WorldWideScience

Sample records for high quality evidence

  1. Automatic evidence quality prediction to support evidence-based decision making.

    Science.gov (United States)

    Sarker, Abeed; Mollá, Diego; Paris, Cécile

    2015-06-01

    Evidence-based medicine practice requires practitioners to obtain the best available medical evidence, and appraise the quality of the evidence when making clinical decisions. Primarily due to the plethora of electronically available data from the medical literature, the manual appraisal of the quality of evidence is a time-consuming process. We present a fully automatic approach for predicting the quality of medical evidence in order to aid practitioners at point-of-care. Our approach extracts relevant information from medical article abstracts and utilises data from a specialised corpus to apply supervised machine learning for the prediction of the quality grades. Following an in-depth analysis of the usefulness of features (e.g., publication types of articles), they are extracted from the text via rule-based approaches and from the meta-data associated with the articles, and then applied in the supervised classification model. We propose the use of a highly scalable and portable approach using a sequence of high precision classifiers, and introduce a simple evaluation metric called average error distance (AED) that simplifies the comparison of systems. We also perform elaborate human evaluations to compare the performance of our system against human judgments. We test and evaluate our approaches on a publicly available, specialised, annotated corpus containing 1132 evidence-based recommendations. Our rule-based approach performs exceptionally well at the automatic extraction of publication types of articles, with F-scores of up to 0.99 for high-quality publication types. For evidence quality classification, our approach obtains an accuracy of 63.84% and an AED of 0.271. The human evaluations show that the performance of our system, in terms of AED and accuracy, is comparable to the performance of humans on the same data. The experiments suggest that our structured text classification framework achieves evaluation results comparable to those of human performance

  2. Average effect estimates remain similar as evidence evolves from single trials to high-quality bodies of evidence: a meta-epidemiologic study.

    Science.gov (United States)

    Gartlehner, Gerald; Dobrescu, Andreea; Evans, Tammeka Swinson; Thaler, Kylie; Nussbaumer, Barbara; Sommer, Isolde; Lohr, Kathleen N

    2016-01-01

    The objective of our study was to use a diverse sample of medical interventions to assess empirically whether first trials rendered substantially different treatment effect estimates than reliable, high-quality bodies of evidence. We used a meta-epidemiologic study design using 100 randomly selected bodies of evidence from Cochrane reports that had been graded as high quality of evidence. To determine the concordance of effect estimates between first and subsequent trials, we applied both quantitative and qualitative approaches. For quantitative assessment, we used Lin's concordance correlation and calculated z-scores; to determine the magnitude of differences of treatment effects, we calculated standardized mean differences (SMDs) and ratios of relative risks. We determined qualitative concordance based on a two-tiered approach incorporating changes in statistical significance and magnitude of effect. First trials both overestimated and underestimated the true treatment effects in no discernible pattern. Nevertheless, depending on the definition of concordance, effect estimates of first trials were concordant with pooled subsequent studies in at least 33% but up to 50% of comparisons. The pooled magnitude of change as bodies of evidence advanced from single trials to high-quality bodies of evidence was 0.16 SMD [95% confidence interval (CI): 0.12, 0.21]. In 80% of comparisons, the difference in effect estimates was smaller than 0.5 SMDs. In first trials with large treatment effects (>0.5 SMD), however, estimates of effect substantially changed as new evidence accrued (mean change 0.68 SMD; 95% CI: 0.50, 0.86). Results of first trials often change, but the magnitude of change, on average, is small. Exceptions are first trials that present large treatment effects, which often dissipate as new evidence accrues. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Leggat, Sandra G; Balding, Cathy

    2017-11-13

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

  4. Measuring earnings quality: Evidence from New Zealand

    Directory of Open Access Journals (Sweden)

    Muhammad Nurul Houqe

    2011-01-01

    Full Text Available We utilize two basic approaches to measure the quality of earnings which control two different dimensions of earnings management. The research design is structured primary on the basis of calculating two different measures of the quality of earnings on the industry level and on the company level. We calculate earnings quality for New Zealand public firms from the OSIRIS (http://www.osiris.com database for 2004-2007. This research concludes that various stakeholders should apply more than one measure for the quality of earning in order to have strong evidence about the level of quality before taking any corrective action or making any decision related to that company. If one company is having low quality of earning according to one technique and high quality of earnings according to another, the stakeholders cannot have a final conclusion about that company and they need more investigations and analysis to assess the quality of earnings

  5. Challenges and Ideas from a Research Program on High Quality, Evidence-Based Practice in School Mental Health

    Science.gov (United States)

    Weist, Mark D.; Youngstrom, Eric A.; Stephan, Sharon; Lever, Nancy; Fowler, Johnathan; Taylor, Leslie; McDaniel, Heather; Chappelle, Lori; Paggeot, Samantha; Hoagwood, Kimberly

    2013-01-01

    Objective Reviews the progression of a research program designed to develop, implement and study the implementation of “achievable” evidence-based practices (EBPs) in schools. Reviews challenges encountered and ideas to overcome them to enhance this avenue of research. Method Presents two federally funded randomized controlled trials involving comparison of a four-component targeted intervention (Quality Assessment and Improvement, Family Engagement and Empowerment, Modular Evidence-Based Practice, Implementation Support) versus a comparison intervention focused on Personal Wellness. In both studies primary aims focused on changes in clinician attitudes and behavior, including the delivery of high quality, evidence-based practices and secondary aims focused on student level impacts. Results A number of challenges, many not reported in the literature are reviewed, and ideas for overcoming them are presented. Conclusions Given the reality that the majority of youth mental health services are delivered in schools and the potential of school mental health (SMH) services to provide a continuum of mental health care from promotion to intervention, it is critical that the field consider and address the logistical and methodological challenges associated with implementing and studying EBP implementation by clinicians. PMID:24063310

  6. Highly qualified does not equal high quality: A study of urban stakeholders' perceptions of quality in science teaching

    Science.gov (United States)

    Miranda, Rommel Joseph

    By employing qualitative methods, this study sought to determine the perceptions that urban stakeholders hold about what characteristics should distinguish a high school science teacher whom they would consider to demonstrate high quality in science teaching. A maximum variation sample of six science teachers, three school administrators, six parents and six students from a large urban public school district were interviewed using semi-structured, in-depth interview techniques. From these data, a list of observable characteristics which urban stakeholders hold as evidence of high quality in science teaching was generated. Observational techniques were utilized to determine the extent to which six urban high school science teachers, who meet the NCLB Act criteria for being "highly qualified", actually possessed the characteristics which these stakeholders hold as evidence of high quality in science teaching. Constant comparative analysis was used to analyze the data set. The findings suggest that urban stakeholders perceive that a high school science teacher who demonstrates high quality in science teaching should be knowledgeable about their subject matter, their student population, and should be resourceful; should possess an academic background in science and professional experience in science teaching; should exhibit professionalism, a passion for science and teaching, and a dedication to teaching and student learning; should be skillful in planning and preparing science lessons and in organizing the classroom, in presenting the subject matter to students, in conducting a variety of hands-on activities, and in managing a classroom; and should assess whether students complete class goals and objectives, and provide feedback about grades for students promptly. The findings further reveal that some of the urban high school science teachers who were deemed to be "highly qualified", as defined by the NCLB Act, engaged in practices that threatened quality in science

  7. Evidence, Quality, and Waste: Solving the Value Equation in Neonatology.

    Science.gov (United States)

    Dukhovny, Dmitry; Pursley, DeWayne M; Kirpalani, Haresh M; Horbar, Jeffrey H; Zupancic, John A F

    2016-03-01

    Rising health care costs challenge governments, payers, and providers in delivering health care services. Tremendous pressures result to deliver better quality care while simultaneously reducing costs. This has led to a wholesale re-examination of current practice methods, including explicit consideration of efficiency and waste. Traditionally, reductions in the costs of care have been considered as independent, and sometimes even antithetical, to the practice of high-quality, intensive medicine. However, it is evident that provision of evidence-based, locally relevant care can result in improved outcomes, lower resource utilization, and opportunities to reallocate resources. This is particularly relevant to the practice of neonatology. In the United States, 12% of the annual birth cohort is affected by preterm birth, and 3% is affected by congenital anomalies. Both of these conditions are associated with costly health care during, and often long after, the NICU admission. We will discuss how 3 drivers of clinical practice in neonatal care (evidence-based medicine, evidence-based economics, and quality improvement) can together optimize clinical and fiscal outcomes. Copyright © 2016 by the American Academy of Pediatrics.

  8. High-quality cardiopulmonary resuscitation: current and future directions.

    Science.gov (United States)

    Abella, Benjamin S

    2016-06-01

    Cardiopulmonary resuscitation (CPR) represents the cornerstone of cardiac arrest resuscitation care. Prompt delivery of high-quality CPR can dramatically improve survival outcomes; however, the definitions of optimal CPR have evolved over several decades. The present review will discuss the metrics of CPR delivery, and the evidence supporting the importance of CPR quality to improve clinical outcomes. The introduction of new technologies to quantify metrics of CPR delivery has yielded important insights into CPR quality. Investigations using CPR recording devices have allowed the assessment of specific CPR performance parameters and their relative importance regarding return of spontaneous circulation and survival to hospital discharge. Additional work has suggested new opportunities to measure physiologic markers during CPR and potentially tailor CPR delivery to patient requirements. Through recent laboratory and clinical investigations, a more evidence-based definition of high-quality CPR continues to emerge. Exciting opportunities now exist to study quantitative metrics of CPR and potentially guide resuscitation care in a goal-directed fashion. Concepts of high-quality CPR have also informed new approaches to training and quality improvement efforts for cardiac arrest care.

  9. Audit quality and the audit partner effect : Evidence from European listed companies

    OpenAIRE

    Buuren, van, J.P.

    2009-01-01

    The main objective of this study is to provide evidence on the differences in audit quality amongst audit partners. I attribute these dissimilarities to (i) differences in the audit risk perception and the risk appetite of individual audit partners and (ii) to differences in the personal business case of audit partners. As a result, three audit partner archetypes have been identified: liberal, high quality and conservative. This paper will provide evidence that 50% of the audit partners (53% ...

  10. Challenges and ideas from a research program on high-quality, evidence-based practice in school mental health.

    Science.gov (United States)

    Weist, Mark D; Youngstrom, Eric A; Stephan, Sharon; Lever, Nancy; Fowler, Johnathan; Taylor, Leslie; McDaniel, Heather; Chappelle, Lori; Paggeot, Samantha; Hoagwood, Kimberly

    2014-01-01

    This article reviews the progression of a research program designed to develop, implement, and study the implementation of "achievable" evidence-based practices (EBPs) in schools. We review challenges encountered and ideas to overcome them to enhance this avenue of research. The article presents two federally funded randomized controlled trials involving comparison of a four-component targeted intervention (Quality Assessment and Improvement, Family Engagement and Empowerment, Modular Evidence-Based Practice, Implementation Support) versus a comparison intervention focused on personal wellness. In both studies, primary aims focused on changes in clinician attitudes and behavior, including the delivery of high-quality EBPs and secondary aims focused on student-level impacts. A number of challenges, many not reported in the literature, are reviewed, and ideas for overcoming them are presented. Given the reality that the majority of youth mental health services are delivered in schools and the potential of school mental health services to provide a continuum of mental health care from promotion to intervention, it is critical that the field consider and address the logistical and methodological challenges associated with implementing and studying EBP implementation by clinicians.

  11. Quality of evidence-based pediatric guidelines

    NARCIS (Netherlands)

    Boluyt, Nicole; Lincke, Carsten R.; Offringa, Martin

    2005-01-01

    Objective. To identify evidence-based pediatric guidelines and to assess their quality. Methods. We searched Medline, Embase, and relevant Web sites of guideline development programs and national pediatric societies to identify evidence-based pediatric guidelines. A list with titles of identified

  12. [GRADE system: classification of quality of evidence and strength of recommendation].

    Science.gov (United States)

    Aguayo-Albasini, José Luis; Flores-Pastor, Benito; Soria-Aledo, Víctor

    2014-02-01

    The acquisition and classification of scientific evidence, and subsequent formulation of recommendations constitute the basis for the development of clinical practice guidelines. There are several systems for the classification of evidence and strength of recommendations; the most commonly used nowadays is the Grading of Recommendations, Assessment, Development and Evaluation system (GRADE). The GRADE system initially classifies the evidence into high or low, coming from experimental or observational studies; subsequently and following a series of considerations, the evidence is classified into high, moderate, low or very low. The strength of recommendations is based not only on the quality of the evidence, but also on a series of factors such as the risk/benefit balance, values and preferences of the patients and professionals, and the use of resources or costs. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  13. Evaluating the state of quality-improvement science through evidence synthesis: insights from the closing the quality gap series.

    Science.gov (United States)

    McDonald, Kathryn M; Schultz, Ellen M; Chang, Christine

    2013-01-01

    The Closing the Quality Gap series from the Agency for Healthcare Research and Quality summarizes evidence for eight high-priority health care topics: outcomes used in disability research, bundled payment programs, public reporting initiatives, health care disparities, palliative care, the patient-centered medical home, prevention of health care-associated infections, and medication adherence. To distill evidence from this series and provide insight into the "state of the science" of quality improvement (QI). We provided common guidance for topic development and qualitatively synthesized evidence from the series topic reports to identify cross-topic themes, challenges, and evidence gaps as related to QI practice and science. Among topics that examined effectiveness of QI interventions, we found improvement in some outcomes but not others. Implementation context and potential harms from QI activities were not widely evaluated or reported, although market factors appeared important for incentive-based QI strategies. Patient-focused and systems-focused strategies were generally more effective than clinician-focused strategies, although the latter approach improved clinician adherence to infection prevention strategies. Audit and feedback appeared better for targeting professionals and organizations, but not patients. Topic reviewers observed heterogeneity in outcomes used for QI evaluations, weaknesses in study design, and incomplete reporting. Synthesizing evidence across topics provided insight into the state of the QI field for practitioners and researchers. To facilitate future evidence synthesis, consensus is needed around a smaller set of outcomes for use in QI evaluations and a framework and lexicon to describe QI interventions more broadly, in alignment with needs of decision makers responsible for improving quality.

  14. How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

    Science.gov (United States)

    OʼRourke, Hannah M; Fraser, Kimberly D

    2016-01-01

    Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.

  15. Quality assurance and evidence in career guidance in Europe

    DEFF Research Database (Denmark)

    Plant, Peter

    2011-01-01

    Quality assurance and evidence in career guidance in Europe is based on a particular, positivtic model. Other approaches are largely neglected.......Quality assurance and evidence in career guidance in Europe is based on a particular, positivtic model. Other approaches are largely neglected....

  16. Evidence-Based Design Features Improve Sleep Quality Among Psychiatric Inpatients.

    Science.gov (United States)

    Pyrke, Ryan J L; McKinnon, Margaret C; McNeely, Heather E; Ahern, Catherine; Langstaff, Karen L; Bieling, Peter J

    2017-10-01

    The primary aim of the present study was to compare sleep characteristics pre- and post-move into a state-of-the-art mental health facility, which offered private sleeping quarters. Significant evidence points toward sleep disruption among psychiatric inpatients. It is unclear, however, how environmental factors (e.g., dorm-style rooms) impact sleep quality in this population. To assess sleep quality, a novel objective technology, actigraphy, was used before and after a facility move. Subjective daily interviews were also administered, along with the Horne-Ostberg Morningness-Eveningness Questionnaire and the Pittsburgh Sleep Quality Index. Actigraphy revealed significant improvements in objective sleep quality following the facility move. Interestingly, subjective report of sleep quality did not correlate with the objective measures. Circadian sleep type appeared to play a role in influencing subjective attitudes toward sleep quality. Built environment has a significant effect on the sleep quality of psychiatric inpatients. Given well-documented disruptions in sleep quality present among psychiatric patients undergoing hospitalization, design elements like single patient bedrooms are highly desirable.

  17. Using social media for knowledge translation, promotion of evidence-based medicine and high-quality information on health.

    Science.gov (United States)

    Puljak, Livia

    2016-02-02

    Knowledge translation activities may be targeted towards all participants in healthcare practices, including patients, consumers, and policy makers. Hereby, use of social media, namely social network Facebook, as a tool for knowledge translation, promotion of evidence-based medicine and high-quality information on health is described. In March 2013, a Facebook page of the Croatian Cochrane Branch was created and its main content are translated plain language summaries (PLS) of the systematic reviews produced by The Cochrane Collaboration. Since the page was created it has gained 1441 followers, mostly from Croatia and neighboring countries with similar language. Most of the page followers are women aged 25 to 44 and the most popular content is related to pregnancy, childbirth and breastfeeding. Page followers are lay persons, health professionals and journalists, who further disseminate the page content. In summary, social media enables multiple possibilities to engage with target audience and to disseminate the evidence-based medicine content. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  18. Rating the strength of scientific evidence: relevance for quality improvement programs.

    Science.gov (United States)

    Lohr, Kathleen N

    2004-02-01

    To summarize an extensive review of systems for grading the quality of research articles and rating the strength of bodies of evidence, and to highlight for health professionals and decision-makers concerned with quality measurement and improvement the available "best practices" tools by which these steps can be accomplished. Drawing on an extensive review of checklists, questionnaires, and other tools in the field of evidence-based practice, this paper discusses clinical, management, and policy rationales for rating strength of evidence in a quality improvement context, and documents best practices methods for these tasks. After review of 121 systems for grading the quality of articles, 19 systems, mostly specific, met a priori scientific standards for grading systematic reviews, randomized controlled trials, observational studies, and diagnostic tests; eight systems (of 40 reviewed) met similar standards for rating the overall strength of evidence. All can be used as is or adapted for particular types of evidence reports or systematic reviews. Formally grading study quality and rating overall strength of evidence, using sound instruments and procedures, can produce reasonable levels of confidence about the science base for parts of quality improvement programs. With such information, health care professionals and administrators concerned with quality improvement can understand better the level of science (versus only clinical consensus or opinion) that supports practice guidelines, review criteria, and assessments that feed into quality assurance and improvement programs. New systems are appearing and research is needed to confirm the conceptual and practical underpinnings of these grading and rating systems, but the need for those developing systematic reviews, practice guidelines, and quality or audit criteria to understand and undertake these steps is becoming increasingly clear.

  19. A quality assessment of systematic reviews on telerehabilitation: what does the evidence tell us?

    Directory of Open Access Journals (Sweden)

    Marco Rogante

    2015-03-01

    Full Text Available Aims. To evaluate the quality of systematic reviews on telerehabilitation. Methods. The AMSTAR - Assessment of Multiple Systematic Reviews - checklist was used to appraise the evidence related to the systematic reviews. Results. Among the 477 records initially identified, 10 systematic reviews matched the inclusion criteria. Fifty percent were of high quality; anyway the majority of them did not report the following aspects: i analysis of the grey literature; ii a list of the excluded studies and their characteristics; iii the identification of possible source of bias and the assessment of its likehood; iv an appropriate method to combine the findings of the included studies addressing the heterogeneity as well. From the main findings of the high-scored systematic reviews telerehabilitation resulted at least as effective as usual care: 1 in the short term treatment of mental health related to people affected by spinal cord injury; 2 in rural communities for treating patients affected by chronic conditions; 3 in treating common pathologies (mainly asthma affecting children and adolescents. As for stroke, evidence is currently insufficient to reach conclusions about its effectiveness. As for costs, there is insufficient evidence to confirm that telerehabilitation is a cost-saving or cost-effective solution. Conclusions. In the authors' knowledge this is the first attempt to evaluate the quality of systematic reviews on telerehabilitation. This work also identified the main findings related to the high-scored systematic reviews; the analysis confirms that there is a mounting evidence concerning the effectiveness of telerehabilitation, at least for some pathologies.

  20. Evidence-Based Healthcare: The Importance of Effective Interprofessional Working for High Quality Veterinary Services, a UK Example

    Directory of Open Access Journals (Sweden)

    Tierney Kinnison

    2016-11-01

    Full Text Available Objective: To highlight the importance of evidence-based research, not only for the consideration of clinical diseases and individual patient treatment, but also for investigating complex healthcare systems, as demonstrated through a focus on veterinary interprofessional working.Background:Evidence-Based Veterinary Medicine (EBVM was developed due to concerns over inconsistent approaches to therapy being delivered by individuals. However, a focus purely on diagnosis and treatment will miss other potential causes of substandard care including the holistic system. Veterinary services are provided by interprofessional teams; research on these teams is growing.Evidentiary value:This paper outlines results from four articles, written by the current authors, which are unique in their focus on interprofessional practice teams in the UK. Through mixed methods, the articles demonstrate an evidence base of the effects of interprofessional working on the quality of service delivery.Results:The articles explored demonstrate facilitators and challenges of the practice system on interprofessional working and the outcomes, including errors. The results encourage consideration of interprofessional relationships and activities in veterinary organisations. Interprofessional working is an example of one area which can affect the quality of veterinary services.Conclusion: The papers presented on veterinary interprofessional working are an example of the opportunities for future research on various topics within evidence-based healthcare.Application:The results are pertinent to members of veterinary teams seeking to improve their service delivery, to educators looking to enhance their students’ understanding of interprofessional working, and to researchers, who will hopefully be encouraged to consider evidence-based healthcare more holistically. 

  1. Factors Affecting Quality of Audit; Empirical Evidence from Iran ...

    African Journals Online (AJOL)

    This study examines factors affecting quality of audit using empirical evidence from Iran Quality of audit was seen as the degree to which an audit report is free from deficiencies and distortions which show up later on. The quality of an audit was measured in terms of an auditor's ability to report financial distortions willingly ...

  2. Willingness to pay for environmental quality: evidence from survey data

    Energy Technology Data Exchange (ETDEWEB)

    Polinard, J L; Wrinkle, R D

    1980-01-01

    The environmental movement evidenced a period of extremely rapid growth during the 1960's and early 1970's. Some recent studies have indicated a decline in general public concern with environmental problems. In this paper we attempt to provide some new evidence which might be of assistance in ascertaining the relative status of concern for the economy, concern for the environment, and willingness to pay for environmental quality. The study focuses upon a major city in a large energy producing state with a large ethnic (Mexican-American) minority. Our data indicate that concern for the environment is not a highly salient issue for our respondents. Economic concerns far outweigh environmental issues. Additionally, willingness to pay for environmental quality is not a unidimensional trait. Perception of who is responsible for pollution rather than perception of a deteriorating environment is a significant indicator of willingness to pay for environmental quality.

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

    Science.gov (United States)

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

    2018-01-13

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

  4. Evidence-informed person-centered healthcare part I: do 'cognitive biases plus' at organizational levels influence quality of evidence?

    Science.gov (United States)

    Seshia, Shashi S; Makhinson, Michael; Phillips, Dawn F; Young, G Bryan

    2014-12-01

    There is increasing concern about the unreliability of much of health care evidence, especially in its application to individuals. Cognitive biases, financial and non-financial conflicts of interest, and ethical violations (which, together with fallacies, we collectively refer to as 'cognitive biases plus') at the levels of individuals and organizations involved in health care undermine the evidence that informs person-centred care. This study used qualitative review of the pertinent literature from basic, medical and social sciences, ethics, philosophy, law etc. Financial conflicts of interest (primarily industry related) have become systemic in several organizations that influence health care evidence. There is also plausible evidence for non-financial conflicts of interest, especially in academic organizations. Financial and non-financial conflicts of interest frequently result in self-serving bias. Self-serving bias can lead to self-deception and rationalization of actions that entrench self-serving behaviour, both potentially resulting in unethical acts. Individuals and organizations are also susceptible to other cognitive biases. Qualitative evidence suggests that 'cognitive biases plus' can erode the quality of evidence. 'Cognitive biases plus' are hard wired, primarily at the unconscious level, and the resulting behaviours are not easily corrected. Social behavioural researchers advocate multi-pronged measures in similar situations: (i) abolish incentives that spawn self-serving bias; (ii) enforce severe deterrents for breaches of conduct; (iii) value integrity; (iv) strengthen self-awareness; and (v) design curricula especially at the trainee level to promote awareness of consequences to society. Virtuous professionals and organizations are essential to fulfil the vision for high-quality individualized health care globally. © 2014 John Wiley & Sons, Ltd.

  5. Pharmacists performing quality spirometry testing: an evidence based review.

    Science.gov (United States)

    Cawley, Michael J; Warning, William J

    2015-10-01

    The scope of pharmacist services for patients with pulmonary disease has primarily focused on drug related outcomes; however pharmacists have the ability to broaden the scope of clinical services by performing diagnostic testing including quality spirometry testing. Studies have demonstrated that pharmacists can perform quality spirometry testing based upon international guidelines. The primary aim of this review was to assess the published evidence of pharmacists performing quality spirometry testing based upon American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. In order to accomplish this, the description of evidence and type of outcome from these services were reviewed. A literature search was conducted using five databases [PubMed (1946-January 2015), International Pharmaceutical Abstracts (1970 to January 2015), Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews] with search terms including pharmacy, spirometry, pulmonary function, asthma or COPD was conducted. Searches were limited to publications in English and reported in humans. In addition, Uniform Resource Locators and Google Scholar searches were implemented to include any additional supplemental information. Eight studies (six prospective multi-center trials, two retrospective single center studies) were included. Pharmacists in all studies received specialized training in performing spirometry testing. Of the eight studies meeting inclusion and exclusion criteria, 8 (100%) demonstrated acceptable repeatability of spirometry testing based upon standards set by the ATS/ERS guidelines. Acceptable repeatability of seven studies ranged from 70 to 99% consistent with published data. Available evidence suggests that quality spirometry testing can be performed by pharmacists. More prospective studies are needed to add to the current evidence of quality spirometry testing performed by

  6. Corporate Governance Quality and Earnings Management: Evidence from Jordan

    Directory of Open Access Journals (Sweden)

    Sinan S. Abbadi

    2016-06-01

    Full Text Available This paper investigates the effect of corporate governance quality on earnings management in Jordan. Using a panel data set of all industrial and service firms listed on Amman Stock Exchange (ASE during the period 2009-2013; this paper provides evidence that earnings management is affected negatively by corporate governance quality. In particular; the results show that earnings management is affected negatively by overall categories of governance index represented by board of director, board meeting, Audit and nomination and compensation committee. Furthermore, results suggest that corporate governance quality has increased over time. Thus, its ability to constrain earnings management has also increased. It is recommended to industrial and service companies to boost their compliance with corporate governance code to improve the integrity and reliability of financial reports. This paper fills a gap in the literature by providing evidence about the effect of corporate governance quality on earnings management in Jordan as an emerging economy.

  7. Pursuing Quality Evidence: Applying Single-Subject Quality Indicators to Non-Experimental Qualitative Educational Research

    Science.gov (United States)

    Stodden, Robert A.; Yamamoto, Kathryn K.; Folk, Eric; Kong, Eran; Otsuji, Derek N.

    2013-01-01

    The need for quality evidence in support of strategies used while working with persons with autism and intellectual disability (ID) has been long been recognized by researchers and practitioners. The authors reviewed and applied a number of evidence-based indicators, developed through the "What Works Clearinghouse" (WWC), to the conduct…

  8. Evidence-based medicine and quality of care.

    Science.gov (United States)

    Dickenson, Donna; Vineis, Paolo

    2002-01-01

    In this paper we set out to examine the arguments for and against the claim that Evidence-Based Medicine (EBM) will improve the quality of care. In particular, we examine the following issues: 1. Are there hidden ethical assumptions in the methodology of EBM? 2. Is there a tension between the duty of care and EBM? 3. How can patient preferences be incorporated into quality guidelines and effectiveness studies? 4. Is there a tension between the quality of a particular intervention and overall quality of care? 5. Are certain branches of medicine and patient groups innately or prima facie disadvantaged by a shift to EBM? In addition we consider a case study in the ethics of EBM, on a clinical trial concerning the collection of umbilical cord blood in utero and ex utero, during or after labour in childbirth.

  9. Competition, information, and quality: Evidence from nursing homes.

    Science.gov (United States)

    Zhao, Xin

    2016-09-01

    Economic theory suggests that competition and information can both be important for product quality, and yet evidence on how they may interact to affect quality is sparse. This paper estimates the impact of competition between nursing homes on their quality, and how this impact varies when consumers have better access to information. The effect of competition is identified using exogenous variation in the geographical proximity of nursing homes to their potential consumers. The change in information transparency is captured by the launch of the Five-Star Quality Rating System in 2009, which improved access to the quality information of nursing homes. We find that while the effect of competition on nursing home quality is generally rather limited, this effect becomes significantly stronger with increased information transparency. The results suggest that regulations on public quality reporting and on market structure are policy complements, and should be considered jointly to best improve quality. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. Improving the quality of the evidence base of health informatics.

    Science.gov (United States)

    Talmon, Jan

    2008-11-06

    Evaluation of health informatics technology has had attention from quite a few researchers in health informatics in the last few decades. In the early nineties of the past century several working groups and research projects have discussed evaluation methods and methodologies. Despite these activities, evaluation of health informatics has not received the recognition it deserves. In this presentation we will reiterate the arguments put forward in the Declaration of Innsbruck to consider evaluation an essential element of the evidence base of health informatics. Not only are evaluation studies essential, it is also required that such studies are properly reported. A joint effort of the IMIA, EFMI and AMIA working groups on evaluation has resulted in a guideline for reporting the results of evaluation studies of health informatics applications (STARE-HI). STARE-HI is currently endorsed by EFMI. The general assembly of IMIA has adopted STARE-HI as an official IMIA document. Endorsement from AMIA is being sought. A pilot study in which STARE-HI was applied to assess the quality of current reporting clearly indicates that there is quite some room for improvement. Application of guidelines such as STARE-HI would contribute to a further improvement of the evidence base of health informatics and would open the road for high quality reviews and meta-analyses.

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

    Science.gov (United States)

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

    2017-06-01

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

  12. Teaching mathematical word problem solving: the quality of evidence for strategy instruction priming the problem structure.

    Science.gov (United States)

    Jitendra, Asha K; Petersen-Brown, Shawna; Lein, Amy E; Zaslofsky, Anne F; Kunkel, Amy K; Jung, Pyung-Gang; Egan, Andrea M

    2015-01-01

    This study examined the quality of the research base related to strategy instruction priming the underlying mathematical problem structure for students with learning disabilities and those at risk for mathematics difficulties. We evaluated the quality of methodological rigor of 18 group research studies using the criteria proposed by Gersten et al. and 10 single case design (SCD) research studies using criteria suggested by Horner et al. and the What Works Clearinghouse. Results indicated that 14 group design studies met the criteria for high-quality or acceptable research, whereas SCD studies did not meet the standards for an evidence-based practice. Based on these findings, strategy instruction priming the mathematics problem structure is considered an evidence-based practice using only group design methodological criteria. Implications for future research and for practice are discussed. © Hammill Institute on Disabilities 2013.

  13. Competition and educational quality: evidence from the Netherlands

    NARCIS (Netherlands)

    E. Dijkgraaf (Elbert); R.H.J.M. Gradus (Raymond); M. de Jong (Matthijs)

    2013-01-01

    textabstractLittle evidence is available for the effect of competition on educational quality as only a few countries allow large-scale competition. In the Netherlands, free parental choice has been present since the beginning of the twentieth century and can be characterized as a full voucher

  14. How evidence-based are the recommendations in evidence-based guidelines?

    Directory of Open Access Journals (Sweden)

    Finlay A McAlister

    2007-08-01

    Full Text Available BACKGROUND: Treatment recommendations for the same condition from different guideline bodies often disagree, even when the same randomized controlled trial (RCT evidence is cited. Guideline appraisal tools focus on methodology and quality of reporting, but not on the nature of the supporting evidence. This study was done to evaluate the quality of the evidence (based on consideration of its internal validity, clinical relevance, and applicability underlying therapy recommendations in evidence-based clinical practice guidelines. METHODS AND FINDINGS: A cross-sectional analysis of cardiovascular risk management recommendations was performed for three different conditions (diabetes mellitus, dyslipidemia, and hypertension from three pan-national guideline panels (from the United States, Canada, and Europe. Of the 338 treatment recommendations in these nine guidelines, 231 (68% cited RCT evidence but only 105 (45% of these RCT-based recommendations were based on high-quality evidence. RCT-based evidence was downgraded most often because of reservations about the applicability of the RCT to the populations specified in the guideline recommendation (64/126 cases, 51% or because the RCT reported surrogate outcomes (59/126 cases, 47%. CONCLUSIONS: The results of internally valid RCTs may not be applicable to the populations, interventions, or outcomes specified in a guideline recommendation and therefore should not always be assumed to provide high-quality evidence for therapy recommendations.

  15. Impact of policy support on uptake of evidence-based continuous quality improvement activities and the quality of care for Indigenous Australians: a comparative case study.

    Science.gov (United States)

    Bailie, Ross; Matthews, Veronica; Larkins, Sarah; Thompson, Sandra; Burgess, Paul; Weeramanthri, Tarun; Bailie, Jodie; Cunningham, Frances; Kwedza, Ru; Clark, Louise

    2017-10-05

    To examine the impact of state/territory policy support on (1) uptake of evidence-based continuous quality improvement (CQI) activities and (2) quality of care for Indigenous Australians. Mixed-method comparative case study methodology, drawing on quality-of-care audit data, documentary evidence of policies and strategies and the experience and insights of stakeholders involved in relevant CQI programmes. We use multilevel linear regression to analyse jurisdictional differences in quality of care. Indigenous primary healthcare services across five states/territories of Australia. 175 Indigenous primary healthcare services. A range of national and state/territory policy and infrastructure initiatives to support CQI, including support for applied research. PRIMARY AND SECONDARY OUTCOME MEASURES: (i) Trends in the consistent uptake of evidence-based CQI tools available through a research-based CQI initiative (the Audit and Best Practice in Chronic Disease programme) and (ii) quality of care (as reflected in adherence to best practice guidelines). Progressive uptake of evidence-based CQI activities and steady improvements or maintenance of high-quality care occurred where there was long-term policy and infrastructure support for CQI. Where support was provided but not sustained there was a rapid rise and subsequent fall in relevant CQI activities. Health authorities should ensure consistent and sustained policy and infrastructure support for CQI to enable wide-scale and ongoing improvement in quality of care and, subsequently, health outcomes. It is not sufficient for improvement initiatives to rely on local service managers and clinicians, as their efforts are strongly mediated by higher system-level influences. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Competition and Educational Quality: Evidence from The Netherlands

    NARCIS (Netherlands)

    E. Dijkgraaf (Elbert); R.H.J.M. Gradus (Raymond); M. de Jong (Matthijs)

    2009-01-01

    textabstractAmple evidence is available for the effect of competition on educational quality as only a few countries allow large scale competition. In the Netherlands free parental choice is present since the beginning of the 20th century, which can be characterized as a full voucher program with

  17. Health Reporting in Print Media in Lebanon: Evidence, Quality and Role in Informing Policymaking

    Science.gov (United States)

    El-Jardali, Fadi; Bou Karroum, Lama; Bawab, Lamya; Kdouh, Ola; El-Sayed, Farah; Rachidi, Hala; Makki, Malak

    2015-01-01

    Background Media plays a vital role in shaping public policies and opinions through disseminating health-related information. This study aims at exploring the role of media in informing health policies in Lebanon, identifying the factors influencing health reporting and investigating the role of evidence in health journalism and the quality of health reporting. It also identifies strategies to enhance the use of evidence in health journalism and improve the quality of health reporting. Methods Media analysis was conducted to assess the way media reports on health-related issues and the quality of reporting using a quality assessment tool. Semi-structured interviews were also conducted with 27 journalists, researchers and policymakers to explore their perception on the role of media in health policymaking and the factors influencing health reporting. In addition, a validation workshop was conducted. Results Out of 1,279 health-related news articles identified, 318 articles used certain type of evidence to report health issues 39.8% of which relied on experts’ opinions as their source of evidence while only 5.9% referenced peer-reviewed research studies. The quality of health reporting was judged to be low based on a quality assessment tool consisting of a set of ten criteria. Journalists raised concerns about issues impeding them from referring to evidence. Journalists also reported difficulties with the investigative health journalism. Policymakers and researchers viewed media as an important tool for evidence-informed health policies, however, serious concerns were voiced in terms of the current practice and capacities. Conclusion Our study provides a structured reflection on the role of media and the factors that influence health reporting including context-specific strategies that would enhance the quality and promote the use of evidence in health reporting. In the light of the political changes in many Middle Eastern countries, findings from this study can

  18. Evidence for high inter-generational individual quality in yellow-eyed penguins

    Directory of Open Access Journals (Sweden)

    Aviva M. Stein

    2017-02-01

    Full Text Available Longitudinal studies focusing on lifetime reproductive success (LRS have been used to measure individual breeding performance and identify commonalities among successful breeders. By extending the focus to subsequent generations we identify a proportion of high-quality individuals that contribute disproportionately to the population over multiple generations. We used 23 years of yellow-eyed penguin (Megadyptes antipodes breeding data from one breeding area to identify the proportion of individual birds that raised successful breeders, which in turn raised offspring. We explored which life-history components influenced LRS, as this knowledge would enable conservation resources to be focused on high-performing individuals in this endangered population. From 2,147 birds marked as chicks, 370 (17.2% survived to adulthood and recruited to their natal location, of which 219 (10.2% fledged offspring: 124 (56.6% of the 219 birds produced offspring that recruited as breeders. Only 102 birds (4.8% of 2,147 fledged first-generation offspring that in turn fledged offspring (second-generation offspring, or grand-offspring. We found that ∼25% of the birds that survived to breed had above-average LRS as well as above-average numbers of grand-offspring, and were more likely to have produced first-generation chicks that recruited and also produced above-average numbers of second-generation chicks. Our findings suggest that there is a core of “super-breeders” that contribute disproportionately to the population over successive generations. Lifespan and age-at-first-breeding were correlated with LRS. We suggest that traits of birds relating to longevity, health (e.g., immunocompetence and fitness could be examined to identify potential links with high LRS and inter-generational fecundity. “Super-breeders” appear to consistently achieve high LRS and long lifespans in a stochastic environment, demonstrating greater resilience in the face of extreme events.

  19. Effect of high-oxygen and high-carbon-dioxide atmospheres on strawberry flavor and other quality traits.

    Science.gov (United States)

    Pérez, A G; Sanz, C

    2001-05-01

    The effect of high-oxygen atmospheres on strawberry flavor was studied. Strawberry fruits (Fragariax ananassa Duch. cv. Camarosa) were stored at 8 degrees C in four different atmospheres: air, 5% O(2)/20% CO(2), 80% O(2)/20% CO(2), and 90% O(2)/10% CO(2). Changes in several quality parameters were evaluated. Atmospheres combining high O(2) and high CO(2) were the most effective in preventing fungal growth and enhancing strawberry firmness. Other quality parameters such as color, titrable acidity, sugars and organic acids distribution, off-flavor development, and aroma were only mildly affected by superatmospheric O(2) levels. After one week of storage, unexpected high contents of off-flavor related compounds were found in the 80% O(2)/20% CO(2) and 90% O(2)/10% CO(2) atmospheres. Evidence of an altered ester biosynthesis was also found in fruits stored under these high-O(2) atmospheres. Data obtained suggest that stress induced by high CO(2) and stress induced by high O(2) have an additive effect on strawberry flavor alteration.

  20. Systematic review of economic analyses in patient safety: a protocol designed to measure development in the scope and quality of evidence.

    Science.gov (United States)

    Carter, Alexander W; Mandavia, Rishi; Mayer, Erik; Marti, Joachim; Mossialos, Elias; Darzi, Ara

    2017-08-18

    Recent avoidable failures in patient care highlight the ongoing need for evidence to support improvements in patient safety. According to the most recent reviews, there is a dearth of economic evidence related to patient safety. These reviews characterise an evidence gap in terms of the scope and quality of evidence available to support resource allocation decisions. This protocol is designed to update and improve on the reviews previously conducted to determine the extent of methodological progress in economic analyses in patient safety. A broad search strategy with two core themes for original research (excluding opinion pieces and systematic reviews) in 'patient safety' and 'economic analyses' has been developed. Medline, Econlit and National Health Service Economic Evaluation Database bibliographic databases will be searched from January 2007 using a combination of medical subject headings terms and research-derived search terms (see table 1). The method is informed by previous reviews on this topic, published in 2012. Screening, risk of bias assessment (using the Cochrane collaboration tool) and economic evaluation quality assessment (using the Drummond checklist) will be conducted by two independent reviewers, with arbitration by a third reviewer as needed. Studies with a low risk of bias will be assessed using the Drummond checklist. High-quality economic evaluations are those that score >20/35. A qualitative synthesis of evidence will be performed using a data collection tool to capture the study design(s) employed, population(s), setting(s), disease area(s), intervention(s) and outcome(s) studied. Methodological quality scores will be compared with previous reviews where possible. Effect size(s) and estimate uncertainty will be captured and used in a quantitative synthesis of high-quality evidence, where possible. Formal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer

  1. Developing evidence-based maternity care in Iran: a quality improvement study

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem

    2008-06-01

    Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

  2. Zerodur polishing process for high surface quality and high efficiency

    International Nuclear Information System (INIS)

    Tesar, A.; Fuchs, B.

    1992-08-01

    Zerodur is a glass-ceramic composite importance in applications where temperature instabilities influence optical and mechanical performance, such as in earthbound and spaceborne telescope mirror substrates. Polished Zerodur surfaces of high quality have been required for laser gyro mirrors. Polished surface quality of substrates affects performance of high reflection coatings. Thus, the interest in improving Zerodur polished surface quality has become more general. Beyond eliminating subsurface damage, high quality surfaces are produced by reducing the amount of hydrated material redeposited on the surface during polishing. With the proper control of polishing parameters, such surfaces exhibit roughnesses of < l Angstrom rms. Zerodur polishing was studied to recommend a high surface quality polishing process which could be easily adapted to standard planetary continuous polishing machines and spindles. This summary contains information on a polishing process developed at LLNL which reproducibly provides high quality polished Zerodur surfaces at very high polishing efficiencies

  3. Treatments for compulsive buying: A systematic review of the quality, effectiveness and progression of the outcome evidence.

    Science.gov (United States)

    Hague, Ben; Hall, Jo; Kellett, Stephen

    2016-09-01

    Background and aims This review appraises the progression and status of the evidence base for the treatment of compulsive buying disorder (CBD), in order to highlight what currently works and to prompt useful future research. Methods Online databases ISI Web of Knowledge, PsycINFO, and PubMed via Ovid were searched at two time points. Two quality checklists and an established model of therapy evaluation (hourglass model) evaluated the quality and progression of both psychotherapy and pharmacotherapy treatments for CBD. Uncontrolled effect sizes were calculated and meta-regression analyses were performed regarding treatment duration. Results A total of 29 articles met the inclusion criteria, which were divided into psychotherapy (n = 17) and pharmacotherapy treatments (n = 12). Of the 29 studies, only 5 studies have been tested under conditions of high methodological quality. Both forms of treatment had been evaluated in a haphazard manner across the stages of the hourglass model. Although large effects were demonstrated for group psychotherapy and pharmacotherapy, such evidence of effectiveness was undermined by poor study quality and risk of publication bias. Long-term CBD treatment was associated with improved outcome with pharmacotherapy, but not when delivering psychotherapy. Discussion Group psychotherapy currently appears the most promising treatment option for CBD. Poor methodological control and sporadic evaluation of specific treatments have slowed the generation of a convincing evidence base for CBD treatment. Defining the active ingredients of effective CBD treatment is a key research goal.

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

    Science.gov (United States)

    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.

  5. Cochrane Rapid Reviews Methods Group to play a leading role in guiding the production of informed high-quality, timely research evidence syntheses.

    Science.gov (United States)

    Garritty, Chantelle; Stevens, Adrienne; Gartlehner, Gerald; King, Valerie; Kamel, Chris

    2016-10-28

    Policymakers and healthcare stakeholders are increasingly seeking evidence to inform the policymaking process, and often use existing or commissioned systematic reviews to inform decisions. However, the methodologies that make systematic reviews authoritative take time, typically 1 to 2 years to complete. Outside the traditional SR timeline, "rapid reviews" have emerged as an efficient tool to get evidence to decision-makers more quickly. However, the use of rapid reviews does present challenges. To date, there has been limited published empirical information about this approach to compiling evidence. Thus, it remains a poorly understood and ill-defined set of diverse methodologies with various labels. In recent years, the need to further explore rapid review methods, characteristics, and their use has been recognized by a growing network of healthcare researchers, policymakers, and organizations, several with ties to Cochrane, which is recognized as representing an international gold standard for high-quality, systematic reviews. In this commentary, we introduce the newly established Cochrane Rapid Reviews Methods Group developed to play a leading role in guiding the production of rapid reviews given they are increasingly employed as a research synthesis tool to support timely evidence-informed decision-making. We discuss how the group was formed and outline the group's structure and remit. We also discuss the need to establish a more robust evidence base for rapid reviews in the published literature, and the importance of promoting registration of rapid review protocols in an effort to promote efficiency and transparency in research. As with standard systematic reviews, the core principles of evidence-based synthesis should apply to rapid reviews in order to minimize bias to the extent possible. The Cochrane Rapid Reviews Methods Group will serve to establish a network of rapid review stakeholders and provide a forum for discussion and training. By facilitating

  6. Omega-3 fatty acids and cardiovascular disease: summary of the 2016 agency of healthcare research and quality evidence review

    Science.gov (United States)

    We summarize the 2016 update of the 2004 Agency of Healthcare Research and Quality's evidence review of omega-3 fatty acids and cardiovascular disease (CVD). The overall findings for the effects of marine oil supplements on intermediate CVD outcomes remain largely unchanged. There is high strength o...

  7. Meta-Review of the Quantity and Quality of Evidence for Knee Arthroplasty Devices.

    Directory of Open Access Journals (Sweden)

    Anna R Gagliardi

    Full Text Available Some cardiovascular devices are licensed based on limited evidence, potentially exposing patients to devices that are not safe or effective. Research is needed to ascertain if the same is true of other types of medical devices. Knee arthroplasty is a widely-used surgical procedure yet implant failures are not uncommon. The purpose of this study was to characterize available evidence on the safety and effectiveness of knee implants.A review of primary studies included in health technology assessments (HTA on total (TKA and unicompartmental knee arthroplasty (UKA was conducted. MEDLINE, EMBASE, CINAHL, Cochrane Library and Biotechnology & BioEngineering Abstracts were searched from 2005 to 2014, plus journal tables of contents and 32 HTA web sites. Patients were aged 18 and older who underwent primary TKA or UKA assessed in cohort or randomized controlled studies. Summary statistics were used to report study characteristics.A total of 265 eligible primary studies published between 1986 and 2014 involving 59,217 patients were identified in 10 HTAs (2 low, 7 moderate, 1 high risk of bias. Most evaluated TKA (198, 74.5%. The quality of evidence in primary studies was limited. Most studies were industry-funded (23.8% or offered no declaration of funding or conflict of interest (44.9%; based on uncontrolled single cohorts (58.5%, enrolled fewer than 100 patients (66.4%, and followed patients for 2 years or less (UKA: single cohort 29.8%, comparative cohort 16.7%, randomized trial 25.0%; TKA: single cohort 25.0%, comparative cohort 31.4%, randomized trial 48.6%. Furthermore, most devices were evaluated in only one study (55.3% TKA implants, 61.1% UKA implants.Patients, physicians, hospitals and payers rely on poor-quality evidence to support decisions about knee implants. Further research is needed to explore how decisions about the use of devices are currently made, and how the evidence base for device safety and effectiveness can be strengthened.

  8. Is the readmission rate a valid quality indicator? A review of the evidence

    NARCIS (Netherlands)

    Fischer, Claudia; Lingsma, Hester F.; Marang-van de Mheen, Perla J.; Kringos, Dionne S.; Klazinga, Niek S.; Steyerberg, Ewout W.

    2014-01-01

    Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of quality of hospital care is not evident. We aimed to give an overview of the different methodological aspects in the definition and measurement

  9. GRADE: Assessing the quality of evidence in environmental and occupational health.

    Science.gov (United States)

    Morgan, Rebecca L; Thayer, Kristina A; Bero, Lisa; Bruce, Nigel; Falck-Ytter, Yngve; Ghersi, Davina; Guyatt, Gordon; Hooijmans, Carlijn; Langendam, Miranda; Mandrioli, Daniele; Mustafa, Reem A; Rehfuess, Eva A; Rooney, Andrew A; Shea, Beverley; Silbergeld, Ellen K; Sutton, Patrice; Wolfe, Mary S; Woodruff, Tracey J; Verbeek, Jos H; Holloway, Alison C; Santesso, Nancy; Schünemann, Holger J

    2016-01-01

    There is high demand in environmental health for adoption of a structured process that evaluates and integrates evidence while making decisions and recommendations transparent. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework holds promise to address this demand. For over a decade, GRADE has been applied successfully to areas of clinical medicine, public health, and health policy, but experience with GRADE in environmental and occupational health is just beginning. Environmental and occupational health questions focus on understanding whether an exposure is a potential health hazard or risk, assessing the exposure to understand the extent and magnitude of risk, and exploring interventions to mitigate exposure or risk. Although GRADE offers many advantages, including its flexibility and methodological rigor, there are features of the different sources of evidence used in environmental and occupational health that will require further consideration to assess the need for method refinement. An issue that requires particular attention is the evaluation and integration of evidence from human, animal, in vitro, and in silico (computer modeling) studies when determining whether an environmental factor represents a potential health hazard or risk. Assessment of the hazard of exposures can produce analyses for use in the GRADE evidence-to-decision (EtD) framework to inform risk-management decisions about removing harmful exposures or mitigating risks. The EtD framework allows for grading the strength of the recommendations based on judgments of the certainty in the evidence (also known as quality of the evidence), as well as other factors that inform recommendations such as social values and preferences, resource implications, and benefits. GRADE represents an untapped opportunity for environmental and occupational health to make evidence-based recommendations in a systematic and transparent manner. The objectives of this article are

  10. Anti-Stokes Luminescence in High Quality Quantum Wells

    Science.gov (United States)

    Vinattieri, A.; Bogani, F.; Miotto, A.; Ceccherini, S.

    1997-11-01

    We present a detailed investigation of the anti-Stokes (AS) luminescence which originates from exciton recombination when below gap excitation is used, in a set of high quality quantum well structures. We observe strong excitonic resonances in the AS signal as measured from photoluminescence and photoluminescence excitation spectra. We demonstrate that neither the electromagnetic coupling between the wells nor the morphological disorder can explain this up-conversion effect. Time-resolved luminescence data after ps excitation and fs correlation spectroscopy results provide clear evidence of the occurrence of a two-step absorption which is assisted by the exciton population resonantly excited by the first photon.

  11. Volatility effect and the role of firm quality factor in returns: Evidence from the Indian stock market

    Directory of Open Access Journals (Sweden)

    Asheesh Pandey

    2017-03-01

    Full Text Available In the study, we examine if there are any volatility patterns in stock returns for India. Data are employed for 493 companies that form part of BSE 500 index from March 2000 to November 2013. Unlike previous international evidence, no volatility anomaly is observed. Consistent with theory, high volatility stocks significantly outperform low volatility stocks. Alternative risk models fail to explain the volatility effect. Consistent with prior research, we confirm the role of firm quality factor in explaining these volatility patterns. Cash flow variability seems to be a more appropriate measure of firm quality compared to profitability.

  12. Approaches to improve the quality of maternal and newborn health care: an overview of the evidence.

    Science.gov (United States)

    Austin, Anne; Langer, Ana; Salam, Rehana A; Lassi, Zohra S; Das, Jai K; Bhutta, Zulfiqar A

    2014-09-04

    Despite progress in recent years, an estimated 273,500 women died as a result of maternal causes in 2010. The burden of these deaths is disproportionately bourne by women who reside in low income countries or belong to the poorest sectors of the population of middle or high income ones, and it is particularly acute in regions where access to and utilization of facility-based services for childbirth and newborn care is lowest. Evidence has shown that poor quality of facility-based care for these women and newborns is one of the major contributing factors for their elevated rates of morbidity and mortality. In addition, women who perceive the quality of facilty-based care to be poor,may choose to avoid facility-based deliveries, where life-saving interventions could be availble. In this context, understanding the underlying factors that impact the quality of facility-based services and assessing the effectiveness of interventions to improve the quality of care represent critical inputs for the improvement of maternal and newborn health. This series of five papers assesses and summarizes information from relevant systematic reviews on the impact of various approaches to improve the quality of care for women and newborns. The first paper outlines the conceptual framework that guided this study and the methodology used for selecting the reviews and for the analysis. The results are described in the following three papers, which highlight the evidence of interventions to improve the quality of maternal and newborn care at the community, district, and facility level. In the fifth and final paper of the series, the overall findings of the review are discussed, research gaps are identified, and recommendations proposed to impove the quality of maternal and newborn health care in resource-poor settings.

  13. Quality Disclosure in Sustainability Reporting: Evidence From Universities

    Directory of Open Access Journals (Sweden)

    Alberto ROMOLINI

    2015-02-01

    Full Text Available Attention towards sustainability reporting is very high with reference to higher education. The paper aims to assess the maturity level of sus-tainability reporting and to measure its quality by evaluating the Global Reporting Initiative (GRI indicators currently disclosed. The research was carried out using the inductive method. We de-limited the study to universities and we evaluated the quality of sustainability reporting by analyzing the indicators disclosed in 2012 reports accord-ing to GRI guidelines. The research gives an overview of sustainability reporting in universities by evaluating the quality level of their disclosure. The results confrm previous research by high-lighting the necessity to improve sustainability reporting. Moreover, the results show there are differences between universities that are con-nected to the peculiarities of each country. They also enable us to draw up an initial classifcation of universities. The paper provides one of the frst in-depth studies of sustainability reporting quality for universities included in the GRI database.

  14. Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners.

    Science.gov (United States)

    Leland, Natalie E; Lepore, Michael; Wong, Carin; Chang, Sun Hwa; Freeman, Lynn; Crum, Karen; Gillies, Heather; Nash, Paul

    2018-03-01

    The majority of post-acute hip fracture rehabilitation in the US is delivered in skilled nursing facilities (SNFs). Currently, there are limited guidelines that equip occupational and physical therapy practitioners with a summary of what constitutes evidence-based high quality rehabilitation. Thus, this study aimed to identify rehabilitation practitioners' perspectives on the practices that constitute high quality hip fracture rehabilitation. Focus groups were conducted with 99 occupational and physical therapy practitioners working in SNFs in southern California. Purposive sampling of facilities was conducted to capture variation in key characteristics known to impact care delivery for this patient population (e.g., financial resources, staffing, and patient case-mix). Questions aimed to elicit practitioners' perspectives on high quality hip fracture rehabilitation practices. Each session was audio-recorded and transcribed. Data were systematically analyzed using a modified grounded theory approach. Seven themes emerged: objectives of care; first 72 h; positioning, pain, and precautions; use of standardized assessments; episode of care practices; facilitating insight into progress; and interdisciplinary collaboration. Clinical guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The findings of this study highlight the practitioners' perspective on what constitutes high quality hip fracture rehabilitation. This work provides critical information to advance the development of stakeholder-driven rehabilitation clinical guidelines. Future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes. Implications for Rehabilitation This study highlights occupational and physiotherapy therapy practitioners' perspectives on the cumulative best

  15. Toward an evidence-based system for innovation support for implementing innovations with quality: tools, training, technical assistance, and quality assurance/quality improvement.

    Science.gov (United States)

    Wandersman, Abraham; Chien, Victoria H; Katz, Jason

    2012-12-01

    An individual or organization that sets out to implement an innovation (e.g., a new technology, program, or policy) generally requires support. In the Interactive Systems Framework for Dissemination and Implementation, a Support System should work with Delivery Systems (national, state and/or local entities such as health and human service organizations, community-based organizations, schools) to enhance their capacity for quality implementation of innovations. The literature on the Support System [corrected] has been underresearched and under-developedThis article begins to conceptualize theory, research, and action for an evidence-based system for innovation support (EBSIS). EBSIS describes key priorities for strengthening the science and practice of support. The major goal of EBSIS is to enhance the research and practice of support in order to build capacity in the Delivery System for implementing innovations with quality, and thereby, help the Delivery System achieve outcomes. EBSIS is guided by a logic model that includes four key support components: tools, training, technical assistance, and quality assurance/quality improvement. EBSIS uses the Getting To Outcomes approach to accountability to aid the identification and synthesis of concepts, tools, and evidence for support. We conclude with some discussion of the current status of EBSIS and possible next steps, including the development of collaborative researcher-practitioner-funder-consumer partnerships to accelerate accumulation of knowledge on the Support System.

  16. Evident?

    DEFF Research Database (Denmark)

    Plant, Peter

    2012-01-01

    Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind......Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind...

  17. Factors Determining Quality of Care in Family Planning Services in Africa: A Systematic Review of Mixed Evidence.

    Science.gov (United States)

    Tessema, Gizachew Assefa; Streak Gomersall, Judith; Mahmood, Mohammad Afzal; Laurence, Caroline O

    2016-01-01

    Improving use of family planning services is key to improving maternal health in Africa, and provision of quality of care in family planning services is critical to support higher levels of contraceptive uptake. The objective of this systematic review was to synthesize the available evidence on factors determining the quality of care in family planning services in Africa. Quantitative and qualitative studies undertaken in Africa, published in English, in grey and commercial literature, between 1990 and 2015 were considered. Methodological quality of included studies was assessed using standardized tools. Findings from the quantitative studies were summarized using narrative and tables. Client satisfaction was used to assess the quality of care in family planning services in the quantitative component of the review. Meta-aggregation was used to synthesize the qualitative study findings. From 4334 records, 11 studies (eight quantitative, three qualitative) met the review eligibility criteria. The review found that quality of care was influenced by client, provider and facility factors, and structural and process aspects of the facilities. Client's waiting time, provider competency, provision/prescription of injectable methods, maintaining privacy and confidentiality were the most commonly identified process factors. The quality of stock inventory was the most commonly identified structural factor. The quality of care was also positively associated with privately-owned facilities. The qualitative synthesis revealed additional factors including access related factors such as 'pre-requisites to be fulfilled by the clients and cost of services, provider workload, and providers' behaviour. There is limited evidence on factors determining quality of care in family planning services in Africa that shows quality of care is influenced by multiple factors. The evidence suggests that lowering access barriers and avoiding unnecessary pre-requisites for taking contraceptive

  18. Factors Determining Quality of Care in Family Planning Services in Africa: A Systematic Review of Mixed Evidence.

    Directory of Open Access Journals (Sweden)

    Gizachew Assefa Tessema

    Full Text Available Improving use of family planning services is key to improving maternal health in Africa, and provision of quality of care in family planning services is critical to support higher levels of contraceptive uptake. The objective of this systematic review was to synthesize the available evidence on factors determining the quality of care in family planning services in Africa.Quantitative and qualitative studies undertaken in Africa, published in English, in grey and commercial literature, between 1990 and 2015 were considered. Methodological quality of included studies was assessed using standardized tools. Findings from the quantitative studies were summarized using narrative and tables. Client satisfaction was used to assess the quality of care in family planning services in the quantitative component of the review. Meta-aggregation was used to synthesize the qualitative study findings.From 4334 records, 11 studies (eight quantitative, three qualitative met the review eligibility criteria. The review found that quality of care was influenced by client, provider and facility factors, and structural and process aspects of the facilities. Client's waiting time, provider competency, provision/prescription of injectable methods, maintaining privacy and confidentiality were the most commonly identified process factors. The quality of stock inventory was the most commonly identified structural factor. The quality of care was also positively associated with privately-owned facilities. The qualitative synthesis revealed additional factors including access related factors such as 'pre-requisites to be fulfilled by the clients and cost of services, provider workload, and providers' behaviour.There is limited evidence on factors determining quality of care in family planning services in Africa that shows quality of care is influenced by multiple factors. The evidence suggests that lowering access barriers and avoiding unnecessary pre-requisites for taking

  19. The quality, safety and governance of telephone triage and advice services - an overview of evidence from systematic reviews.

    Science.gov (United States)

    Lake, Rebecca; Georgiou, Andrew; Li, Julie; Li, Ling; Byrne, Mary; Robinson, Maureen; Westbrook, Johanna I

    2017-08-30

    Telephone triage and advice services (TTAS) are increasingly being implemented around the world. These services allow people to speak to a nurse or general practitioner over the telephone and receive assessment and healthcare advice. There is an existing body of research on the topic of TTAS, however the diffuseness of the evidence base makes it difficult to identify key lessons that are consistent across the literature. Systematic reviews represent the highest level of evidence synthesis. We aimed to undertake an overview of such reviews to determine the scope, consistency and generalisability of findings in relation to the governance, safety and quality of TTAS. We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library for English language systematic reviews focused on key governance, quality and safety findings related to telephone based triage and advice services, published since 1990. The search was undertaken by three researchers who reached consensus on all included systematic reviews. An appraisal of the methodological quality of the systematic reviews was independently undertaken by two researchers using A Measurement Tool to Assess Systematic Reviews. Ten systematic reviews from a potential 291 results were selected for inclusion. TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care. Evidence of TTAS performance was reported across nine key indicators - access, appropriateness, compliance, patient satisfaction, cost, safety, health service utilisation, physician workload and clinical outcomes. Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care. Taken as a whole, current evidence does not provide definitive answers to questions about the quality of care

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

    Science.gov (United States)

    2012-01-01

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

  1. High-quality compressive ghost imaging

    Science.gov (United States)

    Huang, Heyan; Zhou, Cheng; Tian, Tian; Liu, Dongqi; Song, Lijun

    2018-04-01

    We propose a high-quality compressive ghost imaging method based on projected Landweber regularization and guided filter, which effectively reduce the undersampling noise and improve the resolution. In our scheme, the original object is reconstructed by decomposing of regularization and denoising steps instead of solving a minimization problem in compressive reconstruction process. The simulation and experimental results show that our method can obtain high ghost imaging quality in terms of PSNR and visual observation.

  2. A systematic review of serious games in medical education: quality of evidence and pedagogical strategy.

    Science.gov (United States)

    Gorbanev, Iouri; Agudelo-Londoño, Sandra; González, Rafael A; Cortes, Ariel; Pomares, Alexandra; Delgadillo, Vivian; Yepes, Francisco J; Muñoz, Óscar

    2018-12-01

    The literature shows an optimistic landscape for the effectiveness of games in medical education. Nevertheless, games are not considered mainstream material in medical teaching. Two research questions that arise are the following: What pedagogical strategies do developers use when creating games for medical education? And what is the quality of the evidence on the effectiveness of games? A systematic review was made by a multi-disciplinary team of researchers following the Cochrane Collaboration Guidelines. We included peer-reviewed journal articles which described or assessed the use of serious games or gamified apps in medical education. We used the Medical Education Research Study Quality Instrument (MERSQI) to assess the quality of evidence in the use of games. We also evaluated the pedagogical perspectives of such articles. Even though game developers claim that games are useful pedagogical tools, the evidence on their effectiveness is moderate, as assessed by the MERSQI score. Behaviourism and cognitivism continue to be the predominant pedagogical strategies, and games are complementary devices that do not replace traditional medical teaching tools. Medical educators prefer simulations and quizzes focused on knowledge retention and skill development through repetition and do not demand the use of sophisticated games in their classrooms. Moreover, public access to medical games is limited. Our aim was to put the pedagogical strategy into dialogue with the evidence on the effectiveness of the use of medical games. This makes sense since the practical use of games depends on the quality of the evidence about their effectiveness. Moreover, recognition of said pedagogical strategy would allow game developers to design more robust games which would greatly contribute to the learning process.

  3. A systematic review of serious games in medical education: quality of evidence and pedagogical strategy

    Science.gov (United States)

    Gorbanev, Iouri; Agudelo-Londoño, Sandra; González, Rafael A.; Cortes, Ariel; Pomares, Alexandra; Delgadillo, Vivian; Yepes, Francisco J.; Muñoz, Óscar

    2018-01-01

    ABSTRACT Introduction: The literature shows an optimistic landscape for the effectiveness of games in medical education. Nevertheless, games are not considered mainstream material in medical teaching. Two research questions that arise are the following: What pedagogical strategies do developers use when creating games for medical education? And what is the quality of the evidence on the effectiveness of games? Methods: A systematic review was made by a multi-disciplinary team of researchers following the Cochrane Collaboration Guidelines. We included peer-reviewed journal articles which described or assessed the use of serious games or gamified apps in medical education. We used the Medical Education Research Study Quality Instrument (MERSQI) to assess the quality of evidence in the use of games. We also evaluated the pedagogical perspectives of such articles. Results: Even though game developers claim that games are useful pedagogical tools, the evidence on their effectiveness is moderate, as assessed by the MERSQI score. Behaviourism and cognitivism continue to be the predominant pedagogical strategies, and games are complementary devices that do not replace traditional medical teaching tools. Medical educators prefer simulations and quizzes focused on knowledge retention and skill development through repetition and do not demand the use of sophisticated games in their classrooms. Moreover, public access to medical games is limited. Discussion: Our aim was to put the pedagogical strategy into dialogue with the evidence on the effectiveness of the use of medical games. This makes sense since the practical use of games depends on the quality of the evidence about their effectiveness. Moreover, recognition of said pedagogical strategy would allow game developers to design more robust games which would greatly contribute to the learning process. PMID:29457760

  4. Fabrication of high-quality brazed joints

    International Nuclear Information System (INIS)

    Orlov, A.V.

    1980-01-01

    Problem of ensuring of joint high-quality when brazing different parts in power engineering is considered. To obtain high-quality joints it is necessary to correctly design brazed joint and to choose a gap width, overlap length and fillet radius; to clean up carefully the surfaces to be brazed and fix them properly one relative to another; to apply a solder so as to provide its flowing into the gap and sticking in it; to exactly regulate thermal conditions of brazing. High quality and reliability of brazed joints are ensured by the application of solders based on noble metals, and cheap solders based on nickel, manganese and copper. Joints brazed with nickel base solders may operate at temperatures as high as 888 deg C

  5. Animated Cell Biology: A Quick and Easy Method for Making Effective, High-Quality Teaching Animations

    Science.gov (United States)

    O'Day, Danton H.

    2006-01-01

    There is accumulating evidence that animations aid learning of dynamic concepts in cell biology. However, existing animation packages are expensive and difficult to learn, and the subsequent production of even short animations can take weeks to months. Here I outline the principles and sequence of steps for producing high-quality PowerPoint…

  6. Approaches to improve the quality of maternal and newborn health care: an overview of the evidence

    OpenAIRE

    Austin, Anne; Langer, Ana; Salam, Rehana A; Lassi, Zohra S; Das, Jai K; Bhutta, Zulfiqar A

    2014-01-01

    Despite progress in recent years, an estimated 273,500 women died as a result of maternal causes in 2010. The burden of these deaths is disproportionately bourne by women who reside in low income countries or belong to the poorest sectors of the population of middle or high income ones, and it is particularly acute in regions where access to and utilization of facility-based services for childbirth and newborn care is lowest. Evidence has shown that poor quality of facility-based care for the...

  7. Quality of research and level of evidence in foot and ankle publications.

    Science.gov (United States)

    Barske, Heather L; Baumhauer, Judith

    2012-01-01

    The quality of research and evidence to support medical treatments is under scrutiny from the medical profession and the public. This study examined the current quality of research and level of evidence (LOE) of foot and ankle surgery papers published in orthopedic and podiatric medical journals. Two independent evaluators performed a blinded assessment of all foot and ankle clinical research articles (January 2010 to June 2010) from seven North American orthopedic and podiatric journals. JBJS-A grading system was used for LOE. Articles were assessed for indicators of study quality. The data was stratified by journal and medical credentials. A total of 245 articles were published, 128 were excluded based on study design, leaving 117 clinical research articles. Seven (6%) were Level I, 14 (12%) Level II, 18 (15%) Level III, and 78 (67%) Level IV. The orthopedic journals published 78 studies on foot and ankle topics. Of the podiatric journals, the Journal of the American Podiatric Medical Association (JAPMA) published 12 clinical studies and the Journal of Foot and Ankle Surgery (JFAS) published 27, 21 (78%) of which were Level IV studies. When the quality of research was examined, few therapeutic studies used validated outcome measures and only 38 of 96 (40%) gathered data prospectively. Thirty (31%) studies used a comparison group. Eighty-seven articles (74%) were authored by a MD and 22 (19%) by a DPM. Foot & Ankle International (FAI) published higher quality studies with a higher LOE as compared to podiatry journals. Regardless of the journal, MDs produced the majority of published clinical foot and ankle research. Although improvements have been made in the quality of some clinical research, this study highlights the need for continued improvement in methodology within foot and ankle literature.

  8. The impacts of urbanisation and climate change on urban flooding and urban water quality: A review of the evidence concerning the United Kingdom

    Directory of Open Access Journals (Sweden)

    James D. Miller

    2017-08-01

    New hydrological insights: There is a lack of nationally research focused on the dual impacts of climate change and urbanisation on flooding and water quality in UK urban areas. This is despite there being a clear acceptance that flood risk is increasing, water quality is generally not meeting desirable levels, and that combined population and climate change projections pose a pressing challenge. The available evidence has been found to be of medium-high confidence that both pressures will result in (i an increase in pluvial and fluvial flood risk, and (ii further reduction in water quality caused by point source pollution and altered flow regimes. Evidence concerning urban groundwater flooding, diffuse pollution and water temperature was found to be more sparse and was ascribed a low-medium confidence that both pressures will further exacerbate existing issues. The confidence ascribed to evidence was also found to reflect the utility of current science for setting policy and urban planning. Recurring factors that limit the utility of evidence for managing the urban environment includes: (i climate change projection uncertainty and suitability, (ii lack of sub-daily projections for storm rainfall, (iii the complexity of managing and modelling the urban environment, and (iv lack of probable national-scale future urban land-use projections. Suitable climate products are increasingly being developed and their application in applied urban research is critical in the wake of a series of extreme flooding events across the UK and timely for providing state-of-the-art evidence on which to base possible future water quality legislation in a post Brexit-WFD era.

  9. Audit quality and the audit partner effect : Evidence from European listed companies

    NARCIS (Netherlands)

    Buuren, van J.P.

    2009-01-01

    The main objective of this study is to provide evidence on the differences in audit quality amongst audit partners. I attribute these dissimilarities to (i) differences in the audit risk perception and the risk appetite of individual audit partners and (ii) to differences in the personal business

  10. Availability of high quality weather data measurements

    DEFF Research Database (Denmark)

    Andersen, Elsa; Johansen, Jakob Berg; Furbo, Simon

    In the period 2016-2017 the project “Availability of high quality weather data measurements” is carried out at Department of Civil Engineering at the Technical University of Denmark. The aim of the project is to establish measured high quality weather data which will be easily available...... for the building energy branch and the solar energy branch in their efforts to achieve energy savings and for researchers and students carrying out projects where measured high quality weather data are needed....

  11. Does High-Quality Financial Reporting Mitigate the Negative Impact of Global Financial Crises on Firm Performance? Evidence from the United Kingdom

    Directory of Open Access Journals (Sweden)

    Zhiwei Lin

    2014-12-01

    Full Text Available Prior literature has claimed that accounting plays a negative role in a financial crisis. The current study sought to determine whether this effect is dependent on the quality of financial reporting. Specifically, this study examined the impact of the quality of financial reporting (as measured via earnings quality on liquidity (measured by the bid-ask spread in the equity market during the 2008–2009 global financial crisis in the United Kingdom. We found, as expected, that market liquidity was much lower during the crisis than prior to the crisis; however, firms with high-quality financial reporting suffered fewer negative effects as a result of the financial crisis. The results were robust after controlling for other influences, such as return volatility, loss making, market value of equity, and other potential endogeneity problems. In addition, adopting alternative models for earnings quality did not alter our inferences. Our results support the notion that high-quality accounting information can reduce information asymmetry and hence enhance investor confidence during a financial crisis. The results suggest that a stable financial reporting system is an important part of that overall economic fabric. Our findings will help build a framework on which an overall financial crisis risk-management strategy can be developed to avoid future crises.

  12. Cooking and the human commitment to a high-quality diet.

    Science.gov (United States)

    Carmody, R N; Wrangham, R W

    2009-01-01

    For our body size, humans exhibit higher energy use yet reduced structures for mastication and digestion of food compared to chimpanzees, our closest living relatives. This suite of features suggests that humans are adapted to a high-quality diet. Although increased consumption of meat during human evolution certainly contributed to dietary quality, meat-eating alone appears to be insufficient to support the evolution of these traits, because modern humans fare poorly on raw diets that include meat. Here, we suggest that cooking confers physical and chemical benefits to food that are consistent with observed human dietary adaptations. We review evidence showing that cooking facilitates mastication, increases digestibility, and otherwise improves the net energy value of plant and animal foods regularly consumed by humans. We also address the likelihood that cooking was adopted more than 250,000 years ago (kya), a period that we believe is sufficient in length for the proposed adaptations to have occurred. Additional experimental work is needed to help discriminate the relative contributions of cooking, meat eating, and other innovations such as nonthermal food processing in supporting the human transition toward dietary quality.

  13. Health-related quality of life outcomes and level of evidence in pediatric neurosurgery.

    Science.gov (United States)

    Hansen, Daniel; Vedantam, Aditya; Briceño, Valentina; Lam, Sandi K; Luerssen, Thomas G; Jea, Andrew

    2016-10-01

    OBJECTIVE The emphasis on health-related quality of life (HRQOL) outcomes is increasing, along with an emphasis on evidence-based medicine. However, there is a notable paucity of validated HRQOL instruments for the pediatric population. Furthermore, no standardization or consensus currently exists concerning which HRQOL outcome measures ought to be used in pediatric neurosurgery. The authors wished to identify HRQOL outcomes used in pediatric neurosurgery research over the past 10 years, their frequency, and usage trends. METHODS Three top pediatric neurosurgical journals were reviewed for the decade from 2005 to 2014 for clinical studies of pediatric neurosurgical procedures that report HRQOL outcomes. Similar studies in the peer-reviewed journal Pediatrics were also used as a benchmark. Publication year, level of evidence, and HRQOL outcomes were collected for each article. RESULTS A total of 31 HRQOL studies were published in the pediatric neurosurgical literature over the study period. By comparison, there were 55 such articles in Pediatrics. The number of publications using HRQOL instruments showed a significant positive trend over time for Pediatrics (B = 0.62, p = 0.02) but did not increase significantly over time for the 3 neurosurgical journals (B = 0.12, p = 0.5). The authors identified a total of 46 different HRQOL instruments used across all journals. Within the neurosurgical journals, the Hydrocephalus Outcome Questionnaire (HOQ) (24%) was the most frequently used, followed by the Health Utilities Index (HUI) (16%), the Pediatric Quality of Life Inventory (PedsQL) (12%), and the 36-Item Short Form Health Survey (SF-36) (12%). Of the 55 articles identified in Pediatrics, 22 (40%) used a version of the PedsQL. No neurosurgical study reached above Level 4 on the Oxford Centre for Evidence-Based Medicine (OCEBM) system. However, multiple studies from Pediatrics achieved OCEBM Level 3, several were categorized as Level 2, and one reached Level 1

  14. Does the transformation of accounting firms’ organizational form improve audit quality? Evidence from China

    Directory of Open Access Journals (Sweden)

    Chunfei Wang

    2015-12-01

    Full Text Available In this study, we examine the effects of the transformation of accounting firms’ organizational form on audit quality. We find that the transformation from limited liability to limited liability partnerships has a significant negative effect on the absolute value of discretionary accruals of audited companies. In particular, the transformation has a significant negative effect on positive discretionary accruals and no effect on negative discretionary accruals. We also find that CPAs are more likely to issue modified audit opinions in the year after the transformation, and that there is no evidence that accounting firm size and listed company ownership influence the relationship between the transformation and audit quality. Our conclusions provide empirical evidence for policy makers and enrich the literature on accounting firms’ organizational forms.

  15. Cyberbullying Prevalence among United States Middle and High School Aged Adolescents: A Systematic Review and Quality Assessment

    Science.gov (United States)

    Selkie, Ellen M.; Fales, Jessica L.; Moreno, Megan A.

    2015-01-01

    Background Cyberbullying has established links to physical and mental health problems including depression, suicidality, substance use, and somatic symptoms. Quality reporting of cyberbullying prevalence is essential to guide evidence-based policy and prevention priorities. The purpose of this systematic review was to investigate study quality and reported prevalence among cyberbullying research studies conducted in populations of US adolescents of middle and high school age. Methods Searches of peer-reviewed literature published through June 2015 for “cyberbullying” and related terms were conducted using PubMed, PsycINFO, CINAHL Plus, and Web of Science. Included manuscripts reported cyberbullying prevalence in general populations of U.S. adolescents between the ages of 10 and 19. Using a review tool based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, reviewers independently scored study quality on study methods, results reporting, and reported prevalence. Results Search results yielded 1,447 manuscripts; 81 manuscripts representing 58 unique studies were identified as meeting inclusion criteria. Quality scores ranged between 12 and 37 total points out of a possible 42 points (M = 26.7, SD = 4.6). Prevalence rates of cyberbullying ranged as follows: perpetration, 1% to 41%; victimization, 3% to 72%; and overlapping perpetration and victimization, 2.3% to 16.7%. Conclusions Literature on cyberbullying in US middle and high school aged students is robust in quantity but inconsistent in quality and reported prevalence. Consistent definitions and evidence-based measurement tools are needed. PMID:26576821

  16. Fast High-Quality Noise

    DEFF Research Database (Denmark)

    Frisvad, Jeppe Revall; Wyvill, Geoff

    2007-01-01

    At the moment the noise functions available in a graphics programmer's toolbox are either slow to compute or they involve grid-line artifacts making them of lower quality. In this paper we present a real-time noise computation with no grid-line artifacts or other regularity problems. In other words......, we put a new tool in the box that computes fast high-quality noise. In addition to being free of artifacts, the noise we present does not rely on tabulated data (everything is computed on the fly) and it is easy to adjust quality vs. quantity for the noise. The noise is based on point rendering (like...... spot noise), but it extends to more than two dimensions. The fact that it is based on point rendering makes art direction of the noise much easier....

  17. Assuring quality in high-consequence engineering

    Energy Technology Data Exchange (ETDEWEB)

    Hoover, Marcey L.; Kolb, Rachel R.

    2014-03-01

    In high-consequence engineering organizations, such as Sandia, quality assurance may be heavily dependent on staff competency. Competency-dependent quality assurance models are at risk when the environment changes, as it has with increasing attrition rates, budget and schedule cuts, and competing program priorities. Risks in Sandia's competency-dependent culture can be mitigated through changes to hiring, training, and customer engagement approaches to manage people, partners, and products. Sandia's technical quality engineering organization has been able to mitigate corporate-level risks by driving changes that benefit all departments, and in doing so has assured Sandia's commitment to excellence in high-consequence engineering and national service.

  18. Evidence-based review: Quality of life following head and neck intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Scott-Brown, Martin; Miah, Aisha; Harrington, Kevin; Nutting, Chris

    2010-01-01

    Inverse planned Intensity modulated radiotherapy (IMRT) can minimize the dose to normal structures and therefore can reduce long-term radiotherapy-related morbidity and may improve patients' long-term quality of life. Despite overwhelming evidence that IMRT can reduce late functional deficits in patients with head and neck cancer, treated with radiotherapy, a review of the published literature produced conflicting results with regard to quality of life outcomes. Following a critical appraisal of the literature, reasons for the discrepant outcomes are proposed.

  19. A high throughput DNA extraction method with high yield and quality

    Directory of Open Access Journals (Sweden)

    Xin Zhanguo

    2012-07-01

    Full Text Available Abstract Background Preparation of large quantity and high quality genomic DNA from a large number of plant samples is a major bottleneck for most genetic and genomic analyses, such as, genetic mapping, TILLING (Targeting Induced Local Lesion IN Genome, and next-generation sequencing directly from sheared genomic DNA. A variety of DNA preparation methods and commercial kits are available. However, they are either low throughput, low yield, or costly. Here, we describe a method for high throughput genomic DNA isolation from sorghum [Sorghum bicolor (L. Moench] leaves and dry seeds with high yield, high quality, and affordable cost. Results We developed a high throughput DNA isolation method by combining a high yield CTAB extraction method with an improved cleanup procedure based on MagAttract kit. The method yielded large quantity and high quality DNA from both lyophilized sorghum leaves and dry seeds. The DNA yield was improved by nearly 30 fold with 4 times less consumption of MagAttract beads. The method can also be used in other plant species, including cotton leaves and pine needles. Conclusion A high throughput system for DNA extraction from sorghum leaves and seeds was developed and validated. The main advantages of the method are low cost, high yield, high quality, and high throughput. One person can process two 96-well plates in a working day at a cost of $0.10 per sample of magnetic beads plus other consumables that other methods will also need.

  20. The Influence of Pseudo Auditor Rotation on Audit Quality: New Evidence

    Directory of Open Access Journals (Sweden)

    Rahmat Febrianto

    2017-12-01

    Full Text Available The objectives of this research are twofold, to test the audit quality of companies that change their auditors either voluntarily or mandatorily and to test the financial characteristics as a factor for an accounting firm to engage in pseudo mandatory rotation. Since 2002, Indonesia has had legislation mandating companies to rotate their auditor after six years of consecutive engagements (five years prior to 2008. However, auditors sometimes seem to find their own way to deceive the mandatory regulation by a tactic called “pseudo” mandatory rotation. Thus, we divide mandatory rotation into two categories, pure and pseudo mandatory rotation. The results of the data we collected since the Ministerial decree became effective in 2003 indicate companies that rotate their auditors mandatorily have higher audit quality than that of companies voluntarily rotating auditors. However, we cannot find evidence that pseudo and pure mandatory rotation have different audit qualities. The results also indicate that switching among bigger accounting firms have the highest audit quality rather than switching between smaller audit firms which have lower audit quality. Lastly, the motives of an accounting firm to engage in pseudo or pure mandatory rotation are related to the financial size of their clients. Future research must consider the limitation stated in this study.

  1. Concrete Waste Recycling Process for High Quality Aggregate

    International Nuclear Information System (INIS)

    Ishikura, Takeshi; Fujii, Shin-ichi

    2008-01-01

    Large amount of concrete waste generates during nuclear power plant (NPP) dismantling. Non-contaminated concrete waste is assumed to be disposed in a landfill site, but that will not be the solution especially in the future, because of decreasing tendency of the site availability and natural resources. Concerning concrete recycling, demand for roadbeds and backfill tends to be less than the amount of dismantled concrete generated in a single rural site, and conventional recycled aggregate is limited of its use to non-structural concrete, because of its inferior quality to ordinary natural aggregate. Therefore, it is vital to develop high quality recycled aggregate for general uses of dismantled concrete. If recycled aggregate is available for high structural concrete, the dismantling concrete is recyclable as aggregate for industry including nuclear field. Authors developed techniques on high quality aggregate reclamation for large amount of concrete generated during NPP decommissioning. Concrete of NPP buildings has good features for recycling aggregate; large quantity of high quality aggregate from same origin, record keeping of the aggregate origin, and little impurities in dismantled concrete such as wood and plastics. The target of recycled aggregate in this development is to meet the quality criteria for NPP concrete as prescribed in JASS 5N 'Specification for Nuclear Power Facility Reinforced Concrete' and JASS 5 'Specification for Reinforced Concrete Work'. The target of recycled aggregate concrete is to be comparable performance with ordinary aggregate concrete. The high quality recycled aggregate production techniques are assumed to apply for recycling for large amount of non-contaminated concrete. These techniques can also be applied for slightly contaminated concrete dismantled from radiological control area (RCA), together with free release survey. In conclusion: a technology on dismantled concrete recycling for high quality aggregate was developed

  2. A Comprehensive Review of the Evidence of the Impact of Surface Water Quality on Property Values

    Directory of Open Access Journals (Sweden)

    Sarah Nicholls

    2018-02-01

    Full Text Available The desirability of living on or close to water is reflected in sometimes substantial property price premiums. Water quality has an important influence on property prices, since it impacts a water body’s appearance, capacity to support wildlife, and recreational potential. As water quality continues to be altered by human use and activity, and in light of new threats posed by projected climate and associated environmental change, understanding the impact of changing quality on property prices, and the associated property tax base, is paramount. This paper reviews the body of evidence on this topic to date. Of the 43 distinct studies represented in the 48 publications reviewed, the expected, statistically significant relationship between water quality and property price was demonstrated in at least one of the models developed in all but two studies. As a whole, they provide convincing evidence that clean water has a positive effect on property values.

  3. Effect of forage quality in faeces from different ruminant species fed high and low quality forage

    DEFF Research Database (Denmark)

    Jalali, A R; Nørgaard, P; Nielsen, M O

    2010-01-01

    Effect of forage quality in faeces from different ruminant species fed high and low quality forage......Effect of forage quality in faeces from different ruminant species fed high and low quality forage...

  4. Top-Cited Articles in Problem-Based Learning: A Bibliometric Analysis and Quality of Evidence Assessment.

    Science.gov (United States)

    Azer, Samy A

    2017-04-01

    The aims of this study were to identify characteristics of the top-cited articles in problem-based learning (PBL) and assess the quality of evidence provided by these articles. The most frequently cited articles on PBL were searched in April 2015 in the Science Citation Index Expanded database (List A) and Google Scholar database (List B). Eligible articles identified were reviewed for key characteristics. The Oxford Centre for Evidence-Based Medicine guidelines were used in assessing the level of evidence. The number of citations varied (62 to 923 on List A and 218 to 2,859 on List B). Countries that contributed the majority of articles in both lists were the United States, Netherlands, United Kingdom, and Canada. No significant correlations were found between number of citations and number of years since published (p=0.451), number of authors (p=0.144), females in authorship (p=0.189), non-medical authors (p=0.869), number of institutions (p=0.452), and number of grants (p=0.143), but a strong correlation was found with number of countries involved (p=0.007). Application of the Oxford hierarchy of evidence showed that 36 articles were at levels 4 and 5 of evidence. This study found that research articles represented approximately one-third of PBL articles assessed and reported mainly on questionnaire-based studies. The most highly cited articles occupied top-ranking positions in the journals in which they were published. The lower level of evidence observed in most top-cited articles may reflect the significance of innovative ideas or content of these articles. These findings have implications for dental educators and dental researchers.

  5. Certifying leaders? high-quality management practices and healthy organisations: an ISO-9000 based standardisation approach.

    Science.gov (United States)

    Montano, Diego

    2016-08-05

    The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach.

  6. TOTAL QUALITY MANAGEMENT IN HIGH EDUCATION

    Directory of Open Access Journals (Sweden)

    Hasan SERİN, Alper AYTEKİN

    2009-01-01

    Full Text Available The approach of Total Quality Management (TQM has been even more common and most recently its use in high education has been discussed. Likewise the enterprises producing various products, universities have also inputs, processes, and outputs. Due to conditions of competition, universities have to improve the qualities of these inputs, processes, and outputs, according to satisfaction, demands, and expectations of internal and external customers. If the TQM has been implemented in the universities with a manner that aims for customer satisfaction (students, lecturers, public and private establishments, and families, supports constant development, ensures participatory approach, and encourages working in groups, it will provide universities with effectiveness, efficiency, dynamics, and economics. In this study, common problems of universities, definitions of quality and TQM in high education, customer concept at universities, and factors affecting the quality of education have been explained. Besides, in order TQM approach to be successfully implemented in the universities, various suggestions have been presented.

  7. Does standardised structured reporting contribute to quality in diagnostic pathology? The importance of evidence-based datasets.

    Science.gov (United States)

    Ellis, D W; Srigley, J

    2016-01-01

    Key quality parameters in diagnostic pathology include timeliness, accuracy, completeness, conformance with current agreed standards, consistency and clarity in communication. In this review, we argue that with worldwide developments in eHealth and big data, generally, there are two further, often overlooked, parameters if our reports are to be fit for purpose. Firstly, population-level studies have clearly demonstrated the value of providing timely structured reporting data in standardised electronic format as part of system-wide quality improvement programmes. Moreover, when combined with multiple health data sources through eHealth and data linkage, structured pathology reports become central to population-level quality monitoring, benchmarking, interventions and benefit analyses in public health management. Secondly, population-level studies, particularly for benchmarking, require a single agreed international and evidence-based standard to ensure interoperability and comparability. This has been taken for granted in tumour classification and staging for many years, yet international standardisation of cancer datasets is only now underway through the International Collaboration on Cancer Reporting (ICCR). In this review, we present evidence supporting the role of structured pathology reporting in quality improvement for both clinical care and population-level health management. Although this review of available evidence largely relates to structured reporting of cancer, it is clear that the same principles can be applied throughout anatomical pathology generally, as they are elsewhere in the health system.

  8. The Quality of Evidence in Reading Fluency Intervention for Korean Readers with Reading Difficulties and Disabilities

    Science.gov (United States)

    Park, Yujeong; Kim, Min Kyung

    2015-01-01

    This study aimed to provide information about the quality of the evidence on reading fluency instruction for at-risk students and students with reading/learning disabilities as a way to evaluate whether an instructional strategy is evidence-based and has potential for classroom use. An extensive search process with inclusion and exclusion criteria…

  9. Quality of semantic standards

    NARCIS (Netherlands)

    Folmer, Erwin Johan Albert

    2012-01-01

    Little scientific literature addresses the issue of quality of semantic standards, albeit a problem with high economic and social impact. Our problem survey, including 34 semantic Standard Setting Organizations (SSOs), gives evidence that quality of standards can be improved, but for improvement a

  10. Analysis of high-quality modes in open chaotic microcavities

    International Nuclear Information System (INIS)

    Fang, W.; Yamilov, A.; Cao, H.

    2005-01-01

    We present a numerical study of the high-quality modes in two-dimensional dielectric stadium microcavities. Although the classical ray mechanics is fully chaotic in a stadium billiard, all of the high-quality modes show a 'strong scar' around unstable periodic orbits. When the deformation (ratio of the length of the straight segments over the diameter of the half circles) is small, the high-quality modes correspond to whispering-gallery-type trajectories and their quality factors decrease monotonically with increasing deformation. At large deformation, each high-quality mode is associated with multiple unstable periodic orbits. Its quality factor changes nonmonotonically with the deformation, and there exists an optimal deformation for each mode at which its quality factor reaches a local maximum. This unusual behavior is attributed to the interference of waves propagating along different constituent orbits that could minimize light leakage out of the cavity

  11. High beam quality and high energy short-pulse laser with MOPA

    Science.gov (United States)

    Jin, Quanwei; Pang, Yu; Jiang, JianFeng; Tan, Liang; Cui, Lingling; Wei, Bin; Sun, Yinhong; Tang, Chun

    2018-03-01

    A high energy, high beam quality short-pulse diode-pumped Nd:YAG master oscillator power-amplifier (MOPA) laser with two amplifier stages is demonstrated. The two-rod birefringence compensation was used as beam quality controlling methods, which presents a short-pulse energy of 40 mJ with a beam quality value of M2 = 1.2 at a repetition rate of 400Hz. The MOPA system delivers a short-pulse energy of 712.5 mJ with a pulse width of 12.4 ns.The method of spherical aberration compensation is improved the beam quality, a M2 factor of 2.3 and an optical-to-optical efficiency of 27.7% is obtained at the maximum laser out power.The laser obtained 1.4J out energy with polarization integration.

  12. High quality-factor optical resonators

    International Nuclear Information System (INIS)

    Henriet, Rémi; Salzenstein, Patrice; Coillet, Aurélien; Saleh, Khaldoun; Chembo, Yanne K; Ristic, Davor; Ferrari, Maurizio; Mortier, Michel; Rasoloniaina, Alphonse; Dumeige, Yannick; Féron, Patrice; Cibiel, Gilles; Llopis, Olivier

    2014-01-01

    Various resonators are investigated for microwave photonic applications. Micro-sphere, disk and fiber ring resonators were designed, realized and characterized. Obtained quality factors are as high as Q = 10 10 . (paper)

  13. Quality management manual for production of high quality cassava flour

    DEFF Research Database (Denmark)

    Dziedzoave, Nanam Tay; Abass, Adebayo Busura; Amoa-Awua, Wisdom K.

    The high quality cassava flour (HQCF) industry has just started to evolve in Africa and elsewhere. The sustainability of the growing industry, the profitability of small- and medium-scale enterprises (SMEs) that are active in the industry and good-health of consumers can best be guaranteed through...... the adoption of proper quality and food safety procedures. Cassava processing enterprises involved in the productionof HQCF must therefore be commited to the quality and food safety of the HQCF. They must have the right technology, appropriate processing machhinery, standard testing instruments...... and the necessary technical expertise. This quality manual was therefore developed to guide small- to medium-scale cassava in the design and implematation of Hazard Analysis Critical Control Point (HACCP) system and Good manufacturing Practices (GMP) plans for HQCF production. It describes the HQCF production...

  14. Argumentation Quality of Socio-scientific Issue between High School Students and Postgraduate Students about Cancer

    Science.gov (United States)

    Anisa, A.; Widodo, A.; Riandi, R.

    2017-09-01

    Argumentation is one factor that can help improve critical thinking skills. Arguing means to defend statements with the various data, denials, evidence, and reinforcement that support the statement. The research aimed to capture the quality of argument skills by students in grade 12 high school students and in postgraduate student on social-scientific issues of cancer. Both group subjects are not in the same school or institution, chosen purposively with the subject of 39 high school students of grade 12 in one district of West Java and 13 students of Biology education postgraduate in one of University in West Java - Indonesia. The results of the quality structure of arguments in both subject groups show the same pattern, which is claim - warrant - and ground, with the quality of counterclaim aspects on the postgraduate students look better than grade 12 students. This provides an illustration that the ability in argumentation between students and teachers in the socio-scientific issue of cancer should be evaluate so that the learning process would be more refined in schools.

  15. When There Is Not Enough Evidence and When Evidence Is Not Enough: An Australian Indigenous Smoking Policy Study.

    Science.gov (United States)

    Vujcich, Daniel; Rayner, Mike; Allender, Steven; Fitzpatrick, Ray

    2016-01-01

    The Indigenous Tobacco Control Initiative and Tackling Indigenous Smoking Measure were both announced by the Australian Government at a time when its rhetoric around the importance of evidence-based policy making was strong. This article will (1) examine how the Rudd Government used evidence in Indigenous tobacco control policy making and (2) explore the facilitators of and barriers to the use of evidence. Data were collected through (1) a review of primary documents largely obtained under the Freedom of Information Act 1982 (Commonwealth of Australia) and (2) interviews with senior politicians, senior bureaucrats, government advisors, Indigenous health advocates, and academics. Through the Freedom of Information Act process, 24 previously undisclosed government documents relevant to the making of Indigenous tobacco control policies were identified. Interviewees ( n  = 31, response rate 62%) were identified through both purposive and snowball recruitment strategies. The Framework Analysis method was used to analyze documentary and interview data. Government policy design was heavily influenced by the recommendations presented in government authored/commissioned literature reviews. Resulting policies were led by equivocal evidence for improved tobacco control outcomes among Indigenous Australians. Many of the cited studies had methodological limitations. In the absence of high-quality evidence, some policy makers supported policy recommendations that were perceived to be popular among the Indigenous community. Other policy makers recognized that there were barriers to accumulating rigorous, generalizable evidence; in the absence of such evidence, the policy makers considered that the "need for action" could be combined with the "need for research" by introducing innovative strategies and evaluating them. Despite the absence of high-quality evidence, the formulation and adoption of Indigenous tobacco policy was neither irrational nor reckless. The decision to

  16. Fuzzy method of recognition of high molecular substances in evidence-based biology

    Science.gov (United States)

    Olevskyi, V. I.; Smetanin, V. T.; Olevska, Yu. B.

    2017-10-01

    Nowadays modern requirements to achieving reliable results along with high quality of researches put mathematical analysis methods of results at the forefront. Because of this, evidence-based methods of processing experimental data have become increasingly popular in the biological sciences and medicine. Their basis is meta-analysis, a method of quantitative generalization of a large number of randomized trails contributing to a same special problem, which are often contradictory and performed by different authors. It allows identifying the most important trends and quantitative indicators of the data, verification of advanced hypotheses and discovering new effects in the population genotype. The existing methods of recognizing high molecular substances by gel electrophoresis of proteins under denaturing conditions are based on approximate methods for comparing the contrast of electrophoregrams with a standard solution of known substances. We propose a fuzzy method for modeling experimental data to increase the accuracy and validity of the findings of the detection of new proteins.

  17. Mobile and Web 2.0 interventions for weight management: an overview of review evidence and its methodological quality.

    Science.gov (United States)

    Bardus, Marco; Smith, Jane R; Samaha, Laya; Abraham, Charles

    2016-08-01

    The use of Internet and related technologies for promoting weight management (WM), physical activity (PA), or dietary-related behaviours has been examined in many articles and systematic reviews. This overview aims to summarize and assess the quality of the review evidence specifically focusing on mobile and Web 2.0 technologies, which are the most utilized, currently available technologies. Following a registered protocol (CRD42014010323), we searched 16 databases for articles published in English until 31 December 2014 discussing the use of either mobile or Web 2.0 technologies to promote WM or related behaviors, i.e. diet and physical activity (PA). Two reviewers independently selected reviews and assessed their methodological quality using the AMSTAR checklist. Citation matrices were used to determine the overlap among reviews. Forty-four eligible reviews were identified, 39 of which evaluated the effects of interventions using mobile or Web 2.0 technologies. Methodological quality was generally low with only 7 reviews (16%) meeting the highest standards. Suggestive evidence exists for positive effects of mobile technologies on weight-related outcomes and, to a lesser extent, PA. Evidence is inconclusive regarding Web 2.0 technologies. Reviews on mobile and Web 2.0 interventions for WM and related behaviors suggest that these technologies can, under certain circumstances, be effective, but conclusions are limited by poor review quality based on a heterogeneous evidence base. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  18. Quality Assurance Strategy for Existing Homes: Final Quality Management Primer for High Performing Homes

    Energy Technology Data Exchange (ETDEWEB)

    Del Bianco, M.; Taggart, J.; Sikora, J.; Wood, A.

    2012-12-01

    This guide is designed to help Building America (BA) Teams understand quality management and its role in transitioning from conventional to high performance home building and remodeling. It explains what quality means, the value of quality management systems, the unique need for QMS when building high performing homes, and the first steps to a implementing a comprehensive QMS. This document provides a framework and context for BA teams when they encounter builders and remodelers.

  19. Quality Assurance Strategy for Existing Homes. Final Quality Management Primer for High Performing Homes

    Energy Technology Data Exchange (ETDEWEB)

    Del Bianco, M. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Taggart, J. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Sikora, J. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Wood, A. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States)

    2012-12-01

    This guide is designed to help Building America (BA) teams understand quality management and its role in transitioning from conventional to high performance home building and remodeling. It explains what quality means, the value of quality management systems, the unique need for QMS when building high performing homes, and the first steps to a implementing a comprehensive QMS. This document provides a framework and context for BA teams when they encounter builders and remodelers.

  20. Linking clinical quality indicators to research evidence - a case study in asthma management for children.

    Science.gov (United States)

    Choong, Miew Keen; Tsafnat, Guy; Hibbert, Peter; Runciman, William B; Coiera, Enrico

    2017-07-21

    Clinical quality indicators are used to monitor the performance of healthcare services and should wherever possible be based on research evidence. Little is known however about the extent to which indicators in common use are based on research. The objective of this study is to measure the extent to which clinical quality indicators used in asthma management in children with outcome measurements can be linked to results in randomised controlled clinical trial (RCT) reports. This work is part of a broader research program to trial methods that improve the efficiency and accuracy of indicator development. National-level indicators for asthma management in children were extracted from the National Quality Measures Clearinghouse database and the National Institute for Health and Care Excellence quality standards by two independent appraisers. Outcome measures were extracted from all published English language RCT reports for asthma management in children below the age of 12 published between 2005 and 2014. The two sets were then linked by manually mapping both to a common set of Unified Medical Language System (UMLS) concepts. The analysis identified 39 indicators and 562 full text RCTs dealing with asthma management in children. About 95% (37/39) of the indicators could be linked to RCT outcome measures. It is possible to identify relevant RCT reports for the majority of indicators used to assess the quality of asthma management in childhood. The methods reported here could be automated to more generally support assessment of candidate indicators against the research evidence.

  1. The use of Bayesian networks to assess the quality of evidence from research synthesis: 1.

    Directory of Open Access Journals (Sweden)

    Gavin B Stewart

    Full Text Available The grades of recommendation, assessment, development and evaluation (GRADE approach is widely implemented in systematic reviews, health technology assessment and guideline development organisations throughout the world. A key advantage to this approach is that it aids transparency regarding judgments on the quality of evidence. However, the intricacies of making judgments about research methodology and evidence make the GRADE system complex and challenging to apply without training.We have developed a semi-automated quality assessment tool (SAQAT l based on GRADE. This is informed by responses by reviewers to checklist questions regarding characteristics that may lead to unreliability. These responses are then entered into the Bayesian network to ascertain the probabilities of risk of bias, inconsistency, indirectness, imprecision and publication bias conditional on review characteristics. The model then combines these probabilities to provide a probability for each of the GRADE overall quality categories. We tested the model using a range of plausible scenarios that guideline developers or review authors could encounter.Overall, the model reproduced GRADE judgements for a range of scenarios. Potential advantages over standard assessment are use of explicit and consistent weightings for different review characteristics, forcing consideration of important but sometimes neglected characteristics and principled downgrading where small but important probabilities of downgrading are accrued across domains.Bayesian networks have considerable potential for use as tools to assess the validity of research evidence. The key strength of such networks lies in the provision of a statistically coherent method for combining probabilities across a complex framework based on both belief and evidence. In addition to providing tools for less experienced users to implement reliability assessment, the potential for sensitivity analyses and automation may be

  2. The production of the heavy pig for high quality processed products

    Directory of Open Access Journals (Sweden)

    Paolo Bosi

    2010-01-01

    Full Text Available The review discusses the topics presented below, with experimental data and more evidence for some aspects which areproblematic for the pig producer. To obtain high quality processed pig products, heavy pig production in Italy is subjectedto rules fixed by several Consortia, on the basis of the experience of producers and the results from scientific research.Slaughter animals of at least 9 months of age and 160 kg live weight are required to provide heavy cuts with excellentmeat. Breeds are limited to Italian Large White and Landrace, selected for specific parameters such as loss at 1st saltingof the ham, and their crosses. Crosses with Duroc and hybrids can be used if obtained from selection and crossingschemes that fit the objectives of Italian selection. Backfat thickness must be “sufficient” to obtain retailed fresh hamswith fat cover ranging from 20 to 30 mm, depending on ham weight, and the content of linoleic acid in ham fat covercannot exceed 15%. Fat quantity and quality in feeds should be carefully controlled to satisfy the quality of fat in theham. The feeding level is also relevant, due to the imposed minimum age at slaughter. Feed restriction is a necessarypractice to respect the rules for ham production. For castrate males of medium genetic value, the restriction shouldreduce fat deposition, but the diet composition can be adapted to maintain the maximum growth of protein. For strainswith high lean deposition potential and particularly for gilts, protein deposition should also be limited to maintain a sufficientfat cover of ham.

  3. Inequality in Preschool Quality? Community-Level Disparities in Access to High-Quality Learning Environments

    Science.gov (United States)

    Bassok, Daphna; Galdo, Eva

    2016-01-01

    In recent years, unequal access to high-quality preschool has emerged as a growing public policy concern. Because of data limitations, it is notoriously difficult to measure disparities in access to early learning opportunities across communities and particularly challenging to quantify gaps in access to "high-quality" programs. Research…

  4. Physical Therapists in Primary Care Are Interested in High Quality Evidence Regarding Efficacy of Therapeutic Ultrasound for Knee Osteoarthritis: A Provincial Survey

    Directory of Open Access Journals (Sweden)

    Norma J. MacIntyre

    2013-01-01

    Full Text Available Recent high-level evidence favours therapeutic ultrasound (US for reducing pain in people with knee osteoarthritis (OA. It is unknown how current practice patterns align with current evidence regarding US efficacy and whether physical therapists perceive a need for further high-level evidence. We conducted a descriptive electronic survey to characterize the beliefs and use of US among physical therapists in Ontario treating people with nonsurgical knee OA. Most of the 123 respondents (81% reported at least some use of US with 45% using it often or sometimes. The main goal for using US was to reduce pain in the surrounding soft tissue (n=66 and/or the knee joint (n=43. Almost half (46% endorsed the belief that US is likely to be beneficial for clients with nonsurgical knee OA. Most respondents (85% expressed interest in the results of a randomized controlled trial evaluating the effectiveness of US on pain and physical function. Patterns of use reflect the respondents’ belief that US is likely to be beneficial for knee OA pain.

  5. Low-quality birds do not display high-quality signals: The cysteine-pheomelanin mechanism of honesty

    Science.gov (United States)

    Galván, Ismael; Wakamatsu, Kazumasa; Camarero, Pablo R; Mateo, Rafael; Alonso-Alvarez, Carlos

    2015-01-01

    The mechanisms that make that the costs of producing high-quality signals are unaffordable to low-quality signalers are a current issue in animal communication. The size of the melanin-based bib of male house sparrows Passer domesticus honestly signals quality. We induced the development of new bibs while treating males with buthionine-sulfoximine (BSO), a substance that depletes the levels of the antioxidant glutathione (GSH) and the amino acid cysteine, two elements that switch melanogenesis from eumelanin to pheomelanin. Final bib size is negatively related to pheomelanin levels in the bib feathers. BSO reduced cysteine and GSH levels in all birds, but improved phenotypes (bibs larger than controls) were only expressed by high-quality birds (BSO birds with largest bibs initially). Negative associations between final bib size and cysteine levels in erythrocytes, and between pheomelanin and cysteine levels, were observed in high-quality birds only. These findings suggest that a mechanism uncoupling pheomelanin and cysteine levels may have evolved in low-quality birds to avoid producing bibs of size not corresponding to their quality and greater relative costs. Indeed, greater oxidative stress in cells was not observed in low-quality birds. This may represent the first mechanism maintaining signal honesty without producing greater relative costs on low-quality signalers. PMID:25330349

  6. Coherence of evidence from systematic reviews as a basis for evidence strength - a case study in support of an epistemological proposition

    Directory of Open Access Journals (Sweden)

    Mickenautsch Steffen

    2012-01-01

    Full Text Available Abstract Background This article aims to offer, on the basis of Coherence theory, the epistemological proposition that mutually supportive evidence from multiple systematic reviews may successfully refute radical, philosophical scepticism. Methods A case study including seven systematic reviews is presented with the objective of refuting radical philosophical scepticism towards the belief that glass-ionomer cements (GIC are beneficial in tooth caries therapy. The case study illustrates how principles of logical and empirical coherence may be applied as evidence in support of specific beliefs in healthcare. Results The results show that radical scepticism may epistemologically be refuted on the basis of logical and empirical coherence. For success, several systematic reviews covering interconnected beliefs are needed. In praxis, these systematic reviews would also need to be of high quality and its conclusions based on reviewed high quality trials. Conclusions A refutation of radical philosophical scepticism to clinical evidence may be achieved, if and only if such evidence is based on the logical and empirical coherence of multiple systematic review results. Practical application also requires focus on the quality of the systematic reviews and reviewed trials.

  7. Perceptions of sexual harassment by evidence quality, perceiver gender, feminism, and right wing authoritarianism: Debunking popular myths.

    Science.gov (United States)

    Bhattacharya, Gargi; Stockdale, Margaret S

    2016-10-01

    This study examined the critique in public discourse that sexual harassment (SH) victim advocates, particularly women and feminists, ignore the quality of evidence in a SH claim and are reluctant to find evidence of a false accusation. To balance the inquiry, the study also examined whether right wing authoritarians (RWAs) also ignore evidence quality and presume such claims are false accusations. Participants were 961 U.S. adults (51% female) who completed an online experiment in which they read either a gender harassment (GH) or unwanted sexual attention (USA) scenario of hostile work environment SH and rated the scenario on severity, perceived guilt of the accused, belief that the accused should receive negative job consequences, and likelihood that the claimant was making a false accusation. Scenarios varied by the strength of the evidence in support of the SH claim. Participants completed measures of identification with and support for feminism, RWA, and demographic variables. Results found that contrary to expectations, evidence had a stronger effect on women's, feminists', and feminism supporters' perceptions and to a lesser extent RWAs' perceptions of the scenarios. When evidence was weak, women and feminists, compared to others, were less supportive of the prosecution, but when evidence was strong they were more supportive of the prosecution than were others. These findings address criticisms that advocates for gender equity and victim's rights, particularly women and feminists, are unable to reach fair judgments of SH complaints. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  8. Evaluating the evidence: is phrenic nerve stimulation a safe and effective tool for decreasing ventilator dependence in patients with high cervical spinal cord injuries and central hypoventilation?

    Science.gov (United States)

    Sieg, Emily P; Payne, Russell A; Hazard, Sprague; Rizk, Elias

    2016-06-01

    Case reports, case series and case control studies have looked at the use of phrenic nerve stimulators in the setting of high spinal cord injuries and central hypoventilation syndromes dating back to the 1980s. We evaluated the evidence related to this topic by performing a systematic review of the published literature. Search terms "phrenic nerve stimulation," "phrenic nerve and spinal cord injury," and "phrenic nerve and central hypoventilation" were entered into standard search engines in a systematic fashion. Articles were reviewed by two study authors and graded independently for class of evidence according to published guidelines. The published evidence was reviewed, and the overall body of evidence was evaluated using the grading of recommendations, assesment, development and evaluations (GRADE) criteria Balshem et al. (J Clin Epidemiol 64:401-406, 2011). Our initial search yielded 420 articles. There were no class I, II, or III studies. There were 18 relevant class IV articles. There were no discrepancies among article ratings (i.e., kappa = 1). A meta-analysis could not be performed due to the low quality of the available evidence. The overall quality of the body of evidence was evaluated using GRADE criteria and fell within the "very poor" category. The quality of the published literature for phrenic nerve stimulation is poor. Our review of the literature suggests that phrenic nerve stimulation is a safe and effective option for decreasing ventilator dependence in high spinal cord injuries and central hypoventilation; however, we are left with critical questions that provide crucial directions for future studies.

  9. An Organizational Model for Excellence in Healthcare Delivery: Evidence From Winners of the Baldrige Quality Award.

    Science.gov (United States)

    Griffith, John R

    Winners of the Baldrige National Quality Award in healthcare have documented top quartile clinical outcomes and patient satisfaction across a variety of American communities and a full spectrum of care. Their results also show high levels of satisfaction among physicians, nurses, and other workers, as well as effective financial performance. The managerial methods they use-collectively, the Baldrige model-are consistent with organizational theory literature and are found across all winners. The winners have sustained excellence after winning and expanded it by acquisition of other healthcare organizations.The model differs substantially from traditional management approaches in healthcare delivery. It is a comprehensive program that emphasizes a shared focus on excellence, systematically responsive management, evidence-based medicine, multidimensional measures and negotiated goals, improvement of work processes, thorough training, and extensive rewards. The model could be expanded on a much larger scale. Doing so successfully would substantially improve the quality and cost of healthcare, as well as the satisfaction and commitment of care providers and other staff. The opportunity deserves further study and trial by large healthcare delivery systems, insurers, and consulting companies.

  10. Social Support and Supervisory Quality Interventions in the Workplace: A Stakeholder-Centered Best-Evidence Synthesis of Systematic Reviews on Work Outcomes

    Directory of Open Access Journals (Sweden)

    SL Wagner

    2015-10-01

    Full Text Available Background: There is controversy surrounding the impact of workplace interventions aimed at improving social support and supervisory quality on absenteeism, productivity and financial outcomes. Objective: To determine the value of social support interventions for work outcomes. Methods: Databases were searched for systematic reviews between 2000 and 2012 to complete a synthesis of systematic reviews guided by the PRISMA statement and the IOM guidelines for systematic reviews. Assessment of articles for inclusion and methodological quality was conducted independently by at least two researchers, with differences resolved by consensus. Results: The search resulted in 3363 titles of which 3248 were excluded following title/abstract review, leaving 115 articles that were retrieved and underwent full article review. 10 articles met the set inclusion criteria, with 7 focusing on social support, 2 on supervisory quality and 1 on both. We found moderate and limited evidence, respectively, that social support and supervisory quality interventions positively impact workplace outcomes. Conclusion: There is moderate evidence that social support and limited evidence that supervisory quality interventions have a positive effect on work outcomes.

  11. Social Support and Supervisory Quality Interventions in the Workplace: A Stakeholder-Centered Best-Evidence Synthesis of Systematic Reviews on Work Outcomes.

    Science.gov (United States)

    Wagner, S L; White, M I; Schultz, I Z; Williams-Whitt, K; Koehn, C; Dionne, C E; Koehoorn, M; Harder, H G; Pasca, R; Wärje, O; Hsu, V; McGuire, L; Lama, I; Schulz, W; Kube, D; Wright, M D

    2015-10-01

    There is controversy surrounding the impact of workplace interventions aimed at improving social support and supervisory quality on absenteeism, productivity and financial outcomes. To determine the value of social support interventions for work outcomes. Databases were searched for systematic reviews between 2000 and 2012 to complete a synthesis of systematic reviews guided by the PRISMA statement and the IOM guidelines for systematic reviews. Assessment of articles for inclusion and methodological quality was conducted independently by at least two researchers, with differences resolved by consensus. The search resulted in 3363 titles of which 3248 were excluded following title/abstract review, leaving 115 articles that were retrieved and underwent full article review. 10 articles met the set inclusion criteria, with 7 focusing on social support, 2 on supervisory quality and 1 on both. We found moderate and limited evidence, respectively, that social support and supervisory quality interventions positively impact workplace outcomes. There is moderate evidence that social support and limited evidence that supervisory quality interventions have a positive effect on work outcomes.

  12. Emblems of Quality in Higher Education. Developing and Sustaining High-Quality Programs.

    Science.gov (United States)

    Haworth, Jennifer Grant; Conrad, Clifton F.

    This book proposes an "engagement" theory of program quality to evaluate and improve higher education programs at all degree levels. Based on interviews with 781 participants in a national study of Masters degree programs, it focuses on the interactive roles of students, faculty, and administrators in developing high-quality programs…

  13. Can current analytical quality performance of UK clinical laboratories support evidence-based guidelines for diabetes and ischaemic heart disease?--A pilot study and a proposal.

    Science.gov (United States)

    Jassam, Nuthar; Yundt-Pacheco, John; Jansen, Rob; Thomas, Annette; Barth, Julian H

    2013-08-01

    The implementation of national and international guidelines is beginning to standardise clinical practice. However, since many guidelines have decision limits based on laboratory tests, there is an urgent need to ensure that different laboratories obtain the same analytical result on any sample. A scientifically-based quality control process will be a pre-requisite to provide this level of analytical performance which will support evidence-based guidelines and movement of patients across boundaries while maintaining standardised outcomes. We discuss the finding of a pilot study performed to assess UK clinical laboratories readiness to work to a higher grade quality specifications such as biological variation-based quality specifications. Internal quality control (IQC) data for HbA1c, glucose, creatinine, cholesterol and high density lipoprotein (HDL)-cholesterol were collected from UK laboratories participating in the Bio-Rad Unity QC programme. The median of the coefficient of variation (CV%) of the participating laboratories was evaluated against the CV% based on biological variation. Except creatinine, the other four analytes had a variable degree of compliance with the biological variation-based quality specifications. More than 75% of the laboratories met the biological variation-based quality specifications for glucose, cholesterol and HDL-cholesterol. Slightly over 50% of the laboratories met the analytical goal for HBA1c. Only one analyte (cholesterol) had a performance achieving the higher quality specifications consistent with 5σ. Our data from IQC do not consistently demonstrate that the results from clinical laboratories meet evidence-based quality specifications. Therefore, we propose that a graded scale of quality specifications may be needed at this stage.

  14. Long quantum channels for high-quality entanglement transfer

    International Nuclear Information System (INIS)

    Banchi, L; Apollaro, T J G; Cuccoli, A; Verrucchi, P; Vaia, R

    2011-01-01

    High-quality quantum-state and entanglement transfer can be achieved in an unmodulated spin bus operating in the ballistic regime, which occurs when the endpoint qubits A and B are nonperturbatively coupled to the chain by a suitable exchange interaction j 0 . Indeed, the transition amplitude characterizing the transfer quality exhibits a maximum for a finite optimal value j opt 0 (N), where N is the channel length. We show that j opt 0 (N) scales as N -1/6 for large N and that it ensures a high-quality entanglement transfer even in the limit of arbitrarily long channels, almost independently of the channel initialization. For instance, for any chain length the average quantum-state transmission fidelity exceeds 90% and decreases very little in a broad neighbourhood of j opt 0 (N). We emphasize that, taking the reverse point of view, should j 0 be experimentally constrained, high-quality transfer can still be obtained by adjusting the channel length to its optimal value. (paper)

  15. Identifying suitable substrates for high-quality graphene-based heterostructures

    Science.gov (United States)

    Banszerus, L.; Janssen, H.; Otto, M.; Epping, A.; Taniguchi, T.; Watanabe, K.; Beschoten, B.; Neumaier, D.; Stampfer, C.

    2017-06-01

    We report on a scanning confocal Raman spectroscopy study investigating the strain-uniformity and the overall strain and doping of high-quality chemical vapour deposited (CVD) graphene-based heterostuctures on a large number of different substrate materials, including hexagonal boron nitride (hBN), transition metal dichalcogenides, silicon, different oxides and nitrides, as well as polymers. By applying a hBN-assisted, contamination free, dry transfer process for CVD graphene, high-quality heterostructures with low doping densities and low strain variations are assembled. The Raman spectra of these pristine heterostructures are sensitive to substrate-induced doping and strain variations and are thus used to probe the suitability of the substrate material for potential high-quality graphene devices. We find that the flatness of the substrate material is a key figure for gaining, or preserving high-quality graphene.

  16. A framework of quality improvement interventions to implement evidence-based practices for pressure ulcer prevention.

    Science.gov (United States)

    Padula, William V; Mishra, Manish K; Makic, Mary Beth F; Valuck, Robert J

    2014-06-01

    To enhance the learner's competence with knowledge about a framework of quality improvement (QI) interventions to implement evidence-based practices for pressure ulcer (PrU) prevention. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Summarize the process of creating and initiating the best-practice framework of QI for PrU prevention.2. Identify the domains and QI interventions for the best-practice framework of QI for PrU prevention. Pressure ulcer (PrU) prevention is a priority issue in US hospitals. The National Pressure Ulcer Advisory Panel endorses an evidence-based practice (EBP) protocol to help prevent PrUs. Effective implementation of EBPs requires systematic change of existing care units. Quality improvement interventions offer a mechanism of change to existing structures in order to effectively implement EBPs for PrU prevention. The best-practice framework developed by Nelson et al is a useful model of quality improvement interventions that targets process improvement in 4 domains: leadership, staff, information and information technology, and performance and improvement. At 2 academic medical centers, the best-practice framework was shown to physicians, nurses, and health services researchers. Their insight was used to modify the best-practice framework as a reference tool for quality improvement interventions in PrU prevention. The revised framework includes 25 elements across 4 domains. Many of these elements support EBPs for PrU prevention, such as updates in PrU staging and risk assessment. The best-practice framework offers a reference point to initiating a bundle of quality improvement interventions in support of EBPs. Hospitals and clinicians tasked with quality improvement efforts can use this framework to problem-solve PrU prevention and other critical issues.

  17. When There is Not Enough Evidence and When Evidence is Not Enough: An Australian Indigenous Smoking Policy Study

    Directory of Open Access Journals (Sweden)

    Daniel Vujcich

    2016-10-01

    Full Text Available BACKGROUND: The Indigenous Tobacco Control Initiative and Tackling Indigenous Smoking Measure were both announced by the Australian Government at a time when its rhetoric around the importance of evidence-based policy making was strong. This article will (1 examine how the Rudd Government used evidence in Indigenous tobacco control policy making and (2 explore the facilitators of and barriers to the use of evidence. METHODS: Data were collected through: (1 a review of primary documents largely obtained under the Freedom of Information Act 1982 (Commonwealth of Australia and (2 interviews with senior politicians, senior bureaucrats, government advisors, Indigenous health advocates and academics. Through the Freedom of Information Act process, 24 previously undisclosed government documents relevant to the making of Indigenous tobacco control policies were identified. Interviewees (n=31, response rate 62% were identified through both purposive and snowball recruitment strategies. The Framework Analysis method was used to analyse documentary and interview data.RESULTS: Government policy design was heavily influenced by recommendations presented in government authored/commissioned literature reviews. Resulting policies were led by equivocal evidence for improved tobacco control outcomes among Indigenous Australians. Many of the cited studies had methodological limitations. In the absence of high quality evidence, some policy makers supported policy recommendations that were perceived to be popular among the Indigenous community. Other policy makers recognised that there were barriers to accumulating rigorous, generalizable evidence; in the absence of such evidence, the policy makers considered that the ‘need for action’ could be combined with the ‘need for research’ by introducing innovative strategies and evaluating them.DISCUSSION: Despite the absence of high quality evidence, the formulation and adoption of Indigenous Tobacco policy was

  18. Analysis of evidence within the AUA's clinical practice guidelines.

    Science.gov (United States)

    Antoine, Samuel G; Small, Alexander C; McKiernan, James M; Shah, Ojas

    2018-02-01

    Surgical subspecialty societies release clinical practice guidelines (CPGs) to provide topic-specific recommendations to healthcare providers. We hypothesize that there may be significant differences in statement strength and evidence quality both within the American Urological Association (AUA) guidelines and compared to those published by the American Academy of Orthopedic Surgeons (AAOS) and American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). CPGs issued through 2017 were extracted from the AUAnet.org. Statements were characterized by evidence basis, strength, and evidence quality. CPGs were compared among urologic subspecialties and to those from the AAOS and AAO-HNS. Analysis used Fisher's exact tests and Student's t-tests with significance p < 0.05. A total of 25 AUA CPGs (672 statements) were reviewed and 34.6% were non-evidence based with the highest proportions in pediatrics (47.5%) and sexual medicine (46.5%). The AUA has published over twice as many statements as the AAOS and quadruple that of the AAO-HNS. A smaller proportion of the AUA statements were evidence-based (65.4%) compared to the AAOS (80.5%, p < 0.001) and AAO-HNS (99.8%, p < 0.001), and fewer used "high" quality evidence (AUA 7.2% versus AAOS 21.2%, p < 0.001; versus AAO-HNS 16.1%, p < 0.001). The AUA has published broad CPGs that far exceed those from the AAOS and AAO-HNS. The AUA has utilized extensive resources to provide guidance to help standardize care among urologists. The AAOS and AAO-HNS may not provide guidelines when evidence is limited. With the continued increase of high quality clinical trials, the AUA will be able to continue improving its robust set of evidence-based CPGs.

  19. Evidence-based practice: a quality indicator analysis of peer-tutoring in adapted physical education.

    Science.gov (United States)

    Kalef, Laura; Reid, Greg; Macdonald, Cathy

    2013-09-01

    The purpose of the research was to conduct a quality indicator analysis of studies investigating peer-tutoring for students with a disability in adapted physical education. An electronic search was conducted among English journals published from 1960 to November 2012. Databases included ERIC, PsycINFO, and SPORTDiscus. Fifteen research studies employing group-experimental (Gersten et al., 2005) or single-subject designs (Horner et al., 2005) met inclusion criteria. Each study was assessed for the presence and clarity of quality indicators. Group designs met an average of 62.5% essential and 69% desirable indicators. An average of 80% of indicators was present for single-subject designs. Results suggest claims of peer-tutoring being an evidence-based practice are premature. Recommendations for clarifying and applying the quality indicators are offered. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. From evidence-based to evidence-reflected practice

    DEFF Research Database (Denmark)

    Lystbæk, Christian Tang

    “Knowledge” is of the utmost significance for professional practice and learning. Today, though, the established knowledge base is changing in all areas of the labour market (Alvesson, 2004). Work and society are dominated by commitment to demands for high levels of demonstrable accountability......, cost-efficiency and measurable quality. Thus, today, evidence-based practice has become an expectation and fashion, often used to emphasize the grounding of practice in research based knowledge that provides measurable evidence for best practice. But at the same time, there is a growing distrust...... of the supremacy of this kind of knowledge, and traditional monopolies of knowledge are challenged (Gabbay & May, 2010). In the literature, there is an on-going debate about professional knowledge enacted in diverse settings. This debate presents a wide range of epistemological terminologies and typologies, which...

  1. Is the Readmission Rate a Valid Quality Indicator? A Review of the Evidence

    Science.gov (United States)

    Fischer, Claudia; Lingsma, Hester F.; Marang-van de Mheen, Perla J.; Kringos, Dionne S.; Klazinga, Niek S.; Steyerberg, Ewout W.

    2014-01-01

    Introduction Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of quality of hospital care is not evident. We aimed to give an overview of the different methodological aspects in the definition and measurement of readmission rates that need to be considered when interpreting readmission rates as a reflection of quality of care. Methods We conducted a systematic literature review, using the bibliographic databases Embase, Medline OvidSP, Web-of-Science, Cochrane central and PubMed for the period of January 2001 to May 2013. Results The search resulted in 102 included papers. We found that definition of the context in which readmissions are used as a quality indicator is crucial. This context includes the patient group and the specific aspects of care of which the quality is aimed to be assessed. Methodological flaws like unreliable data and insufficient case-mix correction may confound the comparison of readmission rates between hospitals. Another problem occurs when the basic distinction between planned and unplanned readmissions cannot be made. Finally, the multi-faceted nature of quality of care and the correlation between readmissions and other outcomes limit the indicator's validity. Conclusions Although readmission rates are a promising quality indicator, several methodological concerns identified in this study need to be addressed, especially when the indicator is intended for accountability or pay for performance. We recommend investing resources in accurate data registration, improved indicator description, and bundling outcome measures to provide a more complete picture of hospital care. PMID:25379675

  2. Is the readmission rate a valid quality indicator? A review of the evidence.

    Directory of Open Access Journals (Sweden)

    Claudia Fischer

    Full Text Available Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of quality of hospital care is not evident. We aimed to give an overview of the different methodological aspects in the definition and measurement of readmission rates that need to be considered when interpreting readmission rates as a reflection of quality of care.We conducted a systematic literature review, using the bibliographic databases Embase, Medline OvidSP, Web-of-Science, Cochrane central and PubMed for the period of January 2001 to May 2013.The search resulted in 102 included papers. We found that definition of the context in which readmissions are used as a quality indicator is crucial. This context includes the patient group and the specific aspects of care of which the quality is aimed to be assessed. Methodological flaws like unreliable data and insufficient case-mix correction may confound the comparison of readmission rates between hospitals. Another problem occurs when the basic distinction between planned and unplanned readmissions cannot be made. Finally, the multi-faceted nature of quality of care and the correlation between readmissions and other outcomes limit the indicator's validity.Although readmission rates are a promising quality indicator, several methodological concerns identified in this study need to be addressed, especially when the indicator is intended for accountability or pay for performance. We recommend investing resources in accurate data registration, improved indicator description, and bundling outcome measures to provide a more complete picture of hospital care.

  3. High quality data: An evaluation of AIM data quality and data quality procedures

    Science.gov (United States)

    The goal of every monitoring program is to collect high-quality data which can then be used to provide information to decision makers. The Bureau of Land Management (BLM) Assessment, Inventory, and Monitoring (AIM) program is one such data set which provides rangeland status, condition, and trend in...

  4. Risk of transmission of sporadic Creutzfeldt-Jakob disease by surgical procedures: systematic reviews and quality of evidence.

    Science.gov (United States)

    López, Fernando J García; Ruiz-Tovar, María; Almazán-Isla, Javier; Alcalde-Cabero, Enrique; Calero, Miguel; de Pedro-Cuesta, Jesús

    2017-10-01

    Sporadic Creutzfeldt-Jakob disease (sCJD) is potentially transmissible to humans. This study aimed to summarise and rate the quality of the evidence of the association between surgery and sCJD. Firstly, we conducted systematic reviews and meta-analyses of case-control studies with major surgical procedures as exposures under study. To assess quality of evidence, we used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Secondly, we conducted a systematic review of sCJD case reports after sharing neurosurgical instruments. Thirteen case-control studies met the inclusion criteria for the systematic review of case-control studies. sCJD was positively associated with heart surgery, heart and vascular surgery and eye surgery, negatively associated with tonsillectomy and appendectomy, and not associated with neurosurgery or unspecified major surgery. The overall quality of evidence was rated as very low. A single case-control study with a low risk of bias found a strong association between surgery conducted more than 20 years before disease onset and sCJD. Seven cases were described as potentially transmitted by reused neurosurgical instruments. The association between surgery and sCJD remains uncertain. Measures currently recommended for preventing sCJD transmission should be strongly maintained. Future studies should focus on the potential association between sCJD and surgery undergone a long time previously.

  5. University Students' Understanding of Chemistry Processes and the Quality of Evidence in Their Written Arguments

    Science.gov (United States)

    Seung, Eulsun; Choi, Aeran; Pestel, Beverly

    2016-01-01

    We have developed a process-oriented chemistry laboratory curriculum for non-science majors. The purpose of this study is both to explore university students' understanding of chemistry processes and to evaluate the quality of evidence students use to support their claims regarding chemistry processes in a process-oriented chemistry laboratory…

  6. Improving data retrieval quality: Evidence based medicine perspective.

    Science.gov (United States)

    Kamalov, M; Dobrynin, V; Balykina, J; Kolbin, A; Verbitskaya, E; Kasimova, M

    2015-01-01

    The actively developing approach in modern medicine is the approach focused on principles of evidence-based medicine. The assessment of quality and reliability of studies is needed. However, in some cases studies corresponding to the first level of evidence may contain errors in randomized control trials (RCTs). Solution of the problem is the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Studies both in the fields of medicine and information retrieval are conducted for developing search engines for the MEDLINE database [1]; combined techniques for summarization and information retrieval targeted to solving problems of finding the best medication based on the levels of evidence are being developed [2]. Based on the relevance and demand for studies both in the field of medicine and information retrieval, it was decided to start the development of a search engine for the MEDLINE database search on the basis of the Saint-Petersburg State University with the support of Pavlov First Saint-Petersburg State Medical University and Tashkent Institute of Postgraduate Medical Education. Novelty and value of the proposed system are characterized by the use of ranking method of relevant abstracts. It is suggested that the system will be able to perform ranking based on studies level of evidence and to apply GRADE criteria for system evaluation. The assigned task falls within the domain of information retrieval and machine learning. Based on the results of implementation from previous work [3], in which the main goal was to cluster abstracts from MEDLINE database by subtypes of medical interventions, a set of algorithms for clustering in this study was selected: K-means, K-means ++, EM from the sklearn (http://scikit-learn.org) and WEKA (http://www.cs.waikato.ac.nz/~ml/weka/) libraries, together with the methods of Latent Semantic Analysis (LSA) [4] choosing the first 210 facts and the model "bag of words" [5] to represent clustered documents

  7. Evidence for preferential flux flow at the grain boundaries of superconducting RF-quality niobium

    Science.gov (United States)

    Sung, Z.-H.; Lee, P. J.; Gurevich, A.; Larbalestier, D. C.

    2018-04-01

    The question of whether grain boundaries (GBs) in niobium can be responsible for lowered operating field (B RF) or quality factor (Q 0) in superconducting radio frequency (SRF) cavities is still controversial. Here, we show by direct DC transport across planar GBs isolated from a slice of very large-grain SRF-quality Nb that vortices can preferentially flow along the grain boundary when the external magnetic field lies in the GB plane. However, increasing the misalignment between the GB plane and the external magnetic field vector markedly reduces preferential flux flow along the GB. Importantly, we find that preferential GB flux flow is more prominent for a buffered chemical polished than for an electropolished bi-crystal. The voltage-current characteristics of GBs are similar to those seen in low angle grain boundaries of high temperature superconductors where there is clear evidence of suppression of the superconducting order parameter at the GB. While local weakening of superconductivity at GBs in cuprates and pnictides is intrinsic, deterioration of current transparency of GBs in Nb appears to be extrinsic, since the polishing method clearly affect the local GB degradation. The dependence of preferential GB flux flow on important cavity preparation and experimental variables, particularly the final chemical treatment and the angle between the magnetic field and the GB plane, suggests two more reasons why real cavity performance can be so variable.

  8. Impacts of a high-discharge submarine sewage outfall on water quality in the coastal zone of Salvador (Bahia, Brazil)

    International Nuclear Information System (INIS)

    Roth, F.; Lessa, G.C.; Wild, C.; Kikuchi, R.K.P.; Naumann, M.S.

    2016-01-01

    Carbon and nitrogen stable isotopic signatures of suspended particulate organic matter and seawater biological oxygen demand (BOD) were measured along a coastal transect during summer 2015 to investigate pollution impacts of a high-discharge submarine sewage outfall close to Salvador, Brazil. Impacts of untreated sewage discharge were evident at the outfall site by depleted δ 13 C org and δ 15 N signatures and 4-fold increased BOD rates. Pollution effects of a sewage plume were detectable for more than 6 km downstream from the outfall site, as seasonal wind- and tide-driven shelf hydrodynamics facilitated its advective transport into near-shore waters. There, sewage pollution was detectable at recreational beaches by depleted stable isotope signatures and elevated BOD rates at high tides, suggesting high bacterial activity and increased infection risk by human pathogens. These findings indicate the urgent necessity for appropriate wastewater treatment in Salvador to achieve acceptable standards for released effluents and coastal zone water quality. - Highlights: •Pollution by untreated sewage discharge is evident at the outfall and in Salvador's coastal zone. •Seasonal wind- and tide-driven surface currents control advective transport of discharged sewage. •Water quality at Salvador's recreational beaches is impacted by a plume of untreated sewage.

  9. The EVIDENT diet quality index is associated with cardiovascular risk and arterial stiffness in adults

    Directory of Open Access Journals (Sweden)

    Carmela Rodríguez-Martin

    2017-04-01

    Full Text Available Abstract Background We aimed to simplify information from food frequency questionnaires (FFQs in a single parameter that allows for rapid identification of quality of patient diet and its relationship to cardiovascular risk and pulse wave velocity (PWV. Methods The sample from the EVIDENT study, consisting of 1553 subjects (aged 20–80 years with no cardiovascular disease selected by random sampling among those attending primary care clinics, was used. The EVIDENT diet index (range 0–100 was calculated based on the results of a FFQ. Evaluation of dietary habits also included adherence to the Mediterranean diet (MD. Cardiovascular risk was estimated, and carotid-femoral pulse wave velocity was measured. Results Mean subject age was 54.9 ± 13.8 years, and 60.3% of subjects were female. The mean value of the EVIDENT diet index was 52.1 ± 3.2 points. Subjects in the third tertile (the highest score had the greatest adherence to MD and the highest energy intake, with greater amounts of carbohydrates, protein, and fiber. The best cut-off point of the EVIDENT diet index for predicting good adherence to the MD is 52.3 (0.71 sensitivity, 0.61 specificity. In a multiple regression analysis, after a complete adjustment, it was estimated that for each one-point increase in the EVIDENT diet index, cardiovascular risk (CVR, blood-pressure, waist circumference, and PWV decreased by 0.14, 0.43, 0.24, and 0.09 respectively (p < 0.05, all. Conclusions The diet quality index developed is associated to CVR and its components, and also with arterial stiffness, as measured with PWV. This index is also a good predictor of adherence to MD.

  10. Health-related quality of life in children with high-functioning autism.

    Science.gov (United States)

    Potvin, Marie-Christine; Snider, Laurie; Prelock, Patricia A; Wood-Dauphinee, Sharon; Kehayia, Eva

    2015-01-01

    The health-related quality of life of school-aged children with high-functioning autism is poorly understood. The objectives of this study were to compare the health-related quality of life of children with high-functioning autism to that of typically developing peers and to compare child-self and parent-proxy reports of health-related quality of life of children. A cross-sectional study of children with high-functioning autism (n = 30) and peers (n = 31) was conducted using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales. Children with high-functioning autism had significantly poorer health-related quality of life than peers whether reported by themselves (p children and parental scores suggested variance in points of view. This study specifically investigated health-related quality of life in children with high-functioning autism as compared to a sample of peers, from the child's perspective. It strengthens earlier findings that children with high-functioning autism experience poorer health-related quality of life than those without this disorder and points to the importance of clinicians working with families to identify areas in a child's life that promote or hinder their sense of well-being. © The Author(s) 2013.

  11. The patient experience of high technology medical imaging: A systematic review of the qualitative evidence

    International Nuclear Information System (INIS)

    Munn, Zachary; Jordan, Zoe

    2011-01-01

    Background: When presenting to an imaging department, the person who is to be imaged is often in a vulnerable state, and can experience the scan in a number of ways. It is the role of the radiographer to produce a high quality image and facilitate patient care throughout the imaging process. A qualitative systematic review was performed to synthesise the existent evidence on the patient experience of high technology medical imaging. Only papers relating to Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) were identified. Inclusion criteria: Studies that were of a qualitative design that explored the phenomenon of interest, the patient experience of high technology medical imaging. Participants included anyone who had undergone one of these procedures. Methods: A systematic search of medical and allied health databases was conducted. Articles identified during the search process that met the inclusion criteria were then critically appraised for methodological quality independently by two reviewers. Results: During the search and inclusion process, 15 studies were found that were deemed of suitable quality to be included in the review. From the 15 studies, 127 findings were extracted from the included studies. These were analysed in more detail to observe common themes, and then grouped into 33 categories. From these 33 categories, 11 synthesised findings were produced. The 11 synthesised findings highlight the diverse, unique and challenging ways in which people experience imaging with MRI and CT scanners. Conclusion: The results of the review demonstrate the diverse ways in which people experience medical imaging. All health professionals involved in imaging need to be aware of the different ways each patient may experience imaging.

  12. Image Quality in High-resolution and High-cadence Solar Imaging

    Science.gov (United States)

    Denker, C.; Dineva, E.; Balthasar, H.; Verma, M.; Kuckein, C.; Diercke, A.; González Manrique, S. J.

    2018-03-01

    Broad-band imaging and even imaging with a moderate bandpass (about 1 nm) provides a photon-rich environment, where frame selection (lucky imaging) becomes a helpful tool in image restoration, allowing us to perform a cost-benefit analysis on how to design observing sequences for imaging with high spatial resolution in combination with real-time correction provided by an adaptive optics (AO) system. This study presents high-cadence (160 Hz) G-band and blue continuum image sequences obtained with the High-resolution Fast Imager (HiFI) at the 1.5-meter GREGOR solar telescope, where the speckle-masking technique is used to restore images with nearly diffraction-limited resolution. The HiFI employs two synchronized large-format and high-cadence sCMOS detectors. The median filter gradient similarity (MFGS) image-quality metric is applied, among others, to AO-corrected image sequences of a pore and a small sunspot observed on 2017 June 4 and 5. A small region of interest, which was selected for fast-imaging performance, covered these contrast-rich features and their neighborhood, which were part of Active Region NOAA 12661. Modifications of the MFGS algorithm uncover the field- and structure-dependency of this image-quality metric. However, MFGS still remains a good choice for determining image quality without a priori knowledge, which is an important characteristic when classifying the huge number of high-resolution images contained in data archives. In addition, this investigation demonstrates that a fast cadence and millisecond exposure times are still insufficient to reach the coherence time of daytime seeing. Nonetheless, the analysis shows that data acquisition rates exceeding 50 Hz are required to capture a substantial fraction of the best seeing moments, significantly boosting the performance of post-facto image restoration.

  13. Developing Quality Control Procedures to Sustain a Supply of High Quality Blood for Mass Rearing Tsetse Flies

    Energy Technology Data Exchange (ETDEWEB)

    De Beer, C J; Venter, G J; Potgieter, F T [ARC-Onderstepoort Veterinary Institute, Old Soutpans Road, Private Bag X05, 0110 Onderstepoort (South Africa)

    2012-07-15

    Mass rearing tsetse flies Glossina spp. is dependent on the sustained availability of a high quality blood diet. In any mass rearing facility, the logistics for obtaining sterile, high quality fresh blood is challenging. An added complication is the influence of potential chemical, physical and microbiological elements present in the blood of donors, as well as contamination during collection, handling and storage. Research at the Agricultural Research Council - Onderstepoort Veterinary institute (ARC-OVI) is directed towards the development of quality control procedures for the supply of the in vitro diet used to maintain productive colonies of Glossina brevipalpis Newstead and Glossina austeni Newstead. Factors that may influence the blood diet, e.g. defibrination, feeding times, collection of blood in anticoagulants, treatment of blood with taste stimuli, repeated freezing and thawing of blood, effect of bovine growth hormones, and also a preference for bovine or porcine blood were tested. A 25 day bioassay was used to determine the effects of these factors on tsetse survival and reproduction. Defibrination of the blood for 10 to 15 minutes gave the best results for both species. It was found that G. brevipalpis should be fed three times per week for 5 minutes each time, and G. austeni three times per week for 10 minutes. Heparin, acid citrate dextrose (ACD), citric acid, citrate phosphate dextrose adenine (CPDA) and a combination of sodium citrate and citric acid were effective anticoagulants in the blood diets of G. brevipalpis and G. austeni. Blood treated with inosine triphosphate (ITP) gave the highest quality factor (QFC) values for both G. austeni and G. brevipalpis. Repeated freezing and thawing of blood definitely affects pupal production negatively; G. brevipalpis especially produced significantly smaller pupae. A premixed diet of equal amounts of bovine and porcine blood was found to be best suited for G. brevipalpis, and for G. austeni a mixture of

  14. Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector

    NARCIS (Netherlands)

    Croes, R.R.; Krabbe-Alkemade, Y.J.F.M.; Mikkers, M.C.

    2017-01-01

    textabstractThere is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be

  15. Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector.

    Science.gov (United States)

    Croes, R R; Krabbe-Alkemade, Y J F M; Mikkers, M C

    2018-01-01

    There is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a system involving managed competition and mandatory healthcare insurance. Information about the quality of care provided by hospitals has been publicly available since 2008. In this paper, we evaluate the relationship between quality scores for three diagnosis groups and the market power indicators of hospitals. We estimate the impact of competition on quality in an environment of liberalized pricing. For this research, we used unique price and production data relating to three diagnosis groups (cataract, adenoid and tonsils, bladder tumor) produced by Dutch hospitals in the period 2008-2011. We also used the quality indicators relating to these diagnosis groups. We reveal a negative relationship between market share and quality score for two of the three diagnosis groups studied, meaning that hospitals in competitive markets have better quality scores than those in concentrated markets. We therefore conclude that more competition is associated with higher quality scores.

  16. High-performance work systems in health care management, part 2: qualitative evidence from five case studies.

    Science.gov (United States)

    McAlearney, Ann Scheck; Garman, Andrew N; Song, Paula H; McHugh, Megan; Robbins, Julie; Harrison, Michael I

    2011-01-01

    : A capable workforce is central to the delivery of high-quality care. Research from other industries suggests that the methodical use of evidence-based management practices (also known as high-performance work practices [HPWPs]), such as systematic personnel selection and incentive compensation, serves to attract and retain well-qualified health care staff and that HPWPs may represent an important and underutilized strategy for improving quality of care and patient safety. : The aims of this study were to improve our understanding about the use of HPWPs in health care organizations and to learn about their contribution to quality of care and patient safety improvements. : Guided by a model of HPWPs developed through an extensive literature review and synthesis, we conducted a series of interviews with key informants from five U.S. health care organizations that had been identified based on their exemplary use of HPWPs. We sought to explore the applicability of our model and learn whether and how HPWPs were related to quality and safety. All interviews were recorded, transcribed, and subjected to qualitative analysis. : In each of the five organizations, we found emphasis on all four HPWP subsystems in our conceptual model-engagement, staff acquisition/development, frontline empowerment, and leadership alignment/development. Although some HPWPs were common, there were also practices that were distinctive to a single organization. Our informants reported links between HPWPs and employee outcomes (e.g., turnover and higher satisfaction/engagement) and indicated that HPWPs made important contributions to system- and organization-level outcomes (e.g., improved recruitment, improved ability to address safety concerns, and lower turnover). : These case studies suggest that the systematic use of HPWPs may improve performance in health care organizations and provide examples of how HPWPs can impact quality and safety in health care. Further research is needed to specify

  17. Competition and quality indicators in the health care sector : Empirical evidence from the Dutch hospital sector

    NARCIS (Netherlands)

    Croes, Ramsis; Krabbe, Yvonne; Mikkers, Misja

    There is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a

  18. Bronchiectasis: correlation of high-resolution CT findings with health-related quality of life

    Energy Technology Data Exchange (ETDEWEB)

    Eshed, I. [Department of Diagnostic Radiology, E. Wolfson Medical Center, Holon (Israel)]. E-mail: iriseshed@gmail.com; Minski, I. [Department of Diagnostic Radiology, E. Wolfson Medical Center, Holon (Israel); Katz, R. [Department of Diagnostic Radiology, E. Wolfson Medical Center, Holon (Israel); Jones, P.W. [Department of Respiratory Medicine, St George' s Hospital Medical School, University of London (United Kingdom); Priel, I.E. [Department of Pulmonary Medicine, E. Wolfson Medical Center, Holon, Israel, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University (Israel)

    2007-02-15

    Aim: To evaluate the relationship between the severity of bronchiectatic diseases, as evident on high-resolution computed tomography (HRCT) and the patient's quality of life measured using the St George's Respiratory Questionnaire (SGRQ). Methods and materials: Forty-six patients (25 women, 21 men, mean age: 63 years) with bronchiectatic disease as evident on recent HRCT examinations were recruited. Each patient completed the SGRQ and underwent respiratory function tests. HRCT findings were blindly and independently scored by two radiologists, using the modified Bhalla scoring system. The relationships between HRCT scores, SGRQ scores and pulmonary function tests were evaluated. Results: The patients' total CT score did not correlate with the SGRQ scores. However, patients with more advanced disease on HRCT, significantly differed in their SGRQ scores from patients with milder bronchiectatic disease. A significant correlation was found between the CT scores for the middle and distal lung zones and the activity, impacts and total SGRQ scores. No correlation was found between CT scores and respiratory function test indices. However, a significant correlation was found between the SGRQ scores and most of the respiratory function test indices. Conclusion: A correlation between the severity of bronchiectatic disease as expressed in HRCT and the health-related quality of life exists in patients with a more severe bronchiectatic disease but not in patients with mild disease. Such correlation depends on the location of the bronchiectasis in the pulmonary tree.

  19. Hospital competition and patient-perceived quality of care: Evidence from a single-payer system in Taiwan.

    Science.gov (United States)

    Chen, Chi-Chen; Cheng, Shou-Hsia

    2010-11-01

    To examine the effects of market competition on patient-perceived quality of care under a single-payer system in Taiwan. Data came from two nationwide surveys conducted on discharged patients and National Health Insurance (NHI) hospital claim datasets in 2002 and 2004. Competition was measured by the Herfindahl-Hirschman Index (HHI). Quality of care was measured by patient-rated hospital performance including interpersonal skills and clinical competence domains. We used the instrumental variable approach to address the endogeneity between competition and patient-perceived quality of care. The results showed that HHI was significantly associated with a decrease in the perceived interpersonal skills (coefficient of -0.460; pcompetition. A similar association was found for the perceived clinical competence (coefficient of -0.457; p=0.001). Quality of care from the patients' perspective is sensitive to the degree of competition. By using patient-reported data, this study provides new evidence concerning competition and quality of care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  20. Heart Failure in Zambia: Evidence for Improving Clinical Practice.

    African Journals Online (AJOL)

    Esem

    reducing mortality, but also on improving quality of life. ... Heart Failure in Zambia: Evidence for Improving ... likely to be a result of “informed guess work” with ... balance. The study reported that a high serum urea and high creatinine were ...

  1. Real-World Solutions for Developing High-Quality PHP Frameworks and Applications

    CERN Document Server

    Bergmann, Sebastian

    2011-01-01

    Learn to develop high-quality applications and frameworks in PHP Packed with in-depth information and step-by-step guidance, this book escorts you through the process of creating, maintaining and extending sustainable software of high quality with PHP. World-renowned PHP experts present real-world case studies for developing high-quality applications and frameworks in PHP that can easily be adapted to changing business requirements. . They offer different approaches to solving  typical development and quality assurance problems that every developer needs to know and master.Details the process

  2. A Call to Digital Health Practitioners: New Guidelines Can Help Improve the Quality of Digital Health Evidence.

    Science.gov (United States)

    Agarwal, Smisha; Lefevre, Amnesty E; Labrique, Alain B

    2017-10-06

    Despite the rapid proliferation of health interventions that employ digital tools, the evidence on the effectiveness of such approaches remains insufficient and of variable quality. To address gaps in the comprehensiveness and quality of reporting on the effectiveness of digital programs, the mHealth Technical Evidence Review Group (mTERG), convened by the World Health Organization, proposed the mHealth Evidence Reporting and Assessment (mERA) checklist to address existing gaps in the comprehensiveness and quality of reporting on the effectiveness of digital health programs. We present an overview of the mERA checklist and encourage researchers working in the digital health space to use the mERA checklist for reporting their research. The development of the mERA checklist consisted of convening an expert group to recommend an appropriate approach, convening a global expert review panel for checklist development, and pilot-testing the checklist. The mERA checklist consists of 16 core mHealth items that define what the mHealth intervention is (content), where it is being implemented (context), and how it was implemented (technical features). Additionally, a 29-item methodology checklist guides authors on reporting critical aspects of the research methodology employed in the study. We recommend that the core mERA checklist is used in conjunction with an appropriate study-design specific checklist. The mERA checklist aims to assist authors in reporting on digital health research, guide reviewers and policymakers in synthesizing evidence, and guide journal editors in assessing the completeness in reporting on digital health studies. An increase in transparent and rigorous reporting can help identify gaps in the conduct of research and understand the effects of digital health interventions as a field of inquiry. ©Smisha Agarwal, Amnesty E Lefevre, Alain B Labrique. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 06.10.2017.

  3. Measuring the Quality of Professional Development Training

    Science.gov (United States)

    Gaumer Erickson, Amy S.; Noonan, Patricia M.; Brussow, Jennifer; Supon Carter, Kayla

    2017-01-01

    High-quality, evidence-based professional development is essential to ensure that teachers obtain the knowledge, strategies and skills necessary to positively impact student learning. While the primary form of professional development, training has rarely been evaluated for quality beyond the satisfaction of those being trained. The Observation…

  4. Evaluating the Quality of Evidence from a Network Meta-Analysis

    Science.gov (United States)

    Salanti, Georgia; Del Giovane, Cinzia; Chaimani, Anna; Caldwell, Deborah M.; Higgins, Julian P. T.

    2014-01-01

    Systematic reviews that collate data about the relative effects of multiple interventions via network meta-analysis are highly informative for decision-making purposes. A network meta-analysis provides two types of findings for a specific outcome: the relative treatment effect for all pairwise comparisons, and a ranking of the treatments. It is important to consider the confidence with which these two types of results can enable clinicians, policy makers and patients to make informed decisions. We propose an approach to determining confidence in the output of a network meta-analysis. Our proposed approach is based on methodology developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group for pairwise meta-analyses. The suggested framework for evaluating a network meta-analysis acknowledges (i) the key role of indirect comparisons (ii) the contributions of each piece of direct evidence to the network meta-analysis estimates of effect size; (iii) the importance of the transitivity assumption to the validity of network meta-analysis; and (iv) the possibility of disagreement between direct evidence and indirect evidence. We apply our proposed strategy to a systematic review comparing topical antibiotics without steroids for chronically discharging ears with underlying eardrum perforations. The proposed framework can be used to determine confidence in the results from a network meta-analysis. Judgements about evidence from a network meta-analysis can be different from those made about evidence from pairwise meta-analyses. PMID:24992266

  5. Blueprint for action: steps toward a high-quality, high-value maternity care system.

    Science.gov (United States)

    Angood, Peter B; Armstrong, Elizabeth Mitchell; Ashton, Diane; Burstin, Helen; Corry, Maureen P; Delbanco, Suzanne F; Fildes, Barbara; Fox, Daniel M; Gluck, Paul A; Gullo, Sue Leavitt; Howes, Joanne; Jolivet, R Rima; Laube, Douglas W; Lynne, Donna; Main, Elliott; Markus, Anne Rossier; Mayberry, Linda; Mitchell, Lynn V; Ness, Debra L; Nuzum, Rachel; Quinlan, Jeffrey D; Sakala, Carol; Salganicoff, Alina

    2010-01-01

    Childbirth Connection hosted a 90th Anniversary national policy symposium, Transforming Maternity Care: A High Value Proposition, on April 3, 2009, in Washington, DC. Over 100 leaders from across the range of stakeholder perspectives were actively engaged in the symposium work to improve the quality and value of U.S. maternity care through broad system improvement. A multi-disciplinary symposium steering committee guided the strategy from its inception and contributed to every phase of the project. The "Blueprint for Action: Steps Toward a High Quality, High Value Maternity Care System", issued by the Transforming Maternity Care Symposium Steering Committee, answers the fundamental question, "Who needs to do what, to, for, and with whom to improve the quality of maternity care over the next five years?" Five stakeholder workgroups collaborated to propose actionable strategies in 11 critical focus areas for moving expeditiously toward the realization of the long term "2020 Vision for a High Quality, High Value Maternity Care System", also published in this issue. Following the symposium these workgroup reports and recommendations were synthesized into the current blueprint. For each critical focus area, the "Blueprint for Action" presents a brief problem statement, a set of system goals for improvement in that area, and major recommendations with proposed action steps to achieve them. This process created a clear sightline to action that if enacted could improve the structure, process, experiences of care, and outcomes of the maternity care system in ways that when anchored in the culture can indeed transform maternity care. Copyright 2010 Jacobs Institute of Women

  6. Quality of Mobile Phone and Tablet Mobile Apps for Speech Sound Disorders: Protocol for an Evidence-Based Appraisal.

    Science.gov (United States)

    Furlong, Lisa M; Morris, Meg E; Erickson, Shane; Serry, Tanya A

    2016-11-29

    Although mobile apps are readily available for speech sound disorders (SSD), their validity has not been systematically evaluated. This evidence-based appraisal will critically review and synthesize current evidence on available therapy apps for use by children with SSD. The main aims are to (1) identify the types of apps currently available for Android and iOS mobile phones and tablets, and (2) to critique their design features and content using a structured quality appraisal tool. This protocol paper presents and justifies the methods used for a systematic review of mobile apps that provide intervention for use by children with SSD. The primary outcomes of interest are (1) engagement, (2) functionality, (3) aesthetics, (4) information quality, (5) subjective quality, and (6) perceived impact. Quality will be assessed by 2 certified practicing speech-language pathologists using a structured quality appraisal tool. Two app stores will be searched from the 2 largest operating platforms, Android and iOS. Systematic methods of knowledge synthesis shall include searching the app stores using a defined procedure, data extraction, and quality analysis. This search strategy shall enable us to determine how many SSD apps are available for Android and for iOS compatible mobile phones and tablets. It shall also identify the regions of the world responsible for the apps' development, the content and the quality of offerings. Recommendations will be made for speech-language pathologists seeking to use mobile apps in their clinical practice. This protocol provides a structured process for locating apps and appraising the quality, as the basis for evaluating their use in speech pathology for children in English-speaking nations. ©Lisa M Furlong, Meg E Morris, Shane Erickson, Tanya A Serry. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 29.11.2016.

  7. GRADE: Assessing the quality of evidence in environmental and occupational health

    NARCIS (Netherlands)

    Morgan, Rebecca L.; Thayer, Kristina A.; Bero, Lisa; Bruce, Nigel; Falck-Ytter, Yngve; Ghersi, Davina; Guyatt, Gordon; Hooijmans, Carlijn; Langendam, Miranda; Mandrioli, Daniele; Mustafa, Reem A.; Rehfuess, Eva A.; Rooney, Andrew A.; Shea, Beverley; Silbergeld, Ellen K.; Sutton, Patrice; Wolfe, Mary S.; Woodruff, Tracey J.; Verbeek, Jos H.; Holloway, Alison C.; Santesso, Nancy; Schünemann, Holger J.

    2016-01-01

    There is high demand in environmental health for adoption of a structured process that evaluates and integrates evidence while making decisions and recommendations transparent. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework holds promise to address this

  8. A Fast, High Quality, and Reproducible Parallel Lagged-Fibonacci Pseudorandom Number Generator

    Science.gov (United States)

    Mascagni, Michael; Cuccaro, Steven A.; Pryor, Daniel V.; Robinson, M. L.

    1995-07-01

    We study the suitability of the additive lagged-Fibonacci pseudo-random number generator for parallel computation. This generator has relatively short period with respect to the size of its seed. However, the short period is more than made up for with the huge number of full-period cycles it contains. These different full period cycles are called equivalence classes. We show how to enumerate the equivalence classes and how to compute seeds to select a given equivalence class, In addition, we present some theoretical measures of quality for this generator when used in parallel. Next, we conjecture on the size of these measures of quality for this generator. Extensive empirical evidence supports this conjecture. In addition, a probabilistic interpretation of these measures leads to another conjecture similarly supported by empirical evidence. Finally we give an explicit parallelization suitable for a fully reproducible asynchronous MIMD implementation.

  9. Experimental evidence for shape changes at high spin

    International Nuclear Information System (INIS)

    Twin, P.J.

    1985-01-01

    Recent experimental evidence obtained with TESSA for shape changes at high spin is presented. Continuum γ-ray spectroscopy data indicates the co-existence of both prolate and oblate shapes in N = 90 nuclei and lifetime data in 152 Dy shows that the super deformed decays are very enhanced. (orig.)

  10. Systematic analysis of the quality of the scientific evidence and conflicts of interest in osteoarthritis of the hip and knee practice guidelines.

    Science.gov (United States)

    Feuerstein, Joseph D; Pelsis, Jonathan R; Lloyd, Samuel; Cheifetz, Adam S; Stone, Kevin R

    2016-02-01

    To determine the validity of the hip and knee osteoarthritis guidelines. A systematic search of PubMed using a combination of Mesh and text terms with limitations to guidelines was performed to identify hip and knee osteoarthritis guidelines. The study was performed from April 17, 2014 to October 1, 2014. Guidelines were reviewed for graded levels of evidence, methods used to grade the evidence, and disclosures of conflicts of interest. Additionally, guidelines were also assessed for key quality measures using the AGREE II system for assessing the quality of guidelines. A total of 13 guidelines relevant to the diagnosis and/or treatment of hip/knee osteoarthritis was identified. The 180 recommendations reviewed were supported by 231 pieces of evidence. In total, 35% (n = 80; range: 0-26) were supported by level A evidence, 15% (n = 35; range: 0-10) were by level B, and 50% (n = 116; range: 0-62) were by level C. Median age of the guidelines was 4 years (±4.8; range: 0-16) with no comments on planned updates. In total, 31% of the guidelines included patients in the development process. Only one guideline incorporated cost consideration, and only 15% of the guidelines addressed the surgical management of osteoarthritis. Additionally, 46% of guidelines did not comment on conflicts of interest (COI). When present, there was an average 29.8 COI. Notably, 82% of the COI were monetary support/consulting. In total, 50% of the hip/knee osteoarthritis guideline recommendations are based on lower quality evidence. Nearly half the guidelines fail to disclose relevant COI and when disclosed, multiple potential COI are present. Future hip/knee osteoarthritis guideline development committees should strive to improve the transparency and quality of evidence used to formulate practice guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Adoption and impact of high quality bambara flour (HQBF ...

    African Journals Online (AJOL)

    Adoption and impact of high quality bambara flour (HQBF) technology in the ... consumer acceptability/quality of products, credit, availability of raw materials, and ... as a result of 12.5 per cent increase in demand for bambara-based products.

  12. Development of a high-quality cut-off wall using electrophoresis

    International Nuclear Information System (INIS)

    Kawachi, T.; Murahashi, H.

    1991-01-01

    Techniques to build a high-quality cut-off wall have been developed for storage facilities of low-level radioactive waste (LLW) as an emergency measures to prevent leakages. The cut-off wall is highly impermeable, nucleid-adsorptive and have long-term durability. Electrophoresis is used to form impermeable membrane of bentonite as main features of the cut-off wall. First of all, laboratory tests have been conducted to study ways of building barriers on site and to collect data on the barriers properties. Afterwards, on-site construction tests of a high-quality cut-off wall have been carried out. In this paper, we describe the process and results on the studies of the high-quality cut-off wall using electrophoresis

  13. Timing of high-quality child care and cognitive, language, and preacademic development.

    Science.gov (United States)

    Li, Weilin; Farkas, George; Duncan, Greg J; Burchinal, Margaret R; Vandell, Deborah Lowe

    2013-08-01

    The effects of high- versus low-quality child care during 2 developmental periods (infant-toddlerhood and preschool) were examined using data from the National Institute of Child Health and Human Development Study of Early Child Care. Propensity score matching was used to account for differences in families who used different combinations of child care quality during the 2 developmental periods. Findings indicated that cognitive, language, and preacademic skills prior to school entry were highest among children who experienced high-quality care in both the infant-toddler and preschool periods, somewhat lower among children who experienced high-quality child care during only 1 of these periods, and lowest among children who experienced low-quality care during both periods. Irrespective of the care received during infancy-toddlerhood, high-quality preschool care was related to better language and preacademic outcomes at the end of the preschool period; high-quality infant-toddler care, irrespective of preschool care, was related to better memory skills at the end of the preschool period. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

  14. Health-Related Quality of Life in Children with High-Functioning Autism

    Science.gov (United States)

    Potvin, Marie-Christine; Snider, Laurie; Prelock, Patricia A.; Wood-Dauphinee, Sharon; Kehayia, Eva

    2015-01-01

    The health-related quality of life of school-aged children with high-functioning autism is poorly understood. The objectives of this study were to compare the health-related quality of life of children with high-functioning autism to that of typically developing peers and to compare child-self and parent-proxy reports of health-related quality of…

  15. High quality digital holographic reconstruction on analog film

    Science.gov (United States)

    Nelsen, B.; Hartmann, P.

    2017-05-01

    High quality real-time digital holographic reconstruction, i.e. at 30 Hz frame rates, has been at the forefront of research and has been hailed as the holy grail of display systems. While these efforts have produced a fascinating array of computer algorithms and technology, many applications of reconstructing high quality digital holograms do not require such high frame rates. In fact, applications such as 3D holographic lithography even require a stationary mask. Typical devices used for digital hologram reconstruction are based on spatial-light-modulator technology and this technology is great for reconstructing arbitrary holograms on the fly; however, it lacks the high spatial resolution achievable by its analog counterpart, holographic film. Analog holographic film is therefore the method of choice for reconstructing highquality static holograms. The challenge lies in taking a static, high-quality digitally calculated hologram and effectively writing it to holographic film. We have developed a theoretical system based on a tunable phase plate, an intensity adjustable high-coherence laser and a slip-stick based piezo rotation stage to effectively produce a digitally calculated hologram on analog film. The configuration reproduces the individual components, both the amplitude and phase, of the hologram in the Fourier domain. These Fourier components are then individually written on the holographic film after interfering with a reference beam. The system is analogous to writing angularly multiplexed plane waves with individual component phase control.

  16. Biofield Therapies: Helpful or Full of Hype? A Best Evidence Synthesis

    Science.gov (United States)

    Mills, Paul J.

    2009-01-01

    Background Biofield therapies (such as Reiki, therapeutic touch, and healing touch) are complementary medicine modalities that remain controversial and are utilized by a significant number of patients, with little information regarding their efficacy. Purpose This systematic review examines 66 clinical studies with a variety of biofield therapies in different patient populations. Method We conducted a quality assessment as well as a best evidence synthesis approach to examine evidence for biofield therapies in relevant outcomes for different clinical populations. Results Studies overall are of medium quality, and generally meet minimum standards for validity of inferences. Biofield therapies show strong evidence for reducing pain intensity in pain populations, and moderate evidence for reducing pain intensity hospitalized and cancer populations. There is moderate evidence for decreasing negative behavioral symptoms in dementia and moderate evidence for decreasing anxiety for hospitalized populations. There is equivocal evidence for biofield therapies' effects on fatigue and quality of life for cancer patients, as well as for comprehensive pain outcomes and affect in pain patients, and for decreasing anxiety in cardiovascular patients. Conclusion There is a need for further high-quality studies in this area. Implications and future research directions are discussed. Electronic supplementary material The online version of this article (doi:10.1007/s12529-009-9062-4) contains supplementary material, which is available to authorized users. PMID:19856109

  17. Do strategies to improve quality of maternal and child health care in lower and middle income countries lead to improved outcomes? A review of the evidence.

    Science.gov (United States)

    Dettrick, Zoe; Firth, Sonja; Jimenez Soto, Eliana

    2013-01-01

    Efforts to scale-up maternal and child health services in lower and middle income countries will fail if services delivered are not of good quality. Although there is evidence of strategies to increase the quality of health services, less is known about the way these strategies affect health system goals and outcomes. We conducted a systematic review of the literature to examine this relationship. We undertook a search of MEDLINE, SCOPUS and CINAHL databases, limiting the results to studies including strategies specifically aimed at improving quality that also reported a measure of quality and at least one indicator related to health system outcomes. Variation in study methodologies prevented further quantitative analysis; instead we present a narrative review of the evidence. Methodologically, the quality of evidence was poor, and dominated by studies of individual facilities. Studies relied heavily on service utilisation as a measure of strategy success, which did not always correspond to improved quality. The majority of studies targeted the competency of staff and adequacy of facilities. No strategies addressed distribution systems, public-private partnership or equity. Key themes identified were the conflict between perceptions of patients and clinical measures of quality and the need for holistic approaches to health system interventions. Existing evidence linking quality improvement strategies to improved MNCH outcomes is extremely limited. Future research would benefit from the inclusion of more appropriate indicators and additional focus on non-facility determinants of health service quality such as health policy, supply distribution, community acceptability and equity of care.

  18. Information-seeking Behavior During Residency Is Associated With Quality of Theoretical Learning, Academic Career Achievements, and Evidence-based Medical Practice

    Science.gov (United States)

    Oussalah, Abderrahim; Fournier, Jean-Paul; Guéant, Jean-Louis; Braun, Marc

    2015-01-01

    Abstract Data regarding knowledge acquisition during residency training are sparse. Predictors of theoretical learning quality, academic career achievements and evidence-based medical practice during residency are unknown. We performed a cross-sectional study on residents and attending physicians across several residency programs in 2 French faculties of medicine. We comprehensively evaluated the information-seeking behavior (I-SB) during residency using a standardized questionnaire and looked for independent predictors of theoretical learning quality, academic career achievements, and evidence-based medical practice among I-SB components using multivariate logistic regression analysis. Between February 2013 and May 2013, 338 fellows and attending physicians were included in the study. Textbooks and international medical journals were reported to be used on a regular basis by 24% and 57% of the respondents, respectively. Among the respondents, 47% refer systematically (4.4%) or frequently (42.6%) to published guidelines from scientific societies upon their publication. The median self-reported theoretical learning quality score was 5/10 (interquartile range, 3–6; range, 1–10). A high theoretical learning quality score (upper quartile) was independently and strongly associated with the following I-SB components: systematic reading of clinical guidelines upon their publication (odds ratio [OR], 5.55; 95% confidence interval [CI], 1.77–17.44); having access to a library that offers the leading textbooks of the specialty in the medical department (OR, 2.45, 95% CI, 1.33–4.52); knowledge of the specialty leading textbooks (OR, 2.12; 95% CI, 1.09–4.10); and PubMed search skill score ≥5/10 (OR, 1.94; 95% CI, 1.01–3.73). Research Master (M2) and/or PhD thesis enrolment were independently and strongly associated with the following predictors: PubMed search skill score ≥5/10 (OR, 4.10; 95% CI, 1.46–11.53); knowledge of the leading medical journals of the

  19. Does Central Bank Quality Determine Sovereign Ratings and Credit Default Swap Spreads: Evidence from the World?

    Directory of Open Access Journals (Sweden)

    Ramlall Indranarain

    2016-09-01

    Full Text Available This study innovates from prior research which focuses on the determinants of sovereign ratings and credit default swap spreads for a large sample of countries by incorporating the quality of central banks, let alone refined proxies. Findings show that the explanatory power of both sovereign ratings and CDS spreads model improve by a hefty 11 percent in case of sovereign ratings and 6 to 9 percent in the case of CDS spreads when central bank quality is incorporated. Such a finding bolters the notion that institutional quality does play a preponderant role when it comes to assessing country risk, making it a systematic component of institutional quality. The effect of labour participation implies that countries buffeted by stronger effects of an ageing population have greater propensity of increases in CDS spreads. Evidence is also found as to the driving dynamics of CDS spreads and sovereign ratings to be distinct. Our results hold robust post tackling for endogeneity problem.

  20. Can online networks provide quality answers to questions about occupational safety and health?

    Science.gov (United States)

    Rhebergen, Martijn D F; Lenderink, Annet F; van Dijk, Frank J H; Hulshof, Carel T J

    2012-05-01

    To assess whether experts can provide high-quality answers to occupational safety and health (OSH) questions in online Question & Answer (Q&A) networks. The authors evaluated the quality of answers provided by qualified experts in two Dutch online networks: ArboAntwoord and the Helpdesk of the Netherlands Center for Occupational Diseases. A random sample of 594 answers was independently evaluated by two raters using nine answer quality criteria. An additional criterion, the agreement of answers with the best available evidence, was explored by peer review of a sample of 42 answers. Reviewers performed an evidence search in Medline. The median answer quality score of ArboAntwoord (N=295) and the Netherlands Center for Occupational Diseases Helpdesk (N=299) was 8 of 9 (IQR 2). The inter-rater reliability of the first nine quality criteria was high (κ 0.82-0.90, p<0.05). A question answered by two or more experts had a greater probability of a high-quality score than questions answered by one expert (OR 4.9, 95% CI 2.7 to 9.0). Answers most often scored insufficient on the use of evidence to underpin the answer (36% and 38% for the networks, respectively) and on conciseness (35% and 31%, respectively). Peer review demonstrated that 43%-72% of the answers in both online networks were in complete agreement with the best available evidence. OSH experts are able to provide quality answers in online OSH Q&A networks. Our answer quality appraisal instrument was feasible and provided information on how to improve answer quality.

  1. Achieving graphical excellence: suggestions and methods for creating high-quality visual displays of experimental data.

    Science.gov (United States)

    Schriger, D L; Cooper, R J

    2001-01-01

    Graphics are an important means of communicating experimental data and results. There is evidence, however, that many of the graphics printed in scientific journals contain errors, redundancies, and lack clarity. Perhaps more important, many graphics fail to portray data at an appropriate level of detail, presenting summary statistics rather than underlying distributions. We seek to aid investigators in the production of high-quality graphics that do their investigations justice by providing the reader with optimum access to the relevant aspects of the data. The depiction of by-subject data, the signification of pairing when present, and the use of symbolic dimensionality (graphing different symbols to identify relevant subgroups) and small multiples (the presentation of an array of similar graphics each depicting one group of subjects) to portray stratification are stressed. Step-by-step instructions for the construction of high-quality graphics are offered. We hope that authors will incorporate these suggestions when developing graphics to accompany their manuscripts and that this process will lead to improvements in the graphical literacy of scientific journals. We also hope that journal editors will keep these principles in mind when refereeing manuscripts submitted for peer review.

  2. Evidence-based clinical practice, [corrected] evidence-based medicine and the Cochrane collaboration.

    Science.gov (United States)

    Gambrill, E

    1999-03-01

    Encouraging professionals in training and later to consider practice-related research findings when making important clinical decisions is an on-going concern. Evidenced-Based Medicine (EBM) and the Cochrane Collaboration (CC) provide a source of tools and ideas for doing so, as well as a roster of colleagues who share this interest. Evidenced-based medicine involves integrating clinical expertise with the best available external evidence from systematic research as well as considering the values and expectations of patients/clients. Advantage can be taken of educational formats developed in EBM, such as problem-based learning and critical-appraisal workshops in which participants learn how to ask key answerable questions related to important clinical practice questions (e.g., regarding effectiveness, accuracy of assessment measures, prediction, prevention, and quality of clinical practice guidelines) and to access and critically appraise related research. The Cochrane Collaboration is a world-wide network of centers that prepare, maintain, and disseminate high-quality systematic reviews on the efficacy of healthcare. These databases allow access to evidence related to clinical practice decisions. Forging reciprocal working relationships with those involved in EBM reciprocal and the CC should contribute to the pursuit of shared goals such as basing clinical decisions on the best-available evidence and involving clients as informed consumers.

  3. A systematic tale of two differing reviews: evaluating the evidence on public and private sector quality of primary care in low and middle income countries.

    Science.gov (United States)

    Coarasa, Jorge; Das, Jishnu; Gummerson, Elizabeth; Bitton, Asaf

    2017-04-12

    Systematic reviews are powerful tools for summarizing vast amounts of data in controversial areas; but their utility is limited by methodological choices and assumptions. Two systematic reviews of literature on the quality of private sector primary care in low and middle income countries (LMIC), published in the same journal within a year, reached conflicting conclusions. The difference in findings reflects different review methodologies, but more importantly, a weak underlying body of literature. A detailed examination of the literature cited in both reviews shows that only one of the underlying studies met the gold standard for methodological robustness. Given the current policy momentum on universal health coverage and primary health care reform across the globe, there is an urgent need for high quality empirical evidence on the quality of private versus public sector primary health care in LMIC.

  4. New Evidence of the Causal Effect of Family Size on Child Quality in a Developing Country

    Science.gov (United States)

    Ponczek, Vladimir; Souza, Andre Portela

    2012-01-01

    This paper presents new evidence of the causal effect of family size on child quality in a developing-country context. We estimate the impact of family size on child labor and educational outcomes among Brazilian children and young adults by exploring the exogenous variation of family size driven by the presence of twins in the family. Using the…

  5. A porous layer: an evidence for the deterioration of MOVPE InN grown at high temperature (∝650 C)

    International Nuclear Information System (INIS)

    Sugita, K.; Hashimoto, A.; Yamamoto, A.

    2009-01-01

    This paper indicates an evidence for the deterioration of the MOVPE InN during the growth at high temperature (∝650 C). It is noted that the deterioration occurs near the interface and InN film becomes porous layer during the further growth. The porous layer has high electron density. The rate-limiting process of N-face InN decomposition depends on atomic hydrogen. The atomic hydrogen produced by the decomposition of NH 3 is responsible for the deterioration of InN film. The crystal quality of InN improves with decreasing the porous layer which is important for MOVPE InN. (copyright 2009 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim) (orig.)

  6. Prediction of bread-making quality using size exclusion high ...

    African Journals Online (AJOL)

    Variation in the distribution of protein molecular weight in wheat (Triticum aestivum), influences breadmaking quality of wheat cultivars, resulting in either poor or good bread. The objective of this study was to predict breadmaking quality of wheat cultivars using size exclusion high performance liquid chromatography.

  7. Exome sequencing generates high quality data in non-target regions

    Directory of Open Access Journals (Sweden)

    Guo Yan

    2012-05-01

    Full Text Available Abstract Background Exome sequencing using next-generation sequencing technologies is a cost efficient approach to selectively sequencing coding regions of human genome for detection of disease variants. A significant amount of DNA fragments from the capture process fall outside target regions, and sequence data for positions outside target regions have been mostly ignored after alignment. Result We performed whole exome sequencing on 22 subjects using Agilent SureSelect capture reagent and 6 subjects using Illumina TrueSeq capture reagent. We also downloaded sequencing data for 6 subjects from the 1000 Genomes Project Pilot 3 study. Using these data, we examined the quality of SNPs detected outside target regions by computing consistency rate with genotypes obtained from SNP chips or the Hapmap database, transition-transversion (Ti/Tv ratio, and percentage of SNPs inside dbSNP. For all three platforms, we obtained high-quality SNPs outside target regions, and some far from target regions. In our Agilent SureSelect data, we obtained 84,049 high-quality SNPs outside target regions compared to 65,231 SNPs inside target regions (a 129% increase. For our Illumina TrueSeq data, we obtained 222,171 high-quality SNPs outside target regions compared to 95,818 SNPs inside target regions (a 232% increase. For the data from the 1000 Genomes Project, we obtained 7,139 high-quality SNPs outside target regions compared to 1,548 SNPs inside target regions (a 461% increase. Conclusions These results demonstrate that a significant amount of high quality genotypes outside target regions can be obtained from exome sequencing data. These data should not be ignored in genetic epidemiology studies.

  8. Core public health functions for BC : evidence review : air quality-indoor

    Energy Technology Data Exchange (ETDEWEB)

    Copes, R.; Ouellette, V.; Lee, K.S.; Brauer, M. [British Columbia Ministry of Health, Victoria, BC (Canada)

    2006-04-15

    Indoor sources of pollutants can have a major impact on the health of Canadians, as pollutant concentrations are often higher indoors than outdoors. This paper assessed data compiled by public health indoor air interventions. The aim of the study was to identify the current state of evidence on the impacts of indoor pollution in order to develop performance improvement plans for public health programs in British Columbia (BC). The literature review used several databases to review interventions involving humidity control; ventilation; particulate matter; indoor allergens; and environmental tobacco smoke. Results of the review showed that improving inadequate ventilation can significantly decrease the prevalence of sick building syndrome as well as other self-reported symptoms attributed to indoor air pollution. A review of the literature also demonstrated that many building ventilation systems are not functioning to design specifications. The poor quality of studies on the health impacts of particulate matter or dust made it difficult to fully assess the benefits of particle filtration on human health. Studies investigating the impacts of controlling indoor allergens suggested that the avoidance of dust mites may benefit people with allergies. Evidence gained from studies on environmental tobacco smoke showed that banning or restricting smoking will reduce the burden of illness from pollutants in indoor air. 20 refs., 3 tabs.

  9. Core public health functions for BC : evidence review : air quality-indoor

    International Nuclear Information System (INIS)

    Copes, R.; Ouellette, V.; Lee, K.S.; Brauer, M.

    2006-04-01

    Indoor sources of pollutants can have a major impact on the health of Canadians, as pollutant concentrations are often higher indoors than outdoors. This paper assessed data compiled by public health indoor air interventions. The aim of the study was to identify the current state of evidence on the impacts of indoor pollution in order to develop performance improvement plans for public health programs in British Columbia (BC). The literature review used several databases to review interventions involving humidity control; ventilation; particulate matter; indoor allergens; and environmental tobacco smoke. Results of the review showed that improving inadequate ventilation can significantly decrease the prevalence of sick building syndrome as well as other self-reported symptoms attributed to indoor air pollution. A review of the literature also demonstrated that many building ventilation systems are not functioning to design specifications. The poor quality of studies on the health impacts of particulate matter or dust made it difficult to fully assess the benefits of particle filtration on human health. Studies investigating the impacts of controlling indoor allergens suggested that the avoidance of dust mites may benefit people with allergies. Evidence gained from studies on environmental tobacco smoke showed that banning or restricting smoking will reduce the burden of illness from pollutants in indoor air. 20 refs., 3 tabs

  10. Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

    Science.gov (United States)

    Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

    2008-01-01

    The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and

  11. Multi-dimensional water quality assessment of an urban drinking water source elucidated by high resolution underwater towed vehicle mapping.

    Science.gov (United States)

    Lock, Alan; Spiers, Graeme; Hostetler, Blair; Ray, James; Wallschläger, Dirk

    2016-04-15

    Spatial surveys of Ramsey Lake, Sudbury, Ontario water quality were conducted using an innovative underwater towed vehicle (UTV) equipped with a multi-parameter probe providing real-time water quality data. The UTV revealed underwater vent sites through high resolution monitoring of different spatial chemical characteristics using common sensors (turbidity, chloride, dissolved oxygen, and oxidation/reduction sensors) that would not be feasible with traditional water sampling methods. Multi-parameter probe vent site identification is supported by elevated alkalinity and silica concentrations at these sites. The identified groundwater vent sites appear to be controlled by bedrock fractures that transport water from different sources with different contaminants of concern. Elevated contaminants, such as, arsenic and nickel and/or nutrient concentrations are evident at the vent sites, illustrating the potential of these sources to degrade water quality. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. IPO underpricing and audit quality: Evidence from the alternative investment market in the UK

    Directory of Open Access Journals (Sweden)

    Mohammad Muflih Alhadab

    2016-08-01

    Full Text Available This paper aims to investigate the relationship between audit quality and IPO underpricing for IPO firms that went public on the Alternative Investment Market (AIM of the London Stock Exchange in the UK. Prior research has examined this relationship; however, there has been no work investigates this relation for IPO firms that went public on the AIM market. Based on a sample of 413 IPOs, the findings of the current study reassure prior literature that high quality auditors are associated with a lower level of IPO underpricing. The findings show that high quality audit firms help to reduce the level of information asymmetry around the IPO and, therefore, this leads to reduce the level of IPO underpricing. Further, size, liquidity ratio, and high litigation industries are found to contribute the IPO underpricing on the AIM market.

  13. Key factors for a high-quality VR experience

    Science.gov (United States)

    Champel, Mary-Luc; Doré, Renaud; Mollet, Nicolas

    2017-09-01

    For many years, Virtual Reality has been presented as a promising technology that could deliver a truly new experience to users. The media and entertainment industry is now investigating the possibility to offer a video-based VR 360 experience. Nevertheless, there is a substantial risk that VR 360 could have the same fate as 3DTV if it cannot offer more than just being the next fad. The present paper aims at presenting the various quality factors required for a high-quality VR experience. More specifically, this paper will focus on the main three VR quality pillars: visual, audio and immersion.

  14. Sleep quality and its relationship with quality of life among high-risk pregnant women (gestational diabetes and hypertension).

    Science.gov (United States)

    Saadati, Fatemeh; Sehhatiei Shafaei, Fahimeh; Mirghafourvand, Mozhgan

    2018-01-01

    Sleep is one of the most basic human requirements. This research aims at determining the status of sleep quality and its relationship with quality of life among high-risk pregnant women in Tabriz, Iran, in 2015. This research was a sectional study done on 364 qualified women in 28-36 weeks of pregnancy suffering from mild preeclampsia and gestational diabetes. The sampling was done as convenience. Personal-social-midwifery questionnaire, Pittsburg sleep quality, and quality of life in pregnancy (QOL-ORAV) were used for gathering data. Multivariate linear regression model was used for determining the relationship between sleep quality and its subsets with quality of life and controlling confounders. In the current study, the prevalence of sleep disturbance was 96.4%. Mean (SD) of the total score of sleep quality was 10.1 (4.1) and the total score of quality of life was 61.7 (17.3). According to Pearson's correlation test, there was statistically significant relationship between quality of life and sleep quality and all its subsets except sleep duration and use of sleep medication (p quality of life. The findings of current research show that sleep quality is low among high-risk pregnant women and quality of life is medium. So, it is necessary that required training is given by health cares for improving sleep quality and quality of life to mothers.

  15. Improving Access to Quality Care in Family Planning: WHO's Four Cornerstones of Evidence-based Guidance

    Institute of Scientific and Technical Information of China (English)

    Shang-chun WU; Yan ZOU; K Church; O Meirik

    2007-01-01

    The four cornerstones of guidance in technique service of family planning are established by WHO based on high quality evidences. They have been updated according to the appearing new evidences, and the consensuses were reached by the international experts in this field. The four documents include Medical Eligibility Criteria for Contraceptive Use, Selected Practice Recommendations for Contraceptive Use, Decision-making Tool for Family Planning Clients and Providers and The Global Handbook for Family Planning Providers. The first two documents mainlyface to the policy-makers and programme managers and were treated as the important references for creating the local guideline. The other two documents were developed for the front-line health-care and family planning providers at different levels, which include plenty of essential technical information to help providers improve their ability in service delivery and counselling. China paid great attention to the introduction and application of WHO guidelines. As soon as the newer editions of these documents were available, the Chinese version would be followed. WHO guidelines have been primarily adapted with the newly issued national guideline, The Clinical Practical Skill Guidelines- Family Planning Part, which was established by China Medical Association. At the same time, the WHO guidelines have been introduced to some of the linicians and family planning providers at different levels. In the future, more special training courses will be introduced to the township level based on the needs of grassroot providers.

  16. Next Generation High Quality Videoconferencing Service for the LHC

    CERN Multimedia

    CERN. Geneva

    2012-01-01

    In recent times, we have witnessed an explosion of video initiatives in the industry worldwide. Several advancements in video technology are currently improving the way we interact and collaborate. These advancements are forcing tendencies and overall experiences: any device in any network can be used to collaborate, in most cases with an overall high quality. To cope with this technology progresses, CERN IT Department has taken the leading role to establish strategies and directions to improve the user experience in remote dispersed meetings and remote collaboration at large in the worldwide LHC communities. Due to the high rate of dispersion in the LHC user communities, these are critically dependent of videoconferencing technology, with a need of robustness and high quality for the best possible user experience. We will present an analysis of the factors that influenced the technical and strategic choices to improve the reliability, efficiency and overall quality of the LHC remote sessions. In particular, ...

  17. [Job stress and quality of life of primary care health-workers: evidence of validity of the PECVEC questionnaire].

    Science.gov (United States)

    Fernández-López, Juan Antonio; Fernández-Fidalgo, María; Martín-Payo, Rubén; Rödel, Andreas

    2007-08-01

    To evaluate the relationship between Health-Related Quality of Life (HRQL) and stress at work among Primary Care workers, as evidence of the construct validity of the Spanish version (PECVEC) of the profile of quality of life in the chronically ill (PLC) questionnaire. In addition, to check its other psychometric properties. Cross-sectional study. Eighteen primary care centres in Health Area IV, Asturias (Oviedo), Spain, sharing similar socio-demographic conditions. Two hundred and thirty-three primary care nurses and physicians. HRQL was evaluated by the 6 general dimensions of the Spanish version of the PLC. Stress at work was evaluated by the three scales of the Effort-Reward Imbalance (ERI) questionnaire. The construct validity of the PECVEC was assessed by testing the inverse associations of QoL dimensions and job stress ones, when the most important confuser variables were monitored. The non-response rate was low (effects and only small ceiling effects were observed. Internal consistency analysis and exploratory and confirmatory factor analysis demonstrated high reliability, factorial validity and convergent/divergent validity of the PECVEC. The PECVEC demonstrates adequate psychometric properties for evaluating HRQL in healthy subjects.

  18. Optimization of nitridation conditions for high quality inter-polysilicon dielectric layers

    NARCIS (Netherlands)

    Klootwijk, J.H.; Bergveld, H.J.; van Kranenburg, H.; Woerlee, P.H.; Wallinga, Hans

    1996-01-01

    Nitridation of deposited high temperature oxides (HTO) was studied to form high quality inter-polysilicon dielectric layers for embedded non volatile memories. Good quality dielectric layers were obtained earlier by using an optimized deposition of polysilicon and by performing a post-dielectric

  19. Production of High Quality Die Steels from Large ESR Slab Ingots

    Science.gov (United States)

    Geng, Xin; Jiang, Zhou-hua; Li, Hua-bing; Liu, Fu-bin; Li, Xing

    With the rapid development of manufacture industry in China, die steels are in great need of large slab ingot of high quality and large tonnage, such as P20, WSM718R and so on. Solidification structure and size of large slab ingots produced with conventional methods are not satisfied. However, large slab ingots manufactured by ESR process have a good solidification structure and enough section size. In the present research, the new slab ESR process was used to produce the die steels large slab ingots with the maximum size of 980×2000×3200mm. The compact and sound ingot can be manufactured by the slab ESR process. The ultra-heavy plates with the maximum thickness of 410 mm can be obtained after rolling the 49 tons ingots. Due to reducing the cogging and forging process, the ESR for large slab ingots process can increase greatly the yield and production efficiency, and evidently cut off product costs.

  20. Improving low-performing high schools: searching for evidence of promise.

    Science.gov (United States)

    Fleischman, Steve; Heppen, Jessica

    2009-01-01

    Noting that many of the nation's high schools are beset with major problems, such as low student reading and math achievement, high dropout rates, and an inadequate supply of effective teachers, Steve Fleischman and Jessica Heppen survey a range of strategies that educators have used to improve low-performing high schools. The authors begin by showing how the standards-based school reform movement, together with the No Child Left Behind Act requirement that underperforming schools adopt reforms supported by scientifically based research, spurred policy makers, educators, and researchers to create and implement a variety of approaches to attain improvement. Fleischman and Heppen then review a number of widely adopted reform models that aim to change "business as usual" in low-performing high schools. The models include comprehensive school reform programs, dual enrollment and early college high schools, smaller learning communities, specialty (for example, career) academies, charter high schools, and education management organizations. In practice, say the authors, many of these improvement efforts overlap, defying neat distinctions. Often, reforms are combined to reinforce one another. The authors explain the theories that drive the reforms, review evidence of their reforms' effectiveness to date, and suggest what it will take to make them work well. Although the reforms are promising, the authors say, few as yet have solid evidence of systematic or sustained success. In concluding, Fleischman and Heppen emphasize that the reasons for a high school's poor performance are so complex that no one reform model or approach, no matter how powerful, can turn around low-performing schools. They also stress the need for educators to implement each reform program with fidelity to its requirements and to support it for the time required for success. Looking to the future, the authors suggest steps that decision makers, researchers, and sponsors of research can take to promote

  1. Taphonomic evidence for high-speed adapted fins in thunniform ichthyosaurs

    Science.gov (United States)

    Lingham-Soliar, Theagarten; Plodowski, Gerhard

    2007-01-01

    Ichthyosaurs have been compared with the fast-swimming thunniform groups of marine vertebrates, tuna, lamnid sharks, and dolphins, based on similarity of shape of the body and locomotory organs. In addition to shape, high-tensile stiffness of the control surfaces has been shown to be essential in maximizing hydrodynamic efficiency in extant thunniform swimmers. To date, there has been no evidence of a stiffening support system for the dorsal fin and dorsal lobe of the caudal fin in ichthyosaurs, the sole stiffening structure of the ventral lobe being an extension of the vertebral column along its leading edge. Stenopterygius SMF 457 is arguably the best soft-tissue preserved ichthyosaur specimen known. Here, we examine soft-tissue preservation in this specimen in the control surfaces and provide the first evidence of a complex architecture of stiff fibers in the dorsal and caudal fins. We find by comparisons and by analogy that these fibers provided a remarkable mechanism for high tensile stiffness and efficiency of the locomotory organs virtually identical to that of the great white shark, Carcharodon carcharias. It is the first mechanostructural study of the control surfaces of a Jurassic ichthyosaur that adds essential evidence in support of the view that these forms were high-speed thunniform swimmers.

  2. Automated assessment of the quality of depression websites.

    Science.gov (United States)

    Griffiths, Kathleen M; Tang, Thanh Tin; Hawking, David; Christensen, Helen

    2005-12-30

    Since health information on the World Wide Web is of variable quality, methods are needed to assist consumers to identify health websites containing evidence-based information. Manual assessment tools may assist consumers to evaluate the quality of sites. However, these tools are poorly validated and often impractical. There is a need to develop better consumer tools, and in particular to explore the potential of automated procedures for evaluating the quality of health information on the web. This study (1) describes the development of an automated quality assessment procedure (AQA) designed to automatically rank depression websites according to their evidence-based quality; (2) evaluates the validity of the AQA relative to human rated evidence-based quality scores; and (3) compares the validity of Google PageRank and the AQA as indicators of evidence-based quality. The AQA was developed using a quality feedback technique and a set of training websites previously rated manually according to their concordance with statements in the Oxford University Centre for Evidence-Based Mental Health's guidelines for treating depression. The validation phase involved 30 websites compiled from the DMOZ, Yahoo! and LookSmart Depression Directories by randomly selecting six sites from each of the Google PageRank bands of 0, 1-2, 3-4, 5-6 and 7-8. Evidence-based ratings from two independent raters (based on concordance with the Oxford guidelines) were then compared with scores derived from the automated AQA and Google algorithms. There was no overlap in the websites used in the training and validation phases of the study. The correlation between the AQA score and the evidence-based ratings was high and significant (r=0.85, Psites with zero PageRanks were included the association was weak and non-significant (r=0.23, P=.22). When sites with zero PageRanks were excluded, the correlation was moderate (r=.61, P=.002). Depression websites of different evidence-based quality can be

  3. Producing high-quality slash pine seeds

    Science.gov (United States)

    James Barnett; Sue Varela

    2003-01-01

    Slash pine is a desirable species. It serves many purposes and is well adapted to poorly drained flatwoods and seasonally flooded areas along the lower Coastal Plain of the Southeastern US. The use of high-quality seeds has been shown to produce uniform seedlings for outplanting, which is key to silvicultural success along the Coastal Plain and elsewhere. We present...

  4. Breeding and maintaining high-quality insects

    DEFF Research Database (Denmark)

    Jensen, Kim; Kristensen, Torsten Nygård; Heckmann, Lars-Henrik

    2017-01-01

    Insects have a large potential for sustainably enhancing global food and feed production, and commercial insect production is a rising industry of high economic value. Insects suitable for production typically have fast growth, short generation time, efficient nutrient utilization, high...... reproductive potential, and thrive at high density. Insects may cost-efficiently convert agricultural and industrial food by-products into valuable protein once the technology is finetuned. However, since insect mass production is a new industry, the technology needed to efficiently farm these animals is still...... in a starting phase. Here, we discuss the challenges and precautions that need to be considered when breeding and maintaining high-quality insect populations for food and feed. This involves techniques typically used in domestic animal breeding programs including maintaining genetically healthy populations...

  5. High Quality Virtual Reality for Architectural Exhibitions

    DEFF Research Database (Denmark)

    Kreutzberg, Anette

    2016-01-01

    This paper will summarise the findings from creating and implementing a visually high quality Virtual Reality (VR) experiment as part of an international architecture exhibition. It was the aim to represent the architectural spatial qualities as well as the atmosphere created from combining natural...... and artificial lighting in a prominent not yet built project. The outcome is twofold: Findings concerning the integration of VR in an exhibition space and findings concerning the experience of the virtual space itself. In the exhibition, an important aspect was the unmanned exhibition space, requiring the VR...... experience to be self-explanatory. Observations of different visitor reactions to the unmanned VR experience compared with visitor reactions at guided tours with personal instructions are evaluated. Data on perception of realism, spatial quality and light in the VR model were collected with qualitative...

  6. Evidence that masking of synapsis imperfections counterbalances quality control to promote efficient meiosis.

    Directory of Open Access Journals (Sweden)

    Susanna Mlynarczyk-Evans

    Full Text Available Reduction in ploidy to generate haploid gametes during sexual reproduction is accomplished by the specialized cell division program of meiosis. Pairing between homologous chromosomes and assembly of the synaptonemal complex at their interface (synapsis represent intermediate steps in the meiotic program that are essential to form crossover recombination-based linkages between homologs, which in turn enable segregation of the homologs to opposite poles at the meiosis I division. Here, we challenge the mechanisms of pairing and synapsis during C. elegans meiosis by disrupting the normal 1:1 correspondence between homologs through karyotype manipulation. Using a combination of cytological tools, including S-phase labeling to specifically identify X chromosome territories in highly synchronous cohorts of nuclei and 3D rendering to visualize meiotic chromosome structures and organization, our analysis of trisomic (triplo-X and polyploid meiosis provides insight into the principles governing pairing and synapsis and how the meiotic program is "wired" to maximize successful sexual reproduction. We show that chromosomes sort into homologous groups regardless of chromosome number, then preferentially achieve pairwise synapsis during a period of active chromosome mobilization. Further, comparisons of synapsis configurations in triplo-X germ cells that are proficient or defective for initiating recombination suggest a role for recombination in restricting chromosomal interactions to a pairwise state. Increased numbers of homologs prolong markers of the chromosome mobilization phase and/or boost germline apoptosis, consistent with triggering quality control mechanisms that promote resolution of synapsis problems and/or cull meiocytes containing synapsis defects. However, we also uncover evidence for the existence of mechanisms that "mask" defects, thus allowing resumption of prophase progression and survival of germ cells despite some asynapsis. We propose

  7. LOAD-ENHANCED MOVEMENT QUALITY SCREENING AND TACTICAL ATHLETICISM: AN EXTENSION OF EVIDENCE.

    Science.gov (United States)

    Glass, Stephen M; Schmitz, Randy J; Rhea, Christopher K; Ross, Scott E

    2017-06-01

    Military organizations use movement quality screening for prediction of injury risk and performance potential. Currently, evidence of an association between movement quality and performance is limited. Recent work has demonstrated that external loading strengthens the relationship between movement screens and performance outcomes. Such loading may therefore steer us toward robust implementations of movement quality screens while maintaining their appeal as cost effective, field-expedient tools. The purpose of the current study was to quantify the effect of external load-bearing on the relationship between clinically rated movement quality and tactical performance outcomes while addressing the noted limitations. Crossover Trial. Fifty young adults (25 male, 25 female, 22.98 ± 3.09 years, 171.95 ± 11.46 cm, 71.77 ± 14.03 kg) completed the Functional Movement Screen™ with (FMS™W) and without (FMS™C) a weight vest in randomized order. Following FMS™ testing, criterion measures of tactical performance were administered, including agility T-Tests, sprints, a 400-meter run, the Mobility for Battle (MOB) course, and a simulated casualty rescue. For each performance outcome, regression models were selected via group lasso with smoothed FMS™ item scores as candidate predictor variables. For all outcomes, proportion of variance accounted for was greater in FMS™W (R 2 = ;0.22 [T-Test], 0.29 [Sprint], 0.17 [400 meter], 0.29 [MOB], and 0.11 [casualty rescue]) than in FMS™C (R 2 = ;0.00 [T-Test], 0.11 [Sprint], 0.00 [400 meter], 0.19 [MOB], and 0.00 [casualty rescue]). From the FMS™W condition, beneficial performance effects (ptactical performance ability. Future designs should seek to identify mechanisms explaining this effect. 3.

  8. Evidence-based medicine: the fourth revolution in American medicine?

    Science.gov (United States)

    Chung, Kevin C; Ram, Ashwin N

    2009-01-01

    The use of evidence has become a force in American medicine to improve the quality of health care. Funding decisions from payers will demand studies with high-level evidence to support many of the costly interventions in medicine. Plastic surgery is certainly not immune to this national tidal wave to revamp the health care system by embracing evidence-based medicine in our practices. In scientific contributions of plastic surgery research, application of evidence-based principles should enhance the care of all patients by relying on science rather than opinions. In this article, the genesis of evidence-based medicine is discussed to guide plastic surgery in this new revolution in American medicine.

  9. Does competition between hospitals improve clinical quality?: a review of evidence from two eras of competition in the English NHS

    OpenAIRE

    Gwyn Bevan; Matthew Skellern

    2011-01-01

    Gwyn Bevan and Matthew Skellern review evidence on the effects of hospital competition on quality of care within the English NHS and question whether they support government proposals to extend competition.

  10. Quality Assurance and Evidence in Career Guidance in Europe: Counting What Is Measured or Measuring What Counts?

    Science.gov (United States)

    Plant, Peter

    2012-01-01

    Quality assurance (QA) and Evidence in career guidance are increasingly seen as an indispensable part of explaining and even legitimising career guidance activities and policies. It is no longer sufficient to assume that career guidance or career education has an impact. This has to be demonstrated. This paper provides an overview of how and why…

  11. Surviving or thriving: quality assurance mechanisms to promote innovation in the development of evidence-based parenting interventions.

    Science.gov (United States)

    Sanders, Matthew R; Kirby, James N

    2015-04-01

    Parenting interventions have the potential to make a significant impact to the prevention and treatment of major social and mental health problems of children. However, parenting interventions fail to do so because program developers pay insufficient attention to the broader ecological context that influences the adoption and implementation of evidence-based interventions. This context includes the professional and scientific community, end users, consumers, and broader sociopolitical environment within which parenting services are delivered. This paper presents an iterative stage model of quality assurance steps to guide ongoing research and development particularly those related to program innovations including theory building, intervention development, pilot testing, efficacy and effectiveness trials, program refinement, dissemination, and planning for implementation and political advocacy. The key challenges associated with each phase of the research and development process are identified. Stronger consumer participation throughout the entire process from initial program design to wider community dissemination is an important, but an often ignored part of the process. Specific quality assurance mechanisms are discussed that increase accountability, professional, and consumer confidence in an intervention and the evidence supporting its efficacy.

  12. Statistical evidences of absorption at high latitudes

    International Nuclear Information System (INIS)

    Fesenko, B.I.

    1980-01-01

    Evidences are considered which indicate to the significant effect of the irregular interstellar absorption at high latitudes b. The number density of faint galaxies grows with the increasing |b| even at the values of |b| exceeding 50 deg. The effects of interstellar medium are traced even in the directions of the stars and globular clusters with very low values of the colour excess. The coefficient of absorption, Asub(B)=0.29+-0.05, was estimated from the colours of the bright E-galaxies [ru

  13. The Navigation Guide - evidence-based medicine meets environmental health: integration of animal and human evidence for PFOA effects on fetal growth.

    Science.gov (United States)

    Lam, Juleen; Koustas, Erica; Sutton, Patrice; Johnson, Paula I; Atchley, Dylan S; Sen, Saunak; Robinson, Karen A; Axelrad, Daniel A; Woodruff, Tracey J

    2014-10-01

    The Navigation Guide is a novel systematic review method to synthesize scientific evidence and reach strength of evidence conclusions for environmental health decision making. Our aim was to integrate scientific findings from human and nonhuman studies to determine the overall strength of evidence for the question "Does developmental exposure to perfluorooctanoic acid (PFOA) affect fetal growth in humans?" We developed and applied prespecified criteria to systematically and transparently a) rate the quality of the scientific evidence as "high," "moderate," or "low"; b) rate the strength of the human and nonhuman evidence separately as "sufficient," "limited," "moderate," or "evidence of lack of toxicity"; and c) integrate the strength of the human and nonhuman evidence ratings into a strength of the evidence conclusion. We identified 18 epidemiology studies and 21 animal toxicology studies relevant to our study question. We rated both the human and nonhuman mammalian evidence as "moderate" quality and "sufficient" strength. Integration of these evidence ratings produced a final strength of evidence rating in which review authors concluded that PFOA is "known to be toxic" to human reproduction and development based on sufficient evidence of decreased fetal growth in both human and nonhuman mammalian species. We concluded that developmental exposure to PFOA adversely affects human health based on sufficient evidence of decreased fetal growth in both human and nonhuman mammalian species. The results of this case study demonstrate the application of a systematic and transparent methodology, via the Navigation Guide, for reaching strength of evidence conclusions in environmental health.

  14. Building an evidence base for community health: a review of the quality of program evaluations.

    Science.gov (United States)

    Jolley, Gwyn M; Lawless, Angela P; Baum, Fran E; Hurley, Catherine J; Fry, Denise

    2007-11-01

    An assessment of the quality of program evaluations conducted in South Australian community health services investigated how effective evaluation reporting is in producing an evidence base for community health. Evaluation reports were assessed by a team of reviewers. Practitioner workshops allowed an understanding of the uses of evaluation and what promotes or acts as a barrier to undertaking evaluations. Community health services do undertake a good deal of evaluation. However, reports were not generally explicit in dealing with the principles that underpin community health. Few engaged with program theory or rationale. Typically, reports were of short-term projects with uncertain futures so there may seem little point in considering issues of long-term health outcomes and transferability to other settings. The most important issue from our study is the lack of investment in applied health services research of the sort that will be required to produce the evidence for practice that policy makers desire. The current lack of evidence for community health reflects failure of the system to invest in research and evaluation that is adequately resourced and designed for complex community settings.

  15. Abstract analysis method facilitates filtering low-methodological quality and high-bias risk systematic reviews on psoriasis interventions.

    Science.gov (United States)

    Gómez-García, Francisco; Ruano, Juan; Aguilar-Luque, Macarena; Alcalde-Mellado, Patricia; Gay-Mimbrera, Jesús; Hernández-Romero, José Luis; Sanz-Cabanillas, Juan Luis; Maestre-López, Beatriz; González-Padilla, Marcelino; Carmona-Fernández, Pedro J; García-Nieto, Antonio Vélez; Isla-Tejera, Beatriz

    2017-12-29

    Article summaries' information and structure may influence researchers/clinicians' decisions to conduct deeper full-text analyses. Specifically, abstracts of systematic reviews (SRs) and meta-analyses (MA) should provide structured summaries for quick assessment. This study explored a method for determining the methodological quality and bias risk of full-text reviews using abstract information alone. Systematic literature searches for SRs and/or MA about psoriasis were undertaken on MEDLINE, EMBASE, and Cochrane database. For each review, quality, abstract-reporting completeness, full-text methodological quality, and bias risk were evaluated using Preferred Reporting Items for Systematic Reviews and Meta-analyses for abstracts (PRISMA-A), Assessing the Methodological Quality of Systematic Reviews (AMSTAR), and ROBIS tools, respectively. Article-, author-, and journal-derived metadata were systematically extracted from eligible studies using a piloted template, and explanatory variables concerning abstract-reporting quality were assessed using univariate and multivariate-regression models. Two classification models concerning SRs' methodological quality and bias risk were developed based on per-item and total PRISMA-A scores and decision-tree algorithms. This work was supported, in part, by project ICI1400136 (JR). No funding was received from any pharmaceutical company. This study analysed 139 SRs on psoriasis interventions. On average, they featured 56.7% of PRISMA-A items. The mean total PRISMA-A score was significantly higher for high-methodological-quality SRs than for moderate- and low-methodological-quality reviews. SRs with low-bias risk showed higher total PRISMA-A values than reviews with high-bias risk. In the final model, only 'authors per review > 6' (OR: 1.098; 95%CI: 1.012-1.194), 'academic source of funding' (OR: 3.630; 95%CI: 1.788-7.542), and 'PRISMA-endorsed journal' (OR: 4.370; 95%CI: 1.785-10.98) predicted PRISMA-A variability. Reviews with a

  16. Systematic Review of Measurement Property Evidence for 8 Financial Management Instruments in Populations With Acquired Cognitive Impairment.

    Science.gov (United States)

    Engel, Lisa; Chui, Adora; Beaton, Dorcas E; Green, Robin E; Dawson, Deirdre R

    2018-03-07

    To critically appraise the measurement property evidence (ie, psychometric) for 8 observation-based financial management assessment instruments. Seven databases were searched in May 2015. Two reviewers used an independent decision-agreement process to select studies of measurement property evidence relevant to populations with adulthood acquired cognitive impairment, appraise the quality of the evidence, and extract data. Twenty-one articles were selected. This review used the COnsensus-based Standards for the selection of health Measurement Instruments review guidelines and 4-point tool to appraise evidence. After appraising the methodologic quality, the adequacy of results and volume of evidence per instrument were synthesized. Measurement property evidence with high risk of bias was excluded from the synthesis. The volume of measurement property evidence per instrument is low; most instruments had 1 to 3 included studies. Many included studies had poor methodologic quality per measurement property evidence area examined. Six of the 8 instruments reviewed had supporting construct validity/hypothesis-testing evidence of fair methodologic quality. There is a dearth of acceptable quality content validity, reliability, and responsiveness evidence for all 8 instruments. Rehabilitation practitioners assess financial management functions in adults with acquired cognitive impairments. However, there is limited published evidence to support using any of the reviewed instruments. Practitioners should exercise caution when interpreting the results of these instruments. This review highlights the importance of appraising the quality of measurement property evidence before examining the adequacy of the results and synthesizing the evidence. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  17. Integration study of high quality teaching resources in universities

    Directory of Open Access Journals (Sweden)

    Honglu Liu

    2012-12-01

    Full Text Available Purpose: The development level and quality of education depend on the merits and efficiency in the use of teaching resources, especially in the case of obvious contradiction between the demand and supply of teaching resources. So to integrate teaching resources, improve the efficiency in the use of high quality teaching resources, and take the road of content development to enhance the competitiveness of education has become very important and urgent.Design/methodology/approach: On the basis of analysis on the teaching resources of universities and the problems they faced, this paper introduced the basic concepts of cloud storage, and built the integration architecture of high quality teaching resources in universities based on the cloud storage.Findings and Originality/value: The HDFS-based cloud storage proposed in this paper is a dynamically adjustable and Internet-based storage solution, and the users can access storage targets using the network through a common and easy-to-use protocol and application programming interfaces. This new technology is useful for end users benefits. With the continuous development and improvement of cloud storage, it will necessarily result in more and more applications in the institutions of higher learning and education network.Originality/value: This paper introduced the cloud storage into the integration of high quality teaching resources in universities first and as a new form of service, it can be a good solution.

  18. Achieving high-quality care: a view from NICE.

    Science.gov (United States)

    Leng, Gillian; Partridge, Gemma

    2018-01-01

    The National Institute for Health and Care Excellence (NICE) was established in 1999 to provide evidence-based guidance. The task of producing guidance by reviewing primary research data and using an advisory committee to develop evidence-based recommendations, is not straightforward. Guidance production is, however, less challenging than the task of putting evidence-based recommendations into practice.NICE is very sensitive to this challenge as, since 1999, over 1500 pieces of NICE guidance have been published. A number of pieces of guidance relate to heart disease, including pharmaceutical agents, new medical technologies and clinical guidelines. Examples include guidelines on acute heart failure and atrial fibrillation, and advice on technologies including edoxaban and implantable cardioverter defibrillators.The research evidence is clear that a change in practice rarely comes about as a result of simply disseminating guidance on best practice. Simple dissemination is particularly ineffective if the guidance has not been produced by a well-respected, credible organisation. It is also clear from the literature that implementation is more successful when more than one approach is taken, and when there is alignment between efforts at organisational, local and national levels.At an organisational level, there should be support from the Board for quality improvement, with ongoing measurement of progress. Resources should be provided for targeted change programmes, particularly where new guidance suggests improvements are required. A systematic process for putting change in place should include identifying barriers to change, agreeing interventions to overcome the barriers and drive forward improvement and planning for implementation and evaluation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Website quality indicators for consumers.

    Science.gov (United States)

    Griffiths, Kathleen M; Christensen, Helen

    2005-11-15

    The rating tool DISCERN was designed for use by consumers without content expertise to evaluate the quality of health information. There is some evidence that DISCERN may be a valid indicator of evidence-based website quality when applied by health professionals. However, it is not known if the tool is a valid measure of evidence-based quality when used by consumers. Since it is a lengthy instrument requiring training in its use, DISCERN may prove impractical for use by the typical consumer. It is therefore important to explore the validity of other simpler potential indicators of site quality such as Google PageRank. This study aimed to determine (1) whether the instrument DISCERN is a valid indicator of evidence-based Web content quality for consumers without specific mental health training, and (2) whether Google PageRank is an indicator of website content quality as measured by an evidence-based gold standard. This was a cross-sectional survey of depression websites using consumer and health professional raters. The main outcome measures were (1) site characteristics, (2) evidence-based quality of content as measured by evidence-based depression guidelines, (3) DISCERN scores, (4) Google PageRank, and (5) user satisfaction. There was a significant association between evidence-based quality ratings and average DISCERN ratings both for consumers (r = 0.62, P = .001) and health professionals (r = 0.80, P PageRank (r = 0.59, P = .002). However, the correlation between DISCERN scores and user satisfaction was higher than the correlation between Google PageRank and user satisfaction. DISCERN has potential as an indicator of content quality when used either by experts or by consumers. Google PageRank shows some promise as an automatic indicator of quality.

  20. Quality, language, subdiscipline and promotion were associated with article accesses on Physiotherapy Evidence Database (PEDro).

    Science.gov (United States)

    Yamato, Tiê P; Arora, Mohit; Stevens, Matthew L; Elkins, Mark R; Moseley, Anne M

    2018-03-01

    To quantify the relationship between the number of times articles are accessed on the Physiotherapy Evidence Database (PEDro) and the article characteristics. A secondary aim was to examine the relationship between accesses and the number of citations of articles. The study was conducted to derive prediction models for the number of accesses of articles indexed on PEDro from factors that may influence an article's accesses. All articles available on PEDro from August 2014 to January 2015 were included. We extracted variables relating to the algorithm used to present PEDro search results (research design, year of publication, PEDro score, source of systematic review (Cochrane or non-Cochrane)) plus language, subdiscipline of physiotherapy, and whether articles were promoted to PEDro users. Three predictive models were examined using multiple regression analysis. Citation and journal impact factor were downloaded. There were 29,313 articles indexed in this period. We identified seven factors that predicted the number of accesses. More accesses were noted for factors related to the algorithm used to present PEDro search results (synthesis research (i.e., guidelines and reviews), recent articles, Cochrane reviews, and higher PEDro score) plus publication in English and being promoted to PEDro users. The musculoskeletal, neurology, orthopaedics, sports, and paediatrics subdisciplines were associated with more accesses. We also found that there was no association between number of accesses and citations. The number of times an article is accessed on PEDro is partly predicted by how condensed and high quality the evidence it contains is. Copyright © 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  1. Higher prices, higher quality? Evidence from German nursing homes.

    Science.gov (United States)

    Herr, Annika; Hottenrott, Hanna

    2016-02-01

    This study investigates the relationship between prices and quality of 7400 German nursing homes. We use a cross section of public quality reports for all German nursing homes, which had been evaluated between 2010 and 2013 by external institutions. Our analysis is based on multivariate regressions in a two stage least squares framework, where we instrument prices to explain their effect on quality controlling for income, nursing home density, demographics, labour market characteristics, and infrastructure at the regional level. Descriptive analysis shows that prices and quality do not only vary across nursing homes, but also across counties and federal states and that quality and prices correlate positively. Second, the econometric analysis, which accounts for the endogenous relation between negotiated price and reported quality, shows that quality indeed positively depends on prices. In addition, more places in nursing homes per people in need are correlated with both lower prices and higher quality. Finally, unobserved factors at the federal state level capture some of the variation of reported quality across nursing homes. Our results suggest that higher prices increase quality. Furthermore, since reported quality and prices vary substantially across federal states, we conclude that the quality and prices of long-term care facilities may well be compared within federal states but not across. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Substance Abuse Intensive Outpatient Programs: Assessing the Evidence

    Science.gov (United States)

    McCarty, Dennis; Braude, Lisa; Dougherty, Richard H.; Daniels, Allen S.; Ghose, Sushmita Shoma; Delphin-Rittmon, Miriam E.

    2014-01-01

    Objective Substance abuse intensive outpatient programs (IOPs) are direct services for people with substance use disorders or co-occurring mental and substance use disorders who do not require medical detoxification or 24-hour supervision. IOPs are alternatives to inpatient and residential treatment. They are designed to establish psychosocial supports and facilitate relapse management and coping strategies. This article assesses their evidence base. Methods Authors searched major databases: PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, Published International Literature on Traumatic Stress, the Educational Resources Information Center, and the Cumulative Index to Nursing and Allied Health Literature. They identified 12 individual studies and one review published between 1995 and 2012. They chose from three levels of research evidence (high, moderate, and low) based on benchmarks for the number of studies and quality of their methodology. They also described the evidence of service effectiveness. Results Based on the quality of trials, diversity of settings, and consistency of outcomes, the level of evidence for IOP research was considered high. Multiple randomized trials and naturalistic analyses compared IOPs with inpatient or residential care; these types of services had comparable outcomes. All studies reported substantial reductions in alcohol and drug use between baseline and follow-up. However, substantial variability in the operationalization of IOPs and outcome measures was apparent. Conclusions IOPs are an important part of the continuum of care for alcohol and drug use disorders. They are as effective as inpatient treatment for most individuals seeking care. Public and commercial health plans should consider IOP treatment as a covered health benefit. Standardization of the elements included in IOPs may improve their quality and effectiveness. PMID:24445620

  3. Quality Education in Idaho: A Case Study of Academic Achievement in Three High-Poverty Rural Schools

    Science.gov (United States)

    Brown, Christine

    2017-01-01

    The focus of this research is bridging the achievement gap for students living in poverty through quality education. Such a study is important because the percentage of students affected by poverty is increasing and the persistent gap in achievement evidences that the right to quality education for students in poverty is not being met. This is…

  4. Institutional quality and private sector participation: theory and empirical findings

    Directory of Open Access Journals (Sweden)

    Rahel Schomaker

    2014-12-01

    Full Text Available Through several conduits, sound institutional quality is pivotal for economic development, as there is evidence that stable democratic institutions, rule of law and sound governance structures in the administration are highly conducive to promote growth. Therefore, a high institutional quality is not only the end point, but also the starting point of a more sustainable development. In this paper we provide some theoretical considerations as well as empirical evidence, based on several regression analyses, that the quality of institutions in a wider sense, and governance, which includes not only the level of “politics” itself, but also the administrative level, is relevant not only for the macro-level of development (i.e. the increase of the national welfare and foreign investment, but also on a micro-level: A stronger participation of private enterprises in public service provision and the introduction of public-private part¬nerships depends to a high degree on the institutional quality. This is even more relevant as the improvement of public services and of core infrastructures can be seen as crucial multipliers for future growth.

  5. EXPERT-ANALITICAL MONITORING OF LEARNING PROCESS QUALITY IN HIGH SCHOOL

    Directory of Open Access Journals (Sweden)

    T. M. Korotun

    2010-10-01

    Full Text Available The technological model is proposed for monitoring process of learning process quality in high school compliant with current European and home standards. The mathematical methods are elaborated for diverse activities as to learning process objects quality determination unified support. They self-consistently combine: automatic expert evaluation with Bayesian net and Value tree models; Delphi technique enhancement; best practices for education quality assessment. Quality estimates’ consistency index is introduced for their choice and acceptability analysis. Its permanent increasing over monitoring stages is guaranteed. The tools for these stages’ automatic support are described.

  6. Synthesis of high-quality diesel with furfural and 2-methylfuran from hemicellulose.

    Science.gov (United States)

    Li, Guangyi; Li, Ning; Wang, Zhiqiang; Li, Changzhi; Wang, Aiqin; Wang, Xiaodong; Cong, Yu; Zhang, Tao

    2012-10-01

    Hydroxyalkylation-alkylation (HAA) coupled with hydrodeoxygenation is a promising route for the synthesis of renewable high-quality diesel or jet fuel. In this work, a series of solid-acid catalysts were firstly used for HAA between lignocellulose-derived furan and carbonyl compounds. Among the investigated catalysts, Nafion-212 resin demonstrated the highest activity and stability. Owing to the high activity of the reactants and the advantage in industrial integration, the HAA of 2-methylfuran (2-MF) and furfural can be considered as a prospective route in future applications. Catalyst loading, reaction temperature, and time had evident effects on the HAA of 2-MF and furfural over Nafion-212 resin. Finally, the HAA product of 2-MF and furfural was hydrogenated over a Pd/C catalyst and hydrodeoxygenated over Pt-loaded solid-acid catalysts. Pt/zirconium phosphate (Pt/ZrP) was found to be the best catalyst for hydrodeoxygenation. Over the 4 % Pt/ZrP catalyst, a 94 % carbon yield of diesel and 75 % carbon yield of C15 hydrocarbons (with 6-butylundecane as the major component) was achieved. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  7. Combined microfluidization and ultrasonication: a synergistic protocol for high-efficient processing of SWCNT dispersions with high quality

    Energy Technology Data Exchange (ETDEWEB)

    Luo, Sida, E-mail: s.luo@buaa.edu.cn [Beihang University, School of Mechanical Engineering and Automation (China); Liu, Tao, E-mail: tliu@fsu.edu [Florida State University, High-Performance Materials Institute (United States); Wang, Yong; Li, Liuhe [Beihang University, School of Mechanical Engineering and Automation (China); Wang, Guantao; Luo, Yun [China University of Geosciences, Center of Safety Research, School of Engineering and Technology (China)

    2016-08-15

    High-efficient and large-scale production of high-quality CNT dispersions is necessary for meeting the future needs to develop various CNT-based electronic devices. Herein, we have designed novel processing protocols by combining conventional ultrasonication process with a new microfluidization technique to produce high-quality SWCNT dispersions with improved processing efficiency. To judge the quality of SWCNT dispersions, one critical factor is the degree of exfoliation, which could be quantified by both geometrical dimension of the exfoliated nanotubes and percentage of individual tubes in a given dispersion. In this paper, the synergistic effect of the combined protocols was systematically investigated through evaluating SWCNT dispersions with newly developed characterization techniques, namely preparative ultracentrifuge method (PUM) and simultaneous Raman scattering and photoluminescence spectroscopy (SRSPL). The results of both techniques draw similar conclusions that as compared with either of the processes operated separately, a low-pass microfluidization followed by a reasonable duration of ultrasonication could substantially improve the processing efficiency to produce high-quality SWCNT dispersions with averaged particle length and diameter as small as ~600 and ~2 nm, respectively.Graphical abstract.

  8. Development of a method for the classification of geochemical data quality

    International Nuclear Information System (INIS)

    Sugita, Kenichirou

    2005-03-01

    This report describes the development of a method for the classification of geochemical data quality. The project had four tasks: (1) review of quality information; (2) development of Evidence Support Logic (ESL) models; (3) development of rules for choosing parameter values; (4) classification of existing data. During H15, JNC developed a preliminary system for classifying groundwater chemical data according to its quality. This system gives a very general indication of data quality, but has a number of limitations. Notably, it is based on adding together scores for individual quality indicators, so that high scores given by some indicators tend to compensate for low scores given by other indicators. Additionally, the system does not distinguish between cases where data quality is poor and cases where data quality is unknown. A further limitation is that the system is based on only a small number of the quality indicators that could be used. By using ESL to develop a new system for classifying geochemical data quality, these limitations can be avoided. This methodology involves weighing evidence for and against a particular hypothesis being true or reliable. Varied evidence, which may be quantitative or qualitative, can be evaluated in an integrated fashion. A process model is constructed to link a hypothesis of interest to evidence corresponding to observations and quantitative data, usually via intermediate processes. An arithmetical approach is then used to propagate evidence through the model. Thus, the approach does not rely on simple addition of quality scores for individual parameters. In this project, evidence for and evidence against the hypothesis that groundwater chemical data represent in-situ conditions are evaluated independently. Both kinds of evidence are represented using numerical scales from 0 to 1. Lack of information about data quality is then represented by 1 - evidence for - evidence against. In this way the situation where the available

  9. Treatment of Scoliosis-Evidence and Management (Review of the Literature

    Directory of Open Access Journals (Sweden)

    Weiss

    2016-04-01

    Full Text Available Context Scoliosis is a three-dimensional deformity of the spine and trunk which includes lateral deviation, rotation, and a disturbance of the sagittal profile. Treatment is indicated for scoliosis because it may lead to negative consequences with regard to the quality of life and other health issues for some patients. The purpose of this review was to gather current, up-to-date information, and to search the recent articles on scoliosis for evidence of the different modes of treatment. Evidence Acquisition A PubMed search for review articles, prospective controlled trials (PCT, and randomized controlled trials (RCT was performed. The search terms were: 1 scoliosis, treatment (12,045 items found; 2 scoliosis, physiotherapy (776 items found; 3 scoliosis, brace treatment (1,447 items found; and 4 scoliosis, surgery (10,485 items found. Results When looking at the current literature, high quality evidence (level I was found to support physical rehabilitation and brace treatments, while no evidence was found to support spinal fusion surgery. The numerous long-term complications that patients may face post-operation, and the lack of evidence for spinal fusion surgery indicate that there is no clear medical indication for this kind of treatment. Conclusions There is a high level of evidence for the conservative treatment of scoliosis, but there are varying levels of success in the different approaches. The better the correction of the curve, the better the end result and outcome for the patient. This is supported by the current evidence reviewed in this paper. Physiotherapy and bracing should be used and, specifically, those approaches using high corrective methods. Spinal fusion surgery is not supported by the current evidence. According to the literature, the long-term complications of surgery for scoliosis far outweigh the consequences of untreated scoliosis.

  10. Actinic Keratosis Clinical Practice Guidelines: An Appraisal of Quality

    Directory of Open Access Journals (Sweden)

    Joslyn S. Kirby

    2015-01-01

    Full Text Available Actinic keratosis (AK is a common precancerous skin lesion and many AK management guidelines exist, but there has been limited investigation into the quality of these documents. The objective of this study was to assess the strengths and weaknesses of guidelines that address AK management. A systematic search for guidelines with recommendations for AK was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE II was used to appraise the quality of guidelines. Multiple raters independently reviewed each of the guidelines and applied the AGREE II tool and scores were calculated. Overall, 2,307 citations were identified and 7 fulfilled the study criteria. The Cancer Council of Australia/Australian Cancer Network guideline had the highest mean scores and was the only guideline to include a systematic review, include an evidence rating for recommendations, and report conflicts of interest and funding sources. High-quality, effective guidelines are evidence-based with recommendations that are concise and organized, so practical application is facilitated. Features such as concise tables, pictorial diagrams, and explicit links to evidence are helpful. However, the rigor and validity of some guidelines were weak. So, it is important for providers to be aware of the features that contribute to a high-quality, practical document.

  11. Validating evidence based decision making in health care

    DEFF Research Database (Denmark)

    Nüssler, Emil Karl; Eskildsen, Jacob Kjær; Håkonsson, Dorthe Døjbak

    Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register o...... are highly influenced by the geographical placement of surgeons. Therfore, decisions to use mesh are boundedly rationality, rather than rational.......Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register...... of Gynecological Surgery we examine factors related to decisions to use mesh. Our results indicate that decisions to use mesh are not evidence based, and cannot be explained neither by FDA safety communications, nor by medical conditions usually assumed to predict its usage. Instead, decisions to use mesh...

  12. Psiquiatria baseada em evidências Evidence-based psychiatry

    Directory of Open Access Journals (Sweden)

    Maurício S de Lima

    2000-09-01

    Full Text Available Em psiquiatria, observa-se grande variabilidade de práticas clínicas, muitas vezes desnecessária. Essas variações podem estar relacionadas à ausência de evidência científica confiável ou ao desconhecimento das evidências de boa qualidade disponíveis. A medicina baseada em evidências (MBE é uma combinação de estratégias que busca assegurar que o cuidado individual do paciente seja baseado na melhor informação disponível, a qual deve ser incorporada à prática clínica. Neste artigo, conceitos de MBE são discutidos com relação a aspectos e desafios no tratamento de pacientes com distimia, bulimia nervosa e esquizofrenia. A partir de resultados de três revisões sistemáticas recentemente publicadas, conclui-se que a prática de psiquiatria baseada em evidências acrescenta qualidade à prática psiquiátrica tradicional.The unnecessary variability often seen in the clinical practice can be related to both the absence of reliable evidence and unawareness of the existence of good quality evidence. Evidence-Based Medicine (EBM is a set of linked strategies designed to assist clinicians in keeping themselves up-to-date with the best available evidence. Such evidence must be incorporated into the clinical practice. EBM concepts are discussed here through common aspects and challenges doctors face when treating patients with dysthymia, bulimia nervosa, and schizophrenia. In the light of some results from three systematic reviews it is concluded that Evidence-Based Psychiatry strategies, rather than replacing the traditional ones, may be a valuable tool to improving quality in a good clinical practice.

  13. Examination of Operation Quality for High-frequent Railway Operation

    DEFF Research Database (Denmark)

    Landex, Alex; Kaas, Anders H.

    2009-01-01

    take the first train in their direction. The article examines four different approaches to examine operation quality for high-frequent operation that are based on the experiences of the passengers. These approaches are the service frequency of the operation, travel time extension, a combination......The examination of operation quality for high-frequent operation requires other approaches than the typical evaluation of punctuality (trains on time) and reliability (operated trains). This is because passengers in high-frequent railway systems do not necessarily notice train delays as they just...... of the service frequency and travel time approaches, and passenger delays. The service frequency and travel time approaches are simple measurements with low complexity and complement each other. Therefore, the article recommends combining the service frequency and travel time approaches to get a more accurate...

  14. Health-care quality and information failure: Evidence from Nigeria.

    Science.gov (United States)

    Evans, David K; Welander Tärneberg, Anna

    2018-03-01

    Low-quality health services are a problem across low- and middle-income countries. Information failure may contribute, as patients may have insufficient knowledge to discern the quality of health services. That decreases the likelihood that patients will sort into higher quality facilities, increasing demand for better health services. This paper presents results from a health survey in Nigeria to investigate whether patients can evaluate health service quality effectively. Specifically, this paper demonstrates that although more than 90% of patients agree with any positive statement about the quality of their local health services, satisfaction is significantly associated with the diagnostic ability of health workers at the facility. Satisfaction is not associated with more superficial characteristics such as infrastructure quality or prescriptions of medicines. This suggests that patients may have sufficient information to discern some of the most important elements of quality, but that alternative measures are crucial for gauging the overall quality of care. Copyright © The World Bank Health Economics © 2017 John Wiley & Sons, Ltd.

  15. Endorectal high dose rate brachytherapy quality assurance

    International Nuclear Information System (INIS)

    Devic, S.; Vuong, T.; Evans, M.; Podgorsak, E.

    2008-01-01

    We describe our quality assurance method for preoperative high dose rate (HDR) brachytherapy of endorectal tumours. Reproduction of the treatment planning dose distribution on a daily basis is crucial for treatment success. Due to the cylindrical symmetry, two types of adjustments are necessary: applicator rotation and dose distribution shift along the applicator axis. (author)

  16. The quality and accessibility of Australian depression sites on the World Wide Web.

    Science.gov (United States)

    Griffiths, Kathleen M; Christensen, Helen

    2002-05-20

    To provide information about Australian depression sites and the quality of their content; to identify possible indicators of the quality of site content; and determine the accessibility of Australian depression web sites. Cross-sectional survey of 15 Australian depression web sites. (i) Quality of treatment content (concordance of site information with evidence-based guidelines, number of evidence-based treatments recommended, discussion of other relevant issues, subjective rating of treatment content); (ii) potential quality indicators (conformity with DISCERN criteria, citation of scientific evidence); (iii) accessibility (search engine rank). Mean content quality scores were not high and site accessibility was poor. There was a consistent association between the quality-of-content measures and the DISCERN and scientific accountability scores. Search engine rank was not associated with content quality. The quality of information about depression on Australian websites could be improved. DISCERN may be a useful indicator of website quality, as may scientific accountability. The sites that received the highest quality-of-content ratings were beyondblue, BluePages, CRUfAD and InfraPsych.

  17. Mobile Phone Apps to Improve Medication Adherence: A Systematic Stepwise Process to Identify High-Quality Apps.

    Science.gov (United States)

    Santo, Karla; Richtering, Sarah S; Chalmers, John; Thiagalingam, Aravinda; Chow, Clara K; Redfern, Julie

    2016-12-02

    basic apps. Using the MARS instrument, we were able to identify high-quality apps that were rated as being very interesting and entertaining, highly interactive and customizable, intuitive, and easy to use and to navigate as well as having a high level of visual appeal and good-quality information. Many medication reminder apps are available in the app stores; however, the majority of them did not have many of the desirable features and were, therefore, considered low quality. Through a systematic stepwise process, we were able to identify high-quality apps to be tested in a future study that will provide evidence on the use of medication reminder apps to improve medication adherence. ©Karla Santo, Sarah S Richtering, John Chalmers, Aravinda Thiagalingam, Clara K Chow, Julie Redfern. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 02.12.2016.

  18. Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study.

    Science.gov (United States)

    Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

    2016-02-01

    Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.

  19. Information-seeking behavior during residency is associated with quality of theoretical learning, academic career achievements, and evidence-based medical practice: a strobe-compliant article.

    Science.gov (United States)

    Oussalah, Abderrahim; Fournier, Jean-Paul; Guéant, Jean-Louis; Braun, Marc

    2015-02-01

    Data regarding knowledge acquisition during residency training are sparse. Predictors of theoretical learning quality, academic career achievements and evidence-based medical practice during residency are unknown. We performed a cross-sectional study on residents and attending physicians across several residency programs in 2 French faculties of medicine. We comprehensively evaluated the information-seeking behavior (I-SB) during residency using a standardized questionnaire and looked for independent predictors of theoretical learning quality, academic career achievements, and evidence-based medical practice among I-SB components using multivariate logistic regression analysis. Between February 2013 and May 2013, 338 fellows and attending physicians were included in the study. Textbooks and international medical journals were reported to be used on a regular basis by 24% and 57% of the respondents, respectively. Among the respondents, 47% refer systematically (4.4%) or frequently (42.6%) to published guidelines from scientific societies upon their publication. The median self-reported theoretical learning quality score was 5/10 (interquartile range, 3-6; range, 1-10). A high theoretical learning quality score (upper quartile) was independently and strongly associated with the following I-SB components: systematic reading of clinical guidelines upon their publication (odds ratio [OR], 5.55; 95% confidence interval [CI], 1.77-17.44); having access to a library that offers the leading textbooks of the specialty in the medical department (OR, 2.45, 95% CI, 1.33-4.52); knowledge of the specialty leading textbooks (OR, 2.12; 95% CI, 1.09-4.10); and PubMed search skill score ≥5/10 (OR, 1.94; 95% CI, 1.01-3.73). Research Master (M2) and/or PhD thesis enrolment were independently and strongly associated with the following predictors: PubMed search skill score ≥5/10 (OR, 4.10; 95% CI, 1.46-11.53); knowledge of the leading medical journals of the specialty (OR, 3.33; 95

  20. Strong Public Health Recommendations from Weak Evidence? Lessons Learned in Developing Guidance on the Public Health Management of Meningococcal Disease

    Directory of Open Access Journals (Sweden)

    Germaine Hanquet

    2015-01-01

    Full Text Available The evidence underpinning public health policy is often of low quality, leading to inconsistencies in recommended interventions. One example is the divergence in national policies across Europe for managing contacts of invasive meningococcal disease. Aiming to develop consistent guidance at the European level, a group of experts reviewed the literature and formulated recommendations. The group defined eight priority research questions, searched the literature, and formulated recommendations using GRADE methodology. Five of the research questions are discussed in this paper. After taking into account quality of evidence, benefit, harm, value, preference, burden on patient of the intervention, and resource implications, we made four strong recommendations and five weak recommendations for intervention. Strong recommendations related not only to one question with very low quality of evidence as well as to two questions with moderate to high quality of evidence. The weak recommendations related to two questions with low and very low quality of evidence but also to one question with moderate quality of evidence. GRADE methodology ensures a transparent process and explicit recognition of additional factors that should be considered when making recommendations for policy. This approach can be usefully applied to many areas of public health policy where evidence quality is often low.

  1. The Barriers to High-Quality Inpatient Pain Management: A Qualitative Study.

    Science.gov (United States)

    Lin, Richard J; Reid, M Carrington; Liu, Lydia L; Chused, Amy E; Evans, Arthur T

    2015-09-01

    The current literature suggests deficiencies in the quality of acute pain management among general medical inpatients. The aim of this qualitative study is to identify potential barriers to high-quality acute pain management among general medical inpatients at an urban academic medical center during a 2-year period. Data are collected using retrospective chart reviews, survey questionnaires, and semistructured, open-ended interviews of 40 general medical inpatients who have experienced pain during their hospitalization. Our results confirm high prevalence and disabling impacts of pain and significant patient- and provider-related barriers to high-quality acute pain management. We also identify unique system-related barriers such as time delay and pain management culture. Efforts to improve the pain management experience of general medical inpatients will need to address all these barriers. © The Author(s) 2014.

  2. When high-volume PCI operators in high-volume hospitals move to lower volume hospitals-Do they still maintain high volume and quality of outcomes?

    Science.gov (United States)

    Lu, Tsung-Hsueh; Li, Sheng-Tun; Liang, Fu-Wen; Lee, Jo-Chi; Yin, Wei-Hsian

    2017-10-31

    The aim of this quasi-experimental study was to examine whether high-volume percutaneous coronary intervention (PCI) operators still maintain high volume and quality of outcomes when they moved to lower volume hospitals. Systematic reviews have indicated that high-volume PCI operators and hospitals have higher quality outcomes. However, little is known on whether high PCI volume and high quality outcomes are mainly due to operator characteristics (i.e., skill and experience) and is portable across organizations or whether it is due to hospital characteristics (i.e., equipment, team, and management system) and is less portable. We used Taiwan National Health Insurance claims data 2000-2012 to identify 98 high-volume PCI operators, 10 of whom moved from one hospital to another during the study period. We compared the PCI volume, risk-adjusted mortality ratio, and major adverse cardiovascular event (MACE) ratio before and after moving. Of the 10 high-volume operators who moved, 6 moved from high- to moderate- or low-volume hospitals, with median annual PCI volumes (interquartile range) of 130 (117-165) in prior hospitals and 54 (46-84) in subsequent hospitals (the hospital the operator moved to), and the remaining 4 moved from high to high-volume hospitals, with median annual PCI volumes (interquartile range) of 151 (133-162) in prior hospitals and 193 (178-239) in subsequent hospitals. No significant differences were observed in the risk-adjusted mortality ratios and MACE ratios between high-volume operators and matched controls before and after moving. High-volume operators cannot maintain high volume when they moved from high to moderate or low-volume hospitals; however, the quality of care is maintained. High PCI volume and high-quality outcomes are less portable and more hospital bound. © 2017 Wiley Periodicals, Inc.

  3. Vertical Integration of Hospitals and Physicians: Economic Theory and Empirical Evidence on Spending and Quality.

    Science.gov (United States)

    Post, Brady; Buchmueller, Tom; Ryan, Andrew M

    2017-08-01

    Hospital-physician vertical integration is on the rise. While increased efficiencies may be possible, emerging research raises concerns about anticompetitive behavior, spending increases, and uncertain effects on quality. In this review, we bring together several of the key theories of vertical integration that exist in the neoclassical and institutional economics literatures and apply these theories to the hospital-physician relationship. We also conduct a literature review of the effects of vertical integration on prices, spending, and quality in the growing body of evidence ( n = 15) to evaluate which of these frameworks have the strongest empirical support. We find some support for vertical foreclosure as a framework for explaining the observed results. We suggest a conceptual model and identify directions for future research. Based on our analysis, we conclude that vertical integration poses a threat to the affordability of health services and merits special attention from policymakers and antitrust authorities.

  4. Characteristics of primary care practices associated with high quality of care.

    Science.gov (United States)

    Beaulieu, Marie-Dominique; Haggerty, Jeannie; Tousignant, Pierre; Barnsley, Janet; Hogg, William; Geneau, Robert; Hudon, Éveline; Duplain, Réjean; Denis, Jean-Louis; Bonin, Lucie; Del Grande, Claudio; Dragieva, Natalyia

    2013-09-03

    No primary practice care model has been shown to be superior in achieving high-quality primary care. We aimed to identify the organizational characteristics of primary care practices that provide high-quality primary care. We performed a cross-sectional observational study involving a stratified random sample of 37 primary care practices from 3 regions of Quebec. We recruited 1457 patients who had 1 of 2 chronic care conditions or 1 of 6 episodic care conditions. The main outcome was the overall technical quality score. We measured organizational characteristics by use of a validated questionnaire and the Team Climate Inventory. Statistical analyses were based on multilevel regression modelling. The following characteristics were strongly associated with overall technical quality of care score: physician remuneration method (27.0; 95% confidence interval [CI] 19.0-35.0), extent of sharing of administrative resources (7.6; 95% CI 0.8-14.4), presence of allied health professionals (15.3; 95% CI 5.4-25.2) and/or specialist physicians (19.6; 95% CI 8.3-30.9), the presence of mechanisms for maintaining or evaluating competence (7.7; 95% CI 3.0-12.4) and average organizational access to the practice (4.9; 95% CI 2.6-7.2). The number of physicians (1.2; 95% CI 0.6-1.8) and the average Team Climate Inventory score (1.3; 95% CI 0.1-2.5) were modestly associated with high-quality care. We identified a common set of organizational characteristics associated with high-quality primary care. Many of these characteristics are amenable to change through practice-level organizational changes.

  5. High quality maize centromere 10 sequence reveals evidence of frequent recombination events

    Directory of Open Access Journals (Sweden)

    Thomas Kai Wolfgruber

    2016-03-01

    Full Text Available The ancestral centromeres of maize contain long stretches of the tandemly arranged CentC repeat. The abundance of tandem DNA repeats and centromeric retrotransposons (CR have presented a significant challenge to completely assembling centromeres using traditional sequencing methods. Here we report a nearly complete assembly of the 1.85 Mb maize centromere 10 from inbred B73 using PacBio technology and BACs from the reference genome project. The error rates estimated from overlapping BAC sequences are 7 x 10-6 and 5 x 10-5 for mismatches and indels, respectively. The number of gaps in the region covered by the reassembly was reduced from 140 in the reference genome to three. Three expressed genes are located between 92 and 477 kb of the inferred ancestral CentC cluster, which lies within the region of highest centromeric repeat density. The improved assembly increased the count of full-length centromeric retrotransposons from 5 to 55 and revealed a 22.7 kb segmental duplication that occurred approximately 121,000 years ago. Our analysis provides evidence of frequent recombination events in the form of partial retrotransposons, deletions within retrotransposons, chimeric retrotransposons, segmental duplications including higher order CentC repeats, a deleted CentC monomer, centromere-proximal inversions, and insertion of mitochondrial sequences. Double-strand DNA break (DSB repair is the most plausible mechanism for these events and may be the major driver of centromere repeat evolution and diversity. This repair appears to be mediated by microhomology, suggesting that tandem repeats may have evolved to facilitate the repair of frequent DSBs in centromeres.

  6. Restless legs syndrome after high-risk TIA and minor stroke: association with reduced quality of life.

    Science.gov (United States)

    Boulos, Mark I; Wan, Anthony; Black, Sandra E; Lim, Andrew S; Swartz, Richard H; Murray, Brian J

    2017-09-01

    Restless legs syndrome (RLS) is a movement disorder that is associated with poor quality of life and depressive symptoms in the general population. Emerging evidence suggests that RLS is closely associated with cerebrovascular disease. We assessed the effect of RLS on quality of life after stroke and transient ischemic attack (TIA). In this single-center prospective study, we recruited patients within 14 days of high-risk TIA or minor stroke. Patients were diagnosed with RLS using a questionnaire based on the 2003 International RLS Study Group criteria, and diagnoses were confirmed by a sleep neurologist. Follow-up assessments were conducted within 2-6 months of recruitment. The outcome of quality of life was measured using the Stroke-specific Quality of Life (SS-QoL). Of the 94 patients recruited into the study, 23 (24.4%) were diagnosed with RLS: 11 were newly diagnosed with RLS and 12 had RLS preceding the index stroke/TIA. There were no significant differences in baseline characteristics between those with or without RLS. Median SS-QoL in patients with RLS was lower at baseline (p = 0.008) and at follow-up (p = 0.002). RLS patients had more depressive symptoms at follow-up (p = 0.007). Ordinal logistic regression demonstrated that RLS was negatively associated with quality of life at baseline (OR = 0.28; p = 0.010) and at follow-up (OR = 0.14; p = 0.029), independent of functional outcome and depressive symptoms. RLS is common after stroke or TIA and negatively affects the quality of life. Screening for RLS after cerebrovascular events may be warranted, and future research should assess whether treatment of RLS can improve post-stroke quality of life. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Predicting Sport and Occupational Lower Extremity Injury Risk through Movement Quality Screening: A Systematic Review

    Science.gov (United States)

    Whittaker, Jackie L; Booysen, Nadine; de la Motte, Sarah; Dennett, Liz; Lewis, Cara L.; Wilson, Dave; McKay, Carly; Warner, Martin; Padua, Darin; Emery, Carolyn A; Stokes, Maria

    2017-01-01

    Background Identification of risk factors for lower extremity (LE) injury in sport and military/first-responder occupations is required to inform injury prevention strategies. Objective To determine if poor movement quality is associated with LE injury in sport and military/first-responder occupations. Material and methods Five electronic databases were systematically searched. Studies selected included: original data; analytic design; movement quality outcome (qualitative rating of functional compensation, asymmetry, impairment or efficiency of movement control); LE injury sustained with sport or military/first-responder occupation. The PRISMA guidelines were followed. Two independent authors assessed the quality [Downs and Black (DB) criteria] and level of evidence (Oxford Centre of Evidence-Based Medicine model). Results Of 4361 potential studies, 17 were included. The majority were low quality cohort studies (level 4 evidence). Median DB score was 11/33 (range 3–15). Heterogeneity in methodology and injury definition precluded meta-analyses. The Functional Movement Screen was the most common outcome investigated (15/17 studies). Four studies considered interrelationships between risk factors, seven reported diagnostic accuracy and none tested an intervention program targeting individuals identified as high-risk. There is inconsistent evidence that poor movement quality is associated with increased risk of LE injury in sport and military/first-responder occupations. Conclusions Future research should focus on high quality cohort studies to identify the most relevant movement quality outcomes for predicting injury risk followed by developing and evaluating pre-participation screening and LE injury prevention programs through high quality randomized controlled trials targeting individuals at greater risk of injury based upon screening tests with validated test properties. PMID:27935483

  8. Building Quality Foundations: Indicators and Instruments to Measure the Quality of Vocational Education and Training

    Science.gov (United States)

    Coates, Hamish

    2009-01-01

    Vocational education and training plays a major and increasing role in developing the knowledge and skills that underpin Australia's economy and society. It is vital, accordingly, that training outcomes are of high quality. This paper reports work undertaken to develop a new evidence-based and outcomes-focused national approach to monitoring and…

  9. Evidence-Based Advances in Reptile Medicine.

    Science.gov (United States)

    Mitchell, Mark A; Perry, Sean M

    2017-09-01

    Evidence-based medicine allows veterinarians to practice high-quality medicine, because the basis for all decision making is quantitative, objective, and reproducible. Case reports and case series are limited in their scope and application. Cross-sectional studies, likewise, cannot provide answers to specific variable testing with a temporal application. It is essential for the reptile specialty to expand into case-control studies, cohort studies, and experimental/intervention studies. Unfortunately, much of the reptile literature remains limited to descriptive studies. This article reviews current evidence-based topics in reptile medicine and shares how everyone practicing in the field can contribute to improving this specialty. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Availability and Quality of Family Planning Services in the Democratic Republic of the Congo: High Potential for Improvement.

    Science.gov (United States)

    Mpunga, Dieudonné; Lumbayi, J P; Dikamba, Nelly; Mwembo, Albert; Ali Mapatano, Mala; Wembodinga, Gilbert

    2017-06-27

    To determine the availability and quality of family planning services within health facilities throughout the Democratic Republic of the Congo (DRC). Data were collected for the cross-sectional study from April 2014 to June 2014 by the Ministry of Public Health. A total of 1,568 health facilities that reported data to the National Health Information System were selected by multistage random sampling in the 11 provinces of the DRC existing at that time. Data were collected through interviews, document review, and direct observation. Two dependent variables were measured: availability of family planning services (consisting of a room for services, staff assigned to family planning, and evidence of client use of family planning) and quality of family planning services (assessed as "high" if the facility had at least 1 trained staff member, family planning service delivery guidelines, at least 3 types of methods, and a sphygmomanometer, or "low" if the facility did not meet any of these 4 criteria). Pearson's chi-square test and odds ratios (ORs) were used to test for significant associations, using the alpha significance level of .05. We successfully surveyed 1,555 facilities (99.2%) of those included in the sample. One in every 3 facilities (33%) offered family planning services as assessed by the index of availability, of which 20% met all 4 criteria for providing high-quality services. Availability was greatest at the highest level of the health system (hospitals) and decreased incrementally with each health system level, with disparities between provinces and urban and rural areas. Facilities in urban areas were more likely than in rural areas to meet the standard for high-quality services ( P facilities were less likely than private facilities to have high-quality services ( P =.02). Among all 1,555 facilities surveyed, 14% had at least 3 types of methods available at the time of the survey; the most widely available methods were male condoms, combined oral

  11. Effect of High-Intensity Interval Versus Continuous Exercise Training on Functional Capacity and Quality of Life in Patients With Coronary Artery Disease: A RANDOMIZED CLINICAL TRIAL.

    Science.gov (United States)

    Jaureguizar, Koldobika Villelabeitia; Vicente-Campos, Davinia; Bautista, Lorena Ruiz; de la Peña, Cesar Hernández; Gómez, María José Arriaza; Rueda, María José Calero; Fernández Mahillo, Ignacio

    2016-01-01

    There is strong evidence that exercise training has beneficial health effects in patients with cardiovascular disease. Most studies have focused on moderate continuous training (MCT); however, a body of evidence has begun to emerge demonstrating that high-intensity interval training (HIIT) has significantly better results in terms of morbidity and mortality. The aim of this study was to compare the effects of MCT versus HIIT on functional capacity and quality of life and to assess safety. Seventy-two patients with ischemic heart disease were assigned to either HIIT or MCT for 8 weeks. We analyzed cardiopulmonary exercise test data, quality of life, and adverse events. High-intensity interval training resulted in a significantly greater increase in (Equation is included in full-text article.)O2peak (4.5 ± 4.7 mL·kg·min) compared with MCT (2.5 ± 3.6 mL·kg·min) (P HIIT and 14% in MCT. Furthermore, there was a significant (P HIIT group (49.6 ± 6.3 m) when compared with the MCT group (29.6 ± 12.0 m). Both training protocols improved quality of life. No adverse events were reported in either of the groups. On the basis of the results of this study, HIIT should be considered for use in cardiac rehabilitation as it resulted in a greater increase in functional capacity compared with MCT. We also observed greater improvement in quality of life without any increase in cardiovascular risk.

  12. Isolation of high quality RNA from pistachio (Pistacia vera L.) and other woody plants high in secondary metabolites.

    Science.gov (United States)

    Moazzam Jazi, Maryam; Rajaei, Saideh; Seyedi, Seyed Mahdi

    2015-10-01

    The quality and quantity of RNA are critical for successful downstream transcriptome-based studies such as microarrays and RNA sequencing (RNA-Seq). RNA isolation from woody plants, such as Pistacia vera, with very high amounts of polyphenols and polysaccharides is an enormous challenge. Here, we describe a highly efficient protocol that overcomes the limitations posed by poor quality and low yield of isolated RNA from pistachio and various recalcitrant woody plants. The key factors that resulted in a yield of 150 μg of high quality RNA per 200 mg of plant tissue include the elimination of phenol from the extraction buffer, raising the concentration of β-mercaptoethanol, long time incubation at 65 °C, and nucleic acid precipitation with optimized volume of NaCl and isopropyl alcohol. Also, the A260/A280 and A260/A230 of extracted RNA were about 1.9-2.1and 2.2-2.3, respectively, revealing the high purity. Since the isolated RNA passed highly stringent quality control standards for sensitive reactions, including RNA sequencing and real-time PCR, it can be considered as a reliable and cost-effective method for RNA extraction from woody plants.

  13. Quack: A quality assurance tool for high throughput sequence data.

    Science.gov (United States)

    Thrash, Adam; Arick, Mark; Peterson, Daniel G

    2018-05-01

    The quality of data generated by high-throughput DNA sequencing tools must be rapidly assessed in order to determine how useful the data may be in making biological discoveries; higher quality data leads to more confident results and conclusions. Due to the ever-increasing size of data sets and the importance of rapid quality assessment, tools that analyze sequencing data should quickly produce easily interpretable graphics. Quack addresses these issues by generating information-dense visualizations from FASTQ files at a speed far surpassing other publicly available quality assurance tools in a manner independent of sequencing technology. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Use of 4MAT Learning Theory to Promote Better Skin Care During Radiation Therapy: An Evidence-Based Quality Improvement Project.

    Science.gov (United States)

    Bauer, Carole; Magnan, Morris; Laszewski, Pamela

    Radiation therapy is a key treatment modality for cancer patients, but it is associated with adverse side effects such as radiation dermatitis. To mitigate the adverse effects of radiation on the skin, patients must participate in skin-related self-care. However, even with self-care instruction, adherence can be poor. This quality improvement project used best available evidence for skin care in patients undergoing radiation therapy and a theoretical framework, 4MATing, to provide a structured approach to patient education designed to enhance adherence to skin care recommendations. Implementation of this approach resulted in increased adherence to a topical skin care protocol in our facility. Patients were highly satisfied with their education. While there was a 4-day delay in the onset of radiation dermatitis, this difference was not statistically significant.

  15. [Quality of sleep and academic performance in high school students].

    Science.gov (United States)

    Bugueño, Maithe; Curihual, Carolina; Olivares, Paulina; Wallace, Josefa; López-AlegrÍa, Fanny; Rivera-López, Gonzalo; Oyanedel, Juan Carlos

    2017-09-01

    Sleeping and studying are the day-to-day activities of a teenager attending school. To determine the quality of sleep and its relationship to the academic performance among students attending morning and afternoon shifts in a public high school. Students of the first and second year of high school answered an interview about socio-demographic background, academic performance, student activities and subjective sleep quality; they were evaluated using the Pittsburgh Sleep Quality Index (PSQI). The interview was answered by 322 first year students aged 15 ± 5 years attending the morning shift and 364 second year students, aged 16 ± 0.5 years, attending the afternoon shift. The components: sleep latency, habitual sleep efficiency, sleep disturbance, drug use and daytime dysfunction were similar and classified as good in both school shifts. The components subjective sleep quality and duration of sleep had higher scores among students of the morning shift. The mean grades during the first semester of the students attending morning and afternoon shifts were 5.9 and 5.8, respectively (of a scale from 1 to 7). Among students of both shifts, the PSQI scale was associated inversely and significantly with academic performance. A bad sleep quality influences academic performance in these students.

  16. extraction of high quality dna from polysaccharides-secreting ...

    African Journals Online (AJOL)

    cistvr

    A DNA extraction method using CTAB was used for the isolation of genomic DNA from ten. Xanthomonas campestris pathovars, ten isolates of Xanthomonas albilineans and one isolate of. Pseudomonas rubrisubalbicans. High quality DNA was obtained that was ideal for molecular analy- ses. Extracellular polysaccharides ...

  17. The link between water quality and tidal marshes in a highly impacted estuary.

    Science.gov (United States)

    Meire, Patrick; Maris, Tom; van Damme, Stefan; Jacobs, Sander; Cox, Tom; Struyf, Eric

    2010-05-01

    The Schelde estuary is one of the most heavily impacted estuaries in Europe. During several decades, untreated waste water from large cities (e.g. Brussels, Antwerp, Valenciennes, Lille) and industries was discharged in the river. As a result, the Schelde estuary has the reputation of being one of the most polluted estuaries in Europe. For a long time (approx. 1950 - 1995) all forms of higher life (macro-invertebrates and fish) were absent in the fresh and brackish parts of the estuary. Due to European legislation, a large part of the sewage water is now treated resulting in a significant recovery of water quality in the estuary. However, next to water quality, the estuary also suffered serious habitat losses during the last decades, mostly due to economic development and changing hydrological conditions causing more erosion. Over the last fifteen years, the management of the estuary has changed fundamentally. It is now more and more focused on the restoration of ecosystem services. In this presentation we will document the changes in water quality over the last 50 years and summarize recent work on the role of tidal marshes on water quality within the freshwater part of the Schelde estuary. Our results stress the important of taking into account ecosystem services and habitat restoration for long-term estuarine management. .After decades of high inorganic nutrient concentrations and recurring anoxia and hypoxia, we observed a paradoxical increase in chlorophyll-a concentrations with decreasing nutrient inputs, indicating a regime shift. Our results indicate that the recovery of a hypereutrophied systems towards a classical eutrophied state, needs the reduction of waste loads below certain thresholds. Paradoxically, phytoplankton production was inhibited by high ammonia or low oxygen concentrations. The system state change is accompanied by large fluctuations in oxygen concentrations. The improved water quality resulted in a remarkable recovery of different groups

  18. European guidelines for quality assurance in colorectal cancer screening and diagnosis

    DEFF Research Database (Denmark)

    von Karsa, L; Patnick, J; Segnan, N

    2013-01-01

    -based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.  They include 10 chapters and over 250 recommendations, individually graded......Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence...... according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease...

  19. Managing quality inside a high-technology project organization

    OpenAIRE

    Jokinen, T. (Tauno)

    2004-01-01

    Abstract This action research addresses the deployment of Total Quality Management (TQM) principles in a high-technology new product development organisation. During the period of study, the organisation grew fast. High-technology product development and hypergrowth provided a unique combination of extreme conditions for the study. The existing concepts of TQM are presented as an organised map enabling strategic analysis for an implementation plan. The history of TQM dates back to the ...

  20. High quality transportation fuels from renewable feedstock

    Energy Technology Data Exchange (ETDEWEB)

    Lindfors, Lars Peter

    2010-09-15

    Hydrotreating of vegetable oils is novel process for producing high quality renewable diesel. Hydrotreated vegetable oils (HVO) are paraffinic hydrocarbons. They are free of aromatics, have high cetane numbers and reduce emissions. HVO can be used as component or as such. HVO processes can also be modified to produce jet fuel. GHG savings by HVO use are significant compared to fossil fuels. HVO is already in commercial production. Neste Oil is producing its NExBTL diesel in two plants. Production of renewable fuels will be limited by availability of sustainable feedstock. Therefore R and D efforts are made to expand feedstock base further.

  1. Interventions to improve water quality for preventing diarrhoea.

    Science.gov (United States)

    Clasen, Thomas F; Alexander, Kelly T; Sinclair, David; Boisson, Sophie; Peletz, Rachel; Chang, Howard H; Majorin, Fiona; Cairncross, Sandy

    2015-10-20

    outcome in most studies was self-reported diarrhoea, which is at high risk of bias due to the lack of blinding in over 80% of the included studies. Source-based water quality improvementsThere is currently insufficient evidence to know if source-based improvements such as protected wells, communal tap stands, or chlorination/filtration of community sources consistently reduce diarrhoea (one cluster-RCT, five CBA studies, very low quality evidence). We found no studies evaluating reliable piped-in water supplies delivered to households. Point-of-use water quality interventionsOn average, distributing water disinfection products for use at the household level may reduce diarrhoea by around one quarter (Home chlorination products: RR 0.77, 95% CI 0.65 to 0.91; 14 trials, 30,746 participants, low quality evidence; flocculation and disinfection sachets: RR 0.69, 95% CI 0.58 to 0.82, four trials, 11,788 participants, moderate quality evidence). However, there was substantial heterogeneity in the size of the effect estimates between individual studies.Point-of-use filtration systems probably reduce diarrhoea by around a half (RR 0.48, 95% CI 0.38 to 0.59, 18 trials, 15,582 participants, moderate quality evidence). Important reductions in diarrhoea episodes were shown with ceramic filters, biosand systems and LifeStraw® filters; (Ceramic: RR 0.39, 95% CI 0.28 to 0.53; eight trials, 5763 participants, moderate quality evidence; Biosand: RR 0.47, 95% CI 0.39 to 0.57; four trials, 5504 participants, moderate quality evidence; LifeStraw®: RR 0.69, 95% CI 0.51 to 0.93; three trials, 3259 participants, low quality evidence). Plumbed in filters have only been evaluated in high-income settings (RR 0.81, 95% CI 0.71 to 0.94, three trials, 1056 participants, fixed effects model).In low-income settings, solar water disinfection (SODIS) by distribution of plastic bottles with instructions to leave filled bottles in direct sunlight for at least six hours before drinking probably reduces

  2. Quantitative assessment of similarity between randomly acquired characteristics on high quality exemplars and crime scene impressions via analysis of feature size and shape.

    Science.gov (United States)

    Richetelli, Nicole; Nobel, Madonna; Bodziak, William J; Speir, Jacqueline A

    2017-01-01

    Forensic footwear evidence can prove invaluable to the resolution of a criminal investigation. Naturally, the value of a comparison varies with the rarity of the evidence, which is a function of both manufactured as well as randomly acquired characteristics (RACs). When focused specifically on the latter of these two types of features, empirical evidence demonstrates high discriminating power for the differentiation of known match and known non-match samples when presented with exemplars of high quality and exhibiting a sufficient number of clear and complex RACs. However, given the dynamic and unpredictable nature of the media, substrate, and deposition process encountered during the commission of a crime, RACs on crime scene prints are expected to exhibit a large range of variability in terms of reproducibility, clarity, and quality. Although the pattern recognition skill of the expert examiner is adept at recognizing and evaluating this type of natural variation, there is little research to suggest that objective and numerical metrics can globally process this variation when presented with RACs from degraded crime scene quality prints. As such, the goal of this study was to mathematically compare the loss and similarity of RACs in high quality exemplars versus crime-scene-like quality impressions as a function of RAC shape, perimeter, area, and common source. Results indicate that the unpredictable conditions associated with crime scene print production promotes RAC loss that varies between 33% and 100% with an average of 85%, and that when the entire outsole is taken as a constellation of features (or a RAC map), 64% of the crime-scene-like impressions exhibited 10 or fewer RACs, resulting in a 0.72 probability of stochastic dominance. Given this, individual RAC description and correspondence were further explored using five simple, but objective, numerical metrics of similarity. Statistically significant differences in similarity scores for RAC shape and size

  3. Improving high quality, equitable maternal health services in Malawi ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Improving high quality, equitable maternal health services in Malawi (IMCHA) ... In response, the Ministry of Health implemented a Standards-Based Management and Recognition for Reproductive Health initiative to improve ... Total funding.

  4. High throughput electrospinning of high-quality nanofibers via an aluminum disk spinneret

    Science.gov (United States)

    Zheng, Guokuo

    In this work, a simple and efficient needleless high throughput electrospinning process using an aluminum disk spinneret with 24 holes is described. Electrospun mats produced by this setup consisted of fine fibers (nano-sized) of the highest quality while the productivity (yield) was many times that obtained from conventional single-needle electrospinning. The goal was to produce scaled-up amounts of the same or better quality nanofibers under variable concentration, voltage, and the working distance than those produced with the single needle lab setting. The fiber mats produced were either polymer or ceramic (such as molybdenum trioxide nanofibers). Through experimentation the optimum process conditions were defined to be: 24 kilovolt, a distance to collector of 15cm. More diluted solutions resulted in smaller diameter fibers. Comparing the morphologies of the nanofibers of MoO3 produced by both the traditional and the high throughput set up it was found that they were very similar. Moreover, the nanofibers production rate is nearly 10 times than that of traditional needle electrospinning. Thus, the high throughput process has the potential to become an industrial nanomanufacturing process and the materials processed by it may be used as filtration devices, in tissue engineering, and as sensors.

  5. Reliability of physical examination tests for the diagnosis of knee disorders: Evidence from a systematic review.

    Science.gov (United States)

    Décary, Simon; Ouellet, Philippe; Vendittoli, Pascal-André; Desmeules, François

    2016-12-01

    Clinicians often rely on physical examination tests to guide them in the diagnostic process of knee disorders. However, reliability of these tests is often overlooked and may influence the consistency of results and overall diagnostic validity. Therefore, the objective of this study was to systematically review evidence on the reliability of physical examination tests for the diagnosis of knee disorders. A structured literature search was conducted in databases up to January 2016. Included studies needed to report reliability measures of at least one physical test for any knee disorder. Methodological quality was evaluated using the QAREL checklist. A qualitative synthesis of the evidence was performed. Thirty-three studies were included with a mean QAREL score of 5.5 ± 0.5. Based on low to moderate quality evidence, the Thessaly test for meniscal injuries reached moderate inter-rater reliability (k = 0.54). Based on moderate to excellent quality evidence, the Lachman for anterior cruciate ligament injuries reached moderate to excellent inter-rater reliability (k = 0.42 to 0.81). Based on low to moderate quality evidence, the Tibiofemoral Crepitus, Joint Line and Patellofemoral Pain/Tenderness, Bony Enlargement and Joint Pain on Movement tests for knee osteoarthritis reached fair to excellent inter-rater reliability (k = 0.29 to 0.93). Based on low to moderate quality evidence, the Lateral Glide, Lateral Tilt, Lateral Pull and Quality of Movement tests for patellofemoral pain reached moderate to good inter-rater reliability (k = 0.49 to 0.73). Many physical tests appear to reach good inter-rater reliability, but this is based on low-quality and conflicting evidence. High-quality research is required to evaluate the reliability of knee physical examination tests. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Coupling of high-quality-factor optical resonators

    International Nuclear Information System (INIS)

    Salzenstein, Patrice; Henriet, Rémi; Coillet, Aurélien; Chembo, Yanne K; Mortier, Michel; Sérier-Brault, Hélène; Rasoloniaina, Alphonse; Dumeige, Yannick; Féron, Patrice

    2013-01-01

    We improve theoretically and experimentally the problem of the coupling between a high Q-factor resonator and its external coupler. We have observed oscillations of ringing induced by the sweeping of the excitation frequency of an active microsphere. Thanks to this approach, the quality factor of an optical resonator was measured and we obtained Q = 5.8 × 10 8 . (paper)

  7. High-picture quality industrial CT scanner

    International Nuclear Information System (INIS)

    Shoji, Takao; Nishide, Akihiko; Fujii, Masashi.

    1989-01-01

    Industrial X-ray-CT-scanners, which provide cross-sectional images of a tested sample without destroying it, are attracting attention as a new nondestructive inspection device. In 1982, Toshiba commenced the development of industrial CT scanners, and introduced the 'TOSCANER' -3000 and-4000 series. Now, the state of the art 'TOSCANER'-20000 series of CT systems has been developed incorporating the latest computer tomography and image processing technology, such as the T9506 image processor. One of the advantages of this system is its applicability to a wide range of X-ray energy . The 'TOSCANER'-20000 series can be utilized for inspecting castings and other materials with relatively low-transparency to X-rays, as well as ceramics, composite materials and other materials with high X-ray transparency. A further feature of the new system is its high-picture quality, with a high-spatial resolution resulting from a pixel size of 0.2x0.2(mm). (author)

  8. Computer-aided control of high-quality cast iron

    Directory of Open Access Journals (Sweden)

    S. Pietrowski

    2008-04-01

    Full Text Available The study discusses the possibility of control of the high-quality grey cast iron and ductile iron using the author’s genuine computer programs. The programs have been developed with the help of algorithms based on statistical relationships that are said to exist between the characteristic parameters of DTA curves and properties, like Rp0,2, Rm, A5 and HB. It has been proved that the spheroidisation and inoculation treatment of cast iron changes in an important way the characteristic parameters of DTA curves, thus enabling a control of these operations as regards their correctness and effectiveness, along with the related changes in microstructure and mechanical properties of cast iron. Moreover, some examples of statistical relationships existing between the typical properties of ductile iron and its control process were given for cases of the melts consistent and inconsistent with the adopted technology.A test stand for control of the high-quality cast iron and respective melts has been schematically depicted.

  9. Effect of high hydrostatic pressure on overall quality parameters of watermelon juice.

    Science.gov (United States)

    Liu, Y; Zhao, X Y; Zou, L; Hu, X S

    2013-06-01

    High hydrostatic pressure as a kind of non-thermal processing might maintain the quality of thermo-sensitive watermelon juice. So, the effect of high hydrostatic pressure treatment on enzymes and quality of watermelon juice was investigated. After high hydrostatic pressure treatment, the activities of polyphenol oxidase, peroxidase, and pectin methylesterase of juice decreased significantly with the pressure (P  0.05). No significant difference was observed in lycopene and total phenolics after high hydrostatic pressure treatment when compared to the control (P > 0.05). Cloudiness and viscosity increased with pressure (P  0.05). a*- and b*-value both unchanged after high hydrostatic pressure treatment (P > 0.05) while L*-value increased but the values had no significant difference among treated juices. Browning degree after high hydrostatic pressure treatment decreased with increase in pressure and treatment time (P hydrostatic pressure had little effect on color of juice. The results of this study demonstrated the efficacy of high hydrostatic pressure in inactivating enzymes and maintaining the quality of watermelon juice.

  10. High quality ceramic coatings sprayed by high efficiency hypersonic plasma spraying gun

    International Nuclear Information System (INIS)

    Zhu Sheng; Xu Binshi; Yao JiuKun

    2005-01-01

    This paper introduced the structure of the high efficiency hypersonic plasma spraying gun and the effects of hypersonic plasma jet on the sprayed particles. The optimised spraying process parameters for several ceramic powders such as Al 2 O 3 , Cr 2 O 3 , ZrO 2 , Cr 3 C 2 and Co-WC were listed. The properties and microstructure of the sprayed ceramic coatings were investigated. Nano Al 2 O 3 -TiO 2 ceramic coating sprayed by using the high efficiency hypersonic plasma spraying was also studied. Compared with the conventional air plasma spraying, high efficiency hypersonic plasma spraying improves greatly the ceramic coatings quality but at low cost. (orig.)

  11. High quality electron beams from a laser wakefield accelerator

    Energy Technology Data Exchange (ETDEWEB)

    Wiggins, S M; Issac, R C; Welsh, G H; Brunetti, E; Shanks, R P; Anania, M P; Cipiccia, S; Manahan, G G; Aniculaesei, C; Ersfeld, B; Islam, M R; Burgess, R T L; Vieux, G; Jaroszynski, D A [SUPA, Department of Physics, University of Strathclyde, Glasgow (United Kingdom); Gillespie, W A [SUPA, Division of Electronic Engineering and Physics, University of Dundee, Dundee (United Kingdom); MacLeod, A M [School of Computing and Creative Technologies, University of Abertay Dundee, Dundee (United Kingdom); Van der Geer, S B; De Loos, M J, E-mail: m.wiggins@phys.strath.ac.u [Pulsar Physics, Burghstraat 47, 5614 BC Eindhoven (Netherlands)

    2010-12-15

    High quality electron beams have been produced in a laser-plasma accelerator driven by femtosecond laser pulses with a peak power of 26 TW. Electrons are produced with an energy up to 150 MeV from the 2 mm gas jet accelerator and the measured rms relative energy spread is less than 1%. Shot-to-shot stability in the central energy is 3%. Pepper-pot measurements have shown that the normalized transverse emittance is {approx}1{pi} mm mrad while the beam charge is in the range 2-10 pC. The generation of high quality electron beams is understood from simulations accounting for beam loading of the wakefield accelerating structure. Experiments and self-consistent simulations indicate that the beam peak current is several kiloamperes. Efficient transportation of the beam through an undulator is simulated and progress is being made towards the realization of a compact, high peak brilliance free-electron laser operating in the vacuum ultraviolet and soft x-ray wavelength ranges.

  12. Management of drinking water quality in Pakistan

    International Nuclear Information System (INIS)

    Javed, A.A.

    2003-01-01

    Drinking water quality in both urban and rural areas of Pakistan is not being managed properly. Results of various investigations provide evidence that most of the drinking water supplies are faecally contaminated. At places groundwater quality is deteriorating due to the naturally occurring subsoil contaminants, or by anthropogenic activities. The poor bacteriological quality of drinking water has frequently resulted in high incidence of water borne diseases while subsoil contaminants have caused other ailments to consumers. This paper presents a detailed review of drinking water quality in the country and the consequent health impacts. It identifies various factors contributing to poor water quality and proposes key actions required to ensure safe drinking water supplies to consumers. (author)

  13. Isolation of high-quality total RNA from leaves of Myrciaria dubia "CAMU CAMU".

    Science.gov (United States)

    Gómez, Juan Carlos Castro; Reátegui, Alina Del Carmen Egoavil; Flores, Julián Torres; Saavedra, Roberson Ramírez; Ruiz, Marianela Cobos; Correa, Sixto Alfredo Imán

    2013-01-01

    Myrciaria dubia is a main source of vitamin C for people in the Amazon region. Molecular studies of M. dubia require high-quality total RNA from different tissues. So far, no protocols have been reported for total RNA isolation from leaves of this species. The objective of this research was to develop protocols for extracting high-quality total RNA from leaves of M. dubia. Total RNA was purified following two modified protocols developed for leaves of other species (by Zeng and Yang, and by Reid et al.) and one modified protocol developed for fruits of the studied species (by Silva). Quantity and quality of purified total RNA were assessed by spectrophotometric and electrophoretic analysis. Additionally, quality of total RNA was evaluated with reverse-transcription polymerase chain reaction (RT-PCR). With these three modified protocols we were able to isolate high-quality RNA (A260nm/A280nm >1.9 and A260nm/A230nm >2.0). Highest yield was produced with the Zeng and Yang modified protocol (384±46µg ARN/g fresh weight). Furthermore, electrophoretic analysis showed the integrity of isolated RNA and the absence of DNA. Another proof of the high quality of our purified RNA was the successful cDNA synthesis and amplification of a segment of the M. dubia actin 1 gene. We report three modified protocols for isolation total RNA from leaves of M. dubia. The modified protocols are easy, rapid, low in cost, and effective for high-quality and quantity total RNA isolation suitable for cDNA synthesis and polymerase chain reaction.

  14. Quality in Preschool

    DEFF Research Database (Denmark)

    Næsby, Torben

    The Danish Day Care Facilities Act, which provides the curriculum on which day care education is based, does not stipulate very clearly what children should learn and therefore how educational processes should be organized. This means that we must accept that there are large local differences in ...... in a Mixed Methods design. Quality assessment of learning environments: ERS -line (quantitative baseline) Children’s outcome, measured by LearnLab and observations of learning environments identifying high quality and inclusion (qualitative)...... and dialectically influence and are influenced by each other (Bronfenbrenner & Morris, 2006; Sheridan, 2009). The research project takes on a Critical Realistic approach, Building on the bio-ecological model; theory on development (proximal processes); an interactionist perspective on quality and inclusion...... in the quality of the learning environment and the impact on children’s well-being, learning and development. A pedagogical perspective on quality has to originate from research and documented evidence but must also inherit the children’s perspectives (Sommer et al, 2013). It has to be viewed interactively...

  15. Negative Binomial charts for monitoring high-quality processes

    NARCIS (Netherlands)

    Albers, Willem/Wim

    Good control charts for high quality processes are often based on the number of successes between failures. Geometric charts are simplest in this respect, but slow in recognizing moderately increased failure rates p. Improvement can be achieved by waiting until r > 1 failures have occurred, i.e. by

  16. Development of an evidence-based review with recommendations using an online iterative process.

    Science.gov (United States)

    Rudmik, Luke; Smith, Timothy L

    2011-01-01

    The practice of modern medicine is governed by evidence-based principles. Due to the plethora of medical literature, clinicians often rely on systematic reviews and clinical guidelines to summarize the evidence and provide best practices. Implementation of an evidence-based clinical approach can minimize variation in health care delivery and optimize the quality of patient care. This article reports a method for developing an "Evidence-based Review with Recommendations" using an online iterative process. The manuscript describes the following steps involved in this process: Clinical topic selection, Evidence-hased review assignment, Literature review and initial manuscript preparation, Iterative review process with author selection, and Manuscript finalization. The goal of this article is to improve efficiency and increase the production of evidence-based reviews while maintaining the high quality and transparency associated with the rigorous methodology utilized for clinical guideline development. With the rise of evidence-based medicine, most medical and surgical specialties have an abundance of clinical topics which would benefit from a formal evidence-based review. Although clinical guideline development is an important methodology, the associated challenges limit development to only the absolute highest priority clinical topics. As outlined in this article, the online iterative approach to the development of an Evidence-based Review with Recommendations may improve productivity without compromising the quality associated with formal guideline development methodology. Copyright © 2011 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.

  17. [Evidence-based management of medical disposable materials].

    Science.gov (United States)

    Yang, Hai

    2009-03-01

    Evidence-based management of medical disposable materials pays attention to collect evidence comprehensively and systematically, accumulate and create evidence through its own work and also evaluate evidence strictly. This can be used as a function to guide out job. Medical disposable materials evidence system contains product register qualification, product quality certification, supplier's behavior, internal and external communication evidence. Managers can find different ways in creating and using evidence referring to specific inside and outside condition. Evidence-based management can help accelerating the development of management of medical disposable materials from traditional experience pattern to a systematic and scientific pattern. It also has the very important meaning to improve medical quality, control the unreasonable growth of medical expense and make purchase and supply chain be more efficient.

  18. Diel turbidity cycles in a headwater stream: evidence of nocturnal bioturbation?

    OpenAIRE

    Cooper, Richard J.; Outram, Faye; Hiscock, Kevin M.

    2016-01-01

    Purpose: A small number of recent studies have linked daily cycles in stream turbidity to nocturnal bioturbation by aquatic fauna, principally crayfish, and demonstrated this process can significantly impact upon water quality under baseflow conditions. Adding to this limited body of research, we use high-resolution water quality monitoring data to investigate evidence of diel turbidity cycles in a lowland, headwater stream with a known signal crayfish (Pacifastacus leniusculus) population an...

  19. EXPOSURE TO INTERMITTENT AIR POLLUTION AND CHANGES IN SEMEN QUALITY: EVIDENCE FOR AN ASSOCIATION AND IMPLICATIONS FOR REPRODUCTIVE RISK ASSESSMENT

    Science.gov (United States)

    Exposure to Intermittent Air Pollution and Changes in Semen Quality:Evidence for an Association and Implications for Reproductive Risk Assessment. S. D. Perreault1, S.G. Selevan2, J. Rubes3, D. Zudova3, and D.P. Evenson4 1US EPA, ORD/NHEERL, Research Triangle Pa...

  20. High quality mask storage in an advanced Logic-Fab

    Science.gov (United States)

    Jähnert, Carmen; Fritsche, Silvio

    2012-02-01

    High efficient mask logistics as well as safe and high quality mask storage are essential requirements within an advanced lithography area of a modern logic waferfab. Fast operational availability of the required masks at the exposure tool with excellent mask condition requires a safe mask handling, safeguarding of high mask quality over the whole mask usage time without any quality degradation and an intelligent mask logistics. One big challenge is the prevention of haze on high advanced phase shift masks used in a high volume production line for some thousands of 248nm or 193nm exposures. In 2008 Infineon Dresden qualified a customer specific developed semi-bare mask storage system from DMSDynamic Micro Systems in combination with a high advanced mask handling and an interconnected complex logistic system. This high-capacity mask storage system DMS M1900.22 for more than 3000 masks with fully automated mask and box handling as well as full-blown XCDA purge has been developed and adapted to the Infineon Lithotoollandscape using Nikon and SMIF reticle cases. Advanced features for ESD safety and mask security, mask tracking via RFID and interactions with the exposure tools were developed and implemented. The stocker is remote controlled by the iCADA-RSM system, ordering of the requested mask directly from the affected exposure tool allows fast access. This paper discusses the advantages and challenges for this approach as well as the practical experience gained during the implementation of the new system which improves the fab performance with respect to mask quality, security and throughput. Especially the realization of an extremely low and stable humidity level in addition with a well controlled air flow at each mask surface, preventing masks from haze degradation and particle contamination, turns out to be a notable technical achievement. The longterm stability of haze critical masks has been improved significantly. Relevant environmental parameters like

  1. IMPACT OF RESILIENCE, ICT SUPPORT AND QUALITY OF STUDENT'S LIFE ON QUALITY OF HIGH EDUCATION PROCESS

    Directory of Open Access Journals (Sweden)

    Zorica Lazic

    2016-12-01

    Full Text Available Answers to the questions of how and in what way the quality of life of students, resilience and ICT support affects the quality of high education we will get through this work where main objective is to define a network of processes and process management ensuring more quality and more innovative managing and service provision, therefore satisfying the needs of service users - in this case the students of the university. To collect the relevant data in the thematic analysis of this paper, the method of interviewing by questionnaires was applied. The sample survey was conducted among undergraduate students, teachers and staff of the Teacher Training Faculty in Uzice.

  2. Predicting sport and occupational lower extremity injury risk through movement quality screening: a systematic review.

    Science.gov (United States)

    Whittaker, Jackie L; Booysen, Nadine; de la Motte, Sarah; Dennett, Liz; Lewis, Cara L; Wilson, Dave; McKay, Carly; Warner, Martin; Padua, Darin; Emery, Carolyn A; Stokes, Maria

    2017-04-01

    Identification of risk factors for lower extremity (LE) injury in sport and military/first-responder occupations is required to inform injury prevention strategies. To determine if poor movement quality is associated with LE injury in sport and military/first-responder occupations. 5 electronic databases were systematically searched. Studies selected included original data; analytic design; movement quality outcome (qualitative rating of functional compensation, asymmetry, impairment or efficiency of movement control); LE injury sustained with sport or military/first-responder occupation. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. 2 independent authors assessed the quality (Downs and Black (DB) criteria) and level of evidence (Oxford Centre of Evidence-Based Medicine model). Of 4361 potential studies, 17 were included. The majority were low-quality cohort studies (level 4 evidence). Median DB score was 11/33 (range 3-15). Heterogeneity in methodology and injury definition precluded meta-analyses. The Functional Movement Screen was the most common outcome investigated (15/17 studies). 4 studies considered inter-relationships between risk factors, 7 reported diagnostic accuracy and none tested an intervention programme targeting individuals identified as high risk. There is inconsistent evidence that poor movement quality is associated with increased risk of LE injury in sport and military/first-responder occupations. Future research should focus on high-quality cohort studies to identify the most relevant movement quality outcomes for predicting injury risk followed by developing and evaluating preparticipation screening and LE injury prevention programmes through high-quality randomised controlled trials targeting individuals at greater risk of injury based on screening tests with validated test properties. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  3. Radiosynoviorthesis in the reflection of Evidence-based Medicine (EbM)

    International Nuclear Information System (INIS)

    Kampen, W.U.

    2006-01-01

    This paper summarizes the literature on clinical efficacy of radiosynoviorthesis with respect to the criteria of evidence-based medicine (EbM). Each therapy has to face up to the success and the costs of other treatment modalities, especially in times of scarce financial resources of our health care system. For many physicians and scientists, evidence-based medicine, which means weighting clinical trials by several quality factors like randomization, blinding or comparison with a placebo seems to be the ''philosophers'stone'' to some extent. Concerning radiosynoviorthesis, the existence of clinical studies with a high quality according to the EbM is sometimes negated. However, this statement cannot be abided after extensive revision of the literature. The nuclear medicine physician practising radiosynoviorthesis should be provided with arguments from the literature supporting his personal experience for successful discussions with referring colleques. This is achieved by listing the respective papers especially of evidence classes Ib and IIa with a short summary of each of them. Some critical remarks on evidence-based medicine if used as the only basis of therapeutic practise complete this paper. (orig.)

  4. Management of Spinal Deformities and Evidence of Treatment Effectiveness

    Science.gov (United States)

    Bettany-Saltikov, Josette; Turnbull, Deborah; Ng, Shu Yan; Webb, Richard

    2017-01-01

    Introduction: The review evaluates the up-to-date evidence for the treatment of spinal deformities, including scoliosis and hyperkyphosis in adolescents and adults. Material and Methods: The PubMed database was searched for review articles, prospective controlled trials and randomized controlled trials related to the treatment of spinal deformities. Articles on syndromic scoliosis were excluded and so were the articles on hyperkyphosis of the spine with causes other than Scheuermann’s disease and osteoporosis. Articles on conservative and surgical treatments of idiopathic scoliosis, adult scoliosis and hyperkyphosis were also included. For retrospective papers, only studies with a follow up period exceeding 10 years were included. Results: The review showed that early-onset idiopathic scoliosis has a worse outcome than late-onset idiopathic scoliosis, which is rather benign. Patients with AIS function well as adults; they have no more health problems when compared to patients without scoliosis, other than a slight increase in back pain and aesthetic concern. Conservative treatment of adolescent idiopathic scoliosis (AIS) using physiotherapeutic scoliosis-specific exercises (PSSE), specifically PSSR and rigid bracing was supported by level I evidence. Yet to date, there is no high quality evidence (RCT`s) demonstrating that surgical treatment is superior to conservative treatment for the management of AIS. For adult scoliosis, there are only a few studies on the effectiveness of PSSEs and a conclusion cannot as yet be drawn. For hyperkyphosis, there is no high-quality evidence for physiotherapy, bracing or surgery for the treatment of adolescents and adults. However, bracing has been found to reduce thoracic hyperkyphosis, ranging from 55 to 80° in adolescents. In patients over the age of 60, bracing improves the balance score, and reduces spinal deformity and pain. Surgery is indicated in adolescents and adults in the presence of progression of kyphosis

  5. Learning Disabilities and Achieving High-Quality Education Standards

    Science.gov (United States)

    Gartland, Debi; Strosnider, Roberta

    2017-01-01

    This is an official document of the National Joint Committee on Learning Disabilities (NJCLD), of which Council for Learning Disabilities is a long-standing, active member. With this position paper, NJCLD advocates for the implementation of high-quality education standards (HQES) for students with learning disabilities (LD) and outlines the…

  6. CCD Astrophotography High-Quality Imaging from the Suburbs

    CERN Document Server

    Stuart, Adam

    2006-01-01

    This is a reference book for amateur astronomers who have become interested in CCD imaging. Those glorious astronomical images found in astronomy magazines might seem out of reach to newcomers to CCD imaging, but this is not the case. Great pictures are attainable with modest equipment. Adam Stuart’s many beautiful images, reproduced in this book, attest to the quality of – initially – a beginner’s efforts. Chilled-chip astronomical CCD-cameras and software are also wonderful tools for cutting through seemingly impenetrable light-pollution. CCD Astrophotography from the Suburbs describes one man’s successful approach to the problem of getting high-quality astronomical images under some of the most light-polluted conditions. Here is a complete and thoroughly tested program that will help every CCD-beginner to work towards digital imaging of the highest quality. It is equally useful to astronomers who have perfect observing conditions, as to those who have to observe from light-polluted city skies.

  7. Do systematic reviews address community healthcare professionals' wound care uncertainties? Results from evidence mapping in wound care.

    Science.gov (United States)

    Christie, Janice; Gray, Trish A; Dumville, Jo C; Cullum, Nicky A

    2018-01-01

    Complex wounds such as leg and foot ulcers are common, resource intensive and have negative impacts on patients' wellbeing. Evidence-based decision-making, substantiated by high quality evidence such as from systematic reviews, is widely advocated for improving patient care and healthcare efficiency. Consequently, we set out to classify and map the extent to which up-to-date systematic reviews containing robust evidence exist for wound care uncertainties prioritised by community-based healthcare professionals. We asked healthcare professionals to prioritise uncertainties based on complex wound care decisions, and then classified 28 uncertainties according to the type and level of decision. For each uncertainty, we searched for relevant systematic reviews. Two independent reviewers screened abstracts and full texts of reviews against the following criteria: meeting an a priori definition of a systematic review, sufficiently addressing the uncertainty, published during or after 2012, and identifying high quality research evidence. The most common uncertainty type was 'interventions' 24/28 (85%); the majority concerned wound level decisions 15/28 (53%) however, service delivery level decisions (10/28) were given highest priority. Overall, we found 162 potentially relevant reviews of which 57 (35%) were not systematic reviews. Of 106 systematic reviews, only 28 were relevant to an uncertainty and 18 of these were published within the preceding five years; none identified high quality research evidence. Despite the growing volume of published primary research, healthcare professionals delivering wound care have important clinical uncertainties which are not addressed by up-to-date systematic reviews containing high certainty evidence. These are high priority topics requiring new research and systematic reviews which are regularly updated. To reduce clinical and research waste, we recommend systematic reviewers and researchers make greater efforts to ensure that research

  8. Evidence-informed recommendations for rehabilitation with older adults living with HIV: a knowledge synthesis

    Science.gov (United States)

    O'Brien, Kelly K; Solomon, Patricia; Trentham, Barry; MacLachlan, Duncan; MacDermid, Joy; Tynan, Anne-Marie; Baxter, Larry; Casey, Alan; Chegwidden, William; Robinson, Greg; Tran, Todd; Wu, Janet; Zack, Elisse

    2014-01-01

    Objective Our aim was to develop evidence-informed recommendations for rehabilitation with older adults living with HIV. Design We conducted a knowledge synthesis, combining research evidence specific to HIV, rehabilitation and ageing, with evidence on rehabilitation interventions for common comorbidities experienced by older adults with HIV. Methods We included highly relevant HIV-specific research addressing rehabilitation and ageing (stream A) and high-quality evidence on the effectiveness of rehabilitation interventions for common comorbidities experienced by older adults ageing with HIV (stream B). We extracted and synthesised relevant data from the evidence to draft evidence-informed recommendations for rehabilitation. Draft recommendations were refined based on people living with HIV (PLHIV) and clinician experience, values and preferences, reviewed by an interprofessional team for Grading of Recommendations Assessment, Development, and Evaluation (GRADE) (quality) rating and revision and then circulated to PLHIV and clinicians for external endorsement and final refinement. We then devised overarching recommendations to broadly guide rehabilitation with older adults living with HIV. Results This synthesis yielded 8 overarching and 52 specific recommendations. Thirty-six specific recommendations were derived from 108 moderate-level or high-level research articles (meta-analyses and systematic reviews) that described the effectiveness of rehabilitation interventions for comorbidities that may be experienced by older adults with HIV. Recommendations addressed rehabilitation interventions across eight health conditions: bone and joint disorders, cancer, stroke, cardiovascular disease, mental health challenges, cognitive impairments, chronic obstructive pulmonary disease and diabetes. Sixteen specific recommendations were derived from 42 research articles specific to rehabilitation with older adults with HIV. The quality of evidence from which these

  9. Failure of anthropometry as a facial identification technique using high-quality photographs.

    Science.gov (United States)

    Kleinberg, Krista F; Vanezis, Peter; Burton, A Mike

    2007-07-01

    Anthropometry can be used in certain circumstances to facilitate comparison of a photograph of a suspect with that of the potential offender from surveillance footage. Experimental research was conducted to determine whether anthropometry has a place in forensic practice in confirming the identity of a suspect from a surveillance video. We examined an existing database of photographic lineups, where one video image was compared against 10 photographs, which has previously been used in psychological research. Target (1) and test (10) photos were of high quality, although taken with a different camera. The anthropometric landmarks of right and left ectocanthions, nasion, and stomion were chosen, and proportions and angle values between these landmarks were measured to compare target with test photos. Results indicate that these measurements failed to accurately identify targets. There was also no indication that any of the landmarks made a better comparison than another. It was concluded that, for these landmarks, this method does not generate the consistent results necessary for use as evidence in a court of law.

  10. The influence of knowledge management implementation toward the quality of high schools

    Directory of Open Access Journals (Sweden)

    Hilda Ainissyifa

    2012-09-01

    Full Text Available The purpose of this study is to analyze the influence of knowledge management implementation toward the quality of high schools. This study was conducted among five high schools under an education foundation. The analysis models used in the study were correlation analysis and t-test. The respondents were used as the profession references are 86 teachers. The result of the study shows that knowledge management implementation has a positive and significant influence toward the quality of high schools.

  11. Evidence-based approach for continuous improvement of occupational health.

    Science.gov (United States)

    Manzoli, Lamberto; Sotgiu, Giovanni; Magnavita, Nicola; Durando, Paolo

    2015-01-01

    It was recognized early on that an Evidence-Based Medicine (EBM) approach could be applied to Public Health (PH), including the area of Occupational Health (OH). The aim of Evidence-Based Occupational Health (EBOH) is to ensure safety, health, and well-being in the workplace. Currently, high-quality research is necessary in order to provide arguments and scientific evidence upon which effective, efficient, and sustainable preventive measures and policies are to be developed in the workplace in Western countries. Occupational physicians need to integrate available scientific evidence and existing recommendations with a framework of national employment laws and regulations. This paper addresses the state of the art of scientific evidence available in the field (i.e., efficacy of interventions, usefulness of education and training of workers, and need of a multidisciplinary strategy integrated within the national PH programs) and the main critical issues for their implementation. Promoting good health is a fundamental part of the smart, inclusive growth objectives of Europe 2020 - Europe's growth strategy: keeping people healthy and active for longer has a positive impact on productivity and competitiveness. It appears clear that health quality and safety in the workplace play a key role for smart, sustainable, and inclusive growth in Western countries.

  12. Boiling curve in high quality flow boiling

    International Nuclear Information System (INIS)

    Shiralkar, B.S.; Hein, R.A.; Yadigaroglu, G.

    1980-01-01

    The post dry-out heat transfer regime of the flow boiling curve was investigated experimentally for high pressure water at high qualities. The test section was a short round tube located downstream of a hot patch created by a temperature controlled segment of tubing. Results from the experiment showed that the distance from the dryout point has a significant effect on the downstream temperatures and there was no unique boiling curve. The heat transfer coefficients measured sufficiently downstream of the dryout point could be correlated using the Heineman correlation for superheated steam, indicating that the droplet deposition effects could be neglected in this region

  13. Quality of in-hospital stroke care according to evidence-based performance measures: results from the first audit of stroke, Catalonia, Spain.

    Science.gov (United States)

    Abilleira, Sònia; Gallofré, Miquel; Ribera, Aida; Sánchez, Emília; Tresserras, Ricard

    2009-04-01

    Evidence-based standards are used worldwide to determine quality of care. We assessed quality of in-hospital stroke care in all acute-care hospitals in Catalonia by determining adherence to 13 evidence-based performance measures (PMs) of process of care. Data on PMs were collected by retrospective review of medical records of consecutive stroke admissions (January to June, 2005). Compliance with PMs was calculated according to 3 hospital levels determined by their annual stroke case-load (level 1, 350). We defined sampling weights that represented each patient's inverse probability of inclusion in the study sample. Sampling weights were applied to produce estimates of compliance. Factors that predicted good/bad compliance were determined by multivariate weighted logistic regression models. An external monitoring of 10% of cases recruited at each hospital was undertaken, after random selection, to assess quality of data. We analyzed data from 1791 stroke cases (17% of all stroke admissions). Global interobserver agreement was 0.7. Eight PMs achieved compliances >or=75%, 4 of which were more than 90%, and the remaining showed adherences Catalonia was heterogeneous across hospital levels. Rehabilitation-related measures showed poor compliances compared to acute care-related ones, which achieved more satisfactory adherences.

  14. Simple and rapid preparation of [11C]DASB with high quality and reliability for routine applications

    International Nuclear Information System (INIS)

    Haeusler, D.; Mien, L.-K.; Nics, L.; Ungersboeck, J.; Philippe, C.; Lanzenberger, R.R.; Kletter, K.; Dudczak, R.; Mitterhauser, M.; Wadsak, W.

    2009-01-01

    [ 11 C]DASB combines all major prerequisites for a successful SERT-ligand, providing excellent biological properties and in-vivo behaviour. Thus, we aimed to establish a fully automated procedure for the synthesis and purification of [ 11 C]DASB with a high degree of reliability reducing the overall synthesis time while conserving high yields and purity. The optimized [ 11 C]DASB synthesis was applied in more than 60 applications with a very low failure rate (3.2%). We obtained yields up to 8.9 GBq (average 5.3±1.6 GBq). Radiochemical yields based on [ 11 C]CH 3 I, (corrected for decay) were 66.3±6.9% with a specific radioactivity (A s ) of 86.8±24.3 GBq/μmol (both at the end of synthesis, EOS). Time consumption was kept to a minimum, resulting in 43 min from end of bombardment to release of the product after quality control. Form our data, it is evident that the presented method can be implemented for routine preparations of [ 11 C]DASB with high reliability.

  15. CBE growth of high-quality ZnO epitaxial layers

    Energy Technology Data Exchange (ETDEWEB)

    El-Shaer, A.; Bakin, A.; Mofor, A.C.; Kreye, M.; Waag, A. [Institute of Semiconductor Technology, Technical University Braunschweig, Hans-Sommer-Strasse 66, 38106 Braunschweig (Germany); Blaesing, J.; Krost, A. [Institute of Experimental Physics, Otto-von-Guericke-University Magdeburg (Germany); Stoimenos, J. [Physics Department, Aristotele University, Univ. Campus, 54006 Thessaloniki (Greece); Pecz, B. [Research Institute for Technical Physics and Materials Science, Hungarian Academy of Sciences, P.O. Box 49, 1525 Budapest (Hungary); Heuken, M. [Aixtron AG, Kackertstr. 15-17, 52072 Aachen (Germany)

    2006-03-15

    Further improvements on the recently reported novel approach to zinc oxide Chemical Beam Epitaxy (CBE) are presented. Hydrogen peroxide is employed as a very efficient novel oxidant. ZnO layers with a thickness from 100 nm to 600 nm were grown on c-sapphire using a MgO buffer. PL-mapping as well as conductivity mapping shows a good uniformity across the 2 inch ZnO-on-sapphire epiwafers. The measured surface roughness for the best layers is as low as 0.26 nm. HRXRD measurements of the obtained ZnO layers show excellent quality of the single crystalline ZnO. The FWHM of the HRXRD (0002) rocking curves measured for the 2 inch ZnO-on-sapphire wafers is as low as 27 arcsec with a very high lateral homogeneity across the whole wafer. Plane view HRTEM observations reveal the very good quality of the ZnO films. The results indicate that CBE is a suitable technique to fabricate ZnO of very high structural quality, which can eventually be used as an alternative to bulk ZnO substrates. (copyright 2006 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim) (orig.)

  16. Evidence for aerobic exercise training on the autonomic function in patients with chronic obstructive pulmonary disease (COPD): a systematic review.

    Science.gov (United States)

    Mohammed, Jibril; Derom, Eric; Van Oosterwijck, Jessica; Da Silva, Hellen; Calders, Patrick

    2018-03-01

    To assess evidence for the effectiveness of aerobic exercise training (AET) on the autonomic function (AF) outcomes in patients with chronic obstructive pulmonary disease (COPD). Online databases of PubMed, CINAHL and Web of Science were systematically searched for all years till 26th of January, 2017. Clinical studies assessing any measure of AF following exercise training in patients with COPD were included. Data were extracted from studies with high methodological quality for evidence synthesis. Rating of evidence quality was determined using the GRADE guidelines. The Majority of the included studies utilized continuous exercise training mode with a vigorous level of intensity. Each exercise training session lasted between 30 to 40minutes, and the frequency of intervention was ≥3 times/week. Evidence synthesis of studies with high methodological quality revealed that a high quality evidence level supported a significant increase for time-domain heart rate variability (HRV) analyses and the heart rate recovery (HRR) following AET. The review also found that frequency domain HRV analyses were not significantly affected by AET. The evidence to support the effect of exercise training on baroreceptor sensitivity (BRS) in patients with COPD is very low. Aerobic exercise training demonstrated beneficial but limited effects on the AF in COPD. Presently, it is not clear whether these effects are sustained in the long term. Only a limited number of RCTs were available indicating a significant gap in the literature. Copyright © 2017 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  17. High quality factor GaAs microcavity with buried bullseye defects

    DEFF Research Database (Denmark)

    Winkler, K.; Gregersen, Niels; Hayrynen, T.

    2018-01-01

    The development of high quality factor solid-state microcavities with low mode volumes has paved the way towards on-chip cavity quantum electrodynamics experiments and the development of high-performance nanophotonic devices. Here, we report on the implementation of a new kind of solid...

  18. Low-cost high-quality crystalline germanium based flexible devices

    KAUST Repository

    Nassar, Joanna M.

    2014-06-16

    High performance flexible electronics promise innovative future technology for various interactive applications for the pursuit of low-cost, light-weight, and multi-functional devices. Thus, here we show a complementary metal oxide semiconductor (CMOS) compatible fabrication of flexible metal-oxide-semiconductor capacitors (MOSCAPs) with high-κ/metal gate stack, using a physical vapor deposition (PVD) cost-effective technique to obtain a high-quality Ge channel. We report outstanding bending radius ~1.25 mm and semi-transparency of 30%.

  19. Low-cost high-quality crystalline germanium based flexible devices

    KAUST Repository

    Nassar, Joanna M.; Hussain, Aftab M.; Rojas, Jhonathan Prieto; Hussain, Muhammad Mustafa

    2014-01-01

    High performance flexible electronics promise innovative future technology for various interactive applications for the pursuit of low-cost, light-weight, and multi-functional devices. Thus, here we show a complementary metal oxide semiconductor (CMOS) compatible fabrication of flexible metal-oxide-semiconductor capacitors (MOSCAPs) with high-κ/metal gate stack, using a physical vapor deposition (PVD) cost-effective technique to obtain a high-quality Ge channel. We report outstanding bending radius ~1.25 mm and semi-transparency of 30%.

  20. High-quality GaN epitaxially grown on Si substrate with serpentine channels

    Science.gov (United States)

    Wei, Tiantian; Zong, Hua; Jiang, Shengxiang; Yang, Yue; Liao, Hui; Xie, Yahong; Wang, Wenjie; Li, Junze; Tang, Jun; Hu, Xiaodong

    2018-06-01

    A novel serpentine-channeled mask was introduced to Si substrate for low-dislocation GaN epitaxial growth and the fully coalesced GaN film on the masked Si substrate was achieved for the first time. Compared with the epitaxial lateral overgrowth (ELOG) growth method, this innovative mask only requires one-step epitaxial growth of GaN which has only one high-dislocation region per mask opening. This new growth method can effectively reduce dislocation density, thus improving the quality of GaN significantly. High-quality GaN with low dislocation density ∼2.4 × 107 cm-2 was obtained, which accounted for about eighty percent of the GaN film in area. This innovative technique is promising for the growth of high-quality GaN templates and the subsequent fabrication of high-performance GaN-based devices like transistors, laser diodes (LDs), and light-emitting diodes (LEDs) on Si substrate.

  1. Study on quality assurance for high-level radioactive waste disposal project

    International Nuclear Information System (INIS)

    Takada, Susumu

    2005-01-01

    The U.S. Department of Energy (DOE) has developed comparatively detailed quality assurance requirements for the high-level radioactive waste disposal systems. Quality assurance is recognized as a key issue for confidence building and smooth implementation of the HLW program in Japan, and Japan is at an initial phase of repository development. Then the quality assurance requirements at site research and site selection, site characterization, and site suitability analysis used in the Yucca Mountain project were examined in detail and comprehensive descriptions were developed using flow charts. Additionally, the applicability to the Japan high-level radioactive waste disposal project was studied. The examination and study were performed for the following QA requirements: The requirements that have the relative importance at site research and site selection, site characterization, and site suitability analysis (such as planning and performing scientific investigations, sample control, data control, model development and use, technical report review, software control, and control of the electric management of data). The requirements that have the relative importance at the whole repository phases (such as quality assurance program, document control, and control of quality assurance records). (author)

  2. The Navigation Guide—Evidence-Based Medicine Meets Environmental Health: Integration of Animal and Human Evidence for PFOA Effects on Fetal Growth

    Science.gov (United States)

    Koustas, Erica; Sutton, Patrice; Johnson, Paula I.; Atchley, Dylan S.; Sen, Saunak; Robinson, Karen A.; Axelrad, Daniel A.; Woodruff, Tracey J.

    2014-01-01

    Background: The Navigation Guide is a novel systematic review method to synthesize scientific evidence and reach strength of evidence conclusions for environmental health decision making. Objective: Our aim was to integrate scientific findings from human and nonhuman studies to determine the overall strength of evidence for the question “Does developmental exposure to perfluorooctanoic acid (PFOA) affect fetal growth in humans?” Methods: We developed and applied prespecified criteria to systematically and transparently a) rate the quality of the scientific evidence as “high,” “moderate,” or “low”; b) rate the strength of the human and nonhuman evidence separately as “sufficient,” “limited,” “moderate,” or “evidence of lack of toxicity”; and c) integrate the strength of the human and nonhuman evidence ratings into a strength of the evidence conclusion. Results: We identified 18 epidemiology studies and 21 animal toxicology studies relevant to our study question. We rated both the human and nonhuman mammalian evidence as “moderate” quality and “sufficient” strength. Integration of these evidence ratings produced a final strength of evidence rating in which review authors concluded that PFOA is “known to be toxic” to human reproduction and development based on sufficient evidence of decreased fetal growth in both human and nonhuman mammalian species. Conclusion: We concluded that developmental exposure to PFOA adversely affects human health based on sufficient evidence of decreased fetal growth in both human and nonhuman mammalian species. The results of this case study demonstrate the application of a systematic and transparent methodology, via the Navigation Guide, for reaching strength of evidence conclusions in environmental health. Citation: Lam J, Koustas E, Sutton P, Johnson PI, Atchley DS, Sen S, Robinson KA, Axelrad DA, Woodruff TJ. 2014. The Navigation Guide—evidence-based medicine meets environmental health

  3. Measuring quality of care: considering conceptual approaches to quality indicator development and evaluation.

    Science.gov (United States)

    Stelfox, Henry T; Straus, Sharon E

    2013-12-01

    In this article, we describe one approach for developing and evaluating quality indicators. We focus on describing different conceptual approaches to quality indicator development, review one approach for developing quality indicators, outline how to evaluate quality indicators once developed, and discuss quality indicator maintenance. The key steps for developing quality indicators include specifying a clear goal for the indicators; using methodologies to incorporate evidence, expertise, and patient perspectives; and considering contextual factors and logistics of implementation. The Strategic Framework Board and the National Quality Measure Clearinghouse have developed criteria for evaluating quality indicators that complement traditional psychometric evaluations. Optimal strategies for quality indicator maintenance and dissemination have not been determined, but experiences with clinical guideline maintenance may be informative. For quality indicators to effectively guide quality improvement efforts, they must be developed, evaluated, maintained, and implemented using rigorous evidence-informed practices. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. A safe inexpensive method to isolate high quality plant and fungal ...

    African Journals Online (AJOL)

    STORAGESEVER

    2008-08-18

    Aug 18, 2008 ... quality DNA from plant and fungal species. This method uses potassium acetate to remove proteins and polysaccharides in an SDS extraction buffer. Further DNA purification is achieved using a low salt. CTAB treatment. This SDS/CTAB protocol was used to isolate high quality genomic DNA subject to.

  5. Prospective Links between Friendship and Early Physical Aggression: Preliminary Evidence Supporting the Role of Friendship Quality through a Dyadic Intervention

    Science.gov (United States)

    Salvas, Marie-Claude; Vitaro, Frank; Brendgen, Mara; Cantin, Ste´phane

    2016-01-01

    Positive friendships have been related to decreasing levels of children's physical aggression over time. While this evidence calls for interventions aimed at helping children build good-quality friendships, tests of causality through experimental manipulations are still needed. The goal of this study was to examine whether an intervention aimed to…

  6. Quantity and quality assessment of randomized controlled trials on orthodontic practice in PubMed.

    Science.gov (United States)

    Shimada, Tatsuo; Takayama, Hisako; Nakamura, Yoshiki

    2010-07-01

    To find current high-quality evidence for orthodontic practice within a reasonable time, we tested the performance of a PubMed search. PubMed was searched using publication type randomized controlled trial and medical subject heading term "orthodontics" for articles published between 2003 and 2007. The PubMed search results were compared with those from a hand search of four orthodontic journals to determine the sensitivity of PubMed search. We evaluated the precision of the PubMed search result and assessed the quality of individual randomized controlled trials using the Jadad scale. Sensitivity and precision were 97.46% and 58.12%, respectively. In PubMed, of the 277 articles retrieved, 161 (58.12%) were randomized controlled trials on orthodontic practice, and 115 of the 161 articles (71.42%) were published in four orthodontic journals: American Journal of Orthodontics and Dentofacial Orthopedics, The Angle Orthodontist, the European Journal of Orthodontics, and the Journal of Orthodontics. Assessment by the Jadad scale revealed 60 high-quality randomized controlled trials on orthodontic practice, of which 45 (75%) were published in these four journals. PubMed is a highly desirable search engine for evidence-based orthodontic practice. To stay current and get high-quality evidence, it is reasonable to look through four orthodontic journals: American Journal of Orthodontics and Dentofacial Orthopedics, The Angle Orthodontist, the European Journal of Orthodontics, and the Journal of Orthodontics.

  7. Mergers and Product Quality: Evidence from the Airline Industry

    OpenAIRE

    Chen, Yongmin; Gayle, Philip

    2013-01-01

    Retrospective studies of horizontal mergers have focused on their price effects, leaving the important question of how mergers affect product quality largely unanswered. This paper empirically investigates this issue for two recent airline mergers: Delta/Northwest and Continental/United. Consistent with the theoretical premise that mergers improve coordination but diminish competitive pressure for quality provision, we find: (i) each merger is associated with a quality increase in markets whe...

  8. Wellbeing Understanding in High Quality Healthcare Informatics and Telepractice.

    Science.gov (United States)

    Fiorini, Rodolfo A; De Giacomo, Piero; L'Abate, Luciano

    2016-01-01

    The proper use of healthcare informatics technology and multidimensional conceptual clarity are fundamental to create and boost outstanding clinical and telepractice results. Avoiding even terminology ambiguities is mandatory for high quality of care service. For instance, well-being or wellbeing is a different way to write the same concept only, or there is a good deal of ambiguity around the meanings of these terms the way they are written. In personal health, healthcare and healthcare informatics, this kind of ambiguity and lack of conceptual clarity has been called out repeatedly over the past 50 years. It is time to get the right, terse scenario. We present a brief review to develop and achieve ultimate wellbeing understanding for practical high quality healthcare informatics and telepractice application. This article presents an innovative point of view on deeper wellbeing understanding towards its increased clinical effective application.

  9. Construction of High-Quality Camel Immune Antibody Libraries.

    Science.gov (United States)

    Romão, Ema; Poignavent, Vianney; Vincke, Cécile; Ritzenthaler, Christophe; Muyldermans, Serge; Monsion, Baptiste

    2018-01-01

    Single-domain antibodies libraries of heavy-chain only immunoglobulins from camelids or shark are enriched for high-affinity antigen-specific binders by a short in vivo immunization. Thus, potent binders are readily retrieved from relatively small-sized libraries of 10 7 -10 8 individual transformants, mostly after phage display and panning on a purified target. However, the remaining drawback of this strategy arises from the need to generate a dedicated library, for nearly every envisaged target. Therefore, all the procedures that shorten and facilitate the construction of an immune library of best possible quality are definitely a step forward. In this chapter, we provide the protocol to generate a high-quality immune VHH library using the Golden Gate Cloning strategy employing an adapted phage display vector where a lethal ccdB gene has to be substituted by the VHH gene. With this procedure, the construction of the library can be shortened to less than a week starting from bleeding the animal. Our libraries exceed 10 8 individual transformants and close to 100% of the clones harbor a phage display vector having an insert with the length of a VHH gene. These libraries are also more economic to make than previous standard approaches using classical restriction enzymes and ligations. The quality of the Nanobodies that are retrieved from immune libraries obtained by Golden Gate Cloning is identical to those from immune libraries made according to the classical procedure.

  10. Air filtration and indoor air quality

    DEFF Research Database (Denmark)

    Bekö, Gabriel

    2006-01-01

    Demands for better indoor air quality are increasing, since we spend most of our time indoors and we are more and more aware of indoor air pollution. Field studies in different parts of the world have documented that high percentage of occupants in many offices and buildings find the indoor air...... decent ventilation and air cleaning/air filtration, high indoor air quality cannot be accomplished. The need for effective air filtration has increased with increasing evidence on the hazardous effects of fine particles. Moreover, the air contains gaseous pollutants, removal of which requires various air...... cleaning techniques. Supply air filter is one of the key components in the ventilation system. Studies have shown that used ventilation filters themselves can be a significant source of indoor air pollution with consequent impact on perceived air quality, sick building syndrome symptoms and performance...

  11. Evaluating the quality of perinatal anxiety information available online.

    Science.gov (United States)

    Kirby, Paige L; Reynolds, Kristin A; Walker, John R; Furer, Patricia; Pryor, Teaghan A M

    2018-06-22

    The Internet is an easily accessible source of information for women experiencing anxiety in pregnancy and/or postpartum to use when seeking health information. However, the Internet has several drawbacks, including inaccurate content that may be perceived as being accurate, non-biased, and evidence-based. Prior research indicates that anxiety and postpartum mental health websites have poor quality in terms of describing treatment options. There is a lack of research and knowledge in the area of perinatal anxiety, and an absence of research evaluating perinatal anxiety websites. The purpose of this study was to evaluate the quality of information regarding perinatal anxiety available on the Internet. Websites concerning perinatal anxiety were selected using the Google search engine. Each website was evaluated based on quality of health information, website usability, and readability. The 20 websites included in this study had low to moderate quality scores based on the DISCERN tool. There were no associations found between website order and website quality, or between website readability and website quality. Many websites had high PEMAT scores for the understandability section, which included content, style, and layout of information; however, most did not use visual aids to enhance comprehension. Most websites had low actionability scores, suggesting that information may not be useful in describing what actions may be taken to manage perinatal anxiety. This study highlights the need for high-quality websites concerning perinatal anxiety that are easy to navigate and provide the public with evidence-based information.

  12. Air Quality Standards for Particulate Matter (PM) at high altitude cities

    International Nuclear Information System (INIS)

    Bravo Alvarez, H.; Sosa Echeverria, R.; Sanchez Alvarez, P.; Krupa, S.

    2013-01-01

    The Air Quality Standards for Particulate Matter (PM) at high altitude urban areas in different countries, must consider the pressure and temperature due to the effect that these parameters have on the breath volume. This paper shows the importance to correct Air Quality Standards for PM considering pressure and temperature at different altitudes. Specific factors were suggested to convert the information concerning PM, from local to standard conditions, and adjust the Air Quality Standards for different high altitudes cities. The correction factors ranged from: 1.03 for Santiago de Chile to 1.47 for El Alto Bolivia. Other cities in this study include: Mexico City, México; La Paz, Bolivia; Bogota, Cali and Medellin, Colombia; Quito, Ecuador and Cuzco, Peru. If these corrections are not considered, the atmospheric concentrations will be underestimated. - Highlights: ► AQS for particulate matter concentrations adjusted by pressure and temperature. ► Particulate matter concentrations can be underestimated in high altitude Cities. ► Particulate matter concentrations must be compared under the same conditions. - In order to compare high altitude atmospheric PM concentrations with AQS, one must consider T and P of the sampling site.

  13. Providing high-quality care in primary care settings: how to make trade-offs.

    Science.gov (United States)

    Beaulieu, Marie-Dominique; Geneau, Robert; Del Grande, Claudio; Denis, Jean-Louis; Hudon, Eveline; Haggerty, Jeannie L; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William

    2014-05-01

    To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Three regions of Quebec. Health care professionals and staff of 5 PC practices. Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Irrespective of their models, PC practices' pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. Copyright© the College of Family Physicians of Canada.

  14. Stainless steel fabrication for high quality requirements in the nuclear industry

    International Nuclear Information System (INIS)

    Wareing, A.J.

    1990-01-01

    In this paper the author explains the welding procedures and practices adopted within the nuclear industry to achieve the high quality and standards of welds required. The changeover to mechanised welding, orbital TIG welding and synergic MIG welding, has resulted in consistent achievement of high quality standards as well as optimising the productivity. However, the use of mechanised welding machines does require the welder operating them to be fully trained and qualified. The formally organised training courses are described and the cost savings and production rates achieved by utilising the mechanised method are discussed. (author)

  15. Expert opinions and scientific evidence for colonoscopy key performance indicators.

    Science.gov (United States)

    Rees, Colin J; Bevan, Roisin; Zimmermann-Fraedrich, Katharina; Rutter, Matthew D; Rex, Douglas; Dekker, Evelien; Ponchon, Thierry; Bretthauer, Michael; Regula, Jaroslaw; Saunders, Brian; Hassan, Cesare; Bourke, Michael J; Rösch, Thomas

    2016-12-01

    Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. Perspectives on death and an afterlife in relation to quality of life, depression, and hopelessness in cancer patients without evidence of disease and advanced cancer patients.

    Science.gov (United States)

    van Laarhoven, Hanneke W M; Schilderman, Johannes; Verhagen, Constans A H H V M; Vissers, Kris C; Prins, Judith

    2011-06-01

    It is unknown whether cancer patients with different life expectancies have different attitudes and emotions toward death and an afterlife. Also, it is unclear whether these attitudes and emotions toward death and afterlife influence patients' distress. To assess the relationship of attitudes and emotions towards death and an afterlife with quality of life, depression and hopelessness in cancer patients without evidence of disease and advanced cancer patients facing death. Ninety-one cancer patients without evidence of disease and 57 advanced cancer patients completed the Dutch Attitudes Toward Death and Afterlife Scale. Emotions toward death were measured using the Self-Confrontation Method. Quality of life was measured with the Satisfaction with Life Scale and the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire. Depression and hopelessness were measured with the Beck Depression Inventory for Primary Care and the Beck Hopelessness Scale. Average scores on attitudes and emotions toward death and an afterlife were not significantly different between the two groups. However, in the no evidence of disease group, a negative association between negative emotions and social functioning was observed, which was not present in the advanced cancer group. In the advanced cancer group, associations were observed that were not present in the no evidence of disease group: positive associations between an explicitly religious attitude and global health status and between reincarnation belief and role and cognitive functioning, and a negative association between other-directed emotions and social functioning. Patients without evidence of disease and advanced cancer patients do not differ in attitudes or emotions toward death, but the relationship between these attitudes and emotions and aspects of quality of life varies. When there is no evidence of disease, negative emotions play the most important role, whereas in the advanced

  17. Evidence of the clinical effectiveness of cognitive pharmaceutical services for aged patients.

    Science.gov (United States)

    Sáez-Benito, Loreto; Fernandez-Llimos, Fernando; Feletto, Eleonora; Gastelurrutia, Miguel Angel; Martinez-Martinez, Fernando; Benrimoj, Shalom I

    2013-07-01

    cognitive pharmaceutical services (CPSs) encompass a variety of pharmacists' interventions to optimise pharmacotherapy. The clinical effectiveness of CPSs for aged patients remains controversial. to analyse and describe the evidence of the clinical effectiveness of CPSs in aged patients by means of performing a systematic review of systematic reviews. using the recommended methodology by Cochrane, a search was undertaken for systematic reviews of the clinical effectiveness of CPSs in MEDLINE, EMBASE, DOAJ, SCIELO and COCHRANE LIBRARY. Reviews were assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Quality of the evidence in the reviews was ranked using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. a total of 14 systematic reviews and one meta-analysis were analysed. The overall quality of the reviews was moderate. High and moderate strength of evidence was found for the positive effect of certain CPSs on reducing the number and improving the appropriateness of medicines. There was conflicting evidence of the effect on adherence. There was limited evidence of high and moderate strength on clinical outcomes. No positive evidence was found on mortality, hospitalisations, functional capacity and cognitive function. No systematic reviews reported the effect on the level of control of health problems. certain types of CPSs reduce the number of medicines and improve the appropriateness of prescriptions. Longer follow-up periods and/or the use of surrogate clinical variables measuring the short-term impact are required to demonstrate the effect on clinical outcomes.

  18. Process to Continuously Melt, Refine and Cast High Quality Steel

    Energy Technology Data Exchange (ETDEWEB)

    None

    2005-09-01

    The purpose of this project is to conduct research and development targeted at designing a revolutionary steelmaking process. This process will deliver high quality steel from scrap to the casting mold in one continuous process and will be safer, more productive, and less capital intensive to build and operate than conventional steelmaking. The new process will produce higher quality steel faster than traditional batch processes while consuming less energy and other resources.

  19. Increasing the quantity and quality of searching for current best evidence to answer clinical questions: protocol and intervention design of the MacPLUS FS Factorial Randomized Controlled Trials.

    Science.gov (United States)

    Agoritsas, Thomas; Iserman, Emma; Hobson, Nicholas; Cohen, Natasha; Cohen, Adam; Roshanov, Pavel S; Perez, Miguel; Cotoi, Chris; Parrish, Rick; Pullenayegum, Eleanor; Wilczynski, Nancy L; Iorio, Alfonso; Haynes, R Brian

    2014-09-20

    Finding current best evidence for clinical decisions remains challenging. With 3,000 new studies published every day, no single evidence-based resource provides all answers or is sufficiently updated. McMaster Premium LiteratUre Service--Federated Search (MacPLUS FS) addresses this issue by looking in multiple high quality resources simultaneously and displaying results in a one-page pyramid with the most clinically useful at the top. Yet, additional logistical and educational barriers need to be addressed to enhance point-of-care evidence retrieval. This trial seeks to test three innovative interventions, among clinicians registered to MacPLUS FS, to increase the quantity and quality of searching for current best evidence to answer clinical questions. In a user-centered approach, we designed three interventions embedded in MacPLUS FS: (A) a web-based Clinical Question Recorder; (B) an Evidence Retrieval Coach composed of eight short educational videos; (C) an Audit, Feedback and Gamification approach to evidence retrieval, based on the allocation of 'badges' and 'reputation scores.' We will conduct a randomized factorial controlled trial among all the 904 eligible medical doctors currently registered to MacPLUS FS at the hospitals affiliated with McMaster University, Canada. Postgraduate trainees (n=429) and clinical faculty/staff (n=475) will be randomized to each of the three following interventions in a factorial design (AxBxC). Utilization will be continuously recorded through clinicians’ accounts that track logins and usage, down to the level of individual keystrokes. The primary outcome is the rate of searches per month per user during the six months of follow-up. Secondary outcomes, measured through the validated Impact Assessment Method questionnaire, include: utility of answers found (meeting clinicians’ information needs), use (application in practice), and perceived usefulness on patient outcomes. Built on effective models for the point

  20. 76 FR 45397 - Export Inspection and Weighing Waiver for High Quality Specialty Grain Transported in Containers

    Science.gov (United States)

    2011-07-29

    ...-AB18 Export Inspection and Weighing Waiver for High Quality Specialty Grain Transported in Containers... permanent a waiver due to expire on July 31, 2012, for high quality specialty grain exported in containers... of high quality specialty grain exported in containers are small entities that up until recently...

  1. Quality of life of people living with HIV/AIDS and on highly active ...

    African Journals Online (AJOL)

    Quality of life of people living with HIV/AIDS and on highly active ... the Short Form-36 Health Survey (SF-36) was used to measure quality of life among patients on ... instrument for use in Ethiopia to assess the quality of life of people living with ...

  2. A Systematic Process for Developing High Quality SaaS Cloud Services

    Science.gov (United States)

    La, Hyun Jung; Kim, Soo Dong

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

  3. The quality of high-energy X-ray beams

    International Nuclear Information System (INIS)

    LaRiviere, P.D.

    1989-01-01

    Supplement 17 of the British Journal of Radiology is a survey of central-axis depth doses for radiotherapy machines, patterned largely on BJR Supplement 11 (1972). Inspection of high-energy X-ray depth doses for a 10 x 10 cm field at an SSD of 100 cm disclosed large differences between the two sets of data, especially for qualities above 8 MV, e.g. a depth dose of 80% at 10 cm is rated at about 19 MV according to BJR Supplement 11, and 23 MV according to BJR Supplement 17. It was found that Supplement 17 depth-dose data above 8 MV were erratic, but Supplement 11 data could be represented by an analytical expression, providing a unique means of assigning MV quality. It was also found that dose-weighted average energy of the filtered beam plotted smoothly against depth dose. For dosimetric purposes, it is suggested that this parameter be used as a true measure of beam quality, removing discrepancies introduced by the use of nominal MV for this purpose. (author)

  4. Supporting decision-making processes for evidence-based mental health promotion.

    Science.gov (United States)

    Jané-Llopis, Eva; Katschnig, Heinz; McDaid, David; Wahlbeck, Kristian

    2011-12-01

    The use of evidence is critical in guiding decision-making, but evidence from effect studies will be only one of a number of factors that will need to be taken into account in the decision-making processes. Equally important for policymakers will be the use of different types of evidence including implementation essentials and other decision-making principles such as social justice, political, ethical, equity issues, reflecting public attitudes and the level of resources available, rather than be based on health outcomes alone. This paper, aimed to support decision-makers, highlights the importance of commissioning high-quality evaluations, the key aspects to assess levels of evidence, the importance of supporting evidence-based implementation and what to look out for before, during and after implementation of mental health promotion and mental disorder prevention programmes.

  5. HON label and DISCERN as content quality indicators of health-related websites.

    Science.gov (United States)

    Khazaal, Yasser; Chatton, Anne; Zullino, Daniele; Khan, Riaz

    2012-03-01

    Content quality indicators are warranted in order to help patients and consumers to judge the content quality of health-related on-line information. The aim of the present study is to evaluate web-based information on health topics and to assess particular content quality indicators like HON (Health on the Net) and DISCERN. The present study is based on the analysis of data issued from six previous studies which assessed with a standardized tool the general and content quality (evidence-based health information) of health-related websites. Keywords related to Social phobia, bipolar disorders, pathological gambling as well as cannabis, alcohol and cocaine addiction were entered into popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability and content quality (evidence-based information). "Health on the Net" (HON) quality label, and DISCERN scale scores were used to verify their efficiency as quality indicators. Of 874 websites identified, 388 were included. Despite an observed association with higher content quality scores, the HON label fails to predict good content quality websites when used in a multiple regression. Sensibility and specificity of a DISCERN score >40 in the detection of good content quality websites were, respectively, 0.45 and 0.96. The DISCERN is a potential quality indicator with a relatively high specificity. Further developments in this domain are warranted in order to facilitate the identification of high-quality information on the web by patients.

  6. CDS, UX, and System Redesign - Promising Techniques and Tools to Bridge the Evidence Gap.

    Science.gov (United States)

    McGinn, Thomas

    2015-01-01

    In this special issue of eGEMs, we explore the struggles related to bringing evidence into day-to-day practice, what I define as the "evidence gap." We are all aware of high quality evidence in the form of guidelines, randomized clinical trials for treatments and diagnostic tests, and clinical prediction rules, which are all readily available online. We also know that electronic health records (EHRs) are now ubiquitous in health care and in most practices across the country. How we marry this high quality evidence and the practice of medicine through effective decision support is a major challenge. All of the articles in this issue explore, in some fashion, CDS systems and how we can best bring providers and their work environment to the evidence. We are at the very early stages of the science of usability. Much more research and funding is needed in this area if we hope to improve the dissemination and implementation of evidence in practice. While the featured examples, techniques, and tools in the special issue are a promising start to improving usability and CDS, many of the papers highlight current gaps in knowledge and a great need for generalizable approaches. The great promise is for "learning" approaches to generate new evidence and to integrate this evidence in reliable, patient-centered ways at scale using new technology. Closing the evidence gap is a real possibility, but only if the community works together to innovate and invest in research on the best ways to disseminate, communicate, and implement evidence in practice.

  7. Evidence based evaluation of immuno-coagulatory interventions in critical care

    DEFF Research Database (Denmark)

    Afshari, Arash

    2011-01-01

    Cochrane systematic reviews with meta-analyses of randomised trials provide guidance for clinical practice and health-care decision-making. In case of disagreements between research evidence and clinical practice, high quality systematic reviews can facilitate implementation or deimplementation o...... of medical interventions into clinical practice. This applies especially to treatment of critically ill patients where interventions are most often costly and the clinical conditions are associated with high mortality....

  8. High quality flux control system for electron gun evaporation

    International Nuclear Information System (INIS)

    Appelbloom, A.M.; Hadley, P.; van der Marel, D.; Mooij, J.E.

    1991-01-01

    This paper reports on a high quality flux control system for electron gun evaporation developed and tested for the MBE growth of high temperature superconductors. The system can be applied to any electron gun without altering the electron gun itself. Essential elements of the system are a high bandwidth mass spectrometer, control electronics and a high voltage modulator to sweep the electron beam over the melt at high frequencies. the sweep amplitude of the electron beam is used to control the evaporation flux at high frequencies. The feedback loop of the system has a bandwidth of over 100 Hz, which makes it possible to grow superlattices and layered structures in a fast and precisely controlled manner

  9. Local air quality management: some evidence of current practices

    Energy Technology Data Exchange (ETDEWEB)

    Beattie, Clare; Newton, Alex; Longhurst, Jim [University of the West of England, Air Quality Research Group, Bristol (United Kingdom)

    1998-12-01

    The recent legislative changes, notably the Environment Act 1995 and resultant National Air Quality Strategy have brought new powers and obligations to local authorities to reach specified air quality standards and objectives. Initially this will involve local authorities carrying out a review and assessment of air quality in their locality by December 1999. This paper will outline a project currently being undertaken within the University of the West of England investigating how this legislation is being put into practice and present the results from a nation-wide questionnaire survey of environmental health officers. The study found that local authorities are still at an early stage of the process. It seems probable that one possible barrier to the implementation of Air Quality Management will be communication and cooperation within local authorities. (Author)

  10. High quality factor GaAs microcavity with buried bullseye defects

    Science.gov (United States)

    Winkler, K.; Gregersen, N.; Häyrynen, T.; Bradel, B.; Schade, A.; Emmerling, M.; Kamp, M.; Höfling, S.; Schneider, C.

    2018-05-01

    The development of high quality factor solid-state microcavities with low mode volumes has paved the way towards on-chip cavity quantum electrodynamics experiments and the development of high-performance nanophotonic devices. Here, we report on the implementation of a new kind of solid-state vertical microcavity, which allows for confinement of the electromagnetic field in the lateral direction without deep etching. The confinement originates from a local elongation of the cavity layer imprinted in a shallow etch and epitaxial overgrowth technique. We show that it is possible to improve the quality factor of such microcavities by a specific in-plane bullseye geometry consisting of a set of concentric rings with subwavelength dimensions. This design results in a smooth effective lateral photonic potential and therefore in a reduction of lateral scattering losses, which makes it highly appealing for experiments in the framework of exciton-polariton physics demanding tight spatial confinement.

  11. Structural and Process Quality of Danish Preschools

    DEFF Research Database (Denmark)

    Slot, Pauline Louise; Bleses, Dorthe; Justice, Laura M.

    2018-01-01

    Structural quality in childcare centers is considered a precondition for process quality, which in turn is related to children’s outcomes. However, the evidence on relations between structural and process quality is mixed. Moreover, despite strong theoretical claims, empirical evidence supporting...

  12. Psychometric Evaluation of an Instrument for Measuring Organizational Climate for Quality: Evidence From a National Sample of Infection Preventionists.

    Science.gov (United States)

    Pogorzelska-Maziarz, Monika; Nembhard, Ingrid M; Schnall, Rebecca; Nelson, Shanelle; Stone, Patricia W

    2016-09-01

    In recent years, there has been increased interest in measuring the climate for infection prevention; however, reliable and valid instruments are lacking. This study tested the psychometric properties of the Leading a Culture of Quality for Infection Prevention (LCQ-IP) instrument measuring the infection prevention climate in a sample of 972 infection preventionists from acute care hospitals. An exploratory principal component analysis showed that the instrument had structural validity and captured 4 factors related to the climate for infection prevention: Psychological Safety, Prioritization of Quality, Supportive Work Environment, and Improvement Orientation. LCQ-IP exhibited excellent internal consistency, with a Cronbach α of .926. Criterion validity was supported with overall LCQ-IP scores, increasing with the number of evidence-based prevention policies in place (P = .047). This psychometrically sound instrument may be helpful to researchers and providers in assessing climate for quality related to infection prevention. © The Author(s) 2015.

  13. Limited evidence for non-pharmacological interventions for the relief of dry mouth.

    Science.gov (United States)

    Bakarman, Eman O; Keenan, Analia Veitz

    2014-03-01

    The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, AMED, CINAHL and CANCERLIT databases were searched. The metaRegister of Controlled Clinical Trials and ClinicalTrials.gov were also searched to identify ongoing and completed trials. Reference lists of included studies and relevant reviews were also searched. There were no restrictions on the language of publication or publication status. Randomised controlled trials of non-pharmacological treatments for patients with dry mouth at baseline. Study assessment and data extraction were carried out independently by at least two reviewers. Mean difference (MD) and standardised mean differences (SMD) together with 95% CIs were calculated where appropriate. Nine studies (366 participants) were included in this review, eight were assessed at high risk of bias and one at unclear risk of bias. Five small studies (153 participants), with dry mouth following radiotherapy treatment compared acupuncture with placebo. Four were at high risk and one at unclear risk of bias. Two trials reported outcome data for dry mouth in a form suitable for meta- analysis. The pooled estimate of these two trials (70 participants, low quality evidence) showed no difference between acupuncture and control in dry mouth symptoms (SMD -0.34, 95% CI -0.81 to 0.14, P value 0.17, I2 = 39%) with the confidence intervals including both a possible reduction or a possible increase in dry mouth symptoms.Acupuncture was associated with more adverse effects (tiny bruises and tiredness which were mild and temporary). There was a very small increase in unstimulated whole saliva (UWS) at the end of four to six weeks of treatment (three trials, 71 participants, low quality evidence) (MD 0.02 ml/minute, 95% CI 0 to 0.04, P value 0.04, I2 = 57%), and this benefit persisted at the 12-month follow-up evaluation (two trials, 54 participants, low quality evidence) (UWS, MD 0.06 ml/minute, 95

  14. A design technique of low cost but high quality peak stretcher

    Energy Technology Data Exchange (ETDEWEB)

    Lo, H Y; Su, C S; Hsu, J Y; Wang, L

    1981-03-01

    This paper presents the design of low cost but high quality pulse peak stretcher incorporated with a LSI of 12 bit ADC and SKD-85 microcomputer. The conflict between the capacitor high charging speed and longer holding time for realizing a high quality stretcher is discussed and solved. For a lager number of channels available in a dual ramp Wilkinson-type ADC, two-stage stretchers connected in series are designed. The first stage is a fast-discharge to keep the output stretched pulse follow-up the input quickly and the second-stage (main stretcher) is a slow-discharge to keep the transient of the circuit minimum. Both of these two peak stretchers are described and the experiment results are photographically recorded.

  15. Bumblebee family lineage survival is enhanced in high-quality landscapes.

    Science.gov (United States)

    Carvell, Claire; Bourke, Andrew F G; Dreier, Stephanie; Freeman, Stephen N; Hulmes, Sarah; Jordan, William C; Redhead, John W; Sumner, Seirian; Wang, Jinliang; Heard, Matthew S

    2017-03-23

    Insect pollinators such as bumblebees (Bombus spp.) are in global decline. A major cause of this decline is habitat loss due to agricultural intensification. A range of global and national initiatives aimed at restoring pollinator habitats and populations have been developed. However, the success of these initiatives depends critically upon understanding how landscape change affects key population-level parameters, such as survival between lifecycle stages, in target species. This knowledge is lacking for bumblebees, because of the difficulty of systematically finding and monitoring colonies in the wild. We used a combination of habitat manipulation, land-use and habitat surveys, molecular genetics and demographic and spatial modelling to analyse between-year survival of family lineages in field populations of three bumblebee species. Here we show that the survival of family lineages from the summer worker to the spring queen stage in the following year increases significantly with the proportion of high-value foraging habitat, including spring floral resources, within 250-1,000 m of the natal colony. This provides evidence for a positive impact of habitat quality on survival and persistence between successive colony cycle stages in bumblebee populations. These findings also support the idea that conservation interventions that increase floral resources at a landscape scale and throughout the season have positive effects on wild pollinators in agricultural landscapes.

  16. High dose-rate brachytherapy source position quality assurance using radiochromic film

    International Nuclear Information System (INIS)

    Evans, M.D.C.; Devic, S.; Podgorsak, E.B.

    2007-01-01

    Traditionally, radiographic film has been used to verify high-dose-rate brachytherapy source position accuracy by co-registering autoradiographic and diagnostic images of the associated applicator. Filmless PACS-based clinics that do not have access to radiographic film and wet developers may have trouble performing this quality assurance test in a simple and practical manner. We describe an alternative method for quality assurance using radiochromic-type film. In addition to being easy and practical to use, radiochromic film has some advantages in comparison with traditional radiographic film when used for HDR brachytherapy quality assurance

  17. Effect of Promoting High-Quality Staff Interactions on Fall Prevention in Nursing Homes: A Cluster-Randomized Trial.

    Science.gov (United States)

    Colón-Emeric, Cathleen S; Corazzini, Kirsten; McConnell, Eleanor S; Pan, Wei; Toles, Mark; Hall, Rasheeda; Cary, Michael P; Batchelor-Murphy, Melissa; Yap, Tracey; Anderson, Amber L; Burd, Andrew; Amarasekara, Sathya; Anderson, Ruth A

    2017-11-01

    New approaches are needed to enhance implementation of complex interventions for geriatric syndromes such as falls. To test whether a complexity science-based staff training intervention (CONNECT) promoting high-quality staff interactions improves the impact of an evidence-based falls quality improvement program (FALLS). Cluster-randomized trial in 24 nursing homes receiving either CONNECT followed by FALLS (intervention), or FALLS alone (control). Nursing home staff in all positions were asked to complete surveys at baseline, 3, 6, and 9 months. Medical records of residents with at least 1 fall in the 6-month pre- and postintervention windows (n = 1794) were abstracted for fall risk reduction measures, falls, and injurious falls. CONNECT taught staff to improve their connections with coworkers, increase information flow, and use cognitive diversity in problem solving. Intervention components included 2 classroom sessions, relationship mapping, and self-monitoring. FALLS provided instruction in the Agency for Healthcare Research and Quality's Falls Management Program. Primary outcomes were (1) mean number of fall risk reduction activities documented within 30 days of falls and (2) median fall rates among residents with at least 1 fall during the study period. In addition, validated scales measured staff communication quality, frequency, timeliness, and safety climate. Surveys were completed by 1545 staff members, representing 734 (37%) and 811 (44%) of eligible staff in intervention and control facilities, respectively; 511 (33%) respondents were hands-on care workers. Neither the CONNECT nor the FALLS-only facilities improved the mean count of fall risk reduction activities following FALLS (3.3 [1.6] vs 3.2 [1.5] of 10); furthermore, adjusted median recurrent fall rates did not differ between the groups (4.06 [interquartile range {IQR}, 2.03-8.11] vs 4.06 [IQR, 2.04-8.11] falls/resident/y). A modest improvement in staff communication measures was observed

  18. Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery.

    Science.gov (United States)

    Gockel, Ines; Ahlbrand, Constantin Johannes; Arras, Michael; Schreiber, Elke Maria; Lang, Hauke

    2015-12-01

    Ranking systems and comparisons of quality and performance indicators will be of increasing relevance for complex "high-risk" procedures such as esophageal cancer surgery. The identification of evidence-based standards relevant for key performance indicators in esophageal surgery is essential for establishing monitoring systems and furthermore a requirement to enhance treatment quality. In the course of this review, we analyze the key performance indicators case volume, radicality of resection, and postoperative morbidity and mortality, leading to continuous quality improvement. Ranking systems established on this basis will gain increased relevance in highly complex procedures within the national and international comparison and furthermore improve the treatment of patients with esophageal carcinoma.

  19. Simple and rapid preparation of [{sup 11}C]DASB with high quality and reliability for routine applications

    Energy Technology Data Exchange (ETDEWEB)

    Haeusler, D.; Mien, L.-K. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, A-1090 Vienna (Austria); Nics, L. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Department of Nutritional Sciences, University of Vienna, A-1090 Vienna (Austria); Ungersboeck, J. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Department of Inorganic Chemistry, University of Vienna, A-1090 Vienna (Austria); Philippe, C. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, A-1090 Vienna (Austria); Lanzenberger, R.R. [Department of Psychiatry and Psychotherapy, Medical University of Vienna, A-1090 Vienna (Austria); Kletter, K.; Dudczak, R. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Mitterhauser, M. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, A-1090 Vienna (Austria); Hospital Pharmacy of the General Hospital of Vienna, A-1090 Vienna (Austria); Wadsak, W. [Department of Nuclear Medicine, PET, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Department of Inorganic Chemistry, University of Vienna, A-1090 Vienna (Austria)], E-mail: wolfgang.wadsak@meduniwien.ac.at

    2009-09-15

    [{sup 11}C]DASB combines all major prerequisites for a successful SERT-ligand, providing excellent biological properties and in-vivo behaviour. Thus, we aimed to establish a fully automated procedure for the synthesis and purification of [{sup 11}C]DASB with a high degree of reliability reducing the overall synthesis time while conserving high yields and purity. The optimized [{sup 11}C]DASB synthesis was applied in more than 60 applications with a very low failure rate (3.2%). We obtained yields up to 8.9 GBq (average 5.3{+-}1.6 GBq). Radiochemical yields based on [{sup 11}C]CH{sub 3}I, (corrected for decay) were 66.3{+-}6.9% with a specific radioactivity (A{sub s}) of 86.8{+-}24.3 GBq/{mu}mol (both at the end of synthesis, EOS). Time consumption was kept to a minimum, resulting in 43 min from end of bombardment to release of the product after quality control. Form our data, it is evident that the presented method can be implemented for routine preparations of [{sup 11}C]DASB with high reliability.

  20. Quality tools and resources to support organisational improvement integral to high-quality primary care: a systematic review of published and grey literature.

    Science.gov (United States)

    Janamian, Tina; Upham, Susan J; Crossland, Lisa; Jackson, Claire L

    2016-04-18

    To conduct a systematic review of the literature to identify existing online primary care quality improvement tools and resources to support organisational improvement related to the seven elements in the Primary Care Practice Improvement Tool (PC-PIT), with the identified tools and resources to progress to a Delphi study for further assessment of relevance and utility. Systematic review of the international published and grey literature. CINAHL, Embase and PubMed databases were searched in March 2014 for articles published between January 2004 and December 2013. GreyNet International and other relevant websites and repositories were also searched in March-April 2014 for documents dated between 1992 and 2012. All citations were imported into a bibliographic database. Published and unpublished tools and resources were included in the review if they were in English, related to primary care quality improvement and addressed any of the seven PC-PIT elements of a high-performing practice. Tools and resources that met the eligibility criteria were then evaluated for their accessibility, relevance, utility and comprehensiveness using a four-criteria appraisal framework. We used a data extraction template to systematically extract information from eligible tools and resources. A content analysis approach was used to explore the tools and resources and collate relevant information: name of the tool or resource, year and country of development, author, name of the organisation that provided access and its URL, accessibility information or problems, overview of each tool or resource and the quality improvement element(s) it addresses. If available, a copy of the tool or resource was downloaded into the bibliographic database, along with supporting evidence (published or unpublished) on its use in primary care. This systematic review identified 53 tools and resources that can potentially be provided as part of a suite of tools and resources to support primary care practices in

  1. High Quality Education and Learning for All through Open Education

    NARCIS (Netherlands)

    Stracke, Christian M.

    2016-01-01

    Keynote at the International Lensky Education Forum 2016, Yakutsk, Republic of Sakha, Russian Federation, by Stracke, C. M. (2016, 16 August): "High Quality Education and Learning for All through Open Education"

  2. Safety and quality management at the high flux reactor Petten

    International Nuclear Information System (INIS)

    Zurita, A.; Ahlf, J.

    1995-01-01

    The High Flux Reactor (HFR) is one high power multi-purpose materials testing research reactor of the tank-in-pool type, cooled and moderated by light-water. It is operated at 45 MW at a prescribed schedule of 11 cycles per year, each comprising 25 operation days and three shut-down days. Since the licence for the operation of HFR was granted in 1962, a total of 14 amendments to the original licence have been made following different modifications in the installations. In the meantime, international nuclear standards were developed, especially in the framework of the NUSS programme of the IAEA, which were adopted by the Dutch Licensing Authorities. In order to implement the new standards, the situation at the HFR was comprehensively reviewed in the course of an audit performed by the Dutch Licensing Authorities in 1988. This also resulted in formulating the task of setting-up an 'HFR - Integral Quality Assurance Handbook' (HFR-IQAD) involving both organizations JRCIAM and ECN, which had the unique framework and basic guideline to assure the safe and efficient operation and exploitation of the HFR and to promote safety and quality in all aspects of HFR related activities. The assurance of safe and efficient operation and exploitation of the HFR is condensed together under the concepts of safety and quality of services and is achieved through the safety and quality management. (orig.)

  3. Recruiting for Values in Healthcare: A Preliminary Review of the Evidence

    Science.gov (United States)

    Patterson, Fiona; Prescott-Clements, Linda; Zibarras, Lara; Edwards, Helena; Kerrin, Maire; Cousans, Fran

    2016-01-01

    Displaying compassion, benevolence and respect, and preserving the dignity of patients are important for any healthcare professional to ensure the provision of high quality care and patient outcomes. This paper presents a structured search and thematic review of the research evidence relating to values-based recruitment within healthcare. Several…

  4. Economic evidence for the clinical management of major depressive disorder: a systematic review and quality appraisal of economic evaluations alongside randomised controlled trials.

    Science.gov (United States)

    Karyotaki, E; Tordrup, D; Buntrock, C; Bertollini, R; Cuijpers, P

    2017-10-01

    The aim of this systematic review of economic evaluations alongside randomised controlled trials (RCTs) was to provide a comprehensive overview of the evidence concerning cost-effectiveness analyses of common treatment options for major depression. An existing database was used to identify studies reporting cost-effectiveness results from RCTs. This database has been developed by a systematic literature search in the bibliographic databases of PubMed, PsychINFO, Embase and Cochrane library from database inception to December 2014. We evaluated the quality of economic evaluations using a 10-item short version of the Drummond checklist. Results were synthesised narratively. The risk of bias of the included RCTs was assessed, based on the Cochrane risk of bias assessment tool. Fourteen RCTs were included from the 5580 articles screened on titles and abstracts. The methodological quality of the health economic evaluations was relatively high and the majority of the included RCTs had low risk of bias in most of Cochrane items except blinding of participants and personnel. Cognitive behavioural therapy was examined in seven trials as part of a variety of treatment protocols and seems cost-effective compared with pharmacotherapy in the long-term. However cost-effectiveness results for the combination of psychotherapy with pharmacotherapy are conflicting and should be interpreted with caution due to limited comparability between the examined trials. For several treatments, only a single economic evaluation was reported as part of a clinical trial. This was the case for comparisons between different classes of antidepressants, for several types of psychotherapy (behavioural activation, occupational therapy, interpersonal psychotherapy, short-term psychotherapy, psychodynamic psychotherapy, rational emotive behavioural therapy, solution focused therapy), and for transcranial magnetic stimulation v. electroconvulsive therapy. The limited evidence base for these interventions

  5. Home-based telecommuting and quality of life: further evidence on an employee-oriented human resource practice.

    Science.gov (United States)

    Hornung, Severin; Glaser, Jürgen

    2009-04-01

    Building on previous research, further evidence for the potential of home-based telecommuting as an employee-oriented human resource practice is provided from a study in the German public administration. Survey data from 1,008 public employees were analyzed using structural equation modeling. Mean age of the sample was 43.6 yr. (SD = 8.8 yr.), and 27.5% (277) of the participants were women. Analysis supported the roles of higher Autonomy and lower Work-Family Conflict as psychological mediators between Telecommunication Intensity and both Job Satisfaction and Quality of Life. Implications for the design of flexible working arrangements are discussed.

  6. Quality and efficiency in high dimensional Nearest neighbor search

    KAUST Repository

    Tao, Yufei; Yi, Ke; Sheng, Cheng; Kalnis, Panos

    2009-01-01

    Nearest neighbor (NN) search in high dimensional space is an important problem in many applications. Ideally, a practical solution (i) should be implementable in a relational database, and (ii) its query cost should grow sub-linearly with the dataset size, regardless of the data and query distributions. Despite the bulk of NN literature, no solution fulfills both requirements, except locality sensitive hashing (LSH). The existing LSH implementations are either rigorous or adhoc. Rigorous-LSH ensures good quality of query results, but requires expensive space and query cost. Although adhoc-LSH is more efficient, it abandons quality control, i.e., the neighbor it outputs can be arbitrarily bad. As a result, currently no method is able to ensure both quality and efficiency simultaneously in practice. Motivated by this, we propose a new access method called the locality sensitive B-tree (LSB-tree) that enables fast highdimensional NN search with excellent quality. The combination of several LSB-trees leads to a structure called the LSB-forest that ensures the same result quality as rigorous-LSH, but reduces its space and query cost dramatically. The LSB-forest also outperforms adhoc-LSH, even though the latter has no quality guarantee. Besides its appealing theoretical properties, the LSB-tree itself also serves as an effective index that consumes linear space, and supports efficient updates. Our extensive experiments confirm that the LSB-tree is faster than (i) the state of the art of exact NN search by two orders of magnitude, and (ii) the best (linear-space) method of approximate retrieval by an order of magnitude, and at the same time, returns neighbors with much better quality. © 2009 ACM.

  7. Evidence for current recommendations concerning the management of foot health for people with chronic long-term conditions: a systematic review

    Directory of Open Access Journals (Sweden)

    Katherine Edwards

    2017-11-01

    scores with 62 publications falling into the category of high quality (scores 6–7. The number of publications providing a recommendation in the context of a narrative but without an indication of the strength or quality of the underlying evidence was high (79 out of 166. Conclusions It is clear that evidence needs to be accelerated and in place to support the future of the Podiatry workforce. Whilst high level evidence for podiatry is currently low in quantity, the methodological quality is growing. Where levels of evidence have been given in in high quality guidelines, standards of care or recommendations, they also tend to be strong-moderate quality such that further strategically prioritised research, if performed, is likely to have an important impact in the field.

  8. Assessment of wastewater and recycled water quality: a comparison of lines of evidence from in vitro, in vivo and chemical analyses.

    Science.gov (United States)

    Leusch, Frederic D L; Khan, Stuart J; Gagnon, M Monique; Quayle, Pam; Trinh, Trang; Coleman, Heather; Rawson, Christopher; Chapman, Heather F; Blair, Palenque; Nice, Helen; Reitsema, Tarren

    2014-03-01

    We investigated water quality at an advanced water reclamation plant and three conventional wastewater treatment plants using an "ecotoxicity toolbox" consisting of three complementary analyses (chemical analysis, in vitro bioanalysis and in situ biological monitoring), with a focus on endocrine disruption. The in vitro bioassays were chosen to provide an appropriately wide coverage of biological effects relevant to managed aquifer recharge and environmental discharge of treated wastewater, and included bioassays for bacterial toxicity (Microtox), genotoxicity (umuC), photosynthesis inhibition (Max-I-PAM) and endocrine effects (E-SCREEN and AR-CALUX). Chemical analysis of hormones and pesticides using LCMSMS was performed in parallel to correlate standard analytical methods with the in vitro assessment. For two plants with surface water discharge into open drains, further field work was carried out to examine in situ effects using mosquitofish (Gambusia holbrooki) as a bioindicator species for possible endocrine effects. The results show considerable cytotoxicity, phytotoxicity, estrogenicity and androgenicity in raw sewage, all of which were significantly reduced by conventional wastewater treatment. No biological response was detected to RO water, suggesting that reverse osmosis is a significant barrier to biologically active compounds. Chemical analysis and in situ monitoring revealed trends consistent with the in vitro results: chemical analysis confirmed the removal trends observed by the bioanalytical tools, and in situ sampling did not reveal any evidence of endocrine disruption specifically due to discharge of treated wastewater (although other sources may be present). Biomarkers of exposure (in vitro) and effect (in vivo or in situ) are complementary and together provide information with a high level of ecological relevance. This study illustrates the utility of combining multiple lines of evidence in the assessment of water quality. Copyright

  9. Knowledge Translation Strategies for Enhancing Nurses’ Evidence-Informed Decision Making: A Scoping Review

    OpenAIRE

    Yost, Jennifer; Thompson, David; Ganann, Rebecca; Aloweni, Fazila; Newman, Kristine; McKibbon, Ann; Dobbins, Maureen; Ciliska, Donna

    2014-01-01

    Background Nurses are increasingly expected to engage in evidence-informed decision making (EIDM); the use of research evidence with information about patient preferences, clinical context and resources, and their clinical expertise in decision making. Strategies for enhancing EIDM have been synthesized in high-quality systematic reviews, yet most relate to physicians or mixed disciplines. Existing reviews, specific to nursing, have not captured a broad range of strategies for promoting the k...

  10. Does Elite Sport Degrade Sleep Quality? A Systematic Review.

    Science.gov (United States)

    Gupta, Luke; Morgan, Kevin; Gilchrist, Sarah

    2017-07-01

    Information on sleep quality and insomnia symptomatology among elite athletes remains poorly systematised in the sports science and medicine literature. The extent to which performance in elite sport represents a risk for chronic insomnia is unknown. The purpose of this systematic review was to profile the objective and experienced characteristics of sleep among elite athletes, and to consider relationships between elite sport and insomnia symptomatology. Studies relating to sleep involving participants described on a pre-defined continuum of 'eliteness' were located through a systematic search of four research databases: SPORTDiscus, PubMed, Science Direct and Google Scholar, up to April 2016. Once extracted, studies were categorised as (1) those mainly describing sleep structure/patterns, (2) those mainly describing sleep quality and insomnia symptomatology and (3) those exploring associations between aspects of elite sport and sleep outcomes. The search returned 1676 records. Following screening against set criteria, a total of 37 studies were identified. The quality of evidence reviewed was generally low. Pooled sleep quality data revealed high levels of sleep complaints in elite athletes. Three risk factors for sleep disturbance were broadly identified: (1) training, (2) travel and (3) competition. While acknowledging the limited number of high-quality evidence reviewed, athletes show a high overall prevalence of insomnia symptoms characterised by longer sleep latencies, greater sleep fragmentation, non-restorative sleep, and excessive daytime fatigue. These symptoms show marked inter-sport differences. Two underlying mechanisms are implicated in the mediation of sport-related insomnia symptoms: pre-sleep cognitive arousal and sleep restriction.

  11. Evidence for intrinsic critical current density in high Tc superconductors

    International Nuclear Information System (INIS)

    Freltoft, T.; Minnhagen, P.; Jeldtoft Jensen, H.

    1991-01-01

    We present measurements of the voltage-current characteristics of high quality epitaxial YBaCuO films in zero magnetic field. According to the predictions of a current induced vortex pair breaking picture the voltage should follow the functional form V∝I(I-I c ) a-1 . An analysis designed to test this functional behavior is carried out. Consistency is found. (orig.)

  12. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

    Directory of Open Access Journals (Sweden)

    Julie Storr

    2017-01-01

    Full Text Available Abstract Health care-associated infections (HAI are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.

  13. Bank service quality in private sector: Evidence from Iran

    Directory of Open Access Journals (Sweden)

    Niloufar Asgarian

    2013-02-01

    Full Text Available Service quality plays an important role in service industries such as banks, insurance firms, etc. The purpose of this paper is to investigate level of service quality in private banking industry in Iran. The proposed model of this paper uses SERVQUAL tool for measuring service quality and population of this study includes customers of three private banks in Tehran. Results show that except efficiency, other variables of SERVQUAL obtained suitable level mean in this study. As a result, with the development of electronic commerce, internet banking has become an alternative for developing, operating and offering bank services.

  14. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management

    DEFF Research Database (Denmark)

    Chapman, M John; Ginsberg, Henry N; Amarenco, Pierre

    2011-01-01

    Even at low-density lipoprotein cholesterol (LDL-C) goal, patients with cardiometabolic abnormalities remain at high risk of cardiovascular events. This paper aims (i) to critically appraise evidence for elevated levels of triglyceride-rich lipoproteins (TRLs) and low levels of high......-density lipoprotein cholesterol (HDL-C) as cardiovascular risk factors, and (ii) to advise on therapeutic strategies for management. Current evidence supports a causal association between elevated TRL and their remnants, low HDL-C, and cardiovascular risk. This interpretation is based on mechanistic and genetic...

  15. Safe and High Quality Food Production using Low Quality Waters and Improved Irrigation Systems and Management, EU Project

    DEFF Research Database (Denmark)

    Plauborg, Finn; Jensen, Christian Richardt; Dalsgaard, Anders

    2009-01-01

    : the safety and quality of food products, and the increasing competition for clean freshwater. SAFIR is funded for the period 2005-2009 under the Food Quality and Safety thematic area of the EU 6th Framework Research Programme. The challenge for the next years will be to produce safe and high quality foods...... a multi-disciplinary team, with food safety and quality experts, engineers, agronomists and economists from17 research institutes and private companies in Europe, Israel and China working together. The project assesses potential risks to farmers. Coupled with farm management and economic models, a new...... intelligent tool for efficient and safe use and re-use of low-quality water are being developed. Already published results indicate water saving in the order of 25-30% in agricultural crops as potatoes and tomatoes are possible without yield reduction. Slightly treated waste water can be used safely when...

  16. Obstacles to implementing evidence-based practice in Belgium: a context-specific qualitative evidence synthesis including findings from different health care disciplines.

    Science.gov (United States)

    Hannes, K; Goedhuys, J; Aertgeerts, B

    2012-01-01

    ) organizing high quality catch-up programs for those who missed out on evidence-based medicine in their curriculum.

  17. Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. The GRADE approach to developing recommendations

    NARCIS (Netherlands)

    Brożek, J. L.; Akl, E. A.; Compalati, E.; Kreis, J.; Terracciano, L.; Fiocchi, A.; Ueffing, E.; Andrews, J.; Alonso-Coello, P.; Meerpohl, J. J.; Lang, D. M.; Jaeschke, R.; Williams, J. W.; Phillips, B.; Lethaby, A.; Bossuyt, P.; Glasziou, P.; Helfand, M.; Watine, J.; Afilalo, M.; Welch, V.; Montedori, A.; Abraha, I.; Horvath, A. R.; Bousquet, J.; Guyatt, G. H.; Schünemann, H. J.

    2011-01-01

    This is the third and last article in the series about the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the quality of evidence and the strength of recommendations in clinical practice guidelines and its application in the field of allergy. We

  18. Bullying as a risk for poor sleep quality among high school students in China.

    Directory of Open Access Journals (Sweden)

    Ying Zhou

    Full Text Available To determine whether involvement in bullying as a bully, victim, or bully-victim was associated with a higher risk of poor sleep quality among high school students in China.A cross-sectional study was conducted. A total of 23,877 high school students were surveyed in six cities in Guangdong Province. All students were asked to complete the adolescent health status questionnaire, which included the Chinese version of the Pittsburgh Sleep Quality Index (PSQI and bullying involvement. Descriptive statistics were used to evaluate sleep quality and the prevalence of school bullying. Multi-level logistic regression analyses were conducted to examine the association between being victimized and bullying others with sleep quality.Among the 23,877 students, 6,127 (25.66% reported having poor sleep quality, and 10.89% reported being involved in bullying behaviors. Of the respondents, 1,410 (5.91% were pure victims of bullying, 401 (1.68% were bullies and 784 (3.28% were bully-victims. Frequently being involved in bullying behaviors (being bullied or bullying others was related to increased risks of poor sleep quality compared with adolescents who were not involved in bullying behaviors. After adjusting for age, sex, and other confounding factors, the students who were being bullied (OR=2.05, 95%CI=1.81-2.32, bullied others (OR=2.30, 95%CI=1.85-2.86 or both (OR=2.58, 95%CI=2.20-3.03 were at a higher risk for poor sleep quality.Poor sleep quality among high school students is highly prevalent, and school bullying is prevalent among adolescents in China. The present results suggested that being involved in school bullying might be a risk factor for poor sleep quality among adolescents.

  19. Bullying as a risk for poor sleep quality among high school students in China.

    Science.gov (United States)

    Zhou, Ying; Guo, Lan; Lu, Ci-yong; Deng, Jian-xiong; He, Yuan; Huang, Jing-hui; Huang, Guo-liang; Deng, Xue-qing; Gao, Xue

    2015-01-01

    To determine whether involvement in bullying as a bully, victim, or bully-victim was associated with a higher risk of poor sleep quality among high school students in China. A cross-sectional study was conducted. A total of 23,877 high school students were surveyed in six cities in Guangdong Province. All students were asked to complete the adolescent health status questionnaire, which included the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) and bullying involvement. Descriptive statistics were used to evaluate sleep quality and the prevalence of school bullying. Multi-level logistic regression analyses were conducted to examine the association between being victimized and bullying others with sleep quality. Among the 23,877 students, 6,127 (25.66%) reported having poor sleep quality, and 10.89% reported being involved in bullying behaviors. Of the respondents, 1,410 (5.91%) were pure victims of bullying, 401 (1.68%) were bullies and 784 (3.28%) were bully-victims. Frequently being involved in bullying behaviors (being bullied or bullying others) was related to increased risks of poor sleep quality compared with adolescents who were not involved in bullying behaviors. After adjusting for age, sex, and other confounding factors, the students who were being bullied (OR=2.05, 95%CI=1.81-2.32), bullied others (OR=2.30, 95%CI=1.85-2.86) or both (OR=2.58, 95%CI=2.20-3.03) were at a higher risk for poor sleep quality. Poor sleep quality among high school students is highly prevalent, and school bullying is prevalent among adolescents in China. The present results suggested that being involved in school bullying might be a risk factor for poor sleep quality among adolescents.

  20. Perceived neighborhood quality, sleep quality, and health status: evidence from the Survey of the Health of Wisconsin.

    Science.gov (United States)

    Hale, Lauren; Hill, Terrence D; Friedman, Elliot; Nieto, F Javier; Galvao, Loren W; Engelman, Corinne D; Malecki, Kristen M C; Peppard, Paul E

    2013-02-01

    Why does living in a disadvantaged neighborhood predict poorer mental and physical health? Recent research focusing on the Southwestern United States suggests that disadvantaged neighborhoods favor poor health, in part, because they undermine sleep quality. Building on previous research, we test whether this process extends to the Midwestern United States. Specifically, we use cross-sectional data from the Survey of the Health of Wisconsin (SHOW), a statewide probability sample of Wisconsin adults, to examine whether associations among perceived neighborhood quality (e.g., perceptions of crime, litter, and pleasantness in the neighborhood) and health status (overall self-rated health and depression) are mediated by overall sleep quality (measured as self-rated sleep quality and physician diagnosis of sleep apnea). We find that perceptions of low neighborhood quality are associated with poorer self-rated sleep quality, poorer self-rated health, and more depressive symptoms. We also observe that poorer self-rated sleep quality is associated with poorer self-rated health and more depressive symptoms. Our mediation analyses indicate that self-rated sleep quality partially mediates the link between perceived neighborhood quality and health status. Specifically, self-rated sleep quality explains approximately 20% of the association between neighborhood quality and self-rated health and nearly 19% of the association between neighborhood quality and depression. Taken together, these results confirm previous research and extend the generalizability of the indirect effect of perceived neighborhood context on health status through sleep quality. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. The Role of Dosimetry in High-Quality EMI Risk Assessment

    National Research Council Canada - National Science Library

    2006-01-01

    The Final Proceedings for The role of EMF dosimetry in high quality risk assessment 13 September 2006 - 15 September 2006 In the last three decades the use of devices that emit electromagnetic fields (EMF...

  2. A Narrative Review of High-Quality Literature on the Effects of Resident Duty Hours Reforms.

    Science.gov (United States)

    Lin, Henry; Lin, Emery; Auditore, Stephanie; Fanning, Jon

    2016-01-01

    To summarize current high-quality studies evaluating the effect and efficacy of resident duty hours reforms (DHRs) on patient safety and resident education and well-being. The authors searched PubMed and Medline in August 2012 and again in May 2013 for literature (1987-2013) about the effects of DHRs. They assessed the quality of articles using the Medical Education Research Study Quality Instrument (MERSQI) scoring system. They considered randomized controlled trials (RCTs), partial RCTs, and all studies with a MERSQI score ≥ 14 to be "high-quality" methodology studies. A total of 72 high-quality studies met inclusion criteria. Most studies showed no change or slight improvement in mortality and complication rates after DHRs. Resident well-being was generally improved, but there was a perceived negative impact on education (knowledge acquisition, skills, and cognitive performance) following DHRs. Eleven high-quality studies assessed the impact of DHR interventions; all reported a neutral to positive impact. Seven high-quality studies assessed costs associated with DHRs and demonstrated an increase in hospital costs. The results of most studies that allow enough time for DHR interventions to take effect suggest a benefit to patient safety and resident well-being, but the effect on the quality of training remains unknown. Additional methodologically sound studies on the impact of DHRs are necessary. Priorities for future research include approaches to optimizing education and clinical proficiency and studies on the effect of intervention strategies on both education and patient safety. Such studies will provide additional information to help improve duty hours policies.

  3. Malaria treatment policy change in Uganda: what role did evidence play?

    Science.gov (United States)

    Nabyonga-Orem, Juliet; Ssengooba, Freddie; Macq, Jean; Criel, Bart

    2014-09-02

    Although increasing attention is being paid to knowledge translation (KT), research findings are not being utilized to the desired extent. The present study explores the role of evidence, barriers, and factors facilitating the uptake of evidence in the change in malaria treatment policy in Uganda, building on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitatory factors for KT. Application of the MRT to a health policy case will contribute to refining it. Using a case study approach and mixed methods, perceptions of respondents on whether evidence was available, had been considered and barriers and facilitatory factors to the uptake of evidence were explored. In addition, the respondents' rating of the degree of consistency between the policy decision and available evidence was assessed. Data collection methods included key informant interviews and document review. Qualitative data were analysed using content thematic analysis, whereas quantitative data were analysed using Excel spreadsheets. The two data sets were eventually triangulated. Evidence was used to change the malaria treatment policy, though the consistency between evidence and policy decisions varied along the policy development cycle. The availability of high-quality and contextualized evidence, including effective dissemination, Ministry of Health institutional capacity to lead the KT process, intervention of the WHO and a regional professional network, the existence of partnerships for KT with mutual trust and availability of funding, tools, and inputs to implement evidence, were the most important facilitatory factors that enhanced the uptake of evidence. Among the barriers that had to be overcome were resistance from implementers, the health system capacity to implement evidence, and financial sustainability. The results agree with facilitatory factors identified in the earlier developed MRT, though additional factors emerged. These

  4. Impacts of a high-discharge submarine sewage outfall on water quality in the coastal zone of Salvador (Bahia, Brazil)

    KAUST Repository

    Roth, Florian; Lessa, G.C.; Wild, C.; Kikuchi, R.K.P.; Naumann, M.S.

    2016-01-01

    Carbon and nitrogen stable isotopic signatures of suspended particulate organic matter and seawater biological oxygen demand (BOD) were measured along a coastal transect during summer 2015 to investigate pollution impacts of a high-discharge submarine sewage outfall close to Salvador, Brazil. Impacts of untreated sewage discharge were evident at the outfall site by depleted δ13Corg and δ15N signatures and 4-fold increased BOD rates. Pollution effects of a sewage plume were detectable for more than 6 km downstream from the outfall site, as seasonal wind- and tide-driven shelf hydrodynamics facilitated its advective transport into near-shore waters. There, sewage pollution was detectable at recreational beaches by depleted stable isotope signatures and elevated BOD rates at high tides, suggesting high bacterial activity and increased infection risk by human pathogens. These findings indicate the urgent necessity for appropriate wastewater treatment in Salvador to achieve acceptable standards for released effluents and coastal zone water quality.

  5. Impacts of a high-discharge submarine sewage outfall on water quality in the coastal zone of Salvador (Bahia, Brazil).

    Science.gov (United States)

    Roth, F; Lessa, G C; Wild, C; Kikuchi, R K P; Naumann, M S

    2016-05-15

    Carbon and nitrogen stable isotopic signatures of suspended particulate organic matter and seawater biological oxygen demand (BOD) were measured along a coastal transect during summer 2015 to investigate pollution impacts of a high-discharge submarine sewage outfall close to Salvador, Brazil. Impacts of untreated sewage discharge were evident at the outfall site by depleted δ(13)Corg and δ(15)N signatures and 4-fold increased BOD rates. Pollution effects of a sewage plume were detectable for more than 6km downstream from the outfall site, as seasonal wind- and tide-driven shelf hydrodynamics facilitated its advective transport into near-shore waters. There, sewage pollution was detectable at recreational beaches by depleted stable isotope signatures and elevated BOD rates at high tides, suggesting high bacterial activity and increased infection risk by human pathogens. These findings indicate the urgent necessity for appropriate wastewater treatment in Salvador to achieve acceptable standards for released effluents and coastal zone water quality. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Impacts of a high-discharge submarine sewage outfall on water quality in the coastal zone of Salvador (Bahia, Brazil)

    KAUST Repository

    Roth, Florian

    2016-03-30

    Carbon and nitrogen stable isotopic signatures of suspended particulate organic matter and seawater biological oxygen demand (BOD) were measured along a coastal transect during summer 2015 to investigate pollution impacts of a high-discharge submarine sewage outfall close to Salvador, Brazil. Impacts of untreated sewage discharge were evident at the outfall site by depleted δ13Corg and δ15N signatures and 4-fold increased BOD rates. Pollution effects of a sewage plume were detectable for more than 6 km downstream from the outfall site, as seasonal wind- and tide-driven shelf hydrodynamics facilitated its advective transport into near-shore waters. There, sewage pollution was detectable at recreational beaches by depleted stable isotope signatures and elevated BOD rates at high tides, suggesting high bacterial activity and increased infection risk by human pathogens. These findings indicate the urgent necessity for appropriate wastewater treatment in Salvador to achieve acceptable standards for released effluents and coastal zone water quality.

  7. How does auditors’ work stress affect audit quality? Empirical evidence from the Chinese stock market

    Directory of Open Access Journals (Sweden)

    Huanmin Yan

    2016-12-01

    Full Text Available With reference to the Job Demands–Control Model, we empirically examine the effect of auditors’ work stress on audit quality using a sample of Chinese A-share listed companies and their signature auditors from 2009 to 2013. The results show that (1 there is generally no pervasive deterioration in audit quality resulting from auditors’ work stress; (2 there is a significant negative association between work stress and audit quality in the initial audits of new clients; and (3 the perception of work stress depends on auditors’ individual characteristics. Auditors from international audit firms and those in the role of partner respond more strongly to work stress than industry experts. Auditors tend to react more intensively when dealing with state-owned companies. We suggest that audit firms attach more importance to auditors’ work stress and rationalize their allocation of audit resources to ensure high audit quality.

  8. High cardiac vagal control is related to better subjective and objective sleep quality.

    Science.gov (United States)

    Werner, Gabriela G; Ford, Brett Q; Mauss, Iris B; Schabus, Manuel; Blechert, Jens; Wilhelm, Frank H

    2015-03-01

    Cardiac vagal control (CVC) has been linked to both physical and mental health. One critical aspect of health, that has not received much attention, is sleep. We hypothesized that adults with higher CVC--operationalized by high-frequency heart rate variability (HF-HRV)--will exhibit better sleep quality assessed both subjectively (i.e., with Pittsburgh Sleep Quality Index) and objectively (i.e., with polysomnography). HF-HRV was measured in 29 healthy young women during an extended neutral film clip. Participants then underwent full polysomnography to obtain objective measures of sleep quality and HF-HRV during a night of sleep. As expected, higher resting HF-HRV was associated with higher subjective and objective sleep quality (i.e., shorter sleep latency and fewer arousals). HF-HRV during sleep (overall or separated by sleep phases) showed less consistent relationships with sleep quality. These findings indicate that high waking CVC may be a key predictor of healthy sleep. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  9. Management of source and drinking-water quality in Pakistan.

    Science.gov (United States)

    Aziz, J A

    2005-01-01

    Drinking-water quality in both urban and rural areas of Pakistan is not being managed properly. Results of various investigations provide evidence that most of the drinking-water supplies are faecally contaminated. At places groundwater quality is deteriorating due to the naturally occurring subsoil contaminants or to anthropogenic activities. The poor bacteriological quality of drinking-water has frequently resulted in high incidence of waterborne diseases while subsoil contaminants have caused other ailments to consumers. This paper presents a detailed review of drinking-water quality in the country and the consequent health impacts. It identifies various factors contributing to poor water quality and proposes key actions required to ensure safe drinking-water supplies to consumers.

  10. Quality of life and myelomeningocele: an ethical and evidence-based analysis of the Groningen Protocol.

    Science.gov (United States)

    Barry, Sean

    2010-01-01

    In 2005, a group of pediatricians at the University Medical Center in Groningen, The Netherlands, published the Groningen Protocol (GP) for Euthanasia in Newborns. This protocol is a set of guidelines devised in 2001 to clarify and facilitate the assessment of clinically stable neonates deemed to be in unbearable suffering for whom the prognosis is felt to be hopeless. At the time of publication, the GP had been in use for 7 years, and 22 patients, all with diagnosed myelomeningocele (MMC), had met the selection criteria for euthanasia by lethal injection. MMC is the most common neurological congenital anomaly, affecting approximately 300,000 newborns yearly worldwide. Neurosurgeons have a unique perspective on this disease and therefore an important voice, given the significant role they have in caring for these patients at all stages of their lives. This paper reviews the principal ethical arguments presented to date in the literature regarding the GP. It also provides an evidence-based critique of the GP in light of quality-of-life studies addressing adults with MMC, and ascertains whether or not the GP meets the criteria for an evidence-based guideline. Copyright © 2011 S. Karger AG, Basel.

  11. Companion Animals and Child/Adolescent Development: A Systematic Review of the Evidence

    Directory of Open Access Journals (Sweden)

    Rebecca Purewal

    2017-02-01

    Full Text Available Childhood and adolescence are important developmental phases which influence health and well-being across the life span. Social relationships are fundamental to child and adolescent development; yet studies have been limited to children’s relationships with other humans. This paper provides an evidence review for the potential associations between pet ownership and emotional; behavioural; cognitive; educational and social developmental outcomes. As the field is in the early stages; a broad set of inclusion criteria was applied. A systematic search of databases and grey literature sources found twenty-two studies meeting selection criteria. The review found evidence for an association between pet ownership and a wide range of emotional health benefits from childhood pet ownership; particularly for self-esteem and loneliness. The findings regarding childhood anxiety and depression were inconclusive. Studies also showed evidence of an association between pet ownership and educational and cognitive benefits; for example, in perspective-taking abilities and intellectual development. Evidence on behavioural development was unclear due to a lack of high quality research. Studies on pet ownership and social development provided evidence for an association with increased social competence; social networks; social interaction and social play behaviour. Overall, pet ownership and the significance of children’s bonds with companion animals have been underexplored; there is a shortage of high quality and longitudinal studies in all outcomes. Prospective studies that control for a wide range of confounders are required.

  12. Selection of process parameters for producing high quality defatted sesame flour at pilot scale.

    Science.gov (United States)

    Manikantan, M R; Sharma, Rajiv; Yadav, D N; Gupta, R K

    2015-03-01

    The present work was undertaken to study the effect of pearling duration, soaking time, steaming duration and drying temperature on the quality of sesame seeds and mechanically extracted partially defatted sesame cake. On the basis of quality attributes i.e. high protein, low crude fibre, low residual oil and low oxalic acid, the optimum process parameters were selected. The combination of 20 min of pearling duration, 15 min of soaking, 15 min of steaming at 100 kPa pressure and drying at 50 °C yielded high quality partially defatted protein rich sesame flour as compared to untreated defatted sesame flour. The developed high quality partially defatted protein rich sesame flour may be used in various food applications as a vital ingredient to increase the nutritional significance of the prepared foodstuffs.

  13. A 37-year-old man trying to choose a high-quality hospital: review of hospital quality indicators.

    Science.gov (United States)

    Howell, Michael D

    2009-12-02

    Mr A, a previously healthy 37-year-old man, was diagnosed as having Prinzmetal angina and a hypercoagulable state 3 years ago after an ST-elevation myocardial infarction. Now, his cardiologist is moving and Mr A must select a new physician and health system. Geographic relocation, insurance changes, and other events force millions in the United States to change physicians and hospitals every year. Mr A should begin by choosing a primary care physician, since continuity and coordination of care improves outcomes. Evidence for evaluating specific physicians is less robust, though a variety of sources are available. A broad range of detailed quality information, such as Medicare's Hospital Compare (http://www.hospitalcompare.hhs.gov/), is available for selecting a hospital. However, the relationship of these metrics to patient outcomes is variable, and different Web sites provide meaningfully different rankings and data interpretations. For Mr A in particular, a warfarin management team, the hospital's location, and a cardiologist with whom he feels comfortable and who can communicate with his primary care physician are important factors. Nevertheless, hospital quality information and metrics are an important component of the strategy Mr A should take to solve this challenging problem.

  14. Quantification of the effects of quality investment on the Cost of Poor Quality: A quasi-experimental study

    Science.gov (United States)

    Tamimi, Abdallah Ibrahim

    Quality management is a fundamental challenge facing businesses. This research attempted to quantify the effect of quality investment on the Cost of Poor Quality (COPQ) in an aerospace company utilizing 3 years of quality data at United Launch Alliance, a Boeing -- Lockheed Martin Joint Venture Company. Statistical analysis tools, like multiple regressions, were used to quantify the relationship between quality investments and COPQ. Strong correlations were evident by the high correlation coefficient R2 and very small p-values in multiple regression analysis. The models in the study helped produce an Excel macro that based on preset constraints, optimized the level of quality spending to minimize COPQ. The study confirmed that as quality investments were increased, the COPQ decreased steadily until a point of diminishing return was reached. The findings may be used to develop an approach to reduce the COPQ and enhance product performance. Achieving superior quality in rocket launching enhances the accuracy, reliability, and mission success of delivering satellites to their precise orbits in pursuit of knowledge, peace, and freedom while assuring safety for the end user.

  15. An improved multi-exposure approach for high quality holographic femtosecond laser patterning

    International Nuclear Information System (INIS)

    Zhang, Chenchu; Hu, Yanlei; Li, Jiawen; Lao, Zhaoxin; Ni, Jincheng; Chu, Jiaru; Huang, Wenhao; Wu, Dong

    2014-01-01

    High efficiency two photon polymerization through single exposure via spatial light modulator (SLM) has been used to decrease the fabrication time and rapidly realize various micro/nanostructures, but the surface quality remains a big problem due to the speckle noise of optical intensity distribution at the defocused plane. Here, a multi-exposure approach which used tens of computer generate holograms successively loaded on SLM is presented to significantly improve the optical uniformity without losing efficiency. By applying multi-exposure, we found that the uniformity at the defocused plane was increased from ∼0.02 to ∼0.6 according to our simulation. The fabricated two series of letters “HELLO” and “USTC” under single-and multi-exposure in our experiment also verified that the surface quality was greatly improved. Moreover, by this method, several kinds of beam splitters with high quality, e.g., 2 × 2, 5 × 5 Daman, and complex nonseperate 5 × 5, gratings were fabricated with both of high quality and short time (<1 min, 95% time-saving). This multi-exposure SLM-two-photon polymerization method showed the promising prospect in rapidly fabricating and integrating various binary optical devices and their systems

  16. An improved multi-exposure approach for high quality holographic femtosecond laser patterning

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Chenchu; Hu, Yanlei, E-mail: huyl@ustc.edu.cn, E-mail: jwl@ustc.edu.cn; Li, Jiawen, E-mail: huyl@ustc.edu.cn, E-mail: jwl@ustc.edu.cn; Lao, Zhaoxin; Ni, Jincheng; Chu, Jiaru; Huang, Wenhao; Wu, Dong [Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230026 (China)

    2014-12-01

    High efficiency two photon polymerization through single exposure via spatial light modulator (SLM) has been used to decrease the fabrication time and rapidly realize various micro/nanostructures, but the surface quality remains a big problem due to the speckle noise of optical intensity distribution at the defocused plane. Here, a multi-exposure approach which used tens of computer generate holograms successively loaded on SLM is presented to significantly improve the optical uniformity without losing efficiency. By applying multi-exposure, we found that the uniformity at the defocused plane was increased from ∼0.02 to ∼0.6 according to our simulation. The fabricated two series of letters “HELLO” and “USTC” under single-and multi-exposure in our experiment also verified that the surface quality was greatly improved. Moreover, by this method, several kinds of beam splitters with high quality, e.g., 2 × 2, 5 × 5 Daman, and complex nonseperate 5 × 5, gratings were fabricated with both of high quality and short time (<1 min, 95% time-saving). This multi-exposure SLM-two-photon polymerization method showed the promising prospect in rapidly fabricating and integrating various binary optical devices and their systems.

  17. Methods and systems for fabricating high quality superconducting tapes

    Science.gov (United States)

    Majkic, Goran; Selvamanickam, Venkat

    2018-02-13

    An MOCVD system fabricates high quality superconductor tapes with variable thicknesses. The MOCVD system can include a gas flow chamber between two parallel channels in a housing. A substrate tape is heated and then passed through the MOCVD housing such that the gas flow is perpendicular to the tape's surface. Precursors are injected into the gas flow for deposition on the substrate tape. In this way, superconductor tapes can be fabricated with variable thicknesses, uniform precursor deposition, and high critical current densities.

  18. The use of citation indicators to identify and support high-quality research in Poland.

    Science.gov (United States)

    Pilc, Andrzej

    2008-01-01

    In large, mostly English-speaking countries, where the "critical mass" of scientists working in different subfields of science is achieved, the peer review system may be sufficient to assess the quality of scientific research. However, in smaller countries, outside the Anglo-American circle, it is important to introduce different systems to identify research of high quality. In Poland, a parametric system for assessing the quality of research has been introduced. It was largely based on the impact factor of scientific journals. While the use of this indicator to assess research quality is highly questionable, the implementation of the system in the Polish reality is even worse. Therefore it is important to change and improve the system currently used by the Ministry of Science and Higher Education to both evaluate and, more importantly, finance science in Poland. Here, a system based on three factors, i.e. the impact factor, the institutional h-index, and the institutional number of citations, is proposed. The scientific quality of institutions in Division VI: Medical Sciences of the Polish Academy of Sciences were evaluated and the results were compared with the existing system. Moreover, a method to identify high-quality researchers and institutions at the national level based on the quantity of highly cited papers is shown. Additionally, an attempt to identify the highest quality Polish research on an international level is proposed. This is based on the number of individual citations, the individual h-index, the number of publications, and the priority of the discovery.

  19. The Audit Committee Characteristics and Earnings Quality: Evidence from Jordan

    Directory of Open Access Journals (Sweden)

    Allam Mohammed Mousa Hamdan

    2013-12-01

    Full Text Available The aim of the paper is to investigate the relationship between audit committee characteristics and earnings management. Samples in the study included 50 industrial companies listed on the Amman Stock Exchange ASE. Two models were used to measure earnings quality: one which depends on earnings continuity as an indication of quality, and one which depends on the decrease of discretionary accruals of quality, using pooled data regression for the two tests (Ordinary Least Squares OLS and Binary Logit. The study found that there was an influence of some standard characteristics of the audit committee on earnings quality.

  20. Innovative and high quality education through Open Education and OER

    OpenAIRE

    Stracke, Christian M.

    2017-01-01

    Online presentation and webinar by Stracke, C. M. (2017, 18 December) on "Innovative and high quality education through Open Education and OER" for the Belt and Road Open Education Learning Week by the Beijing Normal University, China.

  1. Teaching Surgical Procedures with Movies: Tips for High-quality Video Clips

    OpenAIRE

    Jacquemart, Mathieu; Bouletreau, Pierre; Breton, Pierre; Mojallal, Ali; Sigaux, Nicolas

    2016-01-01

    Summary: Video must now be considered as a precious tool for learning surgery. However, the medium does present production challenges, and currently, quality movies are not always accessible. We developed a series of 7 surgical videos and made them available on a publicly accessible internet website. Our videos have been viewed by thousands of people worldwide. High-quality educational movies must respect strategic and technical points to be reliable.

  2. Teaching Surgical Procedures with Movies: Tips for High-quality Video Clips.

    Science.gov (United States)

    Jacquemart, Mathieu; Bouletreau, Pierre; Breton, Pierre; Mojallal, Ali; Sigaux, Nicolas

    2016-09-01

    Video must now be considered as a precious tool for learning surgery. However, the medium does present production challenges, and currently, quality movies are not always accessible. We developed a series of 7 surgical videos and made them available on a publicly accessible internet website. Our videos have been viewed by thousands of people worldwide. High-quality educational movies must respect strategic and technical points to be reliable.

  3. The Relationship Between Service Quality and Customer Satisfaction in the Telecommunication Industry: Evidence From Nigeria

    Directory of Open Access Journals (Sweden)

    Olu Ojo

    2010-03-01

    Full Text Available This study investigates the relationship between service quality and customer satisfaction in the telecommunication industry with a focus on Mobile Telecommunication Network (MTN Nigeria. A total of 230 respondents participated in the study. Research questions and objectives were set, alongside the hypotheses that were formulated and tested. Descriptive statistics comprising the simple percentage and tables were used for data presentation and analysis. Regression analysis and Pearson product moment correlation coefficient were employed in testing our hypotheses. The study reveals that service quality has effect on customer satisfaction and that there is a positive relationship between service quality and customer satisfaction. The researcher concluded by recommending that organisations should focus more attention on service quality, because of its effects on customer satisfaction. To ensure that customer satisfaction level is high, organisation must first of all know the expectations of the customers and how they can meet such expectations. Customer satisfaction helps in customer loyalty and retention. It has been discovered that it costs to attract new customer than to retain existing ones. It is also recommended that organisations should welcome suggestions from customers and more programmes should be designed to measure service quality and customer satisfaction.Keywords: Customer, Service, Customer Satisfaction, Service Quality, Customer Loyalty.

  4. Synthesizing Quantitative Evidence for Evidence-based Nursing: Systematic Review.

    Science.gov (United States)

    Oh, Eui Geum

    2016-06-01

    As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR), a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings. Copyright © 2016. Published by Elsevier B.V.

  5. Synthesizing Quantitative Evidence for Evidence-based Nursing: Systematic Review

    Directory of Open Access Journals (Sweden)

    Eui Geum Oh, PhD, RN

    2016-06-01

    Full Text Available As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR, a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings.

  6. Key factors for a high-quality peritoneal dialysis program--the role of the PD team and continuous quality improvement.

    Science.gov (United States)

    Fang, Wei; Ni, Zhaohui; Qian, Jiaqi

    2014-06-01

    The proportion of end-stage renal disease (ESRD) patients on peritoneal dialysis (PD) has increased very fast in China over the last decade. Renji Hospital, affiliated with Shanghai Jiaotong University School of Medicine, is a recognized high-quality PD unit with a high PD utilization rate, excellent patient and technique survival (1-year and 5-year patient survival rate of 93% and 71%, and 1-year and 5-year technique survival of 96% and 82%, respectively), low peritonitis rate and a well-documented good quality of life of the treated patients. We believe that a dedicated and experienced PD team, a structured patient training program, continuous patient support, establishing and utilizing standardized protocols, starting PD with low dialysis dose, monitoring key performance indicators (KPIs), and continuous quality improvement (CQI) are the key factors underlying this successful PD program. Copyright © 2014 International Society for Peritoneal Dialysis.

  7. The effectiveness of the Bobath concept in stroke rehabilitation: what is the evidence?

    Science.gov (United States)

    Kollen, Boudewijn J; Lennon, Sheila; Lyons, Bernadette; Wheatley-Smith, Laura; Scheper, Mark; Buurke, Jaap H; Halfens, Jos; Geurts, Alexander C H; Kwakkel, Gert

    2009-04-01

    Concept is not superior to other approaches. Based on best evidence synthesis, no evidence is available for the superiority of any approach. This review has highlighted many methodological shortcomings in the studies reviewed; further high-quality trials need to be published. Evidence-based guidelines rather than therapist preference should serve as a framework from which therapists should derive the most effective treatment.

  8. Integrated Pathology Informatics Enables High-Quality Personalized and Precision Medicine: Digital Pathology and Beyond.

    Science.gov (United States)

    Volynskaya, Zoya; Chow, Hung; Evans, Andrew; Wolff, Alan; Lagmay-Traya, Cecilia; Asa, Sylvia L

    2018-03-01

    - The critical role of pathology in diagnosis, prognosis, and prediction demands high-quality subspecialty diagnostics that integrates information from multiple laboratories. - To identify key requirements and to establish a systematic approach to providing high-quality pathology in a health care system that is responsible for services across a large geographic area. - This report focuses on the development of a multisite pathology informatics platform to support high-quality surgical pathology and hematopathology using a sophisticated laboratory information system and whole slide imaging for histology and immunohistochemistry, integrated with ancillary tools, including electron microscopy, flow cytometry, cytogenetics, and molecular diagnostics. - These tools enable patients in numerous geographic locations access to a model of subspecialty pathology that allows reporting of every specimen by the right pathologist at the right time. The use of whole slide imaging for multidisciplinary case conferences enables better communication among members of patient care teams. The system encourages data collection using a discrete data synoptic reporting module, has implemented documentation of quality assurance activities, and allows workload measurement, providing examples of additional benefits that can be gained by this electronic approach to pathology. - This approach builds the foundation for accurate big data collection and high-quality personalized and precision medicine.

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

    Science.gov (United States)

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

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

  10. Recent developments in high-quality drying of vegetables, fruits, and aquatic products.

    Science.gov (United States)

    Zhang, Min; Chen, Huizhi; Mujumdar, Arun S; Tang, Juming; Miao, Song; Wang, Yuchuan

    2017-04-13

    Fresh foods like vegetables, fruits, and aquatic products have high water activity and they are highly heat-sensitive and easily degradable. Dehydration is one of the most common methods used to improve food shelf-life. However, drying methods used for food dehydration must not only be efficient and economic but also yield high-quality products based on flavor, nutrients, color, rehydration, uniformity, appearance, and texture. This paper reviews some new drying technologies developed for dehydration of vegetables, fruits, and aquatic products. These include: infrared drying, microwave drying, radio frequency drying, electrohydrodynamic drying, etc., as well as hybrid drying methods combining two or more different drying techniques. A comprehensive review of recent developments in high-quality drying of vegetables, fruits and aquatic products is presented and recommendations are made for future research.

  11. High-quality ZnO growth, doping, and polarization effect

    Science.gov (United States)

    Kun, Tang; Shulin, Gu; Jiandong, Ye; Shunming, Zhu; Rong, Zhang; Youdou, Zheng

    2016-03-01

    The authors have reported their recent progress in the research field of ZnO materials as well as the corresponding global advance. Recent results regarding (1) the development of high-quality epitaxy techniques, (2) the defect physics and the Te/N co-doping mechanism for p-type conduction, and (3) the design, realization, and properties of the ZnMgO/ZnO hetero-structures have been shown and discussed. A complete technology of the growth of high-quality ZnO epi-films and nano-crystals has been developed. The co-doping of N plus an iso-valent element to oxygen has been found to be the most hopeful path to overcome the notorious p-type hurdle. High mobility electrons have been observed in low-dimensional structures utilizing the polarization of ZnMgO and ZnO. Very different properties as well as new physics of the electrons in 2DEG and 3DES have been found as compared to the electrons in the bulk. Project supported by the National Natural Science Foundation of China (Nos. 61025020, 61274058, 61322403, 61504057, 61574075), the Natural Science Foundation of Jiangsu Province (Nos. BK2011437, BK20130013, BK20150585), the Priority Academic Program Development of Jiangsu Higher Education Institutions, and the Fundamental Research Funds for the Central Universities.

  12. Using Web 2.0 technologies to enhance evidence-based medical information.

    Science.gov (United States)

    Metzger, Miriam J; Flanagin, Andrew J

    2011-01-01

    This article invokes research on information seeking and evaluation to address how providers of evidence-based medical information can use Web 2.0 technologies to increase access to, enliven users' experiences with, and enrich the quality of the information available. In an ideal scenario, evidence-based medical information can take appropriate advantage of community intelligence spawned by Web 2.0 technologies, resulting in the ideal combination of scientifically sound, high-quality information that is imbued with experiential insights from a multitude of individuals. To achieve this goal, the authors argue that people will engage with information that they can access easily, and that they perceive as (a) relevant to their information-seeking goals and (b) credible. The authors suggest the utility of Web 2.0 technologies for engaging stakeholders with evidence-based medical information through these mechanisms, and the degree to which the information provided can and should be trusted. Last, the authors discuss potential problems with Web 2.0 information in relation to decision making in health contexts, and they conclude with specific and practical recommendations for the dissemination of evidence-based health information via Web 2.0 technologies.

  13. Methods and systems for fabricating high quality superconducting tapes

    Energy Technology Data Exchange (ETDEWEB)

    Majkic, Goran; Selvamanickam, Venkat

    2018-02-13

    An MOCVD system fabricates high quality superconductor tapes with variable thicknesses. The MOCVD system can include a gas flow chamber between two parallel channels in a housing. A substrate tape is heated and then passed through the MOCVD housing such that the gas flow is perpendicular to the tape's surface. Precursors are injected into the gas flow for deposition on the substrate tape. In this way, superconductor tapes can be fabricated with variable thicknesses, uniform precursor deposition, and high critical current densities.

  14. Teacher's sleep quality: linked to social job characteristics?

    Science.gov (United States)

    Kottwitz, Maria U; Gerhardt, Christin; Pereira, Diana; Iseli, Lionel; Elfering, Achim

    2018-02-07

    Besides dealing with high workload, being a teacher is challenging with respect to the social context. There is increasing evidence that adverse social job characteristics challenge sleep quality. The current study tests whether restraint sleep quality (defined as worse sleep quality before than during vacation) is related to time-related job stressors, job resources, and social job characteristics. Forty-eight elementary school teachers (42% women) participated both during the last week before and the first week after vacation. Before vacation, teachers were asked for demographics and working conditions with reference to the last 30 d, and sleep quality with reference to the last 7 d. After vacation sleep quality during vacation was assessed and used as reference for working time sleep quality. Results showed mean levels of sleep quality increased during vacation. In teachers with restrained working time sleep quality (38%), experiences of failure at work, social exclusion, and emotional dissonance were more frequent than in teachers with unrestrained working time sleep quality (Psquality in teachers.

  15. Organizational culture, team climate, and quality management in an important patient safety issue: nosocomial pressure ulcers

    NARCIS (Netherlands)

    Bosch, M.; Halfens, R.J.; Weijden, T.T. van der; Wensing, M.J.P.; Akkermans, R.P.; Grol, R.P.

    2011-01-01

    BACKGROUND: Increasingly, policy reform in health care is discussed in terms of changing organizational culture, creating practice teams, and organizational quality management. Yet, the evidence for these suggested determinants of high-quality care is inconsistent. AIMS: To determine if the type of

  16. Evidence-Based Management of Anticoagulant Therapy

    Science.gov (United States)

    Schulman, Sam; Witt, Daniel M.; Vandvik, Per Olav; Fish, Jason; Kovacs, Michael J.; Svensson, Peter J.; Veenstra, David L.; Crowther, Mark; Guyatt, Gordon H.

    2012-01-01

    Background: High-quality anticoagulation management is required to keep these narrow therapeutic index medications as effective and safe as possible. This article focuses on the common important management questions for which, at a minimum, low-quality published evidence is available to guide best practices. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: Most practical clinical questions regarding the management of anticoagulation, both oral and parenteral, have not been adequately addressed by randomized trials. We found sufficient evidence for summaries of recommendations for 23 questions, of which only two are strong rather than weak recommendations. Strong recommendations include targeting an international normalized ratio of 2.0 to 3.0 for patients on vitamin K antagonist therapy (Grade 1B) and not routinely using pharmacogenetic testing for guiding doses of vitamin K antagonist (Grade 1B). Weak recommendations deal with such issues as loading doses, initiation overlap, monitoring frequency, vitamin K supplementation, patient self-management, weight and renal function adjustment of doses, dosing decision support, drug interactions to avoid, and prevention and management of bleeding complications. We also address anticoagulation management services and intensive patient education. Conclusions: We offer guidance for many common anticoagulation-related management problems. Most anticoagulation management questions have not been adequately studied. PMID:22315259

  17. Evidence Map of Prevention and Treatment Interventions for Depression in Young People

    Directory of Open Access Journals (Sweden)

    Patrick Callahan

    2012-01-01

    Full Text Available Introduction. Depression in adolescents and young people is associated with reduced social, occupational, and interpersonal functioning, increases in suicide and self-harm behaviours, and problematic substance use. Age-appropriate, evidence-based treatments are required to provide optimal care. Methods. “Evidence mapping” methodology was used to quantify the nature and distribution of the extant high-quality research into the prevention and treatment of depression in young people across psychological, medical, and other treatment domains. Results. Prevention research is dominated by cognitive-behavioral- (CBT- based interventions. Treatment studies predominantly consist of CBT and SSRI medication trials, with few trials of other psychological interventions or complementary/alternative treatments. Quality studies on relapse prevention and treatment for persistent depression are distinctly lacking. Conclusions. This map demonstrates opportunities for future research to address the numerous evidence gaps for interventions to prevent or treat depression in young people, which are of interest to clinical researchers, policy makers, and funding bodies.

  18. Formative and summative assessment of science in English primary schools: evidence from the Primary Science Quality Mark

    Science.gov (United States)

    Earle, Sarah

    2014-05-01

    Background:Since the discontinuation of Standard Attainment Tests (SATs) in science at age 11 in England, pupil performance data in science reported to the UK government by each primary school has relied largely on teacher assessment undertaken in the classroom. Purpose:The process by which teachers are making these judgements has been unclear, so this study made use of the extensive Primary Science Quality Mark (PSQM) database to obtain a 'snapshot' (as of March 2013) of the approaches taken by 91 English primary schools to the formative and summative assessment of pupils' learning in science. PSQM is an award scheme for UK primary schools. It requires the science subject leader (co-ordinator) in each school to reflect upon and develop practice over the course of one year, then upload a set of reflections and supporting evidence to the database to support their application. One of the criteria requires the subject leader to explain how science is assessed within the school. Sample:The data set consists of the electronic text in the assessment section of all 91 PSQM primary schools which worked towards the Quality Mark in the year April 2012 to March 2013. Design and methods:Content analysis of a pre-existing qualitative data set. Text in the assessment section of each submission was first coded as describing formative or summative processes, then sub-coded into different strategies used. Results:A wide range of formative and summative approaches were reported, which tended to be described separately, with few links between them. Talk-based strategies are widely used for formative assessment, with some evidence of feedback to pupils. Whilst the use of tests or tracking grids for summative assessment is widespread, few schools rely on one system alone. Enquiry skills and conceptual knowledge were often assessed separately. Conclusions:There is little consistency in the approaches being used by teachers to assess science in English primary schools. Nevertheless

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

    Science.gov (United States)

    Kakyo, Tracy Alexis; Xiao, Lily Dongxia

    2017-06-01

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

  20. Production of high quality water for oil sands application

    Energy Technology Data Exchange (ETDEWEB)

    Beaudette-Hodsman, C.; Macleod, B. [Pall Corp., Mississauga, ON (Canada); Venkatadri, R. [Pall Corp., East Hills, NY (United States)

    2008-10-15

    This paper described a pressurized microfiltration membrane system installed at an oil sands extraction site in Alberta. The system was designed to complement a reverse osmosis (RO) system installed at the site to produce the high quality feed water required by the system's boilers. Groundwater in the region exhibited moderate total suspended solids and high alkalinity and hardness levels, and the RO system required feed water with a silt density index of 3 or less. The conventional pretreatment system used at the site was slowing down production due to the severe fouling of the RO membranes. The new microfiltration system contained an automated PVDF hollow fiber microfiltration membrane system contained in a trailer. Suspended particles and bacteria were captured within the filter, and permeate was sent to the RO unit. Within 6 hours of being installed, the unit was producing water with SDI values in the range of 1.0 to 2.5. It was concluded that the microfiltration system performed reliably regardless of wide variations in feed water quality and flow rates. 3 refs., 1 tab., 8 figs.

  1. Evidence review of hydroxyurea for the prevention of sickle cell complications in low-income countries.

    Science.gov (United States)

    Mulaku, Mercy; Opiyo, Newton; Karumbi, Jamlick; Kitonyi, Grace; Thoithi, Grace; English, Mike

    2013-11-01

    Hydroxyurea is widely used in high-income countries for the management of sickle cell disease (SCD) in children. In Kenyan clinical guidelines, hydroxyurea is only recommended for adults with SCD. Yet many deaths from SCD occur in early childhood, deaths that might be prevented by an effective, disease modifying intervention. The aim of this review was to summarise the available evidence on the efficacy, effectiveness and safety of hydroxyurea in the management of SCD in children below 5 years of age to support guideline development in Kenya. We undertook a systematic review and used the Grading of Recommendations Assessment, Development and Evaluation system to appraise the quality of identified evidence. Overall, available evidence from 1 systematic review (n=26 studies), 2 randomised controlled trials (n=354 children), 14 observational studies and 2 National Institute of Health reports suggest that hydroxyurea may be associated with improved fetal haemoglobin levels, reduced rates of hospitalisation, reduced episodes of acute chest syndrome and decreased frequency of pain events in children with SCD. However, it is associated with adverse events (eg, neutropenia) when high to maximum tolerated doses are used. Evidence is lacking on whether hydroxyurea improves survival if given to young children. Majority of the included studies were of low quality and mainly from high-income countries. Overall, available limited evidence suggests that hydroxyurea may improve morbidity and haematological outcomes in SCD in children aged below 5 years and appears safe in settings able to provide consistent haematological monitoring.

  2. Overview of Evidence in Prevention and Aetiology of Food Allergy: A Review of Systematic Reviews

    Science.gov (United States)

    Lodge, Caroline J.; Allen, Katrina J.; Lowe, Adrian J.; Dharmage, Shyamali C.

    2013-01-01

    The worldwide prevalence of food allergy appears to be increasing. Early life environmental factors are implicated in the aetiology of this global epidemic. The largest burden of disease is in early childhood, where research efforts aimed at prevention have been focused. Evidence synthesis from good quality systematic reviews is needed. We performed an overview of systematic reviews concerning the prevention and aetiology of food allergy, retrieving 14 systematic reviews, which covered three broad topics: formula (hydrolysed or soy) for the prevention of food allergy or food sensitization; maternal and infant diet and dietary supplements for the prevention of food allergy or food sensitization and hygiene hypothesis-related interventions. Using the AMSTAR criteria for assessment of methodological quality, we found five reviews to be of high quality, seven of medium quality and two of low quality. Overall we found no compelling evidence that any of the interventions that had been systematically reviewed were related to the risk of food allergy. Updating of existing reviews, and production of new systematic reviews, are needed in areas where evidence is emerging for interventions and environmental associations. Furthermore, additional primary studies, with greater numbers of participants and objective food allergy definitions are urgently required. PMID:24192789

  3. Organizational learning in high risk technologies: Evidence from the nuclear power industry

    International Nuclear Information System (INIS)

    Marcus, A.; Bromiley, P.; Nichols, M.

    1990-01-01

    Technologies where catastrophe is possible pose dangers not only to the immediate victims, but also to innocent bystanders and to future generations who have no control over the system. The question has been raised as to whether organization theory can be extended to such high risk technologies; for, after all, this theory is based on organizations that do not have catastrophic potential. It has been argued that there may be special features of high risk technologies, for example the need to combine structured and disciplined organizational forms with decentralization to deal with unplanned interactions, that makes the application of organization theory especially difficult. Furthermore, there has been relatively little empirical work on the management of high risk technologies (with regard to the nuclear power industry the exceptions are noted); and much of what is known comes from case analyses. This paper attempts to respond to these challenges, first, by taking a concept from organizational theory and applying it to a high risk technology, and second, by trying to empirically relate measures of this concept to measures of safety. The concept is organizational learning. The authors wish to determine if there is evidence of learning in the nuclear power industry, and, if there is evidence of learning, what form this learning takes

  4. Chemonucleolysis and intradiscal electrothermal therapy: What is the current evidence?

    International Nuclear Information System (INIS)

    Relder-Puig, Rosemarie; Gyimesi, M.; Mittermayr, T.; Geiger-Gritsch, S.

    2009-01-01

    We evaluated the efficacy and safety of chemonucleolysis and intradiscal electrothermal therapy (IDET) on the basis of the data presented in recently published papers with respect to pain relief, function, and complication rates. Detailed searches for English and German articles published between 2003 and 2008 were performed in a number of electronic databases. Further publications were identified by manual search. For summarizing the evidence, we considered only systematic reviews and controlled studies. The internal validity of reviews and studies was judged by two authors independently. Data extraction was performed by one author, and the extracted data was checked for completeness and correctness by a second author. The evidence of the efficacy of chemonucleolysis using chymopapain or collagenase is summarized in two recent, high-quality systematic reviews. We found 5 controlled studies evaluating nucleolysis using an oxygen-ozone mixture (O 2 O 3 -nucleolysis). Some of those studies were of limited methodological quality, but all showed the efficacy of O 2 O 3 -nucleolysis in comparison to microdiscectomy or the use of alternative substances. There is hardly any data regarding O 2 O 3 -nucleolysis complications. Regarding IDET, the authors of the 6 identified systematic reviews come to different conclusions about the efficacy of the procedure. The results of the 3 included controlled IDET studies, of which 2 are of high methodological quality, are also conflicting. The complication rates range from 0 to 15%. In summary, the evidence of efficacy is presently more compelling for chemonucleolysis than for IDET. This may also be because indications for chemonucleolysis are more firmly established. However, safety aspects should be better evaluated and presented in the literature. (orig.)

  5. Links among high-performance work environment, service quality, and customer satisfaction: an extension to the healthcare sector.

    Science.gov (United States)

    Scotti, Dennis J; Harmon, Joel; Behson, Scott J

    2007-01-01

    Healthcare managers must deliver high-quality patient services that generate highly satisfied and loyal customers. In this article, we examine how a high-involvement approach to the work environment of healthcare employees may lead to exceptional service quality, satisfied patients, and ultimately to loyal customers. Specifically, we investigate the chain of events through which high-performance work systems (HPWS) and customer orientation influence employee and customer perceptions of service quality and patient satisfaction in a national sample of 113 Veterans Health Administration ambulatory care centers. We present a conceptual model for linking work environment to customer satisfaction and test this model using structural equations modeling. The results suggest that (1) HPWS is linked to employee perceptions of their ability to deliver high-quality customer service, both directly and through their perceptions of customer orientation; (2) employee perceptions of customer service are linked to customer perceptions of high-quality service; and (3) perceived service quality is linked with customer satisfaction. Theoretical and practical implications of our findings, including suggestions of how healthcare managers can implement changes to their work environments, are discussed.

  6. Evidence-based treatment of metabolic myopathy

    Directory of Open Access Journals (Sweden)

    Yan LIN

    2014-05-01

    Full Text Available Objective To evaluate the current treatments and possible adverse reactions of metabolic myopathy, and to develop the best solution for evidence-based treatment.  Methods Taking metabolic myopathy, mitochondrial myopathy, lipid storage myopathy, glycogen storage diseases, endocrine myopathy, drug toxicity myopathy and treatment as search terms, retrieve in databases such as PubMed, Cochrane Library, ClinicalKey database, National Science and Technology Library (NSTL, in order to collect the relevant literature database including clinical guidelines, systematic reviews (SR, randomized controlled trials (RCT, controlled clinical trials, retrospective case analysis and case study. Jadad Scale was used to evaluate the quality of literature.  Results Twenty-eight related articles were selected, including 6 clinical guidelines, 5 systematic reviews, 10 randomized controlled trials and 7 clinical controlled trials. According to Jadad Scale, 23 articles were evaluated as high-quality literature (≥ 4, and the remaining 5 were evaluated as low-quality literature (< 4. Treatment principles of these clinical trials, efficacy of different therapies and drug safety evaluation suggest that: 1 Acid α-glycosidase (GAA enzyme replacement therapy (ERT is the main treatment for glycogen storage diseases, with taking a high-protein diet, exercising before taking a small amount of fructose orally and reducing the patient's physical activity gradually. 2 Carnitine supplementation is used in the treatment of lipid storage myopathy, with carbohydrate and low fat diet provided before exercise or sports. 3 Patients with mitochondrial myopathy can take coenzyme Q10, vitamin B, vitamin K, vitamin C, etc. Proper aerobic exercise combined with strength training is safe, and it can also enhance the exercise tolerance of patients effectively. 4 The first choice to treat the endocrine myopathy is treating primary affection. 5 Myopathies due to drugs and toxins should

  7. Does quality influence utilization of primary health care? Evidence from Haiti.

    Science.gov (United States)

    Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

    2018-06-20

    Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

  8. Does High School Facility Quality Affect Student Achievement? A Two-Level Hierarchical Linear Model

    Science.gov (United States)

    Bowers, Alex J.; Urick, Angela

    2011-01-01

    The purpose of this study is to isolate the independent effects of high school facility quality on student achievement using a large, nationally representative U.S. database of student achievement and school facility quality. Prior research on linking school facility quality to student achievement has been mixed. Studies that relate overall…

  9. Learning From Others About Research Evidence (editorial

    Directory of Open Access Journals (Sweden)

    Alison Brettle

    2012-06-01

    've attended forthe last few years (don’t ask!. Each time, I've been struck by both the similarities and differences between counselling and LIS research in the UK. Counselling research is conducted by a relatively small number of individuals and, as in LIS, the vast majority of practitioners don’t engage in writing any research up for publication (Clapton, 2010. Particular types of research dominate in counselling, but most are highly qualitative in manner, e.g. using biographical approaches. I can’t immediately see how these could become widely used in LIS, but I do find it fascinating to hear about different approaches and the evidence this provides. Like many of the things that LIS professionals do, counselling and psychotherapy is a complex intervention and it is not always immediately apparent what has caused an effect. It may well be that the counsellor is only one of a number of elements that has led to a positive outcome or a change in effect. This makes it difficult to generate evidence about the effectiveness of counselling, similar, for example, to trying to generate evidence regarding the effectiveness of information literacy.Due to political drivers there is an increasing interest (and resistance to a more evidence based approach in counselling and psychotherapy. One of the main areas of resistance towards evidence based practice (EBP in counselling is that the medical model or paradigm of EBP and the view that the randomized controlled trial (RCT is the method of choice for providing high quality evidence on the effectiveness of services doesn't fit with the way counsellors provide services to their clients. Each client is seen as an individual and therapy is provided according to a client’s particular needs at that time rather than following a set manual or course. This makes it impossible to assess in a "randomized controlled" manner, before even beginning to worry about the ethical and practical implications of conducting an experimental study

  10. (-201) β-Gallium oxide substrate for high quality GaN materials

    KAUST Repository

    Roqan, Iman S.

    2015-03-13

    (-201) oriented β-Ga2O3 has the potential to be used as a transparent and conductive substrate for GaN-growth. The key advantages of Ga2O3 are its small lattice mismatches (4.7%), appropriate structural, thermal and electrical properties and a competitive price compared to other substrates. Optical characterization show that GaN layers grown on (-201) oriented β-Ga2O3 are dominated by intense bandedge emission with a high luminescence efficiency. Atomic force microscopy studies show a modest threading dislocation density of ~108 cm-2, while complementary Raman spectroscopy indicates that the GaN epilayer is of high quality with slight compressive strain. Room temperature time-findings suggest that the limitation of the photoluminescence lifetime (~500 ps) is due to nonradiative recombination arising from threading dislocation. Therefore, by optimizing the growth conditions, high quality material with significant optical efficiency can be obtained.

  11. Does Medical Malpractice Law Improve Health Care Quality?

    Science.gov (United States)

    Frakes, Michael; Jena, Anupam B.

    2016-01-01

    We assess the potential for medical liability forces to deter medical errors and improve health care treatment quality, identifying liability’s influence by drawing on variations in the manner by which states formulate the negligence standard facing physicians. Using hospital discharge records from the National Hospital Discharge Survey and clinically-validated quality metrics inspired by the Agency for Health Care Research and Quality, we find evidence suggesting that treatment quality may improve upon reforms that expect physicians to adhere to higher quality clinical standards. We do not find evidence, however, suggesting that treatment quality may deteriorate following reforms to liability standards that arguably condone the delivery of lower quality care. Similarly, we do not find evidence of deterioration in health care quality following remedy-focused liability reforms such as caps on non-economic damages awards. PMID:28479642

  12. Quality of Educational Support for Children with Autism Spectrum Disorder in Bosnia and Herzegovina--Perception of Parents and Professionals

    Science.gov (United States)

    Mujkanovic, Elvira; Mujkanovic, Edin; Pasalic, Arnela; Biscevic, Inga; Memisevic, Haris

    2017-01-01

    Children with autism spectrum disorder (ASD) attend regular education schools and special education schools in Bosnia and Herzegovina. Regardless of the setting, it is important to provide early, high quality, programs to children with ASD. High quality educational support must encompass evidence-based programs for these children. The goal of the…

  13. High quality voice synthesis middle ware; Kohinshitsu onsei gosei middle war

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2000-03-01

    Toshiba Corp. newly developed a natural voice synthesis system, TOS Drive TTS (TOtally speaker Driven Text-To-Speech) system, in which natural high-quality read-aloud is greatly improved, and also developed as its application a voice synthesis middle ware. In the newly developed system, using as a model a narrator's voice recorded preliminarily, a metrical control dictionary is automatically learned that reproduces the characteristics of metrical patters such as intonation or rhythm of a human voice, as is a voice bases dictionary that reproduces the characteristics of a voice quality, enabling natural voice synthesis to be realized that picks up human voice characteristics. The system is high quality and also very compact, while the voice synthesis middle ware utilizing this technology is adaptable to various platforms such as MPU or OS. The system is very suitable for audio response in the ITS field having car navigation systems as the core; besides, expanded application is expected to an audio response system that used to employ a sound recording and reproducing system. (translated by NEDO)

  14. Comparison of good- and bad-quality cork: application of high-throughput sequencing of phellogenic tissue.

    Science.gov (United States)

    Teixeira, Rita Teresa; Fortes, Ana Margarida; Pinheiro, Carla; Pereira, Helena

    2014-09-01

    Cork is one of the most valuable non-wood forest products and plays an important role in Mediterranean economies. The production of high-quality cork is dependent on both genome and environment, posing constraints on the industry because an ever-growing amount of bad-quality cork (BQC) development has been observed. In order to identify genes responsible for production of cork of superior quality we performed a comparative analysis using the 454 pyrosequencing approach on phellogenic tissue of good- and bad-quality samples. The transcriptional profiling showed a high number of genes differentially expressed (8.48%) from which 78.8% displayed annotation. Genes more highly represented in BQC are involved in DNA synthesis, RNA processing, proteolysis, and transcription factors related to the abiotic stress response. Putative stomatal/lenticular-associated genes which may be responsible for the disadvantageous higher number of lenticular channels in BQC are also more highly represented. BQC also showed an elevated content of free phenolics. On the other hand, good-quality cork (GQC) can be distinguished by highly expressed genes encoding heat-shock proteins. Together the results provide valuable new information about the molecular events leading to cork formation and provide putative biomarkers associated with cork quality that can be useful in breeding programmes. © The Author 2014. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  15. Fabrication of high-quality single-crystal Cu thin films using radio-frequency sputtering.

    Science.gov (United States)

    Lee, Seunghun; Kim, Ji Young; Lee, Tae-Woo; Kim, Won-Kyung; Kim, Bum-Su; Park, Ji Hun; Bae, Jong-Seong; Cho, Yong Chan; Kim, Jungdae; Oh, Min-Wook; Hwang, Cheol Seong; Jeong, Se-Young

    2014-08-29

    Copper (Cu) thin films have been widely used as electrodes and interconnection wires in integrated electronic circuits, and more recently as substrates for the synthesis of graphene. However, the ultra-high vacuum processes required for high-quality Cu film fabrication, such as molecular beam epitaxy (MBE), restricts mass production with low cost. In this work, we demonstrated high-quality Cu thin films using a single-crystal Cu target and radio-frequency (RF) sputtering technique; the resulting film quality was comparable to that produced using MBE, even under unfavorable conditions for pure Cu film growth. The Cu thin film was epitaxially grown on an Al2O3 (sapphire) (0001) substrate, and had high crystalline orientation along the (111) direction. Despite the 10(-3) Pa vacuum conditions, the resulting thin film was oxygen free due to the high chemical stability of the sputtered specimen from a single-crystal target; moreover, the deposited film had >5× higher adhesion force than that produced using a polycrystalline target. This fabrication method enabled Cu films to be obtained using a simple, manufacturing-friendly process on a large-area substrate, making our findings relevant for industrial applications.

  16. Color Shade Nets Improve Vegetables Quality at Harvest and Maintain Quality During Storage

    Directory of Open Access Journals (Sweden)

    Ilić Zoran S.

    2018-03-01

    Full Text Available The photoselective, light-dispersive shade nets can be used as an alternative to protect crops from adverse environmental conditions such as; excessive solar radiation, heat and drought stress, wind and hail, birds, flying pests, thus improving crop’s production, yield and quality. The physiological parameters discussed in the review include: vegetable growth parameters (leaf area, leaf chlorophyll, tissue structure, fruit ripening, physiological disorders, pest and disease incidence, fruit quality parameters (soluble solids content and titratable acidity, bioactive compounds (antioxidant activity, ascorbic acid, carotenoid and flavonoid contents and aroma volatile compounds at harvest. Also, it is evident in the reviewed literature that light quality influences the biosynthesis, accumulation and retention of vegetable phytochemicals, as well as the decay development during storage. These new strategies to modulate light quality should be conveyed to vegetable producing farmers, thus allowing them to preserve the freshness and post-harvest quality of vegetables for an extended period of time, and to meet the consumers demand for vegetables with high nutritional value all year round. Research on light manipulation in horticultural systems is necessary for a sustainable and market-oriented open field and greenhouse vegetable production in the future.

  17. High-quality poly-dispersed mixtures applied in additive 3D technologies.

    Science.gov (United States)

    Gerasimov, M. D.; Brazhnik, Yu V.; Gorshkov, P. S.; Latyshev, S. S.

    2018-03-01

    The paper describes the new mixer design to obtain high-quality poly-dispersed powders applied in additive 3D technologies. It also considers a new mixing principle of dry powder particles ensuring the distribution of such particles in the total volume, which is close to ideal. The paper presents the mathematical model of mixer operation providing for the quality assessment of the ready mixtures. Besides, it demonstrates experimental results and obtained rational values of mixer process parameters.

  18. Methods for slow axis beam quality improvement of high power broad area diode lasers

    Science.gov (United States)

    An, Haiyan; Xiong, Yihan; Jiang, Ching-Long J.; Schmidt, Berthold; Treusch, Georg

    2014-03-01

    For high brightness direct diode laser systems, it is of fundamental importance to improve the slow axis beam quality of the incorporated laser diodes regardless what beam combining technology is applied. To further advance our products in terms of increased brightness at a high power level, we must optimize the slow axis beam quality despite the far field blooming at high current levels. The later is caused predominantly by the built-in index step in combination with the thermal lens effect. Most of the methods for beam quality improvements reported in publications sacrifice the device efficiency and reliable output power. In order to improve the beam quality as well as maintain the efficiency and reliable output power, we investigated methods of influencing local heat generation to reduce the thermal gradient across the slow axis direction, optimizing the built-in index step and discriminating high order modes. Based on our findings, we have combined different methods in our new device design. Subsequently, the beam parameter product (BPP) of a 10% fill factor bar has improved by approximately 30% at 7 W/emitter without efficiency penalty. This technology has enabled fiber coupled high brightness multi-kilowatt direct diode laser systems. In this paper, we will elaborate on the methods used as well as the results achieved.

  19. Academic self-efficacy for high school scale: search for psychometrics evidence

    Directory of Open Access Journals (Sweden)

    Soely Polydoro

    2015-05-01

    Full Text Available This article aims to present the adaptation and the search for psychometrics evidence of an academic self-efficacy scale. High school students (N = 453 participated of the research (mean age 15.93; SD 1.2. The Academic Self-efficacy Scale for High School is an adapted scale composed of 16 items and organized into three factors: self-efficacy for learning, self-efficacy to act in school life, and self-efficacy for the career decision. Through exploratory factor analysis, a KMO = 0.90 was verified, and 56.57% of the variance was explained. The internal consistency was 0.88. The scale demonstrated good conditions to identify academic self-efficacy of high school students.

  20. Association between air pollution and sperm quality: A systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Deng, Zibing; Chen, Fei; Zhang, Meixia; Lan, Lan; Qiao, Zhijiao; Cui, Yan; An, Jinghuan; Wang, Nan; Fan, Zhiwei; Zhao, Xing; Li, Xiaosong

    2016-01-01

    Exposure to ambient air pollution has been clearly linked to adverse reproductive outcome and fecundation index, but its effects on male semen quality are still uncertain. In this study, we reviewed information from ten studies to get the qualitative evidence of the influence of the ambient air pollution on sperm quality and collected data from six of the ten studies to conduct meta-analysis. The original studies classified participants into different exposure levels and the highest and lowest expose levels were chosen as high expose and low expose groups, respectively. The random-effect model was used in the meta-analysis with the weight mean difference (WMD) as the measure indicator. The WMDs (95% confidence intervals, CIs) of sperm volume, sperm count, semen concentration, sperm progressive motility, total motility, and normal morphology were 0.09 (−0.04, 0.23), 0.46 (−4.47, 5.39), −8.21 (−20.38, 3.96), −7.76 (−16.26, 0.74), −7.61 (−16.97, 1.74) and −3.40 (−7.42, 0.62), respectively. In conclusion, although the differences are not statistically significant between the two groups, the overall trends and evidence from this review indicate the chronic exposure to ambient pollutants at high level may alter men sperm quality. - Highlights: • Comparing to the low exposure group, the high exposure group had larger WMD of the sperm volume and sperm count. • Comparing to the low exposure group, the high exposure group had smaller WMD of the rest sperm parameters. • There was an obvious alteration of the sperm parameters in the two groups. - The overall trends and evidence from this review indicate the chronic exposure to ambient pollutants at high level may alter men sperm quality.

  1. Quality assurance system for sitting high risk facilities

    International Nuclear Information System (INIS)

    Rodriguez, Aymee; Peralta, Jose L.; Fernandez, Manuel

    1999-01-01

    The paper shows how we have conceived and designed the quality assurance system for the site selection process of an area for sitting the facility of high risk in correspondence with the approved methodology. The results obtained in the implementation of the system have permitted the satisfactory performance of each one the expected stage, defining the most favorable sectors in order to continue the studies of the repository site for the disposal of low and intermedium. (author)

  2. Soft X-ray generation via inverse compton scattering between high quality electron beam and high power laser

    International Nuclear Information System (INIS)

    Masakazu Washio; Kazuyuki Sakaue; Yoshimasa Hama; Yoshio Kamiya; Tomoko Gowa; Akihiko Masuda; Aki Murata; Ryo Moriyama; Shigeru Kashiwagi; Junji Urakawa

    2007-01-01

    High quality beam generation project based on High-Tech Research Center Project, which has been approved by Ministry of Education, Culture, Sports, Science and Technology in 1999, has been conducted by advance research institute for science and engineering, Waseda University. In the project, laser photo-cathode RF-gun has been selected for the high quality electron beam source. RF cavities with low dark current, which were made by diamond turning technique, have been successfully manufactured. The low emittance electron beam was realized by choosing the modified laser injection technique. The obtained normalized emmitance was about 3 m.mrad at 100 pC of electron charge. The soft x-ray beam generation with the energy of 370 eV, which is in the energy region of so-called water window, by inverse Compton scattering has been performed by the collision between IR laser and the low emmitance electron beams. (Author)

  3. Treatment for overweight Mexican American children: impact on quality of life

    Science.gov (United States)

    Childhood overweight is a serious health problem occurring in especially high rates among Mexican Americans. Although there is empirical support for behaviorally based treatments for pediatric overweight, there is limited evidence that treatment increases children's quality of life (QOL). Our obje...

  4. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management

    NARCIS (Netherlands)

    Chapman, M. John; Ginsberg, Henry N.; Amarenco, Pierre; Andreotti, Felicita; Borén, Jan; Catapano, Alberico L.; Descamps, Olivier S.; Fisher, Edward; Kovanen, Petri T.; Kuivenhoven, Jan Albert; Lesnik, Philippe; Masana, Luis; Nordestgaard, Børge G.; Ray, Kausik K.; Reiner, Zeljko; Taskinen, Marja-Riitta; Tokgözoglu, Lale; Tybjærg-Hansen, Anne; Watts, Gerald F.

    2011-01-01

    Even at low-density lipoprotein cholesterol (LDL-C) goal, patients with cardiometabolic abnormalities remain at high risk of cardiovascular events. This paper aims (i) to critically appraise evidence for elevated levels of triglyceride-rich lipoproteins (TRLs) and low levels of high-density

  5. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management

    DEFF Research Database (Denmark)

    Chapman, M John; Ginsberg, Henry N; Amarenco, Pierre

    2011-01-01

    Even at low-density lipoprotein cholesterol (LDL-C) goal, patients with cardiometabolic abnormalities remain at high risk of cardiovascular events. This paper aims (i) to critically appraise evidence for elevated levels of triglyceride-rich lipoproteins (TRLs) and low levels of high-density lipop...

  6. Accruals quality, underwriter reputation, and corporate bond underpricing: Evidence from China

    Directory of Open Access Journals (Sweden)

    Si Xu

    2017-12-01

    Full Text Available This study examines the relationship between accruals quality and the underpricing of corporate bonds in China and how underwriter reputation affects this relationship. We find that (1 accruals quality is negatively associated with the magnitude of bond underpricing and (2 the impact of low accruals quality on underpricing is partially offset by hiring reputable underwriters. A path analysis shows that approximately 11% of the effect of accruals quality on underpricing is attributable to the indirect path through reputable underwriters, suggesting that accruals quality is more effective than reputable underwriters in lowering bond underpricing. These findings are significant for initial bond offerings, but not for secondary bond offerings. We also find that low accruals quality is associated with more restrictive non-price contract terms such as greater collateral requirements and stricter covenants.

  7. Do Restatements Break Bad Habits? Evidence of Earnings Quality Following Restatements

    DEFF Research Database (Denmark)

    Herly, Marie; Bartholdy, Jan; Thinggaard, Frank

    2014-01-01

    This paper investigates if firms consider restatements so severe that they change their financial reporting strategies and subsequently improve their accounting quality. We compare the accruals quality of restating firms during the period 2000-2010 with a matched control group and hypothesize...... to the restatement announcements lead to significant improvement in accruals quality. Thus, while the restatement itself does not lead to improvements in accounting quality, the punishment by the capital markets does. Our findings thus suggest that capital market forces play a larger disciplining role than...... that the costly consequences of restatements documented in prior research incentivize firms to improve their accounting quality. We use a multivariate difference-in-difference research design and contrary to our expectations we find that firms do not improve the quality of their financial statements more than...

  8. A Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence?

    Directory of Open Access Journals (Sweden)

    Faith Donald

    2014-01-01

    Full Text Available Background. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP and clinical nurse specialist (CNS roles. Objective. To assess the quality of randomized controlled trials (RCTs evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization. Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (n=11, NP-transition (n=5, NP-inpatient (n=2, CNS-outpatient (n=11, CNS-transition (n=13, and CNS-inpatient (n=1. Internal validity was assessed using the Cochrane risk of bias tool; 18 (42% studies were at low, 17 (39% were at moderate, and eight (19% at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.

  9. Higher prices, higher quality? Evidence from German nursing homes

    OpenAIRE

    Herr, Annika; Hottenrott, Hanna

    2016-01-01

    Objectives: This study investigates the relationship between prices and quality of 7,400 German nursing homes controlling for income, nursing home density, demographics, labour market characteristics, and infrastructure at the regional level. Method: We use a cross section of public quality reports for all German nursing homes, which had been evaluated between 2010 and 2013 by external institutions. Our analysis is based on multivariate regressions in a two stage least squares framework, wher...

  10. Quality assurance requirements and methods for high level waste package acceptability

    International Nuclear Information System (INIS)

    1992-12-01

    This document should serve as guidance for assigning the necessary items to control the conditioning process in such a way that waste packages are produced in compliance with the waste acceptance requirements. It is also provided to promote the exchange of information on quality assurance requirements and on the application of quality assurance methods associated with the production of high level waste packages, to ensure that these waste packages comply with the requirements for transportation, interim storage and waste disposal in deep geological formations. The document is intended to assist both the operators of conditioning facilities and repositories as well as national authorities and regulatory bodies, involved in the licensing of the conditioning of high level radioactive wastes or in the development of deep underground disposal systems. The document recommends the quality assurance requirements and methods which are necessary to generate data for these parameters identified in IAEA-TECDOC-560 on qualitative acceptance criteria, and indicates where and when the control methods can be applied, e.g. in the operation or commissioning of a process or in the development of a waste package design. Emphasis is on the control of the process and little reliance is placed on non-destructive or destructive testing. Qualitative criteria, relevant to disposal of high level waste, are repository dependent and are not addressed here. 37 refs, 3 figs, 2 tabs

  11. The quality of instruments to assess the process of shared decision making: A systematic review

    Science.gov (United States)

    Bomhof-Roordink, Hanna; Smith, Ian P.; Scholl, Isabelle; Stiggelbout, Anne M.; Pieterse, Arwen H.

    2018-01-01

    Objective To inventory instruments assessing the process of shared decision making and appraise their measurement quality, taking into account the methodological quality of their validation studies. Methods In a systematic review we searched seven databases (PubMed, Embase, Emcare, Cochrane, PsycINFO, Web of Science, Academic Search Premier) for studies investigating instruments measuring the process of shared decision making. Per identified instrument, we assessed the level of evidence separately for 10 measurement properties following a three-step procedure: 1) appraisal of the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, 2) appraisal of the psychometric quality of the measurement property using three possible quality scores, 3) best-evidence synthesis based on the number of studies, their methodological and psychometrical quality, and the direction and consistency of the results. The study protocol was registered at PROSPERO: CRD42015023397. Results We included 51 articles describing the development and/or evaluation of 40 shared decision-making process instruments: 16 patient questionnaires, 4 provider questionnaires, 18 coding schemes and 2 instruments measuring multiple perspectives. There is an overall lack of evidence for their measurement quality, either because validation is missing or methods are poor. The best-evidence synthesis indicated positive results for a major part of instruments for content validity (50%) and structural validity (53%) if these were evaluated, but negative results for a major part of instruments when inter-rater reliability (47%) and hypotheses testing (59%) were evaluated. Conclusions Due to the lack of evidence on measurement quality, the choice for the most appropriate instrument can best be based on the instrument’s content and characteristics such as the perspective that they assess. We recommend refinement and validation of

  12. FIRE (facilitating implementation of research evidence: a study protocol

    Directory of Open Access Journals (Sweden)

    Seers Kate

    2012-03-01

    Full Text Available Abstract Background Research evidence underpins best practice, but is not always used in healthcare. The Promoting Action on Research Implementation in Health Services (PARIHS framework suggests that the nature of evidence, the context in which it is used, and whether those trying to use evidence are helped (or facilitated affect the use of evidence. Urinary incontinence has a major effect on quality of life of older people, has a high prevalence, and is a key priority within European health and social care policy. Improving continence care has the potential to improve the quality of life for older people and reduce the costs associated with providing incontinence aids. Objectives This study aims to advance understanding about the contribution facilitation can make to implementing research findings into practice via: extending current knowledge of facilitation as a process for translating research evidence into practice; evaluating the feasibility, effectiveness, and cost-effectiveness of two different models of facilitation in promoting the uptake of research evidence on continence management; assessing the impact of contextual factors on the processes and outcomes of implementation; and implementing a pro-active knowledge transfer and dissemination strategy to diffuse study findings to a wide policy and practice community. Setting and sample Four European countries, each with six long-term nursing care sites (total 24 sites for people aged 60 years and over with documented urinary incontinence Methods and design Pragmatic randomised controlled trial with three arms (standard dissemination and two different programmes of facilitation, with embedded process and economic evaluation. The primary outcome is compliance with the continence recommendations. Secondary outcomes include proportion of residents with incontinence, incidence of incontinence-related dermatitis, urinary tract infections, and quality of life. Outcomes are assessed at baseline

  13. Living systematic reviews: an emerging opportunity to narrow the evidence-practice gap.

    Science.gov (United States)

    Elliott, Julian H; Turner, Tari; Clavisi, Ornella; Thomas, James; Higgins, Julian P T; Mavergames, Chris; Gruen, Russell L

    2014-02-01

    The current difficulties in keeping systematic reviews up to date leads to considerable inaccuracy, hampering the translation of knowledge into action. Incremental advances in conventional review updating are unlikely to lead to substantial improvements in review currency. A new approach is needed. We propose living systematic review as a contribution to evidence synthesis that combines currency with rigour to enhance the accuracy and utility of health evidence. Living systematic reviews are high quality, up-to-date online summaries of health research, updated as new research becomes available, and enabled by improved production efficiency and adherence to the norms of scholarly communication. Together with innovations in primary research reporting and the creation and use of evidence in health systems, living systematic review contributes to an emerging evidence ecosystem.

  14. Synthesis and spectroscopic study of high quality alloy Cdx S ...

    Indian Academy of Sciences (India)

    Wintec

    In the present study, we report the synthesis of high quality CdxZn1–xS nanocrystals alloy at. 150°C with .... (XRD) using a Siemens model D 500, powder X-ray ... decays were analysed using IBH DAS6 software. 3. ... This alloying process is.

  15. Formation of a high quality electron beam using photo cathode RF electron gun

    International Nuclear Information System (INIS)

    Washio, Masakazu

    2000-01-01

    Formation of a high quality electron beam using photo cathode RF electron gun is expected for formation of a next generation high brilliant X-ray beam and a source for electron and positron collider. And, on a field of material science, as is possible to carry out an experiment under ultra short pulse and extremely high precision in time, it collects large expectation. Recently, formation of high quality beam possible to develop for multi directions and to use by everyone in future has been able to realize. Here were explained on electron beam source, principle and component on RF electron gun, working features on RF gun, features and simulation of RF gun under operation, and some views in near future. (G.K.)

  16. Real-Time Acquisition of High Quality Face Sequences from an Active Pan-Tilt-Zoom Camera

    DEFF Research Database (Denmark)

    Haque, Mohammad A.; Nasrollahi, Kamal; Moeslund, Thomas B.

    2013-01-01

    -based real-time high-quality face image acquisition system, which utilizes pan-tilt-zoom parameters of a camera to focus on a human face in a scene and employs a face quality assessment method to log the best quality faces from the captured frames. The system consists of four modules: face detection, camera...... control, face tracking, and face quality assessment before logging. Experimental results show that the proposed system can effectively log the high quality faces from the active camera in real-time (an average of 61.74ms was spent per frame) with an accuracy of 85.27% compared to human annotated data.......Traditional still camera-based facial image acquisition systems in surveillance applications produce low quality face images. This is mainly due to the distance between the camera and subjects of interest. Furthermore, people in such videos usually move around, change their head poses, and facial...

  17. Limitations in conduct and reporting of cochrane reviews rarely inhibit the determination of the validity of evidence for clinical decision-making.

    Science.gov (United States)

    Alper, Brian S; Fedorowicz, Zbys; van Zuuren, Esther J

    2015-08-01

    To determine how often clinical conclusions derived from Cochrane Reviews have uncertain validity due to review conduct and reporting deficiencies. We evaluated 5142 clinical conclusions in DynaMed (an evidence-based point-of-care clinical reference) based on 4743 Cochrane Reviews. Clinical conclusions with level 2 evidence due to shortcomings in the review's conduct or reporting (rather than deficiencies in the underlying evidence) were confirmed by a DynaMed editor and two Cochrane Review authors. Thirty-one Cochrane Reviews (0.65%) had confirmed deficiencies in conduct and reporting as the reason for classifying 37 assessed clinical conclusions (0.72%) as level 2 evidence. In all cases, it was not feasible for the assessors to specify a clear criticism of the studies included in the reviews. The deficiencies were specific to not accounting for dropouts (2) or inadequate assessment and reporting of allocation concealment (11), other specific trial quality criteria (14), or all trial quality criteria (4). Cochrane Reviews provide high-quality assessment and synthesis of evidence, with fewer than 1% of Cochrane Reviews having limitations which hinder the summary of best current evidence for clinical decision-making. We expect this will further decrease following recent Cochrane quality initiatives. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

  18. WHO indoor air quality guidelines on household fuel combustion: Strategy implications of new evidence on interventions and exposure-risk functions

    Science.gov (United States)

    Bruce, Nigel; Pope, Dan; Rehfuess, Eva; Balakrishnan, Kalpana; Adair-Rohani, Heather; Dora, Carlos

    2015-04-01

    Background: 2.8 billion people use solid fuels as their primary cooking fuel; the resulting high levels of household air pollution (HAP) were estimated to cause more than 4 million premature deaths in 2012. The people most affected are among the world's poorest, and past experience has shown that securing adoption and sustained use of effective, low-emission stove technologies and fuels in such populations is not easy. Among the questions raised by these challenges are (i) to what levels does HAP exposure need to be reduced in order to ensure that substantial health benefits are achieved, and (ii) what intervention technologies and fuels can achieve the required levels of HAP in practice? New WHO air quality guidelines are being developed to address these issues. Aims: To address the above questions drawing on evidence from new evidence reviews conducted for the WHO guidelines. Methods: Discussion of key findings from reviews covering (i) systematic reviews of health risks from HAP exposure, (ii) newly developed exposure-response functions which combine combustion pollution risk evidence from ambient air pollution, second-hand smoke, HAP and active smoking, and (iii) a systematic review of the impacts of solid fuel and clean fuel interventions on kitchen levels of, and personal exposure to, PM2.5 and carbon monoxide (CO). Findings: Evidence on health risks from HAP suggest that controlling this exposure could reduce the risk of multiple child and adult health outcomes by 20-50%. The new integrated exposure-response functions (IERs) indicate that in order to secure these benefits, HAP levels require to be reduced to the WHO IT-1 annual average level (35 μg/m3 PM2.5), or below. The second review found that, in practice, solid fuel 'improved stoves' led to large percentage and absolute reductions, but post-intervention kitchen levels were still very high, at several hundreds of μg/m3 of PM2.5, although most solid fuel stove types met the WHO 24-hr average guideline

  19. Quality Early Education and Child Care From Birth to Kindergarten.

    Science.gov (United States)

    Donoghue, Elaine A

    2017-08-01

    High-quality early education and child care for young children improves physical and cognitive outcomes for the children and can result in enhanced school readiness. Preschool education can be viewed as an investment (especially for at-risk children), and studies show a positive return on that investment. Barriers to high-quality early childhood education include inadequate funding and staff education as well as variable regulation and enforcement. Steps that have been taken to improve the quality of early education and child care include creating multidisciplinary, evidence-based child care practice standards; establishing state quality rating and improvement systems; improving federal and state regulations; providing child care health consultation; as well as initiating other innovative partnerships. Pediatricians have a role in promoting quality early education and child care for all children not only in the medical home but also at the community, state, and national levels. Copyright © 2017 by the American Academy of Pediatrics.

  20. Influence of Price and Quality to Customer Satisfaction: Neuromarketing Approach

    Directory of Open Access Journals (Sweden)

    Aurimas Dapkevičius

    2011-04-01

    Full Text Available The purpose of this article is to analyze literature and find out empirical evidence on product price and quality influence on customer satisfaction through neuromarketing approach. Customers’ satisfaction on their purchase is a significant factor that leads business to success. In recent times, customer satisfaction has gained new attention within the context of the paradigm shift from transactional marketing to relationship marketing. Even it is agreed in the literature that price and quality has high effect on customer satisfaction; still there is little empirical evidence exploring this relation. Almost nothing is known about the human neural mechanisms through which it affects the decisions made by individuals. So, in this article there are reviewed two neuromarketing study cases as neuromarketing provides qualitatively different information, ostensibly better quality comparing to that obtained by traditional methods. The whole article reveals that price and quality is an important factor for customer satisfaction which leads to marketing managers’ decisions complexity nowadays as markets are becoming more and more complex and overloaded.Article in English

  1. Long pulse KrCl laser with a high discharge quality

    NARCIS (Netherlands)

    Casper, L.C.; Bastiaens, Hubertus M.J.; Peters, P.J.M.; Boller, Klaus J.; Hofstra, R.M.

    2007-01-01

    The discharge quality and optimum pump parameters of a long-pulse high-pressure gas discharge excited KrCl laser are investigated. A three-electrode prepulse–mainpulse excitation circuit is employed as pump source. The discharge volume contains a gas mixture of HCl/Kr/Ne operated at a total pressure

  2. Responses of Rapid Viscoanalyzer Profile and Other Rice Grain Qualities to Exogenously Applied Plant Growth Regulators under High Day and High Night Temperatures.

    Directory of Open Access Journals (Sweden)

    Shah Fahad

    Full Text Available High-temperature stress degrades the grain quality of rice; nevertheless, the exogenous application of plant growth regulators (PGRs might alleviate the negative effects of high temperatures. In the present study, we investigated the responses of rice grain quality to exogenously applied PGRs under high day temperatures (HDT and high night temperatures (HNT under controlled conditions. Four different combinations of ascorbic acid (Vc, alpha-tocopherol (Ve, brassinosteroids (Br, methyl jasmonates (MeJA and triazoles (Tr were exogenously applied to two rice cultivars (IR-64 and Huanghuazhan prior to the high-temperature treatment. A Nothing applied Control (NAC was included for comparison. The results demonstrated that high-temperature stress was detrimental for grain appearance and milling qualities and that both HDT and HNT reduced the grain length, grain width, grain area, head rice percentage and milled rice percentage but increased the chalkiness percentage and percent area of endosperm chalkiness in both cultivars compared with ambient temperature (AT. Significantly higher grain breakdown, set back, consistence viscosity and gelatinization temperature, and significantly lower peak, trough and final viscosities were observed under high-temperature stress compared with AT. Thus, HNT was more devastating for grain quality than HDT. The exogenous application of PGRs ameliorated the adverse effects of high temperature in both rice cultivars, and Vc+Ve+MejA+Br was the best combination for both cultivars under high temperature stress.

  3. Evidence-based health care: its place within clinical governance.

    Science.gov (United States)

    McSherry, R; Haddock, J

    This article explores the principles of evidence-based practice and its role in achieving quality improvements within the clinical governance framework advocated by the recent White Papers 'The New NHS: Modern, Dependable' (Department of Health (DoH), 1997) and 'A First Class Service: Quality in the New NHS' (DoH, 1998a). Within these White Papers there is an emphasis on improving quality of care, treatment and services through employing the principles of clinical governance. A major feature of clinical governance is guaranteeing quality to the public and the NHS, and ensuring that clinical, managerial and educational practice is based on scientific evidence. This article also examines what evidence-based practice is and what processes are required to promote effective healthcare interventions. The authors also look at how clinical governance relates to other methods/systems involved in clinical effectiveness. Finally, the importance for nurses and other healthcare professionals of familiarizing themselves with the development of critical appraisal skills, and their implications for developing evidence-based practice, is emphasized.

  4. Some sauropods raised their necks—evidence for high browsing in Euhelopus zdanskyi

    Science.gov (United States)

    Christian, Andreas

    2010-01-01

    A very long neck that is apparently suitable for feeding at great heights is a characteristic feature of most sauropod dinosaurs. Yet, it remains controversial whether any sauropods actually raised their necks high. Recently, strong physiological arguments have been put forward against the idea of high-browsing sauropods, because of the very high blood pressure that appears to be inevitable when the head is located several metres above the heart. For the sauropod Euhelopus zdanskyi, however, biomechanical evidence clearly indicates high browsing. Energy expenditure owing to high browsing is compared with energy costs for walking a distance. It is demonstrated for Euhelopus as well as for the much larger Brachiosaurus that despite an increase in the metabolic rate, high browsing was worthwhile for a sauropod if resources were far apart. PMID:20519198

  5. Some sauropods raised their necks--evidence for high browsing in Euhelopus zdanskyi.

    Science.gov (United States)

    Christian, Andreas

    2010-12-23

    A very long neck that is apparently suitable for feeding at great heights is a characteristic feature of most sauropod dinosaurs. Yet, it remains controversial whether any sauropods actually raised their necks high. Recently, strong physiological arguments have been put forward against the idea of high-browsing sauropods, because of the very high blood pressure that appears to be inevitable when the head is located several metres above the heart. For the sauropod Euhelopus zdanskyi, however, biomechanical evidence clearly indicates high browsing. Energy expenditure owing to high browsing is compared with energy costs for walking a distance. It is demonstrated for Euhelopus as well as for the much larger Brachiosaurus that despite an increase in the metabolic rate, high browsing was worthwhile for a sauropod if resources were far apart.

  6. Weighing evidence: quantitative measures of the importance of bitemark evidence.

    Science.gov (United States)

    Kittelson, J M; Kieser, J A; Buckingham, D M; Herbison, G P

    2002-12-01

    Quantitative measures of the importance of evidence such as the "likelihood ratio" have become increasingly popular in the courtroom. These measures have been used by expert witnesses formally to describe their certainty about a piece of evidence. These measures are commonly interpreted as the amount by which the evidence should revise the opinion of guilt, and thereby summarize the importance of a particular piece of evidence. Unlike DNA evidence, quantitative measures have not been widely used by forensic dentists to describe their certainty when testifying about bitemark evidence. There is, however, no inherent reason why they should not be used to evaluate bitemarks. The purpose of this paper is to describe the likelihood ratio as it might be applied to bitemark evidence. We use a simple bitemark example to define the likelihood ratio, its application, and interpretation. In particular we describe how the jury interprets the likelihood ratio from a Bayesian perspective when evaluating the impact of the evidence on the odds that the accused is guilty. We describe how the dentist would calculate the likelihood ratio based on frequentist interpretations. We also illustrate some of the limitations of the likelihood ratio, and show how those limitations apply to bitemark evidence. We conclude that the quality of bitemark evidence cannot be adequately summarized by the likelihood ratio, and argue that its application in this setting may be more misleading than helpful.

  7. Student Learning Motivation as a Mediator of the Relationship between Service Quality and Student Performance

    Science.gov (United States)

    Ibrahim, Hamdi H. M.

    2016-01-01

    Students look for evidence of service quality when selecting a university to attend. Student dissatisfaction with the quality of service may reduce student motivation in online higher-education settings, and low levels of motivation may lead to inferior student performance and a persistently high dropout rate. The purpose of this quantitative,…

  8. Non-pharmacological sleep interventions for youth with chronic health conditions: a critical review of the methodological quality of the evidence.

    Science.gov (United States)

    Brown, Cary A; Kuo, Melissa; Phillips, Leah; Berry, Robyn; Tan, Maria

    2013-07-01

    Restorative sleep is clearly linked with well-being in youth with chronic health conditions. This review addresses the methodological quality of non-pharmacological sleep intervention (NPSI) research for youth with chronic health conditions. The Guidelines for Critical Review (GCR) and the Effective Public Health Practice Project Quality Assessment Tool (EPHPP) were used in the review. The search yielded 31 behavioural and 10 non-behavioural NPSI for review. Most studies had less than 10 participants. Autism spectrum disorders, attention deficit/hyperactivity disorders, down syndrome, intellectual disabilities, and visual impairments were the conditions that most studies focused upon. The global EPHPP scores indicated most reviewed studies were of weak quality. Only 7 studies were rated as moderate, none were strong. Studies rated as weak quality frequently had recruitment issues; non-blinded participants/parents and/or researchers; and used outcome measures without sound psychometric properties. Little conclusive evidence exists for NPSIs in this population. However, NPSIs are widely used and these preliminary studies demonstrate promising outcomes. There have not been any published reports of negative outcomes that would preclude application of the different NPSIs on a case-by-case basis guided by clinical judgement. These findings support the need for more rigorous, applied research. • Methodological Quality of Sleep Research • Disordered sleep (DS) in youth with chronic health conditions is pervasive and is important to rehabilitation therapists because DS contributes to significant functional problems across psychological, physical and emotional domains. • Rehabilitation therapists and other healthcare providers receive little education about disordered sleep and are largely unaware of the range of assessment and non-pharmacological intervention strategies that exist. An evidence-based website of pediatric sleep resources can be found at http

  9. THE ACADEMIC PERSONNEL MOTIVATION - A FACTOR FOR HIGH QUALITY EDUCATIONAL PRODUCT

    Directory of Open Access Journals (Sweden)

    Viara Slavianska

    2014-06-01

    Full Text Available The present paper consecutively puts an accent on 1 the quality of higher education as a national priority, 2 the qualification and motivation of the academic staff as factors for offering an educational product of high quality, 3 the strategies, policies and practices for motivating the academic personnel. The necessity of education improvement is adduced, the strategies and politics in the field of academic personnel training are presented, and the possible effects from a wrong approach to employees’ motivation in academic environment are commented.

  10. Does total hip replacement affect sexual quality of life?

    Science.gov (United States)

    Harmsen, Rita Th E; Haanstra, Tsjitske M; Sierevelt, Inger N; Jansma, Elise P; Nolte, Peter A; Nicolai, Melianthe P J; Wall, Peter D H; Van Royen, Barend J

    2016-05-04

    Total Hip Replacement (THR) is an effective treatment for end-stage hip osteoarthritis. Since the introduction of total joint replacement, the effect on the Sexual Quality of Life (SQoL) following THR has been addressed in scant studies. The aim of our study was to systematically review the literature, to summarise effects of THR on patients' SQoL. We searched PubMed, EMBASE and PsycINFO between January 1970 and February 9th, 2015 with search terms including Total Hip, Osteoarthritis, SQoL, and THR. Eligible studies were identified and two independent authors extracted data including details of SQoL, study quality and risk of bias. There were 12 eligible studies, which included a total of 2099 patients with an age range of 20-85 years. The methodological quality of ten studies was rated as low, and of two as moderate. Amongst the majority of patients, SQoL improved after surgery, both in terms of physical-functional and psychosocial well-being. However, changes between pre-operative and postoperative SQoL ranged extensively: for example, Sexual Dysfunction Δ 8-51% and Sexual Activity (SA) Δ 0-77%. Three studies reported that some patients never resumed SA again after surgery. In over 40 years of THR treatment, scant studies have examined the effect of THR on patients' SQoL. This review suggests that SQol improves after THR, although the magnitude of effects varies highly. However, the quality of the supporting evidence was rated as low to moderate. This suggests a need for more high quality evidence about the effects of THR on SQoL.

  11. Study on quality assurance for high-level radioactive waste disposal project (2). Quality assurance system for the site characterization phase in the Yucca Mountain Project

    International Nuclear Information System (INIS)

    Takada, Susumu

    2006-01-01

    The objective of this report is to assist related organizations in the development of quality assurance systems for a high-level radioactive waste disposal system. This report presents detail information with which related organizations can begin the development of quality assurance systems at an initial phase of repository development for a high-level radioactive waste disposal program, including data qualification, model validation, systems and facilities for quality assurance (e.g., technical data management system, sample management facility, etc.), and QA program applicability (items and activities). These descriptions are based on information in QA program for the Yucca Mountain Project (YMP), such as the U.S. Department of Energy (DOE) Quality Assurance Requirements and Description (QARD), DOE/RW-0333P, quality implementing procedures, and reports implemented by the procedures. Additionally, this report includes some brief recommendations for developing of quality assurance systems, such as establishment of quality assurance requirements, measures for establishment of QA system. (author)

  12. Towards evidence-based medicine in specific grass pollen immunotherapy.

    Science.gov (United States)

    Calderon, M; Mösges, R; Hellmich, M; Demoly, P

    2010-04-01

    When initiating grass pollen immunotherapy for seasonal allergic rhinoconjunctivitis, specialist physicians in many European countries must choose between modalities of differing pharmaceutical and regulatory status. We applied an evidence-based medicine (EBM) approach to commercially available subcutaneous and sublingual Gramineae grass pollen immunotherapies (SCIT and SLIT) by evaluating study design, populations, pollen seasons, treatment doses and durations, efficacy, quality of life, safety and compliance. After searching MEDLINE, Embase and the Cochrane Library up until January 2009, we identified 33 randomized, double-blind, placebo-controlled trials (including seven paediatric trials) with a total of 440 specific immunotherapy (SIT)-treated subjects in seven trials (0 paediatric) for SCIT with natural pollen extracts, 168 in three trials (0 paediatric) for SCIT with allergoids, 906 in 16 trials (five paediatric) for natural extract SLIT drops, 41 in two trials (one paediatric) for allergoid SLIT tablets and 1605 in five trials (two paediatric) for natural extract SLIT tablets. Trial design and quality varied significantly within and between SIT modalities. The multinational, rigorous trials of natural extract SLIT tablets correspond to a high level of evidence in adult and paediatric populations. The limited amount of published data on allergoids prevented us from judging the level of evidence for this modality.

  13. Highly purified water production technology. The influence of water purity on steam quality

    International Nuclear Information System (INIS)

    Ganter, J.

    1975-01-01

    The fundamental question related to high-pressure steam generation, intended for powering steam turbines, concerns steam production conditions based on constant quality standards. The characteristics of water (salinity, silica concentration) are indicated for a given steam quality as a function of the pressure. Two processes for the purification of feedwater for high pressure boilers are described: a treatment using precoated cellulose or resin filters and a treatment using mixed-bed ion exchangers. When ultrapure water is required, the demineralized water is filtred using microfiltration and ultrafiltration processes [fr

  14. Supporting Early Math--Rationales and Requirements for High Quality Software

    Science.gov (United States)

    Haake, Magnus; Husain, Layla; Gulz, Agneta

    2015-01-01

    There is substantial evidence that preschooler's performance in early math is highly correlated to math performance throughout school as well as academic skills in general. One way to help children attain early math skills is by using targeted educational software and the paper discusses potential gains of using such software to support early math…

  15. Evidence for Dietary Fibre Modification in the Recovery and Prevention of Reoccurrence of Acute, Uncomplicated Diverticulitis: A Systematic Literature Review

    Science.gov (United States)

    Dahl, Camilla; Crichton, Megan; Jenkins, Julie; Nucera, Romina; Mahoney, Sophie; Marx, Wolfgang

    2018-01-01

    In practice, nutrition recommendations vary widely for inpatient and discharge management of acute, uncomplicated diverticulitis. This systematic review aims to review the evidence and develop recommendations for dietary fibre modifications, either alone or alongside probiotics or antibiotics, versus any comparator in adults in any setting with or recently recovered from acute, uncomplicated diverticulitis. Intervention and observational studies in any language were located using four databases until March 2017. The Cochrane Risk of Bias tool and GRADE were used to evaluate the overall quality of the evidence and to develop recommendations. Eight studies were included. There was “very low” quality evidence for comparing a liberalised and restricted fibre diet for inpatient management to improve hospital length of stay, recovery, gastrointestinal symptoms and reoccurrence. There was “very low” quality of evidence for using a high dietary fibre diet as opposed to a standard or low dietary fibre diet following resolution of an acute episode, to improve reoccurrence and gastrointestinal symptoms. The results of this systematic review and GRADE assessment conditionally recommend the use of liberalised diets as opposed to dietary restrictions for adults with acute, uncomplicated diverticulitis. It also strongly recommends a high dietary fibre diet aligning with dietary guidelines, with or without dietary fibre supplementation, after the acute episode has resolved. PMID:29382074

  16. School Competition and Teacher Labor Markets: Evidence from Charter School Entry in North Carolina

    OpenAIRE

    C. Kirabo Jackson

    2011-01-01

    I analyze changes in teacher turnover, hiring, effectiveness, and salaries at traditional public schools after the opening of a nearby charter school. While I find small effects on turnover overall, difficult to staff schools (low-income, high-minority share) hired fewer new teachers and experienced small declines in teacher quality. I also find evidence of a demand side response where schools increased teacher compensation to better retain quality teachers. The results are robust across a va...

  17. Quality Improvement, Inventory Management, Lead Time Reduction and Production Scheduling in High-Mix Manufacturing Environments

    Science.gov (United States)

    2017-01-13

    Quality Improvement , Inventory Management, Lead Time Reduction and Production Scheduling in High-mix Manufacturing Environments by Sean Daigle B.S...Mechanical Engineering Chairman, Department Committee on Graduate Theses 2 Quality Improvement , Inventory Management, Lead Time Reduction and... Production Scheduling in High-mix Manufacturing Environments by Sean Daigle Submitted to the Department of Mechanical Engineering on January 13, 2017, in

  18. [Quality assurance concepts in intensive care medicine].

    Science.gov (United States)

    Brinkmann, A; Braun, J P; Riessen, R; Dubb, R; Kaltwasser, A; Bingold, T M

    2015-11-01

    Intensive care medicine (ICM) is characterized by a high degree of complexity and requires intense communication and collaboration on interdisciplinary and multiprofessional levels. In order to achieve good quality of care in this environment and to prevent errors, a proactive quality and error management as well as a structured quality assurance system are essential. Since the early 1990s, German intensive care societies have developed concepts for quality management and assurance in ICM. In 2006, intensive care networks were founded in different states to support the implementation of evidence-based knowledge into clinical routine and to improve medical outcome, efficacy, and efficiency in ICM. Current instruments and concepts of quality assurance in German ICM include core intensive care data from the data registry DIVI REVERSI, quality indicators, peer review in intensive care, IQM peer review, and various certification processes. The first version of German ICM quality indicators was published in 2010 by an interdisciplinary and interprofessional expert commission. Key figures, indicators, and national benchmarks are intended to describe the quality of structures, processes, and outcomes in intensive care. Many of the quality assurance tools have proved to be useful in clinical practice, but nationwide implementation still can be improved.

  19. Universal and rapid salt-extraction of high quality genomic DNA for PCR-based techniques.

    OpenAIRE

    Aljanabi, S M; Martinez, I

    1997-01-01

    A very simple, fast, universally applicable and reproducible method to extract high quality megabase genomic DNA from different organisms is described. We applied the same method to extract high quality complex genomic DNA from different tissues (wheat, barley, potato, beans, pear and almond leaves as well as fungi, insects and shrimps' fresh tissue) without any modification. The method does not require expensive and environmentally hazardous reagents and equipment. It can be performed even i...

  20. Recent Evidence on Perception and Esthetic Appreciation: The Role of Value and Expertise in Canon Formation

    Directory of Open Access Journals (Sweden)

    Gianluca Consoli

    2014-04-01

    Full Text Available On the basis of current evidence derived from neurocognitive research, it is possible to mediate two alternative theories concerning the relationship between perception and esthetic appreciation, in particular by distinguishing between high-quality images and popular.

  1. Prosthetic joint infection development of an evidence-based diagnostic algorithm.

    Science.gov (United States)

    Mühlhofer, Heinrich M L; Pohlig, Florian; Kanz, Karl-Georg; Lenze, Ulrich; Lenze, Florian; Toepfer, Andreas; Kelch, Sarah; Harrasser, Norbert; von Eisenhart-Rothe, Rüdiger; Schauwecker, Johannes

    2017-03-09

    Increasing rates of prosthetic joint infection (PJI) have presented challenges for general practitioners, orthopedic surgeons and the health care system in the recent years. The diagnosis of PJI is complex; multiple diagnostic tools are used in the attempt to correctly diagnose PJI. Evidence-based algorithms can help to identify PJI using standardized diagnostic steps. We reviewed relevant publications between 1990 and 2015 using a systematic literature search in MEDLINE and PUBMED. The selected search results were then classified into levels of evidence. The keywords were prosthetic joint infection, biofilm, diagnosis, sonication, antibiotic treatment, implant-associated infection, Staph. aureus, rifampicin, implant retention, pcr, maldi-tof, serology, synovial fluid, c-reactive protein level, total hip arthroplasty (THA), total knee arthroplasty (TKA) and combinations of these terms. From an initial 768 publications, 156 publications were stringently reviewed. Publications with class I-III recommendations (EAST) were considered. We developed an algorithm for the diagnostic approach to display the complex diagnosis of PJI in a clear and logically structured process according to ISO 5807. The evidence-based standardized algorithm combines modern clinical requirements and evidence-based treatment principles. The algorithm provides a detailed transparent standard operating procedure (SOP) for diagnosing PJI. Thus, consistently high, examiner-independent process quality is assured to meet the demands of modern quality management in PJI diagnosis.

  2. RELATIONSHIP AMONG E-SERVICE QUALITY, CULTURE, ATTITUDE, TRUST, RISK OF ONLINE SHOPPING

    OpenAIRE

    Mohammad Al-Nasser; Rushami Zien Yusoff; Rabiul Islam; Abdullah Al-Nasser

    2014-01-01

    Purchasing is considered a risky business specifically in the online purchasing environment. The research was designed to fill the gap in the existing body of knowledge regarding attitudes and differences in electronic service quality perception between two different geographical and cultural countries-Malaysia and Saudi Arabia-regarding online shopping. Specifically, this research extended previous effort done in an online shopping context by providing evidence that high service quality incr...

  3. Free smoking cessation mobile apps available in Australia: a quality review and content analysis.

    Science.gov (United States)

    Thornton, Louise; Quinn, Catherine; Birrell, Louise; Guillaumier, Ashleigh; Shaw, Brad; Forbes, Erin; Deady, Mark; Kay-Lambkin, Frances

    2017-12-01

    This review aimed to identify free, high-quality, smoking cessation mobile applications (apps) that adhere to Australian smoking cessation treatment guidelines. A systematic search of smoking cessation apps was conducted using Google. The technical quality of relevant apps was rated using the Mobile Application Rating Scale. The content of apps identified as high quality was assessed for adherence to smoking cessation treatment guidelines. 112 relevant apps were identified. The majority were of poor technical quality and only six 'high-quality' apps were identified. These apps adhered to Australian treatment guidelines in part. The efficacy of two apps had been previously evaluated. In lieu of more substantial research in this area, it is suggested that the high-quality apps identified in this review may be more likely than other available apps to encourage smoking cessation. Implications for public health: Smoking cessation apps have the potential to address many barriers that prevent smoking cessation support being provided; however few high-quality smoking cessation apps are currently available in Australia, very few have been evaluated and the app market is extremely volatile. More research to evaluate smoking cessation apps, and sustained funding for evidence-based apps, is needed. © 2017 The Authors.

  4. Consumers' expected quality and intention to purchase high quality pork meat.

    Science.gov (United States)

    Papanagiotou, P; Tzimitra-Kalogianni, I; Melfou, K

    2013-03-01

    Expected quality is believed to be one of the most important factors that influence consumers' intention to purchase food. The present study seeks to explore the concept of pork meat expected quality and compare it with self-stated consumer intention to purchase pork meat. The aim is attempted by means of a field research conducted in Greece, following a conjoint analytic procedure. Results show that quality expectations comply with intention to buy pork, in many aspects. However, several differences have been identified. More specifically, country of origin and marbling appear to be more important for respondents' purchase decisions than they are for their quality evaluations, while the opposite appears to be true for price. Finally, socio-demographic factors such as gender, level of education, place of purchase and consumption habits seem to influence perceptions. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Glen Robert

    2009-12-01

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

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

    Science.gov (United States)

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

    2009-12-19

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

  7. Service Station Evaluation Problem in Catering Service of High-Speed Railway: A Fuzzy QFD Approach Based on Evidence Theory

    Directory of Open Access Journals (Sweden)

    Xin Wu

    2015-01-01

    Full Text Available Catering Service of High-Speed Railway (CSHR starts at suppliers, includes distribution centers and service stations in cities, and ends at cabinets in high-speed trains. In Distribution System Design (DSD Problem for CSHR, it is critical to evaluate the alternatives of service stations, which is termed as Service Station Evaluation Problem in Catering Service of High-speed Railway (SSEP-CSHR. As a preparation work for DSD, SSEP-CSHR needs to be solved without detailed information and being accompanied with uncertainty. Fuzzy Quality Function Deployment (F-QFD has been given in the literatures to deal with vagueness in Facility Location Evaluation (FLE. However, SSEP-CSHR that includes identifying and evaluating stations requires not only dealing with the vague nature of assessments but also confirming them. Based on evidence theory, this paper introduces the framework to give the truth of proposition “x is A.” Then it is incorporated into a two-phase F-QFD with an approximate reasoning to enable the truth of the decisions to be measured. A case study that refers to 85 alternative stations on Chinese high-speed railway will be carried out to verify the proposed method. Analysis shows that the proposed evaluation method enhances scientific credibility of FLE and allows decision makers to express how much is known.

  8. Injection Drug Use Quality of Life scale (IDUQOL: A validation study

    Directory of Open Access Journals (Sweden)

    Palepu Anita

    2005-07-01

    Full Text Available Abstract Background Existing measures of injection drug users' quality of life have focused primarily on health and health-related factors. Clearly, however, quality of life among injection drug users is impacted by a range of unique cultural, socioeconomic, medical, and geographic factors that must also be considered in any measure. The Injection Drug User Quality of Life (IDUQOL scale was designed to capture the unique and individual circumstances that determine quality of life among injection drug users. The overall purpose of the present study was to examine the validity of inferences made from the IDUQOL by examining the (a dimensionality, (b reliability of scores, (c criterion-related validity evidence, and (d both convergent and discriminant validity evidence. Methods An exploratory factor analysis using principal axis factoring in SPSS 12.0 was conducted to determine whether the use of a total score on the IDUQOL was advisable. Reliability of scores from the IDUQOL was obtained using internal consistency and one-week test-retest reliability estimates. Criterion-related validity evidence was gathered using variables such as stability of housing, sex trade involvement, high-risk injection behaviours, involvement in treatment programs, emergency treatment or overdose over the previous six months, hospitalization and emergency treatment over the subsequent six month period post data collection. Convergent and discriminant validity evidence was gathered using measures of life satisfaction, self-esteem, and social desirability. Results The sample consisted of 241 injection drug users ranging in age from 19 to 61 years. Factor analysis supports the use of a total score. Both internal consistency (alpha = .88 and one-week test-retest reliability (r = .78 for IDUQOL total scores were good. Criterion-related, convergent, and discriminant validity evidence supports the interpretation of IDUQOL total scores as measuring a construct consistent with

  9. Do they understand the benefits from education? Evidence on Dutch high school students’ earnings expectations

    NARCIS (Netherlands)

    Mazza, J.; Hartog, J.

    2011-01-01

    Using an internet collected dataset, we will provide some empirical evidence on the information that Dutch high school students possess before their decision on tertiary education participation. The sample is prone to selective participation and high attrition, but we detect little systematic

  10. 10 Principles for Building a High-Quality System of Assessments

    Science.gov (United States)

    Jobs for the Future, 2018

    2018-01-01

    Many states and districts are working toward developing and implementing high-quality systems that align assessments with each other, and to college and career readiness, and a comprehensive set of higher-order thinking skills. In order to support states, districts, and communities in this, the following 10 principles as guidance and common…

  11. Headache service quality

    DEFF Research Database (Denmark)

    Schramm, Sara; Uluduz, Derya; Gouveia, Raquel Gil

    2016-01-01

    , producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1...

  12. High quality-factor fano metasurface comprising a single resonator unit cell

    Science.gov (United States)

    Sinclair, Michael B.; Warne, Larry K.; Basilio, Lorena I.; Langston, William L.; Campione, Salvatore; Brener, Igal; Liu, Sheng

    2017-06-20

    A new monolithic resonator metasurface design achieves ultra-high Q-factors while using only one resonator per unit cell. The metasurface relies on breaking the symmetry of otherwise highly symmetric resonators to induce intra-resonator mixing of bright and dark modes (rather than inter-resonator couplings), and is scalable from the near-infrared to radio frequencies and can be easily implemented in dielectric materials. The resulting high-quality-factor Fano metasurface can be used in many sensing, spectral filtering, and modulation applications.

  13. Establishing High-Quality Prostate Brachytherapy Using a Phantom Simulator Training Program

    Energy Technology Data Exchange (ETDEWEB)

    Thaker, Nikhil G. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kudchadker, Rajat J. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Swanson, David A. [Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Albert, Jeffrey M. [Department of Radiation Oncology, Banner Health, Loveland/Greeley, Colorado (United States); Mahmood, Usama; Pugh, Thomas J.; Boehling, Nicholas S. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Bruno, Teresa L. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Prestidge, Bradley R. [Department of Radiation Oncology, Bon Secours Health System, Norfolk, Virginia (United States); Crook, Juanita M. [Department of Radiation Oncology, Cancer Center for the Southern Interior, Kelowna, British Columbia (Canada); Cox, Brett W.; Potters, Louis [Department of Radiation Medicine, North Shore-LIJ Health System, New Hyde Park, New York (United States); Moran, Brian J. [Chicago Prostate Center, Westmont, Illinois (United States); Keyes, Mira [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Center, Vancouver, British Columbia (Canada); Kuban, Deborah A. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Frank, Steven J., E-mail: sjfrank@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-11-01

    Purpose: To design and implement a unique training program that uses a phantom-based simulator to teach the process of prostate brachytherapy (PB) quality assurance and improve the quality of education. Methods and Materials: Trainees in our simulator program were practicing radiation oncologists, radiation oncology residents, and fellows of the American Brachytherapy Society. The program emphasized 6 core areas of quality assurance: patient selection, simulation, treatment planning, implant technique, treatment evaluation, and outcome assessment. Using the Iodine 125 ({sup 125}I) preoperative treatment planning technique, trainees implanted their ultrasound phantoms with dummy seeds (ie, seeds with no activity). Pre- and postimplant dosimetric parameters were compared and correlated using regression analysis. Results: Thirty-one trainees successfully completed the simulator program during the period under study. The mean phantom prostate size, number of seeds used, and total activity were generally consistent between trainees. All trainees met the V100 >95% objective both before and after implantation. Regardless of the initial volume of the prostate phantom, trainees' ability to cover the target volume with at least 100% of the dose (V100) was not compromised (R=0.99 pre- and postimplant). However, the V150 had lower concordance (R=0.37) and may better reflect heterogeneity control of the implant process. Conclusions: Analysis of implants from this phantom-based simulator shows a high degree of consistency between trainees and uniformly high-quality implants with respect to parameters used in clinical practice. This training program provides a valuable educational opportunity that improves the quality of PB training and likely accelerates the learning curve inherent in PB. Prostate phantom implantation can be a valuable first step in the acquisition of the required skills to safely perform PB.

  14. Establishing High-Quality Prostate Brachytherapy Using a Phantom Simulator Training Program

    International Nuclear Information System (INIS)

    Thaker, Nikhil G.; Kudchadker, Rajat J.; Swanson, David A.; Albert, Jeffrey M.; Mahmood, Usama; Pugh, Thomas J.; Boehling, Nicholas S.; Bruno, Teresa L.; Prestidge, Bradley R.; Crook, Juanita M.; Cox, Brett W.; Potters, Louis; Moran, Brian J.; Keyes, Mira; Kuban, Deborah A.; Frank, Steven J.

    2014-01-01

    Purpose: To design and implement a unique training program that uses a phantom-based simulator to teach the process of prostate brachytherapy (PB) quality assurance and improve the quality of education. Methods and Materials: Trainees in our simulator program were practicing radiation oncologists, radiation oncology residents, and fellows of the American Brachytherapy Society. The program emphasized 6 core areas of quality assurance: patient selection, simulation, treatment planning, implant technique, treatment evaluation, and outcome assessment. Using the Iodine 125 ( 125 I) preoperative treatment planning technique, trainees implanted their ultrasound phantoms with dummy seeds (ie, seeds with no activity). Pre- and postimplant dosimetric parameters were compared and correlated using regression analysis. Results: Thirty-one trainees successfully completed the simulator program during the period under study. The mean phantom prostate size, number of seeds used, and total activity were generally consistent between trainees. All trainees met the V100 >95% objective both before and after implantation. Regardless of the initial volume of the prostate phantom, trainees' ability to cover the target volume with at least 100% of the dose (V100) was not compromised (R=0.99 pre- and postimplant). However, the V150 had lower concordance (R=0.37) and may better reflect heterogeneity control of the implant process. Conclusions: Analysis of implants from this phantom-based simulator shows a high degree of consistency between trainees and uniformly high-quality implants with respect to parameters used in clinical practice. This training program provides a valuable educational opportunity that improves the quality of PB training and likely accelerates the learning curve inherent in PB. Prostate phantom implantation can be a valuable first step in the acquisition of the required skills to safely perform PB

  15. The Effect of Financial Incentives on Quality of Care: The Case of Diabetes

    OpenAIRE

    Anthony Scott; Stefanie Schurer; Paul H. Jensen; Peter Sivey

    2008-01-01

    Australia introduced an incentive payment scheme for general practitioners to ensure systematic and high quality care in chronic disease management. There is little empirical evidence and ambiguous theoretical guidance on which effects to expect on the quality of care. This paper evaluates the impact of the payment incentives on quality of care in diabetes, as measured by the probability of ordering an HbA1c test. The empirical analysis is conducted with a unique data set and a multivariate p...

  16. The Effects of Financial Incentives on Quality of Care: The Case of Diabetes

    OpenAIRE

    Scott, A; Schurer, S; Jensen, P H; Sivey, P

    2008-01-01

    Australia introduced an incentive payment scheme for general practitioners to ensure systematic and high quality care in chronic disease management. There is little empirical evidence and ambiguous theoretical guidance on which effects to expect on the quality of care. This paper evaluates the impact of the payment incentives on quality of care in diabetes, as measured by the probability of ordering an HbA1c test. The empirical analysis is conducted with a unique data set and a multivariate p...

  17. Timing of high-quality child care and cognitive, language, and preacademic development

    OpenAIRE

    Li, W; Farkas, G; Duncan, GJ; Burchinal, MR; Vandell, DL

    2013-01-01

    The effects of high- versus low-quality child care during 2 developmental periods (infant-toddlerhood and preschool) were examined using data from the National Institute of Child Health and Human Development Study of Early Child Care. Propensity score matching was used to account for differences in families who used different combinations of child care quality during the 2 developmental periods. Findings indicated that cognitive, language, and preacademic skills prior to school entry were hig...

  18. The serotonin transporter polymorphism (5-HTTLPR) and cortisol stress responsiveness: preliminary evidence for a modulating role for sleep quality.

    Science.gov (United States)

    van Dalfsen, Jens H; Markus, C Rob

    2018-05-23

    The short (S) allele of a functional polymorphism (5-HTTLPR) within the promoter region of the serotonin transporter gene (SLC6A4) is found to predispose the risk for stress-related affective disorders relative to the long (L) allele. Evidence suggests that elevated stress reactivity of the hypothalamic-pituitary-adrenal (HPA) axis might underlie this association although there is little understanding about the origin of inconsistent findings. Since inadequate sleep is commonly known to promote HPA stress reactivity, it might well play an important modulating role. The present study tested this hypothesis by investigating whether sleep quality moderates the relationship between 5-HTTLPR and cortisol stress responsiveness. From a large 5-HTTLPR database (n = 771), a sample of healthy male and female participants homozygous for either the 5-HTTLPR S-allele (n = 25) or L-allele (n = 25) were assessed for sleep quality and salivary cortisol secretion during acute laboratory stress. Diminished sleep quality was found to exclusively potentiate cortisol stress reactivity in the homozygous L-allele genotype. Accounting for this 5-HTTLPR-dependent influence enhanced the predictive value of 5-HTTLPR on cortisol stress responsiveness, revealing greater HPA reactivity in S-allele relative to L-allele carriers. Current findings suggest that variations in sleep quality may serve as a confounding factor in the search for genetic differences in stress sensitivity and related affective disorders.

  19. H{sub 2}O{sub 2}-molecular beam epitaxy of high quality ZnO

    Energy Technology Data Exchange (ETDEWEB)

    El Shaer, A.; Bakin, A.; Che Mofor, A.; Kreye, M.; Waag, A. [Technical University Braunschweig, Institute of Semiconductor Technology, Braunschweig (Germany); Blaesing, J.; Krost, A. [Otto-von-Guericke-University, Institute of Experimental Physics, Magdeburg (Germany); Stoimenos, J. [Aristotele University, Physics Department, Thessaloniki (Greece); Pecz, B. [Hungarian Academy of Sciences, Research Institute for Technical Physics and Materials Science, P.O. Box 49, Budapest (Hungary)

    2007-07-15

    We have studied the growth and characterization of ZnO epilayers on (0001)-sapphire by H{sub 2}O{sub 2}-molecular beam epitaxy (MBE). A high temperature (HT) MgO buffer followed by a low-temperature ZnO buffer was introduced in order to accommodate the lattice mismatch between ZnO and sapphire. The surface morphology of the samples was studied using atomic force microscopy (AFM), and scanning electron microscopy (SEM). The crystalline quality of the layers was investigated by employing high resolution X-ray diffractometry (HRXRD) and high resolution transmission electron microscopy (HRTEM). The electrical properties of the grown ZnO layers were studied by Hall-effect measurements in a standard van der Pauw configuration. The measured surface roughness for the best layers is as low as 0.26 nm rms. HRXRD measurements of the obtained ZnO layers show excellent quality of the single crystalline ZnO heteroepitaxially grown on (0001)-sapphire with a HT MgO buffer layers. The influence of the growth conditions on the crystalline quality is discussed. The FWHM of the HRXRD (0002) rocking curves measured for the 2-inch ZnO-on-sapphire is as low as 27 arcsec with a very high lateral homogeneity across the whole 2-inch ZnO epilayers. The results indicate that H{sub 2}O{sub 2}-MBE is a suitable technique to fabricate ZnO epilayers of very high quality. (orig.)

  20. Quality assurance during fabrication of high-damping rubber isolation bearings

    Energy Technology Data Exchange (ETDEWEB)

    Way, D.; Greaves, W.C. [Base Isolation Consultants, Inc., San Francisco, CA (United States)

    1995-12-01

    Successful implementation of a high-damping rubber (HDR) base isolation project requires the application of Quality Assurance/Quality Control (QA/QC) methodology through all phases of the bearing fabrication process. HDR base isolation bearings must be fabricated with uniform physical characteristics while being produced in large quantities. To satisfy this requirement, manufacturing processes must be controlled. Prototype tests that include dynamic testing of small samples of rubber are necessary. Stringent full scale bearing testing must be carried out prior to beginning production, during which manufacturing is strictly regulated by small rubber sample and production bearing testing. All such activities should be supervised and continuously inspected by independent and experienced QA/QC personnel.

  1. Living systematic reviews: an emerging opportunity to narrow the evidence-practice gap.

    Directory of Open Access Journals (Sweden)

    Julian H Elliott

    2014-02-01

    Full Text Available The current difficulties in keeping systematic reviews up to date leads to considerable inaccuracy, hampering the translation of knowledge into action. Incremental advances in conventional review updating are unlikely to lead to substantial improvements in review currency. A new approach is needed. We propose living systematic review as a contribution to evidence synthesis that combines currency with rigour to enhance the accuracy and utility of health evidence. Living systematic reviews are high quality, up-to-date online summaries of health research, updated as new research becomes available, and enabled by improved production efficiency and adherence to the norms of scholarly communication. Together with innovations in primary research reporting and the creation and use of evidence in health systems, living systematic review contributes to an emerging evidence ecosystem.

  2. In search of quality evidence for lifestyle management and glycemic control in children and adolescents with type 2 diabetes: A systematic review

    Directory of Open Access Journals (Sweden)

    Jetha Mary M

    2010-12-01

    Full Text Available Abstract Background Our purpose was to evaluate the impact of lifestyle behavior modification on glycemic control among children and youth with clinically defined Type 2 Diabetes (T2D. Methods We conducted a systematic review of studies (randomized trials, quasi-experimental studies evaluating lifestyle (diet and/or physical activity modification and glycemic control (HbA1c. Our data sources included bibliographic databases (EMBASE, CINAHL®, Cochrane Library, Medline®, PASCAL, PsycINFO®, and Sociological Abstracts, manual reference search, and contact with study authors. Two reviewers independently selected studies that included any intervention targeting diet and/or physical activity alone or in combination as a means to reduce HbA1c in children and youth under the age of 18 with T2D. Results Our search strategy generated 4,572 citations. The majority of citations were not relevant to the study objective. One study met inclusion criteria. In this retrospective study, morbidly obese youth with T2D were treated with a very low carbohydrate diet. This single study received a quality index score of Conclusions There is no high quality evidence to suggest lifestyle modification improves either short- or long-term glycemic control in children and youth with T2D. Additional research is clearly warranted to define optimal lifestyle behaviour strategies for young people with T2D.

  3. Method for synthesis of high quality graphene

    Science.gov (United States)

    Lanzara, Alessandra [Piedmont, CA; Schmid, Andreas K [Berkeley, CA; Yu, Xiaozhu [Berkeley, CA; Hwang, Choonkyu [Albany, CA; Kohl, Annemarie [Beneditkbeuern, DE; Jozwiak, Chris M [Oakland, CA

    2012-03-27

    A method is described herein for the providing of high quality graphene layers on silicon carbide wafers in a thermal process. With two wafers facing each other in close proximity, in a first vacuum heating stage, while maintained at a vacuum of around 10.sup.-6 Torr, the wafer temperature is raised to about 1500.degree. C., whereby silicon evaporates from the wafer leaving a carbon rich surface, the evaporated silicon trapped in the gap between the wafers, such that the higher vapor pressure of silicon above each of the wafers suppresses further silicon evaporation. As the temperature of the wafers is raised to about 1530.degree. C. or more, the carbon atoms self assemble themselves into graphene.

  4. Estimation of an optimal chemotherapy utilisation rate for cancer: setting an evidence-based benchmark for quality cancer care.

    Science.gov (United States)

    Jacob, S A; Ng, W L; Do, V

    2015-02-01

    There is wide variation in the proportion of newly diagnosed cancer patients who receive chemotherapy, indicating the need for a benchmark rate of chemotherapy utilisation. This study describes an evidence-based model that estimates the proportion of new cancer patients in whom chemotherapy is indicated at least once (defined as the optimal chemotherapy utilisation rate). The optimal chemotherapy utilisation rate can act as a benchmark for measuring and improving the quality of care. Models of optimal chemotherapy utilisation were constructed for each cancer site based on indications for chemotherapy identified from evidence-based treatment guidelines. Data on the proportion of patient- and tumour-related attributes for which chemotherapy was indicated were obtained, using population-based data where possible. Treatment indications and epidemiological data were merged to calculate the optimal chemotherapy utilisation rate. Monte Carlo simulations and sensitivity analyses were used to assess the effect of controversial chemotherapy indications and variations in epidemiological data on our model. Chemotherapy is indicated at least once in 49.1% (95% confidence interval 48.8-49.6%) of all new cancer patients in Australia. The optimal chemotherapy utilisation rates for individual tumour sites ranged from a low of 13% in thyroid cancers to a high of 94% in myeloma. The optimal chemotherapy utilisation rate can serve as a benchmark for planning chemotherapy services on a population basis. The model can be used to evaluate service delivery by comparing the benchmark rate with patterns of care data. The overall estimate for other countries can be obtained by substituting the relevant distribution of cancer types. It can also be used to predict future chemotherapy workload and can be easily modified to take into account future changes in cancer incidence, presentation stage or chemotherapy indications. Copyright © 2014 The Royal College of Radiologists. Published by

  5. Teolenn: an efficient and customizable workflow to design high-quality probes for microarray experiments

    Science.gov (United States)

    Jourdren, Laurent; Duclos, Aurélie; Brion, Christian; Portnoy, Thomas; Mathis, Hugues; Margeot, Antoine; Le Crom, Stéphane

    2010-01-01

    Despite the development of new high-throughput sequencing techniques, microarrays are still attractive tools to study small genome organisms, thanks to sample multiplexing and high-feature densities. However, the oligonucleotide design remains a delicate step for most users. A vast array of software is available to deal with this problem, but each program is developed with its own strategy, which makes the choice of the best solution difficult. Here we describe Teolenn, a universal probe design workflow developed with a flexible and customizable module organization allowing fixed or variable length oligonucleotide generation. In addition, our software is able to supply quality scores for each of the designed probes. In order to assess the relevance of these scores, we performed a real hybridization using a tiling array designed against the Trichoderma reesei fungus genome. We show that our scoring pipeline correlates with signal quality for 97.2% of all the designed probes, allowing for a posteriori comparisons between quality scores and signal intensities. This result is useful in discarding any bad scoring probes during the design step in order to get high-quality microarrays. Teolenn is available at http://transcriptome.ens.fr/teolenn/. PMID:20176570

  6. Towards a high quality high school workforce: A longitudinal, demographic analysis of U.S. public school physics teachers

    OpenAIRE

    Gregory T. Rushton; David Rosengrant; Andrew Dewar; Lisa Shah; Herman E. Ray; Keith Sheppard; Lynn Watanabe

    2017-01-01

    Efforts to improve the number and quality of the high school physics teaching workforce have taken several forms, including those sponsored by professional organizations. Using a series of large-scale teacher demographic data sets from the National Center for Education Statistics (NCES), this study sought to investigate trends in teacher quality at the national level in the two and a half decades between 1987 and 2012. Specifically, we investigated (i) details about the degree backgrounds, ma...

  7. Adherence to evidence based care practices for childbirth before and after a quality improvement intervention in health facilities of Rajasthan, India.

    Science.gov (United States)

    Iyengar, Kirti; Jain, Motilal; Thomas, Sunil; Dashora, Kalpana; Liu, William; Saini, Paramsukh; Dattatreya, Rajesh; Parker, Indrani; Iyengar, Sharad

    2014-08-13

    After the launch of Janani Suraksha Yojana, a conditional cash transfer scheme in India, the proportion of women giving birth in institutions has rapidly increased. However, there are important gaps in quality of childbirth services during institutional deliveries. The aim of this intervention was to improve the quality of childbirth services in selected high caseload public health facilities of 10 districts of Rajasthan. This intervention titled "Parijaat" was designed by Action Research & Training for Health, in partnership with the state government and United Nations Population Fund. The intervention was carried out in 44 public health facilities in 10 districts of Rajasthan, India. These included district hospitals (9), community health centres (32) and primary health centres (3). The main intervention was orientation training of doctors and program managers and regular visits to facilities involving assessment, feedback, training and action. The adherence to evidence based practices before, during and after this intervention were measured using structured checklists and scoring sheets. Main outcome measures included changes in practices during labour, delivery or immediate postpartum period. Use of several unnecessary or harmful practices reduced significantly. Most importantly, proportion of facilities using routine augmentation of labour reduced (p = 0), episiotomy for primigravidas (p = 0.0003), fundal pressure (p = 0.0003), and routine suction of newborns (0 = 0.0005). Among the beneficial practices, use of oxytocin after delivery increased (p = 0.0001) and the practice of listening foetal heart sounds during labour (p = 0.0001). Some practices did not show any improvements, such as dorsal position for delivery, use of partograph, and hand-washing. An intervention based on repeated facility visits combined with actions at the level of decision makers can lead to substantial improvements in quality of childbirth practices at health facilities.

  8. A quality assurance initiative for commercial-scale production in high-throughput cryopreservation of blue catfish sperm.

    Science.gov (United States)

    Hu, E; Liao, T W; Tiersch, T R

    2013-10-01

    Cryopreservation of fish sperm has been studied for decades at a laboratory (research) scale. However, high-throughput cryopreservation of fish sperm has recently been developed to enable industrial-scale production. This study treated blue catfish (Ictalurus furcatus) sperm high-throughput cryopreservation as a manufacturing production line and initiated quality assurance plan development. The main objectives were to identify: (1) the main production quality characteristics; (2) the process features for quality assurance; (3) the internal quality characteristics and their specification designs; (4) the quality control and process capability evaluation methods, and (5) the directions for further improvements and applications. The essential product quality characteristics were identified as fertility-related characteristics. Specification design which established the tolerance levels according to demand and process constraints was performed based on these quality characteristics. Meanwhile, to ensure integrity throughout the process, internal quality characteristics (characteristics at each quality control point within process) that could affect fertility-related quality characteristics were defined with specifications. Due to the process feature of 100% inspection (quality inspection of every fish), a specific calculation method, use of cumulative sum (CUSUM) control charts, was applied to monitor each quality characteristic. An index of overall process evaluation, process capacity, was analyzed based on in-control process and the designed specifications, which further integrates the quality assurance plan. With the established quality assurance plan, the process could operate stably and quality of products would be reliable. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Do knowledge infrastructure facilities support Evidence-Based Practice in occupational health? An exploratory study across countries among occupational physicians enrolled on EBM courses

    NARCIS (Netherlands)

    Hugenholtz, Nathalie I. R.; Nieuwenhuijsen, Karen; Sluiter, Judith K.; van Dijk, Frank J. H.

    2009-01-01

    ABSTRACT: BACKGROUND: Evidence-Based Medicine (EBM) is an important method used by occupational physicians (OPs) to deliver high quality health care. The presence and quality of a knowledge infrastructure is thought to influence the practice of EBM in occupational health care. This study explores

  10. Quality indicators

    DEFF Research Database (Denmark)

    Hjorth-Andersen, Christian

    1991-01-01

    In recent literature it has been suggested that consumers need have no knowledge of product quality as a number of quality indicators (or signals) may be used as substitutes. Very little attention has been paid to the empirical verification of these studies. The present paper is devoted...... to the issue of how well these indicators perform, using market data provided by consumer magazines from 3 countries. The results strongly indicate that price is a poor quality indicator. The paper also presents some evidence which suggests that seller reputation and easily observable characteristics are also...

  11. The design, fabrication, and testing of WETF high-quality, long-term-storage, secondary containment vessels

    International Nuclear Information System (INIS)

    Fisher, Kane J.

    2000-01-01

    Los Alamos National Laboratory's Weapons Engineering Tritium Facility (WETF) requires secondary containment vessels to store primary tritium containment vessels. The primary containment vessel provides the first boundary for tritium containment. The primary containment vessel is stored within a secondary containment vessel that provides the secondary boundary for tritium containment. WETF requires high-quality, long-term-storage, secondary tritium containment vessels that fit within a Mound-designed calorimeter. In order to qualify the WETF high-quality, long-term-storage, secondary containment vessels for use at WETF, steps have been taken to ensure the appropriate design, adequate testing, quality in fabrication, and acceptable documentation

  12. Evidence Based Practice: Valuable and Successful Examples from ...

    African Journals Online (AJOL)

    Keywords: evidence-based practice, nursing, midwifery, education, quality improvement, ... developed by Deming, the father of quality control. ... representative of the total population. .... and helped the management engage in key areas of.

  13. Personality and Relationship Quality During the Transition From High School to Early Adulthood

    Science.gov (United States)

    Parker, Philip D.; Lüdtke, Oliver; Trautwein, Ulrich; Roberts, Brent W.

    2013-01-01

    The post–high school transition period is believed to be associated with considerable changes in social networks, yet longitudinal studies documenting these changes are scarce. To address this gap, the current research explored 3 relevant issues. First, changes in participants’ relationship characteristics during the transition from high school were examined. Second, the roles of personality traits as antecedents of these changes were studied. Third, the association between change in relationship characteristics and personality during the transition was explored. A sample of over 2,000 German emerging adults, surveyed before leaving school and then 2 years after the transition from high school, was assessed on personality traits and a multidimensional assessment of the quality of their relationships. Findings indicated that participants experienced mostly positive changes in relationship quality during the transition from high school and that antecedent personality at school was an important predictor of the nature of this change. Finally, change in relationship quality was found to be associated with personality change during the post-school transition. Findings indicated that personality traits may influence transition success and that change in relationships during this transition may influence personality development. The implications of the research for post-school transition success are discussed. PMID:22224909

  14. Implementation of evidence-based knowledge in general practice.

    Science.gov (United States)

    Le, Jette Videbæk

    2017-12-01

    Background Keeping up with the evidence and implementing it into the daily care for patients are fundamental prerequisites for delivering a high quality of care in general practice. However, despite many years of research into dissemination and implementation of evidence-based recommendations, significant challenges remain. In recent years, organisational factors have become widely acknowledged as vitally important for ensuring successful implementation. Further knowledge is needed to understand more about which factors affect the seeking and implementation of evidence-based knowledge in general practice. Aim The overall aim was to investigate how evidence-based knowledge is sought and implemented in general practice and to analyse associations with GP characteristics and quality of care. Three separate studies, each covering a specific part of the overall aim, were undertaken: I. To examine how GPs implement clinical practice guidelines in everyday clinical practice, and how implementation approaches differ between practices. II. To assess GPs’ information seeking behaviour with regard to the use and perceived importance of scientific medical information sources and to investigate associations with GP characteristics. III. To investigate if there are associations between specific formalised implementation activities within general practice and quality of care – exemplified by the use of spirometry testing among first-time users of medication against obstructive lung diseases. Methods The study was designed as a mixed methods study combining qualitative interviews, questionnaire and register data. Study I was a qualitative interview study that involved purposefully selected GPs representing seven different practices. The interviews were analysed using systematic text condensation, and results were used to qualify the development of a national survey of general practitioners regarding their seeking and implementation of evidence-based knowledge. This survey was

  15. The many meanings of evidence: a comparative analysis of the forms and roles of evidence within three health policy processes in Cambodia.

    Science.gov (United States)

    Walls, Helen; Liverani, Marco; Chheng, Kannarath; Parkhurst, Justin

    2017-11-10

    Discussions within the health community routinely emphasise the importance of evidence in informing policy formulation and implementation. Much of the support for the evidence-based policy movement draws from concern that policy decisions are often based on inadequate engagement with high-quality evidence. In many such discussions, evidence is treated as differing only in quality, and assumed to improve decisions if it can only be used more. In contrast, political science scholars have described this as an overly simplistic view of the policy-making process, noting that research 'use' can mean a variety of things and relies on nuanced aspects of political systems. An approach more in recognition of how policy-making systems operate in practice can be to consider how institutions and ideas influence which pieces of evidence appear to be relevant for, and are used within, different policy processes. Drawing on in-depth interviews undertaken in 2015-2016 with key health sector stakeholders in Cambodia, we investigate the evidence perceived to be relevant to policy decisions for three contrasting health policy examples, namely tobacco control, HIV/AIDS and performance-based salary incentives. These cases allow us to examine the ways that policy-relevant evidence may differ given the framing of the issue and the broader institutional context in which evidence is considered. The three health issues show few similarities in how pieces of evidence were used in various aspects of policy-making, despite all being discussed within a broad policy environment in which evidence-based policy-making is rhetorically championed. Instead, we find that evidence use can be better understood by mapping how these health policy issues differ in terms of the issue characteristics, and also in terms of the stakeholders structurally established as having a dominant influence for each issue. Both of these have important implications for evidence use. Contrasting concerns of key stakeholders

  16. Characteristics of knowledge content in a curated online evidence library.

    Science.gov (United States)

    Varada, Sowmya; Lacson, Ronilda; Raja, Ali S; Ip, Ivan K; Schneider, Louise; Osterbur, David; Bain, Paul; Vetrano, Nicole; Cellini, Jacqueline; Mita, Carol; Coletti, Margaret; Whelan, Julia; Khorasani, Ramin

    2018-05-01

    To describe types of recommendations represented in a curated online evidence library, report on the quality of evidence-based recommendations pertaining to diagnostic imaging exams, and assess underlying knowledge representation. The evidence library is populated with clinical decision rules, professional society guidelines, and locally developed best practice guidelines. Individual recommendations were graded based on a standard methodology and compared using chi-square test. Strength of evidence ranged from grade 1 (systematic review) through grade 5 (recommendations based on expert opinion). Finally, variations in the underlying representation of these recommendations were identified. The library contains 546 individual imaging-related recommendations. Only 15% (16/106) of recommendations from clinical decision rules were grade 5 vs 83% (526/636) from professional society practice guidelines and local best practice guidelines that cited grade 5 studies (P < .0001). Minor head trauma, pulmonary embolism, and appendicitis were topic areas supported by the highest quality of evidence. Three main variations in underlying representations of recommendations were "single-decision," "branching," and "score-based." Most recommendations were grade 5, largely because studies to test and validate many recommendations were absent. Recommendation types vary in amount and complexity and, accordingly, the structure and syntax of statements they generate. However, they can be represented in single-decision, branching, and score-based representations. In a curated evidence library with graded imaging-based recommendations, evidence quality varied widely, with decision rules providing the highest-quality recommendations. The library may be helpful in highlighting evidence gaps, comparing recommendations from varied sources on similar clinical topics, and prioritizing imaging recommendations to inform clinical decision support implementation.

  17. Production of high-quality polydisperse construction mixes for additive 3D technologies.

    Science.gov (United States)

    Gerasimov, M. D.; Brazhnik, Yu V.; Gorshkov, P. S.; Latyshev, S. S.

    2018-03-01

    The paper describes a new design of a mixer allowing production of high quality polydisperse powders, used in additive 3D technologies. A new principle of dry powder particle mixing is considered, implementing a possibility of a close-to-ideal distribution of such particles in common space. A mathematical model of the mixer is presented, allowing evaluating quality indicators of the produced mixture. Experimental results are shown and rational values of process parameters of the mixer are obtained.

  18. Molecular Beam Epitaxy Growth of High Crystalline Quality LiNbO3

    Science.gov (United States)

    Tellekamp, M. Brooks; Shank, Joshua C.; Goorsky, Mark S.; Doolittle, W. Alan

    2016-12-01

    Lithium niobate is a multi-functional material with wide reaching applications in acoustics, optics, and electronics. Commercial applications for lithium niobate require high crystalline quality currently limited to bulk and ion sliced material. Thin film lithium niobate is an attractive option for a variety of integrated devices, but the research effort has been stagnant due to poor material quality. Both lattice matched and mismatched lithium niobate are grown by molecular beam epitaxy and studied to understand the role of substrate and temperature on nucleation conditions and material quality. Growth on sapphire produces partially coalesced columnar grains with atomically flat plateaus and no twin planes. A symmetric rocking curve shows a narrow linewidth with a full width at half-maximum (FWHM) of 8.6 arcsec (0.0024°), which is comparable to the 5.8 arcsec rocking curve FWHM of the substrate, while the film asymmetric rocking curve is 510 arcsec FWHM. These values indicate that the individual grains are relatively free of long-range disorder detectable by x-ray diffraction with minimal measurable tilt and twist and represents the highest structural quality epitaxial material grown on lattice mismatched sapphire without twin planes. Lithium niobate is also grown on lithium tantalate producing high quality coalesced material without twin planes and with a symmetric rocking curve of 193 arcsec, which is nearly equal to the substrate rocking curve of 194 arcsec. The surface morphology of lithium niobate on lithium tantalate is shown to be atomically flat by atomic force microscopy.

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

    Science.gov (United States)

    Richard J. Myhre

    1973-01-01

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

  20. Ensuring High-Quality Learning for All

    Science.gov (United States)

    Núñez, Elsa M.

    2018-01-01

    The Association of American Colleges and Universities (AAC&U) has embarked on a sustained program to enhance the quality of student learning on campuses, while also supporting AAC&U members' efforts to bring liberal education to all sectors of society. This commitment to quality and equity in service to democracy forms the basis for…

  1. Improvement of the image quality of a high-temperature vision system

    International Nuclear Information System (INIS)

    Fabijańska, Anna; Sankowski, Dominik

    2009-01-01

    In this paper, the issues of controlling and improving the image quality of a high-temperature vision system are considered. The image quality improvement is needed to measure the surface properties of metals and alloys. Two levels of image quality control and improvement are defined in the system. The first level in hardware aims at adjusting the system configuration to obtain the highest contrast and weakest aura images. When optimal configuration is obtained, the second level in software is applied. In this stage, image enhancement algorithms are applied which have been developed with consideration of distortions arising from the vision system components and specificity of images acquired during the measurement process. The developed algorithms have been applied in the vision system to images. The influence on the accuracy of wetting angles and surface tension determination are considered

  2. Health-related quality of life in patients with high-grade gliomas

    DEFF Research Database (Denmark)

    Piil, K; Jakobsen, J; Christensen, Karl Bang

    2015-01-01

    follow-up after 1 year. Scores of Karnofsky Performance Status (KPS), physical activity, anxiety and depression and health-related quality of life (FACT-Br) are obtained. Patients' physical activity level and KPS decrease during the disease- and treatment trajectory. The majority of patients did......The diagnosis of a high-grade glioma usual is followed by functional impairment(s), cognitive decline and an impaired psycho-social well-being. This might well have a significant and negative impact on the health related quality of life. The purpose of this study was to explore physical activity...... levels, prevalence and severity of anxiety and depressive symptoms and health-related quality of life among patients with a highgrade glioma. This paper is based on a longitudinal mixed methods study. Patients (n = 30) completed questionnaires at 5 time points from time of diagnosis until the final...

  3. The effect of the amiodarone-warfarin interaction on anticoagulation quality in a single, high-quality anticoagulation center.

    Science.gov (United States)

    White, Ryan D; Riggs, Kyle W; Ege, Ed J; Petroski, Gregory F; Koerber, Scott M; Flaker, Greg

    2016-03-01

    Clinical trials have reported a low time in therapeutic range (TTR) in patients with atrial fibrillation treated with both warfarin andamiodarone. These trials included centers and countries with both high and low TTRs. What is the impact of amiodarone on the TTR in a single, high-quality anticoagulation clinic? TTR was assessed in amiodarone and nonamiodarone-treated patients from a University anticoagulation clinic. Baseline characteristics between patients ever-taking or never-taking amiodarone were similar, except more amiodarone patients were smokers (19.5 vs. 6.1%, P = 0.0031). The TTR calculated from 8901international normalized ratios (INRs) in 249 nonamiodarone patients with a mean follow-up of 34 ± 20 months (mean INR 36 ± 18) was 66 ± 16.6% compared with 61.3 ± 16.2% (P = 0.111) from 1455 INRs in 41 amiodarone-treated patients with a mean follow-up of 28 ± 20 months (mean INR 35 ± 22). Factors associated with a low TTR were male sex (P = 0.0013), smoker (P = 0.0048), and amiodarone use (P = 0.0374). A second on-treatment analysis, in which the TTR was calculated only during amiodarone therapy, resulted in similar findings; however, amiodarone did not emerge as a predictor of a low TTR. In 11 patients, the TTR prior to amiodarone (54.5 ± 22.2%) was not significantly different in the first 3 months (54.6 ± 33.4%) or after 3 months (67.2 ± 33.7%) of amiodarone. In a single high-quality anticoagulation center, anticoagulation quality, as measured by the TTR, can be comparable in amiodarone and nonamiodarone-treated patients.

  4. Quality assurance issues and PACS

    NARCIS (Netherlands)

    Banta, H.D.

    1992-01-01

    Quality assessment and assurance is a growing concern in all areas of health care. The concern is fueled by a body of evidence that indicates that quality of care is not optimal, and in many instances, is unacceptably low. Although different standards for quality have been proposed, health outcome

  5. Quality Assessment in Oncology

    International Nuclear Information System (INIS)

    Albert, Jeffrey M.; Das, Prajnan

    2012-01-01

    The movement to improve healthcare quality has led to a need for carefully designed quality indicators that accurately reflect the quality of care. Many different measures have been proposed and continue to be developed by governmental agencies and accrediting bodies. However, given the inherent differences in the delivery of care among medical specialties, the same indicators will not be valid across all of them. Specifically, oncology is a field in which it can be difficult to develop quality indicators, because the effectiveness of an oncologic intervention is often not immediately apparent, and the multidisciplinary nature of the field necessarily involves many different specialties. Existing and emerging comparative effectiveness data are helping to guide evidence-based practice, and the increasing availability of these data provides the opportunity to identify key structure and process measures that predict for quality outcomes. The increasing emphasis on quality and efficiency will continue to compel the medical profession to identify appropriate quality measures to facilitate quality improvement efforts and to guide accreditation, credentialing, and reimbursement. Given the wide-reaching implications of quality metrics, it is essential that they be developed and implemented with scientific rigor. The aims of the present report were to review the current state of quality assessment in oncology, identify existing indicators with the best evidence to support their implementation, and propose a framework for identifying and refining measures most indicative of true quality in oncologic care.

  6. Quality Assessment in Oncology

    Energy Technology Data Exchange (ETDEWEB)

    Albert, Jeffrey M. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Das, Prajnan, E-mail: prajdas@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2012-07-01

    The movement to improve healthcare quality has led to a need for carefully designed quality indicators that accurately reflect the quality of care. Many different measures have been proposed and continue to be developed by governmental agencies and accrediting bodies. However, given the inherent differences in the delivery of care among medical specialties, the same indicators will not be valid across all of them. Specifically, oncology is a field in which it can be difficult to develop quality indicators, because the effectiveness of an oncologic intervention is often not immediately apparent, and the multidisciplinary nature of the field necessarily involves many different specialties. Existing and emerging comparative effectiveness data are helping to guide evidence-based practice, and the increasing availability of these data provides the opportunity to identify key structure and process measures that predict for quality outcomes. The increasing emphasis on quality and efficiency will continue to compel the medical profession to identify appropriate quality measures to facilitate quality improvement efforts and to guide accreditation, credentialing, and reimbursement. Given the wide-reaching implications of quality metrics, it is essential that they be developed and implemented with scientific rigor. The aims of the present report were to review the current state of quality assessment in oncology, identify existing indicators with the best evidence to support their implementation, and propose a framework for identifying and refining measures most indicative of true quality in oncologic care.

  7. Evidence-Based Dentistry in Everyday Practice.

    Science.gov (United States)

    Gudray, Kiran; Walmsley, Anthony Damien

    2016-12-01

    This article informs readers of a method of implementing evidence-based dentistry in practice. Following these steps, practitioners should be able to use this skill in an efficient manner. The importance of evidence-based dentistry and its relevance to situations encountered in everyday practice is also highlighted. Clinical relevance: This article highlights a series of steps to be followed by practitioners to ensure that treatment provided is supported by the most recent, good quality evidence.

  8. High-Quality Ultra-Compact Grid Layout of Grouped Networks.

    Science.gov (United States)

    Yoghourdjian, Vahan; Dwyer, Tim; Gange, Graeme; Kieffer, Steve; Klein, Karsten; Marriott, Kim

    2016-01-01

    Prior research into network layout has focused on fast heuristic techniques for layout of large networks, or complex multi-stage pipelines for higher quality layout of small graphs. Improvements to these pipeline techniques, especially for orthogonal-style layout, are difficult and practical results have been slight in recent years. Yet, as discussed in this paper, there remain significant issues in the quality of the layouts produced by these techniques, even for quite small networks. This is especially true when layout with additional grouping constraints is required. The first contribution of this paper is to investigate an ultra-compact, grid-like network layout aesthetic that is motivated by the grid arrangements that are used almost universally by designers in typographical layout. Since the time when these heuristic and pipeline-based graph-layout methods were conceived, generic technologies (MIP, CP and SAT) for solving combinatorial and mixed-integer optimization problems have improved massively. The second contribution of this paper is to reassess whether these techniques can be used for high-quality layout of small graphs. While they are fast enough for graphs of up to 50 nodes we found these methods do not scale up. Our third contribution is a large-neighborhood search meta-heuristic approach that is scalable to larger networks.

  9. How dietary evidence for the prevention and treatment of CVD is translated into practice in those with or at high risk of CVD: a systematic review.

    Science.gov (United States)

    Schumacher, Tracy L; Burrows, Tracy L; Neubeck, Lis; Redfern, Julie; Callister, Robin; Collins, Clare E

    2017-01-01

    CVD is a leading cause of mortality and morbidity, and nutrition is an important lifestyle factor. The aim of the present systematic review was to synthesise the literature relating to knowledge translation (KT) of dietary evidence for the prevention and treatment of CVD into practice in populations with or at high risk of CVD. A systematic search of six electronic databases (CINAHL, Cochrane, EMBASE, MEDLINE, PsycINFO and Scopus) was performed. Studies were included if a nutrition or dietary KT was demonstrated to occur with a relevant separate measureable outcome. Quality was assessed using a tool adapted from two quality checklists. Population with or at high risk of CVD or clinicians likely to treat this population. A total of 4420 titles and abstracts were screened for inclusion, with 354 full texts retrieved to assess inclusion. Forty-three articles were included in the review, relating to thirty-five separate studies. No studies specifically stated their aim to be KT. Thirty-one studies were in patient or high-risk populations and four targeted health professionals. Few studies stated a theory on which the intervention was based (n 10) and provision of instruction was the most common behaviour change strategy used (n 26). KT in nutrition and dietary studies has been inferred, not stated, with few details provided regarding how dietary knowledge is translated to the end user. This presents challenges for implementation by clinicians and policy and decision makers. Consequently a need exists to improve the quality of publications in this area.

  10. High Quality RNA Isolation from Leaf, Shell, Root Tissues and Callus of Hazelnut (Corylus avellana L.

    Directory of Open Access Journals (Sweden)

    Hossein Khosravi

    2017-12-01

    Full Text Available Extraction of high quality RNA is a critical step in molecular genetics studies. Hazelnut is one of the most important nuts plants in the world. The presence of the taxol and other taxanes in hazelnut plant necessitates explaining their biosynthesis pathway and identifying the candidate genes. Therefore, an easy and practical method is necessary for RNA extraction from hazelnuts. Hazelnut has high levels of phenolic compounds. High amounts of polyphenolic and polysaccharide compounds in plants could be causing problems in RNA extraction procedures.  To avoid these problems, a simple and efficient method can be used based on cetyltrimethylammonium bromide (CTAB extraction buffer and lithium chloride for extraction of high quality RNA from different parts of hazelnut plant. Using this method, a high-quality RNA sample (light absorbed in the A260/A280 was 2.04

  11. Determining the Measurement Quality of a Montessori High School Teacher Evaluation Survey

    Directory of Open Access Journals (Sweden)

    Anthony Philip Setari

    2017-05-01

    Full Text Available The purpose of this study was to conduct a psychometric validation of a course evaluation instrument, known as a student evaluation of teaching (SET, implemented in a Montessori high school. The authors demonstrate to the Montessori community how to rigorously examine the measurement and assessment quality of instruments used within Montessori schools. The Montessori high school community needs an SET that has been rigorously examined for measurement issues. The examined SET was developed by a Montessori high school, and the sample data were collected from Montessori high school students. Using a Rasch partial credit model, the results of the analysis identified several measurement issues, including multidimensionality, misfit items, and inappropriate item difficulty levels. A revised version of the SET underwent the same analysis procedure, and the results indicated that measurement issues persisted. The authors suggest several ways to improve the overall measurement quality of the instrument while keeping the Montessori foundation. Additional validation studies with a revised version of the SET will be needed before the instrument can be endorsed for full implementation in a Montessori setting.

  12. Recommendations for improving the quality of reporting clinical electrochemotherapy studies based on qualitative systematic review

    DEFF Research Database (Denmark)

    Campana, LG; Clover, AJ; Valpione, S

    2016-01-01

    Electrochemotherapy is becoming a well-established treatment for malignancies of skin and non-skin origin and its use is widening across Europe. The technique was developed and optimized from solid experimental and clinical evidence. A consensus document is now warranted to formalize reporting re...... studies and to provide the recommendations for reporting clinical trials on electrochemotherapy....... results, which should strengthen evidence-based practice recommendations. This consensus should be derived from high quality clinical data collection, clinical expertise and summarizing patient feedback. The first step, which is addressed in this paper, aims to critically analyze the quality of published...

  13. Evidence acquisition and evaluation for evidence summit on enhancing provision and use of maternal health services through financial incentives.

    Science.gov (United States)

    Higgs, Elizabeth S; Stammer, Emily; Roth, Rebecca; Balster, Robert L

    2013-12-01

    Recognizing the need for evidence to inform US Government and governments of the low- and middle-income countries on efficient, effective maternal health policies, strategies, and programmes, the US Government convened the Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives in April 2012 in Washington, DC, USA. This paper summarizes the background and methods for the acquisition and evaluation of the evidence used for achieving the goals of the Summit. The goal of the Summit was to obtain multidisciplinary expert review of literature to inform both US Government and governments of the low- and middle-income countries on evidence-informed practice, policies, and strategies for financial incentives. Several steps were undertaken to define the tasks for the Summit and identify the appropriate evidence for review. The process began by identifying focal questions intended to inform governments of the low-and middle-income countries and the US Government about the efficacy of supply- and demand-side financial incentives for enhanced provision and use of quality maternal health services. Experts were selected representing the research and programme communities, academia, relevant non-governmental organizations, and government agencies and were assembled into Evidence Review Teams. This was followed by a systematic process to gather relevant peer-reviewed literature that would inform the focal questions. Members of the Evidence Review Teams were invited to add relevant papers not identified in the initial literature review to complete the bibliography. The Evidence Review Teams were asked to comply with a specific evaluation framework for recommendations on practice and policy based on both expert opinion and the quality of the data. Details of the search processes and methods used for screening and quality reviews are described.

  14. High quality ion channels recordings on an injection molded polymer chip

    DEFF Research Database (Denmark)

    Tanzi, Simone

    In this thesis we demonstrate high quality recordings of the ion channel activity across the cell membrane in a biological cell by employing the so called patch clamping technique on an injection molded polymer microfluidic device. Such recordings are traditionally made using glass micropipettes,...

  15. History of evidence-based medicine

    Directory of Open Access Journals (Sweden)

    Roger L Sur

    2011-01-01

    Full Text Available This essay reviews the historical circumstances surrounding the introduction and evolution of evidence-based medicine. Criticisms of the approach are also considered. Weaknesses of existing standards of clinical practice and efforts to bring more certainty to clinical decision making were the foundation for evidence-based medicine, which integrates epidemiology and medical research. Because of its utility in designing randomized clinical trials, assessing the quality of the literature, and applying medical research at the bedside, evidence-based medicine will continue to have a strong influence on everyday clinical practice.

  16. “Putting It All Together” to Improve Resuscitation Quality

    Science.gov (United States)

    Sutton, Robert M.; Nadkarni, Vinay; Abella, Benjamin S.

    2013-01-01

    Cardiac arrest is a major public health problem affecting thousands of individuals each year in both the before hospital and in-hospital settings. However, although the scope of the problem is large, the quality of care provided during resuscitation attempts frequently does not meet quality of care standards, despite evidence-based cardiopulmonary resuscitation (CPR) guidelines, extensive provider training, and provider credentialing in resuscitation medicine. Although this fact may be disappointing, it should not be surprising. Resuscitation of the cardiac arrest victim is a highly complex task requiring coordination between various levels and disciplines of care providers during a stressful and relatively infrequent clinical situation. Moreover, it requires a targeted, high-quality response to improve clinical outcomes of patients. Therefore, solutions to improve care provided during resuscitation attempts must be multifaceted and targeted to the diverse number of care providers to be successful. PMID:22107978

  17. Neglecting rice milling yield and quality underestimates economic losses from high-temperature stress.

    Directory of Open Access Journals (Sweden)

    Nathaniel B Lyman

    Full Text Available Future increases in global surface temperature threaten those worldwide who depend on rice production for their livelihoods and food security. Past analyses of high-temperature stress on rice production have focused on paddy yield and have failed to account for the detrimental impact of high temperatures on milling quality outcomes, which ultimately determine edible (marketable rice yield and market value. Using genotype specific rice yield and milling quality data on six common rice varieties from Arkansas, USA, combined with on-site, half-hourly and daily temperature observations, we show a nonlinear effect of high-temperature stress exposure on yield and milling quality. A 1 °C increase in average growing season temperature reduces paddy yield by 6.2%, total milled rice yield by 7.1% to 8.0%, head rice yield by 9.0% to 13.8%, and total milling revenue by 8.1% to 11.0%, across genotypes. Our results indicate that failure to account for changes in milling quality leads to understatement of the impacts of high temperatures on rice production outcomes. These dramatic losses result from reduced paddy yield and increased percentages of chalky and broken kernels, which together decrease the quantity and market value of milled rice. Recently published estimates show paddy yield reductions of up to 10% across the major rice-producing regions of South and Southeast Asia due to rising temperatures. The results of our study suggest that the often-cited 10% figure underestimates the economic implications of climate change for rice producers, thus potentially threatening future food security for global rice producers and consumers.

  18. Autologous Matrix-Induced Chondrogenesis: A Systematic Review of the Clinical Evidence.

    Science.gov (United States)

    Gao, Liang; Orth, Patrick; Cucchiarini, Magali; Madry, Henning

    2017-11-01

    The addition of a type I/III collagen membrane in cartilage defects treated with microfracture has been advocated for cartilage repair, termed "autologous matrix-induced chondrogenesis" (AMIC). To examine the current clinical evidence regarding AMIC for focal chondral defects. Systematic review. A systematic review was performed by searching PubMed, ScienceDirect, and Cochrane Library databases. Inclusion criteria were clinical studies of AMIC for articular cartilage repair, written in English. Relative data were extracted and critically analyzed. PRISMA guidelines were applied, the methodological quality of the included studies was assessed by the modified Coleman Methodology Score (CMS), and aggregate data were generated. Twenty-eight clinical articles were included: 12 studies (245 patients) of knee cartilage defects, 12 studies (214 patients) of ankle cartilage defects, and 4 studies (308 patients) of hip cartilage defects. The CMS demonstrated a suboptimal study design in the majority of published studies (knee, 57.8; ankle, 55.3; hip, 57.7). For the knee, 1 study reported significant clinical improvements for AMIC compared with microfracture for medium-sized cartilage defects (mean defect size 3.6 cm 2 ) after 5 years (level of evidence, 1). No study compared AMIC with matrix-assisted autologous chondrocyte implantation (ACI) in the knee. For the ankle, no clinical trial was available comparing AMIC versus microfracture or ACI. In the hip, only one analysis (level of evidence, 3) compared AMIC with microfracture for acetabular lesions. For medium-sized acetabular defects, one study (level of evidence, 3) found no significant differences between AMIC and ACI at 5 years. Specific aspects not appropriately discussed in the currently available literature include patient-related factors, membrane fixation, and defect properties. No treatment-related adverse events were reported. This systematic review reveals a paucity of high-quality, randomized controlled

  19. Evidence supporting the use of cone-beam computed tomography in orthodontics.

    Science.gov (United States)

    van Vlijmen, Olivier J C; Kuijpers, Mette A R; Bergé, Stefaan J; Schols, Jan G J H; Maal, Thomas J J; Breuning, Hero; Kuijpers-Jagtman, Anne Marie

    2012-03-01

    The authors conducted a systematic review of cone-beam computed tomography (CBCT) applications in orthodontics and evaluated the level of evidence to determine whether the use of CBCT is justified in orthodontics. The authors identified articles by searching the Cochrane Library, PubMed, MEDLINE, Embase, Scopus and Cumulative Index to Nursing and Allied Health Literature databases. They searched the articles' reference lists manually for additional articles and had no language limitations. They did not search the gray literature. Inclusion criteria were CBCT use in orthodontics and that the participants be human. The lowest level of evidence accepted for inclusion was a case series with five or more participants. The authors evaluated the studies' methodological quality according to 13 criteria related to study design, measurements and statistical analysis. The authors identified 550 articles, and 50 met the inclusion criteria. Study topics included temporary anchorage devices, cephalometry, combined orthodontic and surgical treatment, airway measurements, root resorption and tooth impactions, and cleft lip and palate. The methodological quality averaged 53 percent (range, 15-77 percent) of the maximum score. The authors found no high-quality evidence regarding the benefits of CBCT use in orthodontics. Limited evidence shows that CBCT offers better diagnostic potential, leads to better treatment planning or results in better treatment outcome than do conventional imaging modalities. Only the results of studies on airway diagnostics provided sound scientific data suggesting that CBCT use has added value. The additional radiation exposure should be weighed against possible benefits of CBCT, which have not been supported in the literature. In future studies, investigators should evaluate the effects of CBCT on treatment procedures, progression and outcome quantitatively.

  20. High quality atomically thin PtSe2 films grown by molecular beam epitaxy

    Science.gov (United States)

    Yan, Mingzhe; Wang, Eryin; Zhou, Xue; Zhang, Guangqi; Zhang, Hongyun; Zhang, Kenan; Yao, Wei; Lu, Nianpeng; Yang, Shuzhen; Wu, Shilong; Yoshikawa, Tomoki; Miyamoto, Koji; Okuda, Taichi; Wu, Yang; Yu, Pu; Duan, Wenhui; Zhou, Shuyun

    2017-12-01

    Atomically thin PtSe2 films have attracted extensive research interests for potential applications in high-speed electronics, spintronics and photodetectors. Obtaining high quality thin films with large size and controlled thickness is critical. Here we report the first successful epitaxial growth of high quality PtSe2 films by molecular beam epitaxy. Atomically thin films from 1 ML to 22 ML have been grown and characterized by low-energy electron diffraction, Raman spectroscopy and x-ray photoemission spectroscopy. Moreover, a systematic thickness dependent study of the electronic structure is revealed by angle-resolved photoemission spectroscopy (ARPES), and helical spin texture is revealed by spin-ARPES. Our work provides new opportunities for growing large size single crystalline films to investigate the physical properties and potential applications of PtSe2.