank" of purchased storage, downstream flows could be significantly improved without affecting quality. Additional benefits included fishery improvement, new recreation opportunities, dissolved oxygen improvement during critical periods, and the ability to accommodate long-term demand forecasts for surrounding municipalities. This strategy has been presented to, and favorably received by, the Alberta Minister of Environment for guidance during negotiations with the local hydropower utility. Work continues on implementation and new areas of the basin are being considered for similar processes.

Towards health impact assessment of drinking-water privatization--the example of waterborne carcinogens in North Rhine-Westphalia (Germany).

PubMed Central

Fehr, Rainer; Mekel, Odile; Lacombe, Martin; Wolf, Ulrike

2003-01-01

Worldwide there is a tendency towards deregulation in many policy sectors - this, for example, includes liberalization and privatization of drinking-water management. However, concerns about the negative impacts this might have on human health call for prospective health impact assessment (HIA) on the management of drinking-water. On the basis of an established generic 10-step HIA procedure and on risk assessment methodology, this paper aims to produce quantitative estimates concerning health effects from increased exposure to carcinogens in drinking-water. Using data from North Rhine-Westphalia in Germany, probabilistic estimates of excess lifetime cancer risk, as well as estimates of additional cases of cancer from increased carcinogen exposure levels are presented. The results show how exposure to contaminants that are strictly within current limits could increase cancer risks and case-loads substantially. On the basis of the current analysis, we suggest that with uniform increases in pollutant levels, a single chemical (arsenic) is responsible for a large fraction of expected additional risk. The study also illustrates the uncertainty involved in predicting the health impacts of changes in water quality. Future analysis should include additional carcinogens, non-cancer risks including those due to microbial contamination, and the impacts of system failures and of illegal action, which may be increasingly likely to occur under changed management arrangements. If, in spite of concerns, water is privatized, it is particularly important to provide adequate surveillance of water quality. PMID:12894324

Why India should become a global leader in high-quality, affordable TB diagnostics

PubMed Central

Small, Peter

2012-01-01

The scale up of DOTS in India is one of the greatest public health accomplishments, and yet undiagnosed and poorly managed TB continues to fuel the epidemic such that India continues to have the highest number of TB cases in the world. Recognizing these challenges, the Government of India has set an ambitious goal of providing universal access to quality diagnosis and treatment for all TB patients in the country. Innovative tools and delivery systems in both the public and private sectors are essential for reaching this goal. Fortunately, India has the potential to solve its TB problem with “home-grown” solutions. Just as Indian pharmaceutical companies revolutionized access to high-quality, affordable AIDS drugs through generic production, Indian diagnostic companies could also become the world's hub for high-quality generic diagnostics. In the long term, India has the potential to lead the world in developing innovative TB diagnostics. For this to happen, Indian industry must move from the import and imitation approach to genuine innovation in both product development as well as delivery. This must be supported by permissive policies and enhanced funding by the Indian government and the private sector. Strict regulation of diagnostics, increased attention to quality assurance in laboratories, and greater engagement of the private health care providers are also needed to effectively deliver innovative products and approaches. PMID:22771602

Albuquerque constructed wetlands pilot project: Summary and status of City of Albuquerque project, September 1995

Treesearch

Steven Glass; Joan Thullen; Jim Sartoris; Rick Roline

1996-01-01

The Pueblo of Isleta, located five miles downstream from Albuquerque, and the NM Water Quality Control Commission has established strict water quality standards for the Rio Grande, and it has become necessary for the Albuquerque Public Works Department to pursue methods to enhance the purity of treated municipal wastewater effluent produced at the Southside Water...

Maternal management behaviors for young children with type 1 diabetes.

PubMed

Sullivan-Bolyai, Susan; Knafl, Kathleen; Deatrick, Janet; Grey, Margaret

2003-01-01

To describe the process that mothers raising young (0-4 years old) children who are newly diagnosed with type 1 diabetes move through to attain the necessary skills to care for their children. A mixed methods design was used, including qualitative interviews with 28 mothers of young children with type 1 diabetes. Principles of naturalistic inquiry were used to guide the data collection process, management, and analysis of the qualitative findings. The process paralleled two of three management approaches and associated behaviors previously described by Gallo and Knafl. Strict adherence behaviors included rigidly following the team recommendations and avoiding strange environments outside the home. Flexible adherence behaviors strove to bring spontaneity back into family life. Selective adherence was not used by this population. Nurses working with these mothers can provide information and support to help them transition from using strict adherence to the more user-friendly flexible adherence, while avoiding the pitfalls of the possibly harmful third approach of selective adherence. Nurses need to remember to praise the parents' efforts at managing their children's diabetes, for our acknowledgment of their work is empowering and affirming.

Mail-order pharmacy experience of veterans living with AIDS/HIV.

PubMed

Desai, Karishma Rohanraj; Chewning, Betty; Wilcox, Andrew; Safdar, Nasia

2018-02-01

The VA system is the largest single provider of healthcare in the United States and to individuals infected with HIV specifically. High quality medication management is particularly important since HIV is a chronic infectious condition which requires taking multiple medications with strict requirements for adherence to medication regimens. Veterans Administration (VA) patients are required to obtain all chronic medications using the VA mail-order pharmacy system. Drawing on Donabedian's Quality Improvement framework, this study sought to examine experiences that Veterans with HIV have with the Veterans Administration medication mail-order system, and to explore opportunities for quality improvement. A sequential, explanatory mixed-methods design was used to interview Veterans receiving care at a Midwestern Veterans Administration Hospital using a mail-order experience survey followed by in-depth interviews. All 57 Veterans, out of 72, who were successfully contacted consented to participate. Overall, Veterans evaluated the mail-order service positively and valued the accuracy (correct medication delivery). However, a notable problem emerged with respect to assuring access to HIV medications with about half (47%) indicating running out of HIV medication. Respondents identified structural issues with respect to days covered by mailed medications (90 versus current 30 days) and process issues with scheduling new refills. Veterans also indicated the information sheets were too long, complex and not helpful for their queries. Patients were open to pharmacists playing an active role during clinic visits and felt this would help manage their conditions better. Veterans generally reported that the VA Mail-order service was of high quality. However, some findings indicate there are opportunities to improve this service to be more patient-centered particularly for vulnerable HIV patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Water Quality Projects Summary for the Mid-Columbia and Cumberland River Systems

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

Stewart, Kevin M.; Witt, Adam M.; Hadjerioua, Boualem

Scheduling and operational control of hydropower systems is accompanied with a keen awareness of the management of water use, environmental effects, and policy, especially within the context of strict water rights policy and generation maximization. This is a multi-objective problem for many hydropower systems, including the Cumberland and Mid-Columbia river systems. Though each of these two systems have distinct operational philosophies, hydrologic characteristics, and system dynamics, they both share a responsibility to effectively manage hydropower and the environment, which requires state-of-the art improvements in the approaches and applications for water quality modeling. The Department of Energy and Oak Ridge Nationalmore » Laboratory have developed tools for total dissolved gas (TDG) prediction on the Mid-Columbia River and a decision-support system used for hydropower generation and environmental optimization on the Cumberland River. In conjunction with IIHR - Hydroscience & Engineering, The University of Iowa and University of Colorado s Center for Advanced Decision Support for Water and Environmental Systems (CADSWES), ORNL has managed the development of a TDG predictive methodology at seven dams along the Mid-Columbia River and has enabled the ability to utilize this methodology for optimization of operations at these projects with the commercially available software package Riverware. ORNL has also managed the collaboration with Vanderbilt University and Lipscomb University to develop a state-of-the art method for reducing high-fidelity water quality modeling results into surrogate models which can be used effectively within the context of optimization efforts to maximize generation for a reservoir system based on environmental and policy constraints. The novel contribution of these efforts is the ability to predict water quality conditions with simplified methodologies at the same level of accuracy as more complex and resource intensive computing methods. These efforts were designed to incorporate well into existing hydropower and reservoir system scheduling models, with runtimes that are comparable to existing software tools. In addition, the transferability of these tools to assess other systems is enhanced due the use of simplistic and easily attainable values for inputs, straight-forward calibration of predictive equation coefficients, and standardized comparison of traditionally familiar outputs.« less

A cyber infrastructure for the SKA Telescope Manager

NASA Astrophysics Data System (ADS)

Barbosa, Domingos; Barraca, João. P.; Carvalho, Bruno; Maia, Dalmiro; Gupta, Yashwant; Natarajan, Swaminathan; Le Roux, Gerhard; Swart, Paul

2016-07-01

The Square Kilometre Array Telescope Manager (SKA TM) will be responsible for assisting the SKA Operations and Observation Management, carrying out System diagnosis and collecting Monitoring and Control data from the SKA subsystems and components. To provide adequate compute resources, scalability, operation continuity and high availability, as well as strict Quality of Service, the TM cyber-infrastructure (embodied in the Local Infrastructure - LINFRA) consists of COTS hardware and infrastructural software (for example: server monitoring software, host operating system, virtualization software, device firmware), providing a specially tailored Infrastructure as a Service (IaaS) and Platform as a Service (PaaS) solution. The TM infrastructure provides services in the form of computational power, software defined networking, power, storage abstractions, and high level, state of the art IaaS and PaaS management interfaces. This cyber platform will be tailored to each of the two SKA Phase 1 telescopes (SKA_MID in South Africa and SKA_LOW in Australia) instances, each presenting different computational and storage infrastructures and conditioned by location. This cyber platform will provide a compute model enabling TM to manage the deployment and execution of its multiple components (observation scheduler, proposal submission tools, MandC components, Forensic tools and several Databases, etc). In this sense, the TM LINFRA is primarily focused towards the provision of isolated instances, mostly resorting to virtualization technologies, while defaulting to bare hardware if specifically required due to performance, security, availability, or other requirement.

Burnout and quality of life among orthopaedic trainees in a modern educational programme: importance of the learning climate.

PubMed

van Vendeloo, S N; Brand, P L P; Verheyen, C C P M

2014-08-01

We aimed to determine quality of life and burnout among Dutch orthopaedic trainees following a modern orthopaedic curriculum, with strict compliance to a 48-hour working week. We also evaluated the effect of the clinical climate of learning on their emotional well-being. We assessed burnout, quality of life and the clinical climate of learning in 105 orthopaedic trainees using the Maslach Burnout Inventory, linear analogue scale self-assessments, and Dutch Residency Educational Climate Test (D-RECT), respectively. A total of 19 trainees (18%) had poor quality of life and 49 (47%) were dissatisfied with the balance between their personal and professional life. Some symptoms of burnout were found in 29 trainees (28%). Higher D-RECT scores (indicating a better climate of learning) were associated with a better quality of life (r = 0.31, p = 0.001), more work-life balance satisfaction (r = 0.31, p = 0.002), fewer symptoms of emotional exhaustion (r = -0.21, p = 0.028) and depersonalisation (r = -0,28, p = 0.04). A reduced quality of life with evidence of burnout were still seen in a significant proportion of orthopaedic trainees despite following a modern curriculum with strict compliance to a 48-hour working week. It is vital that further work is undertaken to improve the quality of life and reduce burnout in this cohort. ©2014 The British Editorial Society of Bone & Joint Surgery.

Reference architecture of application services for personal wellbeing information management.

PubMed

Tuomainen, Mika; Mykkänen, Juha

2011-01-01

Personal information management has been proposed as an important enabler for individual empowerment concerning citizens' wellbeing and health information. In the MyWellbeing project in Finland, a strictly citizen-driven concept of "Coper" and related architectural and functional guidelines have been specified. We present a reference architecture and a set of identified application services to support personal wellbeing information management. In addition, the related standards and developments are discussed.

Tree injury and mortality in fires: developing process-based models

Treesearch

Bret W. Butler; Matthew B. Dickinson

2010-01-01

Wildland fire managers are often required to predict tree injury and mortality when planning a prescribed burn or when considering wildfire management options; and, currently, statistical models based on post-fire observations are the only tools available for this purpose. Implicit in the derivation of statistical models is the assumption that they are strictly...

Classroom Management Strategies of Highly Effective Teachers in Diverse Middle Schools: Be Strict and Calm, Not Mean

ERIC Educational Resources Information Center

McGregor, Katheryne L.

2012-01-01

This qualitative research study investigated and identified the classroom management strategies of 12 highly effective middle school teachers who served diverse student populations at two different school sites. In addition, this research explored the beliefs and experiences of 305 diverse middle school students regarding their experiences with…

California's Ozone-Reduction Strategy for Light Duty Vehicles - An Economic Assessment

DOT National Transportation Integrated Search

1996-01-01

California has adopted an aggressive plan to bring the state into compliance with national ambient air quality standards. California's strategy includes strict emission standards on mobile and stationary sourcs and on area sources such as solvents, p...

Herd management and social variables associated with bulk tank somatic cell count in dairy herds in the eastern United States.

PubMed

Schewe, R L; Kayitsinga, J; Contreras, G A; Odom, C; Coats, W A; Durst, P; Hovingh, E P; Martinez, R O; Mobley, R; Moore, S; Erskine, R J

2015-11-01

The ability to reduce somatic cell counts (SCC) and improve milk quality depends on the effective and consistent application of established mastitis control practices. The US dairy industry continues to rely more on nonfamily labor to perform critical tasks to maintain milk quality. Thus, it is important to understand dairy producer attitudes and beliefs relative to management practices, as well as employee performance, to advance milk quality within the changing structure of the dairy industry. To assess the adoption rate of mastitis control practices in United States dairy herds, as well as assess social variables, including attitudes toward employees relative to mastitis control, a survey was sent to 1,700 dairy farms in Michigan, Pennsylvania, and Florida in January and February of 2013. The survey included questions related to 7 major areas: sociodemographics and farm characteristics, milking proficiency, milking systems, cow environment, infected cow monitoring and treatment, farm labor, and attitudes toward mastitis and related antimicrobial use. The overall response rate was 41% (21% in Florida, 39% in Michigan, and 45% in Pennsylvania). Herd size ranged from 9 to 5,800 cows. Self-reported 3-mo geometric mean bulk tank SCC (BTSCC) for all states was 194,000 cells/mL. Multivariate analysis determined that proven mastitis control practices such as the use of internal teat sealants and blanket dry cow therapy, and not using water during udder preparation before milking, were associated with lower BTSCC. Additionally, farmer and manager beliefs and attitudes, including the perception of mastitis problems and the threshold of concern if BTSCC is above 300,000 cells/mL, were associated with BTSCC. Ensuring strict compliance with milking protocols, giving employees a financial or other penalty if BTSCC increased, and a perceived importance of reducing labor costs were negatively associated with BTSCC in farms with nonfamily employees. These findings highlight the need for a comprehensive approach to managing mastitis, one that includes the human dimensions of management to maintain the practice of scientifically validated mastitis control practices. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Ensuring long-term reliability of the data storage on optical disc

NASA Astrophysics Data System (ADS)

Chen, Ken; Pan, Longfa; Xu, Bin; Liu, Wei

2008-12-01

"Quality requirements and handling regulation of archival optical disc for electronic records filing" is released by The State Archives Administration of the People's Republic of China (SAAC) on its network in March 2007. This document established a complete operative managing process for optical disc data storage in archives departments. The quality requirements of the optical disc used in archives departments are stipulated. Quality check of the recorded disc before filing is considered to be necessary and the threshold of the parameter of the qualified filing disc is set down. The handling regulations for the staffs in the archives departments are described. Recommended environment conditions of the disc preservation, recording, accessing and testing are presented. The block error rate of the disc is selected as main monitoring parameter of the lifetime of the filing disc and three classes pre-alarm lines are created for marking of different quality check intervals. The strategy of monitoring the variation of the error rate curve of the filing discs and moving the data to a new disc or a new media when the error rate of the disc reaches the third class pre-alarm line will effectively guarantee the data migration before permanent loss. Only when every step of the procedure is strictly implemented, it is believed that long-term reliability of the data storage on optical disc for archives departments can be effectively ensured.

How strictly do dialysis patients want their advance directives followed?

PubMed

Sehgal, A; Galbraith, A; Chesney, M; Schoenfeld, P; Charles, G; Lo, B

1992-01-01

The Cruzan case and the Patient Self-Determination Act will encourage patients to specify in advance which life-sustaining treatments they would want if they become mentally incompetent. However, strictly following such advance directives may not always be in a patient's best interests. We sought to determine whether patients differ in how strictly they want advance directives followed. Interview study. Seven outpatient chronic dialysis centers. One hundred fifty mentally competent dialysis patients. Using a structured questionnaire, we asked the subjects whether they would want dialysis continued or stopped if they developed advanced Alzheimer's disease. We then asked how much leeway their physician and surrogate should have to override that advance directive if overriding were in their best interests. Subjects granting leeway were also asked what factors should be considered in making decisions for them. Subjects varied greatly in how much leeway they would give surrogates to override their advance directives: "no leeway" (39%), "a little leeway" (19%), "a lot of leeway" (11%), and "complete leeway" (31%). Subjects also varied in how much they wanted various factors considered in making decisions, such as pain or suffering, quality of life, possibility of a new treatment, indignity caused by continued treatment, financial impact of treatment on family members, and religious beliefs. Strictly following all advance directives may not truly reflect patients' preferences. To improve advance directives, we recommend that physicians explicitly ask patients how strictly they want their advance directives followed and what factors they want considered in making decisions.

Environmental protection in Hong Kong amidst transition: Is Hong Kong ready to manage its environment by law?

NASA Astrophysics Data System (ADS)

Wing-Hung Lo, Carlos

1995-05-01

Within the context of political democratization, this article explores environmental protection in Hong Kong since the government lauched a ten-year program to “save the environment” in 1989. Examining environmental management by law from a social-choice perspective, it argues that the government has yet to reach an integrative policy orocess. Hence the preconditions for an integrative set of environmental legislation are absent. Institutionally, without a comprehensive green policy, the current arrangements lack a vision as an integrative force to promote effective coordination among various sectoral environmental coordination among various sectoral environmental programs. The dominant approach of policy and law enforcement through consultation has rendered impossible strict enforcement of environmental rules and regulations as local economic growth enjoys a priority over environmental protection. At a time of environmental awakening, the people of Hong Kong are not yet prepared awakening, the people of Hong Kong are not yet prepared to participate in environmental management in a strict legal manner. The overall observation is that Hong Kong has yet to see more mature political, legal, administrative, and social conditions for managing its environment within a legal framework.

Recognising and Managing Refractory Coeliac Disease: A Tertiary Centre Experience.

PubMed

Nasr, Ikram; Nasr, Iman; Beyers, Carl; Chang, Fuju; Donnelly, Suzanne; Ciclitira, Paul J

2015-12-01

Refractory coeliac disease (RCD) is a rare complication of coeliac disease (CD) and involves malabsorption and villous atrophy despite adherence to a strict gluten-free diet (GFD) for at least 12 months in the absence of another cause. RCD is classified based on the T-cells in the intra-epithelial lymphocyte (IEL) morphology into type 1 with normal IEL and type 2 with aberrant IEL (clonal) by PCR (polymerase chain reaction) for T cell receptors (TCR) at the β/γ loci. RCD type 1 is managed with strict nutritional and pharmacological management. RCD type 2 can be complicated by ulcerative jejunitis or enteropathy associated lymphoma (EATL), the latter having a five-year mortality of 50%. Management options for RCD type 2 and response to treatment differs across centres and there have been debates over the best treatment option. Treatment options that have been used include azathioprine and steroids, methotrexate, cyclosporine, campath (an anti CD-52 monoclonal antibody), and cladribine or fluadribine with or without autologous stem cell transplantation. We present a tertiary centre's experience in the treatment of RCD type 2 where treatment with prednisolone and azathioprine was used, and our results show good response with histological recovery in 56.6% of treated individuals.

Food intake diet and sperm characteristics in a blue zone: a Loma Linda Study.

PubMed

Orzylowska, Eliza M; Jacobson, John D; Bareh, Gihan M; Ko, Edmund Y; Corselli, Johannah U; Chan, Philip J

2016-08-01

The study examined the effect the life-long vegetarian diet on male fertility and focused on vegetarians living in the Loma Linda blue zone, a demographic area known for life longevity. The objective was to compare sperm characteristics of vegetarian with non-vegetarian males. The cross-sectional observational study was based on semen analyses of 474 males from 2009 to 2013. Patients categorized themselves as either life-long lacto-ovo vegetarians (N=26; vegetable diet with dairy and egg products), vegans (N=5; strictly vegetables with no animal products) or non-vegetarians (N=443; no diet restrictions). Sperm quality was assessed using a computer-aided sperm analyzer and strict morphology and chromatin integrity were manually evaluated. Lacto-ovo vegetarians had lower sperm concentration (50.7±7.4M/mL versus non-vegetarians 69.6±3.2M/mL, mean±S.E.M.). Total motility was lower in the lacto-ovo and vegan groups (33.2±3.8% and 51.8±13.4% respectively) versus non-vegetarians (58.2±1.0%). Vegans had lowest hyperactive motility (0.8±0.7% versus lacto-ovo 5.2±1.2 and non-vegetarians 4.8±0.3%). Sperm strict morphologies were similar for the 3 groups. There were no differences in rapid progression and chromatin integrity. The study showed that the vegetables-based food intake decreased sperm quality. In particular, a reduction in sperm quality in male factor patients would be clinically significant and would require review. Furthermore, inadequate sperm hyperactivation in vegans suggested compromised membrane calcium selective channels. However, the study results are cautiously interpreted and more corroborative studies are needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Verification and Implementation of Operations Safety Controls for Flight Missions

NASA Technical Reports Server (NTRS)

Smalls, James R.; Jones, Cheryl L.; Carrier, Alicia S.

2010-01-01

There are several engineering disciplines, such as reliability, supportability, quality assurance, human factors, risk management, safety, etc. Safety is an extremely important engineering specialty within NASA, and the consequence involving a loss of crew is considered a catastrophic event. Safety is not difficult to achieve when properly integrated at the beginning of each space systems project/start of mission planning. The key is to ensure proper handling of safety verification throughout each flight/mission phase. Today, Safety and Mission Assurance (S&MA) operations engineers continue to conduct these flight product reviews across all open flight products. As such, these reviews help ensure that each mission is accomplished with safety requirements along with controls heavily embedded in applicable flight products. Most importantly, the S&MA operations engineers are required to look for important design and operations controls so that safety is strictly adhered to as well as reflected in the final flight product.

A Survey of UML Based Regression Testing

NASA Astrophysics Data System (ADS)

Fahad, Muhammad; Nadeem, Aamer

Regression testing is the process of ensuring software quality by analyzing whether changed parts behave as intended, and unchanged parts are not affected by the modifications. Since it is a costly process, a lot of techniques are proposed in the research literature that suggest testers how to build regression test suite from existing test suite with minimum cost. In this paper, we discuss the advantages and drawbacks of using UML diagrams for regression testing and analyze that UML model helps in identifying changes for regression test selection effectively. We survey the existing UML based regression testing techniques and provide an analysis matrix to give a quick insight into prominent features of the literature work. We discuss the open research issues like managing and reducing the size of regression test suite, prioritization of the test cases that would be helpful during strict schedule and resources that remain to be addressed for UML based regression testing.

[The role of patient flow and surge capacity for in-hospital response in mass casualty events].

PubMed

Sefrin, Peter; Kuhnigk, Herbert

2008-03-01

Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. In hospital casualty surge is depending on resources that have to be expanded with a practicable alarm plan. Thus, in-hospital mass casualty management planning is recommended to be organized by specialized persons. To minimise inhospital patient overflow casualty surge principles have to be implemented in both, pre-hospital and in-hospital disaster planning. World soccer championship 2006 facilitated the initiation of surge and damage control principles in in-hospital disaster planning strategies for German hospitals. The presented concept of strict control of in-hospital patient flow using surge principles minimises the risk of in-hospital breakdown and increases definitive hospital treatment capacity in mass casualty incidents.

Evaluating the accotink creek restoration project for improving water quality, in-stream habitat, and bank stability

USGS Publications Warehouse

Struck, S.D.; Selvakumar, A.; Hyer, K.; O'Connor, T.

2007-01-01

Increased urbanization results in a larger percentage of connected impervious areas and can contribute large quantities of stormwater runoff and significant quantities of debris and pollutants (e.g., litter, oils, microorganisms, sediments, nutrients, organic matter, and heavy metals) to receiving waters. To improve water quality in urban and suburban areas, watershed managers often incorporate best management practices (BMPs) to reduce the quantity of runoff as well as to minimize pollutants and other stressors contained in stormwater runoff. It is well known that land-use practices directly impact urban streams. Stream flows in urbanized watersheds increase in magnitude as a function of impervious area and can result in degradation of the natural stream channel morphology affecting the physical, chemical, and biological integrity of the stream. Stream bank erosion, which also increases with increased stream flows, can lead to bank instability, property loss, infrastructure damage, and increased sediment loading to the stream. Increased sediment loads may lead to water quality degradation downstream and have negative impacts on fish, benthic invertebrates, and other aquatic life. Accotink Creek is in the greater Chesapeake Bay and Potomac watersheds, which have strict sediment criteria. The USEPA (United States Environmental Protection Agency) and USGS (United States Geological Survey) are investigating the effectiveness of stream restoration techniques as a BMP to decrease sediment load and improve bank stability, biological integrity, and in-stream water quality in an impaired urban watershed in Fairfax, Virginia. This multi-year project continuously monitors turbidity, specific conductance, pH, and water temperature, as well as biological and chemical water quality parameters. In addition, physical parameters (e.g., pebble counts, longitudinal and cross sectional stream surveys) were measured to assess geomorphic changes associated with the restoration. Data from the pre-construction and initial post-construction phases are presented in this report. ?? 2007 ASCE.

78 FR 13914 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-01

... customer surveys designed to determine the kinds and quality of services our beneficiaries, claimants... purpose of information collection: Voluntary Customer Surveys in Accordance with E.O. 12862; OMB 3220-0192.... The surveys are limited to data collections that solicit strictly voluntary opinions, and do not...

METHYL BROMIDE ALTERNATIVES FOR VINEYARD REPLANT

USDA-ARS?s Scientific Manuscript database

Soil fumigation with methyl bromide is needed by grape growers in central California to control soilborne pests. However, use of methyl bromide is banned and soil fumigation with other chemicals subjects to strict regulations to protect human health and air quality. The objective was to determine,...

The Evolution of Marketing in Education.

ERIC Educational Resources Information Center

Knight, Brent

1982-01-01

Looks at the progression of educational institutions through the five stages of Kotler's marketing process. Identifies anticipated changes and three activities critical for meeting the marketing challenge: research to predict consumer habits, attitudes, and needs; material and research development changes; and strict quality control and relevance…

Quality Assurance and Quality Control, Part 2.

PubMed

Akers, Michael J

2015-01-01

The tragedy surrounding the New England Compounding Center and contaminated steroid syringe preparations clearly points out what can happen if quality-assurance and quality-control procedures are not strictly practiced in the compounding of sterile preparations. This article is part 2 of a two-part article on requirements to comply with United States Pharmacopeia general chapters <797> and <1163> with respect to quality assurance of compounded sterile preparations. Part 1 covered documentation requirements, inspection procedures, compounding accuracy checks, and part of a discussion on bacterial endotoxin testing. Part 2 covers sterility testing, the completion from part 1 on bacterial endotoxin testing, a brief dicussion of United States Pharmacopeia <1163>, and advances in pharmaceutical quality systems.

Quality Assurance in Biobanking for Pre-Clinical Research

PubMed Central

Simeon-Dubach, Daniel; Zeisberger, Steffen M.; Hoerstrup, Simon P.

2016-01-01

It is estimated that not less than USD 28 billion are spent each year in the USA alone on irreproducible pre-clinical research, which is not only a fundamental loss of investment and resources but also a strong inhibitor of efficiency for upstream processes regarding the translation towards clinical applications and therapies. The issues and cost of irreproducibility has mainly been published on pre-clinical research. In contrast to pre-clinical research, test material is often being transferred into humans in clinical research. To protect treated human subjects and guarantee a defined quality standard in the field of clinical research, the manufacturing and processing infrastructures have to strictly follow and adhere to certain (inter-)national quality standards. It is assumed and suggested by the authors that by an implementation of certain quality standards within the area of pre-clinical research, billions of USD might be saved and the translation phase of promising pre-clinical results towards clinical applications may substantially be improved. In this review, we discuss how an implementation of a quality assurance (QA) management system might positively improve sample quality and sustainability within pre-clinically focused biobank infrastructures. Biobanks are frequently positioned at the very beginning of the biomedical research value chain, and, since almost every research material has been stored in a biobank during the investigated life cycle, biobanking seems to be of substantial importance from this perspective. The role model of a QA-regulated biobank structure can be found in biobanks within the context of clinical research organizations such as in regenerative medicine clusters. PMID:27781023

32 CFR 1800.33 - Allocation of resources; agreed extensions of time.

Code of Federal Regulations, 2010 CFR

2010-07-01

... strictly “first-in, first-out” basis and utilizing two or more processing queues to ensure that smaller as... Coordinator is responsible for management of the NACIC-wide program defined by this part and for establishing...

25 CFR 900.46 - What requirements are imposed upon the Secretary for financial management by these standards?

Code of Federal Regulations, 2013 CFR

2013-04-01

... THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization... the Indian tribe or tribal organization in strict compliance with the self-determination contract and...

25 CFR 900.46 - What requirements are imposed upon the Secretary for financial management by these standards?

Code of Federal Regulations, 2010 CFR

2010-04-01

... THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization... the Indian tribe or tribal organization in strict compliance with the self-determination contract and...

25 CFR 900.46 - What requirements are imposed upon the Secretary for financial management by these standards?

Code of Federal Regulations, 2014 CFR

2014-04-01

... THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization... the Indian tribe or tribal organization in strict compliance with the self-determination contract and...

25 CFR 900.46 - What requirements are imposed upon the Secretary for financial management by these standards?

Code of Federal Regulations, 2011 CFR

2011-04-01

... THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization... the Indian tribe or tribal organization in strict compliance with the self-determination contract and...

25 CFR 900.46 - What requirements are imposed upon the Secretary for financial management by these standards?

Code of Federal Regulations, 2012 CFR

2012-04-01

... THE INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT Standards for Tribal or Tribal Organization... the Indian tribe or tribal organization in strict compliance with the self-determination contract and...

48 CFR 49.201 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

....201 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT TERMINATION OF CONTRACTS Additional Principles for Fixed-Price Contracts Terminated for Convenience 49.201... strict accounting principles, is the heart of a settlement. (b) The primary objective is to negotiate a...

[In vitro studies of factors possibly influencing the performance of latex condoms].

PubMed

Guigon, P; Breton, D; Mendes-Oustric, A C; Pech, A; Clair, P

2005-11-01

Male condoms are undoubtedly the best protection against sexually transmitted diseases. The French Military Health Service buys condoms from civilian manufacturers using a public purchasing process. This process includes strict technical analysis that allows selection of the best supplier. In addition each batch of condoms delivered to French armed forces undergoes quality testing in the laboratory of the Armed Services Central Pharmacy before being distributed to troops. Despite these strict control measures, several isss remain unclear. One issue involves the shelf life of condoms stored in warm humid tropical conditions. Another issue involves the effect of lubricants on condom quality. The purpose of this report is to describe a study designed to gain insight into these two issues. This study was conducted by the Armed Services Central Pharmacy in colaboration with the Procuremnt and Central Establishment Directorate. Findings showed that stage conditions have no negative effects on the intrinsic physico-chemial properties of condoms supplied by two different manufacturers. Conversely use of inadequate lubricants (alimentary or cosmetic compounds) appeared to have extremely deleterious effects on condom quality. Laboratory tests showed that lubricants composed mainly of fatty acids dramatically decreased the effectiveness of condoms.

The Effects of Long Time Conservation of Heavily Grazed Shrubland: A Case Study in the Northern Negev, Israel

NASA Astrophysics Data System (ADS)

Leu, Stefan; Mussery, Amir Mor; Budovsky, Arie

2014-08-01

One of the major reasons for desertification is unrestricted grazing leading to vegetation depletion, soil erosion and degradation, phenomena often considered irreversible in the short term. Here, we compare soil and biological parameters of degraded and conserved, recently rehabilitated arid shrubland in the Northern Negev, Israel. The study area was restored by conservation efforts including a strictly controlled grazing regime initiated in 1992. The visually recognizable improvement in the ecology of the restored shrubland is reflected in significant improvement in all examined biotic (herbaceous biomass, shrub patch density, and insect activity), and soil parameters (nutrients, organic matter content, moisture, and water infiltration). The difference is created predominantly by restoration of large biological patches composed of shrubs and other perennial plants often associated with ant or termite nests, where the most significant increases in productivity and soil quality were observed. In the conserved shrubland such patches covered 35 or 25 % of the area (in a normal and a drought year, respectively). In the degraded shrubland 5 % or less of the area was occupied by such patches that were much smaller and of lower biological complexity. With respect to plant biodiversity, six plant species were found only—and 18 others became significantly more common—in the rehabilitated area. The results of this article indicate that functional arid drylands can be restored within <16 years relying on strict conservation management with reduced grazing intensity.

Quantifying the effect of air quality control measures during the 2010 Commonwealth Games at Delhi, India

NASA Astrophysics Data System (ADS)

Beig, Gufran; Chate, Dilip M.; Ghude, Sachin. D.; Mahajan, A. S.; Srinivas, R.; Ali, K.; Sahu, S. K.; Parkhi, N.; Surendran, D.; Trimbake, H. R.

2013-12-01

In 2010, the XIX Commonwealth Games (CWG-2010) were held in India for the first time at Delhi and involved 71 commonwealth nations and dependencies with more than 6000 athletes participating in 272 events. This was the largest international multi-sport event to be staged in India and strict emission controls were imposed during the games in order to ensure improved air quality for the participating athletes as a significant portion of the population in Delhi is regularly exposed to elevated levels of pollution. The air quality control measures ranged from vehicular and traffic controls to relocation of factories and reduction of power plant emissions. In order to understand the effects of these policy induced control measures, a network of air quality and weather monitoring stations was set-up across different areas in Delhi under the Government of India's System of Air quality Forecasting And Research (SAFAR) project. Simultaneous measurements of aerosols, reactive trace gases (e.g. NOx, O3, CO) and meteorological parameters were made before, during and after CWG-2010. Contrary to expectations, the emission controls implemented were not sufficient to reduce the pollutants, instead in some cases, causing an increase. The measured pollutants regularly exceeded the National Ambient Air Quality limits over the games period. The reasons for this increase are attributed to an underestimation of the required control measures, which resulted in inadequate planning. The results indicate that any future air quality control measures need to be well planned and strictly imposed in order to improve the air quality in Delhi, which affects a large population and is deteriorating rapidly. Thus, the presence of systematic high resolution data and realistic emission inventories through networks such as SAFAR will be directly useful for the future.

Comparison of Educational Inspectors' Role of Program Leadership in the Foundation Period of Republic of Turkey with Today

ERIC Educational Resources Information Center

Usta, Mehmet Emin

2018-01-01

From the very early periods of accepting management as a science, main goal of inspection is seen as a control mechanism. Classical management approach evaluated staff as people who need strict inspections by experts to better perform since they are perceived as unreliable and irresponsible on their duties. Later on, expertise areas related to…

What great managers do.

PubMed

Buckingham, Marcus

2005-03-01

Much has been written about the qualities that make a great manager, but most of the literature overlooks a fundamental question: What does a great manager actually do? While there are countless management styles, one thing underpins the behavior of all great managers. Above all, an exceptional manager comes to know and value the particular quirks and abilities of her employees. She figures out how to capitalize on her staffers' strengths and tweaks her environment to meet her larger goals. Such a specialized approach may seem like a lot of work. But in fact, capitalizing on each person's uniqueness can save time. Rather than encourage employees to conform to strict job descriptions that may include tasks they don't enjoy and aren't good at, a manager who develops positions for his staff members based on their unique abilities will be rewarded with behaviors that are far more efficient and effective than they would be otherwise. This focus on individuals also makes employees more accountable. Because staffers are evaluated on their particular strengths and weaknesses, they are challenged to take responsibility for their abilities and to hone them. Capitalizing on a person's uniqueness also builds a stronger sense of team. By taking the time to understand what makes each employee tick, a great manager shows that he sees his people for who they are. This personal investment not only motivates individuals but also galvanizes the entire team. Finally, this approach shakes up existing hierarchies, which leads to more creative thinking. To take great managing from theory to practice, the author says, you must know three things about a person: her strengths, the triggers that activate those strengths, and how she learns. By asking the right questions, squeezing the right triggers, and becoming aware of your employees' learning styles, you will discover what motivates each person to excel.

Cleft Lip and Cleft Palate

MedlinePlus

... jaw are malformed, breathing becomes difficult. Treatments include surgery and oral appliances. Feeding: Problems with feeding are more common ... 2018 American Academy of Otolaryngology–Head and Neck Surgery. Reproduction or republication strictly prohibited without prior written permission. ... Get Involved Professional Development Practice Management ENT ...

Adapting evidence-based clinical practice guidelines at university teaching hospitals: A model for the Eastern Mediterranean Region.

PubMed

Amer, Yasser S; Wahabi, Hayfaa A; Abou Elkheir, Manal M; Bawazeer, Ghada A; Iqbal, Shaikh M; Titi, Maher A; Ekhzaimy, Aishah; Alswat, Khalid A; Alzeidan, Rasmieh A; Al-Ansary, Lubna A

2018-04-24

Clinical practice guidelines (CPGs) are significant tools for evidence-based health care quality improvement. The CPG program at King Saud University was launched as a quality improvement program to fulfil the international accreditation standards. This program was a collaboration between the Research Chair for Evidence-Based Healthcare and Knowledge Translation and the Quality Management Department. This study aims to develop a fast-track method for adaptation of evidence-based CPGs and describe results of the program. Twenty-two clinical departments participated in the program. Following a CPGs awareness week directed to all health care professionals (HCPs), 22 teams were trained to set priorities, search, screen, assess, select, and customize the best available CPGs. The teams were technically supported by the program's CPG advisors. To address the local health care context, a modified version of the ADAPTE was used where recommendations were either accepted or rejected but not changed. A strict peer-review process for clinical content and methodology was employed. In addition to raising awareness and building capacity, 35 CPGs were approved for implementation by March 2018. These CPGs were integrated with other existing projects such as accreditation, electronic medical records, performance management, and training and education. Preliminary implementation audits suggest a positive impact on patient outcomes. Leadership commitment was a strength, but the high turnover of the team members required frequent and extensive training for HCPs. This model for CPG adaptation represents a quick, practical, economical method with a sense of ownership by staff. Using this modified version can be replicated in other countries to assess its validity. © 2018 John Wiley & Sons, Ltd.

Practical insights into gluten-free diets.

PubMed

See, Jacalyn A; Kaukinen, Katri; Makharia, Govind K; Gibson, Peter R; Murray, Joseph A

2015-10-01

Coeliac disease is a global disease, and the only currently available treatment is a gluten-free diet (GFD). Although conceptually simple, the diet changes are substantial and have a profound effect on a patient's life. Untreated coeliac disease is associated with complications, including excess mortality, most of which can be avoided with a strict GFD. However, there are many barriers, including availability, cost and safety of gluten-free foods, and gluten cross-contamination. The GFD can be restrictive in social situations, leading to poor quality of life and, ultimately, nonadherence. As the number of patients with coeliac disease increases worldwide, clinicians need to be aware of the challenges patients face. Heightened awareness by physicians, dietitians and other providers can help maximize successful treatment, improve outcomes, and reduce health-care costs and disease burden. Routine follow-up is necessary to reinforce the need for a GFD, provide social and emotional support, and achieve mucosal healing, leading to reduced risk of complications. Unfortunately, there is wide variation in follow-up practices. The objective of this Review is to increase awareness of the challenges, management and follow-up of patients with coeliac disease to help them achieve GFD adherence and prevent complications whilst preserving their quality of life.

Meeting Temperature TMDL's Through the Development of an Ecosystem Marketplace Using a Systems Dynamics Approach

NASA Astrophysics Data System (ADS)

Lowry, T. S.; Tidwell, V. C.; Cardwell, H. E.; Ockner, G.; Rea, M. T.; Primozich, D.

2006-12-01

Water managers on the Willamette River in the state of Oregon are facing a new biological opinion and potentially strict TMDL regulations for temperature that will require actions by various stakeholders over the next few decades. Considerable public planning has already been accomplished in the basin with much of the assessment and planning phases for solving the basin's problems codified in a TMDL that was issued in 2006. Various alternatives have been proposed to meet the TMDL requirement, including operational changes at US Army Corps-operated reservoirs, projects that increase stream shading or restore the floodplain or hyporheic zone, and operational or technological changes at point sources such as waste water treatment plants and pulp and paper plants. To help meet the TMDL in a shorter time horizon, a collection of stakeholders formed the Willamette Partnership to develop an ecosystem marketplace where water quality and conservation credits can be traded. The marketplace will develop currencies in temperature and other environmental goods and services, and requires tools to describe linkages between credit trades, water operations, and other management changes (e.g. increases in stream shading) that control water temperature. These tools will link basin hydrology to temperature, water quality, and other concerns using a systems dynamics approach to provide real-time feedback to support conflict negotiation and decision making. Here, we present the development and conceptualization of those tools and their use in evaluating the potential and implementation of the ecosystem marketplace.

Common sense about taste: from mammals to insects.

PubMed

Yarmolinsky, David A; Zuker, Charles S; Ryba, Nicholas J P

2009-10-16

The sense of taste is a specialized chemosensory system dedicated to the evaluation of food and drink. Despite the fact that vertebrates and insects have independently evolved distinct anatomic and molecular pathways for taste sensation, there are clear parallels in the organization and coding logic between the two systems. There is now persuasive evidence that tastant quality is mediated by labeled lines, whereby distinct and strictly segregated populations of taste receptor cells encode each of the taste qualities.

Experimental Evaluation of Textbooks and Multimedia.

ERIC Educational Resources Information Center

Mikk, Jaan

This paper begins by providing an overview of three types of textbook research methods: asking teachers, parents, or students about the different aspects of textbook quality; textbook analysis, i.e. counting some characteristics of a textbook using strictly fixed rules; and the experimental evaluation of textbooks, usually carried out in schools.…

75 FR 15754 - Agency Forms Submitted for OMB Review, Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-30

... (RRB) conducts a number of customer surveys designed to determine the kinds and quality of services our... reporting hours: 9,271. 2. Title and Purpose of Information Collection: Voluntary Customer Surveys in... be improved. The surveys are limited to data collections that solicit strictly voluntary opinions...

75 FR 4594 - Proposed Data Collection(s) Available for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-28

... surveys designed to determine the kinds and quality of services our beneficiaries, claimants, employers... of Information Collection Voluntary Customer Surveys in Accordance with E.O. 12862; OMB 3220-0192 In... surveys are limited to data collections that solicit strictly voluntary opinions, and do not collect...

Vocational Teachers' Identity Formation through Boundary Crossing

ERIC Educational Resources Information Center

Fejes, Andreas; Köpsén, Susanne

2014-01-01

Vocational teachers' prior occupational experiences are construed as those that will guarantee high-quality teaching in vocational education, although individuals are no longer required to have formal teaching qualifications to be employed as teachers in Sweden. This lack of strict requirements raises the issue of the preparedness of vocational…

Does Air Quality Matter? Evidence from the Housing Market.

ERIC Educational Resources Information Center

Chay, Kenneth Y.; Greenstone, Michael

2005-01-01

We exploit the structure of the Clean Air Act to provide new evidence on the capitalization of total suspended particulates (TSPs) air pollution into housing values. This legislation imposes strict regulations on polluters in "nonattainment" counties, which are defined by concentrations of TSPs that exceed a federally set ceiling. TSPs…

Management practices associated with conception rate and service rate of lactating Holstein cows in large, commercial dairy herds.

PubMed

Schefers, J M; Weigel, K A; Rawson, C L; Zwald, N R; Cook, N B

2010-04-01

Data from lactating Holstein cows in herds that participate in a commercial progeny testing program were analyzed to explain management factors associated with herd-average conception and service rates on large commercial dairies. On-farm herd management software was used as the source of data related to production, reproduction, culling, and milk quality for 108 herds. Also, a survey regarding management, facilities, nutrition, and labor was completed on 86 farms. A total of 41 explanatory variables related to management factors and conditions that could affect conception and service rate were considered in this study. Models explaining conception and service rates were developed using a machine learning algorithm for constructing model trees. The most important explanatory variables associated with conception rate were the percentage of repeated inseminations between 4 and 17 d post-artificial insemination, stocking density in the breeding pen, length of the voluntary waiting period, days at pregnancy examination, and somatic cell score. The most important explanatory variables associated with service rate were the number of lactating cows per breeding technician, use of a resynchronization program, utilization of soakers in the holding area during the summer, and bunk space per cow in the breeding pen. The aforementioned models explained 35% and 40% of the observed variation in conception rate and service rate, respectively, and underline the association of herd-level management factors not strictly related to reproduction with herd reproductive performance. Copyright (c) 2010 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Intraepidermal Merkel cell carcinoma: A case series of a rare entity with clinical follow up.

PubMed

Jour, George; Aung, Phyu P; Rozas-Muñoz, Eduardo; Curry, Johnathan L; Prieto, Victor; Ivan, Doina

2017-08-01

Merkel cell carcinoma (MCC) is a rare but aggressive cutaneous carcinoma. MCC typically involves dermis and although epidermotropism has been reported, MCC strictly intraepidermal or in situ (MCCIS) is exceedingly rare. Most of the cases of MCCIS described so far have other associated lesions, such as squamous or basal cell carcinoma, actinic keratosis and so on. Herein, we describe 3 patients with MCC strictly in situ, without a dermal component. Our patients were elderly. 2 of the lesions involved the head and neck area and 1 was on a finger. All tumors were strictly intraepidermal in the diagnostic biopsies, and had histomorphologic features and an immunohistochemical profile supporting the diagnosis of MCC. Excisional biopsies were performed in 2 cases and failed to reveal dermal involvement by MCC or other associated malignancies. Our findings raise the awareness that MCC strictly in situ does exist and it should be included in the differential diagnosis of Paget's or extramammary Paget's disease, pagetoid squamous cell carcinoma, melanoma and other neoplasms that typically show histologically pagetoid extension of neoplastic cells. Considering the limited number of cases reported to date, the diagnosis of isolated MCCIS should not warrant a change in management from the typical MCC. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Producing and marketing a specialty egg.

PubMed

Michella, S M; Slaugh, B T

2000-07-01

Eggland's Best, Inc. markets premium quality shell eggs under the Eggland's Best (EB) brand name. The company, started in 1988, is comprised of a franchise network of established egg producers and covers most of the United States. Eggland's Best provides its franchisees with marketing and technical support. The franchisees produce, process, and distribute EB eggs according to the strict program established and monitored by EB. Production follows the all-natural vegetarian feed program in accordance with the company's US patent entitled "Eggs Compatible with a Cholesterol Reducing Diet and Method of Producing the Same." The EB program excludes animal fat and other animal byproducts. Eggland's Best eggs have seven times the generic level of vitamin E, nearly three times more omega-3 fatty acids and iodine, and 25% less saturated fat than regular generic eggs. Eggland's Best has one of the finest shell egg quality assurance programs anywhere. Eggland's Best franchisees submit weekly egg samples that are analyzed for shell quality, interior quality, vitamin E, iodine, cholesterol and fatty acids. Samples of feed and the EB-patented feed supplement are also analyzed. Approximately 28,000 total laboratory tests are conducted annually. Nationwide product and display retail evaluations are contracted through an outside audit company (40 to 50 cities evaluated four times per year). All EB eggs are USDA graded according to EB's strict quality standards. Producers must follow a food safety quality assurance program (United Egg Producers Association 5-Star or equivalent state or company program). Each egg is stamped "EB" as assurance of meeting EB's highest standards of flavor, quality, and nutrition. Eggland's Best has enjoyed record sales growth for the past 3 yr.

Recognising and Managing Refractory Coeliac Disease: A Tertiary Centre Experience

PubMed Central

Nasr, Ikram; Nasr, Iman; Beyers, Carl; Chang, Fuju; Donnelly, Suzanne; Ciclitira, Paul J.

2015-01-01

Refractory coeliac disease (RCD) is a rare complication of coeliac disease (CD) and involves malabsorption and villous atrophy despite adherence to a strict gluten-free diet (GFD) for at least 12 months in the absence of another cause. RCD is classified based on the T-cells in the intra-epithelial lymphocyte (IEL) morphology into type 1 with normal IEL and type 2 with aberrant IEL (clonal) by PCR (polymerase chain reaction) for T cell receptors (TCR) at the β/γ loci. RCD type 1 is managed with strict nutritional and pharmacological management. RCD type 2 can be complicated by ulcerative jejunitis or enteropathy associated lymphoma (EATL), the latter having a five-year mortality of 50%. Management options for RCD type 2 and response to treatment differs across centres and there have been debates over the best treatment option. Treatment options that have been used include azathioprine and steroids, methotrexate, cyclosporine, campath (an anti CD-52 monoclonal antibody), and cladribine or fluadribine with or without autologous stem cell transplantation. We present a tertiary centre’s experience in the treatment of RCD type 2 where treatment with prednisolone and azathioprine was used, and our results show good response with histological recovery in 56.6% of treated individuals. PMID:26633478

Prevention of neonatal late-onset sepsis: a randomised controlled trial.

PubMed

Alcock, Gary; Liley, Helen G; Cooke, Lucy; Gray, Peter H

2017-04-04

Late-onset sepsis (LOS), defined as sepsis occurring after 48 h of age causes substantial mortality and morbidity in very low birth weight infants. Risk factors for LOS include immaturity, intravascular catheters, mechanical ventilation, and prolonged parenteral nutrition (PN). Little attention has been paid to studying the effects of PN administration methods. The aim of the study was to compare a bundle of measures for PN line management incorporating a strict aseptic technique with standard line management on LOS in very low birth weight infants. Infants <1500 g birth weight who required PN were randomised to either a bundle of a strict aseptic technique for line management together with single use intravascular catheter for PN or a standard technique. The primary outcome was the incidence of LOS in the first 28 days of life. Secondary outcomes were mortality, neonatal morbidities and developmental outcome at 12 months of age. There were 126 infants in the aseptic technique group and 123 in the standard technique group. Forty (31.8%) infants in the aseptic technique group and 36 (29.3%) in the standard technique group had an episode of sepsis (p = 0.77). This corresponds to incidences of 15.8 and 14.2 episodes of sepsis per 1000 patient days respectively. Subgroup analyses for infants <1000 g also revealed no difference in the rate of sepsis between the intervention and control groups. (p = 0.43). There were no significant differences in secondary outcomes and development between the groups. A bundle of measures including strict aseptic technique for parenteral nutrition line management did not result in a reduction in LOS when compared to a standard technique. There is no evidence to recommend this as routine practice. Interdisciplinary Maternal Perinatal Australasian Collaborative Trials (IMPACT) Network, TRN registration number: PT0363. Date: 06/03/2001; Australian New Zealand Clinical Trials Registry (ANZCTR), TRN registration number: ACTRN12617000455369 . Date: 28/03/2017 (retrospectively registered).

Application of Sigma Metrics Analysis for the Assessment and Modification of Quality Control Program in the Clinical Chemistry Laboratory of a Tertiary Care Hospital.

PubMed

Iqbal, Sahar; Mustansar, Tazeen

2017-03-01

Sigma is a metric that quantifies the performance of a process as a rate of Defects-Per-Million opportunities. In clinical laboratories, sigma metric analysis is used to assess the performance of laboratory process system. Sigma metric is also used as a quality management strategy for a laboratory process to improve the quality by addressing the errors after identification. The aim of this study is to evaluate the errors in quality control of analytical phase of laboratory system by sigma metric. For this purpose sigma metric analysis was done for analytes using the internal and external quality control as quality indicators. Results of sigma metric analysis were used to identify the gaps and need for modification in the strategy of laboratory quality control procedure. Sigma metric was calculated for quality control program of ten clinical chemistry analytes including glucose, chloride, cholesterol, triglyceride, HDL, albumin, direct bilirubin, total bilirubin, protein and creatinine, at two control levels. To calculate the sigma metric imprecision and bias was calculated with internal and external quality control data, respectively. The minimum acceptable performance was considered as 3 sigma. Westgard sigma rules were applied to customize the quality control procedure. Sigma level was found acceptable (≥3) for glucose (L2), cholesterol, triglyceride, HDL, direct bilirubin and creatinine at both levels of control. For rest of the analytes sigma metric was found <3. The lowest value for sigma was found for chloride (1.1) at L2. The highest value of sigma was found for creatinine (10.1) at L3. HDL was found with the highest sigma values at both control levels (8.8 and 8.0 at L2 and L3, respectively). We conclude that analytes with the sigma value <3 are required strict monitoring and modification in quality control procedure. In this study application of sigma rules provided us the practical solution for improved and focused design of QC procedure.

Management of pump thrombosis in patients with left ventricular assist devices.

PubMed

Stulak, John M; Sharma, Shashank; Maltais, Simon

2015-04-01

The gradual evolution of left ventricular assist device (LVAD) therapy has resulted in a durable option for patients as either a bridge to transplantation (BTT) or a destination therapy (DT). Outcomes with current continuous-flow devices continue to demonstrate significant patient benefit, not only in enhanced survival but also in improved functional capacity and quality of life. While the lessening of adverse events through time has resulted in more widespread adoption of this therapy, there continues to be unintended consequences, including, most notably, infection, bleeding, and thrombosis. Beginning in 2011, centers and collaborative groups began to observe a significant increase in the incidence of pump thrombosis with the HeartMate II LVAD (Thoratec Corp., Pleasanton, CA, USA). However, this clinical scourge is not limited to the HeartMate II, as the HeartWare Ventricular Assist System (HVAD; HeartWare Inc., Framingham, MA, USA) has also had these same issues, which led to pump modifications and the appreciation of more strict control of blood pressure and anticoagulation with this pump design. We review the current status of the field of mechanical circulatory support in its approach to diagnosis, management, and prevention of LVAD pump thrombosis.

Manipulating ship fuel sulfur content and modeling the effects on air quality and climate

NASA Astrophysics Data System (ADS)

Partanen, Antti-Ilari; Laakso, Anton; Schmidt, Anja; Kokkola, Harri; Kuokkanen, Tuomas; Kerminen, Veli-Matti; Lehtinen, Kari E. J.; Laakso, Lauri; Korhonen, Hannele

2013-04-01

Aerosol emissions from international shipping are known to cause detrimental health effects on people mainly via increased lung cancer and cardiopulmonary diseases. On the other hand, the aerosol particles from the ship emissions modify the properties of clouds and are believed to have a significant cooling effect on the global climate. In recent years, aerosol emissions from shipping have been more strictly regulated in order to improve air quality and thus decrease the mortality due to ship emissions. Decreasing the aerosol emissions from shipping is projected to decrease their cooling effect, which would intensify the global warming even further. In this study, we use a global aerosol-climate model ECHAM5.5-HAM2 to test if continental air quality can be improved while still retaining the cooling effect from shipping. The model explicitly resolves emissions of aerosols and their pre-cursor gases. The model also calculates the interaction between aerosol particles and clouds, and can thus predict the changes in cloud properties due to aerosol emissions. We design and simulate a scenario where ship fuel sulfur content is strictly limited to 0.1% near all coastal regions, but doubled in the open oceans from the current global mean value of 2.7% (geo-ships). This scenario is compared to three other simulations: 1) No shipping emissions at all (no-ships), 2) present-day shipping emissions (std-ships) and 3) a future scenario where sulfur content is limited to 0.1% in the coastal zones and to 0.5% in the open ocean (future-ships). Global mean radiative flux perturbation (RFP) in std-ships compared to no-ships is calculated to be -0.4 W m-2, which is in the range of previous estimates for present-day shipping emissions. In the geo-ships simulation the corresponding global mean RFP is roughly equal, but RFP is spatially distributed more on the open oceans, as expected. In future-ships the decreased aerosol emissions provide weaker cooling effect of only -0.1 W m-2. In order to assess the health effects of different emission scenarios we diagnose PM2.5 concentrations from each simulation. Then, we use PM2.5 concentrations and C-R functions to calculate the changes in mortality related to lung cancer and cardiopulmonary diseases. Our preliminary analysis suggests that mortality in geo-ships would be lower than in std-ships. Strict sulfur content limits also in the open oceans (future-ships) would decrease the mortality even more. Idea of deliberately increasing fuel sulfur content in order to produce a cooling effect can be classified as one form of solar radiation management (SRM). There are several scientific, ethical and political problems associated with SRM technologies and a number of them would be applicable to the idea we present here. For example, there would be a conflict between the existing international treaties and the proposed increase in ship fuel sulfur content. However, our study is increasing the knowledge of air quality and climate trade-offs related to ship emission controls. If the cooling effect of ship traffic is considered too precious to lose, there might be ways to preserve it, while still notably increasing the continental air quality.

New systems for treatment of manure from confined animal production

USDA-ARS?s Scientific Manuscript database

New swine waste management systems developed in North Carolina to replace the anaerobic lagoons need to meet the strict performance standards of an environmentally superior technology (EST). These technologies must be able to substantially remove nutrients, heavy metals, emissions of ammonia, odors,...

EDITORIAL: THE STATUS OF LCA IN THE USA

EPA Science Inventory

Life Cycle Assessment (LCA) is alive and well in the USA. Concerns for environmental management, over strict command and control approaches, has led to an increasing presence of the life cycle concept since its initial appearance in the 1970's. In addition, the very reasonablen...

Opportunities and barriers to on-farm composting and compost application: A case study from northwestern Europe.

PubMed

Viaene, J; Van Lancker, J; Vandecasteele, B; Willekens, K; Bijttebier, J; Ruysschaert, G; De Neve, S; Reubens, B

2016-02-01

Maintaining and increasing soil quality and fertility in a sustainable way is an important challenge for modern agriculture. The burgeoning bioeconomy is likely to put further pressure on soil resources unless they are managed carefully. Compost has the potential to be an effective soil improver because of its multiple beneficial effects on soil quality. Additionally, it fits within the bioeconomy vision because it can valorize biomass from prior biomass processing or valorize biomass unsuitable for other processes. However, compost is rarely used in intensive agriculture, especially in regions with high manure surpluses. The aim of this research is to identify the barriers to on-farm composting and the application of compost in agriculture, using a mixed method approach for the case of Flanders. The significance of the 28 identified barriers is analyzed and they are categorized as market and financial, policy and institutional, scientific and technological and informational and behavioral barriers. More specifically, the shortage of woody biomass, strict regulation, considerable financial and time investment, and lack of experience and knowledge are hindering on-farm composting. The complex regulation, manure surplus, variable availability and transport of compost, and variable compost quality and composition are barriers to apply compost. In conclusion, five recommendations are suggested that could alleviate certain hindering factors and thus increase attractiveness of compost use in agriculture. Copyright © 2015 Elsevier Ltd. All rights reserved.

Common Sense about Taste: From Mammals to Insects

PubMed Central

Yarmolinsky, David A.; Zuker, Charles S.; Ryba, Nicholas J.P.

2013-01-01

The sense of taste is a specialized chemosensory system dedicated to the evaluation of food and drink. Despite the fact that vertebrates and insects have independently evolved distinct anatomic and molecular pathways for taste sensation, there are clear parallels in the organization and coding logic between the two systems. There is now persuasive evidence that tastant quality is mediated by labeled lines, whereby distinct and strictly segregated populations of taste receptor cells encode each of the taste qualities. PMID:19837029

Alcohol-specific parenting, adolescents' self-control, and alcohol use: a moderated mediation model.

PubMed

Koning, Ina M; van den Eijnden, Regina J J M; Vollebergh, Wilma A M

2014-01-01

There is convincing evidence that parental rules about alcohol are important in curbing adolescents' alcohol use. However, little is known about the mechanisms through which the direct link between alcohol-specific parenting and alcohol use is obtained. In this study, we investigated the mediating effect of adolescent self-control on the relationship between alcohol-specific rules and adolescents' drinking behavior and whether this mediation effect depends on the level of quality of communication. A total of 883 adolescents participated in this longitudinal study at ages 13, 14, and 15 years. Strict rules predicted lower rates of drinking, but no direct effect of the quality of communication on adolescents' alcohol use was found. A higher level of self-control was related to lower rates of drinking in adolescents. The indirect effect of rules about alcohol through adolescents' self-control was statistically significant, yet only in adolescents with high qualitative parent-child communication about alcohol. In adolescents with low quality of parent-child communication, self-control was not related to drinking. These findings imply that strict rule setting in combination with qualitative parent-child communication is an important target for prevention. In addition, findings point at the importance of high qualitative parent-child communication for adolescents' motivation to engage in self-control to avoid drinking.

An Introduction to Flight Software Development: FSW Today, FSW 2010

NASA Technical Reports Server (NTRS)

Gouvela, John

2004-01-01

Experience and knowledge gained from ongoing maintenance of Space Shuttle Flight Software and new development projects including Cockpit Avionics Upgrade are applied to projected needs of the National Space Exploration Vision through Spiral 2. Lessons learned from these current activities are applied to create a sustainable, reliable model for development of critical software to support Project Constellation. This presentation introduces the technologies, methodologies, and infrastructure needed to produce and sustain high quality software. It will propose what is needed to support a Vision for Space Exploration that places demands on the innovation and productivity needed to support future space exploration. The technologies in use today within FSW development include tools that provide requirements tracking, integrated change management, modeling and simulation software. Specific challenges that have been met include the introduction and integration of Commercial Off the Shelf (COTS) Real Time Operating System for critical functions. Though technology prediction has proved to be imprecise, Project Constellation requirements will need continued integration of new technology with evolving methodologies and changing project infrastructure. Targets for continued technology investment are integrated health monitoring and management, self healing software, standard payload interfaces, autonomous operation, and improvements in training. Emulation of the target hardware will also allow significant streamlining of development and testing. The methodologies in use today for FSW development are object oriented UML design, iterative development using independent components, as well as rapid prototyping . In addition, Lean Six Sigma and CMMI play a critical role in the quality and efficiency of the workforce processes. Over the next six years, we expect these methodologies to merge with other improvements into a consolidated office culture with all processes being guided by automated office assistants. The infrastructure in use today includes strict software development and configuration management procedures, including strong control of resource management and critical skills coverage. This will evolve to a fully integrated staff organization with efficient and effective communication throughout all levels guided by a Mission-Systems Architecture framework with focus on risk management and attention toward inevitable product obsolescence. This infrastructure of computing equipment, software and processes will itself be subject to technological change and need for management of change and improvement,

78 FR 25321 - Agency Forms Submitted for OMB Review, Request for Comments

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-30

... Board (RRB) conducts a number of customer surveys designed to determine the kinds and quality of... what extent services can be improved. The surveys are limited to data collections that solicit strictly.... This generic authority allows the RRB to submit a variety of new or revised customer survey instruments...

Small-scale studies on low intensity chemical dosing (LICD) for treatment of highway runoff.

DOT National Transportation Integrated Search

2006-04-01

In the Tahoe Basin, strict surface water discharge limits of 20 NTU for turbidity and 0.1 mg/L : for total phosphorus are due to come into effect in 2008. The main concern in terms of water : quality is the discharge of fine particles and nutrients i...

The Kurse of Kumbayah: Five Camp Stereotypes That Derail New Staff.

ERIC Educational Resources Information Center

Malinowski, Jon C.

2003-01-01

The camp community is plagued by various stereotypes, including that camps and their staff are excessively happy, of poor quality, focused on partying and debauchery, scary, or overly strict. These cliches are perpetuated by the mass media. Each stereotype is discussed, and strategies for countering them during staff training are presented. (TD)

Parental factors and adolescents' smoking behavior: an extension of The theory of planned behavior.

PubMed

Harakeh, Zeena; Scholte, Ron H J; Vermulst, Ad A; de Vries, Hein; Engels, Rutger C M E

2004-11-01

The aim of the present study is to investigate whether general parenting factors (i.e., quality parent-child relationship, psychological control, strict control, parental knowledge) and parental smoking add to The theory of planned behaviour [Organ Behav. Hum. Dec. 50 (1991) 179] in predicting the onset of smoking. A mediation model is applied in which parental factors affect smoking behavior indirectly by affecting smoking cognitions (i.e., attitude, self-efficacy, and social norm). The model was tested in a longitudinal study on 1,070 adolescents, aged 10-14 years old. Structural equation models (SEM) on current and on future smoking behavior were tested. The findings showed that the quality of the parent-child relationship and parental knowledge affected adolescents' smoking behavior indirectly, while parental smoking behavior had a direct effect. Strict control and psychological control were found to be unrelated to adolescents' smoking onset. In prevention campaigns, parents should be informed of the extent to which they exert influence on their child's smoking behavior and should be given advice and information on how they can prevent their children from starting to smoke.

- Foreign Vessels « Coast Guard Maritime Commons

Science.gov Websites

demonstrated the highest commitment to maintaining strict compliance with U.S. and international safety international safety, security and environmental regulations. 11/22/2017: Notice of public meeting factors, it uncovered evidence of an ineffective safety management system within the operating company

Nitrogen Control Through Decentralized Wastewater Treatment: Process Performance and Alternative Management Strategies

EPA Science Inventory

Decentralized or onsite wastewater treatment (OWT) systems have long been implicated in being a major source of N inputs to surface and ground waters and numerous regulatory bodies have promulgated strict total N (TN) effluent standards in N-sensitive areas. These standards, howe...

[Quality of medicines in least developed countries].

PubMed

Videau, J Y

2006-12-01

Due to worsening economic conditions and poor enforcement of existing pharmaceutical and customs regulations, third world countries are faced with a growing threat from counterfeit and substandard medicines. With the expansion of illicit markets in urban areas, the sales of medicines of uncertain quality and origin are increasing. Most victims of this illicit trade are among the world's poorest populations that cannot afford to buy quality drugs through private-sector distribution channels. National pharmaceutical programs promoting universal access to essential generic medicines at reasonable cost are the key to curbing this problem. A system based on strict, rational pharmaceutical purchasing and distribution policies with quality assurance at every level of the supply chain is needed to guarantee that patients receive safe effective high quality healthcare products.

Characteristics and management of patients with influenza in a German hospital during the 2014/2015 influenza season.

PubMed

Hagel, Stefan; Ludewig, Katrin; Moeser, Anne; Baier, Michael; Löffler, Bettina; Schleenvoigt, Benjamin; Forstner, Christina; Pletz, Mathias W

2016-10-01

The objective of this study was to review the management of patients with influenza during the influenza season 2014/2015 (n = 197). Our study revealed a high rate of healthcare-associated influenza infection (35.5 %) and a correlation between the total number of patients with HA influenza and the number of nurses on sick leave. The results of the study underline the importance of strict hygiene management. Furthermore, widespread influenza vaccination for both high-risk patients and health care workers is recommended.

[Clinical guideline for management of patients with low risk differentiated thyroid carcinoma].

PubMed

Díez, Juan José; Oleaga, Amelia; Álvarez-Escolá, Cristina; Martín, Tomás; Galofré, Juan Carlos

2015-01-01

Incidence of thyroid cancer is increasing in Spain and worldwide. Overall thyroid cancer survival is very high, and stratification systems to reliably identify patients with worse prognosis have been developed. However, marked differences exist between the different specialists in clinical management of low-risk patients with thyroid carcinoma. Almost half of all papillary thyroid carcinomas are microcarcinomas, and 90% are tumors < 2 cm that have a particularly good prognosis. However, they are usually treated more aggressively than needed, despite the lack of adequate scientific support. Surgery remains the gold standard treatment for these tumors. However, lobectomy may be adequate in most patients, without the need for total thyroidectomy. Similarly, prophylactic lymph node dissection of the central compartment is not required in most cases. This more conservative approach prevents postoperative complications such as hypoparathyroidism or recurrent laryngeal nerve injury. Postoperative radioiodine remnant ablation and strict suppression of serum thyrotropin, although effective for the more aggressive forms of thyroid cancer, have not been shown to be beneficial for the treatment of low risk patients, and may impair their quality of life. This guideline provides recommendations from the task force on thyroid cancer of the Spanish Society of Endocrinology and Nutrition for adequate management of patients with low-risk thyroid cancer. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

75 FR 15597 - Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-29

... generally accepted accounting principles, OMB funds management circulars, and accounting guidance provided... exchanges that will be operational in 2014. The Act also imposes strict payment and accounting requirements... Federal financial assistance. The guidelines shall also offer technical information that States should...

Tax Tips for Forest Landowners for the 2007 Tax Year

Treesearch

Linda Wang; John L. Greene

2007-01-01

This guide is designed to assist owners of forest land with timber tax information. It is current as of October 1, 2007, and supercedes Management Bulletin R8-MB 128. It is strictly for educational purposes; consult your legal and tax professionals for advice on a specific tax situation.

14 CFR 1216.321 - Environmental effects abroad of major Federal actions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... participating with or not otherwise involved in the NASA activity; (3) The export of products or facilities... for Management will provide additional guidance regarding the types of chemical, physical, and biological agents involved. (4) A physical project which, in the U.S., would be prohibited or strictly...

Defense Officer Personnel Management Act for Medical Officer Pay and Entitlements

DTIC Science & Technology

1993-03-22

are equitable in nature it is not considered appropriate that the strict legalistic standards of contract law be rigorously applied. It is important...to note that the BCNR panels deciding the cases in question were aware of the established legal standards and principles of contract law , as well

IS-ENES project management - lessons learnt

NASA Astrophysics Data System (ADS)

Parinet, Marie; Guglielmo, Francesca; Joussaume, Sylvie

2017-04-01

IS-ENES is the distributed e-infrastructure of models, model data and metadata of the European Network for Earth System Modelling (ENES). It has benefitted from two EC FP7 grants and aims towards further European and national funding to achieve sustainability. We highlight here several challenges related to project management that have risen in the course of these two project-phases spanning 8 years. Some challenges are related to the heterogeneity of the activities within IS-ENES, with different groups working on very diverse activities, not necessarily strictly interdependent. An immediate consequence is the need of implementing and setting up in early phases of the project efficient collection and circulation of information to preserve and reinforce the systemic view of the infrastructure as a whole and the pursuit of common goals, including coordinated provision of services. Toward and beyond such common goals, managing IS-ENES, covering both scientific and more strictly management-related aspects, implies a double-paced approach: besides setting up efficient project workflow, there is the need of setting up longer term objectives. This implies, within the project lifetime, to elaborate and implement a coherent organizational (consistent with scientific goals, funding schemes, research and technology landscape) strategy to pursue these goals beyond the project itself. Furthermore, a series of more generic project management challenges will also be listed and can be gathered around 3 main objectives: ease the internal processes in order to optimize the work, anticipate delays and budget issues, and motivate the project teams by ensuring an efficient internal and external communication.

Current projects in Pre-analytics: where to go?

PubMed

Sapino, Anna; Annaratone, Laura; Marchiò, Caterina

2015-01-01

The current clinical practice of tissue handling and sample preparation is multifaceted and lacks strict standardisation: this scenario leads to significant variability in the quality of clinical samples. Poor tissue preservation has a detrimental effect thus leading to morphological artefacts, hampering the reproducibility of immunocytochemical and molecular diagnostic results (protein expression, DNA gene mutations, RNA gene expression) and affecting the research outcomes with irreproducible gene expression and post-transcriptional data. Altogether, this limits the opportunity to share and pool national databases into European common databases. At the European level, standardization of pre-analytical steps is just at the beginning and issues regarding bio-specimen collection and management are still debated. A joint (public-private) project entitled on standardization of tissue handling in pre-analytical procedures has been recently funded in Italy with the aim of proposing novel approaches to the neglected issue of pre-analytical procedures. In this chapter, we will show how investing in pre-analytics may impact both public health problems and practical innovation in solid tumour processing.

Quality of Service for Real-Time Applications Over Next Generation Data Networks

NASA Technical Reports Server (NTRS)

Ivancic, William; Atiquzzaman, Mohammed; Bai, Haowei; Su, Hongjun; Jain, Raj; Duresi, Arjan; Goyal, Mukyl; Bharani, Venkata; Liu, Chunlei; Kota, Sastri

2001-01-01

This project, which started on January 1, 2000, was funded by NASA Glenn Research Center for duration of one year. The deliverables of the project included the following tasks: Study of QoS mapping between the edge and core networks envisioned in the Next Generation networks will provide us with the QoS guarantees that can be obtained from next generation networks. Buffer management techniques to provide strict guarantees to real-time end-to-end applications through preferential treatment to packets belonging to real-time applications. In particular, use of ECN to help reduce the loss on high bandwidth-delay product satellite networks needs to be studied. Effect of Prioritized Packet Discard to increase goodput of the network and reduce the buffering requirements in the ATM switches. Provision of new IP circuit emulation services over Satellite IP backbones using MPLS will be studied. Determine the architecture and requirements for internetworking ATN and the Next Generation Internet for real-time applications.

Temporal-Spatial Evolution of Groundwater Nitrogen Pollution Over Seven Years in a Highly Urbanized City in the Southern China.

PubMed

He, Xiaorui; Qian, Jiazhong; Liu, Zufa; Lu, Yuehan; Ma, Lei; Zhao, Weidong; Kang, Bo

2017-12-01

Understanding the temporospatial variation in nitrogen pollution in groundwater and the associated controlling factors is important to establish management practices that ensure sustainable use of groundwater. In this study, we analyzed inorganic nitrogen content (nitrate, nitrite, and ammonium) in 1164 groundwater samples from shallow, middle-deep, and deep aquifers in Zhanjiang, a highly urbanized city in the southern China. Our data span a range of 7 years from 2005 to 2011. Results show that shallow aquifers had been heavily contaminated by nitrate and ammonium. Temporal patterns show that N contamination levels remained high and relatively stable over time in urban areas. This stability and high concentration is hypothesized as a result of uncontrolled, illicit sewer discharges from nearby business facilities. Groundwater in urban land and farmland displays systematic differences in geochemical characteristics. Collectively, our findings demonstrate the importance of continuously monitoring groundwater quality and strictly regulating sewage discharges in Zhanjiang.

Diagnosis, pathophysiology, and management of cluster headache.

PubMed

Hoffmann, Jan; May, Arne

2018-01-01

Cluster headache is a trigeminal autonomic cephalalgia characterised by extremely painful, strictly unilateral, short-lasting headache attacks accompanied by ipsilateral autonomic symptoms or the sense of restlessness and agitation, or both. The severity of the disorder has major effects on the patient's quality of life and, in some cases, might lead to suicidal ideation. Cluster headache is now thought to involve a synchronised abnormal activity in the hypothalamus, the trigeminovascular system, and the autonomic nervous system. The hypothalamus appears to play a fundamental role in the generation of a permissive state that allows the initiation of an episode, whereas the attacks are likely to require the involvement of the peripheral nervous system. Triptans are the most effective drugs to treat an acute cluster headache attack. Monoclonal antibodies against calcitonin gene-related peptide, a crucial neurotransmitter of the trigeminal system, are under investigation for the preventive treatment of cluster headache. These studies will increase our understanding of the disorder and perhaps reveal other therapeutic targets. Copyright © 2018 Elsevier Ltd. All rights reserved.

Reconsidering Planning and Management of Medical Devices Procurement in Public Health Services in Cyprus.

PubMed

Theodorou, Mamas; Georgiou, Marina; Nikolentzos, Athanasios; Bellali, Thalia

2015-04-19

Hospital procurement is a crucial field for any health care system, not only for economic reasons but also for reasons related to the quality and safety of the services provided. That is why the process of procurement is, in most countries, governed by a strict legal framework and policy mechanisms. This study investigates the problems and inefficiencies associated with the procurement of medical devices in public hospitals in Cyprus and formulates empirically documented proposals for improvement. Using the Delphi method, a group of 38 experts approach the procurement system in Cyprus from different angles, achieving high rates of consensus on 35 different statements on the weaknesses and problems of the current medical device procurement system, as well as presenting proposals and recommendations for improvement. The findings are highly valuable for future policy initiatives in Cyprus in the light of the economic crisis and the expected implementation of the new General Health Insurance System (GeSY), which the Government of the Republic of Cyprus and the Troika has agreed.

Oral Manifestations in Pediatric Patients with Coeliac Disease - A Review Article.

PubMed

Macho, Viviana Marisa Pereira; Coelho, Ana Sofia; Veloso E Silva, Diana Maria; de Andrade, David José Casimiro

2017-01-01

Coeliac disease is a chronic enteropathy that remains a challenge for the clinician, due to its atypical manifestations and etiopathogenic complexity. This article intends to describe the oral characteristics of Coeliac Disease in children in order to facilitate their management in the dental office. A review of the literature was performed electronically in PubMed (PubMed Central, and MEDLINE) for articles published in English from 2000 to April of 2017. The article is also based on the authors' clinical experience with children with coeliac disease. The searched keywords were "coeliac disease ","oral manifestations ", "dental enamel defects", "recurrent aphthous stomatitis" and "oral aphthous ulcers". There are some oral manifestations which are strictly related to coeliac disease: dental enamel defects, recurrent aphthous stomatitis, delayed tooth eruption, multiple caries, angular cheilitis, atrophic glossitis, dry mouth and burning tongue. The complete knowledge of the oral manifestations of coeliac disease can trigger an effective change in the quality of life of the patients with this disease.

Use of biologics in severe food allergies.

PubMed

Fiocchi, Alessandro; Pecora, Valentina; Valluzzi, Rocco L; Fierro, Vincenzo; Mennini, Maurizio

2017-06-01

Severe cases of food allergy account for the majority of the burden in terms of risks, quality of life, and resource expenditure. The traditional approach to these forms has been strict avoidance. More recently, Oral ImmunoTherapy (OIT) has gained a role in their management. However, in severe food allergies OIT is often infeasible. Case reports, observational, and prospective studies have recently proposed different approaches to severe food allergy. The majority of them include the use of biologics. Omalizumab has been the most studied drug for severe food allergies, and its role as adjuvant treatment to OIT is well established. Interest has been raised on other biologics, as dupilumab, reslizumab, and mepolizumab. Toll-like receptor agonists, and gene therapy using adeno-associated virus coding for Omalizumab are promising alternatives. The recent studies are deeply influencing the clinical practice. We review the modifications of the clinical approach to severe food allergies so far available. We indicate the possible evolutions of treatment with biologics in severe food allergies.

The Gluten-Free Diet: Testing Alternative Cereals Tolerated by Celiac Patients

PubMed Central

Comino, Isabel; de Lourdes Moreno, María; Real, Ana; Rodríguez-Herrera, Alfonso; Barro, Francisco; Sousa, Carolina

2013-01-01

A strict gluten-free diet (GFD) is the only currently available therapeutic treatment for patients with celiac disease, an autoimmune disorder of the small intestine associated with a permanent intolerance to gluten proteins. The complete elimination of gluten proteins contained in cereals from the diet is the key to celiac disease management. However, this generates numerous social and economic repercussions due to the ubiquity of gluten in foods. The research presented in this review focuses on the current status of alternative cereals and pseudocereals and their derivatives obtained by natural selection, breeding programs and transgenic or enzymatic technology, potential tolerated by celiac people. Finally, we describe several strategies for detoxification of dietary gluten. These included enzymatic cleavage of gliadin fragment by Prolyl endopeptidases (PEPs) from different organisms, degradation of toxic peptides by germinating cereal enzymes and transamidation of cereal flours. This information can be used to search for and develop cereals with the baking and nutritional qualities of toxic cereals, but which do not exacerbate this condition. PMID:24152755

Setting the most robust effluent level under severe uncertainty: application of information-gap decision theory to chemical management.

PubMed

Yokomizo, Hiroyuki; Naito, Wataru; Tanaka, Yoshinari; Kamo, Masashi

2013-11-01

Decisions in ecological risk management for chemical substances must be made based on incomplete information due to uncertainties. To protect the ecosystems from the adverse effect of chemicals, a precautionary approach is often taken. The precautionary approach, which is based on conservative assumptions about the risks of chemical substances, can be applied selecting management models and data. This approach can lead to an adequate margin of safety for ecosystems by reducing exposure to harmful substances, either by reducing the use of target chemicals or putting in place strict water quality criteria. However, the reduction of chemical use or effluent concentrations typically entails a financial burden. The cost effectiveness of the precautionary approach may be small. Hence, we need to develop a formulaic methodology in chemical risk management that can sufficiently protect ecosystems in a cost-effective way, even when we do not have sufficient information for chemical management. Information-gap decision theory can provide the formulaic methodology. Information-gap decision theory determines which action is the most robust to uncertainty by guaranteeing an acceptable outcome under the largest degree of uncertainty without requiring information about the extent of parameter uncertainty at the outset. In this paper, we illustrate the application of information-gap decision theory to derive a framework for setting effluent limits of pollutants for point sources under uncertainty. Our application incorporates a cost for reduction in pollutant emission and a cost to wildlife species affected by the pollutant. Our framework enables us to settle upon actions to deal with severe uncertainty in ecological risk management of chemicals. Copyright © 2013 Elsevier Ltd. All rights reserved.

Atmospheric vs. anaerobic processing of metabolome samples for the metabolite profiling of a strict anaerobic bacterium, Clostridium acetobutylicum.

PubMed

Lee, Sang-Hyun; Kim, Sooah; Kwon, Min-A; Jung, Young Hoon; Shin, Yong-An; Kim, Kyoung Heon

2014-12-01

Well-established metabolome sample preparation is a prerequisite for reliable metabolomic data. For metabolome sampling of a Gram-positive strict anaerobe, Clostridium acetobutylicum, fast filtration and metabolite extraction with acetonitrile/methanol/water (2:2:1, v/v) at -20°C under anaerobic conditions has been commonly used. This anaerobic metabolite processing method is laborious and time-consuming since it is conducted in an anaerobic chamber. Also, there have not been any systematic method evaluation and development of metabolome sample preparation for strict anaerobes and Gram-positive bacteria. In this study, metabolome sampling and extraction methods were rigorously evaluated and optimized for C. acetobutylicum by using gas chromatography/time-of-flight mass spectrometry-based metabolomics, in which a total of 116 metabolites were identified. When comparing the atmospheric (i.e., in air) and anaerobic (i.e., in an anaerobic chamber) processing of metabolome sample preparation, there was no significant difference in the quality and quantity of the metabolomic data. For metabolite extraction, pure methanol at -20°C was a better solvent than acetonitrile/methanol/water (2:2:1, v/v/v) at -20°C that is frequently used for C. acetobutylicum, and metabolite profiles were significantly different depending on extraction solvents. This is the first evaluation of metabolite sample preparation under aerobic processing conditions for an anaerobe. This method could be applied conveniently, efficiently, and reliably to metabolome analysis for strict anaerobes in air. © 2014 Wiley Periodicals, Inc.

The Use of Interactive Methods in the Educational Process of the Higher Education Institution

ERIC Educational Resources Information Center

Kutbiddinova, Rimma A.; Eromasova, Aleksandr? A.; Romanova, Marina A.

2016-01-01

The modernization of higher education and the transition to the new Federal Education Standards require a higher quality training of the graduates. The training of highly qualified specialists must meet strict requirements: a high level of professional competence, the developed communication skills, the ability to predict the results of one's own…

Impact of telemedicine in managing type 1 diabetes among school-age children and adolescents: an integrative review.

PubMed

Guljas, Rebecca; Ahmed, Azza; Chang, Karen; Whitlock, Analei

2014-01-01

Patients with diabetes who have limited access to healthcare services are less likely to maintain adequate diabetes control. Telemedicine represents a useful solution to the strict follow up required in diabetes management. This review analyzes the impact that telemedicine has on the management of type 1 diabetes among school-age children and adolescents, as measured by compliance with blood glucose monitoring, glycemic control, satisfaction, and self management. In general, this review supports the use of telemedicine in maintaining glycemic control. Further studies are desired to observe the impact of telemedicine in managing type 1 diabetes in school-age children and adolescents. Copyright © 2014 Elsevier Inc. All rights reserved.

A systematic review on the composting of green waste: Feedstock quality and optimization strategies.

PubMed

Reyes-Torres, M; Oviedo-Ocaña, E R; Dominguez, I; Komilis, D; Sánchez, A

2018-04-27

Green waste (GW) is an important fraction of municipal solid waste (MSW). The composting of lignocellulosic GW is challenging due to its low decomposition rate. Recently, an increasing number of studies that include strategies to optimize GW composting appeared in the literature. This literature review focuses on the physicochemical quality of GW and on the effect of strategies used to improve the process and product quality. A systematic search was carried out, using keywords, and 447 papers published between 2002 and 2018 were identified. After a screening process, 41 papers addressing feedstock quality and 32 papers on optimization strategies were selected to be reviewed and analyzed in detail. The GW composition is highly variable due to the diversity of the source materials, the type of vegetation, and climatic conditions. This variability limits a strict categorization of the GW physicochemical characteristics. However, this research established that the predominant features of GW are a C/N ratio higher than 25, a deficit in important nutrients, namely nitrogen (0.5-1.5% db), phosphorous (0.1-0.2% db) and potassium (0.4-0.8% db) and a high content of recalcitrant organic compounds (e.g. lignin). The promising strategies to improve composting of GW were: i) GW particle size reduction (e.g. shredding and separation of GW fractions); ii) addition of energy amendments (e.g. non-refined sugar, phosphate rock, food waste, volatile ashes), bulking materials (e.g. biocarbon, wood chips), or microbial inoculum (e.g. fungal consortia); and iii) variations in operating parameters (aeration, temperature, and two-phase composting). These alternatives have successfully led to the reduction of process length and have managed to transform recalcitrant substances to a high-quality end-product. Copyright © 2018 Elsevier Ltd. All rights reserved.

Olive Oil Headspace Characterization by a Gas Sensor Array

NASA Astrophysics Data System (ADS)

Santonico, Marco; Gianni, Giacomo; Capuano, Rosamaria; Migliorini, Marzia; Catini, Alexandro; Dini, Francesca; Martinelli, Eugenio; Paolesse, Roberto; D'Amico, Arnaldo; Di Natale, Corrado

2011-09-01

Olive oil quality is strictly correlated to the volatile compounds profile. Both quality and defects can be connected to the presence of specific volatile compounds in the oil headspace. In this paper, olive oil samples have been artificially modified by adding a number of compounds known to be typical of the more frequent defects: fusty, musty, muddy and rancid. Results demonstrate the sensitivity of the electronic nose to the compounds characterizing the defects and then the capability of the instrument to identify the defects in real samples.

Radical Reform of the French University System

ERIC Educational Resources Information Center

Bereziat, Gilbert

2008-01-01

The French university system is in crisis. After its dismantlement during the French revolution, its rebirth was progressive under the third republic (1871-1945). But it was only after 1968 that the current universities developed, with an autonomy that is strictly supervised by the state. Since 1986 all experiments at modernizing the management of…

Edison Is the Symptom, NCLB Is the Disease

ERIC Educational Resources Information Center

Campbell, Peter

2007-01-01

Engaging students requires giving them a say in what they learn and how they will learn it. However, in strictly disciplined, rule-bound schools with test-driven curricula, this cannot happen. Edison Schools, Inc., a for-profit Education Management Organization (EMO), and Confluence Academy, an Edison-run school located in one of the most…

[From constraint to containment through the nursing link].

PubMed

Chazalet, Nathalie

The implementation of a sufficiently strict, adapted care setting provides constructive support for a move away from isolation and restraint towards new spaces of freedom. The account of the evolutive management of a patient by a nursing team in Bourg-en-Bresse, presents possible therapeutic strategies. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Marriage and End-Stage Renal Disease: Implications for African Americans

ERIC Educational Resources Information Center

Shortridge, Emily F.; James, Cara V.

2010-01-01

African Americans are disproportionately represented among patients with end-stage renal disease (ESRD). ESRD is managed with a strict routine that might include regular dialysis as well as dietary, fluid intake, and other lifestyle changes. In a disease such as this, with such disruptive treatment modalities, marriage, specifically, and its ties…

The Use of the Air Arm During Operation Change of Direction

DTIC Science & Technology

2009-01-01

football stadium.56 Aircraft of the IAF for the first time raid targets in the predominantly Christian area to the north of Beirut. These attacks are...launching capa- bility, the organisation managed to fire a large number of Katyusha missiles from the border area into Israel on a daily basis. Of the...caused by budgetary restrictions. In its turn, Hezbollah was very much aware of the capability of the GSS and managed to keep strict secrecy by hiding

Monitoring and source apportionment of trace elements in PM2.5: Implications for local air quality management.

PubMed

Li, Yueyan; Chang, Miao; Ding, Shanshan; Wang, Shiwen; Ni, Dun; Hu, Hongtao

2017-07-01

Fine particulate matter (PM 2.5 ) samples were collected simultaneously every hour in Beijing between April 2014 and April 2015 at five sites. Thirteen trace elements (TEs) in PM 2.5 were analyzed by online X-ray fluorescence (XRF). The annual average PM 2.5 concentrations ranged from 76.8 to 102.7 μg m -3 . TEs accounted for 5.9%-8.7% of the total PM 2.5 mass with Cl, S, K, and Si as the most dominant elements. Spearman correlation coefficients of PM 2.5 or TE concentrations between the background site and other sites showed that PM 2.5 and some element loadings were affected by regional and local sources, whereas Cr, Si, and Ni were attributed to substantial local emissions. Temporal variations of TEs in PM 2.5 were significant and provided information on source profiles. The PM 2.5 concentrations were highest in autumn and lowest in summer. Mn and Cr showed similar variation. Fe, Ca, Si, and Ti tended to show higher concentrations in spring, whereas concentrations of S peaked in summer. Concentrations of Cl, K, Pb, Zn, Cu, and Ni peaked in winter. PM 2.5 and TE median concentrations were higher on Saturdays than on weekdays. The diurnal pattern of PM 2.5 and TE median concentrations yielded similar bimodal patterns. Five dominant sources of PM 2.5 mass were identified via positive matrix factorization (PMF). These sources included the regional and local secondary aerosols, traffic, coal burning, soil dust, and metal processing. Air quality management strategies, including regional environmental coordination and collaboration, reduction in secondary aerosol precursors, restrictive vehicle emission standards, promotion of public transport, and adoption of clean energy, should be strictly implemented. High time-resolution measurements of TEs provided detailed source profiles, which can greatly improve precision in interpreting source apportionment calculations; the PMF analysis of online XRF data is a powerful tool for local air quality management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Harnessing the Environmental Professional Expertise of Engineering Students—The Course: ``Environmental Management Systems in the Industry''

NASA Astrophysics Data System (ADS)

Ben-Zvi-Assaraf, Orit; Ayal, Nitzan

2010-12-01

More and more technical universities now advocate integrating sustainability in higher education and including it as a strategic goal for improving education's quality and relevance to society. This study examines 30 fourth-year chemical engineering students, graduates of a university course designed to combine their terminological domain with sustainability-oriented goals, focusing on topics like corporate sustainability, developing environmental policy, introduction to ISO 14001—Environmental Management Systems (EMS), and environmental legislation. The study explores their perception of industrial-environmental issues and asks—How did the study unit influence the students' ability to use their preexisting scientific knowledge, while relating to industrial-environmental issues? Our findings indicate that engineering students can develop industrial-environmental awareness, and make use of interdisciplinary knowledge beyond that strictly related to the realm of engineering. Regarding the research's particular aim—i.e. determining the study unit's influence on students' ability to relate industrial-environmental issues to their own field of engineering—the findings indeed show a change in the students' conceptions of environmental elements related to industry. The course graduates became more attentive to the environmental aspects associated with building and opening a factory, and the concepts they raised in connection with the topic gained in variety.

New approach for food allergy management using low-dose oral food challenges and low-dose oral immunotherapies.

PubMed

Yanagida, Noriyuki; Okada, Yu; Sato, Sakura; Ebisawa, Motohiro

2016-04-01

A number of studies have suggested that a large subset of children (approximately 70%) who react to unheated milk or egg can tolerate extensively heated forms of these foods. A diet that includes baked milk or egg is well tolerated and appears to accelerate the development of regular milk or egg tolerance when compared with strict avoidance. However, the indications for an oral food challenge (OFC) using baked products are limited for patients with high specific IgE values or large skin prick test diameters. Oral immunotherapies (OITs) are becoming increasingly popular for the management of food allergies. However, the reported efficacy of OIT is not satisfactory, given the high frequency of symptoms and requirement for long-term therapy. With food allergies, removing the need to eliminate a food that could be consumed in low doses could significantly improve quality of life. This review discusses the importance of an OFC and OIT that use low doses of causative foods as the target volumes. Utilizing an OFC or OIT with a low dose as the target volume could be a novel approach for accelerating the tolerance to causative foods. Copyright © 2015 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

Spanish Guidelines on Treatment of Bronchiectasis in Adults.

PubMed

Martínez-García, Miguel Ángel; Máiz, Luis; Olveira, Casilda; Girón, Rosa Maria; de la Rosa, David; Blanco, Marina; Cantón, Rafael; Vendrell, Montserrat; Polverino, Eva; de Gracia, Javier; Prados, Concepción

2018-02-01

In 2008, the Spanish Society of Pulmonology (SEPAR) published the first guidelines in the world on the diagnosis and treatment of bronchiectasis. Almost 10 years later, considerable scientific advances have been made in both the treatment and the evaluation and diagnosis of this disease, and the original guidelines have been updated to include the latest therapies available for bronchiectasis. These new recommendations have been drafted following a strict methodological process designed to ensure quality of content, and are linked to a large amount of online information that includes a wealth of references. The guidelines are focused on the treatment of bronchiectasis from both a multidisciplinary perspective, including specialty areas and the different healthcare levels involved, and a multidimensional perspective, including a comprehensive overview of the specific aspects of the disease. A series of recommendations have been drawn up, based on an in-depth review of the evidence for treatment of the underlying etiology, the bronchial infection in its different forms of presentation using existing therapies, bronchial inflammation, and airflow obstruction. Nutritional aspects, management of secretions, muscle training, management of complications and comorbidities, infection prophylaxis, patient education, home care, surgery, exacerbations, and patient follow-up are addressed. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

ICON: food allergy.

PubMed

Burks, A Wesley; Tang, Mimi; Sicherer, Scott; Muraro, Antonella; Eigenmann, Philippe A; Ebisawa, Motohiro; Fiocchi, Alessandro; Chiang, Wen; Beyer, Kirsten; Wood, Robert; Hourihane, Jonathan; Jones, Stacie M; Lack, Gideon; Sampson, Hugh A

2012-04-01

Food allergies can result in life-threatening reactions and diminish quality of life. In the last several decades, the prevalence of food allergies has increased in several regions throughout the world. Although more than 170 foods have been identified as being potentially allergenic, a minority of these foods cause the majority of reactions, and common food allergens vary between geographic regions. Treatment of food allergy involves strict avoidance of the trigger food. Medications manage symptoms of disease, but currently, there is no cure for food allergy. In light of the increasing burden of allergic diseases, the American Academy of Allergy, Asthma & Immunology; European Academy of Allergy and Clinical Immunology; World Allergy Organization; and American College of Allergy, Asthma & Immunology have come together to increase the communication of information about allergies and asthma at a global level. Within the framework of this collaboration, termed the International Collaboration in Asthma, Allergy and Immunology, a series of consensus documents called International Consensus ON (ICON) are being developed to serve as an important resource and support physicians in managing different allergic diseases. An author group was formed to describe the natural history, prevalence, diagnosis, and treatment of food allergies in the context of the global community. Copyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

Managing information and knowledge within maternity services: Privacy and consent issues.

PubMed

Baskaran, Vikraman; Davis, Kim; Bali, Rajeev K; Naguib, Raouf N G; Wickramasinghe, Nilmini

2013-09-01

Electronic Patient Records have improved vastly the quality and efficiency of care delivered. However, the formation of single demographic database and the ease of electronic information sharing give rise to many concerns including issues of consent, by whom and how data are accessed and used. This paper examines the organizational and socio-technical issues related to privacy, confidentiality and security when employing electronic records within a maternity service hospital in England. A preliminary questionnaire was administered (n  =  52), in total, 24 responses were received. Sixteen responses were from personnel in the information technology department, 5 from health information department and 3 from midwifery managers. This was followed by a semi-structured interview with representatives from the clinical and technological side. A number of issues related to information governance (IG) have been identified, especially breaches on sharing personal information without consent from the patients have been identified as one immediate challenge that needs to be fixed. There is an immediate need for more robust, realistic, built-in accountability both locally and nationally on data sharing. A culture of ownership and strict adherence to IG principles is paramount. Focused training in the area of data, information and knowledge sharing will bring in a balance of legitimate usage against the individual's rights to confidentiality and privacy.

Perspectives to performance of environment and health assessments and models--from outputs to outcomes?

PubMed

Pohjola, Mikko V; Pohjola, Pasi; Tainio, Marko; Tuomisto, Jouni T

2013-06-26

The calls for knowledge-based policy and policy-relevant research invoke a need to evaluate and manage environment and health assessments and models according to their societal outcomes. This review explores how well the existing approaches to assessment and model performance serve this need. The perspectives to assessment and model performance in the scientific literature can be called: (1) quality assurance/control, (2) uncertainty analysis, (3) technical assessment of models, (4) effectiveness and (5) other perspectives, according to what is primarily seen to constitute the goodness of assessments and models. The categorization is not strict and methods, tools and frameworks in different perspectives may overlap. However, altogether it seems that most approaches to assessment and model performance are relatively narrow in their scope. The focus in most approaches is on the outputs and making of assessments and models. Practical application of the outputs and the consequential outcomes are often left unaddressed. It appears that more comprehensive approaches that combine the essential characteristics of different perspectives are needed. This necessitates a better account of the mechanisms of collective knowledge creation and the relations between knowledge and practical action. Some new approaches to assessment, modeling and their evaluation and management span the chain from knowledge creation to societal outcomes, but the complexity of evaluating societal outcomes remains a challenge.

Hypervigilance to a Gluten-Free Diet and Decreased Quality of Life in Teenagers and Adults with Celiac Disease.

PubMed

Wolf, Randi L; Lebwohl, Benjamin; Lee, Anne R; Zybert, Patricia; Reilly, Norelle R; Cadenhead, Jennifer; Amengual, Chelsea; Green, Peter H R

2018-06-01

Avoidance of gluten is critical for individuals with celiac disease (CD), but there is also concern that "extreme vigilance" to a strict gluten-free diet may increase symptoms such as anxiety and fatigue, and therefore, lower quality of life (QOL). We examined the associations of QOL with energy levels and adherence to, and knowledge about, a gluten-free diet. This is a cross-sectional prospective study of 80 teenagers and adults, all with biopsy-confirmed CD, living in a major metropolitan area. QOL was assessed with CD-specific measures. Dietary vigilance was based on 24-h recalls and an interview. Knowledge was based on a food label quiz. Open-ended questions described facilitators and barriers to maintaining a gluten-free diet. The extremely vigilant adults in our sample had significantly lower QOL scores than their less vigilant counterparts [(mean (SD): 64.2 (16.0) vs 77.2 (12.2), p = 0.004]. Extreme vigilance was also associated with greater knowledge [5.7 (0.7) vs 5.1 (0.8), p = 0.035]. Adults with lower energy levels had significantly lower overall QOL scores than adults with higher energy levels [68.0 (13.6) vs 78.9 (13.0), p = 0.006]. Patterns were similar for teenagers. Cooking at home and using internet sites and apps were prevalent strategies used by the hypervigilant to maintain a strict gluten-free diet. Eating out was particularly problematic. There are potential negative consequences of hypervigilance to a strict gluten-free diet. Clinicians must consider the importance of concurrently promoting both dietary adherence and social and emotional well-being for individuals with CD.

Quality of Life in Patients with Gluten Neuropathy: A Case-Controlled Study.

PubMed

Zis, Panagiotis; Sarrigiannis, Ptolemaios Georgios; Rao, Dasappaiah Ganesh; Hadjivassiliou, Marios

2018-05-23

Gluten neuropathy (GN) is defined as an otherwise idiopathic peripheral neuropathy in the presence of serological evidence of gluten sensitivity (positive native gliadin antibodies and/or transglutaminase or endomysium antibodies). We aimed to compare the quality of life (QoL) of GN patients with that of control subjects and to investigate the effects of a gluten-free diet (GFD) on the QoL. All consecutive patients with GN attending a specialist neuropathy clinic were invited to participate. The Overall Neuropathy Limitations Scale (ONLS) was used to assess the severity of the neuropathy. The 36-Item Short Form Survey (SF-36) questionnaire was used to measure participants’ QoL. A strict GFD was defined as effectively being able to eliminate all circulating gluten sensitivity-related antibodies. Fifty-three patients with GN and 53 age- and gender-matched controls were recruited. Compared to controls, GN patients showed significantly worse scores in the physical functioning, role limitations due to physical health, energy/fatigue, and general health subdomains of the SF-36. After adjusting for age, gender, and disease severity, being on a strict GFD correlated with better SF-36 scores in the pain domain of the SF-36 (beta 0.317, p = 0.019) and in the overall health change domain of the SF-36 (beta 0.306, p = 0.017). In GN patients, physical dysfunctioning is the major determinant of poor QoL compared to controls. Routine checking of the elimination of gluten sensitivity-related antibodies that results from a strict GFD should be encouraged, as such elimination ameliorates the overall pain and health scores, indicating a better QoL.

Comparison of Marine Spatial Planning Methods in Madagascar Demonstrates Value of Alternative Approaches

PubMed Central

Allnutt, Thomas F.; McClanahan, Timothy R.; Andréfouët, Serge; Baker, Merrill; Lagabrielle, Erwann; McClennen, Caleb; Rakotomanjaka, Andry J. M.; Tianarisoa, Tantely F.; Watson, Reg; Kremen, Claire

2012-01-01

The Government of Madagascar plans to increase marine protected area coverage by over one million hectares. To assist this process, we compare four methods for marine spatial planning of Madagascar's west coast. Input data for each method was drawn from the same variables: fishing pressure, exposure to climate change, and biodiversity (habitats, species distributions, biological richness, and biodiversity value). The first method compares visual color classifications of primary variables, the second uses binary combinations of these variables to produce a categorical classification of management actions, the third is a target-based optimization using Marxan, and the fourth is conservation ranking with Zonation. We present results from each method, and compare the latter three approaches for spatial coverage, biodiversity representation, fishing cost and persistence probability. All results included large areas in the north, central, and southern parts of western Madagascar. Achieving 30% representation targets with Marxan required twice the fish catch loss than the categorical method. The categorical classification and Zonation do not consider targets for conservation features. However, when we reduced Marxan targets to 16.3%, matching the representation level of the “strict protection” class of the categorical result, the methods show similar catch losses. The management category portfolio has complete coverage, and presents several management recommendations including strict protection. Zonation produces rapid conservation rankings across large, diverse datasets. Marxan is useful for identifying strict protected areas that meet representation targets, and minimize exposure probabilities for conservation features at low economic cost. We show that methods based on Zonation and a simple combination of variables can produce results comparable to Marxan for species representation and catch losses, demonstrating the value of comparing alternative approaches during initial stages of the planning process. Choosing an appropriate approach ultimately depends on scientific and political factors including representation targets, likelihood of adoption, and persistence goals. PMID:22359534

Comparison of marine spatial planning methods in Madagascar demonstrates value of alternative approaches.

PubMed

Allnutt, Thomas F; McClanahan, Timothy R; Andréfouët, Serge; Baker, Merrill; Lagabrielle, Erwann; McClennen, Caleb; Rakotomanjaka, Andry J M; Tianarisoa, Tantely F; Watson, Reg; Kremen, Claire

2012-01-01

The Government of Madagascar plans to increase marine protected area coverage by over one million hectares. To assist this process, we compare four methods for marine spatial planning of Madagascar's west coast. Input data for each method was drawn from the same variables: fishing pressure, exposure to climate change, and biodiversity (habitats, species distributions, biological richness, and biodiversity value). The first method compares visual color classifications of primary variables, the second uses binary combinations of these variables to produce a categorical classification of management actions, the third is a target-based optimization using Marxan, and the fourth is conservation ranking with Zonation. We present results from each method, and compare the latter three approaches for spatial coverage, biodiversity representation, fishing cost and persistence probability. All results included large areas in the north, central, and southern parts of western Madagascar. Achieving 30% representation targets with Marxan required twice the fish catch loss than the categorical method. The categorical classification and Zonation do not consider targets for conservation features. However, when we reduced Marxan targets to 16.3%, matching the representation level of the "strict protection" class of the categorical result, the methods show similar catch losses. The management category portfolio has complete coverage, and presents several management recommendations including strict protection. Zonation produces rapid conservation rankings across large, diverse datasets. Marxan is useful for identifying strict protected areas that meet representation targets, and minimize exposure probabilities for conservation features at low economic cost. We show that methods based on Zonation and a simple combination of variables can produce results comparable to Marxan for species representation and catch losses, demonstrating the value of comparing alternative approaches during initial stages of the planning process. Choosing an appropriate approach ultimately depends on scientific and political factors including representation targets, likelihood of adoption, and persistence goals.

Quantitative Analysis of High-Quality Officer Selection by Commandants Career-Level Education Board

DTIC Science & Technology

2017-03-01

due to Marines being evaluated before the end of their initial service commitment. Our research utilizes quantitative variables to analyze the...not provide detailed information why. B. LIMITATIONS The photograph analysis in this research is strictly limited to a quantitative analysis in...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release. Distribution is unlimited. QUANTITATIVE

Russian Higher Educational Institutions' Ability to Compete and the Strict Standards of "Hamburg Scoring"

ERIC Educational Resources Information Center

Plaksii, S.

2009-01-01

Russian universities rank poorly in international comparisons, and recent suggested reforms will not change this situation. There is an urgent need to find ways to improve the quality of Russia's higher education and to make it more appealing to scientists and to international students. In general, in order for the world to begin to appreciate and…

The development of reproductive management practices in New Zealand: what will the future hold in a consumer-focused, environmentally-conscious, export-driven marketplace?

PubMed

Burke, C R; Verkerk, G A

2010-01-01

The New Zealand (NZ) economy and its dairy industry are sensitive to global consumer perception of farming practices used to generate milk products because milk exports account for > 25% of national export earnings and > 90% of milk produced is exported as products. Astute management of product image and market risk is, therefore, important for the viability of the industry and country. More than 95% of milk produced in NZ comes from strictly seasonal, pasture-based systems, with associated constraints on reproductive performance. Increasing herd sizes, operational changes and genetic selection priorities have further challenged dairy farmers to achieve optimal levels of herd fertility. Reproductive management practices have developed to address the need to maintain a 365-day inter-calving interval, essentially through maximizing the number of cyclic cows during the breeding period and minimizing the duration of the seasonal calving period. Aspects of the hormonal interventions developed and routinely used to achieve these objectives have been the subject of product quality and market risk concerns forcing the industry to explore alternative ways of achieving reproductive performance goals. One approach has been to exploit the inherently high level of fertility in NZ dairy herds. This approach has seen the inclusion of fertility-related traits in the national genetic evaluation system to prevent further decline in genetic fertility. More recently, a nationally coordinated extension program has been adopted to support farmers and their advisors to identify, prioritize and improve on key management areas for incremental gains in herd reproductive performance. Advances in automation and bio-sensing are yet to make a significant impact, but remain potentially valuable additions in supporting the dairy farmer to manage the areas having the largest effects on reproductive performance.

Ensuring the consistancy of Flow Direction Curve reconstructions: the 'quantile solidarity' approach

NASA Astrophysics Data System (ADS)

Poncelet, Carine; Andreassian, Vazken; Oudin, Ludovic

2015-04-01

Flow Duration Curves (FDCs) are a hydrologic tool describing the distribution of streamflows at a catchment outlet. FDCs are usually used for calibration of hydrological models, managing water quality and classifying catchments, among others. For gauged catchments, empirical FDCs can be computed from streamflow records. For ungauged catchments, on the other hand, FDCs cannot be obtained from streamflow records and must therefore be obtained in another manner, for example through reconstructions. Regression-based reconstructions are methods relying on the evaluation of quantiles separately from catchments' attributes (climatic or physical features).The advantage of this category of methods is that it is informative about the processes and it is non-parametric. However, the large number of parameters required can cause unwanted artifacts, typically reconstructions that do not always produce increasing quantiles. In this paper we propose a new approach named Quantile Solidarity (QS), which is applied under strict proxy-basin test conditions (Klemes, 1986) to a set of 600 French catchments. Half of the catchments are considered as gauged and used to calibrate the regression and compute residuals of the regression. The QS approach consists in a three-step regionalization scheme, which first links quantile values to physical descriptors, then reduces the number of regression parameters and finally exploits the spatial correlation of the residuals. The innovation is the utilisation of the parameters continuity across the quantiles to dramatically reduce the number of parameters. The second half of catchment is used as an independent validation set over which we show that the QS approach ensures strictly growing FDC reconstructions in ungauged conditions. Reference: V. KLEMEŠ (1986) Operational testing of hydrological simulation models, Hydrological Sciences Journal, 31:1, 13-24

Quality control processes in allografting: A twenty-year retrospective review of a hospital-based bone bank in Taiwan.

PubMed

Fu, Shau-Huai; Liu, Jyh-You; Huang, Chuan-Ching; Lin, Feng-Ling; Yang, Rong-Sen; Hou, Chun-Han

2017-01-01

Musculoskeletal allografts are now commonly used. To decrease the potential risks of transmission of pathogenic bacteria, fungi, or viruses to the transplant recipients, certain issues regarding the management of patients who receive contaminated allografts need to be addressed. We aimed to clarify the incidence and extent of disease transmission from allografts by analyzing the allografting procedures performed in the bone bank of our hospital over the past 20 years. We retrospectively reviewed the data from our allograft registry center on 3979 allografts that were implanted in 3193 recipients throughout a period of two decades, from July 1991 to June 2011. The source of the allografts, results of all screening tests, dates of harvesting and implantation, and recipients of all allografts were checked. With the help of the Center for Infection Control of our hospital, a strict prospective, hospital-wide, on-site surveillance was conducted, and every patient with healthcare-associated infection was identified. Fisher's exact test was used to compare the infection rate between recipients with sterile allografts and those with contaminated allografts. The overall discard and infection rates were, respectively, 23% and 1.3% in the first decade (1991-2001); and 18.4% and 1.25% in the second decade (2001-2011). The infection rate of contaminated allograft recipients was significantly higher than that of sterile allograft recipients (10% vs. 1.15%, P < 0.01) in the second decade. Both infection and discard rates of our bone bank are comparable with those of international bone banks. Strict allograft processing and adequate prophylactic use of antibiotics are critical to prevent infection and disease transmission in such cases.

Quality control processes in allografting: A twenty-year retrospective review of a hospital-based bone bank in Taiwan

PubMed Central

Fu, Shau-Huai; Liu, Jyh-You; Huang, Chuan-Ching; Lin, Feng-ling; Yang, Rong-Sen; Hou, Chun-han

2017-01-01

Musculoskeletal allografts are now commonly used. To decrease the potential risks of transmission of pathogenic bacteria, fungi, or viruses to the transplant recipients, certain issues regarding the management of patients who receive contaminated allografts need to be addressed. We aimed to clarify the incidence and extent of disease transmission from allografts by analyzing the allografting procedures performed in the bone bank of our hospital over the past 20 years. We retrospectively reviewed the data from our allograft registry center on 3979 allografts that were implanted in 3193 recipients throughout a period of two decades, from July 1991 to June 2011. The source of the allografts, results of all screening tests, dates of harvesting and implantation, and recipients of all allografts were checked. With the help of the Center for Infection Control of our hospital, a strict prospective, hospital-wide, on-site surveillance was conducted, and every patient with healthcare-associated infection was identified. Fisher’s exact test was used to compare the infection rate between recipients with sterile allografts and those with contaminated allografts. The overall discard and infection rates were, respectively, 23% and 1.3% in the first decade (1991–2001); and 18.4% and 1.25% in the second decade (2001–2011). The infection rate of contaminated allograft recipients was significantly higher than that of sterile allograft recipients (10% vs. 1.15%, P < 0.01) in the second decade. Both infection and discard rates of our bone bank are comparable with those of international bone banks. Strict allograft processing and adequate prophylactic use of antibiotics are critical to prevent infection and disease transmission in such cases. PMID:29049290

Reconsideration of Secondary Risk Management Strategies in Patients with Ischemic Heart Disease.

PubMed

Kashiyama, Kuninobu; Sonoda, Shinjo; Otsuji, Yutaka

2017-01-01

The main risk factors in ischemic heart diseases, including myocardial infarction, are hypertension, dyslipidemia, diabetes, obesity and smoking. The incidence of ischemic heart disease in Japan has been lower than that in Western countries because of differences in lifestyle and the anatomy of the coronary arteries, but the situation has been changing recently because of the westernization of lifestyle. Cardiovascular diseases have become the second most common cause of death in Japan, and 40% of those deaths are attributed to ischemic heart disease. Patients with a history of myocardial infarction, especially, have an increased risk of re-infarction, so strict management of coronary risk factors is important for the prevention of secondary ischemic heart disease. Although there are many guidelines about how to manage the risk factors, there are still many problems. Although lipid management has been demonstrated to have a protective effect against coronary artery disease and arteriosclerotic guidelines have been developed, it is reported that only about one third of patients achieved the low-density lipoprotein (LDL) target value under secondary prevention. Moreover, it is unclear whether the lower target value is required for high-risk patients. Recent research on diabetes has reported increased mortality in patients with intensive glycemic control. We should discuss when to start treatment, which medicine to use, and to what extent we should manage glycemic control. Strict management based on current therapeutic guidelines is effective for secondary prevention of ischemic heart disease, with target values of less than 135/85 mmHg for home blood pressure, less than 100 mg/dl for LDL-C, more than 40 mg/dl for HDL-C, less than 150 mg/dl for TG, and, for diabetic patients, less than 7.0% for HbA1c (NGSP).

Veterinary dairy herd health management in Europe: constraints and perspectives.

PubMed

Cannas da Silva, J; Noordhuizen, J P T M; Vagneur, M; Bexiga, R; Gelfert, C C; Baumgartner, W

2006-03-01

The nature of veterinary work in dairy health management in Europe has changed over the past years and will change even more dramatically in the near future. The consumers and the media show increasing concern about animal welfare, safety of products of animal origin and traceability of animal products. Farmers in Europe have to produce under strict, often expensive and laborious regulations, while still commercially competing with farmers outside the EU and not subject to the same rules. Veterinarians should adapt their knowledge and skills to the new challenges and developments of the dairy sector. Dairy farmers nowadays ask for support in areas that go beyond clinical activities: environmental protection, welfare, nutrition, grassland management, economics and business management. Bovine practitioners should be able to advise in many different areas and subjects--that is the challenge to our profession. Veterinary education with regards to cattle health management should start with individual animal clinical work, which constitutes the basis of herd health advisory programmes. The bovine practitioner should then look beyond that and regard the herd as the unit. Each diseased cow or group of cows should be detected early enough to avoid financial losses or such losses should be prevented altogether by detecting and managing risk factors contributing to disease occurrence. Herd health and production management programmes represent the first level to optimise dairy farm performance. Expansions to that should further be considered, comprising both animal health and welfare issues, as well as food safety and public health issues. The latter could be addressed by quality risk management programmes following the HACCP-principles. Cattle veterinarians should follow recent developments and invest in new skills and knowledge in order to maintain their usefulness to the modern dairy farmer. Finally we are convinced that the cattle practitioner should evolve into this direction, otherwise the veterinarian as we know him will miss the train in the next years.

[Indicators of water microbial pollution: problems and perspectives].

PubMed

Nusca, A; D'Alessandro, D; Funari, E

2008-01-01

Conventional indicators of fecal contamination provide a precious contribution in evaluating water microbiological quality. In recent years some important issues have sprung up which have risen doubts about their reliability and have suggested a revision of their function. In developed countries, where the law regarding water quality is very strict, there have been several outbreaks, even though conventional indicators of fecal pollution pointed an appropriate microbiological quality. These outbreaks have been imputed to new pathogenic microorganisms which are often characterized by a great resistance to disinfection treatments than conventional indicators. In order to obtain an appropriate microbiological quality of waters, various approaches have been started such as the Water Safety Plans by World Health Organization the revision of the functions of suitable indicators (of the water quality), the setting up of specific methods either for pathogen microorganisms and for a quick surveying of an inadequate microbiological water quality.

Praise in Public, Criticize in Private? An Assessment of Performance Feedback Transparency in a Classroom Setting

ERIC Educational Resources Information Center

Seevers, Matthew T.; Rowe, William J.; Skinner, Steven J.

2014-01-01

Conventional wisdom in sales management encourages public delivery of positive feedback, and private delivery of negative feedback. In stark contrast, U.S. educators typically provide all performance feedback in relative (if not strict) privacy to comply with the Family Educational Rights and Privacy Act (FERPA). To investigate this discrepancy,…

Analysis of Cisco Open Network Environment (ONE) OpenFlow Controller Implementation

DTIC Science & Technology

2014-08-01

Software - Defined Networking ( SDN ), when fully realized, offer many improvements over the current rigid and...functionalities like handshake, connection setup, switch management, and security. 15. SUBJECT TERMS OpenFlow, software - defined networking , Cisco ONE, SDN ...innovating packet-forwarding technologies. Network device roles are strictly defined with little or no flexibility. In Software - Defined Networks ( SDNs ),

MEASUREMENT EQUIVALENCE OF NEIGHBORHOOD QUALITY MEASURES FOR EUROPEAN AMERICAN AND MEXICAN AMERICAN FAMILIES

PubMed Central

Kim, Su Yeong; Nair, Rajni; Knight, George P.; Roosa, Mark W.; Updegraff, Kimberly A.

2009-01-01

The factorial and construct equivalence of subscales assessing parents’ and children’s perceptions of the quality of their neighborhood was examined in Mexican American and European American families. All subscales (dangerous people in the neighborhood, sense of safety in the neighborhood, quality of the physical environment) demonstrated adequate partial factorial invariance across English- and Spanish-speaking Mexican American and European American families. Reports by children about dangerous people in the neighborhood was the closest to achieving strict factorial invariance, and the only one of the four dimensions to achieve invariance in the validity analyses across Mexican American and European American families. The implications of using these self-report neighborhood quality measures in studies of multiple cultural or language groups are discussed. PMID:19183709

Nuclear safety: is NRC enforcement working. Hearing before a Subcommittee of the Committee on Government Operations, House of Representatives, Ninety-Seventh Congress, First Session, December 14, 1981

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

Not Available

Nunzio Palladino, the new Chairman of the Nuclear Regulatory Commission, and associates testified at this hearing on the effectiveness of NRC's enforcement program and responded to allegations that quality assurance is inadequate. At issue were the value of NRC fines as a deterrent to utility misconduct and the NRC's reluctance to pursue new provisions for criminal penalties. Mr. Palladino was welcomed and applauded for his strong statements on the nuclear industry's need for strict quality control. (DCK)

Reporting Quality of Search Methods in Systematic Reviews of HIV Behavioral Interventions (2000-2010): Are the Searches Clearly Explained, Systematic and Reproducible?

ERIC Educational Resources Information Center

Mullins, Mary M.; DeLuca, Julia B.; Crepaz, Nicole; Lyles, Cynthia M.

2014-01-01

Systematic reviews are an essential tool for researchers, prevention providers and policy makers who want to remain current with the evidence in the field. Systematic review must adhere to strict standards, as the results can provide a more objective appraisal of evidence for making scientific decisions than traditional narrative reviews. An…

Payload operations management of a planned European SL-Mission employing establishments of ESA and national agencies

NASA Technical Reports Server (NTRS)

Joensson, Rolf; Mueller, Karl L.

1994-01-01

Spacelab (SL)-missions with Payload Operations (P/L OPS) from Europe involve numerous space agencies, various ground infrastructure systems and national user organizations. An effective management structure must bring together different entities, facilities and people, but at the same time keep interfaces, costs and schedule under strict control. This paper outlines the management concept for P/L OPS of a planned European SL-mission. The proposal draws on the relevant experience in Europe, which was acquired via the ESA/NASA mission SL-1, by the execution of two German SL-missions and by the involvement in, or the support of, several NASA-missions.

Management of nosocomial scabies, an outbreak of occupational disease.

PubMed

Jungbauer, Frank H W; Veenstra-Kyuchukova, Yanka K; Koeze, Jacqueline; KruijtSpanjer, Martijn R; Kardaun, Sylvia H

2015-05-01

The optimal approach to managing institutional scabies outbreaks has yet to be defined. We report on outbreak managements are needed. We report on a large outbreak of scabies in three acute care wards in a tertiary university teaching hospital in the Netherlands. The outbreak potentially effected 460 patients and 185 health care workers who had been exposed to the index patient. Containment of an outbreak relies on a quick and strict implementation of appropriate infection control measures and should include simultaneous treatment of all infested persons and exposed contacts to prevent secondary spread and prolonged post-intervention surveillance. © 2015 Wiley Periodicals, Inc.

Impact of a risk management plan on Legionella contamination of dental unit water.

PubMed

Leoni, Erica; Dallolio, Laura; Stagni, Francesca; Sanna, Tiziana; D'Alessandro, Giovanni; Piana, Gabriela

2015-02-23

The study aimed to assess the prevalence of Legionella spp. in dental unit waterlines of a dental clinic and to verify whether the microbiological parameters used as indicators of water quality were correlated with Legionella contamination. A risk management plan was subsequently implemented in the dental health care setting, in order to verify whether the adopted disinfection protocols were effective in preventing Legionella colonization. The water delivered from syringes and turbines of 63 dental units operating in a dental clinic, was monitored for counts of the heterotrophic bacteria P. aeruginosa and Legionella spp. (22 °C and 37 °C). At baseline, output water from dental units continuously treated with disinfection products was more compliant with the recommended standards than untreated and periodically treated water. However, continuous disinfection was still not able to prevent contamination by Legionella and P. aeruginosa. Legionella was isolated from 36.4%, 24.3% and 53.3% of samples from untreated, periodically and continuously treated waterlines, respectively. The standard microbiological parameters used as indicators of water quality proved to be unreliable as predictors of the presence of Legionella, whose source was identified as the tap water used to supply the dental units. The adoption of control measures, including the use of deionized water in supplying the dental unit waterlines and the application of a combined protocol of continuous and periodic disinfection, with different active products for the different devices, resulted in good control of Legionella contamination. The efficacy of the measures adopted was mainly linked to the strict adherence to the planned protocols, which placed particular stress on staff training and ongoing environmental monitoring.

[Effect analysis on the two total load control methods for poisonous heavy metals].

PubMed

Fu, Guo-Wei

2012-12-01

Firstly it should be made clear that implementation of source total load control for the first type of pollutants is necessary for environmental pollution control legislation and economic structure regulation. This kind of surveillance method has been more practical to be implemented since the Manual of the Industry Discharge Coefficient of First National Pollution Sources Investigation was published. The source total load control and water environment total load control are independent of each other and none of them is redundant, on the other side they can be complementary to each other. In the present, some local planning managers are blurring and confusing the contents and styles of the two surveillance methods. They just use the water total load control to manage all the pollutants, and source total load control is discarded, which results in the loss of control for the first type of pollutants especially for the drinking water source surveillance. There is a big difference between the water quality standards and the water environmental background concentration values for the first type of pollutants in the Environmental quality standard for surface water (GB 3838-88), which means that there are problems such as "relaxing the pollutant discharge permit" and "risk induced by valence state change". Taking an enterprise with 10t electrolytic lead production capacity as an example, there is a big difference between the allowable lead discharged loads by the two total load surveillance methods. In summary, it will bring a lot of harmful effects if the water total load control is implemented for the two types of pollutants, so the source total load control and water environmental total load control should be implemented strictly at the same time.

Metal Chemical and Isotope Characterisation in the Upper Loire River Basin, France

NASA Astrophysics Data System (ADS)

Widory, D.; Nigris, R.; Morard, A.; Gassama, N.; Poirier, A.; Bourrain, X.

2016-12-01

The Water Framework Directive (WFD) elaborated by the European Commission regulates water resources in the EC based on five years management plans. A new management plan that started in 2016 imposes strict water quality criteria to its member states, including good status thresholds for metallic contaminants. The Loire River, the most important river in France, flows through areas with lithologies naturally containing high metal concentrations in the upper part of its basin. Understanding these metal fluxes into the river is thus a prerequisite to understand their potential impact on the quality of its water in regards to the criteria defined by the WFD. The Massif Central, a residue of the Hercynian chain, is composed of granitic and volcanic rocks. Both its upstream position in the Loire basin and its numerous metal mineralizations made this region a good candidate for characterizing the natural metal geochemical background of its surface waters. To fulfill this objective we focused on the Pb, Cd and Zn chemical and isotope characteristics of selected non-anthropized small watersheds. The investigated small watersheds were selected for supposedly draining a single lithology and undergoing (as far as possible) negligible to no anthropogenic pressure. Results showed that although the high metal potential of the upper part of the Loire River basin has been highly exploited by humans for centuries, metal concentrations during the hydrological cycle are still under the guidelines defined by the WFD. Isotope compositions/ratios are strongly related to the corresponding lithologies along the rivers and help precisely define the local geochemical background that can then be used to identify and quantify any anthropogenic inputs downstream.

The routing, modulation level, and spectrum allocation algorithm in the virtual optical network mapping

NASA Astrophysics Data System (ADS)

Wang, Yunyun; Li, Hui; Liu, Yuze; Ji, Yuefeng; Li, Hongfa

2017-10-01

With the development of large video services and cloud computing, the network is increasingly in the form of services. In SDON, the SDN controller holds the underlying physical resource information, thus allocating the appropriate resources and bandwidth to the VON service. However, for some services that require extremely strict QoT (quality of transmission), the shortest distance path algorithm is often unable to meet the requirements because it does not take the link spectrum resources into account. And in accordance with the choice of the most unoccupied links, there may be more spectrum fragments. So here we propose a new RMLSA (the routing, modulation Level, and spectrum allocation) algorithm to reduce the blocking probability. The results show about 40% less blocking probability than the shortest-distance algorithm and the minimum usage of the spectrum priority algorithm. This algorithm is used to satisfy strict request of QoT for demands.

The Effects of Sequential Environmental and Harvest Stressors on the Sensory Characteristics of Cultured Channel Catfish (Ictalurus Punctatus) Fillets.

PubMed

Ciaramella, Michael A; Kim, Taejo; Avery, Jimmy L; Allen, Peter J; Schilling, M Wes

2016-08-01

Stress during fish culture alters physiological homeostasis and affects fillet quality. Maintenance of high-quality seafood is important to ensure the production of a marketable product. This study assessed how sequential stressors affect the sensory and quality characteristics of catfish (Ictalurus punctatus) fillets. Three stress trials were conducted where temperature (25 or 33 °C) and dissolved oxygen (DO, approximately 2.5 or >5 mg/L) were manipulated followed by socking and transport stress. After each stage of harvest (environmental stress, socking, and transport), fillet yield, consumer acceptability, descriptive evaluation, cook loss, tenderness, and pH were evaluated. Fillet yield decreased with increasing severity of environmental stress. Fillets from the severe stress treatment (33 °C, approximately 2.5 mg/L) received the highest acceptability scores (P < 0.05). Control fillets (25 °C, >5 mg/L) were the least acceptable (P < 0.05). Increased intensity of less favorable flavor attributes commonly associated with catfish resulted in the differences in acceptability among treatments. As fish progressed through the harvest event, cook loss decreased, tenderness increased, and pH increased, indicating that stress induced textural changes. The data suggest that although environmental stress results in slight changes in flavor attributes, its effects on acceptability are minor with fillets from all treatments still liked (>6 on a 9 point scale). Socking and transport were identified to positively affect textural characteristics of catfish fillets. Although the effects observed were not likely to negatively impact consumer acceptance, a strict management plan should be followed to maintain consistency in the product and avoid changes in stressors that might alter quality more drastically. © 2016 Institute of Food Technologists®

An Analysis of the Depot Material Management Overhead in the VAMOSC (Visibility and Management of Operating Support Cost System) Component Support Cost System.

DTIC Science & Technology

1987-09-01

University, the United States Air Force, or the Department of JDefense. Accession For NTIS GRA&I DTIC TAB Uliannouncedj u s t i f i c a t i o n...114 VI vi W,7% WN T "Vyn An r % List of Tables Table Page 1. ALCs Operation and Maintenance Costs ....... 53 2...CSCS deals strictly with aircraft com- ponents and subsystems that have been designated reparable, which means they are economical to repair. As part

Circular on early marriage, March 1988.

PubMed

1988-01-01

This Circular calls on government at all levels in Hunan, China, to summon the departments concerned thoroughly to investigate the problem of early child-bearing so that they can do a good job in managing the problems of unregistered cohabiting and of unmarried mothers. The Circular recommends that: "It is necessary to criticize and educate, and even punish by discipline, those parents who connive with their sons and daughters in practicing unregistered cohabiting." It also states the following: "It is necessary to keep a strict check on registry personnel who do not carry out their duties properly. Those who violate laws and discipline, engage in malpractices for selfish ends, and practice bribery and corruption, resulting in early marriage and child-bearing, must be dealt with strictly. Legal sanctions must be enforced against those who break the law." full text

From field to cloud: a collaborative software tool to manage hydrological observatories

NASA Astrophysics Data System (ADS)

Kraft, Philipp; Weber, Chris P.; Windhorst, David; Breuer, Lutz

2017-04-01

Managing data collection, assessment, storage, and analysis in hydrological observatories is challenging: Many processes can only be detected when long-term time series are being analysed, but temporary staff like postgraduates perform the measurements. Naturally the students focus on the data needed for their project and do not particularly care about the long-term availability of the data. Data providing new process insights gets often lost in unmaintainable spreadsheets with no clear distinction between raw, error controlled and derived data. Data warehouse systems, like the one developed by the Consortium of Universities for the Advancement of Hydrologic Science (CUAHSI) and strict data management guide lines by funding institutions, intend to mediate this effect. However, data warehouse structures are optimized for write once / read often use and require rigorous quality control and metadata description prior to the upload. Our experience shows a risk for data loss at this stage: Data collected at the end of a project is not reviewed and never enters the database and gets lost with the expiring position. As a solution to this kind of problems, we suggest to enter observation early, if possible online, and perform the review process in the system. We are presenting a new collaborative tool for managing hydrological observatories in a standardized and well documented manner directly from the point of data production, the field. Beside the observation data the system stores the observatory management tasks to ensure regular sampling or sensor maintenance. A second benefit of logging management actions together with observations, is the possibility to interpret side effects of sampling or maintenance actions on measurements. In difference to data warehouse systems, the users do data quality control and sensor calibration directly in the online system. The raw data is not changed but augmented by calibration equations and faulty data points are not deleted but marked as an error. Transformation functions convert direct observation to derived data, like discharge, on the fly. Improved stage-discharge relations apply directly to older measurements. The management system consists of a web portal, plotting and mapping facilities, import and export functions, an image database, and a management tool to assign tasks. A transparent link to CUAHSI Hydrological Information System (HIS), a data sharing portal, is currently under development using the standardized WaterML interface. The system is freely available and built upon open source tools. The system is in operational use for three observatories located in Germany, Ecuador and Kenya holding 10 to 50 Million records.

The compressed average image intensity metric for stereoscopic video quality assessment

NASA Astrophysics Data System (ADS)

Wilczewski, Grzegorz

2016-09-01

The following article depicts insights towards design, creation and testing of a genuine metric designed for a 3DTV video quality evaluation. The Compressed Average Image Intensity (CAII) mechanism is based upon stereoscopic video content analysis, setting its core feature and functionality to serve as a versatile tool for an effective 3DTV service quality assessment. Being an objective type of quality metric it may be utilized as a reliable source of information about the actual performance of a given 3DTV system, under strict providers evaluation. Concerning testing and the overall performance analysis of the CAII metric, the following paper presents comprehensive study of results gathered across several testing routines among selected set of samples of stereoscopic video content. As a result, the designed method for stereoscopic video quality evaluation is investigated across the range of synthetic visual impairments injected into the original video stream.

Legal barriers

Treesearch

Anita E. Ruud

1995-01-01

The law is a strict master regarding any kind of deliberately set fires. The value of natural resources and resource management is low on the list of priorities for this state’s lawmakers. BEWARE is the key word for those who dare to challenge the traditional notion that all fires must be extinguished immediately, except those within the safe confines of your fireplace...

The challenge of a data storage hierarchy

NASA Technical Reports Server (NTRS)

Ruderman, Michael

1992-01-01

A discussion of Mesa Archival Systems' data archiving system is presented. This data archiving system is strictly a software system that is implemented on a mainframe and manages the data into permanent file storage. Emphasis is placed on the fact that any kind of client system on the network can be connected through the Unix interface of the data archiving system.

China Report, Economic Affairs, No. 353

DTIC Science & Technology

1983-06-20

INDUSTRY Introduction to Key Projects Throughout Country (Fei Qiangj XINHUA Domestic Service, 27 May 83) 20 Small Tractors Supply in Rural Areas...reforming the commodity circulation system and the industrial management system at the country level, successfully carrying out readjustment in...must vigorously expand economic activitieswith foreign countries . 5. We must strictly observe discipline. 6. We must do well in structural reform

A novel genotype VII Newcastle disease virus vaccine candidate generated by mutation in the L and F genes confers improved protection in chickens

USDA-ARS?s Scientific Manuscript database

Administration of vaccines combined with the good management and strict biosecurity is an e'ective way for Newcastle disease (ND) control. However, vaccine failure is continuously reported in some countries mainly because the antigenic di'erence between the used vaccine and 'eld strains even they ar...

Major depressive disorder in epilepsy clinics: A meta-analysis.

PubMed

Kim, Minjung; Kim, Young-Soo; Kim, Do-Hyung; Yang, Tae-Won; Kwon, Oh-Young

2018-05-09

Although depression is a frequent psychiatric comorbidity in people with epilepsy (PWE), its prevalence has been underestimated. Comorbid depression has negative impacts on treatment outcomes and quality of life (QOL). It also causes various problems in PWE, such as fatigue, irritability, and suicidality. This meta-analysis was performed to estimate the frequency of major depression disorder (MDD) in clinics managing PWE. We searched MEDLINE, EMBASE, Cochrane Library, Web of Science, and SCOPUS to identify studies. Hospital-based studies and original research presenting information regarding prevalence of MDD, determined using a gold standard diagnostic tool in adult PWE, were considered for inclusion. The prevalence of depression was examined by meta-analysis. In addition, subgroup analysis was performed based on the continent where the selected studies were conducted, the strictness of selection criteria, and gender. Strict selection criteria were defined as any mention of the use of exclusion criteria. A total of 6607 studies were identified by searching the five databases outlined above. After screening and rescreening, 35 studies were included in the meta-analysis. The total number of PWE was 5434. In the test for heterogeneity of the studies, I 2 was 68.014, and the Cochran Q value was 106.296 (p < 0.01). As a pooled estimate, the point prevalence of MDD in PWE was 21.9% with a 95% confidence interval (CI) of 20.8-23.0 in a fixed effects model. In subgroup analyses, continent partly explained the heterogeneity among the selected studies, but the strictness of selection criteria did not. The prevalence of MDD was higher in females than in males (26.4% vs. 16.7%, respectively) with an odds ratio (OR) of 1.805 (95% CI: 1.443-2.258; p < 0.01). The point prevalence of MDD is estimated at 21.9% among PWE in epilepsy clinics and is higher in females than in males. Based on this relatively high prevalence in PWE, measures are required to identify and resolve MDD. In addition, the female predominance of MDD among PWE indicates a need to pay greater attention to females. Such efforts may reduce the impact of depression in PWE and improve their QOL. Copyright © 2018 Elsevier Inc. All rights reserved.

7 CFR 28.441 - Strict Middling Yellow Stained Color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Strict Middling Yellow Stained Color. 28.441 Section... Strict Middling Yellow Stained Color. Strict Middling Yellow Stained Color is color which is deeper than that of Strict Middling Tinged Color. [57 FR 34498, Aug. 5, 1992] ...

7 CFR 28.441 - Strict Middling Yellow Stained Color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Strict Middling Yellow Stained Color. 28.441 Section... Strict Middling Yellow Stained Color. Strict Middling Yellow Stained Color is color which is deeper than that of Strict Middling Tinged Color. [57 FR 34498, Aug. 5, 1992] ...

7 CFR 28.441 - Strict Middling Yellow Stained Color.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Strict Middling Yellow Stained Color. 28.441 Section... Strict Middling Yellow Stained Color. Strict Middling Yellow Stained Color is color which is deeper than that of Strict Middling Tinged Color. [57 FR 34498, Aug. 5, 1992] ...

7 CFR 28.441 - Strict Middling Yellow Stained Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Strict Middling Yellow Stained Color. 28.441 Section... Strict Middling Yellow Stained Color. Strict Middling Yellow Stained Color is color which is deeper than that of Strict Middling Tinged Color. [57 FR 34498, Aug. 5, 1992] ...

7 CFR 28.441 - Strict Middling Yellow Stained Color.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Middling Yellow Stained Color. 28.441 Section... Strict Middling Yellow Stained Color. Strict Middling Yellow Stained Color is color which is deeper than that of Strict Middling Tinged Color. [57 FR 34498, Aug. 5, 1992] ...

7 CFR 28.412 - Strict Middling Light Spotted Color.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Middling Light Spotted Color. 28.412 Section 28... Light Spotted Color. Strict Middling Light Spotted Color is color which in spot or color, or both, is between Strict Middling Color and Strict Middling Spotted Color. ...

Reconsidering Planning and Management of Medical Devices Procurement in Public Health Services in Cyprus

PubMed Central

Theodorou, Mamas; Georgiou, Marina; Nikolentzos, Athanasios; Bellali, Thalia

2015-01-01

Hospital procurement is a crucial field for any health care system, not only for economic reasons but also for reasons related to the quality and safety of the services provided. That is why the process of procurement is, in most countries, governed by a strict legal framework and policy mechanisms. This study investigates the problems and inefficiencies associated with the procurement of medical devices in public hospitals in Cyprus and formulates empirically documented proposals for improvement. Using the Delphi method, a group of 38 experts approach the procurement system in Cyprus from different angles, achieving high rates of consensus on 35 different statements on the weaknesses and problems of the current medical device procurement system, as well as presenting proposals and recommendations for improvement. The findings are highly valuable for future policy initiatives in Cyprus in the light of the economic crisis and the expected implementation of the new General Health Insurance System (GeSY), which the Government of the Republic of Cyprus and the Troika has agreed. PMID:26153175

Oral Manifestations in Pediatric Patients with Coeliac Disease – A Review Article

PubMed Central

Macho, Viviana Marisa Pereira; Coelho, Ana Sofia; Veloso e Silva, Diana Maria; de Andrade, David José Casimiro

2017-01-01

Background: Coeliac disease is a chronic enteropathy that remains a challenge for the clinician, due to its atypical manifestations and etiopathogenic complexity. Objective: This article intends to describe the oral characteristics of Coeliac Disease in children in order to facilitate their management in the dental office. Methods: A review of the literature was performed electronically in PubMed (PubMed Central, and MEDLINE) for articles published in English from 2000 to April of 2017. The article is also based on the authors' clinical experience with children with coeliac disease. The searched keywords were “coeliac disease “,”oral manifestations “, “dental enamel defects”, “recurrent aphthous stomatitis” and “oral aphthous ulcers”. Results: There are some oral manifestations which are strictly related to coeliac disease: dental enamel defects, recurrent aphthous stomatitis, delayed tooth eruption, multiple caries, angular cheilitis, atrophic glossitis, dry mouth and burning tongue. Conclusion: The complete knowledge of the oral manifestations of coeliac disease can trigger an effective change in the quality of life of the patients with this disease. PMID:29238414

Role of high-elevation groundwater flows in the hydrogeology of the Cimino volcano (central Italy) and possibilities to capture drinking water in a geogenically contaminated environment

NASA Astrophysics Data System (ADS)

Piscopo, V.; Armiento, G.; Baiocchi, A.; Mazzuoli, M.; Nardi, E.; Piacentini, S. M.; Proposito, M.; Spaziani, F.

2018-01-01

Origin, yield and quality of the groundwater flows at high elevation in the Cimino volcano (central Italy) were examined. In this area, groundwater is geogenically contaminated by arsenic and fluoride, yet supplies drinking water for approximately 170,000 inhabitants. The origin of the high-elevation groundwater flows is strictly related to vertical and horizontal variability of the rock types (lava flows, lava domes and ignimbrite) in an area of limited size. In some cases, groundwater circuits are related to perched aquifers above noncontinuous aquitards; in other cases, they are due to flows in the highly fractured dome carapace, limited at the bottom by a low-permeability dome core. The high-elevation groundwater outflow represents about 30% of the total recharge of Cimino's hydrogeological system, which has been estimated at 9.8 L/s/km2. Bicarbonate alkaline-earth, cold, neutral waters with low salinity, and notably with low arsenic and fluoride content, distinguish the high-elevation groundwaters from those of the basal aquifer. Given the quantity and quality of these resources, approaches in the capture and management of groundwater in this hydrogeological environment should be reconsidered. Appropriate tapping methods such as horizontal drains, could more efficiently capture the high-elevation groundwater resources, as opposed to the waters currently pumped from the basal aquifer which often require dearsenification treatments.

Role of high-elevation groundwater flows in the hydrogeology of the Cimino volcano (central Italy) and possibilities to capture drinking water in a geogenically contaminated environment

NASA Astrophysics Data System (ADS)

Piscopo, V.; Armiento, G.; Baiocchi, A.; Mazzuoli, M.; Nardi, E.; Piacentini, S. M.; Proposito, M.; Spaziani, F.

2018-06-01

Origin, yield and quality of the groundwater flows at high elevation in the Cimino volcano (central Italy) were examined. In this area, groundwater is geogenically contaminated by arsenic and fluoride, yet supplies drinking water for approximately 170,000 inhabitants. The origin of the high-elevation groundwater flows is strictly related to vertical and horizontal variability of the rock types (lava flows, lava domes and ignimbrite) in an area of limited size. In some cases, groundwater circuits are related to perched aquifers above noncontinuous aquitards; in other cases, they are due to flows in the highly fractured dome carapace, limited at the bottom by a low-permeability dome core. The high-elevation groundwater outflow represents about 30% of the total recharge of Cimino's hydrogeological system, which has been estimated at 9.8 L/s/km2. Bicarbonate alkaline-earth, cold, neutral waters with low salinity, and notably with low arsenic and fluoride content, distinguish the high-elevation groundwaters from those of the basal aquifer. Given the quantity and quality of these resources, approaches in the capture and management of groundwater in this hydrogeological environment should be reconsidered. Appropriate tapping methods such as horizontal drains, could more efficiently capture the high-elevation groundwater resources, as opposed to the waters currently pumped from the basal aquifer which often require dearsenification treatments.

Are new supraglottic airway devices, tracheal tubes and airway viewing devices cost-effective?

PubMed

Slinn, Simon J; Froom, Stephen R; Stacey, Mark R W; Gildersleve, Christopher D

2015-01-01

Over the past two decades, a plethora of new airway devices has become available to the pediatric anesthetist. While all have the laudable intention of improving patient care and some have proven clinical benefits, these devices are often costly and at times claims of an advantage over current equipment and techniques are marginal. Supraglottic airway devices are used in the majority of pediatric anesthetics delivered in the U.K., and airway-viewing devices provide an alternative for routine intubation as well as an option in the management of the difficult airway. Yet hidden beneath the convenience of the former and the technology of the latter, the impact on basic airway skills with a facemask and the lack of opportunities to fine-tune the core skill of intubation represent an unrecognised and unquantifiable cost. A judgement on this value must be factored into the absolute purchase cost and any potential benefits to the quality of patient care, thus blurring any judgement on cost-effectiveness that we might have. An overall value on cost-effectiveness though not in strict monetary terms can then be ascribed. In this review, we evaluate the role of these devices in the care of the pediatric patient and attempt to balance the advantages they offer against the cost they incur, both financial and environmental, and in any quality improvement they might offer in clinical care. © 2014 John Wiley & Sons Ltd.

The partnership between park wild life management policy and landscape wild life management policy. How shall we then manage?

USGS Publications Warehouse

Halvorson, William L.; Eastin, Chris

1999-01-01

Resources management practices are changing in North America, not only based on greater understanding of the resources that are being managed, but also on some critical sociological relationship changes between human beings and between humans and nature. The entire way that humans look at the natural world and our own society is changing dramatically as we come to the end of the twentieth century. Managers are changing from making belief-based decisions to making informed knowledge-based decisions through better science programs. Society appears to increasingly be making a shift to a community mind-set, a mind-set of connectedness and interdependence, and away from strict individualism. Managers appear to be ready to embrace the concept of unity and wholeness; to understand that humans and nature are inextricably tied to each other’s wellbeing

Planning and managing future space facility projects. [management by objectives and group dynamics

NASA Technical Reports Server (NTRS)

Sieber, J. E.; Wilhelm, J. A.; Tanner, T. A.; Helmreich, R. L.; Burgenbauch, S. F.

1979-01-01

To learn how ground-based personnel of a space project plan and organize their work and how such planning and organizing relate to work outcomes, longitudinal study of the management and execution of the Space Lab Mission Development Test 3 (SMD 3) was performed at NASA Ames Research Center. A view of the problems likely to arise in organizations and some methods of coping with these problems are presented as well as the conclusions and recommendations that pertain strictly to SMD 3 management. Emphasis is placed on the broader context of future space facility projects and additional problems that may be anticipated. A model of management that may be used to facilitate problem solving and communication - management by objectives (MBO) is presented. Some problems of communication and emotion management that MBO does not address directly are considered. Models for promoting mature, constructive and satisfying emotional relationships among group members are discussed.

Influence of Protein Abundance on High-Throughput Protein-Protein Interaction Detection

DTIC Science & Technology

2009-06-05

the interaction data sets we determined, via comparisons with strict randomized simulations , the propensity for essential proteins to selectively...and analysis of high- quality PPI data sets. Materials and Methods We analyzed protein interaction networks for yeast and E. coli determined from Y2H...we reinvestigated the centrality-lethality rule, which implies that proteins having more interactions are more likely to be essential. From analysis

A Comparison of National Policies on Research Involving Human Subjects to Facilitate Review and Approval of Collaborative Research

DTIC Science & Technology

2008-11-26

Exemptions: 1. Routine educational testing 2. Quality assurance studies 3. Strict performance reviews 4. Occupational training 5. Anonymous data...following categories are exempt from this policy: (1) Research conducted in established or commonly accepted educational settings, involving normal... educational practices, such as (i) research on regular and special education instructional strategies, or (ii) research on the effectiveness of or the

Savage Wars of Peace: Case Studies of Pacification in the Philippines, 1900-1902

DTIC Science & Technology

2007-01-01

Family ties and business ventures solidified common interests. Society was built on personal relationships reinforced by economic dependence and social...received special respect.6 For the poor, however, a strict patron-client relationship existed. They worked as farm hands, tenant farmers, or day...laborers. The quality of their existence—family, social, economic, physical—depended on the relationship with their patron. Social mobility for most

High-level disinfection of gastrointestinal endoscope reprocessing

PubMed Central

Chiu, King-Wah; Lu, Lung-Sheng; Chiou, Shue-Shian

2015-01-01

High level disinfection (HLD) of the gastrointestinal (GI) endoscope is not simply a slogan, but rather is a form of experimental monitoring-based medicine. By definition, GI endoscopy is a semicritical medical device. Hence, such medical devices require major quality assurance for disinfection. And because many of these items are temperature sensitive, low-temperature chemical methods, such as liquid chemical germicide, must be used rather than steam sterilization. In summarizing guidelines for infection prevention and control for GI endoscopy, there are three important steps that must be highlighted: manual washing, HLD with automated endoscope reprocessor, and drying. Strict adherence to current guidelines is required because compared to any other medical device, the GI endoscope is associated with more outbreaks linked to inadequate cleaning or disinfecting during HLD. Both experimental evaluation on the surveillance bacterial cultures and in-use clinical results have shown that, the monitoring of the stringent processes to prevent and control infection is an essential component of the broader strategy to ensure the delivery of safe endoscopy services, because endoscope reprocessing is a multistep procedure involving numerous factors that can interfere with its efficacy. Based on our years of experience in the surveillance of culture monitoring of endoscopic reprocessing, we aim in this study to carefully describe what details require attention in the GI endoscopy disinfection and to share our experience so that patients can be provided with high quality and safe medical practices. Quality management encompasses all aspects of pre- and post-procedural care including the efficiency of the endoscopy unit and reprocessing area, as well as the endoscopic procedure itself. PMID:25699232

Damage behavior of Nd:glass of high-power disk amplifier medium in ICF Facility

NASA Astrophysics Data System (ADS)

He, Shaobo; Chen, Lin; Yuan, Xiaodong; Chen, Yuanbin; Cheng, Xiaofeng; Xie, Xudong; Wang, Wenyi; Zu, Xiaotao

2016-12-01

Large aperture Nd:glass disk is often used as the amplifier medium in the inertial confinement fusion (ICF) facilities. The typical size of Nd:glass is up to 810mm×460mm×40mm and more than 3,000 Nd:glass components are needed in the ICF facility. At present, the 3ω fused silica glass and DKDP crystal are mainly responsible for the damage of driver used for ICF. However, with the enlargement of the facility and increase of laser shot number, the laser damage of Nd:glass at 1ω waveband is still an important problem to limit the stable operation of facility and improvement of laser beam quality. In this work, the influence of Nd:glass material itself, mechanical processing, service environment, and laser beam quality on its damage behavior is investigated experimentally and theoretically. The results and conclusions can be summarized as follows: (1) It is very important to control the concentration of platinum impurity particles during melting and the sputtering effect of the cladding materials. (2) The number and length of fractural and brittle scratches should be strictly suppressed during mechanical processing of Nd:glass. (3) The B-integral of high power laser beam should be rigorously controlled. Particularly, the top shape of pulses must be well controlled when operating at high peak laser power. (4) The service environment should be well managed to make sure the cleanness of the surface of Nd:glass better than 100/A level during mounting and running. (5) The service environment and beam quality should be monitored during operation.

[Diabetes care and incidence of severe hypoglycemia in nursing home facilities and nursing services: The Heidelberg Diabetes Study].

PubMed

Bahrmann, A; Wörz, E; Specht-Leible, N; Oster, P; Bahrmann, P

2015-04-01

The goal of this study was to perform a structured analysis of the treatment quality and acute complications of geriatric patients with diabetes mellitus (DM) cared for by nursing services and nursing home facilities. Secondly, structural problems and potentials for improvement in the care of multimorbid older people with DM treated by nursing homes and nursing services were analysed from the viewpoint of geriatric nurses, managers of nursing homes and general practitioners. In all, 77 older persons with DM from 13 nursing homes and 3 nursing services were included in the analysis (76.6% female, HbA1c 6.9 ± 1.4%, age 81.6 ± 9.9 years). Structural problems and potentials for improvement were collected from 95 geriatric nurses, 9 managers of nursing homes and 6 general practitioners using semistandardized questionnaires. Metabolic control was too strict in care-dependent older people with DM (mean HbA1c value: 6.9 ± 1.4 %; recommended by guidelines: 7-8%). The measurement of HbA1c was performed in 16 of 77 people (20.8%) within the last year despite a high visitation frequency of the general practitioners (12.7 ± 7.7 within the last 6 months). The incidence of severe hypoglycemia was 7.8%/patient/year. Regarding the management in case of diabetes-related acute complications 33 geriatric nurses (34.7%) stated not having any written standard (nursing home 39%, geriatric services 16.7%). Complex insulin therapies are still used in older people with DM with the consequence of a high incidence of severe hypoglycemia. Concrete management standards in the case of diabetes-related acute complications for geriatric nurses are lacking for more than one third of the nursing services.

Dairy-cattle health in Gyeongnam, Korea.

PubMed

Jong, S K; Gong, S K; Chung, H K; Dae, S H

2001-12-03

An animal-health monitoring system in the Gyeongnam area was started in 1997 to develop statistically valid data for use in estimating disease frequencies in dairy cattle, and the associated costs. The objectives of this study were to: (1) describe what was done to implement and maintain the system in Gyeongnam; (2) present selected disease frequencies; (3) discuss the epidemiological consideration of what was done and implications for results obtained. Veterinary medical officers (VMOs), comprising professors and graduate students from Gyeongsang National University, faculty of Gyeongnam Livestock Promotion Institute and clinic veterinarians, served as data collectors. After training on current disease and management problems of dairy cattle, interview techniques, sampling methods and data-collection instruments, the VMOs participated in selection of the sample herds and data gathering. Forty (n=40) of 167 dairy herds were selected randomly using a computer-generated list of random numbers and the VMOs visited farms once in a month for 12 months to collect data about management, disease, inventory, production, preventive treatment, financial and other relevant data. Strict data-quality control devices were used. Specific feed-back was developed for the producers and data collectors. The six disorders found most frequently in cows (from the highest to the lowest) were breeding problems, clinical mastitis, birth problems, gastrointestinal problems, metabolic problems and lameness. In young stock, respiratory, multiple system, breeding and gastrointestinal problems were predominant, whereas in calves, gastrointestinal, respiratory and integumental problems predominated.

Strategies for the Successful Implementation of Viral Laboratory Automation

PubMed Central

Avivar, Cristóbal

2012-01-01

It has been estimated that more than 70% of all medical activity is directly related to information providing analytical data. Substantial technological advances have taken place recently, which have allowed a previously unimagined number of analytical samples to be processed while offering high quality results. Concurrently, yet more new diagnostic determinations have been introduced - all of which has led to a significant increase in the prescription of analytical parameters. This increased workload has placed great pressure on the laboratory with respect to health costs. The present manager of the Clinical Laboratory (CL) has had to examine cost control as well as rationing - meaning that the CL’s focus has not been strictly metrological, as if it were purely a system producing results, but instead has had to concentrate on its efficiency and efficacy. By applying re-engineering criteria, an emphasis has had to be placed on improved organisation and operating practice within the CL, focussing on the current criteria of the Integrated Management Areas where the technical and human resources are brought together. This re-engineering has been based on the concepts of consolidating and integrating the analytical platforms, while differentiating the production areas (CORE Laboratory) from the information areas. With these present concepts in mind, automation and virological treatment, along with serology in general, follow the same criteria as the rest of the operating methodology in the Clinical Laboratory. PMID:23248733

Strategies for the successful implementation of viral laboratory automation.

PubMed

Avivar, Cristóbal

2012-01-01

It has been estimated that more than 70% of all medical activity is directly related to information providing analytical data. Substantial technological advances have taken place recently, which have allowed a previously unimagined number of analytical samples to be processed while offering high quality results. Concurrently, yet more new diagnostic determinations have been introduced - all of which has led to a significant increase in the prescription of analytical parameters. This increased workload has placed great pressure on the laboratory with respect to health costs. The present manager of the Clinical Laboratory (CL) has had to examine cost control as well as rationing - meaning that the CL's focus has not been strictly metrological, as if it were purely a system producing results, but instead has had to concentrate on its efficiency and efficacy. By applying re-engineering criteria, an emphasis has had to be placed on improved organisation and operating practice within the CL, focussing on the current criteria of the Integrated Management Areas where the technical and human resources are brought together. This re-engineering has been based on the concepts of consolidating and integrating the analytical platforms, while differentiating the production areas (CORE Laboratory) from the information areas. With these present concepts in mind, automation and virological treatment, along with serology in general, follow the same criteria as the rest of the operating methodology in the Clinical Laboratory.

Perspectives to Performance of Environment and Health Assessments and Models—From Outputs to Outcomes?

PubMed Central

Pohjola, Mikko V.; Pohjola, Pasi; Tainio, Marko; Tuomisto, Jouni T.

2013-01-01

The calls for knowledge-based policy and policy-relevant research invoke a need to evaluate and manage environment and health assessments and models according to their societal outcomes. This review explores how well the existing approaches to assessment and model performance serve this need. The perspectives to assessment and model performance in the scientific literature can be called: (1) quality assurance/control, (2) uncertainty analysis, (3) technical assessment of models, (4) effectiveness and (5) other perspectives, according to what is primarily seen to constitute the goodness of assessments and models. The categorization is not strict and methods, tools and frameworks in different perspectives may overlap. However, altogether it seems that most approaches to assessment and model performance are relatively narrow in their scope. The focus in most approaches is on the outputs and making of assessments and models. Practical application of the outputs and the consequential outcomes are often left unaddressed. It appears that more comprehensive approaches that combine the essential characteristics of different perspectives are needed. This necessitates a better account of the mechanisms of collective knowledge creation and the relations between knowledge and practical action. Some new approaches to assessment, modeling and their evaluation and management span the chain from knowledge creation to societal outcomes, but the complexity of evaluating societal outcomes remains a challenge. PMID:23803642

Governance regime and location influence avoided deforestation success of protected areas in the Brazilian Amazon.

PubMed

Nolte, Christoph; Agrawal, Arun; Silvius, Kirsten M; Soares-Filho, Britaldo S

2013-03-26

Protected areas in tropical countries are managed under different governance regimes, the relative effectiveness of which in avoiding deforestation has been the subject of recent debates. Participants in these debates answer appeals for more strict protection with the argument that sustainable use areas and indigenous lands can balance deforestation pressures by leveraging local support to create and enforce protective regulations. Which protection strategy is more effective can also depend on (i) the level of deforestation pressures to which an area is exposed and (ii) the intensity of government enforcement. We examine this relationship empirically, using data from 292 protected areas in the Brazilian Amazon. We show that, for any given level of deforestation pressure, strictly protected areas consistently avoided more deforestation than sustainable use areas. Indigenous lands were particularly effective at avoiding deforestation in locations with high deforestation pressure. Findings were stable across two time periods featuring major shifts in the intensity of government enforcement. We also observed shifting trends in the location of protected areas, documenting that between 2000 and 2005 strictly protected areas were more likely to be established in high-pressure locations than in sustainable use areas and indigenous lands. Our findings confirm that all protection regimes helped reduce deforestation in the Brazilian Amazon.

Governance regime and location influence avoided deforestation success of protected areas in the Brazilian Amazon

PubMed Central

Nolte, Christoph; Agrawal, Arun; Silvius, Kirsten M.; Soares-Filho, Britaldo S.

2013-01-01

Protected areas in tropical countries are managed under different governance regimes, the relative effectiveness of which in avoiding deforestation has been the subject of recent debates. Participants in these debates answer appeals for more strict protection with the argument that sustainable use areas and indigenous lands can balance deforestation pressures by leveraging local support to create and enforce protective regulations. Which protection strategy is more effective can also depend on (i) the level of deforestation pressures to which an area is exposed and (ii) the intensity of government enforcement. We examine this relationship empirically, using data from 292 protected areas in the Brazilian Amazon. We show that, for any given level of deforestation pressure, strictly protected areas consistently avoided more deforestation than sustainable use areas. Indigenous lands were particularly effective at avoiding deforestation in locations with high deforestation pressure. Findings were stable across two time periods featuring major shifts in the intensity of government enforcement. We also observed shifting trends in the location of protected areas, documenting that between 2000 and 2005 strictly protected areas were more likely to be established in high-pressure locations than in sustainable use areas and indigenous lands. Our findings confirm that all protection regimes helped reduce deforestation in the Brazilian Amazon. PMID:23479648

Decision support system for drinking water management

NASA Astrophysics Data System (ADS)

Janža, M.

2012-04-01

The problems in drinking water management are complex and often solutions must be reached under strict time constrains. This is especially distinct in case of environmental accidents in the catchment areas of the wells that are used for drinking water supply. The beneficial tools that can help decision makers and make program of activities more efficient are decision support systems (DSS). In general they are defined as computer-based support systems that help decision makers utilize data and models to solve unstructured problems. The presented DSS was developed in the frame of INCOME project which is focused on the long-term stable and safe drinking water supply in Ljubljana. The two main water resources Ljubljana polje and Barje alluvial aquifers are characterized by a strong interconnection of surface and groundwater, high vulnerability, high velocities of groundwater flow and pollutant transport. In case of sudden pollution, reactions should be very fast to avoid serious impact to the water supply. In the area high pressures arising from urbanization, industry, traffic, agriculture and old environmental burdens. The aim of the developed DSS is to optimize the activities in cases of emergency water management and to optimize the administrative work regarding the activities that can improve groundwater quality status. The DSS is an interactive computer system that utilizes data base, hydrological modelling, and experts' and stakeholders' knowledge. It consists of three components, tackling the different abovementioned issues in water management. The first one utilizes the work on identification, cleaning up and restoration of illegal dumpsites that are a serious threat to the qualitative status of groundwater. The other two components utilize the predictive capability of the hydrological model and scenario analysis. The user interacts with the system by a graphical interface that guides the user step-by-step to the recommended remedial measures. Consequently, the acquisition of information to support the water management's decisions is simplified and faster, thus contributing to more efficient water management and a safer supply of drinking water.

Economic Factors Impacting Food Allergen Management: Perspectives from the Food Industry.

PubMed

Gupta, Ruchi S; Taylor, Steve L; Baumert, Joseph L; Kao, Lauren M; Schuster, Erik; Smith, Bridget M

2017-10-01

Food allergies affect up to 8% of children in the United States and may occasionally lead to severe life-threatening reactions. Because there is currently no cure for food allergies, strict avoidance of the allergen-containing foods is the only means of preventing an allergic reaction. Consumers rely on food manufacturers to reliably track and declare the presence of food allergens in products. Over the past 10 to 20 years, the food industry has increasingly adopted allergen control approaches in its processing facilities. However, the major industry costs related to food allergen management have not been fully described. The objective of this study was to characterize the factors that contribute to the economic impact of food allergen control practices on the food industry. A focus group (n = 100) was conducted with food industry professionals to identify key areas of cost for food allergen management. A survey based on the domains identified was then developed and disseminated to a convenience sample (n = 50) of quality control food industry specialists with knowledge of their company's food allergen management practices. Nearly all companies (92%) produced food products containing one or more of the top eight allergenic foods recognized by the U.S. Food and Drug Administration or sesame seeds. Cleaning procedures, employee training, and the potential for a recall due to allergen cross-contact were most frequently rated as the important factors in food allergen management. Recalls due to food allergen cross-contact, cleaning procedures, equipment and premises design, and employee training were ranked as the greatest allergen management expenses. Although 96% of companies had a food allergen control plan in place, nearly half (42%) had at least one food allergen-related recall within the past 5 years. The industry appears to endorse a willingness to unify precautionary allergen labeling to communicate a clear message more effectively to consumers.

Commercialization of proton exchange membrane fuel cells for transportation applications

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

Wismer, L.

1996-04-01

Environmental concerns with air quality and global warming have triggered strict federal ambient ozone air quality standards. Areas on non-attainment of these standards exist across the United States. Because it contains several of the most difficult attainment areas, the State of California has adopted low emission standards including a zero emission vehicle mandate that has given rise to development of hybrid electric vehicles, both battery-powered and fuel-cell powered. Fuel cell powered vehicles, using on-board hydrogen as a fuel, share the non-polluting advantage of the battery electric vehicle while offering at least three times the range today`s battery technology.

The impact of Sleep Time-Related Information and Communication Technology (STRICT) on sleep patterns and daytime functioning in American adolescents.

PubMed

Polos, Peter G; Bhat, Sushanth; Gupta, Divya; O'Malley, Richard J; DeBari, Vincent A; Upadhyay, Hinesh; Chaudhry, Saqib; Nimma, Anitha; Pinto-Zipp, Genevieve; Chokroverty, Sudhansu

2015-10-01

This cross-sectional study explored the extent and impact of mobile device-based Sleep Time-Related Information and Communication Technology (STRICT) use among American adolescents (N = 3139, 49.3% female, mean age = 13.3 years). Nearly 62% used STRICT after bedtime, 56.7% texted/tweeted/messaged in bed, and 20.8% awoke to texts. STRICT use was associated with insomnia, daytime sleepiness, eveningness, academic underperformance, later bedtimes and shorter sleep duration. Moderation analysis demonstrated that the association between STRICT use and insomnia increased with age, the association between STRICT use and daytime sleepiness decreased with age, and the association between STRICT use and shorter sleep duration decreased with age and was stronger in girls. Insomnia and daytime sleepiness partially mediated the relationship between STRICT use and academic underperformance. Our results illustrate the adverse interactions between adolescent STRICT use and sleep, with deleterious effects on daytime functioning. These worrisome findings suggest that placing reasonable limitations on adolescent STRICT use may be appropriate. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Interface management of pharmacotherapy. Joint hospital and primary care drug recommendations.

PubMed

Björkhem-Bergman, Linda; Andersén-Karlsson, Eva; Laing, Richard; Diogene, Eduardo; Melien, Oyvind; Jirlow, Malena; Malmström, Rickard E; Vogler, Sabine; Godman, Brian; Gustafsson, Lars L

2013-05-01

In September 2012 an interactive course on the "Interface Management of Pharmacotherapy" was organized by the Stockholm Drug and Therapeutics Committee in cooperation with Department of Clinical Pharmacology at Karolinska Institutet and at Karolinska University Hospital in Stockholm, Sweden, in collaboration with the WHO. The basis for the course was the "Stockholm model" for the rational use of medicines but also contained presentations about successful models in interface management of pharmacotherapy in other European countries. The "Stockholm model" consists of 8 components: 1) Independent Drug and Therapeutics Committee with key role for respected drug experts with policy for "interest of conflicts", 2) The "Wise List", recommendations of medicines jointly for primary and hospital care, 3) Communication strategy with continuous medical education, 4) Systematic introduction of new expensive medicines, 5) E-pharmacological support at "point of care", 6) Methods and tools for follow-up of medicines use, 7) Medicines policy strategy and 8) Operative resources. The course highlighted the importance of efficient and targeted communication of drug recommendations building on trust among prescribers and patients for the guidelines to achieve high adherence. Trust is achieved by independent Drug and Therapeutics Committees with a key role for respected experts and a strict policy for "conflicts of interest". Representations of GPs are also crucial for successful implementation, being the link between evidence based medicine and practice. The successful models in Scotland and in Stockholm as well as the ongoing work in Catalonia were considered as examples of multifaceted approaches to improve the quality of medicine use across primary and hospital care.

Implementation of a solvent management program to control paint shop volatile organic compounds

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

Floer, M.M.; Hicks, B.H.

1997-12-31

The majority of automobile assembly plant volatile organic compound (VOC) emissions are generated from painting operations. Typical paint operations generate more than 90 percent of the total plant emissions and, up to, 50 percent can be released by cleaning sources. Plant practices which contribute to the release of VOC emissions include the cleaning of paint lines and equipment, tanks, spray booths, floors and vehicles. Solvents continue to be the largest contributing source of VOC emissions in an automotive paint shop. To reduce overall VOC emissions, environmental regulations and guidelines were introduced under the Clean Air Act; Pollution Prevention and Wastemore » Minimization programs, Control Techniques, and special air permit conditions. The introduction of these regulations and guidelines has driven industry toward continual refinement of their present cleaning methods while pursuing new techniques and technologies. Industry has also shown a proactive approach by introducing new waterborne and powder coating paint technologies to reduce overall emissions. As new paint technologies are developed and introduced, special attention must be given to the types of materials utilized for cleaning. The development and implementation of a solvent management program allows a facility to standardize a program to properly implement materials, equipment, technologies and work practices to reduce volatile organic compound emissions, meet strict cleaning requirements posed by new paint technologies and produce a vehicle which meets the high quality standards of the customer. This paper will assess the effectiveness of a solvent management program by examining pollution prevention initiatives and data from four different painting operations.« less

Effective time management: surgery, research, service, travel, fitness, and family.

PubMed

Porta, C Rees; Anderson, Michael R; Steele, Scott R

2013-12-01

Over 1,500 years ago, the St. Benedictine Monks used planning and strict schedules to increase their productivity. Since then, surgeons have developed several different strategies to manage our time effectively. Finding a balance among career, family, and hobbies is essential for maintaining satisfaction and optimizing productivity. Several recurring themes throughout the medical literature offer potential solutions to help maximize the little time surgeons possess. In this article, we will explore some of the methods and strategies available to help surgeons minimize waste and make the most of the most precious commodity we have-our time.

Effective Time Management: Surgery, Research, Service, Travel, Fitness, and Family

PubMed Central

Porta, C. Rees; Anderson, Michael R.; Steele, Scott R.

2013-01-01

Over 1,500 years ago, the St. Benedictine Monks used planning and strict schedules to increase their productivity. Since then, surgeons have developed several different strategies to manage our time effectively. Finding a balance among career, family, and hobbies is essential for maintaining satisfaction and optimizing productivity. Several recurring themes throughout the medical literature offer potential solutions to help maximize the little time surgeons possess. In this article, we will explore some of the methods and strategies available to help surgeons minimize waste and make the most of the most precious commodity we have—our time. PMID:24436684

Semen parameters in fertile US men: the Study for Future Families.

PubMed

Redmon, J B; Thomas, W; Ma, W; Drobnis, E Z; Sparks, A; Wang, C; Brazil, C; Overstreet, J W; Liu, F; Swan, S H

2013-11-01

Establishing reference norms for semen parameters in fertile men is important for accurate assessment, counselling and treatment of men with male factor infertility. Identifying temporal or geographic variability in semen quality also requires accurate measurement of semen parameters in well-characterized, defined populations of men. The Study for Future Families (SFF) recruited men who were partners of pregnant women attending prenatal clinics in Los Angeles CA, Minneapolis MN, Columbia MO, New York City NY and Iowa City IA. Semen samples were collected on site from 763 men (73% White, 15% Hispanic/Latino, 7% Black and 5% Asian or other ethnic group) using strict quality control and well-defined protocols. Semen volume (by weight), sperm concentration (hemacytometer) and sperm motility were measured at each centre. Sperm morphology (both WHO, 1999 strict and WHO, 1987) was determined at a central laboratory. Mean abstinence was 3.2 days. Mean (median; 5th-95th percentile) values were: semen volume, 3.9 (3.7; 1.5-6.8) mL; sperm concentration, 60 (67; 12-192) × 10(6) /mL; total sperm count 209 (240; 32-763) × 10(6) ; % motile, 51 (52; 28-67) %; and total motile sperm count, 104 (128; 14-395) × 10(6) respectively. Values for sperm morphology were 11 (10; 3-20) % and 57 (59; 38-72) % normal forms for WHO (1999) (strict) and WHO (1987) criteria respectively. Black men had significantly lower semen volume, sperm concentration and total motile sperm counts than White and Hispanic/Latino men. Semen parameters were marginally higher in men who achieved pregnancy more quickly but differences were small and not statistically significant. The SFF provides robust estimates of semen parameters in fertile men living in five different geographic locations in the US. Fertile men display wide variation in all of the semen parameters traditionally used to assess fertility potential. © 2013 American Society of Andrology and European Academy of Andrology.

Management of atrial fibrillation around the world: a comparison of current ACCF/AHA/HRS, CCS, and ESC guidelines.

PubMed

Wasmer, Kristina; Eckardt, Lars

2011-10-01

New guidelines for the management of atrial fibrillation (AF) have recently been published by the American College of Cardiology Foundation/American Heart Association, and Heart Rhythm Society (ACCF/AHA/HRS) task force on practice guidelines, the Canadian Cardiovascular Society (CCS), and the European Society of Cardiology (ESC). Although they all refer to the same scientific data and agree in the majority of AF management, interpretation, and weighing of study results are quite different in some aspects. While recommendations for stroke risk assessment and prophylaxis are rather conservative in the ESC guidelines, the CCS guideline recommendations are more conservative with regard to lenient rate control and the ACCF/AHA/HRS recommendations are rather strict with regard to rhythm management.

Design of a secure remote management module for a software-operated medical device.

PubMed

Burnik, Urban; Dobravec, Štefan; Meža, Marko

2017-12-09

Software-based medical devices need to be maintained throughout their entire life cycle. The efficiency of after-sales maintenance can be improved by managing medical systems remotely. This paper presents how to design the remote access function extensions in order to prevent risks imposed by uncontrolled remote access. A thorough analysis of standards and legislation requirements regarding safe operation and risk management of medical devices is presented. Based on the formal requirements, a multi-layer machine design solution is proposed that eliminates remote connectivity risks by strict separation of regular device functionalities from remote management service, deploys encrypted communication links and uses digital signatures to prevent mishandling of software images. The proposed system may also be used as an efficient version update of the existing medical device designs.

Environmental and Water Quality Operational Studies. Environmental Features for Streamside Levee Projects.

DTIC Science & Technology

1985-08-01

Lyon 1976, Lyon and Basile 1979, Lyon and Jenson 1980) showed that windrows over 1.5 ft tall are avoided by mule deer and elk. Thus, brush piles...various State pesticide control authorities. Label directions and general regulations promulgated by these agencies have the power of law and should be...matters, relative attractiveness of alternative baits can vary with season. 606. Like other pesticides , rodenticides are strictly controlled 0 by

[Thinking on designation of sham acupuncture in clinical research].

PubMed

Pan, Li-Jia; Chen, Bo; Zhao, Xue; Guo, Yi

2014-01-01

Randomized controlled trials (RCT) is the source of the raw data of evidence-based medicine. Blind method is adopted in most of the high-quality RCT. Sham acupuncture is the main form of blinded in acupuncture clinical trial. In order to improve the quality of acupuncture clinical trail, based on the necessity of sham acupuncture in clinical research, the current situation as well as the existing problems of sham acupuncture, suggestions were put forward from the aspects of new way and new designation method which can be adopted as reference, and factors which have to be considered during the process of implementing. Various subjective and objective factors involving in the process of trial should be considered, and used of the current international standards, try to be quantification, and carry out strict quality monitoring.

Cost-Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infection in Long-Term Care Facilities: Economic Evaluation with a Randomized Controlled Trial

PubMed Central

van den Hout, Wilbert B; Caljouw, Monique A A; Putter, Hein; Cools, Herman J M; Gussekloo, Jacobijn

2014-01-01

Objectives To investigate whether the preventive use of cranberry capsules in long-term care facility (LTCF) residents is cost-effective depending on urinary tract infection (UTI) risk. Design Economic evaluation with a randomized controlled trial. Setting Long-term care facilities. Participants LTCF residents (N = 928, 703 female, median age 84), stratified according to UTI risk. Measurements UTI incidence (clinically or strictly defined), survival, quality of life, quality-adjusted life years (QALYs), and costs. Results In the weeks after a clinical UTI, participants showed a significant but moderate deterioration in quality of life, survival, care dependency, and costs. In high-UTI-risk participants, cranberry costs were estimated at €439 per year (1.00 euro = 1.37 U.S. dollar), which is €3,800 per prevented clinically defined UTI (95% confidence interval = €1,300–infinity). Using the strict UTI definition, the use of cranberry increased costs without preventing UTIs. Taking cranberry capsules had a 22% probability of being cost-effective compared with placebo (at a willingness to pay of €40,000 per QALY). In low-UTI-risk participants, use of cranberry capsules was only 3% likely to be cost-effective. Conclusion In high-UTI-risk residents, taking cranberry capsules may be effective in preventing UTIs but is not likely to be cost-effective in the investigated dosage, frequency, and setting. In low-UTI-risk LTCF residents, taking cranberry capsules twice daily is neither effective nor cost-effective. PMID:25180379

Using Landsat time series for characterizing forest disturbance dynamics in the coupled human and natural systems of Central Europe.

PubMed

Senf, Cornelius; Pflugmacher, Dirk; Hostert, Patrick; Seidl, Rupert

2017-08-01

Remote sensing is a key information source for improving the spatiotemporal understanding of forest ecosystem dynamics. Yet, the mapping and attribution of forest change remains challenging, particularly in areas where a number of interacting disturbance agents simultaneously affect forest development. The forest ecosystems of Central Europe are coupled human and natural systems, with natural and human disturbances affecting forests both individually and in combination. To better understand the complex forest disturbance dynamics in such systems, we utilize 32-year Landsat time series to map forest disturbances in five sites across Austria, the Czech Republic, Germany, Poland, and Slovakia. All sites consisted of a National Park and the surrounding forests, reflecting three management zones of different levels of human influence (managed, protected, strictly protected). This allowed for a comparison of spectral, temporal, and spatial disturbance patterns across a gradient from natural to coupled human and natural disturbances. Disturbance maps achieved overall accuracies ranging from 81% to 93%. Disturbance patches were generally small, with 95% of the disturbances being smaller than 10 ha. Disturbance rates ranged from 0.29% yr -1 to 0.95% yr -1 , and differed substantially among management zones and study sites. Natural disturbances in strictly protected areas were longer in duration (median of 8 years) and slightly less variable in magnitude compared to human-dominated disturbances in managed forests (median duration of 1 year). However, temporal dynamics between natural and human-dominated disturbances showed strong synchrony, suggesting that disturbance peaks are driven by natural events affecting managed and unmanaged areas simultaneously. Our study demonstrates the potential of remote sensing for mapping forest disturbances in coupled human and natural systems, such as the forests of Central Europe. Yet, we also highlight the complexity of such systems in terms of agent attribution, as many natural disturbances are modified by management responding to them outside protected areas.

Using Landsat time series for characterizing forest disturbance dynamics in the coupled human and natural systems of Central Europe

NASA Astrophysics Data System (ADS)

Senf, Cornelius; Pflugmacher, Dirk; Hostert, Patrick; Seidl, Rupert

2017-08-01

Remote sensing is a key information source for improving the spatiotemporal understanding of forest ecosystem dynamics. Yet, the mapping and attribution of forest change remains challenging, particularly in areas where a number of interacting disturbance agents simultaneously affect forest development. The forest ecosystems of Central Europe are coupled human and natural systems, with natural and human disturbances affecting forests both individually and in combination. To better understand the complex forest disturbance dynamics in such systems, we utilize 32-year Landsat time series to map forest disturbances in five sites across Austria, the Czech Republic, Germany, Poland, and Slovakia. All sites consisted of a National Park and the surrounding forests, reflecting three management zones of different levels of human influence (managed, protected, strictly protected). This allowed for a comparison of spectral, temporal, and spatial disturbance patterns across a gradient from natural to coupled human and natural disturbances. Disturbance maps achieved overall accuracies ranging from 81% to 93%. Disturbance patches were generally small, with 95% of the disturbances being smaller than 10 ha. Disturbance rates ranged from 0.29% yr-1 to 0.95% yr-1, and differed substantially among management zones and study sites. Natural disturbances in strictly protected areas were longer in duration (median of 8 years) and slightly less variable in magnitude compared to human-dominated disturbances in managed forests (median duration of 1 year). However, temporal dynamics between natural and human-dominated disturbances showed strong synchrony, suggesting that disturbance peaks are driven by natural events affecting managed and unmanaged areas simultaneously. Our study demonstrates the potential of remote sensing for mapping forest disturbances in coupled human and natural systems, such as the forests of Central Europe. Yet, we also highlight the complexity of such systems in terms of agent attribution, as many natural disturbances are modified by management responding to them outside protected areas.

Discrete diffraction managed solitons: Threshold phenomena and rapid decay for general nonlinearities

NASA Astrophysics Data System (ADS)

Choi, Mi-Ran; Hundertmark, Dirk; Lee, Young-Ran

2017-10-01

We prove a threshold phenomenon for the existence/non-existence of energy minimizing solitary solutions of the diffraction management equation for strictly positive and zero average diffraction. Our methods allow for a large class of nonlinearities; they are, for example, allowed to change sign, and the weakest possible condition, it only has to be locally integrable, on the local diffraction profile. The solutions are found as minimizers of a nonlinear and nonlocal variational problem which is translation invariant. There exists a critical threshold λcr such that minimizers for this variational problem exist if their power is bigger than λcr and no minimizers exist with power less than the critical threshold. We also give simple criteria for the finiteness and strict positivity of the critical threshold. Our proof of existence of minimizers is rather direct and avoids the use of Lions' concentration compactness argument. Furthermore, we give precise quantitative lower bounds on the exponential decay rate of the diffraction management solitons, which confirm the physical heuristic prediction for the asymptotic decay rate. Moreover, for ground state solutions, these bounds give a quantitative lower bound for the divergence of the exponential decay rate in the limit of vanishing average diffraction. For zero average diffraction, we prove quantitative bounds which show that the solitons decay much faster than exponentially. Our results considerably extend and strengthen the results of Hundertmark and Lee [J. Nonlinear Sci. 22, 1-38 (2012) and Commun. Math. Phys. 309(1), 1-21 (2012)].

[Coronary artery bypass surgery: methods of performance monitoring and quality control].

PubMed

Albert, A; Sergeant, P; Ennker, J

2009-10-01

The strength of coronary bypass operations depends on the preservation of their benefits regarding freedom of symptoms, quality of life and survival, over decades. Significant variability of the results of an operative intervention according to the hospital or the operating surgeon is considered a weakness in the procedure. The external quality insurance tries to reach a transparent service providing market through hospital ranking comparability. Widely available information and competition will promote the improvement of the whole quality. The structured dialog acts as a control instrument for the BQS (Federal Quality Insurance). It is launched in case of deviations from the standard references or statistically significant differences between the results of the operations in any hospital and the average notational results. In comparison to the external control the hospital internal control has greater ability to reach a medically useful statement regarding the results of the treatment and to correct the mistakes in time. An online information portal based on a departmental databank (DataWarehouse, DataMart) is an attractive solution for the physician in order to get transparently and timely informed about the variability in the performance.The individual surgeon significantly influences the short- and long-term treatment results. Accordingly, selection, targeted training and performance measurements are necessary.Strict risk management and failure analysis of individual cases are included in the methods of internal quality control aiming to identify and correct the inadequacies in the system and the course of treatment. According to the international as well as our own experience, at least 30% of the mortalities after bypass operations are avoidable. A functioning quality control is especially important in minimally invasive interventions because they are often technically more demanding in comparison to the conventional procedures. In the field of OPCAB surgery, the special advantages of the procedure can be utilised to reach a nearly complete avoidance of postoperative stroke through combining the procedure with aorta no-touch technique. The long-term success of the bypass operation depends on the type of bypass material in additions to many other factors. Both internal mammary arteries are considered the most durable.Using an operation preparation check contributes to the operative success.

[Try to improve journal quality by improving standards and editing process].

PubMed

Zheng, Jia-wei

2005-04-01

The quality of medical journals depends on several factors involving 3 groups of people with their independent but relevant roles: the authors, the reviewers and the editors. Peer review and editing is the key factor to improve the quality of medical publications and journals. Shanghai Journal of Stomatology (SJS) has been regarded as a leading journal for publishing high-quality work in the field of stomatology in China. In October 2003, it was accepted by the National Library of Medicine, USA, to be indexed and included in Index Medicus and MEDLINE. To further improve the journal's overall quality, the Editorial Agency led by Professor Zheng Jia-wei has made great efforts to formulate its essential requirements in paper style, bilingual abstract writing and statistical analysis for the manuscripts submitted for possible publication. Strict independent peer review system has been adopted to assess the quality of the manuscripts received since it was founded in 1992. The reviewer is required to address detailed aspects of the paper under review and to resend his or her opinion on the paper. The editorial management is a crucial part of the publishing process. The editors begin action with the receipt of the manuscript, direct the various steps of evaluation, correction and re-submission, until a decision is made to accept or reject the paper at the regular meeting of Decision Making Group on Manuscripts of SJS led by the Editor-in-Chief. Once a paper is accepted and carefully revised, the editors will make necessary text and layout editing. Due consideration is given to the statistical, bilingual and ethical aspects as well as to the overall uniformity of the terminology, nomenclatures and style throughout the volume as a whole in the promotion of standards. The journal has not been cited by Science Citation Index (SCI) till now, further steps should be taken to make this journal better known throughout the World, to improve the quality of the publications and reduce the delay between the initial receipt and the final publication of manuscripts.

Research on Interactive Acquisition and Use of Knowledge.

DTIC Science & Technology

1983-11-01

complex and challenging endeavor. Computer scientists faced with the problem of managing software complexity have de - veloped strict design disciplines...handle most-indeed, probably all-- phenomena in the syntax and semantics of natural language. It has also turned out to be well suited for the classes of...Semantics The previous grammar performs a de facto coordination of syntax and semantics by requiring that the (syntactically) preverbal NP play the

Alertness Management Strategies for Operational Contexts

DTIC Science & Technology

2008-08-01

or reproductive disorders. In addition, there is evidence from some studies that night work is associated with increased accide’nts. In fact, Folkard...behaviorally based strategies for avoiding insomnia in many situations, but in some cases, hypnotic medications or so- called "sleeping pills" may be necessary...preferable to being sleep deprived. Choosing the best hypnotic for each situation requires consideration of a variety of factors. From a strictly

Control of water distribution networks with dynamic DMA topology using strictly feasible sequential convex programming

NASA Astrophysics Data System (ADS)

Wright, Robert; Abraham, Edo; Parpas, Panos; Stoianov, Ivan

2015-12-01

The operation of water distribution networks (WDN) with a dynamic topology is a recently pioneered approach for the advanced management of District Metered Areas (DMAs) that integrates novel developments in hydraulic modeling, monitoring, optimization, and control. A common practice for leakage management is the sectorization of WDNs into small zones, called DMAs, by permanently closing isolation valves. This facilitates water companies to identify bursts and estimate leakage levels by measuring the inlet flow for each DMA. However, by permanently closing valves, a number of problems have been created including reduced resilience to failure and suboptimal pressure management. By introducing a dynamic topology to these zones, these disadvantages can be eliminated while still retaining the DMA structure for leakage monitoring. In this paper, a novel optimization method based on sequential convex programming (SCP) is outlined for the control of a dynamic topology with the objective of reducing average zone pressure (AZP). A key attribute for control optimization is reliable convergence. To achieve this, the SCP method we propose guarantees that each optimization step is strictly feasible, resulting in improved convergence properties. By using a null space algorithm for hydraulic analyses, the computations required are also significantly reduced. The optimized control is actuated on a real WDN operated with a dynamic topology. This unique experimental program incorporates a number of technologies set up with the objective of investigating pioneering developments in WDN management. Preliminary results indicate AZP reductions for a dynamic topology of up to 6.5% over optimally controlled fixed topology DMAs. This article was corrected on 12 JAN 2016. See the end of the full text for details.

The Difficult Gallbladder: A Safe Approach to a Dangerous Problem.

PubMed

Santos, B Fernando; Brunt, L Michael; Pucci, Michael J

2017-06-01

Laparoscopic cholecystectomy is a common surgical procedure, and remains the gold standard for the management of benign gallbladder and biliary disease. While this procedure can be technically straightforward, it can also represent one of the most challenging operations facing surgeons. This dichotomy of a routine operation performed so commonly that poses such a hidden risk of severe complications, such as bile duct injury, must keep surgeons steadfast in the pursuit of safety. The "difficult gallbladder" requires strict adherence to the Culture of Safety in Cholecystectomy, which promotes safety first and assists surgeons in managing or avoiding difficult operative situations. This review will discuss the management of the difficult gallbladder and propose the use of subtotal fenestrating cholecystectomy as a definitive option during this dangerous situation.

Methodological issues in genetic association studies of inherited thrombophilia: original report of recent practice.

PubMed

Simundic, Ana-Maria; Nikolac, Nora; Topic, Elizabeta

2009-01-01

The aims of this article are to evaluate the methodological quality of genetic association studies on the inherited thrombophilia published during 2003 to 2005, to identify the most common mistakes made by authors of those studies, and to examine if overall quality of the article correlates with the quality of the journal. Articles were evaluated by 2 independent reviewers using the checklist of 16 items. A total of 58 eligible studies were identified. Average total score was 7.59 +/- 1.96. Total article score did not correlate with the journal impact factor (r = 0.3971; 95% confidence interval [CI], 0.1547-0.5944, P = .002). Total score did not differ across years (P = .624). Finally, it is concluded that methodological quality of genetic association studies is not optimal, and it does not depend on the quality of the journal. Journals should adopt methodological criteria for reporting the genetic association studies, and editors should encourage authors to strictly adhere to those criteria.

Crystal growth of device quality GaAs in space

NASA Technical Reports Server (NTRS)

Gatos, Harry C.; Lagowski, Jacek

1989-01-01

The program on Crystal Growth of Device Quality GaAs in Space was initiated in 1977. The initial stage covering 1977 to 1984 was devoted strictly to ground-based research. By 1985 the program had evolved into its next logical stage aimed at space growth experiments; however, since the Challenger disaster, the program has been maintained as a ground-based program awaiting activation of experimentation in space. The overall prgram has produced some 80 original scientific publications on GaAs crystal growth, crystal characterization, and new approaches to space processing. Publication completed in the last three years are listed. Their key results are outlined and discussed in the twelve publications included as part of the report.

Satellite observations of changes in air quality during the 2008 Beijing Olympics and Paralympics

NASA Astrophysics Data System (ADS)

Witte, J. C.; Schoeberl, M. R.; Douglass, A. R.; Gleason, J. F.; Krotkov, N. A.; Gille, J. C.; Pickering, K. E.; Livesey, N.

2009-09-01

For the August-September 2008 Olympic and the Paralympic Games held in Beijing, China, strict controls on pollutant emissions and motor vehicle traffic were imposed on Beijing and neighboring provinces to the South to improve the air quality in and around the city. Satellite measurements over Beijing between July and September showed 43% reductions of tropospheric column nitrogen dioxide, compared to the past three years. When neighboring provinces to the south are included in our analyses, satellite measurements show boundary layer sulfur dioxide reductions of 13% and carbon monoxide reductions of 12% at 700 hPa. Thus, based on satellites observations alone, noticeable reductions in these pollutant tracers were measured during both games.

Isolated Operation at Hachinohe Micro-Grid Project

NASA Astrophysics Data System (ADS)

Takano, Tomihiro; Kojima, Yasuhiro; Temma, Koji; Simomura, Masaru

To meet the global warming, renewable energy sources like wind, solar and biomass generations are dramatically increasing. Cogeneration systems are also ever-growing to save consumers' energy costs among factories, buildings and homes where lots of thermal loads are expected. According to these dispersed generators growth, their negative impacts to commercial power systems quality become non-negligible, because their unstable output causes network voltage and frequency fluctuation. Micro-grid technology comes to the front to solve the problem and many demonstrative field tests are now going all over the world. This paper presents the control paradigm and its application to Hachinohe micro-gird project, especially focusing on the power quality at isolated operation on which strict condition is imposed.

What are the roles and valued attributes of a Trial Steering Committee? Ethnographic study of eight clinical trials facing challenges.

PubMed

Daykin, Anne; Selman, Lucy E; Cramer, Helen; McCann, Sharon; Shorter, Gillian W; Sydes, Matthew R; Gamble, Carrol; Macefield, Rhiannon; Lane, J Athene; Shaw, Alison

2016-07-01

Clinical trials oversight by a Trial Steering Committee (TSC) is mandated by Good Clinical Practice. This study used qualitative methods to explore the role and valued attributes of the TSC to inform planned updates of Medical Research Council guidance and TSC terms of reference. An ethnographic study was conducted during 2013-2014. TSC and Trial Management Group meetings from eight trials were observed and audio-recorded, and semi-structured interviews conducted with purposively sampled key informants: independent and non-independent TSC members, trial sponsor representatives, funder representatives and chief investigators. The selected trials were currently recruiting and dealing with challenging scenarios. Data were analysed thematically and findings triangulated and integrated to give a multi-perspective account of the role and valued attributes of a TSC. Eight TSC meetings and six Trial Management Group meetings were observed. Sixty-five interviews were conducted with 51 informants. The two main roles played by the TSC were quality assurance and patient advocacy. Quality assurance involved being a 'critical friend' or a provider of 'tough love'. Factors influencing the ability of the TSC to fulfil this role included the TSC Chair, other independent TSC members and the model of the TSC and its fit with the trial subject. The role of the TSC as an advocate for patient well-being was perceived as paramount. Two attributes of TSC members emerged as critical: experience (of running a trial, trial oversight or in a clinical/methodological area) and independence. While independence was valued for giving impartiality, the lack of consensus about its definition and strict requirements of some funders made it difficult to operationalise. We found tensions and ambiguities in the roles expected of TSCs and the attributes valued of TSC members. In particular, the requirements of independence and experience could conflict, impacting the TSCs' quality assurance role. Concerns were raised regarding whose interests are served by funders' criteria of independence; in particular, funders' selection of TSC members was thought to potentially inhibit TSCs' ability to fulfil their patient advocacy role. These findings should be incorporated in revising guidance and terms of reference for TSCs.

Management of Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis: Looking Beyond Guidelines!

PubMed Central

Kumar, Rajesh; Das, Anupam; Das, Sudip

2018-01-01

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions, which are mainly caused by drugs; and these are usually associated with high degree of morbidity and mortality. Recently, two detailed guidelines were published on the management of SJS/TEN, Indian guidelines and UK guidelines. Still, there is no consensus on the management of SJS/TEN. In this article, our aim is to conceptualize the management aspect of SJS/TEN considering Indian setup. Early discontinuation of all medicines, supportive measures (hydration, electrolytes, and care of denuded skin), corticosteroids and cyclosporine has been found to be useful. Oral provocation test is reserved for patients, who undergo complete remission and this is to be done after hospitalization, under strict vigilance. As there is no consensus, the treatment should be individualized on case to case basis. PMID:29692452

Ecosystem Services Modeling as a Tool for Defining Priority Areas for Conservation.

PubMed

Duarte, Gabriela Teixeira; Ribeiro, Milton Cezar; Paglia, Adriano Pereira

2016-01-01

Conservationists often have difficulty obtaining financial and social support for protected areas that do not demonstrate their benefits for society. Therefore, ecosystem services have gained importance in conservation science in the last decade, as these services provide further justification for appropriate management and conservation of natural systems. We used InVEST software and a set of GIS procedures to quantify, spatialize and evaluated the overlap between ecosystem services-carbon stock and sediment retention-and a biodiversity proxy-habitat quality. In addition, we proposed a method that serves as an initial approach of a priority areas selection process. The method considers the synergism between ecosystem services and biodiversity conservation. Our study region is the Iron Quadrangle, an important Brazilian mining province and a conservation priority area located in the interface of two biodiversity hotspots, the Cerrado and Atlantic Forest biomes. The resultant priority area for the maintenance of the highest values of ecosystem services and habitat quality was about 13% of the study area. Among those priority areas, 30% are already within established strictly protected areas, and 12% are in sustainable use protected areas. Following the transparent and highly replicable method we proposed in this study, conservation planners can better determine which areas fulfill multiple goals and can locate the trade-offs in the landscape. We also gave a step towards the improvement of the habitat quality model with a topography parameter. In areas of very rugged topography, we have to consider geomorfometric barriers for anthropogenic impacts and for species movement and we must think beyond the linear distances. Moreover, we used a model that considers the tree mortality caused by edge effects in the estimation of carbon stock. We found low spatial congruence among the modeled services, mostly because of the pattern of sediment retention distribution.

Ecosystem Services Modeling as a Tool for Defining Priority Areas for Conservation

PubMed Central

Duarte, Gabriela Teixeira; Ribeiro, Milton Cezar; Paglia, Adriano Pereira

2016-01-01

Conservationists often have difficulty obtaining financial and social support for protected areas that do not demonstrate their benefits for society. Therefore, ecosystem services have gained importance in conservation science in the last decade, as these services provide further justification for appropriate management and conservation of natural systems. We used InVEST software and a set of GIS procedures to quantify, spatialize and evaluated the overlap between ecosystem services—carbon stock and sediment retention—and a biodiversity proxy–habitat quality. In addition, we proposed a method that serves as an initial approach of a priority areas selection process. The method considers the synergism between ecosystem services and biodiversity conservation. Our study region is the Iron Quadrangle, an important Brazilian mining province and a conservation priority area located in the interface of two biodiversity hotspots, the Cerrado and Atlantic Forest biomes. The resultant priority area for the maintenance of the highest values of ecosystem services and habitat quality was about 13% of the study area. Among those priority areas, 30% are already within established strictly protected areas, and 12% are in sustainable use protected areas. Following the transparent and highly replicable method we proposed in this study, conservation planners can better determine which areas fulfill multiple goals and can locate the trade-offs in the landscape. We also gave a step towards the improvement of the habitat quality model with a topography parameter. In areas of very rugged topography, we have to consider geomorfometric barriers for anthropogenic impacts and for species movement and we must think beyond the linear distances. Moreover, we used a model that considers the tree mortality caused by edge effects in the estimation of carbon stock. We found low spatial congruence among the modeled services, mostly because of the pattern of sediment retention distribution. PMID:27145031

Nucleic acid testing: Is it the only answer for safe Blood in India?

PubMed Central

Naidu, N. K.; Bharucha, Z. S.; Sonawane, Vandana; Ahmed, Imran

2016-01-01

Background: With the implementation of NAT in countries around the world, there is a growing pressure on the transfusion services in India to adopt NAT testing. India has about 2545 licensed Blood Centres. The Transfusion Services in India are fragmented, poorly regulated and the quality standards are poorly implemented. Blood Centres are still dependent on replacement/family donors and in most places laboratory testing for Transfusion transmitted infections is not quality assured, laboratory equipment are not calibrated and maintained, and validation of results is not carried out. Against the current scenario introducing NAT for screening of blood donors in India would pose a challenge. Aim: To study the prudence of universal NAT testing in India. Materials and Methods: A retrospective study of 5 years from 2008-2012 was undertaken to study the true reactivity of donors using WHO strategy II and III and therefore the true seroprevalence of TTI infections in the donor populations. Results: The true reactivity of the donors was much less as compared to the initially reactive donors due to the use of a well designed testing algorithm. In addition having a total voluntary blood collection along with good pre-donation counseling program also reduces the transmission of infections. Conclusions: What India essentially needs to do is religiously implement the strategies outlined in the WHO Aide-memoire. The blood should be collected only from voluntary non remunerative and repeat donors, there should be stringent donor selection with pre-donation counseling instituted. Strict implementation of quality management system, development of well defined testing startegies and strong haemovigilance system could take us a step in the right direction. PMID:27011677

Implementation of information systems at pharmacies - a case study from the re-regulated pharmacy market in Sweden.

PubMed

Hammar, Tora; Ohlson, Mats; Hanson, Elizabeth; Petersson, Göran

2015-01-01

When the Swedish pharmacy market was re-regulated in 2009, Sweden moved from one state-owned pharmacy chain to several private pharmacy companies, and four new dispensing systems emerged to replace the one system that had previously been used at all Swedish pharmacies for more than 20 years. The aim of this case study was to explore the implementation of the new information systems for dispensing at pharmacies. The vendors of the four dispensing systems in Sweden were interviewed, and a questionnaire was sent to the managers of the pharmacy companies. In addition, a questionnaire was sent to 350 pharmacists who used the systems for dispensing prescriptions. The implementation of four new dispensing systems followed a strict time frame set by political decisions, involved actors completely new to the market, lacked clear regulation and standards for functionality and quality assurance, was complex and resulted in variations in quality. More than half of the pharmacists (58%) perceived their current dispensing system as supporting safe dispensing of medications, 26% were neutral and 15% did not perceive it to support a safe dispensing. Most pharmacists (80%) had experienced problems with their dispensing system during the previous month. The pharmacists experienced problems included reliability issues, usability issues, and missing functionality. In this case study exploring the implementation of new information systems for dispensing prescriptions at pharmacies in Sweden, weaknesses related to reliability, functionality and usability were identified and could affect patient safety. The weaknesses of the systems seem to result from the limited time for the development and implementation, the lack of comprehensive and evidence-based requirements for dispensing systems, and the unclear distribution of quality assurance responsibilities among involved stakeholders. Copyright © 2015 Elsevier Inc. All rights reserved.

Modified Atmosphere Systems and Shelf Life Extension of Fish and Fishery Products

PubMed Central

DeWitt, Christina A. Mireles; Oliveira, Alexandra C.M.

2016-01-01

This review aims at summarizing the findings of studies published over the past 15 years on the application of modified atmosphere (MA) systems for shelf life extension of fish and fishery products. This review highlights the importance of CO2 in the preservation of seafood products, and underscores the benefits of combining MA technology with product storage in the superchilled temperature range. It is generally accepted that MA technology cannot improve product quality and should not be utilized as a substitute for good sanitation and strict temperature control. Benefits derived from application of MA, however, can significantly impact preservation of product quality and it subsequent shelf-life. For this reason, this review is the first of its kind to propose detailed handling and quality guidelines for fresh fish to realize the maximum benefit of MA technology. PMID:28231143

[Consequence of European Directive 2004/23/EC for bone banks in Germany].

PubMed

Pruss, A; Knaepler, H; Katthagen, B-D; Frommelt, L

2005-11-01

Allogenic bone grafting is an established method in revision surgery of artificial joint replacement and spinal surgery in case of bone defects. In Germany, femoral heads from living donors undergoing total hip replacement are frequently used. These grafts are processed according to the "Guidelines for the management of bone banking" issued by the Federal Medical Board. Bone grafts are drugs according to German law. Local bone banks are excluded from the regulations of the federal law on drugs [Arzneimittelgesetz (AMG) section sign 4a (4)] if certain requirements are fulfilled. The Directive 2004/23/EC of the European Parliament and of The Council on Setting Standards of Quality and Safety for the Donation, Procurement, Testing, Processing, Preservation, Storage and Distribution of Human Tissues and Cells has to be implemented into national law within 2 years. The exception of section sign 4a (4) will no longer be possible. Thus a legal construction has to be found which allows running local bone banks in compliance with the new legal settings. Three conditions will be possible: (1) a single physician procures a graft for another patient of his, (2) grafts are procured in one hospital and are used exclusively in this hospital: a license from the local authorities and a strict quality assessment according to GMP-rules is required, (3) if the grafts are distributed to other hospitals, a license from the local authorities and registration as a drug by the federal authorities are necessary.

[Evidence and consensus based treatment guidelines 2010 for juvenile idiopathic arthritis by the German Society of Paediatric Rheumatology].

PubMed

Dueckers, G; Guellac, N; Arbogast, M; Dannecker, G; Foeldvari, I; Frosch, M; Ganser, G; Heiligenhaus, A; Horneff, G; Illhardt, A; Krauspe, R; Markus, B; Michels, H; Schneider, M; Singendonk, W; Sitter, H; Spamer, M; Wagner, N; Niehues, T

2011-11-01

Treatment of Juvenile Idiopathic Arthritis (JIA) has improved quality of life in children and adolescents with JIA. Standardisation of care offers the chance to improve the quality of care of those patients. New studies have been published after completion of our last treatment guideline (2007). An updated consensus process is mandatory. A systematic literature analysis in PUBMED (key words: juvenile idiopathic (rheumatoid) arthritis, therapy; limits: humans, published in the last 3 years, all child 0-18 years, clinical trial) revealed 17 relevant studies. Studies relating to diagnosis of JIA, Uveitis, vaccination, transition were excluded. Representatives nominated by scientific societies and organisations were invited to consensus conferences which were hosted by a professional moderator. The following societies were invited: Berufsverband der Kinder- und Jugendärzte (BVKJ), Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Deutsche Gesellschaft für Rheumatologie (DGRh), Deutsche Ophthalmologische Gesellschaft (DOG), Deutsche Rheuma-Liga Bundesverband, Verein zur Förderung und Unterstützung rheumatologisch erkrankter Kinder und deren Eltern, Vereinigung für Kinderorthopädie, Zentraler Verband der Physiotherapeuten und Krankengymnasten (ZVK). Consensus conferences were each attended by more than 95% of the nominated representatives. Consensus statements were confirmed by nominal group technique and Delphi method. Updated consensus statements regarding drug therapy, symptomatic and surgical management of JIA were compiled and judged strictly by the criteria of Evidence-Based Medicine (EBM). © Georg Thieme Verlag KG Stuttgart · New York.

7 CFR 28.416 - Strict Good Ordinary Light Spotted Color.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Strict Good Ordinary Light Spotted Color. 28.416... CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.416 Strict Good Ordinary Light Spotted Color. Strict Good Ordinary Light Spotted Color is color which in spot or...

7 CFR 28.416 - Strict Good Ordinary Light Spotted Color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Strict Good Ordinary Light Spotted Color. 28.416... CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.416 Strict Good Ordinary Light Spotted Color. Strict Good Ordinary Light Spotted Color is color which in spot or...

7 CFR 28.416 - Strict Good Ordinary Light Spotted Color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Strict Good Ordinary Light Spotted Color. 28.416... CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.416 Strict Good Ordinary Light Spotted Color. Strict Good Ordinary Light Spotted Color is color which in spot or...

7 CFR 28.416 - Strict Good Ordinary Light Spotted Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Strict Good Ordinary Light Spotted Color. 28.416... CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.416 Strict Good Ordinary Light Spotted Color. Strict Good Ordinary Light Spotted Color is color which in spot or...

7 CFR 28.412 - Strict Middling Light Spotted Color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Strict Middling Light Spotted Color. 28.412 Section 28... REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.412 Strict Middling Light Spotted Color. Strict Middling Light Spotted Color is color which in spot or color, or both, is...

7 CFR 28.414 - Strict Low Middling Light Spotted Color.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Low Middling Light Spotted Color. 28.414... CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.414 Strict Low Middling Light Spotted Color. Strict Low Middling Light Spotted Color is color which in spot or...

7 CFR 28.414 - Strict Low Middling Light Spotted Color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Strict Low Middling Light Spotted Color. 28.414... CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.414 Strict Low Middling Light Spotted Color. Strict Low Middling Light Spotted Color is color which in spot or...

7 CFR 28.416 - Strict Good Ordinary Light Spotted Color.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Good Ordinary Light Spotted Color. 28.416... CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.416 Strict Good Ordinary Light Spotted Color. Strict Good Ordinary Light Spotted Color is color which in spot or...

7 CFR 28.414 - Strict Low Middling Light Spotted Color.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Strict Low Middling Light Spotted Color. 28.414... CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.414 Strict Low Middling Light Spotted Color. Strict Low Middling Light Spotted Color is color which in spot or...

7 CFR 28.412 - Strict Middling Light Spotted Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Strict Middling Light Spotted Color. 28.412 Section 28... REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.412 Strict Middling Light Spotted Color. Strict Middling Light Spotted Color is color which in spot or color, or both, is...

7 CFR 28.412 - Strict Middling Light Spotted Color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Strict Middling Light Spotted Color. 28.412 Section 28... REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.412 Strict Middling Light Spotted Color. Strict Middling Light Spotted Color is color which in spot or color, or both, is...

7 CFR 28.414 - Strict Low Middling Light Spotted Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Strict Low Middling Light Spotted Color. 28.414... CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.414 Strict Low Middling Light Spotted Color. Strict Low Middling Light Spotted Color is color which in spot or...

7 CFR 28.414 - Strict Low Middling Light Spotted Color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Strict Low Middling Light Spotted Color. 28.414... CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.414 Strict Low Middling Light Spotted Color. Strict Low Middling Light Spotted Color is color which in spot or...

7 CFR 28.412 - Strict Middling Light Spotted Color.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Strict Middling Light Spotted Color. 28.412 Section 28... REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Light Spotted Cotton § 28.412 Strict Middling Light Spotted Color. Strict Middling Light Spotted Color is color which in spot or color, or both, is...

7 CFR 28.402 - Strict Middling Color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Strict Middling Color. 28.402 Section 28.402... for the Color Grade of American Upland Cotton § 28.402 Strict Middling Color. Strict Middling Color is color which is within the range represented by a set of samples in the custody of the United States...

7 CFR 28.402 - Strict Middling Color.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Strict Middling Color. 28.402 Section 28.402... for the Color Grade of American Upland Cotton § 28.402 Strict Middling Color. Strict Middling Color is color which is within the range represented by a set of samples in the custody of the United States...

7 CFR 28.402 - Strict Middling Color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Strict Middling Color. 28.402 Section 28.402... for the Color Grade of American Upland Cotton § 28.402 Strict Middling Color. Strict Middling Color is color which is within the range represented by a set of samples in the custody of the United States...

7 CFR 28.402 - Strict Middling Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Strict Middling Color. 28.402 Section 28.402... for the Color Grade of American Upland Cotton § 28.402 Strict Middling Color. Strict Middling Color is color which is within the range represented by a set of samples in the custody of the United States...

7 CFR 28.402 - Strict Middling Color.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Middling Color. 28.402 Section 28.402... for the Color Grade of American Upland Cotton § 28.402 Strict Middling Color. Strict Middling Color is color which is within the range represented by a set of samples in the custody of the United States...

Reference management: A critical element of scientific writing

PubMed Central

Kali, Arunava

2016-01-01

With the rapid growth of medical science, the number of scientific writing contributing to medical literature has increased significantly in recent years. Owing to considerable variation of formatting in different citation styles, strict adherence to the accurate referencing manually is labor intensive and challenging. However, the introduction of referencing tools has decreased the complexity to a great extent. These software have advanced overtime to include newer features to support effective reference management. Since scientific writing is an essential component of medical curriculum, it is imperative for medical graduates to understand various referencing systems to effectively make use of these tools in their dissertations and future researches. PMID:26952149

Managing non-alcoholic fatty liver disease

PubMed Central

Ngu, Jing Hieng; Goh, George Boon Bee; Poh, Zhongxian; Soetikno, Roy

2016-01-01

The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing rapidly with the obesity and diabetes mellitus epidemics. It is rapidly becoming the most common cause of liver disease worldwide. NAFLD can progress to serious complications such as cirrhosis, hepatocellular carcinoma and death. Therefore, it is important to recognise this condition so that early intervention can be implemented. Lifestyle modifications and strict control of metabolic risk factors are the mainstay of treatment. As disease progression is slow in the majority of NAFLD patients, most can be managed well by primary care physicians. NAFLD patients with advanced liver fibrosis should be referred to specialist care for further assessment. PMID:27439352

[Information security in health care].

PubMed

Ködmön, József; Csajbók, Zoltán Ernő

2015-07-05

Doctors, nurses and other medical professionals are spending more and more time in front of the computer, using applications developed for general practitioners, specialized care, or perhaps an integrated hospital system. The data they handle during healing and patient care are mostly sensitive data and, therefore, their management is strictly regulated. Finding our way in the jungle of laws, regulations and policies is not simple. Notwithstanding, our lack of information does not waive our responsibility. This study summarizes the most important points of international recommendations, standards and legal regulations of the field, as well as giving practical advices for managing medical and patient data securely and in compliance with the current legal regulations.

Biomedical waste management: study on the awareness and practice among healthcare workers in a tertiary teaching hospital.

PubMed

Joseph, L; Paul, H; Premkumar, J; Paul, R; Michael, J S

2015-01-01

Bio-medical waste has a higher potential of infection and injury to the healthcare worker, patient and the surrounding community. Awareness programmes on their proper handling and management to healthcare workers can prevent the spread of infectious diseases and epidemics. This study was conducted in a tertiary care hospital to assess the impact of training, audits and education/implementations from 2009 to 2012 on awareness and practice of biomedical waste segregation. Our study reveals focused training, strict supervision, daily surveillance, audits inspections, involvement of hospital administrators and regular appraisals are essential to optimise the segregation of biomedical waste.

Between a rock and a hard place: Prescription opioid restrictions in the time of fentanyl and other street drug adulterants.

PubMed

Cheng, Tessa; DeBeck, Kora

2017-09-14

Non-medical prescription opioid use (NMPOU) has increased alarmingly across Canada and resulted in strict prescribing restrictions on opioids. Despite a clear need to reduce opioid prescriptions in response to this crisis, few other policies have been implemented and this singular focus is incongruent with the known characteristics of substance use disorders, negative effects of supply reduction policies, and realities of pain management. Given the recent rise of fentanyl and other dangerous adulterants in street drugs, this commentary argues that a comprehensive response to NMPOU that includes improvements to addiction management and harm-reduction services is urgently needed.

Reference management: A critical element of scientific writing.

PubMed

Kali, Arunava

2016-01-01

With the rapid growth of medical science, the number of scientific writing contributing to medical literature has increased significantly in recent years. Owing to considerable variation of formatting in different citation styles, strict adherence to the accurate referencing manually is labor intensive and challenging. However, the introduction of referencing tools has decreased the complexity to a great extent. These software have advanced overtime to include newer features to support effective reference management. Since scientific writing is an essential component of medical curriculum, it is imperative for medical graduates to understand various referencing systems to effectively make use of these tools in their dissertations and future researches.

Guidelines on "Standards of management of idiopathic scoliosis with corrective braces in everyday clinics and in clinical research": SOSORT Consensus 2008

PubMed Central

Negrini, Stefano; Grivas, Theodoros B; Kotwicki, Tomasz; Rigo, Manuel; Zaina, Fabio

2009-01-01

Background Reported failure rates,(defined based on percentage of cases progressing to surgery) of corrective bracing for idiopathic scoliosis are highly variable. This may be due to the quality of the brace itself, but also of the patient care during treatment. The latter is sometimes neglected, even though it is considered a main determinant of good results among conservative experts of SOSORT. The aim of this paper was to develop and verify the Consensus on management of scoliosis patients treated with braces Methods We followed a Delphi process in four steps, distributing and gradually changing according to the results a set of recommendations: we involved the SOSORT Board twice, then all SOSORT members twice, with a Pre-Meeting Questionnaire (PMQ), and during a Consensus Session at the SOSORT Athens Meeting with a Meeting Questionnaire (MQ). We set a 90% agreement as the minimum to be reached. Results We had a 71% response rate to PMQ, and 66.7% to MQ. Since the PMQ we had a good agreement (no answers below 72% – 70.2% over 90%). With the MQ the agreement consistently increased for all the answers previously below 90% (no answers below 83%, 75% over 90%). With increasing experience in bracing all numerical criteria tended to become more strict. We finally produced a set of 14 recommendations, grouped in 6 Domains (Experience/competence, Behaviours, Prescription, Construction, Brace Check, Follow-up). Conclusion The Consensus permits establishment of recommendations concerning the standards of management of idiopathic scoliosis with bracing, with the aim to increase efficacy and compliance to treatment. The SOSORT recommends to professionals engaged in patient care to follow the guidelines of this Consensus in their clinical practice. The SOSORT criteria should also be followed in clinical research studies to achieve a minimum quality of care. If the aim is to verify the efficacy of bracing these criteria should be companions of the methodological research criteria for bracing proposed by other societies. PMID:19149877

[Quality assurance in interventional cardiology].

PubMed

Gülker, H

2009-10-01

Quality assurance in clinical studies aiming at approval of pharmaceutical products is submitted to strict rules, controls and auditing regulations. Comparative instruments to ensure quality in diagnostic and therapeutic procedures are not available in interventional cardiology, likewise in other fields of cardiovascular medicine. Quality assurance simply consists of "quality registers" with basic data not externally controlled. Based on the experiences of clinical studies and their long history of standardization it is assumed that these data may be severely flawed thus being inappropriate to set standards for diagnostic and therapeutic strategies. The precondition for quality assurance are quality data. In invasive coronary angiography and intervention medical indications, the decision making process interventional versus surgical revascularization, technical performance and after - care are essential aspects affecting quality of diagnostics and therapy. Quality data are externally controlled data. To collect quality data an appropriate infrastructure is a necessary precondition which is not existent. For an appropriate infrastructure investments have to be done both to build up as well as to sustain the necessary preconditions. As long as there are no infrastructure and no investments there will be no "quality data". There exist simply registers of data which are not proved to be a basis for significant assurance and enhancement in quality in interventional coronary cardiology. Georg Thieme Verlag KG Stuttgart, New York.

Influencing Tomorrow: A Study of Emerging Influence Techniques and Their Relevance to United States Information Operations

DTIC Science & Technology

2015-06-12

Publicity Campaign without Going Broke (New York: Harper Business, 2008), 282. 46 Gini Dietrich, Spin Sucks: Communication and Reputation Management ...65 Religious themes stress the strict emulation of the practices of the Prophet and his companions as well as the personal, vice collective...but also dynamic medias that target children, teenagers , and adults. A variety of online games, cartoons, and stories have been designed

Spinal cord stimulation: a review of the safety literature and proposal for perioperative evaluation and management.

PubMed

Walsh, Kevin M; Machado, Andre G; Krishnaney, Ajit A

2015-08-01

There is currently no consensus on appropriate perioperative management of patients with spinal cord stimulator implants. Magnetic resonance imaging (MRI) is considered safe under strict labeling conditions. Electrocautery is generally not recommended in these patients but sometimes used despite known risks. The aim was to discuss the perioperative evaluation and management of patients with spinal cord stimulator implants. A literature review, summary of device labeling, and editorial were performed, regarding the safety of spinal cord stimulator devices in the perioperative setting. A literature review was performed, and the labeling of each Food and Drug Administration (FDA)-approved spinal cord stimulation system was reviewed. The literature review was performed using PubMed and the FDA website (www.fda.gov). Magnetic resonance imaging safety recommendations vary between the models. Certain systems allow for MRI of the brain to be performed, and only one system allows for MRI of the body to be performed, both under strict labeling conditions. Before an MRI is performed, it is imperative to ascertain that the system is intact, without any lead breaks or low impedances, as these can result in heating of the spinal cord stimulation (SCS) and injury to the patient. Monopolar electrocautery is generally not recommended for patients with SCS; however, in some circumstances, it is used when deemed required by the surgeon. When cautery is necessary, bipolar electrocautery is recommended. Modern electrocautery units are to be used with caution as there remains a risk of thermal injury to the tissue in contact with the SCS. As with MRI, electrocautery usage in patients with SCS systems with suspected breaks or abnormal impedances is unsafe and may cause injury to the patient. Spinal cord stimulation is increasingly used in patients with pain of spinal origin, particularly to manage postlaminectomy syndrome. Knowledge of the safety concerns of SCS and appropriate perioperative evaluation and management of the SCS system can reduce risks and improve surgical planning. Copyright © 2015 Elsevier Inc. All rights reserved.

Distinguishing the roles of meteorology, emission control measures, regional transport, and co-benefits of reduced aerosol feedbacks in ;APEC Blue;

NASA Astrophysics Data System (ADS)

Gao, Meng; Liu, Zirui; Wang, Yuesi; Lu, Xiao; Ji, Dongsheng; Wang, Lili; Li, Meng; Wang, Zifa; Zhang, Qiang; Carmichael, Gregory R.

2017-10-01

Air quality are strongly influenced by both emissions and meteorological conditions. During the Asia Pacific Economic Cooperation (APEC) week (November 5-11, 2014), the Chinese government implemented unprecedented strict emission control measures in Beijing and surrounding provinces, and then a phenomenon referred to as ;APEC Blue; (rare blue sky) occurred. It is challenging to quantify the effectiveness of the implemented strict control measures solely based on observations. In this study, we use the WRF-Chem model to distinguish the roles of meteorology, emission control measures, regional transport, and co-benefits of reduced aerosol feedbacks during APEC week. In general, meteorological variables, PM2.5 concentrations and PM2.5 chemical compositions are well reproduced in Beijing. Positive weather conditions (lower temperature, lower relative humidity, higher wind speeds and enhanced boundary layer heights) play important roles in ;APEC Blue;. Applying strict emission control measures in Beijing and five surrounding provinces can only explain an average decrease of 17.7 μg/m3 (-21.8%) decreases in PM2.5 concentrations, roughly more than half of which is caused by emission controls that implemented in the five surrounding provinces (12.5 μg/m3). During the APEC week, non-local emissions contributed to 41.3% to PM2.5 concentrations in Beijing, and the effectiveness of implementing emission control measures hinges on dominant pathways and transport speeds. Besides, we also quantified the contribution of reduced aerosol feedbacks due to strict emission control measures in this study. During daytime, co-benefits of reduced aerosol feedbacks account for about 10.9% of the total decreases in PM2.5 concentrations in urban Beijing. The separation of contributions from aerosol absorption and scattering restates the importance of controlling BC to accelerate the effectiveness of aerosol pollution control.

Digital Control Technologies for Modular DC-DC Converters

NASA Technical Reports Server (NTRS)

Button, Robert M.; Kascak, Peter E.; Lebron-Velilla, Ramon

2002-01-01

Recent trends in aerospace Power Management and Distribution (PMAD) systems focus on using commercial off-the-shelf (COTS) components as standard building blocks. This move to more modular designs has been driven by a desire to reduce costs and development times, but is also due to the impressive power density and efficiency numbers achieved by today's commercial DC-DC converters. However, the PMAD designer quickly learns of the hidden "costs" of using COTS converters. The most significant cost is the required addition of external input filters to meet strict electromagnetic interference (MIAMI) requirements for space systems. In fact, the high power density numbers achieved by the commercial manufacturers are greatly due to the lack of necessary input filters included in the COTS module. The NASA Glenn Research Center is currently pursuing a digital control technology that addresses this problem with modular DC-DC converters. This paper presents the digital control technologies that have been developed to greatly reduce the input filter requirements for paralleled, modular DC-DC converters. Initial test result show that the input filter's inductor size was reduced by 75 percent, and the capacitor size was reduced by 94 percent while maintaining the same power quality specifications.

Potential impact of HITECH security regulations on medical imaging.

PubMed

Prior, Fred; Ingeholm, Mary Lou; Levine, Betty A; Tarbox, Lawrence

2009-01-01

Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act (ARRA) of 2009 [1] include a provision commonly referred to as the "Health Information Technology for Economic and Clinical Health Act" or "HITECH Act" that is intended to promote the electronic exchange of health information to improve the quality of health care. Subtitle D of the HITECH Act includes key amendments to strengthen the privacy and security regulations issued under the Health Insurance Portability and Accountability Act (HIPAA). The HITECH act also states that "the National Coordinator" must consult with the National Institute of Standards and Technology (NIST) in determining what standards are to be applied and enforced for compliance with HIPAA. This has led to speculation that NIST will recommend that the government impose the Federal Information Security Management Act (FISMA) [2], which was created by NIST for application within the federal government, as requirements to the public Electronic Health Records (EHR) community in the USA. In this paper we will describe potential impacts of FISMA on medical image sharing strategies such as teleradiology and outline how a strict application of FISMA or FISMA-based regulations could have significant negative impacts on information sharing between care providers.

Global microbial commons: institutional challenges for the global exchange and distribution of microorganisms in the life sciences.

PubMed

Dedeurwaerdere, Tom

2010-01-01

Exchanges of microorganisms between culture collections, laboratories and researchers worldwide have historically occurred in an informal way. These informal exchanges have facilitated research activities, and, as a consequence, our knowledge and exploitation of microbial resources have advanced rapidly. During the last decades of the twentieth century, the increasing economic importance of biotechnology and the introduction of new legislation concerning the use of and access to biological resources has subjected exchanges of genetic resources to greater controls. Their access and distribution are more strictly regulated and, therefore, exchanges are becoming more and more formalized. This paper analyzes one of the main drivers of the movement toward more formal worldwide exchange regimes, which is increasing global interdependency of access to genetic resources. Its main finding is that formalization of exchange practices as such is not necessarily leading to more restrictive licensing conditions. The goal of further formalization and harmonization of institutional frameworks should therefore be to provide the broadest possible access to essential research materials (within the constraints set by biosecurity and quality management requirements), while maximizing the reciprocity benefits of access and exchange (which motivate the exchange practices to start with). (c) 2010 Elsevier Masson SAS. All rights reserved.

Clinical Evidence for Spinal Cord Stimulation for Failed Back Surgery Syndrome (FBSS): Systematic Review.

PubMed

Kapural, Leonardo; Peterson, Erika; Provenzano, David A; Staats, Peter

2017-07-15

A systematic review. A systematic literature review of the clinical data from prospective studies was undertaken to assess the efficacy of spinal cord stimulation (SCS) in the treatment of failed back surgery syndrome (FBSS) in adults. For patients with unrelenting back pain due to mechanical instability of the spine, degenerative disc disease, spinal injury, or deformity, spinal surgery is a well-accepted treatment option; however, even after surgical intervention, many patients continue to experience chronic back pain that can be notoriously difficult to treat. Clinical evidence suggests that for patients with FBSS, repeated surgery will not likely offer relief. Additionally, evidence suggests long-term use of opioid pain medications is not effective in this population, likely presents additional complications, and requires strict management. A systematic literature review was performed using several bibliographic databases, prospective studies in adults using SCS for FBSS were included. SCS has been shown to be a safe and efficacious treatment for this patient population. Recent technological developments in SCS offer even greater pain relief to patients' refractory to other treatment options, allowing patients to regain functionality and improve their quality of life with significant reductions in pain. N/A.

Review: Recharge rates and chemistry beneath playas of the High Plains aquifer, USA

NASA Astrophysics Data System (ADS)

Gurdak, Jason J.; Roe, Cassia D.

2010-12-01

Playas are ephemeral, closed-basin wetlands that are hypothesized as an important source of recharge to the High Plains aquifer in central USA. The ephemeral nature of playas, low regional recharge rates, and a strong reliance on groundwater from the High Plains aquifer has prompted many questions regarding the contribution and quality of recharge from playas to the High Plains aquifer. As a result, there has been considerable scientific debate about the potential for water to infiltrate the relatively impermeable playa floors, travel through the unsaturated zone sediments that are tens of meters thick, and subsequently recharge the High Plains aquifer. This critical review examines previously published studies on the processes that control recharge rates and chemistry beneath playas. Reported recharge rates beneath playas range from less than 1.0 to more than 500 mm/yr and are generally 1-2 orders of magnitude higher than recharge rates beneath interplaya settings. Most studies support the conceptual model that playas are important zones of recharge to the High Plains aquifer and are not strictly evaporative pans. The major findings of this review provide science-based implications for management of playas and groundwater resources of the High Plains aquifer and directions for future research.

7 CFR 28.404 - Strict Low Middling Color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Strict Low Middling Color. 28.404 Section 28.404... for the Color Grade of American Upland Cotton § 28.404 Strict Low Middling Color. Strict Low Middling Color is color which is within the range represented by a set of samples in the custody of the United...

7 CFR 28.406 - Strict Good Ordinary Color.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Strict Good Ordinary Color. 28.406 Section 28.406... for the Color Grade of American Upland Cotton § 28.406 Strict Good Ordinary Color. Strict Good Ordinary Color is color which is within the range represented by a set of samples in the custody of the...

7 CFR 28.404 - Strict Low Middling Color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Strict Low Middling Color. 28.404 Section 28.404... for the Color Grade of American Upland Cotton § 28.404 Strict Low Middling Color. Strict Low Middling Color is color which is within the range represented by a set of samples in the custody of the United...

7 CFR 28.404 - Strict Low Middling Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Strict Low Middling Color. 28.404 Section 28.404... for the Color Grade of American Upland Cotton § 28.404 Strict Low Middling Color. Strict Low Middling Color is color which is within the range represented by a set of samples in the custody of the United...

7 CFR 28.406 - Strict Good Ordinary Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Strict Good Ordinary Color. 28.406 Section 28.406... for the Color Grade of American Upland Cotton § 28.406 Strict Good Ordinary Color. Strict Good Ordinary Color is color which is within the range represented by a set of samples in the custody of the...

7 CFR 28.406 - Strict Good Ordinary Color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Strict Good Ordinary Color. 28.406 Section 28.406... for the Color Grade of American Upland Cotton § 28.406 Strict Good Ordinary Color. Strict Good Ordinary Color is color which is within the range represented by a set of samples in the custody of the...

7 CFR 28.406 - Strict Good Ordinary Color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Strict Good Ordinary Color. 28.406 Section 28.406... for the Color Grade of American Upland Cotton § 28.406 Strict Good Ordinary Color. Strict Good Ordinary Color is color which is within the range represented by a set of samples in the custody of the...

7 CFR 28.404 - Strict Low Middling Color.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Strict Low Middling Color. 28.404 Section 28.404... for the Color Grade of American Upland Cotton § 28.404 Strict Low Middling Color. Strict Low Middling Color is color which is within the range represented by a set of samples in the custody of the United...

7 CFR 28.406 - Strict Good Ordinary Color.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Good Ordinary Color. 28.406 Section 28.406... for the Color Grade of American Upland Cotton § 28.406 Strict Good Ordinary Color. Strict Good Ordinary Color is color which is within the range represented by a set of samples in the custody of the...

7 CFR 28.404 - Strict Low Middling Color.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Low Middling Color. 28.404 Section 28.404... for the Color Grade of American Upland Cotton § 28.404 Strict Low Middling Color. Strict Low Middling Color is color which is within the range represented by a set of samples in the custody of the United...

Management of urinary tract infections in patients with neurogenic bladder: challenges and solutions.

PubMed

Pannek, Jürgen; Wöllner, Jens

2017-01-01

Urinary tract infections (UTIs) are one of the most common morbidities in persons with neurogenic lower urinary tract dysfunction (NLUTD). They are associated with a significant morbidity and mortality, and they affect the quality of life of the affected patients. Diagnosis and treatment of UTI in this group of patients are challenging. In this review, the current strategies regarding diagnosis, treatment, and prevention are summarized. it is important to correctly diagnose a UTI, as treatment of bacteriuria should strictly be avoided. A UTI is defined as a combination of laboratory findings (leukocyturia and bacteriuria) and symptoms. Laboratory findings without symptoms are classified as asymptomatic bacteriuria. Routine urine screening is not advised. Only UTI should be treated; treatment of asymptomatic bacteriuria is not indicated. Prior to treatment, urine for a urine culture should be obtained. Antibiotic treatment for ~7 days is advised. In recurrent UTI, bladder management should be optimized and morphologic causes for UTI should be excluded. If UTIs persist, medical prophylaxis should be considered. Currently, no prophylactic measure with evidence-based efficacy exists. Long-term antibiotic prophylaxis should be used merely as an ultimate measure. Among the various mentioned innovative approaches for UTI prevention, bacteriophages, intravesical instillations, complementary and alternative medicine techniques, and probiotics seem to be most promising. Recently, several promising innovative options for UTI prophylaxis have been developed which may help overcome the current therapeutic dilemma. However, further well designed studies are necessary to evaluate the safety and efficacy of these approaches.

The management of refractory coeliac disease

PubMed Central

2013-01-01

A significant proportion of patients with coeliac disease are ‘nonresponsive’ to gluten withdrawal. Most cases of nonresponsive coeliac disease are due to persisting gluten ingestion. Refractory coeliac disease (RCD) is currently defined by persistent symptoms and signs of malabsorption after gluten exclusion for 12 months with ongoing intestinal villous atrophy. Primary (without initial response to diet) and secondary (relapse following response to diet) RCD is recognized. RCD is further classified as type I or type II based on the absence or presence of a population of aberrant intestinal lymphocytes. Quality of dietetic advice and support is fundamental, and lack of objective corroboration of gluten exclusion may result in over-identification of RCD I, particularly in those cases with persisting antibody responses. Over-reliance on lymphocyte clonality similarly may result in over-diagnosis of RCD II which requires careful quantification of aberrant lymphocyte populations. Management of RCD should be undertaken in specialist centres. It requires initial intensive dietary supervision, strict gluten exclusion and subsequent re-evaluation. There is currently insufficient evidence to recommend specific treatments. Steroids are often used in both RCD I and II (albeit with little objective evidence of benefit in RCD II), and azathioprine as steroid-sparing therapy in RCD I. There is growing evidence for the use of cladribine in RCD II with autologous stem cell transplantation in nonresponders, but this requires further multicentre evaluation. There remains considerable controversy regarding the diagnosis, treatment and surveillance of RCD: international consensus in these areas is urgently required to facilitate future therapeutic advances. PMID:23556127

Specificity of Good Manufacturing Practice (GMP) for Biomedical Cell Products.

PubMed

Tulina, M A; Pyatigorskaya, N V

2018-03-01

The article describes special aspects of Good Manufacturing Practice (GMP) for biomedical cell products (BMCP) that imply high standards of aseptics throughout the entire productio process, strict requirements to donors and to the procedure of biomaterial isolation, guaranty of tracing BMCP products, defining processing procedures which allow to identify BMCP as minimally manipulated; continuous quality control and automation of the control process at all stages of manufacturing, which will ensure product release simultaneously with completion of technological operations.

Management of Substance Use Disorder in Military Services: A Comprehensive Approach

PubMed Central

Sharbafchi, Mohammad Reza; Heydari, Mostafa

2017-01-01

Background: Historically, substance misuse has been a serious problem faced by worldwide military personnel. Some research showed that military personnel have higher rates of unhealthy substance use than their age peers in the general population. These problems have serious consequences and may lead to significant military difficulties in the field of readiness, discipline, and mental or physical health. In this review, we gathered various methods for prevention, diagnosis, and treatment of substance use disorders and suggested a comprehensive plan for Iran Armed Forces to improve existing services. Materials and Methods: This article is a narrative review study, which was carried out on 2016. A careful literature review was performed between January 1970 and April 2016 on several national and international databases. Articles were screened according to the following inclusion criteria: (1) review articles about prevention and treatment protocols, (2) executive guidance, (3) cohort articles about risk factors of addiction, and (4) randomized controlled trials about prevention or treatment of substance use disorders in army service members. After screening by title and abstract, 130 articles selected of 832 founded articles, and after quality assessment, finally, 63 articles included in the review. Results: There is a necessity to manage substance use disorder through prevention, screening, and then referral to proper services for diagnosis and treatment. Urinalysis programs for screening are cost-effective and should be considered as a main method. Effective treatment includes both behavioral and pharmacological methods. Conclusions: The ideal prevention program will include multiple and mutually reinforcing evidence-based universal, selective, and indicated attempts at both the individual and environmental levels. The implementation of screening and treatment strategies needs strict rules and national guideline for the comprehensive management of substance use disorders in army. PMID:28989915

Dispersal ecology of deadwood organisms and connectivity conservation.

PubMed

Komonen, Atte; Müller, Jörg

2018-06-01

Limited knowledge of dispersal for most organisms hampers effective connectivity conservation in fragmented landscapes. In forest ecosystems, deadwood-dependent organisms (i.e., saproxylics) are negatively affected by forest management and degradation globally. We reviewed empirically established dispersal ecology of saproxylic insects and fungi. We focused on direct studies (e.g., mark-recapture, radiotelemetry), field experiments, and population genetic analyses. We found 2 somewhat opposite results. Based on direct methods and experiments, dispersal is limited to within a few kilometers, whereas genetic studies showed little genetic structure over tens of kilometers, which indicates long-distance dispersal. The extent of direct dispersal studies and field experiments was small and thus these studies could not have detected long-distance dispersal. Particularly for fungi, more studies at management-relevant scales (1-10 km) are needed. Genetic researchers used outdated markers, investigated few loci, and faced the inherent difficulties of inferring dispersal from genetic population structure. Although there were systematic and species-specific differences in dispersal ability (fungi are better dispersers than insects), it seems that for both groups colonization and establishment, not dispersal per se, are limiting their occurrence at management-relevant scales. Because most studies were on forest landscapes in Europe, particularly the boreal region, more data are needed from nonforested landscapes in which fragmentation effects are likely to be more pronounced. Given the potential for long-distance dispersal and the logical necessity of habitat area being a more fundamental landscape attribute than the spatial arrangement of habitat patches (i.e., connectivity sensu strict), retaining high-quality deadwood habitat is more important for saproxylic insects and fungi than explicit connectivity conservation in many cases. © 2018 Society for Conservation Biology.

Management of Substance Use Disorder in Military Services: A Comprehensive Approach.

PubMed

Sharbafchi, Mohammad Reza; Heydari, Mostafa

2017-01-01

Historically, substance misuse has been a serious problem faced by worldwide military personnel. Some research showed that military personnel have higher rates of unhealthy substance use than their age peers in the general population. These problems have serious consequences and may lead to significant military difficulties in the field of readiness, discipline, and mental or physical health. In this review, we gathered various methods for prevention, diagnosis, and treatment of substance use disorders and suggested a comprehensive plan for Iran Armed Forces to improve existing services. This article is a narrative review study, which was carried out on 2016. A careful literature review was performed between January 1970 and April 2016 on several national and international databases. Articles were screened according to the following inclusion criteria: (1) review articles about prevention and treatment protocols, (2) executive guidance, (3) cohort articles about risk factors of addiction, and (4) randomized controlled trials about prevention or treatment of substance use disorders in army service members. After screening by title and abstract, 130 articles selected of 832 founded articles, and after quality assessment, finally, 63 articles included in the review. There is a necessity to manage substance use disorder through prevention, screening, and then referral to proper services for diagnosis and treatment. Urinalysis programs for screening are cost-effective and should be considered as a main method. Effective treatment includes both behavioral and pharmacological methods. The ideal prevention program will include multiple and mutually reinforcing evidence-based universal, selective, and indicated attempts at both the individual and environmental levels. The implementation of screening and treatment strategies needs strict rules and national guideline for the comprehensive management of substance use disorders in army.

[A brief review of research on chronic disease management based on collaborative care model in China].

PubMed

Li, Huayan; Fuller, Jeffrey; Sun, Mei; Wang, Yong; Xu, Shuang; Feng, Hui

2014-11-01

To evaluate the situation for chronic disease management in China, and to seek the method for improving the collaborative management for chronic diseases in community. We searched literature between January 2008 and November 2013 from the Database, such as China Academic Journal Full-Text Database, and PubMed. The screening was strictly in accordance with the inclusion and exclusion criteria and a summary was made among the selected literature based on a collaboration model. We got 698 articles after rough screen and finally selected 33. All studies were involved in patient's self-management support, but only 9 studies mentioned the communication within the team, and 11 showed a clear team division of labor. Chronic disease community management in China displays some disadvantages. It really needs a general service team with clear roles and responsibilities for team members to improve the service ability of team members and provide patients with various forms of self management services.

NIAID-sponsored 2010 guidelines for managing food allergy: applications in the pediatric population.

PubMed

Burks, A Wesley; Jones, Stacie M; Boyce, Joshua A; Sicherer, Scott H; Wood, Robert A; Assa'ad, Amal; Sampson, Hugh A

2011-11-01

Data from many studies have suggested a rise in the prevalence of food allergies during the past 10 to 20 years. Currently, no curative treatments for food allergy exist, and there are no effective means of preventing the disease. Management of food allergy involves strict avoidance of the allergen in the patient's diet and treatment of symptoms as they arise. Because diagnosis and management of the disease can vary between clinical practice settings, the National Institute of Allergy and Infectious Diseases (NIAID) sponsored development of clinical guidelines for the diagnosis and management of food allergy. The guidelines establish consensus and consistency in definitions, diagnostic criteria, and management practices. They also provide concise recommendations on how to diagnose and manage food allergy and treat acute food allergy reactions. The original guidelines encompass practices relevant to patients of all ages, but food allergy presents unique and specific concerns for infants, children, and teenagers. To focus on those concerns, we describe here the guidelines most pertinent to the pediatric population.

Air pollution control residues from waste incineration: current UK situation and assessment of alternative technologies.

PubMed

Rani, D Amutha; Boccaccini, A R; Deegan, D; Cheeseman, C R

2008-11-01

Current disposal options for APC residues in the UK and alternative treatment technologies developed world-wide have been reviewed. APC residues are currently landfilled in the UK where they undergo in situ solidification, although the future acceptability of this option is uncertain because the EU waste acceptance criteria (WAC) introduce strict limits on leaching that are difficult to achieve. Other APC residue treatment processes have been developed which are reported to reduce leaching to below relevant regulatory limits. The Ferrox process, the VKI process, the WES-PHix process, stabilisation/solidification using cementitious binders and a range of thermal treatment processes are reviewed. Thermal treatment technologies convert APC residues combined with other wastes into inert glass or glass-ceramics that encapsulate heavy metals. The waste management industry will inevitably use the cheapest available option for treating APC residues and strict interpretation and enforcement of waste legislation is required if new, potentially more sustainable technologies are to become commercially viable.

Potentials of mathematical modeling and use of GIS in catchment management and the benefits for the Water Framework Directive fulfilling

NASA Astrophysics Data System (ADS)

Dostal, T.; Krasa, J.

2009-04-01

The EU Water Framework Directive (WFD) brings relatively strict demands concerning surface waters protection, soil protection and watershed management. Water quality and soil conservation are among the priorities of European environmental policy. The aims and corresponding limits are clearly and strictly formulated but the ways how to fulfill the task remain unspecified. Moreover the side effects and synergic effects are not considered. Therefore there is no recommended methodology for implementing the protection measures. At the Faculty of Civil Engineering (Czech Technical University in Prague) we deal with development and use of various methods routinely applicable in catchment management and engineering praxis. Mainly we focus on soil conservation, sediment transport assessment, retention capacity of landscape evaluation and flood prevention. Our contribution will present overview of applicable approaches and methods useful for the WFD implementation and for Watershed management strategy defining. Very important part of the problem is use of high precision data sources available for environmental modeling. Data in similar formats and precision (considering soil properties, land use and land cover, precipitation, etc.) exist throughout Europe, but the data availability for research is very limited. In spite of the INSPIRE Directive the European coordination here is low. Typical example can be found in Map of soil loss and sediment transport within Czech Republic. Methodically simple approach (using USLE - Wischmeier et al., 1978) was applied to whole Czech territory in coordination with GIS already in 2001 (Dostal et al.,2001). The map was consistently updated and in 2007 the LPIS database allowed us to estimate soil erosion rates in scale of individual parcels (Dostal et al., 2007). Each agricultural field block was assessed in 25m resolution raster (484 835 individual parcels, 35 301 km2). The data were then used for preparing Watershed management strategy - to estimate phosphorus loads from non-point sources and to define potential prevention measures in most endangered areas. The map is nowadays accessible for any Czech region at the internet as a WMS link. It can be easily downloaded from national metadata portal http://mis.cenia.cz using a key word „eroze"to search for the map. This map can be easily updated using high precision soil map (1:5000 scale) existing for the whole Czech territory. Unfortunately the soil map was not available for the recent assessment. Next example of application, generation of the map of rainfall-runoff conditions for sub catchments with area of ca 5 - 10 km2 can be mentioned. This Map classifies individual sub catchments according to their surface runoff production as response to causal rainfall event (Vrana et al, 2004). This material helps since 2004 for decision making related to state financial subsidy policy for flood control prevention in upper parts of the catchments. Related example are also Assessments of retention capacity of riverine floodplains or urban areas flood risk by surface runoff from agricultural land, which are recently processed for entire territory of The Czech Republic. One of the basic obstructions for wider implementation of simulation models and other mathematic-based tools in practice and especially for decision making support is relatively weak coordination within EU countries. There exist valid and relatively strict regulative on entire EU level on one hand, but the methods, which should be used to determine fixed values and limits are not specified properly. The approach within individual countries is very different regarding to both of methodologies recommended or accepted and input data availability for desired calculations and designs. The third problem is insufficient foreknowledge of important decision makers (local governments and state authorities) about current state of the art in mathematical modeling and GIS application in watershed and water quality management. The above mentioned calculations and mathematical simulations are still assumed mostly being a domain of science and it is not accepted that many analysis and models were already finished to the level of practical routine applicability. Another important problem is missing relation and cooperation between environmental field (where for instance Water Framework Directive is also assumed to be included) and economical and social fields. The regulative and limits are set up in the area of agriculture on one hand, to reach economic goals in food production, but on the other hand, side effects of those measures to water quality protection are not assumed and vice-versa, watershed management measures are mostly not assessed from point of view of the effects on a desired economic field. Already (Van Rompaey et al., 2000) examined the effect of conversion of arable land into peace (conversion mostly to grassland) in agreement with European agricultural policy of food overproduction prevention, on sediment transport into water reservoirs. Based on mathematical simulations and survey between farmers he approved that unimportant increasing of proportion of converted land in certain regions can significantly influence sediment transport and water quality in given catchment. Proposed presentation tends to invoke support of international and interdepartmental cooperation in given fields and to present various possibilities of application of mathematical modeling and GIS assisted analyses on the level of practical and routine applicability for watershed management in various scales. Acknowledgement: This paper has been worked out based on the results reached with support of the project "MSMT CR VZ CEZ MSM 6840770002 - Revitalization of water systems of the landscape and urban sites, significantly affected by anthropogenic changes". References • Dostal T., Krasa J., Vaska J., Vrana K., 2001. The map of soil erosion risk and sediment transport in the Czech Republic. VUV TGM, Czech Journal for Soil and Water Management, 1: p. 1-21 • Dostal, T. et. al., 2007. Metody a zpusoby predikce povrchoveho odtoku, eroznich a transportnich procesu v krajine (The methods of surface runoff, erosion and transport processes in a landscape prediction), annual research report from COST634 action, CTU Prague (in Czech) • Van Rompaey A. et al., 2000. The impact of land use policy on the soil erosion risk: a case study of central Belgium, Agriculture, Ecosystems and Environment, pp1 - 12 • Vrana et al., 2004. The map of rainfall-runoff conditions for Central Bohemia region (in Czech), CTU Prague, • Wischmeier,W.H., Smith, D.D., 1978. Predicting Rainfall Erosion Losses - a guide for conservation planning. Agricultural Handbook 537. US Department of Agriculture

Package of care for active management in labour for reducing caesarean section rates in low-risk women.

PubMed

Brown, Heather C; Paranjothy, Shantini; Dowswell, Therese; Thomas, Jane

2013-09-16

Approximately 15% of women have caesarean sections (CS) and while the rate varies, the number is increasing in many countries. This is of concern because higher CS rates do not confer additional health gain but may adversely affect maternal health and have implications for future pregnancies. Active management of labour has been proposed as a means of reducing CS rates. This refers to a package of care including strict diagnosis of labour, routine amniotomy, oxytocin for slow progress and one-to-one support in labour. To determine whether active management of labour reduces CS rates in low-risk women and improves satisfaction. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (16 April 2013). Randomised controlled trials comparing low-risk women receiving a predefined package of care (active management) with women receiving routine (variable) care. Trials where slow progress had been diagnosed before entry into the trial were excluded. At least two review authors extracted data. We assessed included studies for risk of bias. We included seven trials, with a total of 5390 women. The quality of studies was mixed. The CS rate was slightly lower in the active management group compared with the group that received routine care, but this difference did not reach statistical significance (RR 0.88, 95% CI 0.77 to 1.01). However, in one study there was a large number of post-randomisation exclusions. On excluding this study, CS rates in the active management group were statistically significantly lower than in the routine care group (RR 0.77 95% CI 0.63 to 0.94). More women in the active management group had labours lasting less than 12 hours, but there was wide variation in length of labour within and between trials. There were no differences between groups in use of analgesia, rates of assisted vaginal deliveries or maternal or neonatal complications. Only one trial examined maternal satisfaction; the majority of women (over 75%) in both groups were very satisfied with care. Active management is associated with small reductions in the CS rate, but it is highly prescriptive and interventional. It is possible that some components of the active management package are more effective than others. Further work is required to determine the acceptability of active management to women in labour.

Evolution of data stewardship over two decades at a NASA data center

NASA Astrophysics Data System (ADS)

Armstrong, E. M.; Moroni, D. F.; Hausman, J.; Tsontos, V. M.

2013-12-01

Whether referred to as data science or data engineering, the technical nature and practice of data curation has seen a noticeable shift in the last two decades. The majority of this has been driven by factors of increasing data volumes and complexity, new data structures, and data virtualization through internet access that have themselves spawned new fields or advances in semantic ontologies, metadata, advanced distributed computing and new file formats. As a result of this shifting landscape, the role of the data scientist/engineer has also evolved.. We will discuss the key elements of this evolutionary shift from the perspective of data curation at the NASA Physical Oceanography Distributed Active Archive Center (PO.DAAC), which is one of 12 NASA Earth Science data centers responsible for archiving and distributing oceanographic satellite data since 1993. Earlier responsibilities of data curation in the history of the PO.DAAC focused strictly on data archiving, low-level data quality assessments, understanding and building read software for terse binary data or limited applications of self-describing file formats and metadata. Data discovery was often word of mouth or based on perusing simple web pages built for specific products. At that time the PO.DAAC served only a few tens of datasets. A single data engineer focused on a specific mission or suite of datasets from a specific physical parameter (e.g., ocean topography measurements). Since that time the number of datasets in the PO.DAAC has grown to approach one thousand, with increasing complexity of data and metadata structures in self-describing formats. Advances in ontologies, metadata, applications of MapReduce distributed computing and "big data", improvements in data discovery, data mining, and tools for visualization and analysis have all required new and evolving skill sets. The community began requiring more rigorous assessments of data quality and uncertainty. Although the expert knowledge of the physical domain was still critical, especially relevant to assessments of data quality, additional skills in computer science, statistics and system engineering also became necessary. Furthermore, the level of effort to implement data curation has not expanded linearly either. Management of ongoing data operations demands increased productivity on a continual basis and larger volumes of data, with constraints on funding, must be managed with proportionately less human resources. The role of data curation has also changed within the perspective of satellite missions. In many early missions, data management and curation was an afterthought (since there were no explicit data management plans written into the proposals), while current NASA mission proposals must have explicit data management plans to identify resources and funds for archiving, distribution and implementing overall data stewardship. In conclusion, the role of the data scientist/engineer at the PO.DAAC has shifted from supporting singular missions and primarily representing a point of contact for the science community to complete end-to-end stewardship through the implementation of a robust set of dataset lifecycle policies from ingest, to archiving, including data quality assessment for a broad swath of parameter based datasets that can number in the hundreds.

Role of video games in improving health-related outcomes: a systematic review.

PubMed

Primack, Brian A; Carroll, Mary V; McNamara, Megan; Klem, Mary Lou; King, Brandy; Rich, Michael; Chan, Chun W; Nayak, Smita

2012-06-01

Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it also may be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes. Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source); sample data (e.g., number of study participants, demographics); intervention and control details; outcomes data; and quality measures were abstracted independently by two researchers. Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of <12 weeks, and only 11% of studies blinded researchers. There is potential promise for video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. RCTs with appropriate rigor will help build evidence in this emerging area. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Role of Video Games in Improving Health-Related Outcomes

PubMed Central

Primack, Brian A.; Carroll, Mary V.; McNamara, Megan; Klem, Mary Lou; King, Brandy; Rich, Michael O.; Chan, Chun W.; Nayak, Smita

2012-01-01

Context Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it may also be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes. Evidence acquisition Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source), sample data (e.g., number of study participants, demographics), intervention and control details, outcomes data, and quality measures were abstracted independently by two researchers. Evidence synthesis Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of <12 weeks, and only 11% of studies blinded researchers. Conclusions There is potential promise for video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. RCTs with appropriate rigor will help build evidence in this emerging area. PMID:22608382

Dental management of patients with epidermolysis bullosa.

PubMed

Dağ, Canan; Bezgin, Tuğba; Özalp, Nurhan

2014-09-01

Epidermolysis Bullosa (EB) is a group of rare, genetic skin disorders characterized by fragility and blistering to minimal trauma. All oral surfaces may be involved, including the tongue, buccal mucosa, palate, floor of the mouth and gingiva. Common oral findings of the disease include microstomia, intraoral ulcerations and bullae formation, ankyloglossia, tongue atrophy, elimination of buccal and vestibular sulci, lingual depapillation and atrophy of the palatal folds. In these case reports; systemic findings, oral manifestations and preventive measures are described for 3 patients with EB, all of whom required extensive oral management. Early dental management and preventive care to minimize caries development and improve oral health is very important for patients with EB. Pediatric dentists play an especially important role in early intervention. In describing the dental management of three EB cases, this article stresses the importance of an aggressive dental preventive programme with strict oral hygiene instructions for patients and parents along with frequent professional cleaning and fluoride therapy.

Options for change in the NHS consultant contract.

PubMed

Clarke, R W; Gray, C

The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers.

Options for change in the NHS consultant contract.

PubMed Central

Clarke, R. W.; Gray, C.

1994-01-01

The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers. PMID:8086915

Theory research of seam recognition and welding torch pose control based on machine vision

NASA Astrophysics Data System (ADS)

Long, Qiang; Zhai, Peng; Liu, Miao; He, Kai; Wang, Chunyang

2017-03-01

At present, the automation requirement of the welding become higher, so a method of the welding information extraction by vision sensor is proposed in this paper, and the simulation with the MATLAB has been conducted. Besides, in order to improve the quality of robot automatic welding, an information retrieval method for welding torch pose control by visual sensor is attempted. Considering the demands of welding technology and engineering habits, the relative coordinate systems and variables are strictly defined, and established the mathematical model of the welding pose, and verified its feasibility by using the MATLAB simulation in the paper, these works lay a foundation for the development of welding off-line programming system with high precision and quality.

76 FR 44535 - Revisions to the California State Implementation Plan, Northern Sierra Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... the California State Implementation Plan, Northern Sierra Air Quality Management District, Sacramento Metropolitan Air Quality Management District, and South Coast Air Quality Management District AGENCY... the Northern Sierra Air Quality Management District (NSAQMD), Sacramento Metropolitan Air Quality...

[New analgesics in paediatrics].

PubMed

Avez-Couturier, Justine; Wood, Chantal

2016-01-01

There are a number of different types of analgesics in paediatrics. They must be used in accordance with the situation, the type of pain and the characteristics of the child. In all cases, strict compliance with the posology and the instructions for use is essential to avoid any risk of error. Finally, pharmacological, physical and psychological treatments are employed in a complementary manner, for the biopsychosocial management of the child's care. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

A Performance Based Management System for the United States Navy.

DTIC Science & Technology

1984-06-01

cf compensation can be difficult. :onventional employers (such as manufacturers and serv ice-related producers) usually have the luxury of being able...manned (as well as robotic ) systems that require increased operator skill. Manning this force with strictly the correct numbers of people is not...your Pay and Benef its," ings§ 29 92d pps* 4-5, Spring 1983 16. Center for Naval Analyses Professional Paper 386 Cons truction of "Trainina. Cost Per

[Quality Manager 2.0 in hospitals: A practical guidance for executive managers, medical directors, senior consultants, nurse managers and practicing quality managers].

PubMed

Pilz, Stefan; Hülsmann, Sylvia; Michallik, Stefan; Rimbach-Schurig, Monika; Schollmeier, Margarita; Sommerhoff, Benedikt; Weßling, Adelheid

2013-01-01

Aiming at the development of perspectives and recommendations for modern quality management in health services the GQMG conducted a study on the role and self-conception of quality managers in hospitals. It seems obvious that the effectiveness of quality management clearly depends on the executive board's skilful installation of quality management, their support of quality managers and, particularly in larger-sized institutions on the coordination of staff units and cross-sectional functions.(As supplied by author). Copyright © 2013. Published by Elsevier GmbH.

IMPROVING (SOFTWARE) PATENT QUALITY THROUGH THE ADMINISTRATIVE PROCESS

PubMed Central

Rai, Arti K.

2014-01-01

The available evidence indicates that patent quality, particularly in the area of software, needs improvement. This Article argues that even an agency as institutionally constrained as the U.S. Patent and Trademark Office (“PTO”) could implement a portfolio of pragmatic, cost-effective quality improvement strategies. The argument in favor of these strategies draws upon not only legal theory and doctrine but also new data from a PTO software examination unit with relatively strict practices. Strategies that resolve around Section 112 of the patent statute could usefully be deployed at the initial examination stage. Other strategies could be deployed within the new post-issuance procedures available to the agency under the America Invents Act. Notably, although the strategies the Article discusses have the virtue of being neutral as to technology, they are likely to have a very significant practical impact in the area of software. PMID:25221346

Requirements for modeling airborne microbial contamination in space stations

NASA Astrophysics Data System (ADS)

Van Houdt, Rob; Kokkonen, Eero; Lehtimäki, Matti; Pasanen, Pertti; Leys, Natalie; Kulmala, Ilpo

2018-03-01

Exposure to bioaerosols is one of the facets that affect indoor air quality, especially for people living in densely populated or confined habitats, and is associated to a wide range of health effects. Good indoor air quality is thus vital and a prerequisite for fully confined environments such as space habitats. Bioaerosols and microbial contamination in these confined space stations can have significant health impacts, considering the unique prevailing conditions and constraints of such habitats. Therefore, biocontamination in space stations is strictly monitored and controlled to ensure crew and mission safety. However, efficient bioaerosol control measures rely on solid understanding and knowledge on how these bioaerosols are created and dispersed, and which factors affect the survivability of the associated microorganisms. Here we review the current knowledge gained from relevant studies in this wide and multidisciplinary area of bioaerosol dispersion modeling and biological indoor air quality control, specifically taking into account the specific space conditions.

IMPROVING (SOFTWARE) PATENT QUALITY THROUGH THE ADMINISTRATIVE PROCESS.

PubMed

Rai, Arti K

2013-11-24

The available evidence indicates that patent quality, particularly in the area of software, needs improvement. This Article argues that even an agency as institutionally constrained as the U.S. Patent and Trademark Office ("PTO") could implement a portfolio of pragmatic, cost-effective quality improvement strategies. The argument in favor of these strategies draws upon not only legal theory and doctrine but also new data from a PTO software examination unit with relatively strict practices. Strategies that resolve around Section 112 of the patent statute could usefully be deployed at the initial examination stage. Other strategies could be deployed within the new post-issuance procedures available to the agency under the America Invents Act. Notably, although the strategies the Article discusses have the virtue of being neutral as to technology, they are likely to have a very significant practical impact in the area of software.

40 CFR 130.6 - Water quality management plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Water quality management plans. 130.6... QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM... and certified and approved updates to those plans. Continuing water quality planning shall be based...

40 CFR 130.6 - Water quality management plans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Water quality management plans. 130.6... QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM... when they are needed to address water quality problems. (1) Total maximum daily loads. TMDLs in...

Human population and socioeconomic modulators of conservation performance in 788 Amazonian and Atlantic Forest reserves.

PubMed

de Marques, Ana Alice B; Schneider, Mauricio; Peres, Carlos A

2016-01-01

Protected areas form a quintessential component of the global strategy to perpetuate tropical biodiversity within relatively undisturbed wildlands, but they are becoming increasingly isolated by rapid agricultural encroachment. Here we consider a network of 788 forest protected areas (PAs) in the world's largest tropical country to examine the degree to which they remain intact, and their responses to multiple biophysical and socioeconomic variables potentially affecting natural habitat loss under varying contexts of rural development. PAs within the complex Brazilian National System of Conservation Units (SNUC) are broken down into two main classes-strictly protected and sustainable use. Collectively, these account for 22.6% of the forest biomes within Brazil's national territory, primarily within the Amazon and the Atlantic Forest, but are widely variable in size, ecoregional representation, management strategy, and the degree to which they are threatened by human activities both within and outside reserve boundaries. In particular, we examine the variation in habitat conversion rates in both strictly protected and sustainable use reserves as a function of the internal and external human population density, and levels of land-use revenue in adjacent human-dominated landscapes. Our results show that PAs surrounded by heavily settled agro-pastoral landscapes face much greater challenges in retaining their natural vegetation, and that strictly protected areas are considerably less degraded than sustainable use reserves, which can rival levels of habitat degradation within adjacent 10-km buffer areas outside.

Human population and socioeconomic modulators of conservation performance in 788 Amazonian and Atlantic Forest reserves

PubMed Central

Schneider, Mauricio; Peres, Carlos A.

2016-01-01

Protected areas form a quintessential component of the global strategy to perpetuate tropical biodiversity within relatively undisturbed wildlands, but they are becoming increasingly isolated by rapid agricultural encroachment. Here we consider a network of 788 forest protected areas (PAs) in the world’s largest tropical country to examine the degree to which they remain intact, and their responses to multiple biophysical and socioeconomic variables potentially affecting natural habitat loss under varying contexts of rural development. PAs within the complex Brazilian National System of Conservation Units (SNUC) are broken down into two main classes—strictly protected and sustainable use. Collectively, these account for 22.6% of the forest biomes within Brazil’s national territory, primarily within the Amazon and the Atlantic Forest, but are widely variable in size, ecoregional representation, management strategy, and the degree to which they are threatened by human activities both within and outside reserve boundaries. In particular, we examine the variation in habitat conversion rates in both strictly protected and sustainable use reserves as a function of the internal and external human population density, and levels of land-use revenue in adjacent human-dominated landscapes. Our results show that PAs surrounded by heavily settled agro-pastoral landscapes face much greater challenges in retaining their natural vegetation, and that strictly protected areas are considerably less degraded than sustainable use reserves, which can rival levels of habitat degradation within adjacent 10-km buffer areas outside. PMID:27478703

METHODOLOGICAL QUALITY OF ECONOMIC EVALUATIONS ALONGSIDE TRIALS OF KNEE PHYSIOTHERAPY.

PubMed

García-Pérez, Lidia; Linertová, Renata; Arvelo-Martín, Alejandro; Guerra-Marrero, Carolina; Martínez-Alberto, Carlos Enrique; Cuéllar-Pompa, Leticia; Escobar, Antonio; Serrano-Aguilar, Pedro

2017-01-01

The methodological quality of an economic evaluation performed alongside a clinical trial can be underestimated if the paper does not report key methodological features. This study discusses methodological assessment issues on the example of a systematic review on cost-effectiveness of physiotherapy for knee osteoarthritis. Six economic evaluation studies included in the systematic review and related clinical trials were assessed using the 10-question check-list by Drummond and the Physiotherapy Evidence Database (PEDro) scale. All economic evaluations were performed alongside a clinical trial but the studied interventions were too heterogeneous to be synthesized. Methodological quality of the economic evaluations reported in the papers was not free of drawbacks, and in some cases, it improved when information from the related clinical trial was taken into account. Economic evaluation papers dedicate little space to methodological features of related clinical trials; therefore, the methodological quality can be underestimated if evaluated separately from the trials. Future economic evaluations should follow more strictly the recommendations about methodology and the authors should pay special attention to the quality of reporting.

Real Traceable Signatures

NASA Astrophysics Data System (ADS)

Chow, Sherman S. M.

Traceable signature scheme extends a group signature scheme with an enhanced anonymity management mechanism. The group manager can compute a tracing trapdoor which enables anyone to test if a signature is signed by a given misbehaving user, while the only way to do so for group signatures requires revealing the signer of all signatures. Nevertheless, it is not tracing in a strict sense. For all existing schemes, T tracing agents need to recollect all N' signatures ever produced and perform RN' “checks” for R revoked users. This involves a high volume of transfer and computations. Increasing T increases the degree of parallelism for tracing but also the probability of “missing” some signatures in case some of the agents are dishonest.

Diagnosis and management of congenital hypothyroidism.

PubMed

Harrell, G B; Murray, P D

1998-03-01

Thyroid hormones are integral to the development and maturation of the central nervous system as well as normal growth and development. Comprehensive knowledge of the maturation and function of the thyroid gland is essential to understanding the pathophysiology of thyroid dysfunction. Early diagnosis and appropriate treatment in thyroid disease are imperative for normalization of thyroid hormone ratios. Optimal management includes early introduction and strict adherence to a regimen of L-thyroxine and routine monitoring of thyroid levels throughout life. Parents need to understand the importance of consistent medication administration and daily assessment of well-being because these actions are crucial to the attainment of an optimal level of development for infants with congenital hypothyroidism.

Contamination of blood cultures during venepuncture: fact or myth?

PubMed Central

Shahar, E.; Wohl-Gottesman, B. S.; Shenkman, L.

1990-01-01

Contamination of blood cultures is believed to occur mainly during the venepuncture procedure. Consequently, meticulous preparation of the venepuncture site is widely recommended. To determine whether the contamination rate is indeed affected by the quality of the antiseptic procedure at the venepuncture site, 181 paired cultures were collected from 176 patients during a 6-month period after either strict antiseptic cleansing of skin with alcohol followed by povidone-iodine, or after brief disinfection with alcohol alone. The contamination rate was not influenced by the antiseptic procedure, and corresponded to the accepted percentage reported in most other studies. Eight false positive cultures (4.4%) were obtained after strict antisepsis of the skin and 6 (3.3%) after short simple cleansing with alcohol (P = 0.39). Our results suggest that contamination of blood cultures may not be related to the venepuncture procedure--regardless of the antiseptic technique used--but may be due to later stages of laboratory handling and processing of the specimens. Review of the literature has provided further indirect evidence to support this conclusion. PMID:2084653

Verification of a quality management theory: using a delphi study.

PubMed

Mosadeghrad, Ali Mohammad

2013-11-01

A model of quality management called Strategic Collaborative Quality Management (SCQM) model was developed based on the quality management literature review, the findings of a survey on quality management assessment in healthcare organisations, semi-structured interviews with healthcare stakeholders, and a Delphi study on healthcare quality management experts. The purpose of this study was to verify the SCQM model. The proposed model was further developed using feedback from thirty quality management experts using a Delphi method. Further, a guidebook for its implementation was prepared including a road map and performance measurement. The research led to the development of a context-specific model of quality management for healthcare organisations and a series of guidelines for its implementation. A proper model of quality management should be developed and implemented properly in healthcare organisations to achieve business excellence.

Verification of a Quality Management Theory: Using a Delphi Study

PubMed Central

Mosadeghrad, Ali Mohammad

2013-01-01

Background: A model of quality management called Strategic Collaborative Quality Management (SCQM) model was developed based on the quality management literature review, the findings of a survey on quality management assessment in healthcare organisations, semi-structured interviews with healthcare stakeholders, and a Delphi study on healthcare quality management experts. The purpose of this study was to verify the SCQM model. Methods: The proposed model was further developed using feedback from thirty quality management experts using a Delphi method. Further, a guidebook for its implementation was prepared including a road map and performance measurement. Results: The research led to the development of a context-specific model of quality management for healthcare organisations and a series of guidelines for its implementation. Conclusion: A proper model of quality management should be developed and implemented properly in healthcare organisations to achieve business excellence. PMID:24596883

78 FR 21540 - Revisions to the California State Implementation Plan, Butte County Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-11

... the California State Implementation Plan, Butte County Air Quality Management District and Sacramento Metropolitan Air Quality Management District AGENCY: Environmental Protection Agency (EPA). ACTION: Direct... Quality Management District (BCAQMD) and Sacramento Metropolitan Air Quality Management District (SMAQMD...

76 FR 44493 - Revisions to the California State Implementation Plan, Northern Sierra Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... California State Implementation Plan, Northern Sierra Air Quality Management District, Sacramento Metropolitan Air Quality Management District, and South Coast Air Quality Management District AGENCY... approve revisions to the Northern Sierra Air Quality Management District (NSAQMD), Sacramento Metropolitan...

Investigation and Analysis of Hemoglobin A1c Measurement Systems’ Performance for 135 Laboratories in China

PubMed Central

Zhao, Hai-Jian; Zhang, Tian-Jiao; Zeng, Jie; Hu, Cui-Hua; Ma, Rong; Zhang, Chuan-Bao

2017-01-01

Background: Hemoglobin A1c (HbA1c) measurement is of great value for the diagnosis and monitoring of diabetes. Many manufacturers have developed various experiments to determine the HbA1c concentration. However, the longitudinal use of these tests requires strict quality management. This study aimed to analyze the quality of HbA1c measurement systems in China using six sigma techniques to help improve their performances. Methods: A total of 135 laboratories were involved in this investigation in 2015. Bias values and coefficients of variation were collected from an HbA1c trueness verification external quality assessment program and an internal quality control program organized by the National Center of Clinical Laboratories in China. The sigma (σ) values and the quality goal index (QGI) were used to evaluate the performances of different groups, which were divided according to principles and instruments. Results: The majority of participants (88, 65.2%) were scored as “improvement needed (σ < 3)”, suggesting that the laboratories needed to improve their measurement performance. Only 8.2% (11/135) of the laboratories were scored as “world class (σ ≥ 6)”. Among all the 88 laboratories whose σ values were below 3, 52 (59.1%) and 23 (26.1%) laboratories needed to improve measurement precision (QGI <8.0) and trueness (QGI >1.2), respectively; the remaining laboratories (13, 14.8%) needed to improve both measurement precision and trueness. In addition, 16.1% (5/31) and 15.0% (3/20) of the laboratories in “TOSOH” and “ARKRAY” groups, respectively, were scored as “world class”, whereas none of the laboratories in “BIO-RAD” group were scored as “world class”. Conclusions: This study indicated that, although participating laboratories were laboratories with better performance in China, the performances were still unsatisfactory. Actions should be taken to improve HbA1c measurement performance before we can include HbA1c assays in diabetes diagnosis in China. PMID:28469104

75 FR 41798 - Solicitation of Letters of Interest to Participate in Biotechnology Quality Management System...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

...] Solicitation of Letters of Interest to Participate in Biotechnology Quality Management System Program AGENCY... participate in the APHIS Biotechnology Quality Management System Program. The Biotechnology Quality Management..., audit-based compliance assistance program known as the Biotechnology Quality Management System Program...

77 FR 12495 - Revisions to the California State Implementation Plan, Antelope Valley Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-01

... the California State Implementation Plan, Antelope Valley Air Quality Management District and Mojave Desert Quality Management District AGENCY: Environmental Protection Agency (EPA). ACTION: Direct final... Quality Management District (AVAQMD) and Mojave Desert Air Quality Management District (MDAQMD) portion of...

40 CFR 130.6 - Water quality management plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Water quality management plans. 130.6 Section 130.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM...

40 CFR 130.6 - Water quality management plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 23 2013-07-01 2013-07-01 false Water quality management plans. 130.6 Section 130.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM...

40 CFR 130.6 - Water quality management plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 22 2014-07-01 2013-07-01 true Water quality management plans. 130.6 Section 130.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM...

The Environmental Data Initiative: A broad-use data repository for environmental and ecological data that strives to balance data quality and ease of submission

NASA Astrophysics Data System (ADS)

Servilla, M. S.; Brunt, J.; Costa, D.; Gries, C.; Grossman-Clarke, S.; Hanson, P. C.; O'Brien, M.; Smith, C.; Vanderbilt, K.; Waide, R.

2017-12-01

In the world of data repositories, there seems to be a never ending struggle between the generation of high-quality data documentation and the ease of archiving a data product in a repository - the higher the documentation standards, the greater effort required by the scientist, and the less likely the data will be archived. The Environmental Data Initiative (EDI) attempts to balance the rigor of data documentation to the amount of effort required by a scientist to upload and archive data. As an outgrowth of the LTER Network Information System, the EDI is funded by the US NSF Division of Environmental Biology, to support the LTER, LTREB, OBFS, and MSB programs, in addition to providing an open data archive for environmental scientists without a viable archive. EDI uses the PASTA repository software, developed originally by the LTER. PASTA is metadata driven and documents data with the Ecological Metadata Language (EML), a high-fidelity standard that can describe all types of data in great detail. PASTA incorporates a series of data quality tests to ensure that data are correctly documented with EML in a process that is termed "metadata and data congruence", and incongruent data packages are forbidden in the repository. EDI reduces the burden of data documentation on scientists in two ways: first, EDI provides hands-on assistance in data documentation best practices using R and being developed in Python, for generating EML. These tools obscure the details of EML generation and syntax by providing a more natural and contextual setting for describing data. Second, EDI works closely with community information managers in defining rules used in PASTA quality tests. Rules deemed too strict can be turned off completely or just issue a warning, while the community learns to best handle the situation and improve their documentation practices. Rules can also be added or refined over time to improve overall quality of archived data. The outcome of quality tests are stored as part of the data archive in PASTA and are accessible to all users of the EDI data repository. In summary, EDI's metadata support to scientists and the comprehensive set of data quality tests for metadata and data congruency provide an ideal archive for environmental and ecological data.

Oral anticoagulant therapy in adults with congenital heart disease and atrial arrhythmias: Implementation of guidelines.

PubMed

Yang, H; Heidendael, J F; de Groot, J R; Konings, T C; Veen, G; van Dijk, A P J; Meijboom, F J; Sieswerda, G Tj; Post, M C; Winter, M M; Mulder, B J M; Bouma, B J

2018-04-15

Current guidelines on oral anticoagulation (OAC) in adults with congenital heart disease (ACHD) and atrial arrhythmias (AA) consist of heterogeneous and divergent recommendations with limited level of evidence, possibly leading to diverse OAC management and different outcomes. Therefore, we aimed to evaluate real-world implementation and outcome of three guidelines on OAC management in ACHD patients with AA. The ESC GUCH 2010, PACES/HRS 2014 and ESC atrial fibrillation (AF) 2016 guidelines were assessed for implementation. ACHD patients with recurrent or sustained non-valvular AA from 5 tertiary centers were identified using a national ACHD registry. After two years of prospective follow-up, thromboembolism, major bleeding and death were assessed. In total, 225 adults (mean age 54±15years, 55% male) with various defects (simple 43%; moderate 37%; complex 20%) and AA were included. Following the most strict indication (OAC is recommended in all three guidelines), one should treat a mere 37% of ACHD patients with AA, whereas following the least strict indication (OAC is recommended in any one of the three guidelines), one should treat 98% of patients. The various guidelines were implemented in 54-80% of patients. From all recommendations, Fontan circulation, CHA2DS2-VASc≥1 and AF were independently associated with OAC prescription. Superiority of any guideline in identifying outcome (n=15) could not be demonstrated. The implementation of current guidelines on OAC management in ACHD patients with AA is low, probably due to substantial heterogeneity among guidelines. OAC prescription in daily practice was most consistent in patients with AF and CHA2DS2-VASc≥1 or Fontan circulation. Copyright © 2017 Elsevier B.V. All rights reserved.

The grown-up patient. The new customer in dialysis or--how to handle the demanding and emancipated dialysis patient.

PubMed

Hippold, I

2001-01-01

The treatment of dialysis patients is under pressure. As a result of strict budgeting and increased administrative work, enhancement and the further development of the dialysis health care system is needed. An essential element of that development is a radical change in the patient/nurse relationship. Customer relationship management assumes that the patient is seen as a client, is encouraged to make decisions on their treatment and also emphasises the professionalism of nursing.

The Role of Organizational Culture in the Leadership of United States Air Force Services Squadrons

DTIC Science & Technology

1988-01-01

correlation to the private sector , while others, e.g., mortuary affairs and honor guard, are strictly military in nature. In any case, all functions and...similar to its private sector commercial hotel or motel counterpart. Air Force personnel traveling as * part of their duty requirement are required to stay...oriented management style prevalent in both the private and public sector ; this is not the case. The question becomes whether one -17 wants to push the

The Image and Data Archive at the Laboratory of Neuro Imaging.

PubMed

Crawford, Karen L; Neu, Scott C; Toga, Arthur W

2016-01-01

The LONI Image and Data Archive (IDA)(1) is a repository for sharing and long-term preservation of neuroimaging and biomedical research data. Originally designed to archive strictly medical image files, the IDA has evolved over the last ten years and now encompasses the storage and dissemination of neuroimaging, clinical, biospecimen, and genetic data. In this article, we report upon the genesis of the IDA and how it currently securely manages data and protects data ownership. Copyright © 2015 Elsevier Inc. All rights reserved.

Management of a black leopard (Panthera pardus) with seasonal atopy and cutaneous adverse food reaction by using transmucosal immunotherapy.

PubMed

Newton, Heather P; Gamble, Kathryn C; Friberg, Cecilia

2013-03-01

An 11-yr-old female black leopard (Panthera pardus) was presented with pruritus and intermittent gastrointestinal distress for a duration of 18 mo. Dietary elimination trial and challenge confirmed food hypersensitivity. Milder and persistent pruritus, while consuming a strict elimination diet, confirmed atopic dermatitis also was related to airborne environmental triggers identified by intradermal allergy testing. Ultimately, atopy was controlled successfully by antihistamines and transmucosal immunotherapy for 7 yr after diagnosis.

JPRS Report, Soviet Union, World Economy & International Relations, No. 10, October 1987

DTIC Science & Technology

1988-02-17

finance-monopoly groups corporations own one another’s shares and their managers in fact delegate to one another right of control without interfer- ence... research . The individual will be encouraged within the framework of some group . The results of his research , profit and the income which it produces will...has been able to take under its wing by means of strict control or, on the other hand, flexible tutelage and "tender treatment" the groups of the

The SEIS Experiment for the Insight Mission: Development and management plan

NASA Astrophysics Data System (ADS)

Laudet, P.

2015-10-01

SEIS is a Mars seismometer, provided by CNES to JPL to be the threshold instrument of the next Mars mission, InSight, to be launched by NASA in March 2016. Discovery missions leads to a very strict frame of development, where schedule is driving development and qualification plans. We will explain how this constraint has been taken into account during development phases, until delivery of flight model, with a context of international cooperation without exchange of founds between partners.

76 FR 60376 - Revisions to the California State Implementation Plan, Santa Barbara Air Pollution Control...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-29

... Municipal Air Quality Management District and South Coast Air Quality Management District AGENCY... Quality Management District (SMAQMD) and South Coast Air Quality Management District (SCAQMD) portions of...,'' revised September 20, 2010. (D) Sacramento Metropolitan Air Quality Management District. (1) Rule 466...

Morphology, geology and water quality assessment of former tin mining catchment.

PubMed

Ashraf, Muhammad Aqeel; Maah, Mohd Jamil; Yusoff, Ismail

2012-01-01

Bestari Jaya, former tin mining catchment covers an area of 2656.31 hectares comprised of four hundred and forty-two different-size lakes and ponds. The present study area comprise of 92 hectares of the catchment that include four large size lakes. Arc GIS version 9.2 used to develop bathymetric map, Global Positioning System (GPS) for hydrographical survey and flow meter was utilized for water discharge analysis (flow routing) of the catchment. The water quality parameters (pH, temperature, electric conductivity, dissolved oxygen DO, total dissolved solids TDS, chlorides, ammonium, nitrates) were analyzed by using Hydrolab. Quality assurance (QA) and quality control (QC) procedures were strictly followed throughout the field work and data analysis. Different procedures were employed to evaluate the analytical data and to check for possible transcription or dilution errors, changes during analysis, or unusual or unlikely values. The results obtained are compared with interim national water quality standards for Malaysia indicates that water quality of area is highly degraded. It is concluded that Bestri Jaya ex-mining catchment has a high pollution potential due to mining activities and River Ayer Hitam, recipient of catchment water, is a highly polluted river.

Morphology, Geology and Water Quality Assessment of Former Tin Mining Catchment

PubMed Central

Ashraf, Muhammad Aqeel; Maah, Mohd. Jamil; Yusoff, Ismail

2012-01-01

Bestari Jaya, former tin mining catchment covers an area of 2656.31 hectares comprised of four hundred and forty-two different-size lakes and ponds. The present study area comprise of 92 hectares of the catchment that include four large size lakes. Arc GIS version 9.2 used to develop bathymetric map, Global Positioning System (GPS) for hydrographical survey and flow meter was utilized for water discharge analysis (flow routing) of the catchment. The water quality parameters (pH, temperature, electric conductivity, dissolved oxygen DO, total dissolved solids TDS, chlorides, ammonium, nitrates) were analyzed by using Hydrolab. Quality assurance (QA) and quality control (QC) procedures were strictly followed throughout the field work and data analysis. Different procedures were employed to evaluate the analytical data and to check for possible transcription or dilution errors, changes during analysis, or unusual or unlikely values. The results obtained are compared with interim national water quality standards for Malaysia indicates that water quality of area is highly degraded. It is concluded that Bestri Jaya ex-mining catchment has a high pollution potential due to mining activities and River Ayer Hitam, recipient of catchment water, is a highly polluted river. PMID:22761549

Effects of packaging and storage conditions on the quality of amoxicillin-clavulanic acid – an analysis of Cambodian samples

PubMed Central

2013-01-01

Background The use of substandard and degraded medicines is a major public health problem in developing countries such as Cambodia. A collaborative study was conducted to evaluate the quality of amoxicillin–clavulanic acid preparations under tropical conditions in a developing country. Methods Amoxicillin-clavulanic acid tablets were obtained from outlets in Cambodia. Packaging condition, printed information, and other sources of information were examined. The samples were tested for quantity, content uniformity, and dissolution. Authenticity was verified with manufacturers and regulatory authorities. Results A total of 59 samples were collected from 48 medicine outlets. Most (93.2%) of the samples were of foreign origin. Using predetermined acceptance criteria, 12 samples (20.3%) were non-compliant. Eight (13.6%), 10 (16.9%), and 20 (33.9%) samples failed quantity, content uniformity, and dissolution tests, respectively. Samples that violated our observational acceptance criteria were significantly more likely to fail the quality tests (Fisher’s exact test, p < 0.05). Conclusions Improper packaging and storage conditions may reduce the quality of amoxicillin–clavulanic acid preparations at community pharmacies. Strict quality control measures are urgently needed to maintain the quality of amoxicillin–clavulanic acid in tropical countries. PMID:23773420

Policy on manager involvement in work re-integration: managers' experiences in a Canadian setting.

PubMed

Maiwald, Karin; Meershoek, Agnes; de Rijk, Angelique; Nijhuis, Frans J N

2014-01-01

In Canada and other countries, sickness absence among workers is a significant concern. Local return-to-work policies developed by both management and workers' representatives are preferred to tackle the problem. This article examines how managers perceive this local bipartite agreed upon return-to-work policy, wherein a social constructivist view on the policy process is taken. In-depth interviews were held with 10 managers on their experiences with execution of this policy in a Canadian healthcare organization. Interviews were transcribed verbatim and qualitative analyses were completed to gain deep insight into the managers' perspectives. Results show that the managers viewed themselves as a linchpin between the workplace and the worker. They did not feel heard by the other stakeholders, wrestled with worker's limitations, struggled getting plans adjusted and became overextended to meet return-to-work objectives. The study shows that the managers felt unable to meet the responsibilities the policy demanded and got less involved in the return-to-work process than this policy intended. RTW policy needs to balance on the one hand, flexibility to safeguard active involvement of managers and, on the other hand, strictness regarding taking responsibility by stakeholders, particularly the health care and re-integration professionals.

From the traditional concept of safety management to safety integrated with quality.

PubMed

García Herrero, Susana; Mariscal Saldaña, Miguel Angel; Manzanedo del Campo, Miguel Angel; Ritzel, Dale O

2002-01-01

This editorial reviews the evolution of the concepts of safety and quality that have been used in the traditional workplace. The traditional programs of safety are explored showing strengths and weaknesses. The concept of quality management is also viewed. Safety management and quality management principles, stages, and measurement are highlighted. The concepts of quality and safety guarantee are assessed. Total Quality Management concepts are reviewed and applied to safety quality. Total safety management principles are discussed. Finally, an analysis of the relationship between quality and safety from data collected from a company in Spain is presented.

Is having quality as an item on the executive board agenda associated with the implementation of quality management systems in European hospitals: a quantitative analysis

PubMed Central

Botje, Daan; Klazinga, N.S.; Suñol, R.; Groene, O.; Pfaff, H.; Mannion, R.; Depaigne-Loth, A.; Arah, O.A.; Dersarkissian, M.; Wagner, C.; Klazinga, N.; Kringos, D.S.; Lombarts, M.J.M.H.; Plochg, T.; Lopez, M.A.; Vallejo, P.; Saillour-Glenisson, F.; Car, M.; Jones, S.; Klaus, E.; Bottaro, S.; Garel, P.; Saluvan, M.; Bruneau, C.; Depaigne-Loth, A.; Hammer, A.; Ommen, O.; Pfaff, H.; Botje, D.; Escoval, A.; Lívio, A.; Eiras, M.; Franca, M.; Leite, I.; Almeman, F.; Kus, H.; Ozturk, K.; Mannion, R.; Wang, A.; Thompson, A.

2014-01-01

Objective To assess whether there is a relationship between having quality as an item on the board's agenda, perceived external pressure (PEP) and the implementation of quality management in European hospitals. Design A quantitative, mixed method, cross-sectional study in seven European countries in 2011 surveying CEOs and quality managers and data from onsite audits. Participants One hundred and fifty-five CEOs and 155 quality managers. Setting One hundred and fifty-five randomly selected acute care hospitals in seven European countries (Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Main outcome measure(s) Three constructs reflecting quality management based on questionnaire and audit data: (i) Quality Management System Index, (ii) Quality Management Compliance Index and (iii) Clinical Quality Implementation Index. The main predictor was whether quality performance was on the executive board's agenda. Results Discussing quality performance at executive board meetings more often was associated with a higher quality management system score (regression coefficient b = 2.53; SE = 1.16; P = 0.030). We found a trend in the associations of discussing quality performance with quality compliance and clinical quality implementation. PEP did not modify these relationships. Conclusions Having quality as an item on the executive board's agenda allows them to review and discuss quality performance more often in order to improve their hospital's quality management. Generally, and as this study found, having quality on the executive board's agenda matters. PMID:24550260

Is having quality as an item on the executive board agenda associated with the implementation of quality management systems in European hospitals: a quantitative analysis.

PubMed

Botje, Daan; Klazinga, N S; Suñol, R; Groene, O; Pfaff, H; Mannion, R; Depaigne-Loth, A; Arah, O A; Dersarkissian, M; Wagner, C

2014-04-01

To assess whether there is a relationship between having quality as an item on the board's agenda, perceived external pressure (PEP) and the implementation of quality management in European hospitals. A quantitative, mixed method, cross-sectional study in seven European countries in 2011 surveying CEOs and quality managers and data from onsite audits. One hundred and fifty-five CEOs and 155 quality managers. One hundred and fifty-five randomly selected acute care hospitals in seven European countries (Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Main outcome measure(s) Three constructs reflecting quality management based on questionnaire and audit data: (i) Quality Management System Index, (ii) Quality Management Compliance Index and (iii) Clinical Quality Implementation Index. The main predictor was whether quality performance was on the executive board's agenda. Discussing quality performance at executive board meetings more often was associated with a higher quality management system score (regression coefficient b = 2.53; SE = 1.16; P = 0.030). We found a trend in the associations of discussing quality performance with quality compliance and clinical quality implementation. PEP did not modify these relationships. Having quality as an item on the executive board's agenda allows them to review and discuss quality performance more often in order to improve their hospital's quality management. Generally, and as this study found, having quality on the executive board's agenda matters.

Associations between Parenting Behaviors and Adolescent Romantic Relationships

PubMed Central

Auslander, Beth A.; Short, Mary B.; Succop, Paul A.; Rosenthal, Susan L.

2014-01-01

We examined associations between parenting behaviors and romantic relationship qualities in 102 adolescent girls (14–21 years) who lived with their parent/parental figure and had current boyfriends. Adolescent girls’ perceptions that parents were accepting/involved and provided appropriate strictness and supervision were significantly related to adolescent girls’ perceptions of mutuality (i.e., bidirectional movement of thoughts, feelings, and activities between persons) [1] within their own romantic relationships which in turn was related to their romantic relationship satisfaction. No parenting variables were related to non-exclusivity. PMID:19541257

Next Steps for K-12 Education: Upholding the Letter and Intent of the Every Student Succeeds Act. Hearing before the Committee on Education and the Workforce, U.S. House of Representatives, One Hundred Fourteenth Congress, Second Session (February 25, 2016). Serial No. 114-40

ERIC Educational Resources Information Center

US House of Representatives, 2016

2016-01-01

This document records testimony from a hearing held to learn what actions the Department of Education intends to take to implement the Every Student Succeeds Act and to help ensure the department acts in a manner that strictly adheres to the letter and intent of the law. Under the new law, authority over accountability, teacher quality, and school…

Sleep Deprivation.

PubMed

Abrams, Robert M

2015-09-01

Sleep deprivation occurs when inadequate sleep leads to decreased performance, inadequate alertness, and deterioration in health. It is incompletely understood why humans need sleep, although some theories include energy conservation, restoration, and information processing. Sleep deprivation has many deleterious health effects. Residency programs have enacted strict work restrictions because of medically related errors due to sleep deprivation. Because obstetrics is an unpredictable specialty with long irregular hours, enacting a hospitalist program enhances patient safety, decreases malpractice risk, and improves the physician's quality of life by allowing obstetricians to get sufficient rest. Copyright © 2015 Elsevier Inc. All rights reserved.

77 FR 73320 - Approval of Air Quality Implementation Plans; California; South Coast Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-10

... Quality Implementation Plans; California; South Coast Air Quality Management District; Prevention of... Implementation Plan (SIP) revision for the South Coast Air Quality Management District (SCAQMD or District... in a August 15, 2012 letter from the South Coast Air Quality Management District regarding specific...

Development of risk-based air quality management strategies under impacts of climate change.

PubMed

Liao, Kuo-Jen; Amar, Praveen; Tagaris, Efthimios; Russell, Armistead G

2012-05-01

Climate change is forecast to adversely affect air quality through perturbations in meteorological conditions, photochemical reactions, and precursor emissions. To protect the environment and human health from air pollution, there is an increasing recognition of the necessity of developing effective air quality management strategies under the impacts of climate change. This paper presents a framework for developing risk-based air quality management strategies that can help policy makers improve their decision-making processes in response to current and future climate change about 30-50 years from now. Development of air quality management strategies under the impacts of climate change is fundamentally a risk assessment and risk management process involving four steps: (1) assessment of the impacts of climate change and associated uncertainties; (2) determination of air quality targets; (3) selections of potential air quality management options; and (4) identification of preferred air quality management strategies that minimize control costs, maximize benefits, or limit the adverse effects of climate change on air quality when considering the scarcity of resources. The main challenge relates to the level of uncertainties associated with climate change forecasts and advancements in future control measures, since they will significantly affect the risk assessment results and development of effective air quality management plans. The concept presented in this paper can help decision makers make appropriate responses to climate change, since it provides an integrated approach for climate risk assessment and management when developing air quality management strategies. Development of climate-responsive air quality management strategies is fundamentally a risk assessment and risk management process. The risk assessment process includes quantification of climate change impacts on air quality and associated uncertainties. Risk management for air quality under the impacts of climate change includes determination of air quality targets, selections of potential management options, and identification of effective air quality management strategies through decision-making models. The risk-based decision-making framework can also be applied to develop climate-responsive management strategies for the other environmental dimensions and assess costs and benefits of future environmental management policies.

Defense Depot Tracy Total Quality Management Plan

DTIC Science & Technology

1989-07-01

PAGES TQM (Total Quality Management ), Depot Operations, Continuous Process Improvement 16. PRICE CODE 17. SECURITY CLASSIFICATION 18. SECURITY...make up our pcrceptions of Total Quality Management . Our goal is to improve those proven management processes that have brought us success while being...MANIAGEMENT F. QUALITY AUDITS OF PRODUCTS AND OPERATIONS ASSETS MANAGEMENT 00 i .......... / ~899 29 03 1 EFENSE DEPOT TACY TOTAL QUALITY MANAGEMENT PLAN

TQM (Total Quality Management) SPARC (Special Process Action Review Committees) Handbook

DTIC Science & Technology

1989-08-01

This document describes the techniques used to support and guide the Special Process Action Review Committees for accomplishing their goals for Total Quality Management (TQM). It includes concepts and definitions, checklists, sample formats, and assessment criteria. Keywords: Continuous process improvement; Logistics information; Process analysis; Quality control; Quality assurance; Total Quality Management ; Statistical processes; Management Planning and control; Management training; Management information systems.

Automated sample plan selection for OPC modeling

NASA Astrophysics Data System (ADS)

Casati, Nathalie; Gabrani, Maria; Viswanathan, Ramya; Bayraktar, Zikri; Jaiswal, Om; DeMaris, David; Abdo, Amr Y.; Oberschmidt, James; Krause, Andreas

2014-03-01

It is desired to reduce the time required to produce metrology data for calibration of Optical Proximity Correction (OPC) models and also maintain or improve the quality of the data collected with regard to how well that data represents the types of patterns that occur in real circuit designs. Previous work based on clustering in geometry and/or image parameter space has shown some benefit over strictly manual or intuitive selection, but leads to arbitrary pattern exclusion or selection which may not be the best representation of the product. Forming the pattern selection as an optimization problem, which co-optimizes a number of objective functions reflecting modelers' insight and expertise, has shown to produce models with equivalent quality to the traditional plan of record (POR) set but in a less time.

Advanced Taste Sensors Based on Artificial Lipids with Global Selectivity to Basic Taste Qualities and High Correlation to Sensory Scores

PubMed Central

Kobayashi, Yoshikazu; Habara, Masaaki; Ikezazki, Hidekazu; Chen, Ronggang; Naito, Yoshinobu; Toko, Kiyoshi

2010-01-01

Effective R&D and strict quality control of a broad range of foods, beverages, and pharmaceutical products require objective taste evaluation. Advanced taste sensors using artificial-lipid membranes have been developed based on concepts of global selectivity and high correlation with human sensory score. These sensors respond similarly to similar basic tastes, which they quantify with high correlations to sensory score. Using these unique properties, these sensors can quantify the basic tastes of saltiness, sourness, bitterness, umami, astringency and richness without multivariate analysis or artificial neural networks. This review describes all aspects of these taste sensors based on artificial lipid, ranging from the response principle and optimal design methods to applications in the food, beverage, and pharmaceutical markets. PMID:22319306

Air Quality Measurements from Satellites during the 2008 Beijing Olympics and Paralympics

NASA Astrophysics Data System (ADS)

Witte, J. C.; Schoeberl, M.; Douglass, A.; Gleason, J.; Krotkov, N.; Gille, J.; Pickering, K.; Livesey, N.

2009-05-01

In preparation for the Olympic and Paralympic games in August and September 2008 in Beijing, China, the Chinese government imposed strict controls on industrial emissions and motor vehicle traffic in and around the city and vicinity before and during the events to improve the air quality for the competitors and visitors. To test the efficacy of these measures, we used satellite data from NASA's Aura/Ozone Monitoring Instrument (OMI) and Terra/Measurements Of Pollution In The Troposphere (MOPITT) over Beijing and surrounding areas during the Olympic and Paralympic period. The satellite instruments recorded significant reductions in nitrogen dioxide of up to 50%, up to 10% in tropospheric column ozone, 20-40% in boundary layer sulfur dioxide, and 10-20% reductions in carbon monoxide concentrations below 700 hPa.

In Sickness and in Health: a Literature Review about Function of Social Support within Anxiety and Heart Disease Association

PubMed Central

Zarbo, Cristina; Compare, Angelo; Baldassari, Elena; Bonardi, Alberto; Romagnoni, Claudia

2013-01-01

A narrative review of the major evidence concerning the relationship between anxiety, social support and cardiac disease was conducted. Literature demonstrates that a strict relationship between anxiety, social support and cardiac disease outcomes subsists. However, the function of social support within anxiety and heart disease association remains unclear and needs to further researches to be established. Moreover evidence suggests that it’s the quality of close relationships to play an important role in affecting psychological and physiological health status. The main components that the literature suggests for a better quality of social support and close relationship, and the main assessment measure are presented. Evidence about cardiac rehabilitation programs and the need to assess and intervene on psychological and psychosocial factors is discussed. PMID:24403952

[China expert consensus on the management of dyslipidemia in postmenopausal patients with early-stage breast cancer].

PubMed

2017-01-23

Estrogen has an impact on the type of lipoproteins and the blood lipid levels, thus protecting the cardiovascular system. Postmenopausal breast cancer patients suffer a significant decrease in estrogen levels due to both physiological changes and the use of drugs, and thus have a higher risk of atherosclerotic cardiovascular diseases. Therefore, strict lipid management is required for postmenopausal breast cancer patients receiving endocrine therapy. However, no guidelines have been developed in terms of lipid management and intervention for postmenopausal breast cancer patients. The Chinese expert group of multidisciplinary management of dyslipidemia in breast cancer patients with endocrine therapy, after deep investigation into the management of dyslipidemia in postmenopausal patients with early-stage breast cancer, has developed the China Expert Consensus on Dyslipidemia Management in Postmenopausal Patients with Early-stage Breast Cancer. The Consensus clearly defines the goals and measures of interventions for dyslipidemia, hoping to effectively reduce the risk of atherosclerotic cardiovascular disease in postmenopausal breast cancer patients and further improve the long-term survival of the patients.

A dynamic model for organic waste management in Quebec (D-MOWIQ) as a tool to review environmental, societal and economic perspectives of a waste management policy.

PubMed

Hénault-Ethier, Louise; Martin, Jean-Philippe; Housset, Johann

2017-08-01

A dynamic systems model of organic waste management for the province of Quebec, Canada, was built. Six distinct modules taking into account social, economical and environmental issues and perspectives were included. Five scenarios were designed and tested to identify the potential consequences of different governmental and demographic combinations of decisions over time. Among these scenarios, one examines Quebec's organic waste management policy (2011-2015), while the other scenarios represent business as usual or emphasize ecology, economy or social benefits in the decision-making process. Model outputs suggest that the current governmental policy should yield favorable environmental benefits, energy production and waste valorization. The projections stemming from the current policy action plan approach the benefits gained by another scenario emphasizing the environmental aspects in the decision-making process. As expected, without the current policy and action plan in place, or business as usual, little improvements are expected in waste management compared to current trends, and strictly emphasizing economic imperatives does not favor sustainable organic waste management. Copyright © 2017. Published by Elsevier Ltd.

7 CFR 28.431 - Strict Middling Tinged Color.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Strict Middling Tinged Color. 28.431 Section 28.431 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Color. Strict Middling Tinged Color is color which is better than Middling Tinged Color. ...

7 CFR 28.431 - Strict Middling Tinged Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Strict Middling Tinged Color. 28.431 Section 28.431 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Color. Strict Middling Tinged Color is color which is better than Middling Tinged Color. ...

7 CFR 28.431 - Strict Middling Tinged Color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Strict Middling Tinged Color. 28.431 Section 28.431 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Color. Strict Middling Tinged Color is color which is better than Middling Tinged Color. ...

7 CFR 28.431 - Strict Middling Tinged Color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Strict Middling Tinged Color. 28.431 Section 28.431 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Color. Strict Middling Tinged Color is color which is better than Middling Tinged Color. ...

7 CFR 28.431 - Strict Middling Tinged Color.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Middling Tinged Color. 28.431 Section 28.431 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Color. Strict Middling Tinged Color is color which is better than Middling Tinged Color. ...

78 FR 63934 - Approval of Air Quality Implementation Plans; California; El Dorado County Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-25

...] Approval of Air Quality Implementation Plans; California; El Dorado County Air Quality Management District... California for the El Dorado County Air Quality Management District (EDAQMD) portion of the California SIP... 24, 1987 Federal Register, May 25, 1988, U.S. EPA, Air Quality Management Division, Office of Air...

[Quality management is associated with high quality services in health care].

PubMed

Nielsen, Tenna Hassert; Riis, Allan; Mainz, Jan; Jensen, Anne-Louise Degn

2013-12-09

In these years, quality management has been the focus in order to meet high quality services for the patients in Danish health care. This article provides information on quality management and quality improvement and it evaluates its effectiveness in achieving better organizational structures, processes and results in Danish health-care organizations. Our findings generally support that quality management is associated with high quality services in health care.

DESC (Defense Electronics Supply Center) Total Quality Management Plan

DTIC Science & Technology

1989-04-01

Paoerwort Reduction Proodt(0704.01 ge. Washington. DC 20S03 4. TITLE AND SUBTITLE Api598 . FUNDING NUMBERS DESC Total Quality Management Master Plan...OF PAGES TQM (Total Quality Management ), Continuous Process Improvement,_________ cTainingManagement 16. PRICE CODE 17. SECURITY CLASSIFICATION 18... QUALITY MANAGEMENT As you read the DESC Total Quality Management Plan, I ask each of you to make a commitment to continuously strive for improvement

Advantages and possibilities of solid recovered fuel cocombustion in the European energy sector.

PubMed

Hilber, Thomas; Maier, Jörg; Scheffknecht, Günter; Agraniotis, Michalis; Grammelis, Panagiotis; Kakaras, Emmanuel; Glorius, Thomas; Becker, Uwe; Derichs, Willy; Schiffer, Hans-Peter; De Jong, Martin; Torri, Lucia

2007-10-01

The 1999/31 Elemental Carbon Directive sets strict rules on the disposal of untreated municipal solid waste in the European Union countries and forces a reduction of the biodegradable quantities disposed off to landfills up to 35% of the amount produced in 1995 in the coming decade. More environmentally friendly waste management options shall be promoted under the framework of the Community Waste Strategy ([96] 399 Final). In this context, the production and thermal use of solid recovered fuels (SRFs), derived from nonhazardous bioresidues and mixed- and mono-waste streams, could be a key element in a future waste management system. Within the scope of the European Demonstration Project, RECOFUEL, SRF cocombustion was demonstrated in two large-scale lignite-fired coal boilers at RWE power station in Weisweiler, Germany. As a consequence of the high biogenic share of the cocombusted material, this approach can be considered beneficial following European Directive 2001/77/EC on electricity from renewable energy sources (directive). During the experimental campaign, the share of SRF in the overall thermal input was adjusted to approximately 2%, resulting into a feeding rate of approximately 25 t/hr. The measurement campaign included boiler measurements in different locations, fuel and ash sampling, and its characterization. The corrosion rates were monitored by dedicated corrosion probes. The overall results showed no significant influence of SRF cocombustion on boiler operation, emissions behavior, and residues quality for the thermal shares applied. Also, no effect of the increased chlorine concentration of the recovered fuel was observed in the flue gas path after the desulfurization unit.

Camera Traps on Wildlife Crossing Structures as a Tool in Gray Wolf (Canis lupus) Management - Five-Years Monitoring of Wolf Abundance Trends in Croatia

PubMed Central

Križan, Josip; Gužvica, Goran

2016-01-01

The conservation of gray wolf (Canis lupus) and its coexistence with humans presents a challenge and requires continuous monitoring and management efforts. One of the non-invasive methods that produces high-quality wolf monitoring datasets is camera trapping. We present a novel monitoring approach where camera traps are positioned on wildlife crossing structures that channel the animals, thereby increasing trapping success and increasing the cost-efficiency of the method. In this way we have followed abundance trends of five wolf packs whose home ranges are intersected by a motorway which spans throughout the wolf distribution range in Croatia. During the five-year monitoring of six green bridges we have recorded 28 250 camera-events, 132 with wolves. Four viaducts were monitored for two years, recording 4914 camera-events, 185 with wolves. We have detected a negative abundance trend of the monitored Croatian wolf packs since 2011, especially severe in the northern part of the study area. Further, we have pinpointed the legal cull as probable major negative influence on the wolf pack abundance trends (linear regression, r2 > 0.75, P < 0.05). Using the same approach we did not find evidence for a negative impact of wolves on the prey populations, both wild ungulates and livestock. We encourage strict protection of wolf in Croatia until there is more data proving population stability. In conclusion, quantitative methods, such as the one presented here, should be used as much as possible when assessing wolf abundance trends. PMID:27327498

Camera Traps on Wildlife Crossing Structures as a Tool in Gray Wolf (Canis lupus) Management - Five-Years Monitoring of Wolf Abundance Trends in Croatia.

PubMed

Šver, Lidija; Bielen, Ana; Križan, Josip; Gužvica, Goran

2016-01-01

The conservation of gray wolf (Canis lupus) and its coexistence with humans presents a challenge and requires continuous monitoring and management efforts. One of the non-invasive methods that produces high-quality wolf monitoring datasets is camera trapping. We present a novel monitoring approach where camera traps are positioned on wildlife crossing structures that channel the animals, thereby increasing trapping success and increasing the cost-efficiency of the method. In this way we have followed abundance trends of five wolf packs whose home ranges are intersected by a motorway which spans throughout the wolf distribution range in Croatia. During the five-year monitoring of six green bridges we have recorded 28 250 camera-events, 132 with wolves. Four viaducts were monitored for two years, recording 4914 camera-events, 185 with wolves. We have detected a negative abundance trend of the monitored Croatian wolf packs since 2011, especially severe in the northern part of the study area. Further, we have pinpointed the legal cull as probable major negative influence on the wolf pack abundance trends (linear regression, r2 > 0.75, P < 0.05). Using the same approach we did not find evidence for a negative impact of wolves on the prey populations, both wild ungulates and livestock. We encourage strict protection of wolf in Croatia until there is more data proving population stability. In conclusion, quantitative methods, such as the one presented here, should be used as much as possible when assessing wolf abundance trends.

[Organization of safe cost-effective blood transfusion: experience APHM-EFSAM].

PubMed

Ferrera-Tourenc, V; Dettori, I; Chiaroni, J; Lassale, B

2013-03-01

Blood transfusion safety depends on strict compliance with each step of a process beginning with the order for labile blood products and related immunohematologic testing and ending with administration and follow-up of the receiver. This process is governed by stringent regulatory texts and guidelines. Despite precautions, processing errors are still reported. Analysis of incident reports shows that the most common cause involves patient identification and that most errors occur at two levels, i.e. the entry of patient information and management of multiple regulatory crosschecks and record-keeping using different systems. The purpose of this report is to describe the collaborative approach implemented by the Établissement français du Sang Alpes-Méditerranée (EFSAM) and the Assistance publique des Hôpitaux de Marseille (APHM) to secure the blood transfusion process and protect interfaces while simplifying and facilitating exchanges. Close cooperation has had a threefold impact with simplification of administration, improvement of experience feedback, and better management of test ordering. The organization implemented between the two institutions has minimized document redundancy and interfaces between immunohematologic testing and delivery. Collaboration based on experience feedback has improved the level of quality and cost control. In the domain of blood transfusion safety, the threshold of 10(-5) has been reached with regard to the risk of ABO errors in the distribution concentrated red cells (CRC). In addition, this collaborative organization has created further opportunity for improvement by deploying new methods to identify simplification measures and by controlling demand and usage. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Nurse managers' conceptions of quality management as promoted by peer supervision.

PubMed

Hyrkäs, Kristiina; Koivula, Meeri; Lehti, Kristiina; Paunonen-Ilmonen, Marita

2003-01-01

The aim of the study was to describe nurse managers' conceptions of quality management in their work as promoted by peer supervision. Quality management is one of the topical issues in a nurse manager's demanding and changing work. As first-line managers, they have a key role in quality management which is seen to create the system and environment for high quality services and quality improvement. Despite the official recommendations and definitions of quality management, several published reports have shown that there is no single solution for quality management. Peer supervision or the support provided by it to nursing managers have rarely been a subject of study. This study was carried out at Tampere University Hospital between 1996 and 1998. The peer supervision intervention was organized once a month, 2 hours at a time and in closed supervisor-led groups of nine nurse managers. Data were collected by themed interviews. Fifteen nurse managers participated in the study. The data were analysed using the phenomenographic method. Two main categories were formed of nurse managers' conceptions. The first described supportive and reflective characteristics of peer supervision. This main category was described by horizontal, hierarchical categories of support from peer group and reflection. The second main category described nurse managers' conceptions of individual development of leadership during peer supervision. This main category was also described by three horizontal categories: personal growth, finding psychological resources and internalization of leadership. The finding of this study show that peer supervision benefited nurse managers in quality management through reflection and support. The reflective and supportive characteristics of peer supervision promoted the nurse managers' individual development, but also that of leadership. It can be concluded that peer supervision promotes quality management in nurse managers' work.

Total quality management in American industry.

PubMed

Widtfeldt, A K; Widtfeldt, J R

1992-07-01

The definition of total quality management is conformance to customer requirements and specifications, fitness for use, buyer satisfaction, and value at an affordable price. The three individuals who have developed the total quality management concepts in the United States are W.E. Deming, J.M. Juran, and Philip Crosby. The universal principles of total quality management are (a) a customer focus, (b) management commitment, (c) training, (d) process capability and control, and (e) measurement through quality improvement tools. Results from the National Demonstration Project on Quality Improvement in Health Care showed the principles of total quality management could be applied to healthcare.

75 FR 40726 - Revisions to the California State Implementation Plan, Sacramento Metropolitan Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-14

... the California State Implementation Plan, Sacramento Metropolitan Air Quality Management District and South Coast Air Quality Management District AGENCY: Environmental Protection Agency (EPA). ACTION... Metropolitan Air Quality Management District (SMAQMD) and South Coast Air Quality Management District (SCAQMD...

The development of WEEE management and effects of the fund policy for subsidizing WEEE treating in China

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

Yu, Luling; He, Wenzhi, E-mail: hithwz@163.com; Li, Guangming

2014-09-15

Highlights: • The paper systematically introduces recycling system of WEEE management in China. • The paper introduces the new policy about WEEE management in China. • This paper analyzes the results of its implementation. • This paper evaluates the effectiveness to WEEE management in China. - Abstract: The consumption of electrical and electronic equipment is surging, so is the generation of waste electrical and electronic equipment (WEEE). Due to the large quantity, high potential risk and valuable capacity of WEEE, many countries are taking measures to regulate the management of WEEE. The environmental pollution and human health-harming problems caused bymore » irregular treatment of WEEE in China make the government pay more and more attention to its management. This paper reviews the development of WEEE management in China, introduces the new policy which is established for WEEE recycling and especially analyzes the effectiveness of the policy, including huge recovery, formation of new recycling system, strict supervision to related enterprises, and the stimulation to public awareness. Based on the current achievement, some recommendations are given to optimize the WEEE management in China.« less

Total Quality Management in a Knowledge Management Perspective.

ERIC Educational Resources Information Center

Johannsen, Carl Gustav

2000-01-01

Presents theoretical considerations on both similarities and differences between information management and knowledge management and presents a conceptual model of basic knowledge management processes. Discusses total quality management and quality control in the context of information management. (Author/LRW)

[IVF surrogacy after embryo transfer abroad. Dilemmas of pregnancy follow-up].

PubMed

Winkel, Esther; Roumen, Frans J M E; Dermout, Sylvia M

2010-01-01

A 43-year-old female, gravida 3, para 2, who was 9 weeks pregnant, presented herself as a surrogate mother for a 33-year-old couple at our outpatient clinic in Heerlen, the Netherlands, for pregnancy follow-up. As she had not passed the selection procedure in the Netherlands (VU University Medical Center, Amsterdam), IVF using the gametes of the prospective parents and embryo transfer was performed in Belgium. We discussed the management of possible problems and complications during pregnancy and delivery. After an uneventful pregnancy and delivery a healthy boy was taken home by the donor couple. In the Netherlands, high-tech surrogate motherhood under strict non-commercial conditions has been accepted by law since 1997. Since the inclusion criteria are very strict, some couples seem to find a way to have their wish fulfilled abroad. Uniformity of the IVF surrogacy legislation in Europe is necessary to discourage this practice. When this situation occurs nevertheless, it is important that doctors involved know how to handle the (often unknown) medical, ethical, legal, emotional and psychosocial aspects associated with high-tech IVF-surrogacy.

[120 mmHg for everyone?].

PubMed

Wiersma, Tjerk

2016-01-01

The recently published Systolic Blood Pressure Intervention Trial (SPRINT) casts new light on the issue of lowering blood pressure to 120 mmHg. The trial randomized 9161 patients with systolic blood pressures of 130 mmHg - 180 mmHg and increased cardiovascular risk into a group receiving intensive treatment (target 120 mmHg) and a group given standard treatment (target 140 mmHg). The trial was stopped earlier than foreseen because interim analysis showed a lower incidence rate of myocardial infarction, stroke, heart failure and death from cardiovascular causes in the group given intensive treatment (1.65 versus 2.19 per year, hazard ratio 0.75; 95% CI 0.64-0.89; p < 0.001). These results open up the possibility of aiming for lower blood pressure targets in antihypertensive treatment. It is questionable whether this strategy would be preferred by every patient. New guidelines on cardiovascular risk management should pay more attention to shared decision-making where doctors inform patients about the benefits and risks of strict or less strict blood pressure control and patients choose personal targets.

[Management systems of the quality of health care in Quebec hospitals].

PubMed

François, P

2001-03-31

The aim of this study was to take stock of the development of quality management systems in the Quebec health care services. The study relied on semi-guided interviews and on a documentary analysis. It concerned the structure and the activity of quality management in 4 Montreal university hospitals as well as on outside organizations dealing with quality of care. Quality management of the health care services is dealt with by council on health care accreditation and regional health and social services agencies. In hospitals, the quality of services is managed by structures created by the administration council and the top management: the piloting committee, the head of quality assurance, the executive committees and the multidisciplinary team or self-evaluation of the hospital, and development of plans for improvement. Other activities are management of complaints, users satisfaction evaluation and follow-up of indicators. This system of quality management of services is currently expanding. This change of paradigm leads to accepting the view of services users and to change quality management methods. Those methods have evolved from normative approach to a continuous quality improvement approach.

Quality Management in Education.

ERIC Educational Resources Information Center

Tribus, Myron

When transferring the methods of quality management from industry to academia, there are important differences that must be considered. This paper describes the differences between traditional management and quality management, and shows how Deming's principles of Total Quality Management (TQM) can be applied to education. Some of these principles…

Strategic Issues in Quality Management: 1. Theoretical Considerations.

ERIC Educational Resources Information Center

Johannsen, Carl Gustav

1996-01-01

Examines the relationship between strategic management and quality management concepts in a library and information services setting. Conceptual frameworks are presented and a new strategic quality management framework, inspired by the Japanese policy deployment approach, is developed that also discusses total quality management. (Author/LRW)

Quality management, a directive approach to patient safety.

PubMed

Ayuso-Murillo, Diego; de Andrés-Gimeno, Begoña; Noriega-Matanza, Concha; López-Suárez, Rafael Jesús; Herrera-Peco, Ivan

Nowadays the implementation of effective quality management systems and external evaluation in healthcare is a necessity to ensure not only transparency in activities related to health but also access to health and patient safety. The key to correctly implementing a quality management system is support from the managers of health facilities, since it is managers who design and communicate to health professionals the strategies of action involved in quality management systems. This article focuses on nursing managers' approach to quality management through the implementation of cycles of continuous improvement, participation of improvement groups, monitoring systems and external evaluation quality models (EFQM, ISO). The implementation of a quality management system will enable preventable adverse effects to be minimized or eliminated, and promote patient safety and safe practice by health professionals. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

A new form of application service provider (ASP) in the development of data systems and data flow and management of data in (multiple campus) health care institutions.

PubMed

Laurent, Christophe R

2004-01-01

There is a distinct lag in the way the informatics management is applied, implemented and used in health care institutions in comparison to other industries. Part of this is caused by strict regulations, but there also seems to be a defined trust and attitude problem from the medical corps towards dependency from automatisation. The only way to guarantee overall advance however is to apply technology implementations which enhance the performance capabilities of the medical corps, the way they already have in other fields. We propose a new model for implementing software applications and their communication on the scale of a multi campus health care institution.

[Preeclampsia: A challenge also for cardiologists].

PubMed

Cournot, M; Lairez, O; Medzech, B

2018-05-18

Due to its short-term consequences on perinatal outcome, preeclampsia has been long regarded as an obstetrical disease, strictly confined to a management by OB/GYNs. It has been now widely accepted that preeclampsia is most a systemic inflammatory and systemic vascular disease during pregnancy and then a lifelong risk factor for subsequent cardiovascular event in women's life. The aim of this review is to propose an overview in the current state-of-art in definition, early identification and management of preeclampsia. We will also discuss the growing evidence that support that cardiologists must be fully involved in screening and prevention of preeclampsia during pregnancy and beyond in the subsequent medical follow-up of women who have experienced a preeclampsia. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

[Structural requirements for the management of patients with highly contagious life-threatening infectious diseases: update 2015].

PubMed

Grünewald, Thomas

2015-07-01

The care of highly contagious life-threatening infectious diseases (HLID) requires specialized treatment facilities that are capable of strict isolation measures and appropriate medical treatment. The German approach to the management of these diseases, which is maintained by the Permanent Working Group of Medical Competence and Treatment Centers for Highly Contagious and Life-Threatening Diseases (STAKOB) is adjusted in the present publication with regards to recent experiences and upcoming needs. Clear synergies in using infrastructures and bundling of resources have led to similar efforts at the European level. The German concept, therefore, has a pioneering role. This update is intended to improve professional patient care and also minimize the risk of disease spread and transmission.

[Management of infections in palliative and terminal cancer care].

PubMed

Sochor, M

2013-01-01

Patients with cancer are highly susceptible to infections. There is a lack of evidencebased guidelines or protocols for their management in palliative and endoflife care. To define an optimal dia-gnostic approach and therapeutic management of infections in patients with palliative and terminal cancer care. Along with thromboembolic disease and cancer progression, infections are the most frequent causes of death in oncology. Besides the impact on mortality, they are accompanied with a myriad of symptoms decreasing the quality of life. High incidence of infectons is due to a malignancy itself, the oncolgical therapy and host factors. There is a lack of evidencebased guidelines and protocols for the therapy of infections in palliative and terminal cancer care. Most of available studies are retrospective in nature, with diverse methods and cohorts. Incidence of infections in these patient oscillates between 16- 55% in specialized palliative units, and rises up to 83% in acute care hospitals. From the epidemiologic viewpoint, urinary (39- 42%) and respiratory infections (22- 36%) are the most frequent cases, followed by soft tissue and skin infections (6- 12%) and bacteremias (5- 14%). At present, the antibio-tic treatment does not seem to have a positive impact on the survival rate. Symptom control antibio-tic therapy as a means of symptom control still remains controversial, since it meets this purpose only in a few percents of studies. The most successful is the symtom control in urinary tract infections (60- 79%), in contrast to other sites of infection (30- 43%). In the last week of life there the symptom control is achieved only in 10% of patient. One should always consider the prognosis, actual preformance status and patients preferences when it comes to the management of dia-gnostics and therapy of infections. If the prognosis counts in weeks or months the dia-gnostics and therapy should not differ from the approach to any other oncological patient. In terminal cancer care the antibio-tics should be spared strictly for the purpose of symptom control and with a palliative intent. This article reviews current knowledge of dia-gnostics and therapy of infections in palliative cancer care and includes an algorithm for their management.

Dynamic ambulance reallocation for the reduction of ambulance response times using system status management.

PubMed

Lam, Sean Shao Wei; Zhang, Ji; Zhang, Zhong Cheng; Oh, Hong Choon; Overton, Jerry; Ng, Yih Yng; Ong, Marcus Eng Hock

2015-02-01

Dynamically reassigning ambulance deployment locations throughout a day to balance ambulance availability and demands can be effective in reducing response times. The objectives of this study were to model dynamic ambulance allocation plans in Singapore based on the system status management (SSM) strategy and to evaluate the dynamic deployment plans using a discrete event simulation (DES) model. The geographical information system-based analysis and mathematical programming were used to develop the dynamic ambulance deployment plans for SSM based on ambulance calls data from January 1, 2011, to June 30, 2011. A DES model that incorporated these plans was used to compare the performance of the dynamic SSM strategy against static reallocation policies under various demands and travel time uncertainties. When the deployment plans based on the SSM strategy were followed strictly, the DES model showed that the geographical information system-based plans resulted in approximately 13-second reduction in the median response times compared to the static reallocation policy, whereas the mathematical programming-based plans resulted in approximately a 44-second reduction. The response times and coverage performances were still better than the static policy when reallocations happened for only 60% of all the recommended moves. Dynamically reassigning ambulance deployment locations based on the SSM strategy can result in superior response times and coverage performance compared to static reallocation policies even when the dynamic plans were not followed strictly. Copyright © 2014 Elsevier Inc. All rights reserved.

75 FR 61413 - Notice of Availability of Biotechnology Quality Management System Audit Standard and Evaluation...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-05

...] Notice of Availability of Biotechnology Quality Management System Audit Standard and Evaluation of... Biotechnology Quality Management System Program (BQMS Program) to assist regulated entities in achieving and... customized biotechnology quality management system (BQMS) to improve their management of domestic research...

Progress on quality management in the German health system – a long and winding road

PubMed Central

Breckenkamp, Juergen; Wiskow, Christiane; Laaser, Ulrich

2007-01-01

The interest in quality management in health care has increased in the last decades as the financial crises in most health systems generated the need for solutions to contain costs while maintaining quality of care. In Germany the development of quality management procedures has been closely linked with health care reforms. Starting in the early nineties quality management issues gained momentum in reform legislation only 10 years later. This review summarizes recent developments in medical quality management as related to the federal reform legislation in Germany. It provides an overview on the infrastructure, actors and on the current discussion concerning quality management in medical care. Germany had to catch up on implementing quality management in the health system compared to other countries. Considerable progress has been made, however, it is recognized that the full integration of quality management will require long-term commitment in developing methods, instruments and communication procedures. The most ambitious project at present is the development of a comprehensive comparative quality management system for hospitals at national level, including public reporting. For the time being medical quality management in Germany is dealt with as a technical and professional issue while the aspects of patient orientation and transparency need further advancement. PMID:17550593

7 CFR 28.424 - Strict Low Middling Spotted Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Strict Low Middling Spotted Color. 28.424 Section 28.424 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Spotted Color. Strict Low Middling Spotted Color is color which is within the range represented by a set...

7 CFR 28.433 - Strict Low Middling Tinged Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Strict Low Middling Tinged Color. 28.433 Section 28.433 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Tinged Color. Strict Low Middling Tinged Color is color which is within the range represented by a set of...

7 CFR 28.433 - Strict Low Middling Tinged Color.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Strict Low Middling Tinged Color. 28.433 Section 28.433 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Tinged Color. Strict Low Middling Tinged Color is color which is within the range represented by a set of...

7 CFR 28.422 - Strict Middling Spotted Color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Strict Middling Spotted Color. 28.422 Section 28.422 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Color. Strict Middling Spotted Color is color which is within the range represented by a set of samples...

7 CFR 28.426 - Strict Good Ordinary Spotted Color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Strict Good Ordinary Spotted Color. 28.426 Section 28.426 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Spotted Color. Strict Good Ordinary Spotted Color is color which is within the range represented by a set...

7 CFR 28.426 - Strict Good Ordinary Spotted Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Strict Good Ordinary Spotted Color. 28.426 Section 28.426 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Spotted Color. Strict Good Ordinary Spotted Color is color which is within the range represented by a set...

7 CFR 28.424 - Strict Low Middling Spotted Color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Strict Low Middling Spotted Color. 28.424 Section 28.424 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Spotted Color. Strict Low Middling Spotted Color is color which is within the range represented by a set...

7 CFR 28.424 - Strict Low Middling Spotted Color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Strict Low Middling Spotted Color. 28.424 Section 28.424 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Spotted Color. Strict Low Middling Spotted Color is color which is within the range represented by a set...

7 CFR 28.433 - Strict Low Middling Tinged Color.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Strict Low Middling Tinged Color. 28.433 Section 28.433 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Tinged Color. Strict Low Middling Tinged Color is color which is within the range represented by a set of...

7 CFR 28.426 - Strict Good Ordinary Spotted Color.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Strict Good Ordinary Spotted Color. 28.426 Section 28.426 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Spotted Color. Strict Good Ordinary Spotted Color is color which is within the range represented by a set...

7 CFR 28.422 - Strict Middling Spotted Color.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Strict Middling Spotted Color. 28.422 Section 28.422 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Color. Strict Middling Spotted Color is color which is within the range represented by a set of samples...

7 CFR 28.424 - Strict Low Middling Spotted Color.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Strict Low Middling Spotted Color. 28.424 Section 28.424 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Spotted Color. Strict Low Middling Spotted Color is color which is within the range represented by a set...

7 CFR 28.422 - Strict Middling Spotted Color.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Strict Middling Spotted Color. 28.422 Section 28.422 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Color. Strict Middling Spotted Color is color which is within the range represented by a set of samples...

7 CFR 28.433 - Strict Low Middling Tinged Color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Strict Low Middling Tinged Color. 28.433 Section 28.433 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Tinged Color. Strict Low Middling Tinged Color is color which is within the range represented by a set of...

7 CFR 28.426 - Strict Good Ordinary Spotted Color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Strict Good Ordinary Spotted Color. 28.426 Section 28.426 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Spotted Color. Strict Good Ordinary Spotted Color is color which is within the range represented by a set...

7 CFR 28.422 - Strict Middling Spotted Color.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Strict Middling Spotted Color. 28.422 Section 28.422 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Color. Strict Middling Spotted Color is color which is within the range represented by a set of samples...

Behavioral Variability of Choices versus Structural Inconsistency of Preferences

ERIC Educational Resources Information Center

Regenwetter, Michel; Davis-Stober, Clintin P.

2012-01-01

Theories of rational choice often make the structural consistency assumption that every decision maker's binary strict preference among choice alternatives forms a "strict weak order". Likewise, the very concept of a "utility function" over lotteries in normative, prescriptive, and descriptive theory is mathematically equivalent to strict weak…

7 CFR 28.433 - Strict Low Middling Tinged Color.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Low Middling Tinged Color. 28.433 Section 28.433 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Tinged Color. Strict Low Middling Tinged Color is color which is within the range represented by a set of...

7 CFR 28.422 - Strict Middling Spotted Color.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Middling Spotted Color. 28.422 Section 28.422 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Color. Strict Middling Spotted Color is color which is within the range represented by a set of samples...

7 CFR 28.426 - Strict Good Ordinary Spotted Color.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Good Ordinary Spotted Color. 28.426 Section 28.426 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Spotted Color. Strict Good Ordinary Spotted Color is color which is within the range represented by a set...

7 CFR 28.424 - Strict Low Middling Spotted Color.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Strict Low Middling Spotted Color. 28.424 Section 28.424 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards... Spotted Color. Strict Low Middling Spotted Color is color which is within the range represented by a set...

The role of nurses and dietitians in managing paediatric coeliac disease.

PubMed

Fok, Chi-Yee; Holland, Kate Sara; Gil-Zaragozano, Elena; Paul, Siba Prosad

Coeliac disease (CD) is an immune-mediated genetic condition elicited by the ingestion of gluten, leading to proximal small bowel enteropathy. It affects around 1% of the population, although only a small proportion of cases are actually diagnosed. It is a multisystem disorder presenting with both gastrointestinal and extra-intestinal manifestations such as diarrhoea, abdominal pain, constipation, vomiting, iron deficiency anaemia, faltering growth, dental enamel defects, short stature, liver disease, arthropathy and recurrent aphthous ulcers. Nurses, working in different clinical settings, are best placed for early recognition and diagnosis of CD in children. Suspicion of CD should lead to immunoglobulin A (IgA)-based anti-tissue transglutaminase antibody screening tests and a diagnosis confirmed by an intestinal biopsy. Modification of European (ESPGHAN) guidelines now enables CD to be diagnosed without a small-bowel biopsy in a select group of symptomatic children. A gluten-free diet should preferably be started by paediatric dietitians. Strict adherence to a gluten-free diet is essential to maintain good health and to prevent long-term complications. A case study demonstrating some of the challenges that may be faced in children with CD in clinical practice is described. Specialist nurse-led CD clinics are gaining popularity and have been found to be equally effective in providing continuity of quality care.

The significance of motivation in periodontal treatment: the influence of adult patients' motivation on the clinical periodontal status.

PubMed

Oruba, Z; Pac, A; Olszewska-Czyż, I; Chomyszyn-Gajewska, M

2014-09-01

Motivation plays an important role in the treatment process of chronic diseases, as treatment requires behavioural change and lifelong adherence to medical recommendations. Periodontitis is a good example of such health condition as to maintain good periodontal health patients have to adhere to a strict oral hygiene regimen. To examine whether the motivation of patients suffering from chronic periodontitis influences their clinical periodontal condition. Cross sectional study. Department of Periodontology and Oral Medicine, Dental University Clinic, Jagiellonian University, Krakow, Poland. 199 adult periodontal patients, aged 20-78 years. Questionnaire concerning patients' medical and dental history, modified Zychlińscy motivation assessment questionnaire, clinical periodontal examination. The extent of motivation. Periodontal status evaluated with the use of periodontal indices (API, BOP, CPITN). The mean motivation score was 57.4. The mean API and BOP values were 55.7% and 46.4%, respectively. For most of the patients the recorded CPITN value was 3. Correlations were observed between motivation and both API and BOP, and between API and BOP. Periodontal patients with greater motivation having better oral health (lower API and BOP) suggests an influence on the quality of their self-management of the disease (i.e. adherence to their oral hygiene regimen).

The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review.

PubMed

Cummings, A J; Knibb, R C; King, R M; Lucas, J S

2010-08-01

Food allergy affects 6% of children but there is no cure, and strict avoidance of index allergens along with immediate access to rescue medication is the current best management. With specialist care, morbidity from food allergy in children is generally low, and mortality is very rare. However, there is strong evidence that food allergy and food hypersensitivity has an impact on psychological distress and on the quality of life (QoL) of children and adolescents, as well as their families. Until recently, the measurement of QoL in allergic children has proved difficult because of the lack of investigative tools available. New instruments for assessing QoL in food allergic children have recently been developed and validated, which should provide further insights into the problems these children encounter and will enable us to measure the effects of interventions in patients. This review examines the published impact of food allergy on affected children, adolescents and their families. It considers influences such as gender, age, disease severity, co-existing allergies and external influences, and examines how these may impact on allergy-related QoL and psychological distress including anxiety and depression. Implications of the impact are considered alongside avenues for future research.

Quality of Service for Real-Time Applications Over Next Generation Data Networks

NASA Technical Reports Server (NTRS)

Atiquzzaman, Mohammed; Jain, Raj

2001-01-01

This project, which started on January 1, 2000, was funded by the NASA Glenn Research Center for duration of one year. The deliverables of the project included the following tasks: (1) Study of QoS mapping between the edge and core networks envisioned in the Next Generation networks will provide us with the QoS guarantees that can be obtained from next generation networks; (2) Buffer management techniques to provide strict guarantees to real-time end-to-end applications through preferential treatment to packets belonging to real-time applications. In particular, use of ECN to help reduce the loss on high bandwidth-delay product satellite networks needs to be studied; (3) Effect of Prioritized Packet Discard to increase goodput of the network and reduce the buffering requirements in the ATM switches; (4) Provision of new IP circuit emulation services over Satellite IP backbones using MPLS will be studied; and (5) Determine the architecture and requirements for internetworking ATN and the Next Generation Internet for real-time applications. The project has been completed on time. All the objectives and deliverables of the project have been completed. Research results obtained from this project have been published in a number of papers in journals, conferences, and technical reports, included in this document.

Recent developments in processing systems for cell and tissue cultures toward therapeutic application.

PubMed

Kino-oka, Masahiro; Taya, Masahito

2009-10-01

Innovative techniques of cell and tissue processing, based on tissue engineering, have been developed for therapeutic applications. Cell expansion and tissue reconstruction through ex vivo cultures are core processes used to produce engineered tissues with sufficient structural integrity and functionality. In manufacturing, strict management against contamination and human error is compelled due to direct use of un-sterilable products and the laboriousness of culture operations, respectively. Therefore, the development of processing systems for cell and tissue cultures is one of the critical issues for ensuring a stable process and quality of therapeutic products. However, the siting criterion of culture systems to date has not been made clear. This review article classifies some of the known processing systems into 'sealed-chamber' and 'sealed-vessel' culture systems based on the difference in their aseptic spaces, and describes the potential advantages of these systems and current states of culture systems, especially those established by Japanese companies. Moreover, on the basis of the guidelines for isolator systems used in aseptic processing for healthcare products, which are issued by the International Organization for Standardization, the siting criterion of the processing systems for cells and tissue cultures is discussed in perspective of manufacturing therapeutic products in consideration of the regulations according to the Good Manufacturing Practice.

The Earth System Documentation (ES-DOC) Software Process

NASA Astrophysics Data System (ADS)

Greenslade, M. A.; Murphy, S.; Treshansky, A.; DeLuca, C.; Guilyardi, E.; Denvil, S.

2013-12-01

Earth System Documentation (ES-DOC) is an international project supplying high-quality tools & services in support of earth system documentation creation, analysis and dissemination. It is nurturing a sustainable standards based documentation eco-system that aims to become an integral part of the next generation of exa-scale dataset archives. ES-DOC leverages open source software, and applies a software development methodology that places end-user narratives at the heart of all it does. ES-DOC has initially focused upon nurturing the Earth System Model (ESM) documentation eco-system and currently supporting the following projects: * Coupled Model Inter-comparison Project Phase 5 (CMIP5); * Dynamical Core Model Inter-comparison Project (DCMIP); * National Climate Predictions and Projections Platforms Quantitative Evaluation of Downscaling Workshop. This talk will demonstrate that ES-DOC implements a relatively mature software development process. Taking a pragmatic Agile process as inspiration, ES-DOC: * Iteratively develops and releases working software; * Captures user requirements via a narrative based approach; * Uses online collaboration tools (e.g. Earth System CoG) to manage progress; * Prototypes applications to validate their feasibility; * Leverages meta-programming techniques where appropriate; * Automates testing whenever sensibly feasible; * Streamlines complex deployments to a single command; * Extensively leverages GitHub and Pivotal Tracker; * Enforces strict separation of the UI from underlying API's; * Conducts code reviews.

Cardiovascular and Interventional Radiological Society of Europe Guidelines on Endovascular Treatment in Aortoiliac Arterial Disease

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

Rossi, Michele, E-mail: michele.rossi@uniroma1.it; Iezzi, Roberto, E-mail: roberto.iezzi.md@gmail.com

2013-11-06

PurposeThese guidelines are intended for use in assessing the standard for technical success and safety in aorto-iliac percutaneous endovascular interventions.MethodsAny recommendation contained in the text comes from the highest level and extension of literature review available to date.ResultsThe success of endovascular procedures is strictly related to an accurate planning based mainly on CT- or MR-angiography. TASC II A through C lesions have an endovascular-first option Pre-procedure ASA antiplatelet therapy is advisable in all cases. The application of stents improves the immediate hemodynamic and most likely long-term clinical results. Cumulative mean complication rate is 7.51 % according to the most relevant literature.more » Most of the complications can be managed by means of percutaneous techniques.ConclusionThe design and quality of devices, as well as the easy and accuracy of performing these procedures, have improved over the last decades, leading to the preferential treatment of aorto-iliac steno-obstructive disease via endovascular means, often as first-line therapy, with high technical success rate and low morbidity. This is mirrored by the decreasing number of patients undergoing surgical grafts over the last years with patency, limb salvage, and survival rates equivalent to open reconstruction.« less

The associations between organizational culture, organizational structure and quality management in European hospitals

PubMed Central

Wagner, C.; Mannion, R.; Hammer, A.; Groene, O.; Arah, O.A.; Dersarkissian, M.; Suñol, R.

2014-01-01

Objective To better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals. Design A multi-method, multi-level, cross-sectional observational study. Setting and participants As part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospitals in 7 countries (France, Poland, Turkey, Portugal, Spain, Germany and Czech Republic) participated in a comprehensive questionnaire survey and a one-day on-site surveyor audit. Respondents for this study (n = 158) included professional quality managers and hospital trustees. Main outcome measures Extent of implementation of quality management systems, extent of compliance with existing management procedures and implementation of clinical quality activities. Results Among participating hospitals, 33% had a clan culture as their dominant culture type, 26% an open and developmental culture type, 16% a hierarchical culture type and 25% a rational culture type. The culture type had no statistically significant association with the outcome measures. Some structural characteristics were associated with the development of quality management systems. Conclusion The type of OC was not associated with the development of quality management in hospitals. Other factors (not culture type) are associated with the development of quality management. An OS that uses fewer protocols is associated with a less developed quality management system, whereas an OS which supports innovation in care is associated with a more developed quality management system. PMID:24671119

The associations between organizational culture, organizational structure and quality management in European hospitals.

PubMed

Wagner, C; Mannion, R; Hammer, A; Groene, O; Arah, O A; Dersarkissian, M; Suñol, R

2014-04-01

To better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals. A multi-method, multi-level, cross-sectional observational study. As part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospitals in 7 countries (France, Poland, Turkey, Portugal, Spain, Germany and Czech Republic) participated in a comprehensive questionnaire survey and a one-day on-site surveyor audit. Respondents for this study (n = 158) included professional quality managers and hospital trustees. Extent of implementation of quality management systems, extent of compliance with existing management procedures and implementation of clinical quality activities. Among participating hospitals, 33% had a clan culture as their dominant culture type, 26% an open and developmental culture type, 16% a hierarchical culture type and 25% a rational culture type. The culture type had no statistically significant association with the outcome measures. Some structural characteristics were associated with the development of quality management systems. The type of OC was not associated with the development of quality management in hospitals. Other factors (not culture type) are associated with the development of quality management. An OS that uses fewer protocols is associated with a less developed quality management system, whereas an OS which supports innovation in care is associated with a more developed quality management system.

The Evolution of Successful Satellite Science to Air Quality Application Projects: From Inception to Realization

NASA Astrophysics Data System (ADS)

Soja, A. J.

2012-12-01

Teams of scientist have been working for almost a decade with state, local, regional and federal Air Quality regulators and scientists on several projects that have been focused on improving biomass burning emissions within our nation's National Emissions Inventory (NEI). Initially, the NEI was based strictly on ground-based information that often used data aggregated from previous years reported at the county-centroid and completely ignored the spatial domain of all fires. This methodology resulted in gross inaccuracies; however it was an ingrained system and the users and organizations were largely comfortable. Improvements were viewed as too costly. Our task was to convince regulators, managers and users of the value that could be added by using satellite data to enhance the NEI. Certainly, there were individuals that understood the value of using satellite data, but they needed support to convince the establishment of the intrinsic, cost-effective value of publically-available satellite data. It was essential to present arguments, as well as requested verification and validation statistics, in the format that most suited the objectives of application organizations. This process incorporated: knowledge of state-of-the-art satellite data, algorithms and science; a working knowledge of the users applications and requirements; interacting with individuals with a variety of skill sets and goals; and perhaps most importantly, listening to the goals and responsibilities of the user community and fully communicating. Today, the Environmental Protection Agency and several state and regional organizations are using satellite data to estimate biomass burnings emissions at daily and annual scales for a number of critical environmental management and policy activities including regulation setting and regional strategy development for attainment of the National Ambient Air Quality Standards (NAAQS). We continue to work at the local, state and federal levels to improve the biomass burning portion of our nation's NEI at the crossroads of the applications 'largest cost-effective unknowns and uncertainties' and the 'best-available science and data'. Here, we will present a diagram tree of the completed evolution of a successful project, which includes the basic science on which this development is based and the succession of the use of satellite data within the applications and user communities.

The Impact of Healthcare Workers Job Environment on Their Mental-emotional Health. Coping Strategies: The Case of a Local General Hospital.

PubMed

Koinis, Aristotelis; Giannou, Vasiliki; Drantaki, Vasiliki; Angelaina, Sophia; Stratou, Elpida; Saridi, Maria

2015-04-13

Workplace stress can influence healthcare professionals' physical and emotional well-being by curbing their efficiency and having a negative impact on their overall quality of life. The aim of the present study was to investigate the impact that work environment in a local public general hospital can have on the health workers' mental-emotional health and find strategies in order to cope with negative consequences. The study took place from July 2010 to October 2010. Our sample consisted of 200 healthcare professionals aged 21-58 years working in a 240-bed general hospital and the response rate was 91.36%). Our research protocol was first approved by the hospital's review board. A standardized questionnaire that investigates strategies for coping with stressful conditions was used. A standardized questionnaire was used in the present study Coping Strategies for Stressful Events, evaluating the strategies that persons employ in order to overcome a stressful situation or event. The questionnaire was first tested for validity and reliability which were found satisfactory (Cronbach's α=0.862). Strict anonymity of the participants was guaranteed. The SPSS 16.0 software was used for the statistical analysis. Regression analysis showed that health professionals' emotional health can be influenced by strategies for dealing with stressful events, since positive re-assessment, quitting and seeking social support are predisposing factors regarding the three first quality of life factors of the World Health Organization Quality of Life - BREF. More specifically, for the physical health factor, positive re-assessment (t=3.370, P=0.001) and quitting (t=-2.564, P=0.011) are predisposing factors. For the 'mental health and spirituality' regression model, positive re-assessment (t=5.528, P=0.000) and seeking social support (t=-1.991, P=0.048) are also predisposing factors, while regarding social relationships positive re-assessment (t=4.289, P=0.000) is a predisposing factor. According to our findings, there was a notable lack of workplace stress management strategies, which the participants usually perceive as a lack of interest on behalf of the management regarding their emotional state. Some significant factors for lowering workplace stress were found to be the need to encourage and morally reward the staff and also to provide them with opportunities for further or continuous education.

Quality assurance in forensic odontology

PubMed

Solheim, T

2018-05-30

Quality assurance or quality control is a term and concept coming from the industry. Here it is most important. All products must have a minimum quality and variation in size, for example, must be kept within certain strict limits. There must be a system to control this. May be not every single product is controlled, but spot tests must be taken. Measures must be taken to improve the quality if it is not good enough. This concept has been transferred to medicine, odontology, and consequently also to forensic odontology. These areas have in common with industry the production of that certain products. However, they are usually handmade and not produced in an industrial process. In addition, dentistry is a great deal of art and judgement and quality control of these factors may be difficult. In this paper, I will focus on forensic odontology. What are the problems? What can we do and cannot do? In addition, how can we assure the quality of the work, the assessment and conclusion, and the report? I have some personal opinions on that and I will give some suggestions. Quality assurance on an international level is difficult. Conditions and juridical systems are different in different countries. Especially forensic odontologists are different and have different opinions. This presentation will be relevant to the ongoing discussion and attempts at revising the IOFOS' guidelines for quality assurance.

Characterization of tropospheric ozone based on lidar measurement in Hangzhou, East China during the G20 Leaders' Summit

NASA Astrophysics Data System (ADS)

Su, Wenjing; Liu, Cheng; Fan, Guangqiang; Hu, Qihou; Huang, Xin; Dong, Yunsheng; Zhang, Tianshu; Liu, Jianguo

2017-04-01

Owing to the G20 (Group of Twenty Finance Ministers and Central Bank Governors) Leaders' Summit (Sep.5th-6th, 2016), a series of strict air quality control measures were implemented in Hangzhou and its surrounding regions from Aug.26th to Sep.6th. A differential absorption lidar was employed to monitor tropospheric ozone in urban Hangzhou during a campaign from Aug. 24th to Sep. 10th, and the satellite-based NO2 VCDs and HCHO VCDs in the troposphere were also retrieved using the Ozone Monitoring Instrument (OMI). During our campaign, six O3 pollution events, which were determined according to the National Ambient Air Quality Standard of China (GB-3095-2012), and two stages with rapid reduction of O3 concentration on Aug. 26th and Sep.4-6th were observed. The temporal variation tendency of O3 concentrations was well reproduced by the Weather Research and Forecasting model coupled with chemistry (WRF-Chem). Typical cases with the abrupt rise and decline of O3 concentrations were analyzed using Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) back trajectory, satellite NO2 and HCHO product and the prediction by WRF-Chem model. The transport from northern cities have an important impact on pollutants observed in Hangzhou, and the chemical sensitivity of O3 production, which were approximately evaluated using the ratio of HCHO VCDs to NO2 VCDs in the troposphere, was turned from a mixed VOC-NOx-limited regime into a NOX-limited regime in Hangzhou due to the strict emission control measures.

The limits of evidence in drug approval and availability: a case study of cilostazol and naftidrofuryl for the treatment of intermittent claudication.

PubMed

Hong, Haeyeon; Mackey, William C

2014-08-01

Despite numerous efforts to develop effective medications for the treatment of intermittent claudication (IC) over the past 4 decades, a gold standard medical management option has yet to be defined. Although not life-threatening, IC interferes with mobility and activities of daily living, significantly impairing quality of life and potentially causing depression. Cilostazol, the leading pharmacologic agent for IC in the United States, was approved by the US Food and Drug Administration (FDA) in 1999 based on controversial data. Meanwhile, naftidrofuryl, the first-line pharmacologic agent for IC in the United Kingdom and Europe, has never been approved by the FDA and therefore is not available in the United States. The clinical data for cilostazol and naftidrofuryl are plagued by flaws related to lack of protocol standardization, objective endpoints, and strict eligibility criteria in study subjects, making identification of a true treatment effect impossible. Furthermore, no prospective randomized trial comparing the efficacy of cilostazol and naftidrofuryl has been conducted, because the manufacturers of these agents have much to lose and little to gain from such a study. This article provides an overview of the pharmacology of cilostazol and naftidrofuryl, and the clinical studies leading to their approval and clinical acceptance. It further explores the possible sources of bias in analyzing these clinical trials, some of which have been brought to light by the National Institute for Health and Clinical Excellence (NICE) of the United Kingdom in its technology appraisal guidance. It also speculates the ways in which economic incentives may affect drug-marketing decisions. A literature review of pharmacology and clinical trials for cilostazol and naftidrofuryl was performed in PubMed. The majority of included clinical trials were initially identified through the most recent Cochrane review articles as well as the FDA's approval packet for cilostazol. The technology appraisal guidance of the National Institute for Health and Care Excellence of the United Kingdom and the manufacturer's response to this guidance document were located via an online search engine. The clinical data for cilostazol and naftidrofuryl are plagued by flaws related to lack of protocol standardization, objective endpoints, and strict eligibility criteria in study subjects, making identification of a true treatment effect difficult. Furthermore, no prospective randomized trial comparing the efficacy of cilostazol and naftidrofuryl has been conducted. The history of the evaluation, approval, and marketing of these drugs illustrates the limitations of data in the regulatory approval and marketing of agents whose benefit is subjective and difficult to quantify. Implementation of a standardized protocol with strict eligibility criteria, objective quantifiable measurement of drug effect, and validated endpoints will eventually allow development of an ideal pharmacotherapy for IC. Copyright © 2014 Elsevier HS Journals, Inc. All rights reserved.

Total Quality Management Implementation Plan: Defense Depot, Ogden

DTIC Science & Technology

1989-07-01

NUMBERS Total Quality Management Implementation Plan Defense Depot Ogden 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING...PAGES TQM (Total Quality Management ), Continuous Process Improvement, Depot Operations, Process Action Teams 16. PRICE CODE 17. SECURITY...034 A Message From The Commander On Total Quality Management i fully support the DLA aoproacii to Total Quality Management . As stated by General

Association between quality management and performance indicators in Dutch diabetes care groups: a cross-sectional study.

PubMed

Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M

2015-05-11

To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. A cross-sectional study. All Dutch care groups (n=97). 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. The association between quality management, overall and in 6 domains ('organisation of care', 'multidisciplinary teamwork', 'patient centredness', 'performance management', 'quality improvement policy' and 'management strategies') on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression. The domain 'management strategies' was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. This first exploratory study on quality management showed weak or no associations between quality management of diabetes care groups and their performance. It remains uncertain whether this second layer on quality management adds to better quality of care. 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.

Air pollution and public health: a guidance document for risk managers.

PubMed

Craig, Lorraine; Brook, Jeffrey R; Chiotti, Quentin; Croes, Bart; Gower, Stephanie; Hedley, Anthony; Krewski, Daniel; Krupnick, Alan; Krzyzanowski, Michal; Moran, Michael D; Pennell, William; Samet, Jonathan M; Schneider, Jurgen; Shortreed, John; Williams, Martin

2008-01-01

This guidance document is a reference for air quality policymakers and managers providing state-of-the-art, evidence-based information on key determinants of air quality management decisions. The document reflects the findings of five annual meetings of the NERAM (Network for Environmental Risk Assessment and Management) International Colloquium Series on Air Quality Management (2001-2006), as well as the results of supporting international research. The topics covered in the guidance document reflect critical science and policy aspects of air quality risk management including i) health effects, ii) air quality emissions, measurement and modeling, iii) air quality management interventions, and iv) clean air policy challenges and opportunities.

Making a technological choice for disaster management and poverty alleviation in India.

PubMed

Srivastava, Sanjay K

2009-03-01

The right mix of policy, institutional arrangements and use of technology provides the framework for a country's approach to disaster mitigation. Worldwide, there has been a shift away from a strictly 'top-down' approach relying on government alone, to a combination of 'top-down' and 'bottom-up' approaches. The aim is to enhance the indigenous coping mechanisms of vulnerable communities; draw on their cooperative spirit and energy; and empower them through appropriate information and contextual knowledge to mitigate natural disasters. In light of this, the paper examines India's use of space technology in its disaster management efforts. Poverty alleviation and disaster management are almost inseparable in many parts of the country, as vulnerability to natural disasters is closely aligned with poverty. Addressing these issues together requires integrated knowledge systems. The paper examines how knowledge inputs from space technology have strengthened the national resolve to combat natural disasters in conjunction with alleviating rural poverty.

Metals in wine--impact on wine quality and health outcomes.

PubMed

Tariba, Blanka

2011-12-01

Metals in wine can originate from both natural and anthropogenic sources, and its concentration can be a significant parameter affecting consumption and conservation of wine. Since metallic ions have important role in oxide-reductive reactions resulting in wine browning, turbidity, cloudiness, and astringency, wine quality depends greatly on its metal composition. Moreover, metals in wine may affect human health. Consumption of wine may contribute to the daily dietary intake of essential metals (i.e., copper, iron, and zinc) but can also have potentially toxic effects if metal concentrations are not kept under allowable limits. Therefore, a strict analytical control of metal concentration is required during the whole process of wine production. This article presents a critical review of the existing literature regarding the measured metal concentration in wine, methods applied for their determination, and possible sources, as well as their impact on wine quality and human health. The main focus is set on aluminum, arsenic, cadmium, chromium, copper, iron, manganese, nickel, lead, and zinc, as these elements most often affect wine quality and human health.

[The Scope, Quality and Safety Requirements of Drug Abuse Testing].

PubMed

Küme, Tuncay; Karakükcü, Çiğdem; Pınar, Aslı; Coşkunol, Hakan

2017-01-01

The aim of this review is to inform about the scopes and requirements of drug abuse testing. Drug abuse testing is one of the tools for determination of drug use. It must fulfill the quality and safety requirements in judgmental legal and administrative decisions. Drug abuse testing must fulfill some requirements like selection of the appropriate test matrix, appropriate screening test panel, sampling in detection window, patient consent, identification of the donor, appropriate collection site, sample collection with observation, identification and control of the sample, specimen custody chain in preanalytical phase; analysis in authorized laboratories, specimen validity tests, reliable testing METHODS, strict quality control, two-step analysis in analytical phase; storage of the split specimen, confirmation of the split specimen in the objection, result custody chain, appropriate cut-off concentration, the appropriate interpretation of the result in postanalytical phase. The workflow and analytical processes of drug abuse testing are explained in last regulation of the Department of Medical Laboratory Services, Ministry of Health in Turkey. The clinical physicians have to know and apply the quality and safety requirements in drug abuse testing according to last regulations in Turkey.

A systematic review of neuropsychological studies involving young binge drinkers.

PubMed

Carbia, Carina; López-Caneda, Eduardo; Corral, Montserrat; Cadaveira, Fernando

2018-07-01

Binge drinking (BD) is a public health concern with serious implications for brain development. This review is the first in which neuropsychological studies of healthy young BDs are synthesized following PRISMA guidelines. We conducted a literature search in PsycINFO, Web of Science, and PubMed. Articles were screened using strict inclusion criteria. Two authors independently assessed the methodological quality. Of the 27 studies included, 14 (52%) were of intermediate quality, 7 (26%) of poor quality and 6 (22%) of high quality. BD is associated with deficits in verbal memory and executive functions, principally poor inhibitory control. Tentatively, BD may be related to deficits in cognitive flexibility and monitoring of information in working memory. Further studies are needed to determine potential impairments in prospective memory and decision-making. BDs do not seem to show difficulties in planning, short-term memory, attention, processing speed or visuospatial construction. The evidence does not seem to support greater vulnerability in females. Future longitudinal studies should identify the characteristics of extreme trajectories, explore recovery deficits and design intervention programs. Copyright © 2018 Elsevier Ltd. All rights reserved.

Beyond image quality: designing engaging interactions with digital products

NASA Astrophysics Data System (ADS)

de Ridder, Huib; Rozendaal, Marco C.

2008-02-01

Ubiquitous computing (or Ambient Intelligence) promises a world in which information is available anytime anywhere and with which humans can interact in a natural, multimodal way. In such world, perceptual image quality remains an important criterion since most information will be displayed visually, but other criteria such as enjoyment, fun, engagement and hedonic quality are emerging. This paper deals with engagement, the intrinsically enjoyable readiness to put more effort into exploring and/or using a product than strictly required, thus attracting and keeping user's attention for a longer period of time. The impact of the experienced richness of an interface, both visually and degree of possible manipulations, was investigated in a series of experiments employing game-like user interfaces. This resulted in the extension of an existing conceptual framework relating engagement to richness by means of two intermediating variables, namely experienced challenge and sense of control. Predictions from this revised framework are evaluated against results of an earlier experiment assessing the ergonomic and hedonic qualities of interactive media. Test material consisted of interactive CD-ROM's containing presentations of three companies for future customers.

Impact of Volume Management on Volume Overload and Rehospitalization in CAPD Patients.

PubMed

Xu, Yi; Yang, Shen-Min; Wang, Xiao-Hua; Wang, Hai-Fang; Niu, Mei-E; Yang, Yi-Qun; Lu, Guo-Yuan; Pang, Jian-Hong; Wang, Fei; Li, Lin

2018-05-01

Heart failure due to volume overload is a major reason for rehospitalization in continuous ambulatory peritoneal dialysis patients. Strict volume control provides better cardiac functions and blood pressure in this population. Volume management, which is a volume control strategy, may decrease volume overload and related complications. Using a quasi-experimental design, 66 continuous ambulatory peritoneal dialysis patients were randomly assigned to the intervention group ( n = 34) and control group ( n = 32). The patients were followed up for 6 months with scheduled clinic and/or telephone visits; the intervention group adopted volume management strategy, while the control group adopted conventional care. Volume overload and cardiac function were compared between the two groups at the baseline and at 6 months. At Month 6, the intervention group resulted in significant improvement in volume overloaded status, cardiac function, and volume-overload-related rehospitalization. Volume management strategy allows for better control of volume overload and is associated with fewer volume-related readmissions.

Quality management of human resources. Providers should begin by focusing on education, performance management, and reward systems.

PubMed

Blair, C S; Fordyce, M; Barney, S M

1993-10-01

For a quality management transformation to occur, a healthcare organization must focus on education and development, performance management, and recognition and reward systems during the first years of implementation. Education and development are perhaps the most important human resource management functions when implementing quality management principles and processes because behavioral changes will be required at all organizational levels. Specific programs that support an organization's quality management effort will vary but should include the conceptual, cultural, and technical aspects of quality management. The essence of quality management is to always satisfy the customer and to continuously improve the services and products the organization offers. The approach to performance management should therefore rely on customer feedback and satisfaction. An organization committed to quality management should base its performance management approach on customer orientation, process improvement, employee involvement, decision making with data, and continuous improvement. Managers and trustees are being challenged to provide innovative recognition and reward systems that reinforce the values and behaviors consistent with quality management. Such systems must also be aligned with the behaviors and outcomes that support the philosophy, mission, and values of the Catholic healthcare ministry. The following components should be considered for a recognition and reward system: base pay, incentives, benefits, and nonmonetary rewards.

Defining and improving quality management in Dutch diabetes care groups and outpatient clinics: design of the study.

PubMed

Campmans-Kuijpers, Marjo J E; Lemmens, Lidwien C; Baan, Caroline A; Gorter, Kees J; Groothuis, Jolanda; van Vuure, Klementine H; Rutten, Guy E H M

2013-04-05

Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support. This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire. This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries as well.

Public health laboratory quality management in a developing country.

PubMed

Wangkahat, Khwanjai; Nookhai, Somboon; Pobkeeree, Vallerut

2012-01-01

The article aims to give an overview of the system of public health laboratory quality management in Thailand and to produce a strengths, weaknesses, opportunities and threats (SWOT) analysis that is relevant to public health laboratories in the country. The systems for managing laboratory quality that are currently employed were described in the first component. The second component was a SWOT analysis, which used the opinions of laboratory professionals to identify any areas that could be improved to meet quality management systems. Various quality management systems were identified and the number of laboratories that met both international and national quality management requirements was different. The SWOT analysis found the opportunities and strengths factors offered the best chance to improve laboratory quality management in the country. The results are based on observations and brainstorming with medical laboratory professionals who can assist laboratories in accomplishing quality management. The factors derived from the analysis can help improve laboratory quality management in the country. This paper provides viewpoints and evidence-based approaches for the development of best possible practice of services in public health laboratories.

Package of care for active management in labour for reducing caesarean section rates in low-risk women

PubMed Central

Brown, Heather C; Paranjothy, Shantini; Dowswell, Therese; Thomas, Jane

2014-01-01

Background Approximately 15% of women have caesarean sections (CS) and while the rate varies, the number is increasing in many countries. This is of concern because higher CS rates do not confer additional health gain but may adversely affect maternal health and have implications for future pregnancies. Active management of labour has been proposed as a means of reducing CS rates. This refers to a package of care including strict diagnosis of labour, routine amniotomy, oxytocin for slow progress and one to one support in labour. Objectives To determine whether active management of labour reduces CS rates in low-risk women and improves satisfaction. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (February 2008), MEDLINE (1966 to December 2007), EMBASE (1980 to 2007), MIDIRS (1985 to 2007) and CINAHL (1982 to 2007). Selection criteria Randomised controlled trials comparing low-risk women receiving a predefined package of care (active management) with women receiving routine (variable) care. Trials where slow progress had been diagnosed before entry into the trial were excluded. Data collection and analysis At least two review authors extracted data. We assessed included studies for risk of bias. Main results We included seven trials, with a total of 5390 women. The quality of studies was mixed. The CS rate was slightly lower in the active management group compared to the group that received routine care, but this difference did not reach statistical significance (RR 0.88, 95% CI 0.77 to 1.01). However, in one study there was a large number of post-randomisation exclusions. On excluding this study, CS rates in the active management group were statistically significantly lower than in the routine care group (RR 0.77 95% CI 0.63 to 0.94). More women in the active management group had labours lasting less than twelve hours, but there was wide variation in length of labour within and between trials. There were no differences between groups in use of analgesia, rates of assisted vaginal deliveries or maternal or neonatal complications. Only one trial examined maternal satisfaction; the majority of women (over 75%) in both groups were very satisfied with care. Authors’ conclusions Active management is associated with small reductions in the CS rate, but it is highly prescriptive and interventional. It is possible that some components of the active management package are more effective than others. Further work is required to determine the acceptability of active management to women in labour. PMID:18843671

Quality Management in Higher Education: Towards a Better Understanding of an Emerging Field

ERIC Educational Resources Information Center

Pratasavitskaya, Halina; Stensaker, Bjorn

2010-01-01

The article analyses how quality management is understood in higher education research. By reviewing a number of academic contributions addressing quality management issues in "Quality in Higher Education" from 1995-2008, the article identifies central concepts associated with quality management, discusses whether there are commonalities to be…

Responsibility of University and College Staff for Higher Education Quality Management

ERIC Educational Resources Information Center

Valiuskeviciute, Audrone; Ziogeviciute, Areta

2006-01-01

The article analyses the issue of indefiniteness of higher education quality management as a specific area of quality management. It analyses the participation of staff in the development of quality culture. It investigates the perceptions of university and college staff of their responsibilities to participate in quality management. On the basis…

Influence of alkalinity, hardness and dissolved solids on drinking water taste: A case study of consumer satisfaction.

PubMed

Lou, Jie-Chung; Lee, Wei-Li; Han, Jia-Yun

2007-01-01

Two surveys of consumer satisfaction with drinking water conducted by Taiwan Water Supply Corp. are presented in this study. The study results show that although a lot of money was invested to modify traditional treatment processes, over 60% of local residents still avoided drinking tap water. Over half of the respondents felt that sample TT (from the traditional treatment process) was not a good drinking water, whether in the first or second survey, whereas almost 60% of respondents felt that samples PA, PB, CCL and CT (from advanced treatment processes) were good to drink. For all drinking water samples, respondent satisfaction with a sample primarily depended on it having no unpleasant flavors. Taiwan Environmental Protection Administration plans to revise the drinking water quality standards for TH and TDS in the near future. The new standards require a lower TH concentration (from currently 400mg/L (as CaCO(3)) to 150mg/L (as CaCO(3))), and a lower TDS maximum admissible concentration from the current guideline of 600 to 250mg/L. Therefore, this study also evaluated the impacts on drinking water tastes caused by variations in TH and TDS concentrations, and assessed the need to issue more strict drinking water quality standards for TH and TDS. The research results showed that most respondents could not tell the difference in water taste among water samples with different TDS, TH and alkalinity. Furthermore, hardness was found to be inversely associated with cardiovascular diseases and cancers, and complying with more strict standards would lead most water facilities to invest billions of dollars to upgrade their treatment processes. Consequently, in terms of drinking water tastes alone, this study suggested that Taiwan Environmental Protection Administration should conduct more thorough reviews of the scientific literature that provides the rationale for setting standards and reconsider if it is necessary to revise drinking water quality standards for TH and TDS.

Analysis of Management Practices in Lagos State Tertiary Institutions through Total Quality Management Structural Framework

ERIC Educational Resources Information Center

AbdulAzeez, Abbas Tunde

2016-01-01

This research investigated total quality management practices and quality teacher education in public tertiary institutions in Lagos State. The study was therefore designed to analyse management practices in Lagos state tertiary institutions through total quality management structural framework. The selected public tertiary institutions in Lagos…

Organic food consumption in Poland: Motives and barriers.

PubMed

Bryła, Paweł

2016-10-01

This paper aims to investigate selected aspects of organic food consumption in Poland. We conducted a survey in a representative sample of 1000 consumers. Polish consumers are convinced that organic food is more expensive, healthier, more environmentally friendly, more tasty and more authentic than conventional food. They believe its arouses more trust, has a better quality, is subject to more strict controls, and is produced in a more traditional way. According to Polish consumers, the most important characteristics of organic food are healthiness and high quality. The perceived authenticity of organic food depends on its natural taste, product quality, labelling, in particular having a European quality sign, as well as the retailer type and a separate exposition place in the points of purchase (merchandising). The critical barrier to the development of the organic food market in Poland is the high price, followed by an insufficient consumer awareness, low availability of organic products, short expiry dates and low visibility in the shop. The principal motives of organic food selection in Poland include: healthiness, ecological character of the product, food safety considerations, superior taste, and quality assurance. We identified the motives for and barriers to organic food consumption in Poland. Copyright © 2016 Elsevier Ltd. All rights reserved.

Association between quality management and performance indicators in Dutch diabetes care groups: a cross-sectional study

PubMed Central

Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M

2015-01-01

Objectives To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. Design A cross-sectional study. Setting All Dutch care groups (n=97). Participants 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. Primary outcomes The association between quality management, overall and in 6 domains (‘organisation of care’, ‘multidisciplinary teamwork’, ‘patient centredness’, ‘performance management’, ‘quality improvement policy’ and ‘management strategies’) on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression. Results The domain ‘management strategies’ was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. Conclusions This first exploratory study on quality management showed weak or no associations between quality management of diabetes care groups and their performance. It remains uncertain whether this second layer on quality management adds to better quality of care. PMID:25968001

Recent Local and State Action in Arizona to Maintain Sky Quality

NASA Astrophysics Data System (ADS)

Hall, Jeffrey C.; Shankland, P. D.; Green, R. F.; Jannuzi, B.

2014-01-01

The large number of observatories in Arizona has led to the development of a number of lighting control ordinances around the state, some quite strict. Several factors are now contributing to an increased need for active effort at the local, County, and State levels in maintaining the quality of these codes; these factors include an expansion of competing interests in the state, the increasing use of LED lighting, and the potential for major new investments through projects such as the Cherenkov Telescope Array (CTA) and enhancements to the Navy Precision Optical Interferometer. I will review recent strategies Arizona's observatories have used to effect maintenance of ordinances and preserve sky quality; cases include (1) a statewide effort in 2012 to curb a proliferation of electronic billboards and (2) engagement of a broad group of local, County, and State officials, as well as individuals from the private sector, in support of projects like CTA, including awareness of and support for dark-sky preservation.

Legalized abortion: a public health success story.

PubMed

Kelly, M

1999-06-01

60% of more than 2000 women surveyed by the Picker Institute who underwent induced abortion procedures rated the quality of their care as excellent. Another third reported their care as being either very good or good. The survey also found that the quality of abortion care is comparable to other outpatient surgery. However, the high quality of care women receive from abortion providers is lost in the hostile anti-abortion climate created by threatening protesters outside of clinics and the murder of 7 clinic workers and physicians who performed abortions. Abortion opponents fail to acknowledge that legal abortion is a medical procedure which protects women's health and saves their lives. Before abortion was legalized in the US, countless women were either rendered unable to reproduce or died from abortion-related complications. Efforts to outlaw abortion persist despite it being widely recognized by medical experts as one of the most safe medical procedures currently performed in the US. When state legislatures target abortion providers with unduly strict regulations, abortion becomes prohibitively expensive and difficult to obtain.

Selvester scoring in patients with strict LBBB using the QUARESS software.

PubMed

Xia, Xiaojuan; Chaudhry, Uzma; Wieslander, Björn; Borgquist, Rasmus; Wagner, Galen S; Strauss, David G; Platonov, Pyotr; Ugander, Martin; Couderc, Jean-Philippe

2015-01-01

Estimation of the infarct size from body-surface ECGs in post-myocardial infarction patients has become possible using the Selvester scoring method. Automation of this scoring has been proposed in order to speed-up the measurement of the score and improving the inter-observer variability in computing a score that requires strong expertise in electrocardiography. In this work, we evaluated the quality of the QuAReSS software for delivering correct Selvester scoring in a set of standard 12-lead ECGs. Standard 12-lead ECGs were recorded in 105 post-MI patients prescribed implantation of an implantable cardiodefibrillator (ICD). Amongst the 105 patients with standard clinical left bundle branch block (LBBB) patterns, 67 had a LBBB pattern meeting the strict criteria. The QuAReSS software was applied to these 67 tracings by two independent groups of cardiologists (from a clinical group and an ECG core laboratory) to measure the Selvester score semi-automatically. Using various level of agreement metrics, we compared the scores between groups and when automatically measured by the software. The average of the absolute difference in Selvester scores measured by the two independent groups was 1.4±1.5 score points, whereas the difference between automatic method and the two manual adjudications were 1.2±1.2 and 1.3±1.2 points. Eighty-two percent score agreement was observed between the two independent measurements when the difference of score was within two point ranges, while 90% and 84% score agreements were reached using the automatic method compared to the two manual adjudications. The study confirms that the QuAReSS software provides valid measurements of the Selvester score in patients with strict LBBB with minimal correction from cardiologists. Copyright © 2015 Elsevier Inc. All rights reserved.

Aspects and Some Results on Passivity and Positivity of Dynamic Systems

NASA Astrophysics Data System (ADS)

De la Sen, M.

2017-12-01

This paper is devoted to discuss certain aspects of passivity results in dynamic systems and the characterization of the regenerative systems counterparts. In particular, the various concepts of passivity as standard passivity, strict input passivity, strict output passivity and very strict passivity (i.e. joint strict input and output passivity) are given and related to the existence of a storage function and a dissipation function. Later on, the obtained results are related to external positivity of systems and positivity or strict positivity of the transfer matrices and transfer functions in the time-invariant case. On the other hand, it is discussed how to achieve or how eventually to increase the passivity effects via linear feedback by the synthesis of the appropriate feed-forward or feedback controllers or, simply, by adding a positive parallel direct input-output matrix interconnection gain.

78 FR 53270 - Revision of Air Quality Implementation Plan; California; Sacramento Metropolitan Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-29

... Quality Implementation Plan; California; Sacramento Metropolitan Air Quality Management District... to the Sacramento Metropolitan Air Quality Management District (SMAQMD or District) portion of the..., Sacramento Metropolitan Air Quality Management District, Rule 214 (Federal New Source Review), Rule 203...

Prevalence and clinical significance of left bundle branch block according to classical or strict definition criteria in permanent pacemaker patients.

PubMed

Mazza, Andrea; Bendini, Maria Grazia; De Cristofaro, Raffaele; Lovecchio, Mariolina; Valsecchi, Sergio; Leggio, Massimo; Boriani, Giuseppe

2017-06-01

Previous studies have shown that the presence of left bundle branch block (LBBB) is associated with an increased risk of cardiac mortality and heart failure (HF). Recently, new criteria to define strict LBBB have been proposed: QRS duration ≥140 ms for men and ≥130 ms for women, along with mid-QRS notching or slurring in ≥2 contiguous leads. We assessed the prevalence and prognostic significance of LBBB according to classical (QRS duration ≥120ms) and strict criteria in permanent pacemaker patients. We retrospectively enrolled 723 consecutive patients who had undergone single- or dual-chamber pacemaker implantation at the study center from July 2002 to December 2014. Patients with a left ventricular ejection fraction ≤35% or a prior diagnosis of HF were excluded. LBBB was reported in 54 (7%) patients, and strict-LBBB in 15 (2%) patients. During a median follow-up of 48 months (range, 18-92 months), 147 (20%) patients reached the combined endpoint of death or HF hospitalization. Patients with LBBB and those with strict-LBBB displayed significantly higher rates of death or HF hospitalization (log-rank test, all P < 0.0001). In particular, strict-LBBB was associated with the worst outcome. The presence of LBBB according to classical definition criteria (hazard ratio [HR] = 1.98, confidence interval [CI]: 1.23-3.19, P = 0.005) and to strict criteria (HR = 2.20; CI: 1.04-4.65; P = 0.039) were both confirmed as independent predictors of death or HF hospitalization after adjustment for relevant clinical covariates. Among patients who had undergone standard pacemaker implantation, the prevalence of LBBB was 7% according to classical definition criteria and 2% according to strict criteria. The presence of LBBB, and particularly of strict-LBBB, at the baseline predicted a poor outcome in terms of death or HF hospitalization. © 2017 Wiley Periodicals, Inc.

[Quality management in intensive care medicine].

PubMed

Martin, J; Braun, J-P

2014-02-01

Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to external quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system.

[Quality management in intensive care medicine].

PubMed

Martin, J; Braun, J-P

2013-09-01

Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to extern quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system.

[Quality Management for Surgeons: The Knowledge of Basic Contexts and Innovative Strategies Promotes the Competitiveness of Clinical Department].

PubMed

Hellmann, Wolfgang

2017-12-01

Efficient quality management aiming to achieve high quality in patient care is crucial to the success of a surgery department. This requires the knowledge of relevant terms und contexts of quality management. Implementation remains difficult in the light of demographic change and skills shortage. If a hospital has an efficient internal quality management in place, this should be used as a supplementary instrument. Otherwise it is the (sole) task of a specialist department to ensure quality for patients, employees, and cooperative partners. This paper provides basic knowledge on quality management, risk management, and quality assurance in the context of relevant medical terms. It demonstrates new ways for implementation on the level of a surgery department, and introduces a new model of quality. Georg Thieme Verlag KG Stuttgart · New York.

41 CFR 102-80.25 - What are Federal agencies' responsibilities concerning the management of indoor air quality?

Code of Federal Regulations, 2010 CFR

2010-07-01

... agencies' responsibilities concerning the management of indoor air quality? 102-80.25 Section 102-80.25... Environmental Management Indoor Air Quality § 102-80.25 What are Federal agencies' responsibilities concerning the management of indoor air quality? Federal agencies must assess indoor air quality of buildings as...

41 CFR 102-80.25 - What are Federal agencies' responsibilities concerning the management of indoor air quality?

Code of Federal Regulations, 2011 CFR

2011-01-01

... agencies' responsibilities concerning the management of indoor air quality? 102-80.25 Section 102-80.25... Environmental Management Indoor Air Quality § 102-80.25 What are Federal agencies' responsibilities concerning the management of indoor air quality? Federal agencies must assess indoor air quality of buildings as...

Political ecology of groundwater: the contrasting case of water-abundant West Bengal and water-scarce Gujarat, India

NASA Astrophysics Data System (ADS)

Mukherji, Aditi

2006-03-01

Three apparently disparate themes (groundwater, farmers and politics) interweave in this account of how groundwater-related policies in India have very little to do with the scarcity, depletion or quality of groundwater, and more to do with rural politics manifested, among other things, in terms of the presence or absence of farmer lobbies. Examples from two states of India, the water-abundant state of West Bengal and water-scarce state of Gujarat, were investigated using readily available data, analysis of the literature, interviews and fieldwork. In the case of West Bengal, although there is no pressing groundwater crisis, the government of West Bengal (GOWB) was able to successfully implement strict groundwater regulations along with a drastic increase in electricity tariff. More importantly, GOWB was able to implement these without any form of visible farmer protest, though these measures negatively affected farmer incomes. On the other hand, in Gujarat, where there is a real and grave groundwater crisis, the government of Gujarat has neither been able to implement strict groundwater regulations, nor has it been able to increase electricity tariff substantially. Thus, through the lens of ‘political ecology’ the contrasting case of these two Indian states is explained.

High Photocatalytic Performance of Two Types of Graphene Modified TiO2 Composite Photocatalysts

NASA Astrophysics Data System (ADS)

Zhang, Jun; Li, Sen; Tang, Bo; Wang, Zhengwei; Ji, Guojian; Huang, Weiqiu; Wang, Jinping

2017-07-01

High quality and naturally continuous structure of three-dimensional graphene network (3DGN) endow it a promising candidate to modify TiO2. Although the resulting composite photocatalysts display outstanding performances, the lacking of active sites of the 3DGN not only goes against a close contact between the graphene basal plane and TiO2 nanoparticles (weaken electron transport ability) but also limits the efficient adsorption of pollutant molecules. Similar with surface functional groups of the reduced graphene oxide (RGO) nanosheets, surface defects of the 3DGN can act as the adsorption sites. However, the defect density of the 3DGN is difficult to control (a strict cool rate of substrate and a strict flow of precursor gas are necessary) because of its growth approach (chemical vapor deposition method). In this study, to give full play to the functions of graphene, the RGO nanosheets and 3DGN co-modified TiO2 composite photocatalysts are prepared. After optimizing the mass fraction of the RGO nanosheets in the composite photocatalyst, the resulting chemical adsorption ability and yields of strong oxidizing free radicals increase significantly, indicating the synergy of the RGO nanosheets and 3DGN.

Summation by parts, projections, and stability

NASA Technical Reports Server (NTRS)

Olsson, Pelle

1993-01-01

We have derived stability results for high-order finite difference approximations of mixed hyperbolic-parabolic initial-boundary value problems (IBVP). The results are obtained using summation by parts and a new way of representing general linear boundary conditions as an orthogonal projection. By slightly rearranging the analytic equations, we can prove strict stability for hyperbolic-parabolic IBVP. Furthermore, we generalize our technique so as to yield strict stability on curvilinear non-smooth domains in two space dimensions. Finally, we show how to incorporate inhomogeneous boundary data while retaining strict stability. Using the same procedure one can prove strict stability in higher dimensions as well.

Chinese herbal medicine Kuntai capsule for treatment of menopausal syndrome: a systematic review of randomized clinical trials.

PubMed

Zhou, Quan; Tao, Jing; Song, Huamei; Chen, Aihua; Yang, Huaijie; Zuo, Manzhen; Li, Hairong

2016-12-01

Kuntai capsule has been widely used for the treatment of menopausal syndrome in China for long time. We conducted this review to assess efficacy and safety of Kuntai capsule for the treatment of menopausal syndrome. We searched studies in PubMed, ClinicalTrials, the Cochrane Library, China National Knowledge Infrastructure Database(CNKI), China Science and Technology Journal Database (VIP), Wan fang Database and Chinese Biomedical Literature Database(CBM) until November 20, 2014. Randomized trials on Kuntai capsule for menopausal syndrome, compared with placebo or hormone replacement therapy (HRT) were included. Two reviewers independently retrieved the randomized controlled trials (RCTs) and extracted the information. The Cochrane risk of bias method was used to assess the quality of the included studies, and a Meta-analysis was conducted with Review Manager 5.2 software. A total of 17 RCTs (1455 participants) were included. The studies were of low methodological quality. Meta-analysis indicated that there was no statistical difference in the Kupperman index (KI) [WMD=0.51, 95% CI (-0.04, 1.06)], the effective rate of KI [OR=1.21, 95% CI (0.72, 2.04)], E2 level [WMD=-15.18, 95% CI (-33.93, 3.56)], and FSH level [WMD=-3.46, 95% CI (-7.2, 0.28)] after treatment between Kuntai versus HRT group (P>0.05). However, Compared with HRT, Kuntai capsule could significantly reduce the total incidence of adverse events [OR=0.28, 95% CI (0.17, 0.45)]. Kuntai capsule may be effective for treating menopausal syndrome and lower risk of side effects. The studies we analyzed were of low methodological quality. Therefore, more strictly designed large-scale randomized clinical trials are needed to evaluate the efficacy of Kuntai capsule in menopausal syndrome. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cancer registration, public health and the reform of the European data protection framework: Abandoning or improving European public health research?

PubMed

Andersen, Mette Rye; Storm, Hans H

2015-06-01

The importance of cancer- and other disease registries for planning, management and evaluation of healthcare systems has been shown repeatedly during the last 50 years. Complete and unbiased population-level analyses on routinely collected, individual data concerning health and personal characteristics can address significant concerns about risk factors for cancer and provide sound evidence about public health and the effectiveness of healthcare systems. The existence of quality controlled and comprehensive data in registries, allowed to be used for quality control, research and public health purposes are taken as granted by most health professionals and researchers. However, the current revision of the European Union (EU) data protection framework suggests a harmonisation of requirements for confidentiality and individual consent to data processing, likely at the expense of proper use of registry data in the health sector. Consequences of excessive confidentiality rules that may lead to missed data linkages have been simulated. The simulations provide one possible explanation for observed heterogeneity among some cancer incidence data. Further, public health, quality control and epidemiological research on large populations can no longer provide evidence for health interventions, if requirements for consent renders research impossible or where attempts to obtain consent from each data subject generates biased results. Health professionals should engage in the on-going debate on the Commission's proposal for a General Data Protection Regulation. The nature and use of registry data in public health research must be explained and known to policy-makers and the public. Use of cancer registry data and other epidemiological activity will terminate abruptly if an unnecessarily strict EU data protection regulation is adopted. Research based interventions, as well as the international recognised standing of cancer registries and register-based research institutions in Europe are at stake. Copyright © 2013 Elsevier Ltd. All rights reserved.

Understanding the lessons and limitations of conservation and development.

PubMed

Oldekop, Johan A; Bebbington, Anthony J; Brockington, Dan; Preziosi, Richard F

2010-04-01

The lack of concrete instances in which conservation and development have been successfully merged has strengthened arguments for strict exclusionist conservation policies. Research has focused more on social cooperation and conflict of different management regimes and less on how these factors actually affect the natural environments they seek to conserve. Consequently, it is still unknown which strategies yield better conservation outcomes? We conducted a meta-analysis of 116 published case studies on common resource management regimes from Africa, south and central America, and southern and Southeast Asia. Using ranked sociodemographic, political, and ecological data, we analyzed the effect of land tenure, population size, social heterogeneity, as well as internally devised resource-management rules and regulations (institutions) on conservation outcome. Although land tenure, population size, and social heterogeneity did not significantly affect conservation outcome, institutions were positively associated with better conservation outcomes. There was also a significant interaction effect between population size and institutions, which implies complex relationships between population size and conservation outcome. Our results suggest that communities managing a common resource can play a significant role in conservation and that institutions lead to management regimes with lower environmental impacts.

[The organization of system of quality management in large multitype hospital].

PubMed

Taĭts, B M; Krichmar, G N; Stvolinskiĭ, I Iu; Grandilevskaia, O L

2013-01-01

The article presents the characteristics and assessment of functioning of model of quality management in large multitype hospital. The results of work of the municipal hospital of Saint Venerable martyr Elizabeth of St Petersburg concerning the implementation of system of quality management in 2001-2011 of the foundation of principles of total quality management of medical service and principles of quality management according international standards ISO and their Russian analogues.

40 CFR 130.8 - Water quality report.

Code of Federal Regulations, 2010 CFR

2010-07-01

... QUALITY PLANNING AND MANAGEMENT § 130.8 Water quality report. (a) Each State shall prepare and submit... quality data and problems identified in the 305(b) report, States develop water quality management (WQM... the 305(b) report should be analyzed through water quality management planning leading to the...

Total Quality Management (TQM) as the Procedure for Management of Integrated Academics.

ERIC Educational Resources Information Center

Anderson, Lowell D.

Total Quality Management (TQM) is a way of doing business that involves every employee, both labor and management, in an effort to improve quality and productivity. The quality management concept consists of common principles: (1) customer focus; (2) process focus; (3) failure prevention; (4) mobilization of work force; (5) decision making based…

DLA-X Total Quality Management (TQM) Implementation Plan

DTIC Science & Technology

1989-07-01

PAGES TOM (Total Quality Management ), Continuous Process Improvement.( .) 4L-- Administration 16. PRICE CODE 17. SECURITY CLASSIFICATION 18. SECURITY...NSN 7540-01-280-5500 Standard Form 298 (Rev. 2-89) Pr.-cr,bed by ANSI Std ,,fl.f 296-102 DLA-X TOTAL QUALITY MANAGEMENT (TQM) IMPLEMENTATION PLAN o...application of proven Total Quality Management techniques. Quality Policy: Responsibility for quality is delegated to every employee ;11 DLA-X. Every

40 CFR 1518.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY OFFICE OF ENVIRONMENTAL QUALITY MANAGEMENT FUND... Management Fund (“Fund”): The Management Fund for the Office of Environmental Quality. (d) Interagency... of Environmental Quality. The Environmental Quality Improvement Act specifies that the Chairman of...

Plant use in the medicinal practices known as "strict diets" in Chazuta valley (Peruvian Amazon).

PubMed

Sanz-Biset, Jaume; Cañigueral, Salvador

2011-09-01

Strict diets are traditional medicinal practices where plant remedies are consumed with nearly fasting and with some sort of social seclusion. The aim of this work was to describe these practices of Chazuta and the use of plants within, as well as to analyse the possible functions of the last. The information was obtained through interviews to the 6.3% of the district rural adult population (140 individuals, 75% of which was considered Quechua). In total, 122 strict diets were recorded and 106 different plant species were reported to be used. Strict diets present a characteristic structure and plant use. The main effects reported in strict diets were antinflammatory, antiinfective, brain function alteration and depuration. Strict diets are well structured traditional medicinal practices, also with a symbolic significance in the life cycle of chazutian men. Plants used in strict diets can contribute to the main effects through antinflammation, antiinfective actions, psychoactivity and depurative related activities. The correlation between literature evidence of activity of most used plants and effects reported for the correspondent diet (i.e. in which the plant was used) are 36% for antinflammatory activity, 29% for antimicrobial activity, 18% for psychoactivity and 5% for depurative related activities. The percentages go to 77%, 64%, 73% and 32%, respectively, when literature evidences on related taxa are also considered. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

75 FR 40762 - Revisions to the California State Implementation Plan, Sacramento Metropolitan Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-14

... the California State Implementation Plan, Sacramento Metropolitan Air Quality Management District and South Coast Air Quality Management District AGENCY: Environmental Protection Agency (EPA). ACTION... Management District (SMAQMD) and South Coast Air Quality Management District (SCAQMD) portions of the...

Total Quality Management: A Recipe for Success

DTIC Science & Technology

1990-04-02

Total Quality Management (TQM) is a high level Department of Defense (DOD) initiative that is being touted as the primary management tool to force...to create a DOD wide organizational climate that will stimulate and perpetuate individual productivity enhancing contributions. Keywords: Quality control; Quality management ; TQM.

[Development of whole process quality control and management system of traditional Chinese medicine decoction pieces based on traditional Chinese medicine quality tree].

PubMed

Yu, Wen-Kang; Dong, Ling; Pei, Wen-Xuan; Sun, Zhi-Rong; Dai, Jun-Dong; Wang, Yun

2017-12-01

The whole process quality control and management of traditional Chinese medicine (TCM) decoction pieces is a system engineering, involving the base environment, seeds and seedlings, harvesting, processing and other multiple steps, so the accurate identification of factors in TCM production process that may induce the quality risk, as well as reasonable quality control measures are very important. At present, the concept of quality risk is mainly concentrated in the aspects of management and regulations, etc. There is no comprehensive analysis on possible risks in the quality control process of TCM decoction pieces, or analysis summary of effective quality control schemes. A whole process quality control and management system for TCM decoction pieces based on TCM quality tree was proposed in this study. This system effectively combined the process analysis method of TCM quality tree with the quality risk management, and can help managers to make real-time decisions while realizing the whole process quality control of TCM. By providing personalized web interface, this system can realize user-oriented information feedback, and was convenient for users to predict, evaluate and control the quality of TCM. In the application process, the whole process quality control and management system of the TCM decoction pieces can identify the related quality factors such as base environment, cultivation and pieces processing, extend and modify the existing scientific workflow according to their own production conditions, and provide different enterprises with their own quality systems, to achieve the personalized service. As a new quality management model, this paper can provide reference for improving the quality of Chinese medicine production and quality standardization. Copyright© by the Chinese Pharmaceutical Association.

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

PubMed

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

2015-01-01

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

Resilient Urban Infrastructures - Basics of Smart Sustainable Cities

NASA Astrophysics Data System (ADS)

Timashev, S. A.

2017-11-01

In this paper the notion of urban infrastructure resilience is formulated being expressed verbally and strictly in conditional probability terms. It is further used to formulate several most important features of a smart city. This multidisciplinary and multifaceted approach is used to explain the concept of quantitative resilience in urban design, operation, managing urban risk and mitigating of the consequences of a natural or industrial disaster. The extremely urgent problem is formulated on how to connect the physical and spatial (core) resiliencies with the functional, organizational, economic and social resiliencies.

Studying the Earth from space

USGS Publications Warehouse

,

1977-01-01

Pictures of the Earth's surface obtained from satellites are providing scientists with new tools to investigate the Earth and its environment. At the same time, a growing population and an ever-expanding technology place unprecedented demands on natural resources. Man can no longer treat his resources strictly according to immediate economic dictates; a balance must be struck between the short-term demands of technological and industrial development and the long-term effects on the environment. Intelligent development, management, and conservation of resources are goals that represent a challenge in the acquisition and use of information.

Studying the Earth from space

USGS Publications Warehouse

,

1974-01-01

Pictures of the Earth's surface obtained from satellites are providing scientists with new tools to investigate tne Earth and its environment. A growing population and an everexpanding technology place demands on our natural resources. However, man can no longer treat his resources strictly according to immediate economic dictates; a balance must be struck between the short-term demands of technological and industrial development and the long-term effects on the environment. Intelligent development, management, and conservation of resources are goals that represent an unprecedented challenge in the acquisition and use of information.

Quality Management Plan for the Environmental Assessment and Innovation Division

EPA Pesticide Factsheets

Quality management plan (QMP) which identifies the mission, roles, responsibilities of personnel with regard to quality assurance and quality management for the environmental assessment and innovation division.

7 CFR 28.525 - Symbols and code numbers.

Code of Federal Regulations, 2013 CFR

2013-01-01

... designations in inches. (a) Symbols and Code numbers used for Color Grades of American Upland Cotton. Color... 41 Low Middling LM 51 Strict Good Ordinary SGO 61 Good Ordinary GO 71 Good Middling Light Spotted GM Lt SP 12 Strict Middling Light Spotted SM Lt Sp 22 Middling Light Spotted Mid Lt Sp 32 Strict Low...

7 CFR 28.525 - Symbols and code numbers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... designations in inches. (a) Symbols and Code numbers used for Color Grades of American Upland Cotton. Color... 41 Low Middling LM 51 Strict Good Ordinary SGO 61 Good Ordinary GO 71 Good Middling Light Spotted GM Lt SP 12 Strict Middling Light Spotted SM Lt Sp 22 Middling Light Spotted Mid Lt Sp 32 Strict Low...

7 CFR 28.525 - Symbols and code numbers.

Code of Federal Regulations, 2014 CFR

2014-01-01

... designations in inches. (a) Symbols and Code numbers used for Color Grades of American Upland Cotton. Color... 41 Low Middling LM 51 Strict Good Ordinary SGO 61 Good Ordinary GO 71 Good Middling Light Spotted GM Lt SP 12 Strict Middling Light Spotted SM Lt Sp 22 Middling Light Spotted Mid Lt Sp 32 Strict Low...

7 CFR 28.525 - Symbols and code numbers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... designations in inches. (a) Symbols and Code numbers used for Color Grades of American Upland Cotton. Color... 41 Low Middling LM 51 Strict Good Ordinary SGO 61 Good Ordinary GO 71 Good Middling Light Spotted GM Lt SP 12 Strict Middling Light Spotted SM Lt Sp 22 Middling Light Spotted Mid Lt Sp 32 Strict Low...