WorldWideScience

Sample records for modeling continuous improvement

  1. A Continuous Improvement Capital Funding Model.

    Science.gov (United States)

    Adams, Matt

    2001-01-01

    Describes a capital funding model that helps assess facility renewal needs in a way that minimizes resources while maximizing results. The article explains the sub-components of a continuous improvement capital funding model, including budgeting processes for finish renewal, building performance renewal, and critical outcome. (GR)

  2. A model of continuous quality improvement for health service organisations.

    Science.gov (United States)

    Thornber, M

    1992-01-01

    Continuous Quality Improvement (or Total Quality Management) is an approach to management originally used in manufacturing and now being applied in the health services. This article describes a model of Continuous Quality Improvement which has been used in NSW public and private hospitals. The model consists of Ten Key Elements. The first driving force of this model is 'defining quality in terms of customer expectations' of quality. The second driving force emphasises that 'quality improvement is a leadership issue'. Leaders are required to: coordinate staff participation in work process analysis; train staff in the customer service orientation; lead effective meetings and negotiate with both internal and external service partners. Increased staff motivation, quality improvement and reduction in running costs are seen to be the benefits of CQI for health service organisations.

  3. Promoting Continuous Quality Improvement in Online Teaching: The META Model

    Science.gov (United States)

    Dittmar, Eileen; McCracken, Holly

    2012-01-01

    Experienced e-learning faculty members share strategies for implementing a comprehensive postsecondary faculty development program essential to continuous improvement of instructional skills. The high-impact META Model (centered around Mentoring, Engagement, Technology, and Assessment) promotes information sharing and content creation, and fosters…

  4. The Continuous Improvement Model: A K-12 Literacy Focus

    Science.gov (United States)

    Brown, Jennifer V.

    2013-01-01

    The purpose of the study was to determine if the eight steps of the Continuous Improvement Model (CIM) provided a framework to raise achievement and to focus educators in identifying high-yield literacy strategies. This study sought to determine if an examination of the assessment data in reading revealed differences among schools that fully,…

  5. Modelling the Role of Human Resource Management in Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Hyland, Paul; Kofoed, Lise B.

    2006-01-01

    Although it is widely acknowledged that both Human Resource Management (HRM) and Continuous Improvement have the potential to positively influencing organizational performance, very little attention has been given to how certain HRM practices may support CI, and consequently, a company's performa......Although it is widely acknowledged that both Human Resource Management (HRM) and Continuous Improvement have the potential to positively influencing organizational performance, very little attention has been given to how certain HRM practices may support CI, and consequently, a company...... of the paper is theoretical in nature, as the model developed provides a greater understanding of how HRM can contribute to CI; however, the model also has practical value in that it suggests important relationships between various HRM practices and the behaviors necessary for successful CI. The paper...

  6. Continual improvement plan

    Science.gov (United States)

    1994-01-01

    NASA's approach to continual improvement (CI) is a systems-oriented, agency-wide approach that builds on the past accomplishments of NASA Headquarters and its field installations and helps achieve NASA's vision, mission, and values. The NASA of the future will fully use the principles of continual improvement in every aspect of its operations. This NASA CI plan defines a systematic approach and a model for continual improvement throughout NASA, stressing systems integration and optimization. It demonstrates NASA's constancy of purpose for improvement - a consistent vision of NASA as a worldwide leader in top-quality science, technology, and management practices. The CI plan provides the rationale, structures, methods, and steps, and it defines NASA's short term (1-year) objectives for improvement. The CI plan presents the deployment strategies necessary for cascading the goals and objectives throughout the agency. It also provides guidance on implementing continual improvement with participation from top leadership and all levels of employees.

  7. With Scale in Mind: A Continuous Improvement Model for Implementation

    Science.gov (United States)

    Redding, Christopher; Cannata, Marisa; Taylor Haynes, Katherine

    2017-01-01

    The conventional approach to scaling up educational reforms considers the development and testing phases to be distinct from the work of implementing at scale. Decades of research suggest that this approach yields inconsistent and often disappointing improvements for schools most in need. More recent scholarship on scaling school improvement…

  8. Toward Continuous Program Improvement: Using a Logic Model for Professional Development School Program Evaluation

    Science.gov (United States)

    He, Ye; Rohr, Jean; Miller, Samuel D.; Levin, Barbara B.; Mercier, Susan

    2010-01-01

    The purpose of this study was to develop a model for evaluating a professional development school program to enact an evidence-based model for a continuous cycle of program improvement. Guided by the logic model for program evaluation, we developed three survey instruments based on the professional development school standards of the National…

  9. Continuous Personal Improvement.

    Science.gov (United States)

    Emiliani, M. L.

    1998-01-01

    Suggests that continuous improvement tools used in the workplace can be applied to self-improvement. Explains the use of such techniques as one-piece flow, kanban, visual controls, and total productive maintenance. Points out misapplications of these tools and describes the use of fishbone diagrams to diagnose problems. (SK)

  10. Continuous quality improvement

    International Nuclear Information System (INIS)

    Bourne, P.B.

    1985-01-01

    This paper describes the various statistical tools used at the Hanford Engineering Development Laboratory to achieve continuous quality improvement in the development of Breeder Reactor Technology and in reactor operations. The role of the quality assurance professionals in this process, including quantifiable measurements using actual examples, is provided. The commitment to quality improvement through top management involvement is dramatically illustrated

  11. Regularised Model Identification Improves Accuracy of Multisensor Systems for Noninvasive Continuous Glucose Monitoring in Diabetes Management

    Directory of Open Access Journals (Sweden)

    Mattia Zanon

    2013-01-01

    Full Text Available Continuous glucose monitoring (CGM by suitable portable sensors plays a central role in the treatment of diabetes, a disease currently affecting more than 350 million people worldwide. Noninvasive CGM (NI-CGM, in particular, is appealing for reasons related to patient comfort (no needles are used but challenging. NI-CGM prototypes exploiting multisensor approaches have been recently proposed to deal with physiological and environmental disturbances. In these prototypes, signals measured noninvasively (e.g., skin impedance, temperature, optical skin properties, etc. are combined through a static multivariate linear model for estimating glucose levels. In this work, by exploiting a dataset of 45 experimental sessions acquired in diabetic subjects, we show that regularisation-based techniques for the identification of the model, such as the least absolute shrinkage and selection operator (better known as LASSO, Ridge regression, and Elastic-Net regression, improve the accuracy of glucose estimates with respect to techniques, such as partial least squares regression, previously used in the literature. More specifically, the Elastic-Net model (i.e., the model identified using a combination of and norms has the best results, according to the metrics widely accepted in the diabetes community. This model represents an important incremental step toward the development of NI-CGM devices effectively usable by patients.

  12. Organizational climate survey: management model tool on continuous improvement promotion in Finantial Institutional Environment

    Directory of Open Access Journals (Sweden)

    Alex Amancio da Silva

    2016-06-01

    Full Text Available The organizational climate survey has been an important tool in the corporate world, the way in which the institutions can assess and ascertain through the results, the degree of satisfaction of its employees and look through plan of action, achieve better results in both performance and production. Through an empirical research, exploratory qualitative research, with collection of secondary data, it was found that the implementation of the organizational climate survey, "Speak Frankly" from Itaú Unibanco, it could analyze data and make a plan of effective action aiming at continuous improvement in the organizational environment, serving as personnel management model. The results were favorable in the period from year 2012 to 2014 with an increase of the degree of satisfaction in four 4% and maintained excellent adherence to answer questions reaching 90% the number of employees.

  13. A Knowledge Tree Model and Its Application for Continuous Management Improvement

    Science.gov (United States)

    Lu, Yun; Bao, Zhen-Qiang; Zhao, Yu-Qin; Wang, Yan; Wang, Gui-Jun

    This chapter analyzes the relationship of organizational knowledge and brings forward that organizational knowledge consists of three layers: core knowledge, structural knowledge, and implicit knowledge. According to the principle of knowledge maps, a dynamic management model of organizational knowledge based on knowledge tree is introduced and the definition of the value of knowledge node is given so that the quantitative management on knowledge is realized, which lays a foundation for performance evaluation of knowledge management. We also carefully study the application of knowledge tree in service quality management of hospital organizations and management innovation process and give the example of cooperation in endoscopic surgery to establish a knowledge tree about operational cooperation degree, which states the principle of organizational knowledge management and the knowledge innovation process of continuous management improvement.

  14. Using continuous time stochastic modelling and nonparametric statistics to improve the quality of first principles models

    DEFF Research Database (Denmark)

    A methodology is presented that combines modelling based on first principles and data based modelling into a modelling cycle that facilitates fast decision-making based on statistical methods. A strong feature of this methodology is that given a first principles model along with process data......, the corresponding modelling cycle model of the given system for a given purpose. A computer-aided tool, which integrates the elements of the modelling cycle, is also presented, and an example is given of modelling a fed-batch bioreactor....

  15. Continuing Professional Development for doctors, certification, licensure and quality improvement. A model to follow?

    Directory of Open Access Journals (Sweden)

    Alejandro Aparicio

    2015-01-01

    The article concludes with a reference to the research evidence in support of the effectiveness of CME/CPD and the impact that Continuous Quality Improvement and Performance Improvement have had on CME/CPD, on the new program to maintain specialty certification and on the proposed new licensure framework, and how they all interact.

  16. KAIZEN CONTINUOUS IMPROVEMENT

    OpenAIRE

    Yenque D., Julio; García P., Manuel; Raez G., Luis

    2014-01-01

    Many times we ask the question why Japanese companies are competitive?, Surely many of the answers to this mystery have support in the Kaizen. And the Kaizen is not a simple concept, it is a whole way of life that involves both managers and workers in the pursuit of progressive improvement of enterprises. In his book Kaizen, The Key to Japanese Competitive Advantage, Masaaki Imai explains in simple terms what is the essence of this philosophy: Kaizen means improvement means further progressiv...

  17. Implementing a Course Review Process for a Continuous Quality Improvement Model for a Medical School Curriculum.

    Science.gov (United States)

    Ward, Cassandra S; Andrade, Amy; Walker-Winfree, Lena

    2018-01-01

    In 1901, Abraham Flexner, a research scholar at the Carnegie Foundation for the Advancement of Teaching, visited 155 medical schools in the United States and Canada to assess medical education. Flexner's recommendations became the foundation for the Liaison Committee on Medical Education accreditation, a voluntary, peer-reviewed quality assurance process to determine whether a medical education program meets established standards. The Meharry Medical College School of Medicine, a historically Black college/university (HBCU) established the Office of Curriculum Evaluation and Effectiveness in 2013 to ensure the consistent monitoring of the medical education program's compliance with accreditation standards. The motto and logo, LCME 24/7, highlight the school's emphasis on meeting accreditation standards. The school uses the 1994 Plan-Do-Study-Act Cycle for Learning and Improvement for continuous review of course content, outcomes, and evaluations. This process identifies strengths, challenges, and opportunities for innovative steps for continuous quality improvements to the curriculum.

  18. Partnership for Continuous Improvement

    Science.gov (United States)

    1990-01-01

    The proceedings are presented of the sixth annual conference on quality control between NASA and its contractors. The emphasis is placed on a commitment to quality and excellence that guarantees mission success. A forum is provided for representatives from government, industry, and academia to exchange ideas and experiences, encouraging total quality performance that results in high quality products and services. Key points are highlighted from the presentations and activities are described that have resulted in a broad range of improvements in products and services from government, industry, and academia. Long term commitment to quality is an essential requirement that ensures future success. That commitment reinterates the dedication to excellence in space exploration and to national quality and productivity improvement.

  19. Continuous improvement for the firm's competitiveness: implementation of a new management model

    Directory of Open Access Journals (Sweden)

    Rabia Azzemou

    2018-01-01

    Full Text Available To get ready for the hard international competition, firms have to convince themselves of the pressing necessity of optimizing its competitiveness factors. In this perspective, this article proposes a general model of management system of firms through the implementation of tools of Lean Manu-facturing. This method establishes an approach to introduce an action plan to improve the perfor-mance of a firm. Knowing that the Algerian firms do not escape the constraints of competitiveness, the adopted model is applied to two strategic firms of the Algerian industry and the final result gives a series of measures to improve their competitiveness and their performances, simultaneously.

  20. A Quality Framework for Continuous Improvement of e-Learning: The e-Learning Maturity Model

    Science.gov (United States)

    Marshall, Stephen

    2010-01-01

    The E-Learning Maturity Model (eMM) is a quality improvement framework designed to help institutional leaders assess their institution's e-learning maturity. This paper reviews the eMM, drawing on examples of assessments conducted in New Zealand, Australia, the UK and the USA to show how it helps institutional leaders assess and compare their…

  1. Perspectives: The Continuous Improvement Trap

    Science.gov (United States)

    Arnold, David L.

    2011-01-01

    Accrediting agencies, legislators, pundits, and even higher educational professionals have become enamored with applying the language of continuous improvement to learning outcomes. The Southern Association of Colleges and Schools Commission on Colleges specifically uses the term "continuing improvement" in Core Standard 2.5, one of its…

  2. A Model of Continuous Improvement in High Schools: A Process for Research, Innovation Design, Implementation, and Scale

    Science.gov (United States)

    Cohen-Vogel, Lora; Cannata, Marisa; Rutledge, Stacey A.; Socol, Allison Rose

    2016-01-01

    This chapter describes a model for continuous improvement that guides the work of the National Center on Scaling Up Effective Schools, or NCSU. NCSU is a research and development center funded by the Institute for Education Sciences, the research arm of the United States Department of Education. At the core of the Center's work is an innovative…

  3. Integrating Quality Improvement and Continuing Professional Development: A Model From the Mental Health Care System.

    Science.gov (United States)

    Sockalingam, Sanjeev; Tehrani, Hedieh; Lin, Elizabeth; Lieff, Susan; Harris, Ilene; Soklaridis, Sophie

    2016-04-01

    To explore the perspectives of leaders in psychiatry and continuing professional development (CPD) regarding the relationship, opportunities, and challenges in integrating quality improvement (QI) and CPD. In 2013-2014, the authors interviewed 18 participants in Canada: 10 psychiatrists-in-chief, 6 CPD leaders in psychiatry, and 2 individuals with experience integrating these domains in psychiatry who were identified through snowball sampling. Questions were designed to identify participants' perspectives about the definition, relationship, and integration of QI and CPD in psychiatry. Interviews were recorded and transcribed. An iterative, inductive method was used to thematically analyze the transcripts. To ensure the rigor of the analysis, the authors performed member checking and sampling until theoretical saturation was achieved. Participants defined QI as a concept measured at the individual, hospital, and health care system levels and CPD as a concept measured predominantly at the individual and hospital levels. Four themes related to the relationship between QI and CPD were identified: challenges with QI training, adoption of QI into the mental health care system, implementation of QI in CPD, and practice improvement outcomes. Despite participants describing QI and CPD as mutually beneficial, they expressed uncertainty about the appropriateness of aligning these domains within a mental health care context because of the identified challenges. This study identified challenges with aligning QI and CPD in psychiatry and yielded a framework to inform future integration efforts. Further research is needed to determine the generalizability of this framework to other specialties and health care professions.

  4. Exemplary Care and Learning Sites: A Model for Achieving Continual Improvement in Care and Learning in the Clinical Setting.

    Science.gov (United States)

    Headrick, Linda A; Ogrinc, Greg; Hoffman, Kimberly G; Stevenson, Katherine M; Shalaby, Marc; Beard, Albertine S; Thörne, Karin E; Coleman, Mary T; Baum, Karyn D

    2016-03-01

    Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting. From 2008-2012, an iterative, interactive process was used to develop the ECLS model and its core elements--patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012-2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site's ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden). Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites. The next test of the model should be prospective, linked to clinical and educational outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development.

  5. Improving catchment scale water quality modelling with continuous high resolution monitoring of metals in runoff

    Science.gov (United States)

    Saari, Markus; Rossi, Pekka; Blomberg von der Geest, Kalle; Mäkinen, Ari; Postila, Heini; Marttila, Hannu

    2017-04-01

    High metal concentrations in natural waters is one of the key environmental and health problems globally. Continuous in-situ analysis of metals from runoff water is technically challenging but essential for the better understanding of processes which lead to pollutant transport. Currently, typical analytical methods for monitoring elements in liquids are off-line laboratory methods such as ICP-OES (Inductively Coupled Plasma Optical Emission Spectroscopy) and ICP-MS (ICP combined with a mass spectrometer). Disadvantage of the both techniques is time consuming sample collection, preparation, and off-line analysis at laboratory conditions. Thus use of these techniques lack possibility for real-time monitoring of element transport. We combined a novel high resolution on-line metal concentration monitoring with catchment scale physical hydrological modelling in Mustijoki river in Southern Finland in order to study dynamics of processes and form a predictive warning system for leaching of metals. A novel on-line measurement technique based on micro plasma emission spectroscopy (MPES) is tested for on-line detection of selected elements (e.g. Na, Mg, Al, K, Ca, Fe, Ni, Cu, Cd and Pb) in runoff waters. The preliminary results indicate that MPES can sufficiently detect and monitor metal concentrations from river water. Water and Soil Assessment Tool (SWAT) catchment scale model was further calibrated with high resolution metal concentration data. We show that by combining high resolution monitoring and catchment scale physical based modelling, further process studies and creation of early warning systems, for example to optimization of drinking water uptake from rivers, can be achieved.

  6. Improvement in latent variable indirect response joint modeling of a continuous and a categorical clinical endpoint in rheumatoid arthritis.

    Science.gov (United States)

    Hu, Chuanpu; Zhou, Honghui

    2016-02-01

    Improving the quality of exposure-response modeling is important in clinical drug development. The general joint modeling of multiple endpoints is made possible in part by recent progress on the latent variable indirect response (IDR) modeling for ordered categorical endpoints. This manuscript aims to investigate, when modeling a continuous and a categorical clinical endpoint, the level of improvement achievable by joint modeling in the latent variable IDR modeling framework through the sharing of model parameters for the individual endpoints, guided by the appropriate representation of drug and placebo mechanism. This was illustrated with data from two phase III clinical trials of intravenously administered mAb X for the treatment of rheumatoid arthritis, with the 28-joint disease activity score (DAS28) and 20, 50, and 70% improvement in the American College of Rheumatology (ACR20, ACR50, and ACR70) disease severity criteria were used as efficacy endpoints. The joint modeling framework led to a parsimonious final model with reasonable performance, evaluated by visual predictive check. The results showed that, compared with the more common approach of separately modeling the endpoints, it is possible for the joint model to be more parsimonious and yet better describe the individual endpoints. In particular, the joint model may better describe one endpoint through subject-specific random effects that would not have been estimable from data of this endpoint alone.

  7. [AMD Annals: a model of continuous monitoring and improvement of the quality of diabetes care].

    Science.gov (United States)

    2011-01-01

    in recent years, several initiatives have been launched by the Associazione medici diabetologi (AMD) in the context of a national quality improvement program.These activities include: identification of specific indicators of quality of diabetes care, development of a software to calculate such indicators by using routine clinical data, creation of a network of diabetes clinics and analysis and publication of the results in ad hoc reports (AMD Annals). Through the best performer approach, each centre could compare its own performance not only with the theoretical targets suggested by existing guidelines, but also with the results achieved by the best centres operating within the same healthcare system.We evaluated whether the involvement of diabetes clinics into the AMD Annals initiative improved the quality of care over 4 years. a controlled before and after study was performed to compare data collected from 2004 to 2007 by two groups of centres: group A included centres that had been involved in the project since the first edition of AMD Annals; group B included centres only involved in the last edition. overall, 124 diabetes clinics provided data on over 100,000 type 2 diabetes patients/year seen from 2004 to 2007. process indicators included the proportion of patients with at least one measurement of HbA1c, blood pressure and lipid profile during the previous 12 months. Intermediate outcomes included percentages of patients with levels of HbA1c ≤ 7%, blood pressure ≤ 130/85 mmHg and LDL-cholesterol Annals approach can be considered as a case model for quality improvement activities in chronic diseases and a tool to evaluate the level of adoption/acceptance of guidelines in clinical practice. The considerable success documented was obtained without allocation of extra resources or financial incentives but simply through a physician-led effort made possible by the commitment of the specialists involved.

  8. Sustaining motivation for continuous improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Kofoed, Lise Busk

    2007-01-01

    The objective of this article is to explore possibilities for improving motivation for participation in Continuous Improvement (CI). Due to a number of issues, for example, challenges with measuring outcomes of CI activities on performance, the inherent slower, incremental rather than big bang...

  9. ARE WE A LEARNING ORGANISATION? AN ASSESSMENT MODEL FOR CONTINUOUS IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    C.C. Van Waveren

    2012-01-01

    Full Text Available

    ENGLISH ABSTRACT: It is generally agreed that one way for organisations to be competitive in the new global economy is by embracing the principles of Peter Senge’s “The Fifth Discipline” and becoming “learning organisations”. The literature on the nature of learning organisations is extensive, but few of the discussions break through the philosophical barrier and actually address practical ways in which organisations can move away from traditional organisation thinking models and become learning organisations. This paper discusses a 9-S framework and an accompanying measurement model that can be used by organisations to determine whether they are learning organisations, and if not, where and how they need to improve. The framework is based on the Hitt 8-S framework, and the measurement model takes the form of a series of weighted questions and results that graphically represent how successful an organisation has been in its quest to become a learning organisation. A practical implementation of the measurement model that focuses on the planning aspect of organisational management is included in the paper.

    AFRIKAANSE OPSOMMING: Vir ’n organisasie om kompeterend in ’n wereldekonomie te wees, word daar algemeen aanvaar dat die organisasie sekere leergerigtheidseienskappe moet bemeester soos beskryf in Peter Senge se boek “The Fifth Discipline”. Omvattende literatuur oor die leergerigtheidseienskappe van organisasies bestaan, maar daar is egter min inligting oor praktiese maniere om ’n tradisionele organisasie na 'n leergerigtheidsorganisasie oor te skakel. Hierdie artikel bespreek ’n 9-S raamwerk asook ’n gepaardgaande evalueringsmodel wat gebruik kan word om ’n organisasie te meet aan sekere leergerigtheidseienskappe. Die raamwerk is gebaseer op die Hitt 8-S raamwerk en die evalueringsmodel maak gebruik van geweegde vrae waarvan die resultate grafies vertoon word om die sukses van leergerigtheid in die organisasie

  10. Using a predictive model of clinician intention to improve continuing health professional education on cancer survivorship.

    Science.gov (United States)

    Buriak, S E; Potter, J; Bleckley, M Kathryn

    2015-01-01

    Cancer survivorship is a chronic disease that places patients in limbo between oncologists and primary care clinicians. Strategies have been proposed to ease the shift in coordination of care, including broad-based educational outreach to primary care providers. Guided by the theory of planned behavior (TPB), predictors of intention to provide survivorship care, including credentials, experience, perception of barriers, and personal survivorship status, were evaluated using logistic regression with a cohort of physicians, nurse practitioners, and registered nurses participating in an unprecedented online continuing medical education/continuing education survivorship care course. Results showed that physicians were significantly less likely to express intent to provide survivorship care (odds ratio [OR] = .237, p = .0001) compared to the other groups. Overall, clinicians with 6-10 years of experience were 3 times more likely to express intent to provide survivorship care (OR = 2.86, p = .045) than those with less or more experience. When clinicians perceived the presence of a barrier, they were nearly twice as likely to have diminished intent (OR = 1.89, p = .035). Most participants (66%; n = 1185) selected two barriers: lack of survivorship care plans and treatment summaries (45.4%; n = 821) and lack of education (20.1%; n = 364). Barriers to the delivery of survivorship care can influence clinicians' intention to provide survivorship care, which varied by years of experience in this study. Interdisciplinary educational strategies featuring midcareer provider champions who have successfully incorporated survivorship care and can offer specific solutions to these barriers are recommended for future interventions. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

  11. An integrated continuous improvement model of TPM, TPS and TQM for boosting profitability of manufacturing industries: An innovative model & guideline

    Directory of Open Access Journals (Sweden)

    Haftu Hailu

    2018-01-01

    Full Text Available The purpose of this research is to develop an integrated literature based TPM, TPS and TQM mod-el through PDCA cycle, and implementation guideline for the implementation of the model. At this time very few studies are available on this research area, even this research on integrated model of TPM, TPS and TQM practices, and implementation guideline are not corresponding. The method-ology to develop the model and the implementation guideline is based on identifying the uniqueness and common practices of TPM, TPS and TQM systems, existing practice of the integration and implementation guideline, identifying the existing gaps on the model and implementation guideline, developing new integrated TPM, TPS and TQM practice model, and implementation guideline. Previous very few studies of uniqueness, common practices and implementation guideline of the three systems are preserved. The findings of this research, an integrated cutting-edge model of TPM, TPS and TQM practices and implementation guidelines are developed. The originality / value of the developed model and implementation guideline enable manufacturing industries continuously to be competitive and profitable.

  12. An Improved Continuous-Time Model Predictive Control of Permanent Magnetic Synchronous Motors for a Wide-Speed Range

    Directory of Open Access Journals (Sweden)

    Dandan Su

    2017-12-01

    Full Text Available This paper proposes an improved continuous-time model predictive control (CTMPC of permanent magnetic synchronous motors (PMSMs for a wide-speed range, including the constant torque region and the flux-weakening (FW region. In the constant torque region, the mathematic models of PMSMs in dq-axes are decoupled without the limitation of DC-link voltage. However, in the FW region, the mathematic models of PMSMs in dq-axes are cross-coupled together with the limitation of DC-link voltage. A nonlinear PMSMs mathematic model in the FW region is presented based on the voltage angle. The solving of the nonlinear mathematic model of PMSMs in FW region will lead to heavy computation load for digital signal processing (DSP. To overcome such a problem, a linearization method of the voltage angle is also proposed to reduce the computation load. The selection of transiting points between the constant torque region and FW regions is researched to improve the performance of the driven system. Compared with the proportional integral (PI controller, the proposed CTMPC has obvious advantages in dealing with systems’ nonlinear constraints and improving system performance by restraining overshoot current under step torque changing. Both simulation and experimental results confirm the effectiveness of the proposed method in achieving good steady-state performance and smooth switching between the constant torque and FW regions.

  13. Software Maintenance Management Evaluation and Continuous Improvement

    CERN Document Server

    April, Alain

    2008-01-01

    This book explores the domain of software maintenance management and provides road maps for improving software maintenance organizations. It describes full maintenance maturity models organized by levels 1, 2, and 3, which allow for benchmarking and continuous improvement paths. Goals for each key practice area are also provided, and the model presented is fully aligned with the architecture and framework of software development maturity models of CMMI and ISO 15504. It is complete with case studies, figures, tables, and graphs.

  14. Continuous improvement of pump seals

    International Nuclear Information System (INIS)

    Wong, W.; Eyvindson, A.; Rhodes, D.B.

    2003-01-01

    Pump seal reliability continues to be an area needing improvement and ongoing vigilance. Methods have been developed for identifying and assessing factors relating to seal performance, selecting the most relevant ones for a specific station, and then focusing on the most significant aspects and how to improve. Discussion invariably addresses maintenance practices, seal design, monitoring capabilities, operating conditions, transients, and pump and motor design. Success in reliability improvement requires ongoing dialogue among the station operators, pump manufacturers and seal designers. AECL CAN-seals lead the nuclear industry in reliability and seal life. They effectively save operators millions of dollars in outage time and person-rem. This paper describes some of the significant developments in AECL's ongoing program in seal R and D, as well as recent new installations following the most demanding seal qualification programs to date. (author)

  15. An integrated continuous improvement model of TPM, TPS and TQM for boosting profitability of manufacturing industries: An innovative model & guideline

    OpenAIRE

    Haftu Hailu; Solomon Mengstu; Tewedros Hailu

    2018-01-01

    The purpose of this research is to develop an integrated literature based TPM, TPS and TQM mod-el through PDCA cycle, and implementation guideline for the implementation of the model. At this time very few studies are available on this research area, even this research on integrated model of TPM, TPS and TQM practices, and implementation guideline are not corresponding. The method-ology to develop the model and the implementation guideline is based on identifying the uniqueness and common pra...

  16. Continuous Improvement in Schools: Understanding the Practice

    Science.gov (United States)

    Anderson, Stephen; Kumari, Roshni

    2009-01-01

    This article investigates conceptually and practically what it means for schools to engage in the practice of continuous improvement. The analysis draws upon prior research and discussion to predict core elements of the practice of continuous improvement in schools. The predictions are then applied to a case study of continuous improvement efforts…

  17. Human Resource Development's Contribution to Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Hyland, Paul

    2007-01-01

    Continuous Improvement (CI) is an approach to organizational change that requires active involvement of skilled and motivated employees, which implies an important role for HRD practitioners. The findings from a literature review and a survey of 168 Danish manufacturing companies indicate however...... that HRD is rarely integrated with CI. The paper contributes by offering a model that depicts how HR and HRD functions could be exploited to support successful CI development and implementation....

  18. Teamwork, Leadership, and Continuous Improvement

    NARCIS (Netherlands)

    Keijser, Wouter Alexander; Glaudemans, Andor; Medema, Jitze; Dierckx, Rudi; Ahaus, Kees

    2017-01-01

    In this chapter, we describe the enhanced TeamSTEPPS® curriculum as fundament to creating a “culture of continuous improvement” in nuclear medicine. This evidence-based and modular teamwork system is deployed in concordance with a novel medical leadership development program. It provides a

  19. Developing a Continuous Improvement System

    Science.gov (United States)

    2016-09-16

    included the development of the soft leadership skills for its supervisors with training in communication, conflict resolution, effective appraisals...change. Most of its supervisors possessed strong technical skills but lacked critical soft skills necessary for effective leadership. So, CAAA...to ensure that its employees enhance their knowledge, skills and experiences. These improved competencies help them achieve personal and career

  20. CTE's Focus on Continuous Improvement

    Science.gov (United States)

    Foster, John; Kelley, Patricia; Pritz, Sandy; Hodes, Carol

    2011-01-01

    Just one of the ways career and technical education (CTE) is revamping its image is through increased attention to data-driven instructional techniques as a means of improving and focusing instruction on what matters most. Accountability and data have increasingly become a core focus of research, news, and commentary about education in recent…

  1. Continuous Improvement and Collaborative Improvement: Similarities and Differences

    DEFF Research Database (Denmark)

    Middel, Rick; Boer, Harry; Fisscher, Olaf

    2006-01-01

    A substantial body of theoretical and practical knowledge has been developed on continuous improvement. However, there is still a considerable lack of impirically grounded contributions and theories on collaborative improvement, that is, continuous improvement in an interorganizational setting....... The CO-IMPROVE project investigated whether and how the concept of continuous improvement can be extended and transferred to such settings. The objective of this article is ti evaluate the CO-IMPROVE research findings in view of existing theories on continuous innovation. The article investigates...... the similarities and differences between key components of continuous and collaborative improvement by assessing what is specific for continuous improvement, what for collaborative improvement, and where the two areas of application meet and overlap. The main conclusions are that there are many more similarities...

  2. Teacher Research as Continuous Process Improvement

    Science.gov (United States)

    Ellis, Charles; Castle, Kathryn

    2010-01-01

    Purpose: Teacher research (inquiry) has been characterized as practice improvement, professional development and action research, among numerous names and descriptions. The purpose of this paper is to support the case that teacher research is also a form of quality improvement known as continuous process improvement (CPI).…

  3. Continuous Improvement through Baldridge in Education.

    Science.gov (United States)

    Siri, Diane K.; Miller, Ruth

    2001-01-01

    Describes efforts of the Baldrige in Education Center and Quality Leadership Academy in Santa Cruz County, California, to support teacher and administrator efforts to improve student performance in selected schools through the use of continuous-improvement techniques adopted by many American corporations to improve product quality and increase…

  4. Managerial implications for improving continuous production processes

    DEFF Research Database (Denmark)

    Capaci, Francesca; Vanhatalo, Erik; Bergquist, Bjarne

    2017-01-01

    Data analytics remains essential for process improvement and optimization. Statistical process control and design of experiments are among the most powerful process and product improvement methods available. However, continuous process environments challenge the application of these methods....... In this article we highlight SPC and DoE implementation challenges described in the literature for managers, researchers and practitioners interested in continuous production process improvement. The results may help managers support the implementation of these methods and make researchers and practitioners aware...... of methodological challenges in continuous process environments...

  5. Continuous Improvement and Collaborative Improvement: Similarities and Differences

    NARCIS (Netherlands)

    Middel, H.G.A.; Boer, Harm; Fisscher, O.A.M.

    2006-01-01

    A substantial body of theoretical and practical knowledge has been developed on continuous improvement. However, there is still a considerable lack of empirically grounded contributions and theories on collaborative improvement, that is, continuous improvement in an inter-organizational setting. The

  6. Occupational Analysis: A Continuous Improvement Approach

    National Research Council Canada - National Science Library

    Duffy, Tom

    1998-01-01

    .... In doing so, the Air Force has implemented "Quality Air Force (QAF)" (AF Handbook 90-502). QAF is a leadership commitment that inspires trust, teamwork, and continuous improvement everywhere in the Air Force...

  7. Continuous improvement methods in the nuclear industry

    International Nuclear Information System (INIS)

    Heising, Carolyn D.

    1995-01-01

    The purpose of this paper is to investigate management methods for improved safety in the nuclear power industry. Process improvement management, methods of business process reengineering, total quality management, and continued process improvement (KAIZEN) are explored. The anticipated advantages of extensive use of improved process oriented management methods in the nuclear industry are increased effectiveness and efficiency in virtually all tasks of plant operation and maintenance. Important spin off include increased plant safety and economy. (author). 6 refs., 1 fig

  8. A hybrid health service accreditation program model incorporating mandated standards and continuous improvement: interview study of multiple stakeholders in Australian health care.

    Science.gov (United States)

    Greenfield, David; Hinchcliff, Reece; Hogden, Anne; Mumford, Virginia; Debono, Deborah; Pawsey, Marjorie; Westbrook, Johanna; Braithwaite, Jeffrey

    2016-07-01

    The study aim was to investigate the understandings and concerns of stakeholders regarding the evolution of health service accreditation programs in Australia. Stakeholder representatives from programs in the primary, acute and aged care sectors participated in semi-structured interviews. Across 2011-12 there were 47 group and individual interviews involving 258 participants. Interviews lasted, on average, 1 h, and were digitally recorded and transcribed. Transcriptions were analysed using textual referencing software. Four significant issues were considered to have directed the evolution of accreditation programs: altering underlying program philosophies; shifting of program content focus and details; different surveying expectations and experiences and the influence of external contextual factors upon accreditation programs. Three accreditation program models were noted by participants: regulatory compliance; continuous quality improvement and a hybrid model, incorporating elements of these two. Respondents noted the compatibility or incommensurability of the first two models. Participation in a program was reportedly experienced as ranging on a survey continuum from "malicious compliance" to "performance audits" to "quality improvement journeys". Wider contextual factors, in particular, political and community expectations, and associated media reporting, were considered significant influences on the operation and evolution of programs. A hybrid accreditation model was noted to have evolved. The hybrid model promotes minimum standards and continuous quality improvement, through examining the structure and processes of organisations and the outcomes of care. The hybrid model appears to be directing organisational and professional attention to enhance their safety cultures. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  9. Human Resource Management for Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Laugen, Bjørge; Boer, Harry

    2006-01-01

    The objective of this paper is to investigate the relationship between HRM practices and Continuous Improvement (CI) activities in order to gain an understanding of how the HRM function may be utilized to improve CI implementation success, and consequently, organizational performance. The paper i...

  10. Human Resource Management for Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Laugen, Bjørge Timenes; Boer, Harry

    2007-01-01

    This paper investigates the relationship between HRM practices and Continuous Improvement (CI) activities in order to gain an understanding of how the HRM function may be utilized to improve CI implementation success, and consequently, company performance. The paper begins with a brief review...... of the HRM and CI literature and then presents statistical analyses of data collected from the Continuous Improvement Network Survey (2003), which demonstrate that HRM has a significant effect on CI behaviour and company performance, with the strongest relationship between HRM, CI and performance occurring...

  11. Continue service improvement at CERN computing centre

    International Nuclear Information System (INIS)

    Lopez, M Barroso; Everaerts, L; Meinhard, H; Baehler, P; Haimyr, N; Guijarro, J M

    2014-01-01

    Using the framework of ITIL best practises, the service managers within CERN-IT have engaged into a continuous improvement process, mainly focusing on service operation. This implies an explicit effort to understand and improve all service management aspects in order to increase efficiency and effectiveness. We will present the requirements, how they were addressed and share our experiences. We will describe how we measure, report and use the data to continually improve both the processes and the services being provided. The focus is not the tool or the process, but the results of the continuous improvement effort from a large team of IT experts providing services to thousands of users, supported by the tool and its local team. This is not an initiative to address user concerns in the way the services are managed but rather an on-going working habit of continually reviewing, analysing and improving the service management processes and the services themselves, having in mind the currently agreed service levels and whose results also improve the experience of the users about the current services.

  12. Continue Service Improvement at CERN Computing Centre

    Science.gov (United States)

    Barroso Lopez, M.; Everaerts, L.; Meinhard, H.; Baehler, P.; Haimyr, N.; Guijarro, J. M.

    2014-06-01

    Using the framework of ITIL best practises, the service managers within CERN-IT have engaged into a continuous improvement process, mainly focusing on service operation. This implies an explicit effort to understand and improve all service management aspects in order to increase efficiency and effectiveness. We will present the requirements, how they were addressed and share our experiences. We will describe how we measure, report and use the data to continually improve both the processes and the services being provided. The focus is not the tool or the process, but the results of the continuous improvement effort from a large team of IT experts providing services to thousands of users, supported by the tool and its local team. This is not an initiative to address user concerns in the way the services are managed but rather an on-going working habit of continually reviewing, analysing and improving the service management processes and the services themselves, having in mind the currently agreed service levels and whose results also improve the experience of the users about the current services.

  13. INSIDE CONTINUOUS IMPROVEMENT - A LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    Daniel Indarto Prajogo

    2000-01-01

    Full Text Available This paper discusses the concept of continuous improvement (CI by looking beyond what traditionally highlighted in literature concerning continuous improvement or Total Quality Management (TQM. The primary argument put forwarded in the discussion is that despite the undeniable positive results from CI practices, the way these activities are implemented, however, will lead to most programs becoming self-limiting. It needs to be asserted here that this paper is not intended to despise CI, rather, its purpose is limited only to provide a balance on the prevailing positive views toward CI.

  14. Health Care Improvement and Continuing Interprofessional Education: Continuing Interprofessional Development to Improve Patient Outcomes

    Science.gov (United States)

    Wilcock, Peter M.; Janes, Gillian; Chambers, Alison

    2009-01-01

    Health care improvement and continuing professional education must be better understood if we are to promote continuous service improvement through interprofessional learning in the workplace. We propose that situating interprofessional working, interprofessional learning, work-based learning, and service improvement within a framework of social…

  15. Continuous Improvement in State Funded Preschool Programs

    Science.gov (United States)

    Jackson, Sarah L.

    2012-01-01

    State funded preschool programs were constantly faced with the need to change in order to address internal and external demands. As programs engaged in efforts towards change, minimal research was available on how to support continuous improvement efforts within the context unique to state funded preschool programs. Guidance available had…

  16. A Typology of Continuous Improvement Implementation Processes

    DEFF Research Database (Denmark)

    Rijnders, Sander; Boer, Harry

    2004-01-01

    This article presents a typology of continuous improvement (CI) implementation processes. The typology is based on an empirical study of 26 companies engaged in the implementation of CI. The data underpinning the typology was collected through retrospective interviews guided by a semi-structured ...

  17. Human Resource Development's Contribution to Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Hyland, Paul

    2007-01-01

    Continuous Improvement (CI) is an approach to organizational change that requires active involvement of skilled and motivated employees, which implies an important role for HRD practitioners. The findings from a literature review and a survey of 168 Danish manufacturing companies indicate however...

  18. Continuous mutual improvement of macromolecular structure models in the PDB and of X-ray crystallographic software: the dual role of deposited experimental data

    Energy Technology Data Exchange (ETDEWEB)

    Terwilliger, Thomas C., E-mail: terwilliger@lanl.gov [Los Alamos National Laboratory, Mail Stop M888, Los Alamos, NM 87507 (United States); Bricogne, Gerard, E-mail: terwilliger@lanl.gov [Global Phasing Ltd, Sheraton House, Castle Park, Cambridge CB3 0AX (United Kingdom); Los Alamos National Laboratory, Mail Stop M888, Los Alamos, NM 87507 (United States)

    2014-10-01

    Macromolecular structures deposited in the PDB can and should be continually reinterpreted and improved on the basis of their accompanying experimental X-ray data, exploiting the steady progress in methods and software that the deposition of such data into the PDB on a massive scale has made possible. Accurate crystal structures of macromolecules are of high importance in the biological and biomedical fields. Models of crystal structures in the Protein Data Bank (PDB) are in general of very high quality as deposited. However, methods for obtaining the best model of a macromolecular structure from a given set of experimental X-ray data continue to progress at a rapid pace, making it possible to improve most PDB entries after their deposition by re-analyzing the original deposited data with more recent software. This possibility represents a very significant departure from the situation that prevailed when the PDB was created, when it was envisioned as a cumulative repository of static contents. A radical paradigm shift for the PDB is therefore proposed, away from the static archive model towards a much more dynamic body of continuously improving results in symbiosis with continuously improving methods and software. These simultaneous improvements in methods and final results are made possible by the current deposition of processed crystallographic data (structure-factor amplitudes) and will be supported further by the deposition of raw data (diffraction images). It is argued that it is both desirable and feasible to carry out small-scale and large-scale efforts to make this paradigm shift a reality. Small-scale efforts would focus on optimizing structures that are of interest to specific investigators. Large-scale efforts would undertake a systematic re-optimization of all of the structures in the PDB, or alternatively the redetermination of groups of structures that are either related to or focused on specific questions. All of the resulting structures should be

  19. [Improvement of municipal sewage sludge dewaterability by bioleaching: a pilot-scale study with a continuous plug flow reaction model].

    Science.gov (United States)

    Liu, Fen-Wu; Zhou, Li-Xiang; Zhou, Jun; Jiang, Feng

    2011-10-01

    A plug-flow bio-reactor of 700 L working volume for sludge bioleaching was used in this study. The reactor was operationally divided into six sections along the direction of the sludge movement. Ten duration of continuous operation of sludge bioleaching with Acidibacillus spp. and 1.2 m3 x h(-1) aeration amount was conducted. In this system, sludge retention time was 2.5 d, and the added amount of microbial nutritional substance was 4 g x L(-1). During sludge bioleaching, the dynamic changes of pH, dewaterability (specific resistance to filtration, SRF) of sewage sludge in different sections, the moisture content and moisture evaporation rate of dewatered bioleached sludge cake obtained by chamber filter press were investigated. The results showed that the SRF of sludge significantly decreased from initial 1.50 x 10(13) m x kg(-1) to the final 0.34 x 10(13) m x kg(-1). The wasted bioleached sludge was collected and dewatered by chamber filter press under the following pressures as 0.3 MPa for 4 h (2 h for feeding sludge, 2 h for holding pressure), 3 h (1.5 h for feeding sludge, 1.5 h for holding pressure), 2 h (1 h for feeding sludge, 1 h for holding pressure), and 1 h (0.5 h for feeding sludge, 0.5 h for holding pressure). Correspondingly, the moisture of dewatered sludge was reduced to 57.9%, 59.2%, 59.6%, and 63.4% of initial moisture, respectively. Moreover, the moisture content of bioleached sludge cake was reduced to about 45% and less than 10% if the cake was placed at 25 degrees C for 15 h and 96 h, respectively. Obviously, sludge bioleaching followed by sludge dewatering using chamber filter press is a promising attractive approach for sludge half-dryness treatment in engineering application.

  20. KEY FACTORS FOR A CONTINUOUS IMPROVEMENT PROCESS

    Directory of Open Access Journals (Sweden)

    Hector Ricardo Formento

    2013-11-01

    Full Text Available The goal of this work was to examine the content of continuous improvement strategies, taking into account the important role they play in building competitiveness. This paper argues that several specific issues must be taken into account in order to reach successful outcomes. This work starts with a literature review on the matter. On this basis, we designed a survey administered to a group of 30 large companies, each of which is renowned leader in Argentina. Finally, we compared the development of continuous improvement process in companies with very effective results and with scarce results. Differences that emerged from this comparison enabled us to identify critical factors for achieving a successful improvement process. As there are no recent researches on continuous improvement programs in Argentina, this paper contributes to recognizing and systematizing what has been done, comparing it with theoretical framework and uncovering research gaps for future studies. However, further research must confirm these findings and move forward on the analysis of intangible factors, like: internal communications, climate, culture, self reflexion, consensus, etc.

  1. Using the D-DANP-mV Model to Explore the Continuous System Improvement Strategy for Sustainable Development of Creative Communities

    Science.gov (United States)

    Xiong, Lei; Teng, Cheng-Lein; Zhu, Bo-Wei; Tzeng, Gwo-Hshiung; Huang, Shan-Lin

    2017-01-01

    With globalization, the notion of “creative city” has become a core concept of many cities in the world development policies, with real properties being upgraded or used to change, renewal is being conducted, and creative industries are emerging. This trend has reached its peak in the past decade, with different forms and scales gathering global development momentum among the creative communities to promote the development of creative economies. In recent years, however, there was still skepticism about the sustainability of the current creative communities. Many scholars have pointed out that signs of unsustainability have begun to appear in many creative communities. To overcome these obstacles, the development of rational and highly effective improvement strategy requires a dynamic thinking process. Therefore, this study employs the DEMATEL-based ANP with modified VIKOR (D-DANP-mV) model in presenting an assessment framework for the sustainability of creative communities. This system is used to assess the sustainability of current creative communities and determine how to solve their problems. Thus, continuous and systemic improvement strategies can be developed to achieve the aim of sustainable development. Two creative communities in Taiwan, Taichung Cultural and Creative Industries Park (TCCIP), and Shen-Ji New Village (SJNV), are used as case studies in this study. Based on the concept of systematic improvement from fundamental issues, the results indicate that the improvement priorities can be determined by applying the D-DANP-mV model. This approach is different from those found by a conventional method with the hypothesis of independent criteria (e.g., diversification of creative talents in TCCIP), and cannot use for performance improvement (e.g., only can be used for ranking and selection among alternatives). Considering these points, unreasonable premises, biased errors, and lack of some real application functions in the process of resource

  2. Using the D-DANP-mV Model to Explore the Continuous System Improvement Strategy for Sustainable Development of Creative Communities.

    Science.gov (United States)

    Xiong, Lei; Teng, Cheng-Lein; Zhu, Bo-Wei; Tzeng, Gwo-Hshiung; Huang, Shan-Lin

    2017-10-27

    With globalization, the notion of "creative city" has become a core concept of many cities in the world development policies, with real properties being upgraded or used to change, renewal is being conducted, and creative industries are emerging. This trend has reached its peak in the past decade, with different forms and scales gathering global development momentum among the creative communities to promote the development of creative economies. In recent years, however, there was still skepticism about the sustainability of the current creative communities. Many scholars have pointed out that signs of unsustainability have begun to appear in many creative communities. To overcome these obstacles, the development of rational and highly effective improvement strategy requires a dynamic thinking process. Therefore, this study employs the DEMATEL-based ANP with modified VIKOR (D-DANP-mV) model in presenting an assessment framework for the sustainability of creative communities. This system is used to assess the sustainability of current creative communities and determine how to solve their problems. Thus, continuous and systemic improvement strategies can be developed to achieve the aim of sustainable development. Two creative communities in Taiwan, Taichung Cultural and Creative Industries Park (TCCIP), and Shen-Ji New Village (SJNV), are used as case studies in this study. Based on the concept of systematic improvement from fundamental issues, the results indicate that the improvement priorities can be determined by applying the D-DANP-mV model. This approach is different from those found by a conventional method with the hypothesis of independent criteria (e.g., diversification of creative talents in TCCIP), and cannot use for performance improvement (e.g., only can be used for ranking and selection among alternatives). Considering these points, unreasonable premises, biased errors, and lack of some real application functions in the process of resource allocation

  3. Using the D-DANP-mV Model to Explore the Continuous System Improvement Strategy for Sustainable Development of Creative Communities

    Directory of Open Access Journals (Sweden)

    Lei Xiong

    2017-10-01

    Full Text Available With globalization, the notion of “creative city” has become a core concept of many cities in the world development policies, with real properties being upgraded or used to change, renewal is being conducted, and creative industries are emerging. This trend has reached its peak in the past decade, with different forms and scales gathering global development momentum among the creative communities to promote the development of creative economies. In recent years, however, there was still skepticism about the sustainability of the current creative communities. Many scholars have pointed out that signs of unsustainability have begun to appear in many creative communities. To overcome these obstacles, the development of rational and highly effective improvement strategy requires a dynamic thinking process. Therefore, this study employs the DEMATEL-based ANP with modified VIKOR (D-DANP-mV model in presenting an assessment framework for the sustainability of creative communities. This system is used to assess the sustainability of current creative communities and determine how to solve their problems. Thus, continuous and systemic improvement strategies can be developed to achieve the aim of sustainable development. Two creative communities in Taiwan, Taichung Cultural and Creative Industries Park (TCCIP, and Shen-Ji New Village (SJNV, are used as case studies in this study. Based on the concept of systematic improvement from fundamental issues, the results indicate that the improvement priorities can be determined by applying the D-DANP-mV model. This approach is different from those found by a conventional method with the hypothesis of independent criteria (e.g., diversification of creative talents in TCCIP, and cannot use for performance improvement (e.g., only can be used for ranking and selection among alternatives. Considering these points, unreasonable premises, biased errors, and lack of some real application functions in the process of

  4. Quick and continuous improvement through kaizen blitz.

    Science.gov (United States)

    McNichols, T; Hassinger, R; Bapst, G W

    1999-05-01

    It is our objective to provide you with a step-by-step approach to conducting a kaizen blitz within two days and describe how to achieve dramatic performance improvement with employee buy-in through this process. Kaizen blitz has been used dozens of times by the authors, and in some instances the same area has been blitzed as many as four times, with significant improvements each and every time. Employees have even taken it on themselves to conduct informal blitzes as a continuing improvement effort after a formal blitz has been conducted in their area. Blitzes can succeed in a variety of environments. The morning after the employees of one company attended this presentation, they self initiated a mini-blitz and discovered opportunities for improvement that they enthusiastically presented to management.

  5. Continuous improvement: A win-win process

    International Nuclear Information System (INIS)

    Lawrence, T.M.; Wichert, A.

    1992-01-01

    The strategies used within PanCanadian Petroleum Limited's production division to successfully introduce the continuous improvement (CI) process are discussed. Continuous improvement is an operating philosophy and management style which allows all employees to participate in and improve the way an organization performs its day-to-day business. In the CI work environment the supervisor's traditional role changes from one of monitoring and controlling, to one of inspiring, motivating and leading people by communicating a clear vision. Employees at all levels in the work environment are organized into teams and armed with a good working knowledge of the problem-solving tools which allow them to pursue and implement improvement initiatives. The outcome of the process is an ongoing win-win situation for both PanCanadian and its people. Employees are gaining more trust, eliminating job irritants, and enjoying their work in a team environment. The company is benefiting through increased production, improved safety and reduced operating expenses, thanks to the many innovative ideas introduced by employees. 4 refs

  6. Public Open Space Development for Elderly People by Using the DANP-V Model to Establish Continuous Improvement Strategies towards a Sustainable and Healthy Aging Society

    Directory of Open Access Journals (Sweden)

    Bo-Wei Zhu

    2017-03-01

    Full Text Available With the global trend of population aging, how to integrate the health needs of elderly people into public open space (POS development while taking into account public interest is a major challenge in the 21st century. Although the issues of elderly people’s health and their POS needs are receiving increasing attention, research on continuous improvement strategies for POS for healthy aging societies is still limited. Hence, this study explored continuous improvement strategies thoroughly and systematically by using the DANP-V model. The findings revealed cognitive differences between expert and elderly groups. Moreover, water features, waste management, and co-maintenance spaces were the three criteria with the largest gap value. POS improvement has previously been implemented based on a priority order ranked from the criterion with largest gap value to the criterion with the smallest one. However, an alternative approach based on the cause–effect relationship is proposed in this paper. The study findings have both theoretical and practical implications for POS planners and designers.

  7. Continuous Improvement in Action: Educators' Evidence Use for School Improvement

    Science.gov (United States)

    Cannata, Marisa; Redding, Christopher; Rubin, Mollie

    2016-01-01

    The focus of the article is the process educators use to interpret data to turn it into usable knowledge (Honig & Coburn, 2008) while engaging in a continuous improvement process. The authors examine the types of evidence educators draw upon, its perceived relevance, and the social context in which the evidence is examined. Evidence includes…

  8. Methods and Conditions for Achieving Continuous Improvement of Processes

    OpenAIRE

    Florica BADEA; Catalina RADU; Ana-Maria GRIGORE

    2010-01-01

    In the early twentieth century, the Taylor model improved, in a spectacular maner the efficiency of the production processes. This allowed obtaining high productivity by low-skilled workers, but used in large number in the execution of production. Currently this model is questioned by experts and was replaced by the concept of "continuous improvement". The first signs of change date from the '80s, with the apparition of quality circles and groups of operators on quality issues, principles whi...

  9. Continuous improvement: A win... win process

    International Nuclear Information System (INIS)

    Lawrence, T.; Wichert, A.

    1993-01-01

    Implementing a continuous improvement (CI) process within PanCanadian's oil and gas production operations might have been a simple assignment if one were not also trying to capture the hearts and imaginations of the people in a changing work environment. Meeting the challenge is resulting in big payoffs to both the organization and its people. The plan used within the Company's Production Division to successfully introduce the CI process is discussed. A brief insight is provided on the process philosophy, with emphasis placed on planning, training and coaching used to launch the process. Also reviewed at length are the impediments to change and the challenges faced when changing an organization's culture. In a CI work environment, the supervisor's traditional role changes from one of monitoring and controlling to one of inspiring, motivating and leading people by communicating a clear vision. Employees at all levels in the work environment are organized into teams and armed with a good working knowledge of the problem solving tools which allow them to pursue and implement improvement initiatives. The outcome of the process is an ongoing 'win-win' situation for both the Company and its people. Employees are gaining more trust, eliminating job irritants and enjoying their work more in a team environment. The Company is winning through increased production, improved safety and reduced operating expenses, thanks to many innovative ideas which the employees have implemented. 4 refs

  10. Generalized continuous linear model of international trade

    Directory of Open Access Journals (Sweden)

    Kostenko Elena

    2014-01-01

    Full Text Available The probability-based approach to the linear model of international trade based on the theory of Markov processes with continuous time is analysed. A generalized continuous model of international trade is built, in which the transition of the system from state to state is described by linear differential equations. The methodology of how to obtain the intensity matrices, which are differential in nature, is shown, and the same is done for their corresponding transition matrices for processes of purchasing and selling. In the process of the creation of the continuous model, functions and operations of matrices were used in addition to the Laplace transform, which gave the analytical form of the transition matrices, and therefore the expressions for the state vectors of the system. The obtained expressions simplify analysis and calculations in comparison to other methods. The values of the continuous transition matrices include in themselves the results of discrete model of international trade at moments in time proportional to the time step. The continuous model improves the quality of planning and the effectiveness of control of international trade agreements.

  11. A Report Card on Continuous Quality Improvement

    Science.gov (United States)

    Blumenthal, David; Kilo, Charles M.

    1998-01-01

    Efforts to incorporate the principles of continuous quality improvement (CQI) into health care have been underway for about ten years. In order to understand the lessons of this decade of experience, senior organizational leaders and experts in the field of health care were interviewed. This select group agreed that there have been concrete accomplishments: the tactic of assigning blame for mistakes to individuals is gradually giving way to an emphasis on detecting problems with process; there is a new focus on the health care customer; and many valuable projects have been inaugurated. Nevertheless, the interviews underlined the reality that the movement has not yet made a sizable impact on the U.S. health care system. Until there is a profound, organization-wide recognition of the need for change, universal commitment to CQI principles will not be achieved. PMID:9879305

  12. Improved Coumadin therapy using a continuous quality improvement process.

    Science.gov (United States)

    Eckhart, J; Gilbert, P

    1996-01-01

    Through the Continuous Quality Improvement process, we determined that a significant number of patients were receiving too much Coumadin and having potentially serious side effects. The number of patients studied is limited, and there are only two time intervals reported postintervention. This makes it difficult to draw a definite relationship between the observed rates of Coumadin overdosing and the selected intervention. By educating the physicians on proper Coumadin dosing, we were able to reduce the number of patients experiencing hemorrhage or other complications. Our follow-up data review 1 year later showed that the gain had not been maintained as well as we would have hoped. This demonstrates that active review by Pharmacy and Laboratory on a regular basis and additional physician education would be beneficial. Through this process we gained valuable experience using the FOCUS PDCA method of continuous quality improvement.

  13. How can we recognize continuous quality improvement?

    Science.gov (United States)

    Rubenstein, Lisa; Khodyakov, Dmitry; Hempel, Susanne; Danz, Margie; Salem-Schatz, Susanne; Foy, Robbie; O'Neill, Sean; Dalal, Siddhartha; Shekelle, Paul

    2014-02-01

    Continuous quality improvement (CQI) methods are foundational approaches to improving healthcare delivery. Publications using the term CQI, however, are methodologically heterogeneous, and labels other than CQI are used to signify relevant approaches. Standards for identifying the use of CQI based on its key methodological features could enable more effective learning across quality improvement (QI) efforts. The objective was to identify essential methodological features for recognizing CQI. Previous work with a 12-member international expert panel identified reliably abstracted CQI methodological features. We tested which features met rigorous a priori standards as essential features of CQI using a three-phase online modified-Delphi process. Primarily United States and Canada. 119 QI experts randomly assigned into four on-line panels. Participants rated CQI features and discussed their answers using online, anonymous and asynchronous discussion boards. We analyzed ratings quantitatively and discussion threads qualitatively. Main outcome measure(s) Panel consensus on definitional CQI features. /st> Seventy-nine (66%) panelists completed the process. Thirty-three completers self-identified as QI researchers, 18 as QI practitioners and 28 as both equally. The features 'systematic data guided activities,' 'designing with local conditions in mind' and 'iterative development and testing' met a priori standards as essential CQI features. Qualitative analyses showed cross-cutting themes focused on differences between QI and CQI. We found consensus among a broad group of CQI researchers and practitioners on three features as essential for identifying QI work more specifically as 'CQI.' All three features are needed as a minimum standard for recognizing CQI methods.

  14. Continuous improvement projects: an authorship bibliometric analysis.

    Science.gov (United States)

    Gonzalez Aleu, Fernando; Van Aken, Eileen M

    2017-06-12

    Purpose The purpose of this paper is to describe the current research on hospital continuous improvement projects (CIPs) from an author characteristics' perspective. This work addresses the following questions: who are the predominant research authors in hospital CIPs? To what extent are the research communities collaborating in distinct research groups? How internationalized has hospital CIPs research become with respect to author location? Design/methodology/approach A systematic literature review was conducted, identifying 302 academic publications related to hospital CIPs. Publications were analyzed using: author, quantity, diversity, collaboration, and impact. Findings Hospital CIPs are increasingly attracting new scholars each year. Based on the authors' analysis, authors publishing in this area can be described as a relatively new international community given the countries represented. Originality/value This paper describes the current hospital CIP research by assessing author characteristics. Future work should examine additional attributes to characterize maturity such as how new knowledge is being created and to what extent new knowledge is being disseminated to practitioners.

  15. Lean management systems: creating a culture of continuous quality improvement.

    Science.gov (United States)

    Clark, David M; Silvester, Kate; Knowles, Simon

    2013-08-01

    This is the first in a series of articles describing the application of Lean management systems to Laboratory Medicine. Lean is the term used to describe a principle-based continuous quality improvement (CQI) management system based on the Toyota production system (TPS) that has been evolving for over 70 years. Its origins go back much further and are heavily influenced by the work of W Edwards Deming and the scientific method that forms the basis of most quality management systems. Lean has two fundamental elements--a systematic approach to process improvement by removing waste in order to maximise value for the end-user of the service and a commitment to respect, challenge and develop the people who work within the service to create a culture of continuous improvement. Lean principles have been applied to a growing number of Healthcare systems throughout the world to improve the quality and cost-effectiveness of services for patients and a number of laboratories from all the pathology disciplines have used Lean to shorten turnaround times, improve quality (reduce errors) and improve productivity. Increasingly, models used to plan and implement large scale change in healthcare systems, including the National Health Service (NHS) change model, have evidence-based improvement methodologies (such as Lean CQI) as a core component. Consequently, a working knowledge of improvement methodology will be a core skill for Pathologists involved in leadership and management.

  16. Human Resource Management for Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Laugen, Bjørge; Boer, Harry

    2006-01-01

    includes a brief literature review of HRM and CI and statistical analyses of data collected from the Continuous Innovation Network Survey (2002). The results of the analyses demonstrate that HRM has a significant effect on CI and organizational behavior, with the strongest relationship between HRM, CI...

  17. Case Studies in Continuous Process Improvement

    Science.gov (United States)

    Mehta, A.

    1997-01-01

    This study focuses on improving the SMT assembly process in a low-volume, high-reliability environment with emphasis on fine pitch and BGA packages. Before a process improvement is carried out, it is important to evaluate where the process stands in terms of process capability.

  18. Studying Implementation within a Continuous Continuous-Improvement Process: What Happens When We Design with Adaptations in Mind?

    Science.gov (United States)

    Tichnor-Wagner, Ariel; Allen, Danielle; Socol, Allison Rose; Cohen-Vogel, Lora; Rutledge, Stacey A.; Xing, Qi W.

    2018-01-01

    Background/Context: This study examines the implementation of an academic and social-emotional learning innovation called Personalization for Academic and Social-Emotional Learning, or PASL. The innovation was designed, tested, and implemented using a continuous continuous-improvement model. The model emphasized a top-and-bottom process in which…

  19. Continuous improvement in teams : The (mis)fit between improvement and operational activities of improvement teams

    NARCIS (Netherlands)

    Ros, D.J.

    1999-01-01

    Since the 1970s and 1980s, increasing attention has been paid to the Japanese ways of organising production. One of the subjects often discussed is the importance of continuous incremental improvements. Nowadays, for many organisations, continuous improvement has become an important topic; many

  20. Involving vendors in continuous quality improvement efforts.

    Science.gov (United States)

    McDevitt, M C

    1995-03-01

    In the hospital environment, vendors supply a wide range of items, from surgical sutures to the latest in high-cost technological equipment. Also, many clinical and support services, such as respiratory therapy, transcription, and computer databanks are now outsourced to commercial vendors. Interaction with such vendors is often less than satisfactory, with prolonged timelines and disruption of an important process that is being computerized. Although hospitals deal with very few vendors in long-term relationships, such as those seen in manufacturing, this should not preclude the formation of a supplier-customer relationship that goes beyond management's interaction with the sales representative in response to a request for proposal. This is especially true when a process improvement team has studied an internal process and defined a key quality characteristic.

  1. The use of continuous improvement techniques: A survey-based ...

    African Journals Online (AJOL)

    Prior research has focused mainly on the effect of continuous improvement practices on performance. In contrast, this research collected data through a survey administered across multiple industries throughout the U.S. and identified the continuous improvement techniques (i.e., lean and quality improvement methods) that ...

  2. Continuing education for performance improvement: a creative approach.

    Science.gov (United States)

    Collins, Patti-Ann; Hardesty, Ilana; White, Julie L; Zisblatt, Lara

    2012-10-01

    In an effort to improve patient safety and health care outcomes, continuing medical education has begun to focus on performance improvement initiatives for physician practices. Boston University School of Medicine's (BUSM) Continuing Nursing Education Accredited Provider Unit has begun a creative project to award nursing contact hours for nurses' participation in performance improvement activities. This column highlights its initial efforts. Copyright 2012, SLACK Incorporated.

  3. Continual Improvement In Small Soaps Company

    Directory of Open Access Journals (Sweden)

    Borget Alfred Anoye

    2015-08-01

    Full Text Available Abstract In this paper using quality management tools we track root causes and principal causes of the rising manufacturing cost of the bar soaps and propose solution to solve the problem. First we identify and analyze the roots causes of problem with the Fishbone Diagram. We use multivoting approach to reduce roots causes to main causes from which we identify classify and analyze principal causes using the Pareto Diagram. We then perform a deep analysis of these principal causes using the 5 whys analysis technique. Three principal causes were found amp61480high level of overtime poor machine performance and poor employees performanceamp61481 and were weighing 55 of the problem. For that reason working on these areas was necessary to address the problem of the rising manufacturing cost of the bar soaps. With the result we then use the PDCA 7 steps of TQM method to solve the problem of the rising manufacturing cost by testing whether expanding production capacity leads to performance improvements of these areas. We decide to expand production capacity by adding two more machine groups. Six months after implementation of the proposed solution the result shows an enhanced workload and schedule an increased production capacity an elimination of the overtime issue an increased machines performance and an improved workers performance. Two main savings were achieved as wage costs and maintenance costs. As a result while competitors bar soaps prices increased the company bar soaps price decreased by 50 making the company bar soaps more attractive on market as this performance permitted the company to apply price reduction at the retailer level.

  4. Comparing the Discrete and Continuous Logistic Models

    Science.gov (United States)

    Gordon, Sheldon P.

    2008-01-01

    The solutions of the discrete logistic growth model based on a difference equation and the continuous logistic growth model based on a differential equation are compared and contrasted. The investigation is conducted using a dynamic interactive spreadsheet. (Contains 5 figures.)

  5. IMPLEMENTASI ???CONTINUOUS IMPROVEMENT MINDSET DAN CHANGE MANAGEMENT??? DALAM ORGANISASI BISNIS

    OpenAIRE

    Payangan, Otto Randa

    2014-01-01

    This paper explains that the "Continuous Improvement Mindset and Change Management" is very important to implement in support of an organization's business performance improvement on ongoing basis. The goal in developing the "Continuous Improvement Mindset and Change Management" is, strongly influenced by changes in a highly dynamic environment and the increasing level of dynamic competition, in creating products and services excellence. The approach used in the realization of Continuous Imp...

  6. Accreditation council for graduate medical education (ACGME annual anesthesiology residency and fellowship program review: a "report card" model for continuous improvement

    Directory of Open Access Journals (Sweden)

    Long Timothy R

    2010-02-01

    Full Text Available Abstract Background The Accreditation Council for Graduate Medical Education (ACGME requires an annual evaluation of all ACGME-accredited residency and fellowship programs to assess program quality. The results of this evaluation must be used to improve the program. This manuscript describes a metric to be used in conducting ACGME-mandated annual program review of ACGME-accredited anesthesiology residencies and fellowships. Methods A variety of metrics to assess anesthesiology residency and fellowship programs are identified by the authors through literature review and considered for use in constructing a program "report card." Results Metrics used to assess program quality include success in achieving American Board of Anesthesiology (ABA certification, performance on the annual ABA/American Society of Anesthesiology In-Training Examination, performance on mock oral ABA certification examinations, trainee scholarly activities (publications and presentations, accreditation site visit and internal review results, ACGME and alumni survey results, National Resident Matching Program (NRMP results, exit interview feedback, diversity data and extensive program/rotation/faculty/curriculum evaluations by trainees and faculty. The results are used to construct a "report card" that provides a high-level review of program performance and can be used in a continuous quality improvement process. Conclusions An annual program review is required to assess all ACGME-accredited residency and fellowship programs to monitor and improve program quality. We describe an annual review process based on metrics that can be used to focus attention on areas for improvement and track program performance year-to-year. A "report card" format is described as a high-level tool to track educational outcomes.

  7. Continual improvement: A bibliography with indexes, 1992-1993

    Science.gov (United States)

    1994-01-01

    This bibliography lists 606 references to reports and journal articles entered into the NASA Scientific and Technical Information Database during 1992 to 1993. Topics cover the philosophy and history of Continual Improvement (CI), basic approaches and strategies for implementation, and lessons learned from public and private sector models. Entries are arranged according to the following categories: Leadership for Quality, Information and Analysis, Strategic Planning for CI, Human Resources Utilization, Management of Process Quality, Supplier Quality, Assessing Results, Customer Focus and Satisfaction, TQM Tools and Philosophies, and Applications. Indexes include subject, personal author, corporate source, contract number, report number, and accession number.

  8. Continuous improvement of the BNFL transport integrated management system

    International Nuclear Information System (INIS)

    Hale, J.A.

    1998-01-01

    The integrated Management System of BNFL Transport and Pacific Nuclear Transport Limited (PNTL) is subject to continuous improvement by the application of established improvement techniques adopted by BNFL. The technique currently being used is the application of a Total Quality Management (TQM) philosophy, involving the identification of key processes, benchmarking against existing measures, initiating various improvement projects and applying process changes within the Company. The measurement technique being used is based upon the European Foundation for Quality Management Model (EFQM). A major initiative was started in 1996 to include the requirements of the Environmental Management Systems standard ISO 14001 within the existing integrated management system. This resulted in additional activities added to the system, modification to some existing activities and additional training for personnel. The system was audited by a third party certification organisation, Lloyds Register Quality Assurance (LRQA), during 1997. This paper describes the arrangements to review and update the integrated management system of BNFL Transport and PNTL to include the requirements of the environmental standard ISO 14001 and it also discusses the continuous improvement process adopted by BNFL Transport. (authors)

  9. Teaching performance improvement: an opportunity for continuing medical education.

    Science.gov (United States)

    Staker, Larry V

    2003-01-01

    Practicing physicians generally are not engaged in either the methods of performance improvement for health care or the measurement and reporting of clinical outcomes. The principal reasons are lack of compensation for such work, the perception that the work of performance improvement adds no value and is a waste of time, the lack of knowledge and skill in the use of basic tools for outcomes measurement and performance improvement, the failure of medical educators to teach these skills, and the inability of mentors to model their use in practice. In this article, an overview of the history of quality improvement or performance improvement in general and the adoption of two methods of improvement (Plan-Do-Study-Act and SIX SIGMA) by health care is given. Six simple tools that are easy to understand and use and could be used in every continuing medical education (CME) program are then explained and illustrated. Postgraduate medical educators and CME program directors must step up to the challenge of teaching these skills. By learning to include them in planning, evaluation, policy making, and needs assessments of CME programs, the skills of every physician could be improved. Additional goals of every CME program could be accountability for outcomes, reduction of errors, alignment of incentives, and advocacy for the very best in evidence-based health care. To develop activities that affect physician practice and population health, CME professionals must partner with performance improvement experts for needs assessment and evaluation of outcomes data. An understanding of performance improvement principles helps those in performance improvement and those in CME to determine which educational activities might be expected to influence physician competency and performance.

  10. A Health Care Project Management Office's Strategies for Continual Change and Continuous Improvement.

    Science.gov (United States)

    Lavoie-Tremblay, Mélanie; Aubry, Monique; Richer, Marie-Claire; Cyr, Guylaine

    Health care organizations need project and change management support in order to achieve successful transformations. A project management office (PMO) helps support the organizations through their transformations along with increasing their capabilities in project and change management. The aim of the present study was to extend understanding of the continuous improvement mechanisms used by PMOs and to describe PMO's strategies for continual change and continuous improvement in the context of major transformation in health care. This study is a descriptive case study design with interviews conducted from October to December 2015 with PMO's members (3 managers and 1 director) and 3 clients working with the PMO after a major redevelopment project ended (transition to the new facility). Participants suggested a number of elements including carefully selecting the members of the PMO, having a clear mandate for the PMO, having a method and a discipline at the same time as allowing openness and flexibility, clearly prioritizing projects, optimizing collaboration, planning for everything the PMO will need, not overlooking organizational culture, and retaining the existing support model. This study presents a number of factors ensuring the sustainability of changes.

  11. Improved transition models for cepstral trajectories

    CSIR Research Space (South Africa)

    Badenhorst, J

    2012-11-01

    Full Text Available is ideal for the investigation of contextual effects on cepstral trajectories. We show that modelling improvements, such as continuity constraints on parameter values and more flexible transition models, systematically improve the robustness of our...

  12. Automated cold temperature cycling improves in vitro platelet properties and in vivo recovery in a mouse model compared to continuous cold storage.

    Science.gov (United States)

    Skripchenko, Andrey; Gelderman, Monique P; Awatefe, Helen; Turgeon, Annette; Thompson-Montgomery, Dedeene; Cheng, Chunrong; Vostal, Jaroslav G; Wagner, Stephen J

    2016-01-01

    Platelets (PLTs) stored at cold temperatures (CTs) for prolonged time have dramatically reduced bacterial growth but poor survival when infused. A previous study demonstrated that human PLTs stored with manual cycling between 4 °C (12 hr) and 37 °C (30 min) and infused into severe combined immunodeficient (SCID) mice had survivals similar to or greater than those stored at room temperature (RT). In this study, the in vitro and in vivo properties of PLTs stored in an automated incubator programmed to cycle between 5 °C (11 hr) and 37 °C (1 hr) were evaluated. A Trima apheresis unit (n = 12) was aliquoted (60 mL) in CLX bags. One sample was stored with continuous agitation (RT), a second sample was stored at 4-6 °C without agitation (CT), and a third sample was placed in an automated temperature cycler with 5 minutes of agitation during the warm-up period (thermocycling [TC]). PLTs were assayed for several relevant quality variables. On Day 7, PLTs were infused into SCID mice and in vivo recovery was assessed at predetermined time points after transfusion. The glucose consumption rate, morphology score, hypotonic shock recovery level, and aggregation levels were increased and mitochondrial reactive oxygen species accumulations were decreased in TC-PLTs compared to those of CT-PLTs. The pH and Annexin V binding were comparable to those of RT-PLTs. All TC-PLTs had greater recovery than CT-PLTs and were comparable to RT-PLTs. PLTs stored under automated TC conditions have improved in vivo recovery and improved results for a number of in vitro measures compared to CT-PLTs. © 2015 AABB.

  13. Continuous Improvement and its Barriers in Electrical and Electronic Industry

    Directory of Open Access Journals (Sweden)

    Ahmad Md Fauzi

    2017-01-01

    Full Text Available Continuous improvement is one of the core strategies for manufacturing excellent and it is considered vital in today’s business environment. Continuous improvement is an important factor in TQM implementation. However, manufacturers in Electrical and Electronic Industry is facing variety of challenges such as, time constraint, quality issue, headcount issue, human issue and competition in domestic as well as the global market. This paper presents total quality management practices in Electrical and Electronic (EE Industry. These manufacturers have to keep improving in key activities and processes to cope the challenges. Therefore, EE industry realize the importance of continuous improvement in helping the industries by setting clear goals and priorities for the area of improvement. The aims of this study are to determine the main factor in implementing continuous improvement practices, identify tools of continuous improvement that have been used and their obstacle in implementing continuous improvement practices. 200 questionnaires had been distributed to the employees in Electrical and Electronic Industry located at Bayan Lepas, Penang, Malaysia. A total of 41 questionnaires were answered which represented about 20.5% response rates. Survey result shows that teamwork and training and learning are respectively the importance factor and the most practices factor in Electrical and Electronic Industry. Most of the Electrical and Electronic Industry emphasis is on using Lean Manufacturing as the tool of continuous improvement practices. Besides that, Electrical and Electronic Industry faced the problems of lack of budget and lack of worker commitment.

  14. Multimedia Mapping using Continuous State Space Models

    DEFF Research Database (Denmark)

    Lehn-Schiøler, Tue

    2004-01-01

    In this paper a system that transforms speech waveforms to animated faces are proposed. The system relies on continuous state space models to perform the mapping, this makes it possible to ensure video with no sudden jumps and allows continuous control of the parameters in 'face space'. Simulatio...

  15. Improving Long-term Quality and Continuity of Landsat-7 Data Through Inpainting of Lost Data Based on the Nonconvex Model of Dynamic Dictionary Learning

    Science.gov (United States)

    Miao, J.; Zhou, Z.; Zhou, X.; Huang, T.

    2017-12-01

    On May 31, 2003, the scan line corrector (SLC) of the Enhance Thematic Mapper Plus (ETM+) on board the Landsat-7 satellite was broken down, resulting in strips of lost data in the Landsat-7 images, which seriously affected the quality and continuous applications of the ETM+ data for space and earth science. This paper proposes a new inpainting method for repairing the Landsat-7 ETM+ images taking into account the physical characteristics and geometric features of the ground area of which the data are missed. Firstly, the two geometric slopes of the boundaries of each missing stripe of the georeferenced ETM+ image is calculated by the Hough, ignoring the slope of the part of the missing strip that are on the same edges of the whole image. Secondly, an adaptive dictionary was developed and trained using a large number of Landsat-7 ETM+ SLC-ON images. When the adaptive dictionary is used to restore an image with missing data, the dictionary is actually dynamic. Then the data-missing strips were repaired along their slope directions by using the logdet (.) low-rank non-convex model along with dynamic dictionary. Imperfect points are defined as the pixels whose values are quite different from its surrounding pixel values. They can be real values but most likely can be noise. Lastly, the imperfect points after the second step were replaced by using the method of sparse restoration of the overlapping groups. We take the Landsat ETM+ images of June 10, 2002 as the test image for our algorithm evaluation. There is no data missing in this image. Therefore we extract the same missing -stripes of the images of the same WRS path and WRS row as the 2002 image but acquired after 2003 to form the missing-stripe model. Then we overlay the missing-stripe model over the image of 2002 to get the simulated missing image. Fig.1(a)-(c) show the simulated missing images of Bands 1, 3, and 5 of the 2002 ETM+ image data. We apply the algorithm to restore the missing stripes. Fig.1(d

  16. La Hague Continuous Improvement Program: Enhancement of the Vitrification Throughput

    International Nuclear Information System (INIS)

    Petitjean, V.; De Vera, R.; Hollebecque, J.F.; Tronche, E.; Flament, T.; Pereira Mendes, F.; Prod'homme, A.

    2006-01-01

    The vitrification of high-level liquid waste produced from nuclear fuel reprocessing has been carried out industrially for over 25 years by AREVA/COGEMA, with two main objectives: containment of the long lived fission products and reduction of the final volume of waste. At the 'La Hague' plant, in the 'R7' and 'T7' facilities, vitrified waste is obtained by first evaporating and calcining the nitric acid feed solution-containing fission products in calciners. The product-named calcinate- is then fed together with glass frit into induction-heated metallic melters to produce the so-called R7/T7 glass, well known for its excellent containment properties. Both facilities are equipped with three processing lines. In the near future the increase of the fuel burn-up will influence the amount of fission product solutions to be processed at R7/T7. As a consequence, in order to prepare these changes, it is necessary to feed the calciner at higher flow-rates. Consistent and medium-term R and D programs led by CEA (French Atomic Energy Commission, the AREVA/COGEMA's R and D and R and T provider), AREVA/COGEMA (Industrial Operator) and AREVA/SGN (AREVA/COGEMA's Engineering), and associated to the industrial feed back of AREVA/COGEMA operations, have allowed continuous improvement of the process since 1998: - The efficiency and limitation of the equipment have been studied and solutions for technological improvements have been proposed whenever necessary, - The increase of the feeding flow-rate has been implemented on the improved CEA test rig (so called PEV, Evolutional Prototype of Vitrification) and adapted by AREVA/SGN for the La Hague plant using their modeling studies; the results obtained during this test confirmed the technological and industrial feasibility of the improvements achieved, - After all necessary improved equipments have been implemented in R7/T7 facilities, and a specific campaign has been performed on the R7 facility by AREVA/COGEMA. The flow-rate to the

  17. Can Schools Meet the Promise of Continuous Improvement?

    Science.gov (United States)

    Elgart, Mark A.

    2018-01-01

    Continuous improvement is "an embedded behavior within the culture of a school that constantly focuses on the conditions, processes, and practices that will improve teaching and learning." The phrase has been part of the lexicon of school improvement for decades, but real progress is rare. Based on its observations of about 5,000…

  18. Continuous Improvement Implementation in the Nottingham University Hospitals NHS Trust: A Case Study of a Continuous Improvement Programme & Project

    OpenAIRE

    Velzen, Jeena

    2012-01-01

    This paper aims at identifying the extent to which the Nottingham University Hospitals NHS Trust has fulfilled literature requirements for successful continuous improvement as exemplified by its Better for You programme and chemotherapy service improvement project. Both the theory and ideals of the continuous improvement programme, along with the actualization of these philosophies and methodologies in the context of the particular project,were compared against a framework for the enabling...

  19. Continuous Competence Development Model for Teacher Teams

    DEFF Research Database (Denmark)

    Weitze, Charlotte Lærke

    2014-01-01

    "This paper presents the development of the IT‐Pedagogical Think Tank for Teacher Teams (ITP4T), a continuous competence development model. The model was co‐designed following a design‐based research approach with teachers from VUC Storstrøm’s (VUC) Global Classroom (GC), an innovative hybrid...... to create their own continuous competence development. This article describes how and why the different components of the model were developed in response to the teachers’ challenges. Such challenges included lack of time, competence and support from the educational organisation to innovate learning design...

  20. The soul of the machine: continual improvement in ISO 14001

    NARCIS (Netherlands)

    Brouwer, M.A.C.; van Koppen, C.S.A.

    2008-01-01

    Continual improvement is a key component of ISO 14001, but in contrast to most other specifications in the standard, it is difficult to assess. Based on interviews with 19 certified companies in the chemical, food, and environmental services sectors, this article explores the dynamics of continual

  1. The soul of the machine: continual improvement in ISO 14001.

    NARCIS (Netherlands)

    Brouwer, M.A.C.; Koppen, van C.S.A.

    2008-01-01

    Continual improvement is a key component of ISO 14001, but in contrast to most other specifications in the standard, it is difficult to assess. Based on interviews with 19 certified companies in the chemical, food, and environmental services sectors, this article explores the dynamics of continual

  2. Continuous improvement and the mini-company concept

    NARCIS (Netherlands)

    de Leede, Jan; Looise, Jan C.

    1999-01-01

    The key issue of continuous improvement (CI) seems to be the problem of combining extensive employee involvement with market orientation and continuation of CI. In this article we review some existing organisational designs for CI on these three essential characteristics of CI. As an alternative to

  3. Should we do more to improve oral contraceptive continuation?

    Science.gov (United States)

    Castaño, Paula M; White, Katharine O'Connell

    2013-03-01

    Oral contraceptives are commonly chosen methods whose contraceptive effectiveness is very user-dependent. Approaches to significantly improving oral contraceptive continuation have been largely unsuccessful. Long-acting reversible methods are the most highly effective reversible contraceptives, with the highest continuation rates, and should be the first-line methods offered to reproductive-aged women.

  4. Applying Continuous Improvement in Order to Reach Operational Excellence

    OpenAIRE

    Ritamaki, Ari

    2017-01-01

    Research’s primary goal is to find out what are the success factors of continuous improvement as a change management discipline, and second goal is to clear out what role organizational culture and leadership have in this change in order to reach operational excellence. Personal and professional aim of this research is to produce operational manual type of guideline collection from continuous improvement targeted for small and middle sized companies, which are developing their change manageme...

  5. Continuous Improvement and its Barriers in Electrical and Electronic Industry

    OpenAIRE

    Ahmad Md Fauzi; Yan Toh Li; Wei Chan Shiau; Aizat Ahmad Ahmad Nur; Raja Mohd Rasi Raja Zuraidah; Abdul Rahman Nor Aida; Muhd Nor Nik Hisyamudin; Hassan Mohd Fahrul; Hashim Fatan Adibah

    2017-01-01

    Continuous improvement is one of the core strategies for manufacturing excellent and it is considered vital in today’s business environment. Continuous improvement is an important factor in TQM implementation. However, manufacturers in Electrical and Electronic Industry is facing variety of challenges such as, time constraint, quality issue, headcount issue, human issue and competition in domestic as well as the global market. This paper presents total quality management practices in Electric...

  6. Continuous Time Structural Equation Modeling with R Package ctsem

    Directory of Open Access Journals (Sweden)

    Charles C. Driver

    2017-04-01

    Full Text Available We introduce ctsem, an R package for continuous time structural equation modeling of panel (N > 1 and time series (N = 1 data, using full information maximum likelihood. Most dynamic models (e.g., cross-lagged panel models in the social and behavioural sciences are discrete time models. An assumption of discrete time models is that time intervals between measurements are equal, and that all subjects were assessed at the same intervals. Violations of this assumption are often ignored due to the difficulty of accounting for varying time intervals, therefore parameter estimates can be biased and the time course of effects becomes ambiguous. By using stochastic differential equations to estimate an underlying continuous process, continuous time models allow for any pattern of measurement occasions. By interfacing to OpenMx, ctsem combines the flexible specification of structural equation models with the enhanced data gathering opportunities and improved estimation of continuous time models. ctsem can estimate relationships over time for multiple latent processes, measured by multiple noisy indicators with varying time intervals between observations. Within and between effects are estimated simultaneously by modeling both observed covariates and unobserved heterogeneity. Exogenous shocks with different shapes, group differences, higher order diffusion effects and oscillating processes can all be simply modeled. We first introduce and define continuous time models, then show how to specify and estimate a range of continuous time models using ctsem.

  7. Implications of Continuous Quality Improvement for Program Evaluation and Evaluators.

    Science.gov (United States)

    Mark, Melvin M.; Pines, Edward

    1995-01-01

    Explores the implications that continuous quality improvement (CQI) programs are likely to have for evaluation. CQI, often known as total quality management, offers a structured approach to the analysis of an organization's processes and improvement that should provide advantages to evaluators once they have gained experience with the approach.…

  8. Continuous Improvement in Schools and Districts: Policy Considerations

    Science.gov (United States)

    Best, Jane; Dunlap, Allison

    2014-01-01

    Discussions about improving public education often focus on outcomes without considering how schools and districts can accomplish those outcomes. Research shows that using a continuous improvement process has proven successful in healthcare, manufacturing, and technology, and may hold potential for use in education as well. This brief defines and…

  9. Closing the Loop on a Continuous Program Improvement Process

    Science.gov (United States)

    Booth, Vickie; Booth, Larry

    2010-01-01

    The WebBSIT, a Bachelor of Science in Information Technology, is a fully online degree offered through a consortium of five University System of Georgia institutions. This paper begins by summarizing the change management system developed for continuous program improvement. Analysis of data should drive improvement, closing the loop. The balance…

  10. Creating a Cycle of Continuous Improvement through Instructional Rounds

    Science.gov (United States)

    Meyer-Looze, Catherine L.

    2015-01-01

    Instructional Rounds is a continuous improvement strategy that focuses on the technical core of educational systems as well as educators collaborating side-by-side. Concentrating on collective learning, this process only makes sense within an overall strategy of improvement. This case study examined the Instructional Rounds process in a northern…

  11. Evaluation of 60 continuous quality improvement projects in French hospitals.

    Science.gov (United States)

    Maguerez, G; Erbault, M; Terra, J L; Maisonneuve, H; Matillon, Y

    2001-04-01

    To evaluate the feasibility of implementing continuous quality improvement (CQI) projects in French health care organizations. The French Ministry of Health issued two calls for CQI projects (in 1995 and 1996). ANAES was commissioned to monitor and evaluate the projects, and to provide advice. ANAES in collaboration with French public hospitals. A jury selected 64 projects from 483 submissions. The first series of projects related to safety issues (e.g. blood transfusions), the second related chiefly to patient management. ANAES instructed project leaders in process analysis (modified four-step FOCUS-PDCA model), convened regular meetings between leaders and performed on-site visits. Objective outcomes: goal achievement, extension of projects to other topics and departments, allocation of resources. Subjective outcomes: changes in attitudes. Statistics were obtained from two questionnaires completed by project leaders. Four projects were discontinued; 82% (49 out of 60) met more than half their objectives. The CQI method was adopted by other departments in 65% and 50% (1st and 2nd series respectively) of cases. Hospital management often chose to provide continued support (81%/88%), offer training (59%/80%), create a CQI unit (62%/73%), and allocate a budget (61%/65%). A positive impact on staff attitudes was noted in over 75% of projects. ANAES' co-ordinated initiative to acquaint a hard core of French public hospitals with CQI proved successful. Identification of the factors for success and of potential hurdles helped pave the way for the national hospital accreditation procedure currently underway.

  12. Continuous Improvement in Nursing Education through Total Quality Management (TQM

    Directory of Open Access Journals (Sweden)

    Tang Wai Mun

    2013-11-01

    Full Text Available Total Quality Management (TQM has generally been validated as a crucial revolution in the management field. Many academicians believe that the concept of TQM is applicable to academics and provides guiding principles towards improving education. Therefore, an increasing number of educational institutions such as schools, colleges and universities have started to embrace TQM philosophies to their curricula.Within the context of TQM, this paper would explore the concept of continuous improvement by using the Deming philosophy. Subsequently, this paper would elaborate on the application of TQM to bring about continuous improvement in the current education system.

  13. Dissipative Continuous Spontaneous Localization (CSL) model.

    Science.gov (United States)

    Smirne, Andrea; Bassi, Angelo

    2015-08-05

    Collapse models explain the absence of quantum superpositions at the macroscopic scale, while giving practically the same predictions as quantum mechanics for microscopic systems. The Continuous Spontaneous Localization (CSL) model is the most refined and studied among collapse models. A well-known problem of this model, and of similar ones, is the steady and unlimited increase of the energy induced by the collapse noise. Here we present the dissipative version of the CSL model, which guarantees a finite energy during the entire system's evolution, thus making a crucial step toward a realistic energy-conserving collapse model. This is achieved by introducing a non-linear stochastic modification of the Schrödinger equation, which represents the action of a dissipative finite-temperature collapse noise. The possibility to introduce dissipation within collapse models in a consistent way will have relevant impact on the experimental investigations of the CSL model, and therefore also on the testability of the quantum superposition principle.

  14. Thriving in Partnership: Models for Continuing Education

    Science.gov (United States)

    Moroney, Peter; Boeck, Deena

    2012-01-01

    This article, based on a presentation at the University Professional and Continuing Education Association Annual Conference, March 29, 2012, provides concepts, terminology, and financial models for establishing and maintaining successful institutional partnerships. The authors offer it as a contribution to developing a wider understanding of the…

  15. A Unified Framework for Systematic Model Improvement

    DEFF Research Database (Denmark)

    Kristensen, Niels Rode; Madsen, Henrik; Jørgensen, Sten Bay

    2003-01-01

    A unified framework for improving the quality of continuous time models of dynamic systems based on experimental data is presented. The framework is based on an interplay between stochastic differential equation (SDE) modelling, statistical tests and multivariate nonparametric regression...

  16. The continuous improvement process and ergonomics in ultrasound department.

    Science.gov (United States)

    Coffin, Carolyn T

    2013-01-01

    Continuous improvement processes, such as Lean, Six Sigma and Quality Control Circles, have been implemented in the manufacturing industries in an effort to increase productivity, eliminate waste, and engage employees in problem solving. These processes can be adapted to the healthcare sector as medical facilities strive to improve the patient experience, increase financial returns, and improve worker safety and morale. In the ultrasound department, productivity can be improved and the quality of patient care can be ensured by standardizing exam protocols and decreasing work related musculoskeletal disorders among sonography professionals. This article summarizes the more commonly used continuous improvement processes and provides a description of how one method might be applied to the ultrasound department.

  17. Continuous utility factor in segregation models.

    Science.gov (United States)

    Roy, Parna; Sen, Parongama

    2016-02-01

    We consider the constrained Schelling model of social segregation in which the utility factor of agents strictly increases and nonlocal jumps of the agents are allowed. In the present study, the utility factor u is defined in a way such that it can take continuous values and depends on the tolerance threshold as well as the fraction of unlike neighbors. Two models are proposed: in model A the jump probability is determined by the sign of u only, which makes it equivalent to the discrete model. In model B the actual values of u are considered. Model A and model B are shown to differ drastically as far as segregation behavior and phase transitions are concerned. In model A, although segregation can be achieved, the cluster sizes are rather small. Also, a frozen state is obtained in which steady states comprise many unsatisfied agents. In model B, segregated states with much larger cluster sizes are obtained. The correlation function is calculated to show quantitatively that larger clusters occur in model B. Moreover for model B, no frozen states exist even for very low dilution and small tolerance parameter. This is in contrast to the unconstrained discrete model considered earlier where agents can move even when utility remains the same. In addition, we also consider a few other dynamical aspects which have not been studied in segregation models earlier.

  18. Concept Evaluation Using the PDSA Cycle for Continuous Quality Improvement.

    Science.gov (United States)

    Laverentz, Delois Meyer; Kumm, Sharon

    As concept-based nursing education gains popularity, there is little literature on how to sustain quality after initiation of the curriculum. Critical appraisal of concepts in a university program revealed varying definitions, attributes, and exemplars resulting in student confusion. The Plan, Do, Study, Act (PDSA) cycle for continuous quality improvement was used for concept evaluation. The goals of the evaluation project were: 1) to develop common definition and attributes for concepts and 2) to develop horizontal and vertical leveling of exemplars to build on prior student learning. The continuous quality improvement process can be used to prevent "concept creep" and ensure internal consistency of concept definitions, attributes, and exemplars.

  19. Continuous improvement comparison between Danish and Mexican companies

    DEFF Research Database (Denmark)

    Christiansen, Thomas Bøhm

    2004-01-01

    This article investigates continuous improvement tools that are used in two countries on two continents. For that purpose two surveys were conducted in the metropolitan area of Mexico City and in Denmark using the same scales and having about the same sample size. The continuous improvement tools...... comprise such concepts as TQM, Kaizen, Six Sigma and Lean Manufacturing. The paper shows the results of the analysis and a comparison of how and to what degree such tools are used in different places, which allow us to address similarities and dissimilarities of the application. The results are discussed...

  20. Agile kaizen managing continuous improvement far beyond retrospectives

    CERN Document Server

    Medinilla, Ángel

    2014-01-01

    Agile teams have been struggling with the concept of continuous improvement since the first Agile frameworks were developed, and still very little has been written about the practice of continuous improvement in Agile environments. Although team retrospectives have been prescribed and some practices have been introduced in order to implement and facilitate them, the truth is that most Agile teams are conducting dull retrospectives that end with a list of things that have been done wrong, just to repeat the same list two weeks later at the next meeting.Instead of listing hundreds of Japanese-la

  1. Design of launch systems using continuous improvement process

    Science.gov (United States)

    Brown, Richard W.

    1995-01-01

    The purpose of this paper is to identify a systematic process for improving ground operations for future launch systems. This approach is based on the Total Quality Management (TQM) continuous improvement process. While the continuous improvement process is normally identified with making incremental changes to an existing system, it can be used on new systems if they use past experience as a knowledge base. In the case of the Reusable Launch Vehicle (RLV), the Space Shuttle operations provide many lessons. The TQM methodology used for this paper will be borrowed from the United States Air Force 'Quality Air Force' Program. There is a general overview of the continuous improvement process, with concentration on the formulation phase. During this phase critical analyses are conducted to determine the strategy and goals for the remaining development process. These analyses include analyzing the mission from the customers point of view, developing an operations concept for the future, assessing current capabilities and determining the gap to be closed between current capabilities and future needs and requirements. A brief analyses of the RLV, relative to the Space Shuttle, will be used to illustrate the concept. Using the continuous improvement design concept has many advantages. These include a customer oriented process which will develop a more marketable product and a better integration of operations and systems during the design phase. But, the use of TQM techniques will require changes, including more discipline in the design process and more emphasis on data gathering for operational systems. The benefits will far outweigh the additional effort.

  2. Applying PPM to ERP Maintenance and Continuous Improvement Initiatives

    DEFF Research Database (Denmark)

    El-Tal, Nada Maria; Fonnesbæk, Majbrit; Kræmmergaard, Pernille

    2006-01-01

    Enterprise Resource Planning Systems (ERP) has been implemented in many companies during the last decade and has gained an increasing significance. For many companies it means that the focus is no longer on how to implement the ERP system, but rather on how to maintain and improve the system...... are to prioritize and select maintenance and continuous improvement initiatives. This is done by reviewing the existing literature in the fields of PPM from R&D literature and then by reviewing the existing literature about maintenance and improvement initiatives in the ERP literature, after which the two...... are compared and discussed using three case-studies. The paper contributes with a discussion on how PPM from R&D can be applied to maintenance and continuous improvement initiatives in the second wave of ERP. The paper ends with arguing that emphasis needs to be given to this field, since a conscious...

  3. Continuous quality improvement program for hip and knee replacement.

    Science.gov (United States)

    Marshall, Deborah A; Christiansen, Tanya; Smith, Christopher; Squire Howden, Jane; Werle, Jason; Faris, Peter; Frank, Cy

    2015-01-01

    Improving quality of care and maximizing efficiency are priorities in hip and knee replacement, where surgical demand and costs increase as the population ages. The authors describe the integrated structure and processes from the Continuous Quality Improvement (CQI) Program for Hip and Knee Replacement Surgical Care and summarize lessons learned from implementation. The Triple Aim framework and 6 dimensions of quality care are overarching constructs of the CQI program. A validated, evidence-based clinical pathway that measures quality across the continuum of care was adopted. Working collaboratively, multidisciplinary experts embedded the CQI program into everyday practices in clinics across Alberta. Currently, 83% of surgeons participate in the CQI program, representing 95% of the total volume of hip and knee surgeries. Biannual reports provide feedback to improve care processes, infrastructure planning, and patient outcomes. CQI programs evaluating health care services inform choices to optimize care and improve efficiencies through continuous knowledge translation. © The Author(s) 2014.

  4. A stochastic surplus production model in continuous time

    DEFF Research Database (Denmark)

    Pedersen, Martin Wæver; Berg, Casper Willestofte

    2017-01-01

    surplus production model in continuous time (SPiCT), which in addition to stock dynamics also models the dynamics of the fisheries. This enables error in the catch process to be reflected in the uncertainty of estimated model parameters and management quantities. Benefits of the continuous-time state......Surplus production modelling has a long history as a method for managing data-limited fish stocks. Recent advancements have cast surplus production models as state-space models that separate random variability of stock dynamics from error in observed indices of biomass. We present a stochastic...... and improve estimation of reference points relative to discrete-time analysis of aggregated annual data. Finally, subannual data from five North Sea stocks are analysed with particular focus on using residual analysis to diagnose model insufficiencies and identify necessary model extensions such as robust...

  5. From Continuous Improvement to Organisational Learning: Developmental Theory.

    Science.gov (United States)

    Murray, Peter; Chapman, Ross

    2003-01-01

    Explores continuous improvement methods, which underlie total quality management, finding barriers to implementation in practice that are related to a one-dimensional approach. Suggests a multiple, unbounded learning cycle, a holistic approach that includes adaptive learning, learning styles, generative learning, and capability development.…

  6. Infrastructure under construction: continuous improvement and learning in projects

    NARCIS (Netherlands)

    Gieskes, J.F.B.; ten Broeke, André M.

    2000-01-01

    Continuous improvement and learning are popular concepts in management literature and practice. Often they are situated in an environment where the work is of a repetitive nature. However, there are a lot of organisations where (part of) the primary processes are carried out by means of projects. An

  7. Continuous Process Improvement at Tinker Air Logistics Complex

    Science.gov (United States)

    2013-03-01

    assembly line work. Continuous improvement through the use of the Plan, Do, Check, Act ( PDCA ) cycle proposed by Deming became essential to the...Plan Do Check Act ( PDCA ) cycle (Deming, 1982), to create standards capturing new knowledge ensures that the organization learns as well (Liker J. K

  8. Continuous restraint control systems: safety improvement for various occupants

    NARCIS (Netherlands)

    Laan, E. van der; Jager, B. de; Veldpaus, F.; Steinbuch, M.; Nunen, E. van; Willemsen, D.

    2009-01-01

    Occupant safety can be significantly improved by continuous restraint control systems. These restraint systems adjust their configuration during the impact according to the actual operating conditions, such as occupant size, weight, occupant position, belt usage and crash severity. In this study,

  9. Behavioural dynamics in high-performing continuous improvement teams

    NARCIS (Netherlands)

    van Dun, Desirée Hermina; van Eck, Tim; van Vuuren, Hubrecht A.; Wilderom, Celeste P.M.

    2011-01-01

    We have explored from an Organisational-Behavioural perspective, why a Continuous Improvement (CI) team performs well. We report on the first part of a longitudinal study on intra-team behaviour of five, carefully selected, high-performing CI teams in five major Dutch organizations. Not only did we

  10. Fault diagnosis based on continuous simulation models

    Science.gov (United States)

    Feyock, Stefan

    1987-01-01

    The results are described of an investigation of techniques for using continuous simulation models as basis for reasoning about physical systems, with emphasis on the diagnosis of system faults. It is assumed that a continuous simulation model of the properly operating system is available. Malfunctions are diagnosed by posing the question: how can we make the model behave like that. The adjustments that must be made to the model to produce the observed behavior usually provide definitive clues to the nature of the malfunction. A novel application of Dijkstra's weakest precondition predicate transformer is used to derive the preconditions for producing the required model behavior. To minimize the size of the search space, an envisionment generator based on interval mathematics was developed. In addition to its intended application, the ability to generate qualitative state spaces automatically from quantitative simulations proved to be a fruitful avenue of investigation in its own right. Implementations of the Dijkstra transform and the envisionment generator are reproduced in the Appendix.

  11. Organisational learning: A tool for continuous improvement of the organization

    International Nuclear Information System (INIS)

    Santos, J. L.; Esteban, M. J.

    2013-01-01

    We are used to hear a success company in today's world is not possible unless a continuous improvement is developed. How can we be successful in the nuclear plant? We have to achieve safety for workers, people and environment in the first step, and for the second step availability and reliability for systems and components to avoid failure of components that could reduce availability. The aim is to search for new measures to reach this way. One of the improvements implemented in the plants to improve continuously was mainly Operating Experience activities, which was based in event analysis in the plants, causes identification, and to implement corrective actions. For External Operating Experience the aim was to learn from others to avoid occurrence of events in our plants. This was the lessons learned from Three Mile Island event. This was the learning process implemented so far, to get a continuous improvement. So far, the developed capabilities for process improvement follow the Operating Experience process that could be considered classical and will be revitalized nowadays. (Author)

  12. Multidisciplinary Prerounding Meeting as a Continuous Quality Improvement Tool: Leveraging to Reduce Continuous Benzodiazepine Use at an Academic Medical Center.

    Science.gov (United States)

    Flannery, Alexander H; Thompson Bastin, Melissa L; Montgomery-Yates, Ashley; Hook, Corrine; Cassity, Evan; Eaton, Phillip M; Morris, Peter E

    2018-01-01

    Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization. This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period. A morning multidisciplinary prerounding meeting was implemented to report on metrics required to establish a dashboard for MICU care for the previous 24 hours. Fellows and nurse practitioners on respective teams reported on key quality metrics and other important data related to patient census. Continuous benzodiazepines were tracked daily as the number of patients per team who had orders for a continuous benzodiazepine infusion. The aim of this report is to describe the development of the morning multidisciplinary prerounding meeting and its impact on continuous benzodiazepine use, along with associated clinical outcomes. The median number of patients prescribed a continuous benzodiazepine daily decreased over this time period and demonstrated a sustained reduction at 1 year. Furthermore, sedation scores improved, corresponding to a reduction in median duration of mechanical ventilation. The effectiveness of this intervention was mapped post hoc to conceptual models used in implementation science. A brief multidisciplinary meeting to review select data points prior to morning rounds establishes mechanisms for continuous quality improvement and may serve as a mediating factor for successful implementation when initiating and monitoring practice change in the ICU.

  13. IMHEX fuel cell repeat component manufacturing continuous improvement accomplishments

    Energy Technology Data Exchange (ETDEWEB)

    Jakaitis, L.A.; Petraglia, V.J.; Bryson, E.S. [M-C Power Corp., Burr Ridge, IL (United States)] [and others

    1996-12-31

    M-C Power is taking a power generation technology that has been proven in the laboratory and is making it a commercially competitive product. There are many areas in which this technology required scale up and refinement to reach the market entry goals for the IMHEX{reg_sign} molten carbonate fuel cell power plant. One of the primary areas that needed to be addressed was the manufacturing of the fuel cell stack. Up to this point, the fuel cell stack and associated components were virtually hand made for each system to be tested. M-C Power has now continuously manufactured the repeat components for three 250 kW stacks. M-C Power`s manufacturing strategy integrated both evolutionary and revolutionary improvements into its comprehensive commercialization effort. M-C Power`s objectives were to analyze and continuously improve stack component manufacturing and assembly techniques consistent with established specifications and commercial scale production requirements. Evolutionary improvements are those which naturally occur as the production rates are increased and experience is gained. Examples of evolutionary (learning curve) improvements included reducing scrap rates and decreasing raw material costs by buying in large quantities. Revolutionary improvements result in significant design and process changes to meet cost and performance requirements of the market entry system. Revolutionary changes often involve identifying new methods and developing designs to accommodate the new process. Based upon our accomplishments, M-C Power was able to reduce the cost of continuously manufactured fuel cell repeat components from the first to third 250 kW stack by 63%. This paper documents the continuous improvement accomplishments realized by M-C Power during IMHEX{reg_sign} fuel cell repeat component manufacturing.

  14. Developing a Forensic Continuous Audit Model

    Directory of Open Access Journals (Sweden)

    Grover S. Kearns

    2011-06-01

    Full Text Available Despite increased attention to internal controls and risk assessment, traditional audit approaches do not seem to be highly effective in uncovering the majority of frauds. Less than 20 percent of all occupational frauds are uncovered by auditors. Forensic accounting has recognized the need for automated approaches to fraud analysis yet research has not examined the benefits of forensic continuous auditing as a method to detect and deter corporate fraud. The purpose of this paper is to show how such an approach is possible. A model is presented that supports the acceptance of forensic continuous auditing by auditors and management as an effective tool to support the audit function, meet management’s regulatory objectives, and to combat fraud. An approach to developing such a system is presented.

  15. Continuous improvement in the Netherlands: A survey-based study into the current practices of continuous improvement

    NARCIS (Netherlands)

    Middel, H.G.A.; op de Weegh, S.; Gieskes, J.F.B.; Schuring, R.W.

    2004-01-01

    Continuous Improvement is a well-known and consolidated concept in literature and practice and is considered vital in today¿s business environment. In 2003 a survey, as part of the international CINet survey, has been performed in the Netherlands in order to gain insight into the current practices

  16. Continuous Improvement in Education. Advancing Teaching--Improving Learning. White Paper

    Science.gov (United States)

    Park, Sandra; Hironaka, Stephanie; Carver, Penny; Nordstrum, Lee

    2013-01-01

    In recent years, "continuous improvement" has become a popular catchphrase in the field of education. However, while continuous improvement has become commonplace and well-documented in other industries, such as healthcare and manufacturing, little is known about how this work has manifested itself in education. This white paper attempts…

  17. Successful integration of ergonomics into continuous improvement initiatives.

    Science.gov (United States)

    Monroe, Kimberly; Fick, Faye; Joshi, Madina

    2012-01-01

    Process improvement initiatives are receiving renewed attention by large corporations as they attempt to reduce manufacturing costs and stay competitive in the global marketplace. These initiatives include 5S, Six Sigma, and Lean. These programs often take up a large amount of available time and budget resources. More often than not, existing ergonomics processes are considered separate initiatives by upper management and struggle to gain a seat at the table. To effectively maintain their programs, ergonomics program managers need to overcome those obstacles and demonstrate how ergonomics initiatives are a natural fit with continuous improvement philosophies.

  18. Improved USGS methodology for assessing continuous petroleum resources

    Science.gov (United States)

    Charpentier, Ronald R.; Cook, Troy A.

    2010-01-01

    This report presents an improved methodology for estimating volumes of continuous (unconventional) oil and gas resources within the United States and around the world. The methodology is based on previously developed U.S. Geological Survey methodologies that rely on well-scale production data. Improvements were made primarily to how the uncertainty about estimated ultimate recoveries is incorporated in the estimates. This is particularly important when assessing areas with sparse or no production data, because the new methodology allows better use of analog data from areas with significant discovery histories.

  19. Continued SOFC cell and stack technology and improved production methods

    Energy Technology Data Exchange (ETDEWEB)

    Wandel, M.; Brodersen, K.; Phair, J. (and others)

    2009-05-15

    Within this project significant results are obtained on a number of very diverse areas ranging from development of cell production, metallic creep in interconnect to assembling and test of stacks with foot print larger than 500 cm2. Out of 38 milestones 28 have been fulfilled and 10 have been partly fulfilled. This project has focused on three main areas: 1) The continued cell development and optimization of manufacturing processes aiming at production of large foot-print cells, improving cell performance and development environmentally more benign production methods. 2) Stack technology - especially stacks with large foot print and improving the stack design with respect to flow geometry and gas leakages. 3) Development of stack components with emphasis on sealing (for 2G as well as 3G), interconnect (coat, architecture and creep) and test development. Production of cells with a foot print larger than 500 cm2 is very difficult due to the brittleness of the cells and great effort has been put into this topic. Eight cells were successfully produced making it possible to assemble and test a real stack thereby giving valuable results on the prospects of stacks with large foot print. However, the yield rate is very low and a significant development to increase this yield lies ahead. Several lessons were learned on the stack level regarding 'large foot print' stacks. Modelling studies showed that the width of the cell primarily is limited by production and handling of the cell whereas the length (in the flow direction) is limited by e.g. pressure drop and necessary manifolding. The optimal cell size in the flow direction was calculated to be between approx20 cm and < 30 cm. From an economical point of view the production yield is crucial and stacks with large foot print cell area are only feasible if the cell production yield is significantly enhanced. Co-casting has been pursued as a production technique due to the possibilities in large scale production

  20. Improving Our Odds: Success through Continuous Risk Management

    Science.gov (United States)

    Greenhalgh, Phillip O.

    2009-01-01

    Launching a rocket, running a business, driving to work and even day-to-day living all involve some degree of risk. Risk is ever present yet not always recognized, adequately assessed and appropriately mitigated. Identification, assessment and mitigation of risk are elements of the risk management component of the "continuous improvement" way of life that has become a hallmark of successful and progressive enterprises. While the application of risk management techniques to provide continuous improvement may be detailed and extensive, the philosophy, ideals and tools can be beneficially applied to all situations. Experiences with the use of risk identification, assessment and mitigation techniques for complex systems and processes are described. System safety efforts and tools used to examine potential risks of the Ares I First Stage of NASA s new Constellation Crew Launch Vehicle (CLV) presently being designed are noted as examples. Recommendations from lessons learned are provided for the application of risk management during the development of new systems as well as for the improvement of existing systems. Lessons learned and suggestions given are also examined for applicability to simple systems, uncomplicated processes and routine personal daily tasks. This paper informs the reader of varied uses of risk management efforts and techniques to identify, assess and mitigate risk for improvement of products, success of business, protection of people and enhancement of personal life.

  1. Paths to continuous improvement of a CRM strategy

    Directory of Open Access Journals (Sweden)

    Lluís G. Renart

    2008-07-01

    Full Text Available The concept of relationship marketing has led to a paradigm change in marketing. Over the last few decades, numerous studies have analyzed the impact of customer relationship management (CRM programs on customer satisfaction and loyalty. Quite a few CRM programs have been found to have little or no impact. Having already published several articles and cases on the subject, in this paper we set out to answer the following question: assuming a company already has a reasonably successful CRM strategy in place, how can it continuously adapt and improve that strategy? Our recommendation is that such companies implement a continuous improvement process at four different but complementary levels: first, review and reinforce the company’s mission, culture and values; second, reconsider and, if necessary, redesign the CRM strategy; third, manage the various relationship-building activities more effectively; and lastly, review and, if necessary, improve the quality of material and human resources, program execution and process governance. A systematic review of these four levels or “paths” of improvement should help generate and maintain high quality relationships over time.

  2. How to Sustain Change and Support Continuous Quality Improvement.

    Science.gov (United States)

    Silver, Samuel A; McQuillan, Rory; Harel, Ziv; Weizman, Adam V; Thomas, Alison; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T; Chertow, Glenn M

    2016-05-06

    To achieve sustainable change, quality improvement initiatives must become the new way of working rather than something added on to routine clinical care. However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement. Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles. Process control and performance boards are methods to communicate improvement results to staff and leadership. Standard work is a written or visual outline of current best practices for a task and provides a framework to ensure that changes that have improved patient care are consistently and reliably applied to every patient encounter. Improvement huddles are short, regular meetings among staff to anticipate problems, review performance, and support a culture of improvement. Many of these tools rely on principles of visual management, which are systems transparent and simple so that every staff member can rapidly distinguish normal from abnormal working conditions. Even when quality improvement methods are properly applied, the success of a project still depends on contextual factors. Context refers to aspects of the local setting in which the project operates. Context affects resources, leadership support, data infrastructure, team motivation, and team performance. For these reasons, the same project may thrive in a supportive context and fail in a different context. To demonstrate the practical applications of these quality improvement principles, these principles are

  3. Compression planning for continuous improvement in quality programs

    International Nuclear Information System (INIS)

    Willis, Y.A.; Hood, F.C.

    1992-01-01

    This paper describes Compression Planning, an innovative approach for planning in groups. This participative and structured approach is especially suitable for technical and highly regulated organizations. Compression Planning was applied to the first organization-wide effort at training integration for regulatory compliance, at Battelle Pacific Northwest Laboratory (PNL), a multi-program national laboratory. The planning process was judged as measurably superior to PNL's customary planning. Within 10 days a training policy was issued and an action plan drafted. The participants produced a report identifying and prioritizing 33 key training issues; began to data gather and solicit input from personnel Lab-wide, producing a 2-volume training inventory; and formulated 14 recommendations for implementation. Two years later the plan is still evolving, as PNL training continues to develop, consistent with Continuous Improvement Process objectives

  4. Risk reduction and TQM: A corporate culture of continuous improvement

    International Nuclear Information System (INIS)

    Nau, D.C.

    1992-01-01

    A company supplying products and services to the nuclear industry that implements a cultural commitment to continuous improvement, in addition to providing higher quality products and services, also represents a significant reduction in operational risk to that industry. The implementation of a culture of total quality management (TQM), initiated by Sorrento Electronics (SE) in 1989, involves total commitment to the basic TQM principles: continuous improvement, people performing the work are the best sources of how to do it better, and employees must be empowered to make the improvements. What this means to the nuclear industry is a significant reduction in operational risk through: (1) products based on simpler, standardized, proven designs with established operational track records, enhancing confidence that they will perform as expected; (2) the highest confidence that products and supporting documentation are delivered with zero defects; (3) critical power plant schedules can be supported through the shortest possible equipment delivery times; (4) highly motivated employees with extremely positive attitudes, working together in cross-functional teams, virtually eliminate the possibility of deliberate product tampering or sabotage

  5. R and D techniques and how to continuously improve them?

    International Nuclear Information System (INIS)

    Massaut, V.; Collard, G.

    2005-01-01

    Although decommissioning of nuclear installations has been carried out successfully in different countries, and decommissioning is sometimes considered as a mature industrial activity, Research and Development can still improve the operations, and is also needed to keep the current know how. The research and development can bring reduction of costs, limitation of radioactive waste generation, and improve the safety and radioprotection aspects. When one consider that less than 100 facilities are currently in decommissioning for more than 800 reactors (power plants and research reactors, almost half and half) worldwide, the present used technology can be considered as the prehistory of D and D. The paper will focus on the needs for improvements and developments, on the attached constraints and restriction, and will then look at the potential ways to continue R and D and technology improvement. Regarding the rather recent development of the D and D technology and the large remaining market for D and D of nuclear installations, there is still a large field of open development for techniques and technologies for the dismantling of nuclear installations worldwide. Although D and D of all kinds of nuclear installations have proven to be feasible, improvements are surely needed to reduce the costs and waste of D and D, therefore reducing the burden to the plant owners, and to improve the radioprotection of the operations. The same applies for the improvement of the overall operators safety during such operations. There are different ways to go in this direction and the groups to gather the necessary experience and technological data are existing, but the will has to be present to go forward, in a competitive environment. It is difficult to believe that such improvements in the technologies and the approach of decommissioning can rely only on commercial and private initiatives. Therefore, organized international R and D should be promoted wherever it is possible, enhancing

  6. Modeling plasticity by non-continuous deformation

    Science.gov (United States)

    Ben-Shmuel, Yaron; Altus, Eli

    2017-10-01

    Plasticity and failure theories are still subjects of intense research. Engineering constitutive models on the macroscale which are based on micro characteristics are very much in need. This study is motivated by the observation that continuum assumptions in plasticity in which neighbour material elements are inseparable at all-time are physically impossible, since local detachments, slips and neighbour switching must operate, i.e. non-continuous deformation. Material microstructure is modelled herein by a set of point elements (particles) interacting with their neighbours. Each particle can detach from and/or attach with its neighbours during deformation. Simulations on two- dimensional configurations subjected to uniaxial compression cycle are conducted. Stochastic heterogeneity is controlled by a single "disorder" parameter. It was found that (a) macro response resembles typical elasto-plastic behaviour; (b) plastic energy is proportional to the number of detachments; (c) residual plastic strain is proportional to the number of attachments, and (d) volume is preserved, which is consistent with macro plastic deformation. Rigid body displacements of local groups of elements are also observed. Higher disorder decreases the macro elastic moduli and increases plastic energy. Evolution of anisotropic effects is obtained with no additional parameters.

  7. Framework for continuous performance improvement in small drinking water systems.

    Science.gov (United States)

    Bereskie, Ty; Haider, Husnain; Rodriguez, Manuel J; Sadiq, Rehan

    2017-01-01

    Continuous performance improvement (CPI) can be a useful approach to overcome water quality problems impacting small communities. Small drinking water systems (SDWSs) struggle to meet regulatory requirements and often lack the economic and human resource flexibility for immediate improvement. A CPI framework is developed to provide SDWS managers and operators an approach to gauge their current performance against similar systems and to track performance improvement from the implementation of the new technologies or innovations into the future. The proposed CPI framework incorporates the use of a water quality index (WQI) and functional performance benchmarking to evaluate and compare drinking water quality performance of an individual water utility against that of a representative benchmark. The results are then used to identify and prioritize the most vulnerable water quality indicators and subsequently identify and prioritize performance improvement strategies. The proposed CPI framework has been demonstrated using data collected from SDWSs in the province of Newfoundland and Labrador (NL), Canada and using the Canadian Council of Ministers of the Environment (CCME) WQI. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. Performance indicators: A tool for continuous quality improvement

    Directory of Open Access Journals (Sweden)

    Nidhi M Bhatnagar

    2016-01-01

    Full Text Available Background: Performance monitoring is an important tool which can be used for setting priorities for process improvement. At our centre, we have been monitoring every step in the processes, right from inventory of consumables (both critical and routine to number of donors reactive for TTI. We conducted a study to measure the impact of monitoring Performance Indicators and how it could be used as a tool for Continuous Quality Improvement (CQI. Materials and Methods: The present study was a retrospective study where the performance indicator (PI data of blood bank was analyzed for over four years. For certain parameters, benchmarks or thresholds were set that represented warning limits or action limits. The yearly data were collated from monthly data. "Shifts" or "Trends", if any, were identified and Corrective and Preventive Action (CAPA taken accordingly. At the end, outcomes of the analysis were charted. Results: After the yearly data evaluation, outcomes obtained were used to plan, correct and amend processes and systems in the blood center. It was observed that the workload of the center showed an upward trend. This helped us to plan for the purchase of consumables and management of manpower. The monitoring of usage and discard of blood helped in the efficient management of blood stocks. The need for any new equipment could also be judged by the trends in workload. Conclusion: Performance indicators are indispensible tools which various stakeholders in the Blood Transfusion centres should implement to improve on quality performance.

  9. Performance indicators: A tool for continuous quality improvement.

    Science.gov (United States)

    Bhatnagar, Nidhi M; Soni, Shital; Gajjar, Maitrey; Shah, Mamta; Shah, Sangita; Patel, Vaidehi

    2016-01-01

    Performance monitoring is an important tool which can be used for setting priorities for process improvement. At our centre, we have been monitoring every step in the processes, right from inventory of consumables (both critical and routine) to number of donors reactive for TTI. We conducted a study to measure the impact of monitoring Performance Indicators and how it could be used as a tool for Continuous Quality Improvement (CQI). The present study was a retrospective study where the performance indicator (PI) data of blood bank was analyzed for over four years. For certain parameters, benchmarks or thresholds were set that represented warning limits or action limits. The yearly data were collated from monthly data. Shifts or Trends, if any, were identified and Corrective and Preventive Action (CAPA) taken accordingly. At the end, outcomes of the analysis were charted. After the yearly data evaluation, outcomes obtained were used to plan, correct and amend processes and systems in the blood center. It was observed that the workload of the center showed an upward trend. This helped us to plan for the purchase of consumables and management of manpower. The monitoring of usage and discard of blood helped in the efficient management of blood stocks. The need for any new equipment could also be judged by the trends in workload. Performance indicators are indispensible tools which various stakeholders in the Blood Transfusion centres should implement to improve on quality performance.

  10. Improving continuing medical education by enhancing interactivity: lessons from Iran.

    Science.gov (United States)

    Faghihi, Seyed Aliakbar; Khankeh, Hamid Reza; Hosseini, Seyed Jalil; Soltani Arabshahi, Seyed Kamran; Faghih, Zahra; Parikh, Sagar V; Shirazi, Mandana

    2016-04-01

    Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. The participants' experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers' use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME.

  11. Innovative Outcome Assessment in Graduate Business Education and Continuous Improvement

    Directory of Open Access Journals (Sweden)

    Chattopadhyay Satya P.

    2014-11-01

    Full Text Available The changed environment of global economy with painful austerity and restructuring measures causing severe economic dislocations in many diverse parts of the world have brought into focus the usefulness and value of management education in general and graduate management education in particular. The various accrediting bodies in America, Europe and Asia in recent years have shifted their emphasis to ensuring that learning outcomes of students in the program are tied to the goals and missions of the academic institution and meet the needs of the external partners of the academic enterprise that the students go on to serve. This has resulted in rapid advances in the field of innovative outcome assessment, and measurement of competency in performing higher order tasks as well as demonstration of traits related to successful transition into the business world and contribution to the success of the enterprise where the students are employed. The mere assessment/measurement of traits is not the end, but rather the first step in the cycle of continuous improvement in the tradition of the Plan-Do-Study-Act tradition of TQM. The goal is to identify shortcomings or opportunities for improvement via the assessment process and then to “close the loop” by introducing planned changes to improve system performance.

  12. Quantitative research versus quality assurance, quality improvement, total quality management, and continuous quality improvement.

    Science.gov (United States)

    Vogelsang, J

    1999-04-01

    The purpose of this report is to provide a review of the scientific method used in the quantitative research studies for consumers, evaluators, and applied nurse researchers. The fundamental characteristics of the problem-solving/ performance-improvement processes of quality assurance, quality improvement, total quality management, and continuous quality improvement are described. Research is compared with these processes, and is followed by a discussion about the publication of quantitative research findings.

  13. Economy of Force: Continuous Process Improvement And The Air Service

    Science.gov (United States)

    2017-06-01

    Process Improvement,” and Harold Linnean III with his thesis, “Air Force Smart Operations for the Twenty-first Century : Identifying Potential...models throughout AF existence—Management By Objectives, Total Quality Management, Quality Air Force, Air Force Smart Operations for the 21st Century ...all, one of the chief customers of the Air Force is the American public. Chapter Outline The chapter structure of this thesis is intended to take

  14. Improving prehospital trauma care in Rwanda through continuous quality improvement: an interrupted time series analysis.

    Science.gov (United States)

    Scott, John W; Nyinawankusi, Jeanne D'Arc; Enumah, Samuel; Maine, Rebecca; Uwitonze, Eric; Hu, Yihan; Kabagema, Ignace; Byiringiro, Jean Claude; Riviello, Robert; Jayaraman, Sudha

    2017-07-01

    Injury is a major cause of premature death and disability in East Africa, and high-quality pre-hospital care is essential for optimal trauma outcomes. The Rwandan pre-hospital emergency care service (SAMU) uses an electronic database to evaluate and optimize pre-hospital care through a continuous quality improvement programme (CQIP), beginning March 2014. The SAMU database was used to assess pre-hospital quality metrics including supplementary oxygen for hypoxia (O2), intravenous fluids for hypotension (IVF), cervical collar placement for head injuries (c-collar), and either splinting (splint) or administration of pain medications (pain) for long bone fractures. Targets of >90% were set for each metric and daily team meetings and monthly feedback sessions were implemented to address opportunities for improvement. These five pre-hospital quality metrics were assessed monthly before and after implementation of the CQIP. Met and unmet needs for O2, IVF, and c-collar were combined into a summative monthly SAMU Trauma Quality Scores (STQ score). An interrupted time series linear regression model compared the STQ score during 14 months before the CQIP implementation to the first 14 months after. During the 29-month study period 3,822 patients met study criteria. 1,028 patients needed one or more of the five studied interventions during the study period. All five endpoints had a significant increase between the pre-CQI and post-CQI periods (pimprovement of +6.1% (p=0.017) and sustained monthly improvements in care delivery-improving at a rate of 0.7% per month (p=0.028). The SAMU experience demonstrates the utility of a responsive, data-driven quality improvement programme to yield significant immediate and sustained improvements in pre-hospital care for trauma in Rwanda. This programme may be used as an example for additional efforts engaging frontline staff with real-time data feedback in order to rapidly translate data collection efforts into improved care for the

  15. Development of the Continued Improvement System for Nuclear Safety Culture

    International Nuclear Information System (INIS)

    Park, H. C.; Park, H. G.; Park, Y. W.; Park, J. Y.

    2016-01-01

    It has been found that almost 80 % of the incidents and accidents occurred recently, such as the Fukushima Daiichi disaster and Domestic SBO accident etc. were analyzed to be caused from human errors. (IAEA NES NG-G-2.1) Which strongly claims the importance of the safety culture system. Accordingly, it should be away from a cursory approach like one-off field survey or Snap shop which were being conducted at present for the continued improvement of safety culture. This study introduces an analytical methodology which approaches the generic form of the safety both consciously and unconsciously expressed with behavior, thoughts, and attitude etc. This study was implemented only for open materials such as Inspection report, incidents and accidents reports, QA documents because of the limitation in accessibility to data. More effective use with securing operational data will be possible in future

  16. Pump Early, Pump Often: A Continuous Quality Improvement Project.

    Science.gov (United States)

    Spatz, Diane L; Froh, Elizabeth B; Schwarz, Jessica; Houng, Kathy; Brewster, Isabel; Myers, Carey; Prince, Judy; Olkkola, Michelle

    2015-01-01

    Research demonstrates that although many mothers initiate pumping for their critically ill children, few women are successful at maintaining milk supply throughout their infants' entire hospital stay. At the Garbose Family Special Delivery Unit (SDU) at the Children's Hospital of Philadelphia, we care for mothers who have critically ill infants born with complex cardiac and congenital anomalies. Human milk is viewed as a medical intervention at our institution. Therefore, nurses on the SDU wanted to ensure best practice in terms of pumping initiation. This article describes a continuous quality improvement project that ensured mothers pumped early and often. Childbirth educators can play a key role in preparing mothers who are anticipating an infant who will require hospitalization immediately post-birth.

  17. Determination Effective Elements of Continuing Interprofessional Education Models

    OpenAIRE

    Leila Safabakhsh; Alireza Irajpour; Nikoo Yamani

    2017-01-01

    Background: Traditional continuing education (CE) approaches have limited impact on patient management and outcomes. Continuing interprofessional education is an innovated educational approach that can improve patient care and outcomes related to health care. There is a need to provide guidance to continuing education professionals in the development, implementation, and evaluation of continuing interprofessional education activities. Objectives: This study attempted to identity effective ele...

  18. Computer Aided Continuous Time Stochastic Process Modelling

    DEFF Research Database (Denmark)

    Kristensen, N.R.; Madsen, Henrik; Jørgensen, Sten Bay

    2001-01-01

    A grey-box approach to process modelling that combines deterministic and stochastic modelling is advocated for identification of models for model-based control of batch and semi-batch processes. A computer-aided tool designed for supporting decision-making within the corresponding modelling cycle...

  19. Improving continuing medical education by enhancing interactivity: lessons from Iran

    Directory of Open Access Journals (Sweden)

    SEYED ALIAKBAR FAGHIHI

    2016-04-01

    Full Text Available Introduction: Continuing Medical Education (CME has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. Methods: Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. Results: The participants’ experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers’ use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. Conclusion: Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME.

  20. Factors Influencing Team Performance in a Continuous Quality Improvement Process in the Wisconsin Technical College System

    Science.gov (United States)

    Pietz, Victoria Lynn

    2014-01-01

    Continuous Quality Improvement (CQI) programs are growing in popularity in higher education settings and a key component is the use of work groups, which require active employee involvement. The problem addressed in this research was the lack of employee engagement in the Quality Review Process (QRP), which is a statewide CQI model developed by…

  1. Implementing a customer focused continual business improvement program to improve the maintenance process

    International Nuclear Information System (INIS)

    Kharshafdjian, G.; Fisher, C.; Beres, T.; Brooks, S.; Forbes, S.; Krause, M.; McAuley, K.; Wendorf, M.

    2006-01-01

    Global market pressures and increasing competition demands that successful companies establish a continual business improvement program as part of implementing its business strategy. Such programs must be driven by the definition of quality from the customer's perspective. This customer quality focus often requires a change in all aspects of the business including products, services, processes and culture. This paper will describe how Atomic Energy of Canada Limited implemented a Continual Business Improvement Program in their Nuclear Laboratories Business Unit. In particular, to review how the techniques were applied to improve the maintenance process and the status of the project. Customer (internal users of the processes at CRL) feedback has shown repeatedly there is dissatisfaction of the maintenance process. Customers complain about jobs not getting done to schedule or being deferred. A project has been launched with the following goals: to improve the maintenance process customer satisfaction and increase trades wrench time by 30 minutes / trade / day. DMAIC (Define-Measure-Analyze-Improve-Control) methodology was applied to find out the Root Cause(s) of the problem, provide solutions, and implement improvements. The expected Operational Benefits include: Executing work efficiently to quality standards and business performance of the site, improve maintenance efficiencies, reduce cycle time for maintenance process and improve process yield, and improve customer and employee satisfaction. (author)

  2. Continuous quality improvement in nephrology: a systematic review.

    Science.gov (United States)

    Nunes, Julie Wright; Seagull, F Jacob; Rao, Panduranga; Segal, Jonathan H; Mani, Nandita S; Heung, Michael

    2016-11-24

    Continuous quality improvement (CQI) has been successfully applied in business and engineering for over 60 years. While using CQI techniques within nephrology has received increased attention, little is known about where, and with what measure of success, CQI can be attributed to improving outcomes within nephrology care. This is particularly important as payors' focus on value-based healthcare and reimbursement is tied to achieving quality improvement thresholds. We conducted a systematic review of CQI applications in nephrology. Studies were identified from PubMed, MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar, ProQuest Dissertation Abstracts and sources of grey literature (i.e., available in print/electronic format but not controlled by commercial publishers) between January 1, 2004 and October 13, 2014. We developed a systematic evaluation protocol and pre-defined criteria for review. All citations were reviewed by two reviewers with disagreements resolved by consensus. We initially identified 468 publications; 40 were excluded as duplicates or not available/not in English. An additional 352 did not meet criteria for full review due to: 1. Not meeting criteria for inclusion = 196 (e.g., reviews, news articles, editorials) 2. Not nephrology-specific = 153, 3. Only available as abstracts = 3. Of 76 publications meeting criteria for full review, the majority [45 (61%)] focused on ESRD care. 74% explicitly stated use of specific CQI tools in their methods. The highest number of publications in a given year occurred in 2011 with 12 (16%) articles. 89% of studies were found in biomedical and allied health journals and most studies were performed in North America (52%). Only one was randomized and controlled although not blinded. Despite calls for healthcare reform and funding to inspire innovative research, we found few high quality studies either rigorously evaluating the use of CQI in nephrology or reporting best practices. More rigorous

  3. Benchmarking: a method for continuous quality improvement in health.

    Science.gov (United States)

    Ettorchi-Tardy, Amina; Levif, Marie; Michel, Philippe

    2012-05-01

    Benchmarking, a management approach for implementing best practices at best cost, is a recent concept in the healthcare system. The objectives of this paper are to better understand the concept and its evolution in the healthcare sector, to propose an operational definition, and to describe some French and international experiences of benchmarking in the healthcare sector. To this end, we reviewed the literature on this approach's emergence in the industrial sector, its evolution, its fields of application and examples of how it has been used in the healthcare sector. Benchmarking is often thought to consist simply of comparing indicators and is not perceived in its entirety, that is, as a tool based on voluntary and active collaboration among several organizations to create a spirit of competition and to apply best practices. The key feature of benchmarking is its integration within a comprehensive and participatory policy of continuous quality improvement (CQI). Conditions for successful benchmarking focus essentially on careful preparation of the process, monitoring of the relevant indicators, staff involvement and inter-organizational visits. Compared to methods previously implemented in France (CQI and collaborative projects), benchmarking has specific features that set it apart as a healthcare innovation. This is especially true for healthcare or medical-social organizations, as the principle of inter-organizational visiting is not part of their culture. Thus, this approach will need to be assessed for feasibility and acceptability before it is more widely promoted.

  4. A formula for continued improvement: Audit follow-up

    International Nuclear Information System (INIS)

    Maday, J.H. Jr.

    1989-10-01

    In his book Management Audits, Allan J. Sayle states, ''QA standards stipulate that corrective action, required as a result of performing an audit, be followed up and closed out. There would, indeed, be little point in performing audits, requiring corrective action, or having a QA system at all if the auditee knows that the auditor will never verify that the corrective action has been efficaciously implemented.'' The QA auditor has an obligation to include follow-up in the overall audit planning. All too often the auditor will go to great lengths to plan and perform an audit only to have a recurring finding in the next audit. The proposed corrective action was only promissory and was not designed to stop the problem from recurring or to identify its root cause. Auditors do a disservice to the overall QA program and particularly to the customer when they fail to follow up and verify that an audit corrective action has been effectively implemented. In this paper, the techniques used by the quality assurance auditors at the Pacific Northwest Laboratory (PNL) will be presented. Although PNL is a research and development laboratory, the techniques outlined in this paper could be applied to any industry conducting quality assurance audits. Most important, they provide a formula for continued improvement by assuring that audit follow-up is timely, meaningful, and permanent

  5. What drives continuous improvement project success in healthcare?

    Science.gov (United States)

    Stelson, Paul; Hille, Joshua; Eseonu, Chinweike; Doolen, Toni

    2017-02-13

    Purpose The purpose of this paper is to present findings from a study of factors that affect continuous improvement (CI) project success in hospitals. Design/methodology/approach Quantitative regression analysis was performed on Likert scale survey responses. Qualitative thematic analysis was performed on open-ended survey responses and written reports on CI projects. Findings The paper identifies managerial and employee factors that affect project success. These factors include managerial support, communication, and affective commitment. Affective commitment is the extent to which employees perceive the change as being needed or necessary. Practical implications The results highlight how managerial decisions, approaches to communication - including communication before, during and after CI projects affect project success. The results also show that success depends on the way employees perceive proposed changes. This suggests the need for a more individualized approach to CI, lean, and broader change initiatives. Originality/value This research is the first to fuse project success and sustainability theory to CI projects, beyond Kaizen events, in healthcare environments. The research is particularly important at a time when healthcare organizations are required to make rapid changes with limited resources as they work toward outcome-based assessment and reimbursement rules.

  6. From continuous improvement to collaborative improvement: scope, scale, skill and social networking in collaborative improvement

    NARCIS (Netherlands)

    Middel, H.G.A.; Groen, Arend J.; Fisscher, O.A.M.

    2004-01-01

    More than ever, companies are challenged to improve their performance and respond quickly and accurately to changes within the market. As competitive battlefield is moving towards the level of networks of organisations, the individual firm is an inadequate entity for identifying improvements.

  7. A continuous-time control model on production planning network ...

    African Journals Online (AJOL)

    A continuous-time control model on production planning network. DEA Omorogbe, MIU Okunsebor. Abstract. In this paper, we give a slightly detailed review of Graves and Hollywood model on constant inventory tactical planning model for a job shop. The limitations of this model are pointed out and a continuous time ...

  8. A continuous quality improvement program to focus a college of pharmacy on programmatic advancement.

    Science.gov (United States)

    Hall, Philip D; Dipiro, Joseph T; Rowen, Randall C; McNair, David

    2013-08-12

    To enhance the achievement of a college of pharmacy's goals for education, research, and service missions by implementing an excellence program based on the Studer Group model for continuous quality improvement. The Studer model was combined with university strategic planning for a comprehensive quality-improvement program that was implemented over 5 years. The program included identifying and measuring key performance indicators, establishing specific "pillar" goals, aligning behaviors with goals and values, and training leaders. Assessment of key performance indicators over 5 years demonstrated progress toward achieving college goals for student and faculty satisfaction, research funding, numbers of students seeking formal postgraduate training, and private giving. Implementation of a continuous quality-improvement program based on the Studer program enabled the college to focus on and meet its yearly and strategic goals for all components of its mission.

  9. Modifying the Toyota Production System for continuous performance improvement in an academic children's hospital.

    Science.gov (United States)

    Stapleton, F Bruder; Hendricks, James; Hagan, Patrick; DelBeccaro, Mark

    2009-08-01

    The Toyota Production System (TPS) has become a successful model for improving efficiency and eliminating errors in manufacturing processes. In an effort to provide patients and families with the highest quality clinical care, our academic children's hospital has modified the techniques of the TPS for a program in continuous performance improvement (CPI) and has expanded its application to educational and research programs. Over a period of years, physicians, nurses, residents, administrators, and hospital staff have become actively engaged in a culture of continuous performance improvement. This article provides background into the methods of CPI and describes examples of how we have applied these methods for improvement in clinical care, resident teaching, and research administration.

  10. Discrete and Continuous Models for Partitioning Problems

    KAUST Repository

    Lellmann, Jan

    2013-04-11

    Recently, variational relaxation techniques for approximating solutions of partitioning problems on continuous image domains have received considerable attention, since they introduce significantly less artifacts than established graph cut-based techniques. This work is concerned with the sources of such artifacts. We discuss the importance of differentiating between artifacts caused by discretization and those caused by relaxation and provide supporting numerical examples. Moreover, we consider in depth the consequences of a recent theoretical result concerning the optimality of solutions obtained using a particular relaxation method. Since the employed regularizer is quite tight, the considered relaxation generally involves a large computational cost. We propose a method to significantly reduce these costs in a fully automatic way for a large class of metrics including tree metrics, thus generalizing a method recently proposed by Strekalovskiy and Cremers (IEEE conference on computer vision and pattern recognition, pp. 1905-1911, 2011). © 2013 Springer Science+Business Media New York.

  11. Modelling continuing professional development in an innovative context

    DEFF Research Database (Denmark)

    Fink, Flemming K.

    2001-01-01

    subject to very fast innovation processes. Continuing Professional Development of engineering staff is therefore very important. A model for the continuing education process will be described. The elements of the model and their interaction will be discussed. Part of the modelling is based on interviews...

  12. Fuzzy Logic-Based Aerodynamic Modeling with Continuous Differentiability

    Directory of Open Access Journals (Sweden)

    Ray C. Chang

    2013-01-01

    Full Text Available This paper presents a modeling method based on a fuzzy-logic algorithm to establish aerodynamic models by using the datasets from flight data recorder (FDR. The fuzzy-logic aerodynamic models are utilized to estimate more accurately the nonlinear unsteady aerodynamics for a transport aircraft, including the effects of atmospheric turbulence. The main objective in this paper is to present the model development and the resulting models with continuous differentiability. The uncertainty and correlation of the data points are estimated and improved by monitoring a multivariable correlation coefficient in the modeling process. The latter is increased by applying a least square method to a set of data points to train a set of modeling coefficients. A commercial transport aircraft encountered severe atmospheric turbulence twice at transonic flight in descending phase is the study case in the present paper. The robustness and nonlinear interpolation capability of the fuzzy-logic algorithm are demonstrated in predicting the degradation in performance and stability characteristics of this transport in severe atmospheric turbulence with sudden plunging motion.

  13. Modelling spatial density using continuous wavelet transforms

    Indian Academy of Sciences (India)

    Space debris; wavelets; Mexican hat; Laplace distribution; random search; parameter estimation. ... Author Affiliations. D Sudheer Reddy1 N Gopal Reddy2 A K Anilkumar3. Digital Mapping and Modelling Division, Advanced Data Processing Research Institute, Secunderabad 500 009, India; Department of Mathematics, ...

  14. Modelling spatial density using continuous wavelet transforms

    Indian Academy of Sciences (India)

    A K ANILKUMAR3. 1Digital Mapping and Modelling Division, Advanced Data Processing Research .... probability of conjunction is very high and the miss distance between active satellite and debri object is less ... particularly helpful in tackling problems involving signal identification and detection of hidden transients (hard ...

  15. Current Density and Continuity in Discretized Models

    Science.gov (United States)

    Boykin, Timothy B.; Luisier, Mathieu; Klimeck, Gerhard

    2010-01-01

    Discrete approaches have long been used in numerical modelling of physical systems in both research and teaching. Discrete versions of the Schrodinger equation employing either one or several basis functions per mesh point are often used by senior undergraduates and beginning graduate students in computational physics projects. In studying…

  16. Course Development Cycle Time: A Framework for Continuous Process Improvement.

    Science.gov (United States)

    Lake, Erinn

    2003-01-01

    Details Edinboro University's efforts to reduce the extended cycle time required to develop new courses and programs. Describes a collaborative process improvement framework, illustrated data findings, the team's recommendations for improvement, and the outcomes of those recommendations. (EV)

  17. Building district-level capacity for continuous improvement in maternal and newborn health.

    Science.gov (United States)

    Stover, Kim Ethier; Tesfaye, Solomon; Frew, Aynalem Hailemichael; Mohammed, Hajira; Barry, Danika; Alamineh, Lamesgin; Teshome, Abebe; Hepburn, Kenneth; Sibley, Lynn M

    2014-01-01

    The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) adapted a collaborative improvement strategy to develop woreda (district) leadership capacity to support and facilitate continuous improvement of community maternal and neonatal health (CMNH) and to provide a model for other woredas, dubbed "lead" woredas. Community-level quality improvement (QI) teams tested solutions to improve CMNH care supported by monthly coaching and regular meetings to share experiences. This study examines the extent of the capacity built to support continuous improvement in CMNH care. Surveys and in-depth interviews assessed the extent to which MaNHEP developed improvement capacity. A survey questionnaire evaluated woreda culture, leadership support, motivation, and capacity for improvement activities. Interviews focused on respondents' understanding and perceived value of the MaNHEP improvement approach. Bivariate analyses and multivariate linear regression models were used to analyze the survey data. Interview transcripts were organized by region, cadre, and key themes. Respondents reported significant positive changes in many areas of woreda culture and leadership, including involving a cross-section of community stakeholders (increased from 3.0 to 4.6 on 5-point Likert scale), using improvement data for decision making (2.8-4.4), using locally developed and tested solutions to improve CMNH care (2.5-4.3), demonstrating a commitment to improve the health of women and newborns (2.6-4.2), and creating a supportive environment for coaches and QI teams to improve CMNH (2.6-4.0). The mean scores for capacity were 3.7 and higher, reflecting respondents' agreement that they had gained capacity in improvement skills. Interview respondents universally recognized the capacity built in the woredas. The themes of community empowerment and focused improvement emerged strongly from the interviews. MaNHEP was able to build capacity for continuous improvement and develop lead woredas. The

  18. Discounting Models for Outcomes over Continuous Time

    DEFF Research Database (Denmark)

    Harvey, Charles M.; Østerdal, Lars Peter

    Events that occur over a period of time can be described either as sequences of outcomes at discrete times or as functions of outcomes in an interval of time. This paper presents discounting models for events of the latter type. Conditions on preferences are shown to be satisfied if and only if t...... if the preferences are represented by a function that is an integral of a discounting function times a scale defined on outcomes at instants of time....

  19. Success beyond success : The ‘Golden Triangle’ of continuous performance improvement

    NARCIS (Netherlands)

    2009-01-01

    The main subject of the article is continuous performance improvement (CPI). More specifically, the author seeks to understand the most important management challenges under that heading. An extensive empirical study determines companies' most important continuous performance improvement roots.

  20. Model checking conditional CSL for continuous-time Markov chains

    DEFF Research Database (Denmark)

    Gao, Yang; Xu, Ming; Zhan, Naijun

    2013-01-01

    In this paper, we consider the model-checking problem of continuous-time Markov chains (CTMCs) with respect to conditional logic. To the end, we extend Continuous Stochastic Logic introduced in Aziz et al. (2000) [1] to Conditional Continuous Stochastic Logic (CCSL) by introducing a conditional p...

  1. Improving pediatric immunization rates: description of a resident-led clinical continuous quality improvement project.

    Science.gov (United States)

    Jones, Kyle Bradford; Gren, Lisa H; Backman, Richard

    2014-09-01

    Increased emphasis is being placed on the continuous quality improvement (CQI) education of residents of all specialties. This article describes a resident-led continuous quality improvement (CQI) project, based on a novel curriculum, to improve the immunization rates of children under 2 years old at the Madsen Family Health Center (MHC). All third-year residents were trained in the FOCUS-PDSA CQI methodology through concurrent didactic lectures and experience leading the CQI team. The CQI team included clinical staff led by a third-year family medicine resident and mentored by a member of the family medicine faculty. Immunization records were distributed to provider-medical assistant teamlets daily for each pediatric patient scheduled in clinic as the intervention. Compliance with the intervention (process measure), as well as immunization rates at 2 and 5 months post-intervention (outcome measure), were monitored. Immunization records were printed on 84% of clinic days from October 24, 2011 to March 31, 2012. The percentage of patients immunized at baseline was 66%. The percentage immunized as of December 31, 2011 was 96% and was 91% as of March 31, 2012. An important educational experience was organized for third-year family medicine residents through learning CQI skills, leading a CQI team, and directing a CQI project to completion. Significant improvement in the percentage of patients under 2 years old immunized at the MHC was achieved by presenting provider-medical assistant teamlets with immunization records of all pediatric patients on the daily clinic schedule.

  2. Improving Continuity of Care Reduces Emergency Department Visits by Long-Term Care Residents.

    Science.gov (United States)

    Marshall, Emily Gard; Clarke, Barry; Burge, Frederick; Varatharasan, Nirupa; Archibald, Greg; Andrew, Melissa K

    2016-01-01

    Care by Design™ (CBD) (Canada), a model of coordinated team-based primary care, was implemented in long-term care facilities (LTCFs) in Halifax, Nova Scotia, Canada, to improve access to and continuity of primary care and to reduce high rates of transfers to emergency departments (EDs). This was an observational time series before and after the implementation of CBD (Canada). Participants are LTCF residents with 911 Emergency Health Services calls from 10 LTCFs, representing 1424 beds. Data were abstracted from LTCF charts and Emergency Health Services databases. The primary outcome was ambulance transports from LTCFs to EDs. Secondary outcomes included access (primary care physician notes in charts) and continuity (physician numbers and contacts). After implementation of CBD (Canada), transports from LTCFs to EDs were reduced by 36%, from 68 to 44 per month (P = .01). Relational and informational continuity of care improved with resident charts with ≥10 physician notes, increasing 38% before CBD to 55% after CBD (P = .003), and the median number of chart notes increased from 7 to 10 (P = .0026). Physicians contacted before 911 calls and onsite assessment increased from 38% to 54% (P = .01) and 3.7% to 9.2% (P = .03), respectively, before CBD to after CBD. A 34% reduction in overall transports from LTCFs to EDs is likely attributable to improved onsite primary care, with consistent physician and team engagement and improvements in continuity of care. © Copyright 2016 by the American Board of Family Medicine.

  3. Improving the management of anemia in hemodialysis patients by implementing the continuous quality improvement program.

    Science.gov (United States)

    Chen, Min; Deng, Jin-Hua; Zhou, Fu-De; Wang, Mei; Wang, Hai-Yan

    2006-01-01

    Anemia is common in hemodialysis patients, and improvement in anemia management is possible with the implementation of continuous quality improvement (CQI) programs. The aim of this study is to improve anemia management in chronic hemodialysis patients using CQI. Ninety hemodialysis patients in our single center were enrolled in the study. The patients were followed up from January 2004 to October 2005. The CQI team-oriented approach was driven by a process called the 'FOCUS-PDCA cycle plan' (find, organize, clarify, uncover, start, plan, do, check and act). Hemoglobin (Hb), serum ferritin and transferrin saturation were monitored periodically. By implementation of the CQI program, the proportion of patients with Hb >or=110 g/l increased from 42.2 to 60.0% (p method in the management of anemia in hemodialysis patients. Copyright 2006 S. Karger AG, Basel.

  4. 78 FR 40625 - National School Lunch Program: Direct Certification Continuous Improvement Plans Required by the...

    Science.gov (United States)

    2013-07-08

    ... National School Lunch Program: Direct Certification Continuous Improvement Plans Required by the Healthy... Continuous Improvement Plans Required by the Healthy, Hunger-Free Kids Act of 2010'' on February 22, 2013... performance benchmarks and to develop and implement continuous improvement plans if they fail to do so. The...

  5. How to Sustain Change and Support Continuous Quality Improvement

    OpenAIRE

    Silver, Samuel A.; McQuillan, Rory; Harel, Ziv; Weizman, Adam V.; Thomas, Alison; Nesrallah, Gihad; Bell, Chaim M.; Chan, Christopher T.; Chertow, Glenn M.

    2016-01-01

    To achieve sustainable change, quality improvement initiatives must become the new way of working rather than something added on to routine clinical care. However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement. Threats to sustainability may be identified both at the beginning of a project and when it is ready f...

  6. Management of continual improvement for facilities and activities: A structured approach

    International Nuclear Information System (INIS)

    2006-04-01

    In recent years there has been an upward trend in the safety and operational performance of nuclear installations. Safe, efficient operation is their goal. Continual improvement of the processes of organizations has led to enhanced safety performance and efficiency benefits such as cost reductions and improved cycle times. Many organizations have experienced significant cost improvement largely by or through better financial management and a common drive to reduce costs brought on by commercial pressures. Without the use of a structured methodology to identify and implement improvements, changes to an organization to reduce costs through cutting staff and activities could eventually fail to produce the desired changes and even have a negative effect on safety and overall performance. The following fundamental principles are considered essential to the effective introduction of structured continual improvement: - Long term commitment from senior management throughout the entire organization; - The implementation in the organization of a process management approach such as that advocated by IAEA Safety Standards, ISO 9001, Malcolm Baldridge National Quality Award and European Foundation for Quality Management Business Excellence model; - The alignment of the processes with the objectives of the organization through the organization's business plan; - The utilization by Management of the process information as an input to managing the organization; - The employment of the information derived from the process performance to identify and prioritize the processes that require improvement; - The active participation of all staff of the organization to using its processes in order to contribute to continual process improvement (CPI). This publication defines a structured approach for continual improvement and focuses on the way an organization can improve its processes. It is recognized that there are many different approaches and methods available in the marketplace to

  7. Improving the Relationship between Continuing Education Leadership and Marketing Directors

    Science.gov (United States)

    Fong, Jim

    2009-01-01

    In this economy, college and university continuing education units will not automatically reap the benefits of returning adult learners as in past recessions: this economy caused a drastic reduction of resources available to the workforce and for personal revenue. As a result of decreased personal income and workforce training funding, competition…

  8. The Social Intelligence of Principals: Links to Teachers' Continuous Improvement

    Science.gov (United States)

    McQuade, Joan

    2013-01-01

    Despite multiple efforts to reform 21st education to better meet the needs of all students, school improvement successes have been sporadic and debatable. Research suggests that significant improvement lies within the purview of teachers and principals, and this current research provided the underpinnings for the study. Based on neuroscience…

  9. Process Evaluation and Continuous Improvement in Community Youth Programs

    Directory of Open Access Journals (Sweden)

    Jennifer V. Trachtenberg

    2008-06-01

    Full Text Available A method of using process evaluation to provide improvement plans in order to promote community youth programs is described. The core elements of this method include the following: (1 collection and analysis of baseline data, (2 feedback provided to programs describing their strengths and limitations, (3 programs provided with assistance in preparing improvement plans in regard to their baseline data, and (4 follow-up evaluation assessed program changes based on their improvement plans and baseline data. A case study of an inner-city neighborhood youth center is used to demonstrate this method.

  10. Measure to succeed: How to improve employee participation in continuous improvement

    International Nuclear Information System (INIS)

    Jurburg, M.; Viles, E.; Tanco, M.; Mateo, R.; Lleó, A.

    2016-01-01

    Purpose: Achieving employee participation in continuous improvement (CI) systems is considered as one of the success factors for the sustainability of those systems. Yet, it is also very difficult to obtain because of the interaction of many critical factors that affect employee participation. Therefore, finding ways of measuring all these critical factors can help practitioners manage the employee participation process accordingly. Design/methodology/approach: Based upon the existing literature, this paper presents a 4-Phase (9 steps) diagnostic tool to measure the main determinants associated with the implementation of CI systems affecting employee participation in improvement activities. Findings: The tool showed its usefulness to detect the main weaknesses and improvement opportunities for improving employee participation in CI through the application in two different cases. Practical implications: This diagnostic tool could be particularly interesting for companies adopting CI and other excellence frameworks, which usually include a pillar related to people development inside the organization, but do not include tools to diagnose the state of this pillar. Originality/value: This diagnostic tool presents a user’s perspective approach, ensuring that the weaknesses and improvement opportunities detected during the diagnose come directly from the users of the CI system, which in this case are the employees themselves. Given that the final objective is to identify reasons and problems hindering employee participation, adopting this user’s perspective approach seem more relevant than adopting other more traditional approaches, based on gathering information from the CI system itself or from the CI managers.

  11. Measure to succeed: How to improve employee participation in continuous improvement

    Directory of Open Access Journals (Sweden)

    Daniel Jurburg

    2016-12-01

    Full Text Available Purpose: Achieving employee participation in continuous improvement (CI systems is considered as one of the success factors for the sustainability of those systems. Yet, it is also very difficult to obtain because of the interaction of many critical factors that affect employee participation. Therefore, finding ways of measuring all these critical factors can help practitioners manage the employee participation process accordingly. Design/methodology/approach: Based upon the existing literature, this paper presents a 4-Phase (9 steps diagnostic tool to measure the main determinants associated with the implementation of CI systems affecting employee participation in improvement activities. Findings: The tool showed its usefulness to detect the main weaknesses and improvement opportunities for improving employee participation in CI through the application in two different cases. Practical implications: This diagnostic tool could be particularly interesting for companies adopting CI and other excellence frameworks, which usually include a pillar related to people development inside the organization, but do not include tools to diagnose the state of this pillar. Originality/value: This diagnostic tool presents a user’s perspective approach, ensuring that the weaknesses and improvement opportunities detected during the diagnose come directly from the users of the CI system, which in this case are the employees themselves. Given that the final objective is to identify reasons and problems hindering employee participation, adopting this user’s perspective approach seem more relevant than adopting other more traditional approaches, based on gathering information from the CI system itself or from the CI managers.

  12. Applying Continuous Process Improvement to the Contract Closeout Process

    Science.gov (United States)

    1993-12-16

    the work they supervise. Closing out U. S. Government contracts is part of the acquisition cycle and can not continue to be brushed aside when higher...rAplc to crAtain aly10t *65 00w5NWd as f iacsan odfctin teet nexes f$2, entered into w or alte January 1. 1989. 125 FAC 90-13 SEPTEMBER 24, 1992 4.f3

  13. Integral-Value Models for Outcomes over Continuous Time

    DEFF Research Database (Denmark)

    Harvey, Charles M.; Østerdal, Lars Peter

    Models of preferences between outcomes over continuous time are important for individual, corporate, and social decision making, e.g., medical treatment, infrastructure development, and environmental regulation. This paper presents a foundation for such models. It shows that conditions on prefere...... on preferences between real- or vector-valued outcomes over continuous time are satisfied if and only if the preferences are represented by a value function having an integral form......Models of preferences between outcomes over continuous time are important for individual, corporate, and social decision making, e.g., medical treatment, infrastructure development, and environmental regulation. This paper presents a foundation for such models. It shows that conditions...

  14. Continuous time modeling of panel data by means of SEM

    NARCIS (Netherlands)

    Oud, J.H.L.; Delsing, M.J.M.H.; Montfort, C.A.G.M.; Oud, J.H.L.; Satorra, A.

    2010-01-01

    After a brief history of continuous time modeling and its implementation in panel analysis by means of structural equation modeling (SEM), the problems of discrete time modeling are discussed in detail. This is done by means of the popular cross-lagged panel design. Next, the exact discrete model

  15. Continuous time structural equation modeling with R package ctsem

    NARCIS (Netherlands)

    Driver, C.C.; Oud, J.H.L.; Völkle, M.C.

    2017-01-01

    We introduce ctsem, an R package for continuous time structural equation modeling of panel (N > 1) and time series (N = 1) data, using full information maximum likelihood. Most dynamic models (e.g., cross-lagged panel models) in the social and behavioural sciences are discrete time models. An

  16. Measuring and modelling occupancy time in NHS continuing healthcare

    Directory of Open Access Journals (Sweden)

    Millard Peter H

    2011-06-01

    Full Text Available Abstract Background Due to increasing demand and financial constraints, NHS continuing healthcare systems seek to find better ways of forecasting demand and budgeting for care. This paper investigates two areas of concern, namely, how long existing patients stay in service and the number of patients that are likely to be still in care after a period of time. Methods An anonymised dataset containing information for all funded admissions to placement and home care in the NHS continuing healthcare system was provided by 26 (out of 31 London primary care trusts. The data related to 11289 patients staying in placement and home care between 1 April 2005 and 31 May 2008 were first analysed. Using a methodology based on length of stay (LoS modelling, we captured the distribution of LoS of patients to estimate the probability of a patient staying in care over a period of time. Using the estimated probabilities we forecasted the number of patients that are likely to be still in care after a period of time (e.g. monthly. Results We noticed that within the NHS continuing healthcare system there are three main categories of patients. Some patients are discharged after a short stay (few days, some others staying for few months and the third category of patients staying for a long period of time (years. Some variations in proportions of discharge and transition between types of care as well as between care groups (e.g. palliative, functional mental health were observed. A close agreement of the observed and the expected numbers of patients suggests a good prediction model. Conclusions The model was tested for care groups within the NHS continuing healthcare system in London to support Primary Care Trusts in budget planning and improve their responsiveness to meet the increasing demand under limited availability of resources. Its applicability can be extended to other types of care, such as hospital care and re-ablement. Further work will be geared towards

  17. Cyberbullying: Assessment of Student Experience for Continuous Improvement Planning

    Science.gov (United States)

    Strom, Paris S.; Strom, Robert D.; Wingate, Julius J.; Kraska, Marie F.; Beckert, Troy E.

    2012-01-01

    This study examines the use of polling students to improve conditions of learning in their school. Students from three schools (N = 2,006) in Grades 5, 6, 7, and 8 completed an online poll about how cyberbullying affects their personal lives. Principals' impressions about the benefits of student polling are explained along with the Cyberbullying…

  18. Applying PPM to ERP Maintenance and Continuous Improvement Initiatives

    DEFF Research Database (Denmark)

    El-Tal, Nada Maria; Fonnesbæk, Majbrit; Kræmmergaard, Pernille

    2006-01-01

    Enterprise Resource Planning Systems (ERP) has been implemented in many companies during the last decade and has gained an increasing significance. For many companies it means that the focus is no longer on how to implement the ERP system, but rather on how to maintain and improve the system...

  19. Continuous improvement, burnout and job engagement: a study in a Dutch nursing department.

    Science.gov (United States)

    Benders, Jos; Bleijerveld, Hans; Schouteten, Roel

    2017-10-01

    Continuous improvement (CI) programs are potentially powerful means to improve the quality of care. The more positive nurses perceive these programs' effects, the better they may be expected to cooperate. Crucial to this perception is how nurses' quality of working life is affected. We studied this in a nursing department, using the job demands-resources model. We found that two job demands improved, and none of the job resources. Job engagement did not change significantly, while the burnout risk decreased slightly. Overall, the nurses felt the impact to be small yet the changes were in a positive direction. CI can thus be used to improve nurses' working lives and, by restructuring the work processes, the quality of care. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  20. Using Continuous Improvement to Enhance an Online Course

    Science.gov (United States)

    Aggarwal, Anil K.; Lynn, Susan A.

    2012-01-01

    Assessment is becoming important from many different perspectives. Universities are planning, developing, and testing various assessment models to satisfy stakeholders. Many accrediting agencies are also requiring assessment plans and their implementation from universities for reaccreditation. This article describes how assessment was used to…

  1. Continuous improvement processes using Lean Management tools. A case study

    Directory of Open Access Journals (Sweden)

    Pârv Luminița

    2017-01-01

    Full Text Available The paper describes how Lean Management may be applied in the university setting to improve the management processes. The correlation of didactic, educational and research activities with the stakeholders needs is one of the main objectives of the university. In this respect, an indicator used to analyse a university, for the purposes of fulfilling its mission, respectively for the purposes of streamlining its didactic and scientific activity, is related to the number of graduates on the labour market, acting in their area of specialization. This work presents a best practice of Lean Management at Transilvania University of Brasov, Romania.

  2. Modeling irregularly spaced residual series as a continuous stochastic process

    NARCIS (Netherlands)

    Von Asmuth, J.R.; Bierkens, M.F.P.

    2005-01-01

    In this paper, the background and functioning of a simple but effective continuous time approach for modeling irregularly spaced residual series is presented. The basic equations were published earlier by von Asmuth et al. (2002), who used them as part of a continuous time transfer function noise

  3. Eigenfunction statistics for Anderson model with Hölder continuous ...

    Indian Academy of Sciences (India)

    continuous (0 < α ≤ 1) single site distribution. In localized regime, we study the distri- bution of eigenfunctions in space and energy simultaneously. In a certain scaling limit, we prove limit points are Poisson. Keywords. Anderson model; Hölder continuous measure; Poisson statistics. 2010 Mathematics Subject Classification ...

  4. Improved models of dense anharmonic lattices

    Energy Technology Data Exchange (ETDEWEB)

    Rosenau, P., E-mail: rosenau@post.tau.ac.il; Zilburg, A.

    2017-01-15

    We present two improved quasi-continuous models of dense, strictly anharmonic chains. The direct expansion which includes the leading effect due to lattice dispersion, results in a Boussinesq-type PDE with a compacton as its basic solitary mode. Without increasing its complexity we improve the model by including additional terms in the expanded interparticle potential with the resulting compacton having a milder singularity at its edges. A particular care is applied to the Hertz potential due to its non-analyticity. Since, however, the PDEs of both the basic and the improved model are ill posed, they are unsuitable for a study of chains dynamics. Using the bond length as a state variable we manipulate its dispersion and derive a well posed fourth order PDE. - Highlights: • An improved PDE model of a Newtonian lattice renders compacton solutions. • Compactons are classical solutions of the improved model and hence amenable to standard analysis. • An alternative well posed model enables to study head on interactions of lattices' solitary waves. • Well posed modeling of Hertz potential.

  5. Constrained optimization with a continuous Hopfield-Lagrange model

    NARCIS (Netherlands)

    J.H. van den Berg (Jan); J.C. Bioch (Cor)

    1993-01-01

    textabstractIn this paper, a generalized Hopfield model with continuous neurons using Lagrange multipliers, originally introduced Wacholder, Han &Mann [1989], is thoroughly analysed. We have termed the model the Hopfield-Lagrange model. It can be used to resolve constrained optimization problems. In

  6. Positioning Continuing Education: Boundaries and Intersections between the Domains Continuing Education, Knowledge Translation, Patient Safety and Quality Improvement

    Science.gov (United States)

    Kitto, Simon; Bell, Mary; Peller, Jennifer; Sargeant, Joan; Etchells, Edward; Reeves, Scott; Silver, Ivan

    2013-01-01

    Public and professional concern about health care quality, safety and efficiency is growing. Continuing education, knowledge translation, patient safety and quality improvement have made concerted efforts to address these issues. However, a coordinated and integrated effort across these domains is lacking. This article explores and discusses the…

  7. Identifying effective pathways in a successful continuous quality improvement programme: the GEDAPS study.

    Science.gov (United States)

    Bodicoat, Danielle H; Mundet, Xavier; Gray, Laura J; Cos, Xavier; Davies, Melanie J; Khunti, Kamlesh; Cano, Juan-Franciso

    2014-12-01

    Continuous quality improvement programmes often target several aspects of care, some of which may be more effective meaning that resources could be focussed on these. The objective was to identify the effective and ineffective aspects of a successful continuous quality improvement programme for individuals with type 2 diabetes in primary care. Data were from a series of cross-sectional studies (GEDAPS) in primary care, Catalonia, Spain, in 55 centres (2239 participants) in 1993, and 92 centres (5819 participants) in 2002. A structural equation modelling approach was used. The intervention was associated with improved microvascular outcomes through microalbuminuria and funduscopy screening, which had a direct effect on microvascular outcomes, and through attending 2-4 nurse visits and having ≥1 blood pressure measurement, which acted through reducing systolic blood pressure. The intervention was associated with improved macrovascular outcomes through blood pressure measurement and attending 2-4 nurse visits (through systolic blood pressure) and having ≥3 education topics, ≥1 HbA1c measurement and adequate medication (through HbA1c). Cholesterol measurement, weight measurement and foot examination did not contribute towards the effectiveness of the intervention. The pathways through which a continuous quality improvement programme appeared to act to reduce microvascular and macrovascular complications were driven by reductions in systolic blood pressure and HbA1c, which were attained through changes in nurse and education visits, measurement and medication. This suggests that these factors are potential areas on which future quality improvement programmes should focus. © 2014 John Wiley & Sons, Ltd.

  8. Identifying continuous quality improvement publications: what makes an improvement intervention ‘CQI’?

    Science.gov (United States)

    Hempel, Susanne; Lim, Yee-Wei; Danz, Marjorie S; Foy, Robbie; Suttorp, Marika J; Shekelle, Paul G; Rubenstein, Lisa V

    2011-01-01

    Background The term continuous quality improvement (CQI) is often used to refer to a method for improving care, but no consensus statement exists on the definition of CQI. Evidence reviews are critical for advancing science, and depend on reliable definitions for article selection. Methods As a preliminary step towards improving CQI evidence reviews, this study aimed to use expert panel methods to identify key CQI definitional features and develop and test a screening instrument for reliably identifying articles with the key features. We used a previously published method to identify 106 articles meeting the general definition of a quality improvement intervention (QII) from 9427 electronically identified articles from PubMed. Two raters then applied a six-item CQI screen to the 106 articles. Results Per cent agreement ranged from 55.7% to 75.5% for the six items, and reviewer-adjusted intra-class correlation ranged from 0.43 to 0.62. ‘Feedback of systematically collected data’ was the most common feature (64%), followed by being at least ‘somewhat’ adapted to local conditions (61%), feedback at meetings involving participant leaders (46%), using an iterative development process (40%), being at least ‘somewhat’ data driven (34%), and using a recognised change method (28%). All six features were present in 14.2% of QII articles. Conclusions We conclude that CQI features can be extracted from QII articles with reasonable reliability, but only a small proportion of QII articles include all features. Further consensus development is needed to support meaningful use of the term CQI for scientific communication. PMID:21727199

  9. Identifying continuous quality improvement publications: what makes an improvement intervention 'CQI'?

    Science.gov (United States)

    O'Neill, Sean M; Hempel, Susanne; Lim, Yee-Wei; Danz, Marjorie S; Foy, Robbie; Suttorp, Marika J; Shekelle, Paul G; Rubenstein, Lisa V

    2011-12-01

    The term continuous quality improvement (CQI) is often used to refer to a method for improving care, but no consensus statement exists on the definition of CQI. Evidence reviews are critical for advancing science, and depend on reliable definitions for article selection. As a preliminary step towards improving CQI evidence reviews, this study aimed to use expert panel methods to identify key CQI definitional features and develop and test a screening instrument for reliably identifying articles with the key features. We used a previously published method to identify 106 articles meeting the general definition of a quality improvement intervention (QII) from 9427 electronically identified articles from PubMed. Two raters then applied a six-item CQI screen to the 106 articles. Per cent agreement ranged from 55.7% to 75.5% for the six items, and reviewer-adjusted intra-class correlation ranged from 0.43 to 0.62. 'Feedback of systematically collected data' was the most common feature (64%), followed by being at least 'somewhat' adapted to local conditions (61%), feedback at meetings involving participant leaders (46%), using an iterative development process (40%), being at least 'somewhat' data driven (34%), and using a recognised change method (28%). All six features were present in 14.2% of QII articles. We conclude that CQI features can be extracted from QII articles with reasonable reliability, but only a small proportion of QII articles include all features. Further consensus development is needed to support meaningful use of the term CQI for scientific communication.

  10. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

    Science.gov (United States)

    McFadden, Kathleen L; Stock, Gregory N; Gowen, Charles R

    2014-10-01

    Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

  11. THEORY OF REASONED ACTION FOR CONTINUOUS IMPROVEMENT CAPABILITIES: A BEHAVIORAL APPROACH

    Directory of Open Access Journals (Sweden)

    Janaina Siegler

    2012-09-01

    Full Text Available The importance of interaction between Operations Management (OM and Human Behavior has been recently re-addressed. This paper introduced the Reasoned Action Theory suggested by Froehle and Roth (2004 to analyze Operational Capabilities exploring the suitability of this model in the context of OM. It also seeks to discuss the behavioral aspects of operational capabilities from the perspective of organizational routines. This theory was operationalized using Fishbein and Ajzen (F/A behavioral model and a multi-case strategy was employed to analyze the Continuous Improvement (CI capability. The results posit that the model explains partially the CI behavior in an operational context and some contingency variables might influence the general relationsamong the variables involved in the F/A model. Thus intention might not be the determinant variable of behavior in this context.

  12. Design, experimentation, and modeling of a novel continuous biodrying process

    Science.gov (United States)

    Navaee-Ardeh, Shahram

    Massive production of sludge in the pulp and paper industry has made the effective sludge management increasingly a critical issue for the industry due to high landfill and transportation costs, and complex regulatory frameworks for options such as sludge landspreading and composting. Sludge dewatering challenges are exacerbated at many mills due to improved in-plant fiber recovery coupled with increased production of secondary sludge, leading to a mixed sludge with a high proportion of biological matter which is difficult to dewater. In this thesis, a novel continuous biodrying reactor was designed and developed for drying pulp and paper mixed sludge to economic dry solids level so that the dried sludge can be economically and safely combusted in a biomass boiler for energy recovery. In all experimental runs the economic dry solids level was achieved, proving the process successful. In the biodrying process, in addition to the forced aeration, the drying rates are enhanced by biological heat generated through the microbial activity of mesophilic and thermophilic microorganisms naturally present in the porous matrix of mixed sludge. This makes the biodrying process more attractive compared to the conventional drying techniques because the reactor is a self-heating process. The reactor is divided into four nominal compartments and the mixed sludge dries as it moves downward in the reactor. The residence times were 4-8 days, which are 2-3 times shorter than the residence times achieved in a batch biodrying reactor previously studied by our research group for mixed sludge drying. A process variable analysis was performed to determine the key variable(s) in the continuous biodrying reactor. Several variables were investigated, namely: type of biomass feed, pH of biomass, nutrition level (C/N ratio), residence times, recycle ratio of biodried sludge, and outlet relative humidity profile along the reactor height. The key variables that were identified in the continuous

  13. Improving training tools for continuing operator qualification in Spain

    International Nuclear Information System (INIS)

    Marti, F.; San Antonio, S.

    1991-01-01

    There are currently nine nuclear power plants in service in Spain; the most recent started commercial operation in 1988. Spanish legislation requires operators to have an academic technical background of at least 3 yr. The turnover rate is <5%, and in recent years, symptom-based emergency procedure has been introduced. These facts have given rise to a situation in which Spanish licensed operators are demanding more in-depth training to avoid a stagnant routine and boredom. In responding to this challenge, Tecnatom has had to significantly update its two simulators for boiling water reactor (BWR) and pressurized water reactor (PSR) plants, to ensure coverage of the emergency procedures and has had to create a tool - the Interactive Graphics Simulator - that allows these problems to be ameliorated. With a view to updating its simulators, Tecnatom initiated in 1985 a project known as advanced simulation models (MAS), which was completed at the end of 1990. The TRACS code is a real-time advanced thermohydraulic code for upgrading Tecnatom's nuclear plant simulators. The interactive graphic simulator, (SGI) is a system that provides a graphic display of the models of a full-scope simulator by means of color monitors. The two new tools used are enabling higher levels of motivation to be achieved among the plant operations personnel, especially with respect to requalification

  14. Continuous quality improvement in small general medical practices: the attitudes of general practitioners and other practice staff.

    NARCIS (Netherlands)

    Geboers, H.J.A.M.; Mokkink, H.G.A.; Montfort, P.A.P. van; Hoogen, H.J.M. van den; Bosch, W.J.H.M. van den; Grol, R.P.T.M.

    2001-01-01

    OBJECTIVES: Continuous quality improvement (CQI) offers opportunities to improve care in small-scale office-based practice. Little is yet known about the implementation of CQI in small primary care practices. We studied the attitudes of physicians and staff in small family practices to a model of

  15. Advancing obstetric and neonatal care in a regional hospital in Ghana via continuous quality improvement.

    Science.gov (United States)

    Srofenyoh, Emmanuel; Ivester, Thomas; Engmann, Cyril; Olufolabi, Adeyemi; Bookman, Laurel; Owen, Medge

    2012-01-01

    To reduce maternal and neonatal death at a large regional hospital through the use of quality improvement methodologies. In 2007, Kybele and the Ghana Health Service formed a partnership to analyze systems and patient care processes at a regional hospital in Accra, Ghana. A model encompassing continuous assessment, implementation, advocacy, outputs, and outcomes was designed. Key areas for improvement were grouped into "bundles" based on personnel, systems management, and service quality. Primary outcomes included maternal and perinatal mortality, and case fatality rates for hemorrhage and hypertensive disorders. Implementation and outcomes were evaluated tri-annually between 2007 and 2009. During the study period, there was a 34% decrease in maternal mortality despite a 36% increase in patient admission. Case fatality rates for pre-eclampsia and hemorrhage decreased from 3.1% to 1.1% (Pcontinuous quality improvement were developed and employed. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  16. Models of maternity care: evidence for midwifery continuity of care.

    Science.gov (United States)

    Homer, Caroline Se

    2016-10-17

    There has been substantial reform in the past decade in the provision of maternal and child health services, and specifically regarding models of maternity care. Increasingly, midwives are working together in small groups to provide midwife-led continuity of care. This article reviews the current evidence for models of maternity care that provide midwifery continuity of care, in terms of their impact on clinical outcomes, the views of midwives and childbearing women, and health service costs. A systematic review of midwife-led continuity of care models identified benefits for women and babies, with no adverse effects. Non-randomised studies have shown benefits of midwifery continuity of care for specific groups, such as Aboriginal and Torres Strait Islander women. There are also benefits for midwives, including high levels of job satisfaction and less occupational burnout. Implementing midwifery continuity of care in public and private settings in Australia has been challenging, despite the evidence in its favour and government policy documents that support it. A reorganisation of the way maternity services are provided in Australia is required to ensure that women across the country can access this model of care. Critical to such reform is collaboration with obstetricians, general practitioners, paediatricians and other medical professionals involved in the care of pregnant women, as well as professional respect for the central role of midwives in the provision of maternity care. More research is needed into ways to ensure that all childbearing women can access midwifery continuity of care.

  17. Modeling of water treatment plant using timed continuous Petri nets

    Science.gov (United States)

    Nurul Fuady Adhalia, H.; Subiono, Adzkiya, Dieky

    2017-08-01

    Petri nets represent graphically certain conditions and rules. In this paper, we construct a model of the Water Treatment Plant (WTP) using timed continuous Petri nets. Specifically, we consider that (1) the water pump always active and (2) the water source is always available. After obtaining the model, the flow through the transitions and token conservation laws are calculated.

  18. A Quasispecies Continuous Contact Model in a Critical Regime

    Science.gov (United States)

    Kondratiev, Yuri; Pirogov, Sergey; Zhizhina, Elena

    2016-04-01

    We study a new non-equilibrium dynamical model: a marked continuous contact model in d-dimensional space (d ge 3). We prove that for certain values of rates (the critical regime) this system has the one-parameter family of invariant measures labelled by the spatial density of particles. Then we prove that the process starting from the marked Poisson measure converges to one of these invariant measures. In contrast with the continuous contact model studied earlier in Kondratiev (Infin Dimens Anal Quantum Probab Relat Top 11(2):231-258, 2008), now the spatial particle density is not a conserved quantity.

  19. CONTINUOUS MODELING OF FOREIGN EXCHANGE RATE OF USD VERSUS TRY

    Directory of Open Access Journals (Sweden)

    Yakup Arı

    2011-01-01

    Full Text Available This study aims to construct continuous-time autoregressive (CAR model and continuous-time GARCH (COGARCH model from discrete time data of foreign exchange rate of United States Dollar (USD versus Turkish Lira (TRY. These processes are solutions to stochastic differential equation Lévy-driven processes. We have shown that CAR(1 and COGARCH(1,1 processes are proper models to represent foreign exchange rate of USD and TRY for different periods of time February 2002- June 2010.

  20. Modelling continuing professional development in an innovative context

    DEFF Research Database (Denmark)

    Fink, Flemming K.

    2001-01-01

    Being one step ahead of your competitors with incorporation of new knowledge in the products puts focus on the importance of human resources as a significant resource for industrial development. A major competitive parameter in knowledge society is engineering competence, especially in the industry...... subject to very fast innovation processes. Continuing Professional Development of engineering staff is therefore very important. A model for the continuing education process will be described. The elements of the model and their interaction will be discussed. Part of the modelling is based on interviews...

  1. Modeling electricity loads in California: a continuous-time approach

    Science.gov (United States)

    Weron, R.; Kozłowska, B.; Nowicka-Zagrajek, J.

    2001-10-01

    In this paper we address the issue of modeling electricity loads and prices with diffusion processes. More specifically, we study models which belong to the class of generalized Ornstein-Uhlenbeck processes. After comparing properties of simulated paths with those of deseasonalized data from the California power market and performing out-of-sample forecasts we conclude that, despite certain advantages, the analyzed continuous-time processes are not adequate models of electricity load and price dynamics.

  2. Extending Growth Mixture Models Using Continuous Non-Elliptical Distributions

    OpenAIRE

    Wei, Yuhong; Tang, Yang; Shireman, Emilie; McNicholas, Paul D.; Steinley, Douglas L.

    2017-01-01

    Growth mixture models (GMMs) incorporate both conventional random effects growth modeling and latent trajectory classes as in finite mixture modeling; therefore, they offer a way to handle the unobserved heterogeneity between subjects in their development. GMMs with Gaussian random effects dominate the literature. When the data are asymmetric and/or have heavier tails, more than one latent class is required to capture the observed variable distribution. Therefore, a GMM with continuous non-el...

  3. Improving practical atmospheric dispersion models

    International Nuclear Information System (INIS)

    Hunt, J.C.R.; Hudson, B.; Thomson, D.J.

    1992-01-01

    The new generation of practical atmospheric dispersion model (for short range ≤ 30 km) are based on dispersion science and boundary layer meteorology which have widespread international acceptance. In addition, recent improvements in computer skills and the widespread availability of small powerful computers make it possible to have new regulatory models which are more complex than the previous generation which were based on charts and simple formulae. This paper describes the basis of these models and how they have developed. Such models are needed to satisfy the urgent public demand for sound, justifiable and consistent environmental decisions. For example, it is preferable that the same models are used to simulate dispersion in different industries; in many countries at present different models are used for emissions from nuclear and fossil fuel power stations. The models should not be so simple as to be suspect but neither should they be too complex for widespread use; for example, at public inquiries in Germany, where simple models are mandatory, it is becoming usual to cite the results from highly complex computational models because the simple models are not credible. This paper is written in a schematic style with an emphasis on tables and diagrams. (au) (22 refs.)

  4. Continuous Improvement in the Industrial and Management Systems Engineering Programme at Kuwait University

    Science.gov (United States)

    Aldowaisan, Tariq; Allahverdi, Ali

    2016-01-01

    This paper describes the process employed by the Industrial and Management Systems Engineering programme at Kuwait University to continuously improve the programme. Using a continuous improvement framework, the paper demonstrates how various qualitative and quantitative analyses methods, such as hypothesis testing and control charts, have been…

  5. Sustained participation in annual continuous quality improvement activities improves quality of care for Aboriginal and Torres Strait Islander children.

    Science.gov (United States)

    McAullay, Daniel; McAuley, Kimberley; Bailie, Ross; Mathews, Veronica; Jacoby, Peter; Gardner, Karen; Sibthorpe, Beverly; Strobel, Natalie; Edmond, Karen

    2018-02-01

    To determine whether participation in the continuous quality improvement (CQI) Audit and Best Practice for Chronic Disease programme improved care and outcomes for Indigenous children. Data were collected from 59 Australian primary health-care centres providing services to Indigenous people and participating in the programme (February 2008 and December 2013). Indigenous children aged less than 2 years and centres that completed three or more consecutive annual audits within the 6-year study period were included. Crude and adjusted logistic generalised estimating equation models were used to examine the effect of year of audit on the delivery of care. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Outcomes were related to age-relevant health issues, including prevention and early intervention. These included administrative, health check, anticipatory guidance and specific health issues. During the audit period, there were 2360 files from 59 centres. Those that had a recall recorded, improved from 84 to 95% (OR 2.44, 95% CI 1.44-4.11). Hearing assessments improved from 52 to 89% (OR 1.37, 95% CI 1.22-1.54). Improvement in anticipatory guidance, treatment and follow-up of medical conditions was almost universal. We documented significant improvements in quality of care of Indigenous children. Outcomes and their corresponding treatment and follow-ups improved over time. This appears to be related to services participating in annual CQI activities. However, these services may be more committed to CQI than others and therefore possibly better performing. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  6. Patients’ experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care

    Science.gov (United States)

    Chung, Vincent CH; Yip, Benjamin HK; Griffiths, Sian M; Yu, Ellen LM; Liu, Siya; Ho, Robin ST; Wu, Xinyin; Leung, Albert WN; Sit, Regina WS; Wu, Justin CY; Wong, Samuel YS

    2015-01-01

    Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients’ experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients’ perspective; and (ii) to investigate how quality varies with patients’ demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of “coordination of patient information”, “continuity of care”, and “range of service provided”. Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services. PMID:26686267

  7. Patients' experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care.

    Science.gov (United States)

    Chung, Vincent Ch; Yip, Benjamin Hk; Griffiths, Sian M; Yu, Ellen Lm; Liu, Siya; Ho, Robin St; Wu, Xinyin; Leung, Albert Wn; Sit, Regina Ws; Wu, Justin Cy; Wong, Samuel Ys

    2015-12-21

    Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients' experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients' perspective; and (ii) to investigate how quality varies with patients' demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of "coordination of patient information", "continuity of care", and "range of service provided". Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.

  8. Continuous and Discontinuous Modelling of Fracture in Concrete Using FEM

    CERN Document Server

    Tejchman, Jacek

    2013-01-01

    The book analyzes a quasi-static fracture process in concrete and reinforced concrete by means of constitutive models formulated within continuum mechanics. A continuous and discontinuous modelling approach was used. Using a continuous approach, numerical analyses were performed using a finite element method and three different enhanced continuum models: isotropic elasto-plastic, isotropic damage and anisotropic smeared crack one. The models were equipped with a characteristic length of micro-structure by means of a non-local and a second-gradient theory. So they could properly describe the formation of localized zones with a certain thickness and spacing and a related deterministic size effect. Using a discontinuous FE approach, numerical results of cracks using a cohesive crack model and XFEM were presented which were also properly regularized. Finite element analyses were performed with concrete elements under monotonic uniaxial compression, uniaxial tension, bending and shear-extension. Concrete beams un...

  9. Model Selection in Continuous Test Norming With GAMLSS.

    Science.gov (United States)

    Voncken, Lieke; Albers, Casper J; Timmerman, Marieke E

    2017-06-01

    To compute norms from reference group test scores, continuous norming is preferred over traditional norming. A suitable continuous norming approach for continuous data is the use of the Box-Cox Power Exponential model, which is found in the generalized additive models for location, scale, and shape. Applying the Box-Cox Power Exponential model for test norming requires model selection, but it is unknown how well this can be done with an automatic selection procedure. In a simulation study, we compared the performance of two stepwise model selection procedures combined with four model-fit criteria (Akaike information criterion, Bayesian information criterion, generalized Akaike information criterion (3), cross-validation), varying data complexity, sampling design, and sample size in a fully crossed design. The new procedure combined with one of the generalized Akaike information criterion was the most efficient model selection procedure (i.e., required the smallest sample size). The advocated model selection procedure is illustrated with norming data of an intelligence test.

  10. A story of success: continuous quality improvement in cystic fibrosis care in the USA.

    Science.gov (United States)

    Quon, Bradley S; Goss, Christopher H

    2011-12-01

    Continuous quality improvement (CQI) in healthcare can be described as a reiterative approach to improving processes to reduce unexpected variation in health outcomes. CQI represents one model to achieve quality improvement (QI) and has long been recognized as a key to success in the manufacturing industry with companies like Toyota leading the way. Healthcare, and specifically pulmonary, critical care and sleep medicine represent ideal settings for the application of CQI. This opinion piece will describe QI and CQI initiatives in the US Cystic fibrosis (CF) population. QI in CF care in the United States has been ongoing since inception of the US CF Foundation (CFF) in 1955. This effort has included work to improve the quality of clinical care provided at CF centers and work to improve clinical outcomes in CF. More recently, QI methods have been applied to the conduct of clinical research. The CF community has become a leader in the area of QI and has pointed out the opportunities for others to follow in the area of lung diseases.

  11. Modeling and simulation of continuous powder blending applied to a continuous direct compression process.

    Science.gov (United States)

    Galbraith, Shaun C; Liu, Huolong; Cha, Bumjoon; Park, Seo-Young; Huang, Zhuangrong; Yoon, Seongkyu

    2018-01-17

    Continuous manufacturing techniques are increasingly being adopted in the pharmaceutical industry and powder blending is a key operation for solid-dosage tablets. A modeling methodology involving axial and radial tanks-in-series flowsheet models is developed to describe the residence time distribution (RTD) and blend uniformity of a commercial powder blending system. Process data for a six-component formulation processed in a continuous direct compression line (GEA Pharma Systems) is used to test the methodology. Impulse tests were used to generate experimental RTDs which are used along with parameter estimation to determine the number of axial tanks in the flowsheet. The weighted residual from the parameter estimation was less than the χ 2 value at a 95% confidence indicating a good fit between the model and measured data. In-silico impulse tests showed the tanks-in-series modeling methodology could successfully describe the RTD behavior of the blenders along with blend uniformity through the use of radial tanks. The simulation output for both impulse weight percentage and blend uniformity were within the experimentally observed variance.

  12. Recent improvements in CRACUK modelling

    International Nuclear Information System (INIS)

    Egan, M.J.; Nixon, W.

    1986-08-01

    The CRACUK computer code is a revised version of the US consequence modelling code CRAC2, adapted to suit UK applications. This report describes in detail the modifications to the dosimetric models contained within the code, and assesses their influence upon the predicted consequences of postulated atmospheric releases following severe light water and fast reactor accidents. The impact for such source terms is not marked, when compared with existing uncertainty bands, although, for the fast reactor case, the distribution of predicted cancers among the different types is significantly affected. Nevertheless, the improvements lend confidence to the use of CRACUK for the assessment of accidents for a wider range of nuclear plant. (author)

  13. Continuing geographic education model contribution to environmental culture development

    Directory of Open Access Journals (Sweden)

    González E. A.

    2014-01-01

    Full Text Available Low levels of geographic culture and educations were found in schools and communities caused by formal education systems shortcomings, poor geographic educative influence aside learning institutions, and lose comprehension of individual and social needs. The main objective of the research supporting this article was to devise a continuing geographic education model for social agents at schools and communities, as a requirement to attain a sustainable development based on the practical usage of this model to favor the organization of its systematic cultural influences. This research is part of a larger project leaded by the author and is derived from his PH D studies. The findings are being appraised since 2005 in social and educative contexts of Camagüey Province making evident the validity of the model. Key words: continuing geographic education model, geographic education, geographic culture.

  14. Continuous host-macroparasite models with application to aquaculture

    Directory of Open Access Journals (Sweden)

    Catherine Bouloux Marquet

    2004-11-01

    Full Text Available We study a continuous deterministic host-macroparasite system which involves populations of hosts, parasites, and larvae. This system leads to a countable number of partial differential equations that under certain hypotheses, is reduced to finitely many equations. Also we assume hypotheses to close the system and to define the global dynamics for the hosts. Then, we analyze the spatially homogeneous model without demography (aquaculture hypothesis, and show some preliminary results for the spatially structured model.

  15. Data Workflow - A Workflow Model for Continuous Data Processing

    NARCIS (Netherlands)

    Wombacher, Andreas

    2010-01-01

    Online data or streaming data are getting more and more important for enterprise information systems, e.g. by integrating sensor data and workflows. The continuous flow of data provided e.g. by sensors requires new workflow models addressing the data perspective of these applications, since

  16. Modeling herbivorous animal digestive system as 3- continuous ...

    African Journals Online (AJOL)

    Modeling herbivorous animal digestive system as 3- continuous stirred tank reactor (CSTR) and 1-plug flow reactor (PFR) in series with specific reference to ... This shows the efficiency of each reactor at converting the purely lignocellulosics substrates to useful products like protein, vitamin, fatty acid and the bye-products.

  17. Shortlist B: A Bayesian model of continuous speech recognition

    NARCIS (Netherlands)

    Norris, D.; McQueen, J.M.

    2008-01-01

    A Bayesian model of continuous speech recognition is presented. It is based on Shortlist (D. Norris, 1994; D. Norris, J. M. McQueen, A. Cutler, & S. Butterfield, 1997) and shares many of its key assumptions: parallel competitive evaluation of multiple lexical hypotheses, phonologically abstract

  18. Shortlist B: A Bayesian Model of Continuous Speech Recognition

    Science.gov (United States)

    Norris, Dennis; McQueen, James M.

    2008-01-01

    A Bayesian model of continuous speech recognition is presented. It is based on Shortlist (D. Norris, 1994; D. Norris, J. M. McQueen, A. Cutler, & S. Butterfield, 1997) and shares many of its key assumptions: parallel competitive evaluation of multiple lexical hypotheses, phonologically abstract prelexical and lexical representations, a feedforward…

  19. An Examination of Models of Relaxation in Complex Systems. I. Continuous Time Random Walk (CTRW) Models.

    Science.gov (United States)

    1986-02-04

    M NRL Memorandum Report 5719 An Examination of Models of Relaxation in Complex Systems 1. Continuous Time Random Walk ( CTRW ) Models K. L. NGAI, R. W...Examination of Models of Relaxation in Complex Systems I. Continuous Time Random Walk ( CTRW ) Models E. PSRSONAL AUTHOR(S) Ntgi, K.L., Rendell. R.W...necessary and idenrify by block number) Models of relaxation in complex systemL based on the continuous time random walk ( CTRW ) formalism are examined on

  20. Improvements in ECN Wake Model

    Energy Technology Data Exchange (ETDEWEB)

    Versteeg, M.C. [University of Twente, Enschede (Netherlands); Ozdemir, H.; Brand, A.J. [ECN Wind Energy, Petten (Netherlands)

    2013-08-15

    Wind turbines extract energy from the flow field so that the flow in the wake of a wind turbine contains less energy and more turbulence than the undisturbed flow, leading to less energy extraction for the downstream turbines. In large wind farms, most turbines are located in the wake of one or more turbines causing the flow characteristics felt by these turbines differ considerably from the free stream flow conditions. The most important wake effect is generally considered to be the lower wind speed behind the turbine(s) since this decreases the energy production and as such the economical performance of a wind farm. The overall loss of a wind farm is very much dependent on the conditions and the lay-out of the farm but it can be in the order of 5-10%. Apart from the loss in energy production an additional wake effect is formed by the increase in turbulence intensity, which leads to higher fatigue loads. In this sense it becomes important to understand the details of wake behavior to improve and/or optimize a wind farm layout. Within this study improvements are presented for the existing ECN wake model which constructs the fundamental basis of ECN's FarmFlow wind farm wake simulation tool. The outline of this paper is as follows: first, the governing equations of the ECN wake farm model are presented. Then the near wake modeling is discussed and the results compared with the original near wake modeling and EWTW (ECN Wind Turbine Test Site Wieringermeer) data as well as the results obtained for various near wake implementation cases are shown. The details of the atmospheric stability model are given and the comparison with the solution obtained for the original surface layer model and with the available data obtained by EWTW measurements are presented. Finally the conclusions are summarized.

  1. 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.

  2. Integrating Essential Components of Quality Improvement into a New Paradigm for Continuing Education

    Science.gov (United States)

    Van Hoof, Thomas J.; Meehan, Thomas P.

    2011-01-01

    Continuing education (CE) that strives to improve patient care in a complex health care system requires a different paradigm than CE that seeks to improve clinician knowledge and competence in an educational setting. A new paradigm for CE is necessary in order to change clinician behavior and to improve patient outcomes in an increasingly…

  3. An action research study; cultural differences impact how manufacturing organizations receive continuous improvement

    Science.gov (United States)

    Kattman, Braden R.

    National culture and organizational culture impact how continuous improvement methods are received, implemented and deployed by suppliers. Previous research emphasized the dominance of national culture over organizational culture. The countries studied included Poland, Mexico, China, Taiwan, South Korea, Estonia, India, Canada, the United States, the United Kingdom, and Japan. The research found that Canada was most receptive to continuous improvement, with China being the least receptive. The study found that organizational culture was more influential than national culture. Isomorphism and benchmarking is driving continuous-improvement language and methods to be more universally known within business. Business and management practices are taking precedence in driving change within organizations.

  4. A continuous-time neural model for sequential action.

    Science.gov (United States)

    Kachergis, George; Wyatte, Dean; O'Reilly, Randall C; de Kleijn, Roy; Hommel, Bernhard

    2014-11-05

    Action selection, planning and execution are continuous processes that evolve over time, responding to perceptual feedback as well as evolving top-down constraints. Existing models of routine sequential action (e.g. coffee- or pancake-making) generally fall into one of two classes: hierarchical models that include hand-built task representations, or heterarchical models that must learn to represent hierarchy via temporal context, but thus far lack goal-orientedness. We present a biologically motivated model of the latter class that, because it is situated in the Leabra neural architecture, affords an opportunity to include both unsupervised and goal-directed learning mechanisms. Moreover, we embed this neurocomputational model in the theoretical framework of the theory of event coding (TEC), which posits that actions and perceptions share a common representation with bidirectional associations between the two. Thus, in this view, not only does perception select actions (along with task context), but actions are also used to generate perceptions (i.e. intended effects). We propose a neural model that implements TEC to carry out sequential action control in hierarchically structured tasks such as coffee-making. Unlike traditional feedforward discrete-time neural network models, which use static percepts to generate static outputs, our biological model accepts continuous-time inputs and likewise generates non-stationary outputs, making short-timescale dynamic predictions. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

  5. A queueing theory based model for business continuity in hospitals.

    Science.gov (United States)

    Miniati, R; Cecconi, G; Dori, F; Frosini, F; Iadanza, E; Biffi Gentili, G; Niccolini, F; Gusinu, R

    2013-01-01

    Clinical activities can be seen as results of precise and defined events' succession where every single phase is characterized by a waiting time which includes working duration and possible delay. Technology makes part of this process. For a proper business continuity management, planning the minimum number of devices according to the working load only is not enough. A risk analysis on the whole process should be carried out in order to define which interventions and extra purchase have to be made. Markov models and reliability engineering approaches can be used for evaluating the possible interventions and to protect the whole system from technology failures. The following paper reports a case study on the application of the proposed integrated model, including risk analysis approach and queuing theory model, for defining the proper number of device which are essential to guarantee medical activity and comply the business continuity management requirements in hospitals.

  6. Occam factors and model independent Bayesian learning of continuous distributions

    International Nuclear Information System (INIS)

    Nemenman, Ilya; Bialek, William

    2002-01-01

    Learning of a smooth but nonparametric probability density can be regularized using methods of quantum field theory. We implement a field theoretic prior numerically, test its efficacy, and show that the data and the phase space factors arising from the integration over the model space determine the free parameter of the theory ('smoothness scale') self-consistently. This persists even for distributions that are atypical in the prior and is a step towards a model independent theory for learning continuous distributions. Finally, we point out that a wrong parametrization of a model family may sometimes be advantageous for small data sets

  7. Government/contractor partnerships for continuous improvement. A Goddard Space Flight Center example

    Science.gov (United States)

    Tagler, Richard C.

    1992-01-01

    The efforts of a government organization and its major contractors to foster a continuous improvement environment which transcends the traditional government/contractor relationship is discussed. This relationship is aimed at communication, partnership, and trust - creating benefits for all involved.

  8. Estimation of Continuous Velocity Model Variations in Rock Deformation Tests.

    Science.gov (United States)

    Flynn, J. W.; Tomas, R.; Benson, P. M.

    2017-12-01

    Seismic interferometry, using either seismic waves coda or ambient noise, is a passive technique to image the sub-surface seismic velocity structure, which directly relates to the physical properties of the material through which they travel. The methodology estimates the Green's function for the volume between two seismic stations by cross-correlating long time series of ambient noise recorded at both stations, with the Green's function being effectively the seismogram recorded at one station due to an impulsive or instantaneous energy source at the second station. In laboratory rock deformation experiments, changes in the velocity structure of the rock sample are generally measured through active surveys using an array of AE piezoelectric P-wave transducers, producing a time series of ultrasonic velocities in both axial and radial directions. The velocity information from the active surveys is used to provide a time dependent velocity model for the inversion of AE event source locations. These velocity measurements are carried out at regular intervals throughout the laboratory test, causing the interruption of passive AE monitoring for the length of the surveys. There is therefore a trade-off between the frequency at which the active velocity surveys are carried out to optimise the velocity model and the availability of a complete AE record during the rock deformation test.This study proposes to use noise interferometry to provide a continuous measurement of velocity variations in a rock sample during a laboratory rock deformation experiment without the need to carry out active velocity surveys while simultaneously passively monitoring AE activity. The continuous noise source in this test, is an AE transducer fed with a white gaussian noise signal from a function generator. Data from all AE transducers is continuously acquired and recorded during the deformation experiment. The cross correlation of the continuous AE record is used to produce a continuous velocity

  9. Utilization of a numerical model of the temperature field of a conti-casting and prediction anti-break systems at the continuous caster of the steelworks division plant to improve the production quality at U. S Steel Košice, Ltd.

    Directory of Open Access Journals (Sweden)

    Marek Pavol

    2003-09-01

    Full Text Available The paper presents the optimization elements at the continuous caster (CC from the view of the quality management and the costsavingprogram at U. S. Steel Košice, Ltd. The presented issue represents a partial problem within one step of the production cycle, which isconnected with the quality of slabs and with managing their subsequent processing. The solutions to reduce the occurrence of slab defectsare presented. The authors describe the utilization of anti-break systems of the continuous caster and an original numerical model of thenon-stationary temperature field of a conti-casting for CC#2, which solves current thermo-kinetic problems generally, as well asindividually. This model helps to optimize the primary and secondary cooling at CC#2 and to improve the surface quality of slabs.

  10. PDCA cycle as a part of continuous improvement in the production company - a case study

    OpenAIRE

    Marta Jagusiak-Kocik

    2017-01-01

    The paper presents a case study of the practical use of Deming cycle in a manufacturing company, from the plastics processing industry, from the sector of small and medium-sized enterprises. The paper is a study of literature in the field of continuous improvement and characterized by a cycle of continuous improvement, called the Deming cycle, or PDCA cycle. This cycle was used as a solution to quality problems which occurred during production of photo frames: discolorations and ...

  11. A spatial and temporal continuous surface-subsurface hydrologic model

    Science.gov (United States)

    Xiao, Qing-Fu; Ustin, Susan L.; Wallender, Wesley W.

    1996-12-01

    A hydrologic model integrating surface-subsurface processes was developed based on spatial and temporal continuity theory. The raster-based mass balance hydrologic model consists of several submodels which determine spatial and temporal patterns in precipitation, surface flow, infiltration, subsurface flow, and the linkages between these submodels. Model parameters and variables are derived directly or indirectly from satellite remote sensing data, topographic maps, soil maps, literature, and weather station data and are stored in a Geographic Information System (GIS) database used for visualization. Surface resolution of cells in the model is 20 m by 20 m (pixel resolution of the Systeme Probatoire d'Observation de la Terre (SPOT) satellite image) over a 2511 km2 study area around the Crazy Mountains, Alaska, a watershed on the Arctic Circle draining into the Yukon River. The outputs from this model illustrate the interaction of physical and biologic factors on the partitioning of hydrologic components in a complex landscape.

  12. Fully automated whole-head segmentation with improved smoothness and continuity, with theory reviewed.

    Directory of Open Access Journals (Sweden)

    Yu Huang

    Full Text Available Individualized current-flow models are needed for precise targeting of brain structures using transcranial electrical or magnetic stimulation (TES/TMS. The same is true for current-source reconstruction in electroencephalography and magnetoencephalography (EEG/MEG. The first step in generating such models is to obtain an accurate segmentation of individual head anatomy, including not only brain but also cerebrospinal fluid (CSF, skull and soft tissues, with a field of view (FOV that covers the whole head. Currently available automated segmentation tools only provide results for brain tissues, have a limited FOV, and do not guarantee continuity and smoothness of tissues, which is crucially important for accurate current-flow estimates. Here we present a tool that addresses these needs. It is based on a rigorous Bayesian inference framework that combines image intensity model, anatomical prior (atlas and morphological constraints using Markov random fields (MRF. The method is evaluated on 20 simulated and 8 real head volumes acquired with magnetic resonance imaging (MRI at 1 mm3 resolution. We find improved surface smoothness and continuity as compared to the segmentation algorithms currently implemented in Statistical Parametric Mapping (SPM. With this tool, accurate and morphologically correct modeling of the whole-head anatomy for individual subjects may now be feasible on a routine basis. Code and data are fully integrated into SPM software tool and are made publicly available. In addition, a review on the MRI segmentation using atlas and the MRF over the last 20 years is also provided, with the general mathematical framework clearly derived.

  13. Fully automated whole-head segmentation with improved smoothness and continuity, with theory reviewed.

    Science.gov (United States)

    Huang, Yu; Parra, Lucas C

    2015-01-01

    Individualized current-flow models are needed for precise targeting of brain structures using transcranial electrical or magnetic stimulation (TES/TMS). The same is true for current-source reconstruction in electroencephalography and magnetoencephalography (EEG/MEG). The first step in generating such models is to obtain an accurate segmentation of individual head anatomy, including not only brain but also cerebrospinal fluid (CSF), skull and soft tissues, with a field of view (FOV) that covers the whole head. Currently available automated segmentation tools only provide results for brain tissues, have a limited FOV, and do not guarantee continuity and smoothness of tissues, which is crucially important for accurate current-flow estimates. Here we present a tool that addresses these needs. It is based on a rigorous Bayesian inference framework that combines image intensity model, anatomical prior (atlas) and morphological constraints using Markov random fields (MRF). The method is evaluated on 20 simulated and 8 real head volumes acquired with magnetic resonance imaging (MRI) at 1 mm3 resolution. We find improved surface smoothness and continuity as compared to the segmentation algorithms currently implemented in Statistical Parametric Mapping (SPM). With this tool, accurate and morphologically correct modeling of the whole-head anatomy for individual subjects may now be feasible on a routine basis. Code and data are fully integrated into SPM software tool and are made publicly available. In addition, a review on the MRI segmentation using atlas and the MRF over the last 20 years is also provided, with the general mathematical framework clearly derived.

  14. Exploiting the steady state, continuous fueling reactor model

    International Nuclear Information System (INIS)

    Vondy, D.R.; Cunningham, G.W.; Fowler, T.B.

    1979-01-01

    A continuously fueled reactor presents an analysis challenge, especially so when the neutron accounting is sensitive to the core design and the fuel handling. A scheme was implemented to solve the steady state, continuous fueling problem. This problem is an accurate model of the reactor for assessing performance at a point in its operating history. Available capability in a modular code system developed to treat fixed fuel reactors was extended in this effort. Parametric studies have been made with this capability to assess the performance of a pebble bed power plant reactor over a wide range of fueling possibilities. The model and the calculational methods are discussed. A global iteration scheme is used to effect a solution for the critical reactor state. The schemes used to accelerate the rate of convergence of one- and two-dimensional problems are described and the interactive behavior is shown for representative problems

  15. A Stochastic Continuous Time Model for Microgrid Energy Management

    OpenAIRE

    Heymann, Benjamin; Frédéric Bonnans, J; Silva, Francisco; Jimenez, Guillermo

    2016-01-01

    International audience; We propose a novel stochastic control formulation for the microgrid energy management problem and extend previous works on continuous time rolling horizon strategy to uncertain demand. We modelize the demand dynamics with a stochastic differential equation. We decompose this dynamics into three terms: an average drift, a time-dependent mean-reversion term and a Brownian noise. We use BOCOPHJB for the numerical simulations. This optimal control toolbox implements a semi...

  16. AN EMPIRICAL MODEL OF ONLINE BUYING CONTINUANCE INTENTION

    OpenAIRE

    ORZAN Gheorghe; ICONARU Claudia; MACOVEI Octav-Ionut

    2012-01-01

    The aim of this paper is to propose, test and validate a model of consumers` continuance intention to buy online as a main function of affective attitude towards using the Internet for purchasing goods and services and the overall satisfaction towards the decision of buying online. The confirmation of initial expectations regarding online buying is the main predictor of online consumers` satisfaction and online consumers` perceived usefulness of online buying. Affective attitude is mediating ...

  17. Estimation of Continuous Time Models in Economics: an Overview

    OpenAIRE

    Clifford R. Wymer

    2009-01-01

    The dynamics of economic behaviour is often developed in theory as a continuous time system. Rigorous estimation and testing of such systems, and the analysis of some aspects of their properties, is of particular importance in distinguishing between competing hypotheses and the resulting models. The consequences for the international economy during the past eighteen months of failures in the financial sector, and particularly the banking sector, make it essential that the dynamics of financia...

  18. Shortlist B: A Bayesian model of continuous speech recognition

    OpenAIRE

    Norris, D.; McQueen, J.

    2008-01-01

    A Bayesian model of continuous speech recognition is presented. It is based on Shortlist ( D. Norris, 1994; D. Norris, J. M. McQueen, A. Cutler, & S. Butterfield, 1997) and shares many of its key assumptions: parallel competitive evaluation of multiple lexical hypotheses, phonologically abstract prelexical and lexical representations, a feedforward architecture with no online feedback, and a lexical segmentation algorithm based on the viability of chunks of the input as possible words. Shortl...

  19. Building a Culture of Continuous Quality Improvement in an Academic Radiology Department.

    Science.gov (United States)

    Katzman, Gregory L; Paushter, David M

    2016-04-01

    As we enter a new era of health care in the United States, radiologists must be adequately prepared to prove, and continually improve, our value to our customers. This goal can be achieved in large part by providing high-quality services. Although quality efforts on the national and international levels provide a framework for improving radiologic quality, some of the greatest opportunities for quality improvement can be found at the departmental level, through the implementation of total quality management programs. Establishing such a program requires not only strong leadership and employee engagement, but also a firm understanding of the multiple total quality management tools and continuous quality improvement strategies available. In this article, we discuss key tools and strategies required to build a culture of continuous quality improvement in an academic department, based on our experience. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  20. Predicting core losses and efficiency of SRM in continuous current mode of operation using improved analytical technique

    Science.gov (United States)

    Parsapour, Amir; Dehkordi, Behzad Mirzaeian; Moallem, Mehdi

    2015-03-01

    In applications in which the high torque per ampere at low speed and rated power at high speed are required, the continuous current method is the best solution. However, there is no report on calculating the core loss of SRM in continuous current mode of operation. Efficiency and iron loss calculation which are complex tasks in case of conventional mode of operation is even more involved in continuous current mode of operation. In this paper, the Switched Reluctance Motor (SRM) is modeled using finite element method and core loss and copper loss of SRM in discontinuous and continuous current modes of operation are calculated using improved analytical techniques to include the minor loop losses in continuous current mode of operation. Motor efficiency versus speed in both operation modes is obtained and compared.

  1. Continuation-like semantics for modeling structural process anomalies

    Directory of Open Access Journals (Sweden)

    Grewe Niels

    2012-09-01

    Full Text Available Abstract Background Biomedical ontologies usually encode knowledge that applies always or at least most of the time, that is in normal circumstances. But for some applications like phenotype ontologies it is becoming increasingly important to represent information about aberrations from a norm. These aberrations may be modifications of physiological structures, but also modifications of biological processes. Methods To facilitate precise definitions of process-related phenotypes, such as delayed eruption of the primary teeth or disrupted ocular pursuit movements, I introduce a modeling approach that draws inspiration from the use of continuations in the analysis of programming languages and apply a similar idea to ontological modeling. This approach characterises processes by describing their outcome up to a certain point and the way they will continue in the canonical case. Definitions of process types are then given in terms of their continuations and anomalous phenotypes are defined by their differences to the canonical definitions. Results The resulting model is capable of accurately representing structural process anomalies. It allows distinguishing between different anomaly kinds (delays, interruptions, gives identity criteria for interrupted processes, and explains why normal and anomalous process instances can be subsumed under a common type, thus establishing the connection between canonical and anomalous process-related phenotypes. Conclusion This paper shows how to to give semantically rich definitions of process-related phenotypes. These allow to expand the application areas of phenotype ontologies beyond literature annotation and establishment of genotype-phenotype associations to the detection of anomalies in suitably encoded datasets.

  2. Improving critical thinking and clinical reasoning with a continuing education course.

    Science.gov (United States)

    Cruz, Dina Monteiro; Pimenta, Cibele Mattos; Lunney, Margaret

    2009-03-01

    Continuing education courses related to critical thinking and clinical reasoning are needed to improve the accuracy of diagnosis. This study evaluated a 4-day, 16-hour continuing education course conducted in Brazil.Thirty-nine nurses completed a pretest and a posttest consisting of two written case studies designed to measure the accuracy of nurses' diagnoses. There were significant differences in accuracy from pretest to posttest for case 1 (p = .008) and case 2 (p = .042) and overall (p = .001). Continuing education courses should be implemented to improve the accuracy of nurses' diagnoses.

  3. Continuous Modeling of Calcium Transport Through Biological Membranes

    Science.gov (United States)

    Jasielec, J. J.; Filipek, R.; Szyszkiewicz, K.; Sokalski, T.; Lewenstam, A.

    2016-08-01

    In this work an approach to the modeling of the biological membranes where a membrane is treated as a continuous medium is presented. The Nernst-Planck-Poisson model including Poisson equation for electric potential is used to describe transport of ions in the mitochondrial membrane—the interface which joins mitochondrial matrix with cellular cytosis. The transport of calcium ions is considered. Concentration of calcium inside the mitochondrion is not known accurately because different analytical methods give dramatically different results. We explain mathematically these differences assuming the complexing reaction inside mitochondrion and the existence of the calcium set-point (concentration of calcium in cytosis below which calcium stops entering the mitochondrion).

  4. The continuous similarity model of bulk soil-water evaporation

    Science.gov (United States)

    Clapp, R. B.

    1983-01-01

    The continuous similarity model of evaporation is described. In it, evaporation is conceptualized as a two stage process. For an initially moist soil, evaporation is first climate limited, but later it becomes soil limited. During the latter stage, the evaporation rate is termed evaporability, and mathematically it is inversely proportional to the evaporation deficit. A functional approximation of the moisture distribution within the soil column is also included in the model. The model was tested using data from four experiments conducted near Phoenix, Arizona; and there was excellent agreement between the simulated and observed evaporation. The model also predicted the time of transition to the soil limited stage reasonably well. For one of the experiments, a third stage of evaporation, when vapor diffusion predominates, was observed. The occurrence of this stage was related to the decrease in moisture at the surface of the soil. The continuous similarity model does not account for vapor flow. The results show that climate, through the potential evaporation rate, has a strong influence on the time of transition to the soil limited stage. After this transition, however, bulk evaporation is independent of climate until the effects of vapor flow within the soil predominate.

  5. Continuous improvement, burnout and job engagement: a study in a Dutch nursing department

    NARCIS (Netherlands)

    Benders, J.G.J.M.; Bleijerveld, H.; Schouteten, R.L.J.

    2017-01-01

    Continuous improvement (CI) programs are potentially powerful means to improve the quality of care. The more positive nurses perceive these programs' effects, the better they may be expected to cooperate. Crucial to this perception is how nurses' quality of working life is affected. We studied this

  6. Using Surveys of Students' Social-Emotional Learning and School Climate for Accountability and Continuous Improvement

    Science.gov (United States)

    Hough, Heather; Kalogrides, Demetra; Loeb, Susanna

    2017-01-01

    The research featured in this paper is part of the CORE-PACE Research Partnership, through which Policy Analysis for California Education (PACE) has partnered with the CORE districts to conduct research designed to support them in continuous improvement while simultaneously helping to improve policy and practice in California and nationwide.…

  7. The RISE Framework: Using Learning Analytics to Automatically Identify Open Educational Resources for Continuous Improvement

    Science.gov (United States)

    Bodily, Robert; Nyland, Rob; Wiley, David

    2017-01-01

    The RISE (Resource Inspection, Selection, and Enhancement) Framework is a framework supporting the continuous improvement of open educational resources (OER). The framework is an automated process that identifies learning resources that should be evaluated and either eliminated or improved. This is particularly useful in OER contexts where the…

  8. Creating Sustainable Education Projects in Roatán, Honduras through Continuous Process Improvement

    Science.gov (United States)

    Raven, Arjan; Randolph, Adriane B.; Heil, Shelli

    2010-01-01

    The investigators worked together with permanent residents of Roatán, Honduras on sustainable initiatives to help improve the island's troubled educational programs. Our initiatives focused on increasing the number of students eligible and likely to attend a university. Using a methodology based in continuous process improvement, we developed…

  9. A multiscale slice model for continuous casting of steel

    International Nuclear Information System (INIS)

    Šarler, B; Vertnik, R; Lorbiecka, A Z; Vušanović, I; Sencic, B

    2012-01-01

    A simple Lagrange-an traveling slice model has been applied for the prediction of the relations between process parameters, macrosegregation and solidification grain structure formation (equiaxed to columnar and columnar to equiaxed transition) during the continuous casting process of steel billets. The main advantage of the slice model is its very fast calculation time in comparison with the complete 3D heat and fluid flow model which might need calculation time, measured in days. The slice models thus allows for fast optimisation and even for on-line simulation. The heat and species transfer models are based on the mixture continuum assumptions with Lever solidification rule and enhanced thermal and solutal diffusivities for heuristic accounting of fluid flow effects. The grain structure evolution model is based on the Gaussian nucleation rule, and KGT growth model, coupled to the macroscopic heat and species transfer models. The heat and species transfer models are solved by the meshless technique by using local collocation with radial basis functions. The grain structure evolution model is solved by the point automata technique, a novel meshless variant of the cellular automata method. A comparison of the results with the experimental data for steel grade 51CrV4 is shown in terms of macrosegregation and grain structure across the billet. Simulations and comparisons have been carried out for nominal casting conditions, reduced casting temperature, and reduced casting speed. The model predicts surprisingly well the qualitative features of the macrosegregation and grain structure patterns. Possible refinements of the model with respect to other physical mechanisms are discussed.

  10. [Interaction between continuous variables in logistic regression model].

    Science.gov (United States)

    Qiu, Hong; Yu, Ignatius Tak-Sun; Tse, Lap Ah; Wang, Xiao-rong; Fu, Zhen-ming

    2010-07-01

    Rothman argued that interaction estimated as departure from additivity better reflected the biological interaction. In a logistic regression model, the product term reflects the interaction as departure from multiplicativity. So far, literature on estimating interaction regarding an additive scale using logistic regression was only focusing on two dichotomous factors. The objective of the present report was to provide a method to examine the interaction as departure from additivity between two continuous variables or between one continuous variable and one categorical variable. We used data from a lung cancer case-control study among males in Hong Kong as an example to illustrate the bootstrap re-sampling method for calculating the corresponding confidence intervals. Free software R (Version 2.8.1) was used to estimate interaction on the additive scale.

  11. Attitudes and Opinions of Canadian Nephrologists Toward Continuous Quality Improvement Options

    Directory of Open Access Journals (Sweden)

    Carina Iskander

    2017-08-01

    Full Text Available Background and objectives: A shift to holding individual physicians accountable for patient outcomes, rather than facilities, is intuitively attractive to policy makers and to the public. We were interested in nephrologists’ attitudes to, and awareness of, quality metrics and how nephrologists would view a potential switch from the current model of facility-based quality measurement and reporting to publically available reports at the individual physician level. Design, setting, participants, and measurements: The study was conducted using a web-based survey instrument (Online Appendix 1. The survey was initially pilot tested on a group of 8 nephrologists from across Canada. The survey was then finalized and e-mailed to 330 nephrologists through the Canadian Society of Nephrology (CSN e-mail distribution list. The 127 respondents were 80% university based, and 33% were medical/dialysis directors. Results: The response rate was 43%. Results demonstrate that 89% of Canadian nephrologists are engaged in efforts to improve the quality of patient care. A minority of those surveyed (29% had training in quality improvement. They feel accountable for this and would welcome the inclusion of patient-centered metrics of care quality. Support for public reporting as an effective strategy on an individual nephrologist level was 30%. Conclusions: Support for public reporting of individual nephrologist performance was low. The care of nephrology patients will be best served by the continued development of a critical mass of physicians trained in patient safety and quality improvement, by focusing on patient-centered metrics of care delivery, and by validating that all proposed new methods are shown to improve patient care and outcomes.

  12. Some extensions in continuous models for immunological correlates of protection.

    Science.gov (United States)

    Dunning, Andrew J; Kensler, Jennifer; Coudeville, Laurent; Bailleux, Fabrice

    2015-12-28

    A scaled logit model has previously been proposed to quantify the relationship between an immunological assay and protection from disease, and has been applied in a number of settings. The probability of disease was modelled as a function of the probability of exposure, which was assumed to be fixed, and of protection, which was assumed to increase smoothly with the value of the assay. Some extensions are here investigated. Alternative functions to represent the protection curve are explored, applications to case-cohort designs are evaluated, and approaches to variance estimation compared. The steepness of the protection curve must sometimes be bounded to achieve convergence and methods for doing so are outlined. Criteria for evaluating the fit of models are proposed and approaches to assessing the utility of results suggested. Models are evaluated by application to sixteen datasets from vaccine clinical trials. Alternative protection curve functions improved model evaluation criteria for every dataset. Standard errors based on the observed information were found to be unreliable; bootstrap estimates of precision were to be preferred. In most instances, case-cohort designs resulted in little loss of precision. Some results achieved suggested measures for utility. The original scaled logit model can be improved upon. Evaluation criteria permit well-fitting models and useful results to be identified. The proposed methods provide a comprehensive set of tools for quantifying the relationship between immunological assays and protection from disease.

  13. Experimentally supported mathematical modeling of continuous baking processes

    DEFF Research Database (Denmark)

    Stenby Andresen, Mette

    and temperature) and control the process (air flow, temperature, and humidity) are therefore emphasized. The oven is furthermore designed to work outside the range of standard tunnel ovens, making it interesting for manufacturers of both baking products and baking equipment. A mathematical model describing......The scope of the PhD project was to increase knowledge on the process-to-product interactions in continuous tunnel ovens. The work has focused on five main objectives. These objectives cover development of new experimental equipment for pilot plant baking experiments, mathematical modeling of heat...... on mass transfer was examined through comparison of different modeling set-ups and experimental data. It was found that while the baking tray is likely to reduce the evaporation from the bottom surface, it is not correct to assume that no evaporation takes place at the covered surface. Parallel...

  14. Cooling nozzles characteristics for numerical models of continuous casting

    Directory of Open Access Journals (Sweden)

    R. Pyszko

    2013-10-01

    Full Text Available Modelling the temperature field of a continuously cast strand is an important tool for the process diagnostics. The main preconditions for numerical simulation of the temperature field of the solidifying strand are correct boundary conditions, especially the surface condition in the secondary zone of the caster. The paper deals with techniques of determining the surface condition under cooling nozzles as well as their approximation and implementation into the model algorithm. Techniques used for laboratory measurements of both cold and hot spraying characteristics of water or water-air cooling nozzles are described. The relationship between the cold and hot characteristics was found. Implementation of such a dependence into the model algorithm reduces the duration and cost of laboratory measurements.

  15. A Continuous-Time Model for Valuing Foreign Exchange Options

    Directory of Open Access Journals (Sweden)

    James J. Kung

    2013-01-01

    Full Text Available This paper makes use of stochastic calculus to develop a continuous-time model for valuing European options on foreign exchange (FX when both domestic and foreign spot rates follow a generalized Wiener process. Using the dollar/euro exchange rate as input for parameter estimation and employing our FX option model as a yardstick, we find that the traditional Garman-Kohlhagen FX option model, which assumes constant spot rates, values incorrectly calls and puts for different values of the ratio of exchange rate to exercise price. Specifically, it undervalues calls when the ratio is between 0.70 and 1.08, and it overvalues calls when the ratio is between 1.18 and 1.30, whereas it overvalues puts when the ratio is between 0.70 and 0.82, and it undervalues puts when the ratio is between 0.86 and 1.30.

  16. Predicting core losses and efficiency of SRM in continuous current mode of operation using improved analytical technique

    Energy Technology Data Exchange (ETDEWEB)

    Parsapour, Amir, E-mail: amirparsapour@gmail.com [Department of Electrical Engineering, University of Isfahan, Isfahan (Iran, Islamic Republic of); Dehkordi, Behzad Mirzaeian, E-mail: mirzaeian@eng.ui.ac.ir [Department of Electrical Engineering, University of Isfahan, Isfahan (Iran, Islamic Republic of); Moallem, Mehdi, E-mail: moallem@cc.iut.ac.ir [Department of Electrical Engineering, Isfahan University of Technology, Isfahan (Iran, Islamic Republic of)

    2015-03-15

    In applications in which the high torque per ampere at low speed and rated power at high speed are required, the continuous current method is the best solution. However, there is no report on calculating the core loss of SRM in continuous current mode of operation. Efficiency and iron loss calculation which are complex tasks in case of conventional mode of operation is even more involved in continuous current mode of operation. In this paper, the Switched Reluctance Motor (SRM) is modeled using finite element method and core loss and copper loss of SRM in discontinuous and continuous current modes of operation are calculated using improved analytical techniques to include the minor loop losses in continuous current mode of operation. Motor efficiency versus speed in both operation modes is obtained and compared. - Highlights: • Continuous current method for Switched Reluctance Motor (SRM) is explained. • An improved analytical technique is presented for SRM core loss calculation. • SRM losses in discontinuous and continuous current operation modes are presented. • Effect of mutual inductances on SRM performance is investigated.

  17. Continuous Spatial Process Models for Spatial Extreme Values

    KAUST Repository

    Sang, Huiyan

    2010-01-28

    We propose a hierarchical modeling approach for explaining a collection of point-referenced extreme values. In particular, annual maxima over space and time are assumed to follow generalized extreme value (GEV) distributions, with parameters μ, σ, and ξ specified in the latent stage to reflect underlying spatio-temporal structure. The novelty here is that we relax the conditionally independence assumption in the first stage of the hierarchial model, an assumption which has been adopted in previous work. This assumption implies that realizations of the the surface of spatial maxima will be everywhere discontinuous. For many phenomena including, e. g., temperature and precipitation, this behavior is inappropriate. Instead, we offer a spatial process model for extreme values that provides mean square continuous realizations, where the behavior of the surface is driven by the spatial dependence which is unexplained under the latent spatio-temporal specification for the GEV parameters. In this sense, the first stage smoothing is viewed as fine scale or short range smoothing while the larger scale smoothing will be captured in the second stage of the modeling. In addition, as would be desired, we are able to implement spatial interpolation for extreme values based on this model. A simulation study and a study on actual annual maximum rainfall for a region in South Africa are used to illustrate the performance of the model. © 2009 International Biometric Society.

  18. CONTINUOUS QUALITY IMPROVEMENT (CQI FRAMEWORK: A CASE OF INDUSTRIAL ENGINEERING DEPARTMENT

    Directory of Open Access Journals (Sweden)

    Tooba Sikander

    2017-06-01

    Full Text Available This paper aims to present an educational framework for outcomes based continuous quality improvement. Well defined program outcomes, program educational objectives and assessment process have been developed to ensure graduates’ outcomes achievement. Direct and indirect tools have been used for assessment process. Course evaluation surveys, alumni surveys, and employer surveys have been deployed for indirect outcome assessment. Exams, quizzes, assignments and projects, on the other hand, have been used for direct outcome assessment. In developed framework, the educational processes committees and facilities committees have been integrated to continuously evaluate and monitor the educational processes. Furthermore, program outcomes and course learning outcomes are proposed to be evaluated and continuously monitored by programs goals committee and continuous course improvement committee respectively. Forms and procedures have been developed to assess student outcomes.

  19. Problem Lah! Learning to Tell the Story of Continuous Assessment and Improvement

    OpenAIRE

    Hanken, Tamera

    2014-01-01

    To succeed organizations rely on the purposeful application of the management functions, planning, organizing, leading and controlling, i.e., assessment. Assessment involves the collection and analysis of service and performance data to inform planning, organizing and leading-- opening the door to a culture of assessment and continuous improvement. Like other organizations responding to ever challenging economies and ever changing customer expectations, libraries are examining continuous impr...

  20. Visual Acuity Improvement in Continuous vs Divided Occlusion in Anisometropic Amblyopia.

    Science.gov (United States)

    Irfani, Irawati; Feriyanto, Feri; Oktarima, Primawita; Kartasasmita, Arief

    2018-01-01

    To compare visual acuity improvement between continuous and split part-time occlusion for the treatment of moderate and severe anisometropic amblyopia. Randomised clinical trials in 6 - 13 y.o children with moderate and severe anisometropic amblyopia. Each patient was consecutively selected with continuous or split part-time occlusion. Best corrected visual acuity's improvement was followed up to six weeks and statistical data were analyzed using chi square and unpaired t-test. Best corrected visual acuity's improvement was comparable between continuous and split part-time occlusion (0.20±0.27 vs 0.21±0.25; p = 0.79). Split part-time occlusion may be considered as an alternative treatment for moderate and severe anisometropic amblyopia treatment.

  1. On an elastic dissipation model as continuous approximation for discrete media

    Directory of Open Access Journals (Sweden)

    I. V. Andrianov

    2006-01-01

    Full Text Available Construction of an accurate continuous model for discrete media is an important topic in various fields of science. We deal with a 1D differential-difference equation governing the behavior of an n-mass oscillator with linear relaxation. It is known that a string-type approximation is justified for low part of frequency spectra of a continuous model, but for free and forced vibrations a solution of discrete and continuous models can be quite different. A difference operator makes analysis difficult due to its nonlocal form. Approximate equations can be obtained by replacing the difference operators via a local derivative operator. Although application of a model with derivative of more than second order improves the continuous model, a higher order of approximated differential equation seriously complicates a solution of continuous problem. It is known that accuracy of the approximation can dramatically increase using Padé approximations. In this paper, one- and two-point Padé approximations suitable for justify choice of structural damping models are used.

  2. Perturbation analysis for Monte Carlo continuous cross section models

    International Nuclear Information System (INIS)

    Kennedy, Chris B.; Abdel-Khalik, Hany S.

    2011-01-01

    Sensitivity analysis, including both its forward and adjoint applications, collectively referred to hereinafter as Perturbation Analysis (PA), is an essential tool to complete Uncertainty Quantification (UQ) and Data Assimilation (DA). PA-assisted UQ and DA have traditionally been carried out for reactor analysis problems using deterministic as opposed to stochastic models for radiation transport. This is because PA requires many model executions to quantify how variations in input data, primarily cross sections, affect variations in model's responses, e.g. detectors readings, flux distribution, multiplication factor, etc. Although stochastic models are often sought for their higher accuracy, their repeated execution is at best computationally expensive and in reality intractable for typical reactor analysis problems involving many input data and output responses. Deterministic methods however achieve computational efficiency needed to carry out the PA analysis by reducing problem dimensionality via various spatial and energy homogenization assumptions. This however introduces modeling error components into the PA results which propagate to the following UQ and DA analyses. The introduced errors are problem specific and therefore are expected to limit the applicability of UQ and DA analyses to reactor systems that satisfy the introduced assumptions. This manuscript introduces a new method to complete PA employing a continuous cross section stochastic model and performed in a computationally efficient manner. If successful, the modeling error components introduced by deterministic methods could be eliminated, thereby allowing for wider applicability of DA and UQ results. Two MCNP models demonstrate the application of the new method - a Critical Pu Sphere (Jezebel), a Pu Fast Metal Array (Russian BR-1). The PA is completed for reaction rate densities, reaction rate ratios, and the multiplication factor. (author)

  3. A modified Continuous Quality Improvement approach to improve culturally and socially inclusive care within rural health services.

    Science.gov (United States)

    Mitchell, Olivia; Malatzky, Christina; Bourke, Lisa; Farmer, Jane

    2018-03-23

    The sickest Australians are often those belonging to non-privileged groups, including Indigenous Australians, gay, lesbian, bisexual, transsexual, intersex and queer people, people from culturally and linguistically diverse backgrounds, socioeconomically disadvantaged groups, and people with disabilities and low English literacy. These consumers are not always engaged by, or included within, mainstream health services, particularly in rural Australia where health services are limited in number and tend to be generalist in nature. The aim of this study was to present a new approach for improving the sociocultural inclusivity of mainstream, generalist, rural, health care organisations. This approach combines a modified Continuous Quality Improvement framework with Participatory Action Research principles and Foucault's concepts of power, discourse and resistance to develop a change process that deconstructs the power relations that currently exclude marginalised rural health consumers from mainstream health services. It sets up processes for continuous learning and consumer responsiveness. The approach proposed could provide a Continuous Quality Improvement process for creating more inclusive mainstream health institutions and fostering better engagement with many marginalised groups in rural communities to improve their access to health care. The approach to improving cultural inclusion in mainstream rural health services presented in this article builds on existing initiatives. This approach focuses on engaging on-the-ground staff in the need for change and preparing the service for genuine community consultation and responsive change. It is currently being trialled and evaluated. © 2018 National Rural Health Alliance Ltd.

  4. Accreditation of Medical Education Programs: Moving From Student Outcomes to Continuous Quality Improvement Measures.

    Science.gov (United States)

    Blouin, Danielle; Tekian, Ara

    2018-03-01

    Accreditation of undergraduate medical education programs aims to ensure the quality of medical education and promote quality improvement, with the ultimate goal of providing optimal patient care. Direct linkages between accreditation and education quality are, however, difficult to establish. The literature examining the impact of accreditation predominantly focuses on student outcomes, such as performances on national examinations. However, student outcomes present challenges with regard to data availability, comparability, and contamination.The true impact of accreditation may well rest in its ability to promote continuous quality improvement (CQI) within medical education programs. The conceptual model grounding this paper suggests accreditation leads medical schools to commit resources to and engage in self-assessment activities that represent best practices of CQI, leading to the development within schools of a culture of CQI. In line with this model, measures of the impact of accreditation on medical schools need to include CQI-related markers. The CQI orientation of organizations can be measured using validated instruments from the business and management fields. Repeated determinations of medical schools' CQI orientation at various points throughout their accreditation cycles could provide additional evidence of the impact of accreditation on medical education. Strong CQI orientation should lead to high-quality medical education and would serve as a proxy marker for the quality of graduates and possibly for the quality of care they provide.It is time to move away from a focus on student outcomes as measures of the impact of accreditation and embrace additional markers, such as indicators of organizational CQI orientation.

  5. [Modeling continuous scaling of NDVI based on fractal theory].

    Science.gov (United States)

    Luan, Hai-Jun; Tian, Qing-Jiu; Yu, Tao; Hu, Xin-Li; Huang, Yan; Du, Ling-Tong; Zhao, Li-Min; Wei, Xi; Han, Jie; Zhang, Zhou-Wei; Li, Shao-Peng

    2013-07-01

    Scale effect was one of the very important scientific problems of remote sensing. The scale effect of quantitative remote sensing can be used to study retrievals' relationship between different-resolution images, and its research became an effective way to confront the challenges, such as validation of quantitative remote sensing products et al. Traditional up-scaling methods cannot describe scale changing features of retrievals on entire series of scales; meanwhile, they are faced with serious parameters correction issues because of imaging parameters' variation of different sensors, such as geometrical correction, spectral correction, etc. Utilizing single sensor image, fractal methodology was utilized to solve these problems. Taking NDVI (computed by land surface radiance) as example and based on Enhanced Thematic Mapper Plus (ETM+) image, a scheme was proposed to model continuous scaling of retrievals. Then the experimental results indicated that: (a) For NDVI, scale effect existed, and it could be described by fractal model of continuous scaling; (2) The fractal method was suitable for validation of NDVI. All of these proved that fractal was an effective methodology of studying scaling of quantitative remote sensing.

  6. PDCA cycle as a part of continuous improvement in the production company - a case study

    Directory of Open Access Journals (Sweden)

    Marta Jagusiak-Kocik

    2017-04-01

    Full Text Available The paper presents a case study of the practical use of Deming cycle in a manufacturing company, from the plastics processing industry, from the sector of small and medium-sized enterprises. The paper is a study of literature in the field of continuous improvement and characterized by a cycle of continuous improvement, called the Deming cycle, or PDCA cycle. This cycle was used as a solution to quality problems which occurred during production of photo frames: discolorations and scorches on the surface of the frame. When measures were introduced to reduce the number of nonconformities, a decrease by more than 60% was observed.

  7. The continuous improvement system of nuclear power plant of Laguna Verde

    International Nuclear Information System (INIS)

    Rivera C, A.

    2009-10-01

    This paper describes the continuous improvement system of nuclear power plant of Laguna Verde and the achievements in implementing the same and additionally two study cases are presents. In February 2009 is noteworthy because the World Association of Nuclear Operators we identified as a learning organization, qualification which shows that the continuous improvement system has matured, and this system will expose as I get to learn to capitalize on our own experiences and external experiences diffused by the nuclear industry. In 2007 the management of nuclear power plants integrates its improvement systems and calls it continuous improvement system and is presented in the same extensive report that won the National Quality Award. This system is made up of 5 subsystems operating individually and are also related 1) human performance; 2) referential comparison or benchmarking; 3) self-assessment; 4) corrective action and 5) external operating experience. Five subsystems that plan, generate, capture, manage, communicate and protect the knowledge generated during the processes execution of nuclear power plant of Laguna Verde, as well as from external sources. The target set in 2007 was to increase the intellectual capital to always give response to meeting the security requirements, but creating a higher value to quality, customer, environment protection and society. In brief each of them, highlighting the objective, expectations management, implementation and some benefits. At the end they will describe two study cases selected to illustrate these cases as the organization learns by their continuous improvement system. (Author)

  8. Expanding Continuous Quality Improvement Capacity in the Medical Intensive Care Unit: Prehealth Volunteers as a Solution.

    Science.gov (United States)

    Priest, Kelsey C; Lobingier, Hannah; McCully, Nancy; Lombard, Jackie; Hansen, Mark; Uchiyama, Makoto; Hagg, Daniel S

    2016-01-01

    Health care delivery systems are challenged to support the increasing demands for improving patient safety, satisfaction, and outcomes. Limited resources and staffing are common barriers for making significant and sustained improvements. At Oregon Health & Science University, the medical intensive care unit (MICU) leadership team faced internal capacity limitations for conducting continuous quality improvement, specifically for the implementation and evaluation of the mobility portion of an evidence-based care bundle. The MICU team successfully addressed this capacity challenge using the person power of prehealth volunteers. In the first year of the project, 52 trained volunteers executed an evidence-based mobility intervention for 305 critically ill patients, conducting more than 200 000 exercise repetitions. The volunteers contributed to real-time evaluation of the project, with the collection of approximately 26 950 process measure data points. Prehealth volunteers are an untapped resource for effectively expanding internal continuous quality improvement capacity in the MICU and beyond.

  9. Continuous Improvement and Employee Engagement, Part 2: Design, Implementation, and Outcomes of a Daily Management System.

    Science.gov (United States)

    Maurer, Marsha; Browall, Pamela; Phelan, Cynthia; Sanchez, Sandra; Sulmonte, Kimberlyann; Wandel, Jane; Wang, Allison

    2018-04-01

    A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact quality or work flow and to address them on a daily basis. Through a DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 2 describes the implementation and outcomes of the program.

  10. Success Factors for PDCA as Continuous Improvement Method in Product Development

    OpenAIRE

    Lodgaard, Eirin; Gamme, Inger; Aasland, Knut,

    2012-01-01

    Part 3: Human Factors, Learning and Innovation; International audience; In order to maintain sustainability in an ever changing environment, where customer requirements contains a yearly price reduction over the life cycle of a product, decreased time for development of new products and increased product quality, there is an increased need for focus on continuous improvements. A well-known improvement method is the PDCA (Plan-Do-Check-Act), which many companies have succeeded in implementing ...

  11. Continuous sea-level reconstructions beyond the Pleistocene: improving the Mediterranean sea-level method

    Science.gov (United States)

    Grant, K.; Rohling, E. J.; Amies, J.

    2017-12-01

    Sea-level (SL) reconstructions over glacial-interglacial timeframes are critical for understanding the equilibrium response of ice sheets to sustained warming. In particular, continuous and high-resolution SL records are essential for accurately quantifying `natural' rates of SL rise. Global SL changes are well-constrained since the last glacial maximum ( 20,000 years ago, ky) by radiometrically-dated corals and paleoshoreline data, and fairly well-constrained over the last glacial cycle ( 150 ky). Prior to that, however, studies of ice-volume:SL relationships tend to rely on benthic δ18O, as geomorphological evidence is far more sparse and less reliably dated. An alternative SL reconstruction method (the `marginal basin' approach) was developed for the Red Sea over 500 ky, and recently attempted for the Mediterranean over 5 My (Rohling et al., 2014, Nature). This method exploits the strong sensitivity of seawater δ18O in these basins to SL changes in the relatively narrow and shallow straits which connect the basins with the open ocean. However, the initial Mediterranean SL method did not resolve sea-level highstands during Northern Hemisphere insolation maxima, when African monsoon run-off - strongly depleted in δ18O - reached the Mediterranean. Here, we present improvements to the `marginal basin' sea-level reconstruction method. These include a new `Med-Red SL stack', which combines new probabilistic Mediterranean and Red Sea sea-level stacks spanning the last 500 ky. We also show how a box model-data comparison of water-column δ18O changes over a monsoon interval allows us to quantify the monsoon versus SL δ18O imprint on Mediterranean foraminiferal carbonate δ18O records. This paves the way for a more accurate and fully continuous SL reconstruction extending back through the Pliocene.

  12. Mathematical modelling of a continuous biomass torrefaction reactor: TORSPYDTM column

    International Nuclear Information System (INIS)

    Ratte, J.; Fardet, E.; Mateos, D.; Hery, J.-S.

    2011-01-01

    Torrefaction is a soft thermal process usually applied to cocoa or coffee beans to obtain the Maillard reaction to produce aromatics and enhance the flavour. In the case of biomass the main interest of torrefaction it is to break the fibers. To do so, Thermya company has developed and patented a biomass torrefaction/depolymerisation process called TORSPYD TM . It is a homogeneous 'soft' thermal process that takes place in an inert atmosphere. The process progressively eliminates the biomass water content transforms a portion of the biomass organic matter and breaks the biomass structure by depolymerisation of the fibers. This produces a high performance solid fuel, called Biocoal, which offers a range of benefits over and above that of normal biomass fuel. To develop such a process, this company has developed two main tools: - a continuous torrefaction laboratory pilot with a capacity to produce 3 - 8 kg/h of torrefied biomass; - a mathematical model dedicated to the design and optimisation of the TORSPYD reactor. The mathematical model is able to describe the chemical and physical processes that take place in the torrefaction column at two different scales, namely: the particle, and the surrounding gas. The model enables the gas temperature profiles inside the column to be predicted, and the results of the model are then validated through experiment in the laboratory pilot. The model also allows us to estimate the thermal power necessary to torrefy any type of biomass for a given moisture content. -- Highlights: → We model a patented torrefaction/depolymerisation biomass process: TORPSPYD. → We compare simulated results to experimental data obtained from our torrefaction pilot plant. → We describe phenomenon that occurs in our torrefaction reactor and discuss about the influence of moisture of the input biomass.

  13. (Mis)Perceptions of Continuing Education: Insights from Knowledge Translation, Quality Improvement, and Patient Safety Leaders

    Science.gov (United States)

    Kitto, Simon C.; Bell, Mary; Goldman, Joanne; Peller, Jennifer; Silver, Ivan; Sargeant, Joan; Reeves, Scott

    2013-01-01

    Introduction: Minimal attention has been given to the intersection and potential collaboration among the domains of continuing education (CE), knowledge translation (KT), quality improvement (QI), and patient safety (PS), despite their overlapping objectives. A study was undertaken to examine leaders' perspectives of these 4 domains and their…

  14. Demystifying Data: Designing and Implementing Data-Driven Systems and Practices for Continuous Quality Improvement

    Science.gov (United States)

    Krugly, Andrew; Stein, Amanda; Centeno, Maribel G.

    2014-01-01

    Data-based decision making should be the driving force in any early care and education setting. Data usage compels early childhood practitioners and leaders to make decisions on the basis of more than just professional instinct. This article explores why early childhood schools should be using data for continuous quality improvement at various…

  15. Record of Assessment Moderation Practice (RAMP): Survey Software as a Mechanism of Continuous Quality Improvement

    Science.gov (United States)

    Johnson, Genevieve Marie

    2015-01-01

    In higher education, assessment integrity is pivotal to student learning and satisfaction, and, therefore, a particularly important target of continuous quality improvement. This paper reports on the preliminary development and application of a process of recording and analysing current assessment moderation practices, with the aim of identifying…

  16. Continuous Plasma Treatment of Ultra-High-Molecular-Weight Polyethylene (UHMWPE) Fibres for Adhesion Improvement

    DEFF Research Database (Denmark)

    Teodoru, Steluta; Kusano, Yukihiro; Rozlosnik, Noemi

    2009-01-01

    A dielectric barrier discharge in Ar, He, He/O2, N2 or O2 at atmospheric pressure was used for the continuous plasma treatment of UHMWPE fibres. The influence of the input power of the discharge and the gas flow rate on surface modification is studied with the aim of adhesion improvement. Surface...

  17. Continuous Improvement: A Way of Integrating Student Enrollment, Advising, and Retention Systems in a Metropolitan University.

    Science.gov (United States)

    Beeler, Karl J.; Moehl, Pamela J.

    1996-01-01

    The University of Missouri-St. Louis has discovered the value of continuous quality improvement methods in upgrading its core student-related administrative processes. As a result, it is increasing efficiency and personalizing a traditionally bureaucratic system of student service. Concurrent goals are to increase retention and decrease time to…

  18. Using Data to Drive Success in Educator Prep: Massachusetts and Endicott College Collaborate for Continuous Improvement

    Science.gov (United States)

    Data Quality Campaign, 2016

    2016-01-01

    For educator preparation programs (EPPs) to produce effective teachers, they must engage in a process of continuous improvement using timely, high-quality information about the performance of their respective graduates in the classroom as measured by student outcomes. While states have the capacity to provide this information through their…

  19. Re-Culturing Educator Preparation Programs: A Collaborative Case Study of Continuous Improvement

    Science.gov (United States)

    Snow, Jennifer; Dismuke, Sherry; Zenkert, A. J.; Loffer, Carolyn

    2017-01-01

    Teacher educators at one institution of higher education collaborated to reculture systems for a focus on continuous improvement even within mounting accountability pressures. A framework of social network theory allowed for themes to develop around layered interactions of faculty, processes, and professional capital. Findings focused on people,…

  20. A Study of Leadership and Continuous Improvement at Leadership Preparatory Academy

    Science.gov (United States)

    Medina Araujo, Jacqueline

    2013-01-01

    This capstone project examines how an elementary school principal and her leadership team transformed Leadership Prep Academy in Capital City into a collaborative, high performing community school. This five-year process of continuous improvement involved engaging students, staff, parents, and members of the community in developing a culture of…

  1. Continuous improvement in managing R&D: A TQM approach at SkogForsk, Sweden

    Science.gov (United States)

    Magnus Larsson

    1999-01-01

    Continuous improvement is an imperative process for any organization) even in the R&D field) who wants to stay competitive and alive. Our experience is that the most important ingredients in this process are engagement and participation by everybody) shared visions) and a holistic view of the organization. Structural changes and quick fixes cannot accomplish this....

  2. Four routes to continuous improvement. An empirical typology of CI implementation processes

    NARCIS (Netherlands)

    Rijnders, Sander

    2002-01-01

    Continuous Improvement (CI) is a well-established concept that many companies adopt in some form. It is often suggested that CI's main problem lies in its implementation. Most of the literature is prescriptive or focuses on success and failure aspects. Until now, however, little is known about the

  3. Motivational Interviewing (MINT) Improves Continuous Positive Airway Pressure (CPAP) Acceptance and Adherence: A Randomized Controlled Trial

    Science.gov (United States)

    Olsen, Sara; Smith, Simon S.; Oei, Tian P. S.; Douglas, James

    2012-01-01

    Objective: Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) is poor. We assessed the effectiveness of a motivational interviewing intervention (motivational interview nurse therapy [MINT]) in addition to best practice standard care to improve acceptance and adherence to CPAP therapy in people with…

  4. Integrating the development of continuous improvement andinnovation capabilities into engineering education

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Kofoed, Lise B.

    2007-01-01

    In this paper, a study is presented in which engineering students at a Danish university developed Continuous Improvement (CI) and innovation capabilities through action research and experientiallearning methods. The paper begins with a brief overview of the literature on CI and innovation...

  5. Modeling opinion dynamics: Theoretical analysis and continuous approximation

    International Nuclear Information System (INIS)

    Pinasco, Juan Pablo; Semeshenko, Viktoriya; Balenzuela, Pablo

    2017-01-01

    Highlights: • We study a simple model of persuasion dynamics with long range pairwise interactions. • The continuous limit of the master equation is a nonlinear, nonlocal, first order partial differential equation. • We compute the analytical solutions to this equation, and compare them with the simulations of the dynamics. - Abstract: Frequently we revise our first opinions after talking over with other individuals because we get convinced. Argumentation is a verbal and social process aimed at convincing. It includes conversation and persuasion and the agreement is reached because the new arguments are incorporated. Given the wide range of opinion formation mathematical approaches, there are however no models of opinion dynamics with nonlocal pair interactions analytically solvable. In this paper we present a novel analytical framework developed to solve the master equations with non-local kernels. For this we used a simple model of opinion formation where individuals tend to get more similar after each interactions, no matter their opinion differences, giving rise to nonlinear differential master equation with non-local terms. Simulation results show an excellent agreement with results obtained by the theoretical estimation.

  6. Development of new model of mold oscillator in continuous casting

    International Nuclear Information System (INIS)

    Kang, G. P.; Shin, G.; Kang, C. G.

    2007-01-01

    To develop the hydraulic mold oscillator in continuous casting machine, the guiding mechanism of mold was studied. The main topics of this study were to design the guiding mechanism of mold which oscillates to prevent the sticking and to reduce the friction resistant force between the solidified shell and mold on casting. We studied many guiding types to analyze the features of worldwide mold oscillator and developed the new model of hydraulic mold oscillator. On the basis of the mold oscillating experiment, the capability of guiding system was proofed by the position error measuring system. The experiment was carried out up to 50∼500 cpm frequencies and 2∼10 mm stroke in the variable waveform and the casting results was analyzed by the oscillation mark of slab surface which was formed unavoidably by oscillation

  7. Identification of Barriers Towards Change and Proposal to Institutionalize Continuous Improvement Programs in Manufacturing Operations

    Directory of Open Access Journals (Sweden)

    Alvair Silveira Torres Jr.

    2011-06-01

    Full Text Available A multi case research unfolded into a study in a sample of Brazilian manufacturing companies concerning their Continuous Improvement (CI program in manufacturing operations. Stakeholders interviews and performance analyses were conducted. The study aims to analyze the existence or absence of the institutionalization of a CI culture in manufacturing operations, identify barriers and difficulties within the process and propose a model for change. As a result of the research, it was observed that despite the considerable motivation of staff, rapid gains of the company and superior results during the early phases of the CI program, time and again such results were either not upheld or faded out over time, delivering no significant mid-term or long term results, due to poor management of changes. This happened mainly as a result of lack of strategic alignment at all levels of the organization, translated in measureable activities and projects, coached and mentored by the middle and upper management throughout the implementation and maintenance of the program. The selected cases showed a declining in performance after two years of CI program start up. Learning, union and process ownership among participants by means of interactions, are necessary to absorb and incorporate changes, instead of merely "smart words" .

  8. Improving continuity of care for frequent users of emergency departments: service user and provider perspectives.

    Science.gov (United States)

    Poremski, Daniel; Harris, Deborah Wise; Kahan, Deborah; Pauly, Daniel; Leszcz, Molyn; O'Campo, Patricia; Wasylenki, Donald; Stergiopoulos, Vicky

    2016-01-01

    This study explored service user and provider perspectives on barriers and facilitators of continuity of care for frequent users of emergency departments (ED) participating in a brief intensive case management intervention. We conducted semistructured interviews with 20 frequent ED users with mental health and addiction challenges participating in a brief intensive case management intervention, eliciting experiences of care and care continuity. We interviewed 13 service providers working with this population. We used thematic analysis to determine shared and unique barriers and facilitators to continuity of care, and we gave priority to themes reported by both service users and providers. Within fragmented systems of care, strong working relationships between service users and providers, timely access to coordinated services and seamless transitions to needed supports increased perceived care continuity. Barriers to continuity of care included difficulties engaging this population, short intervention duration and the lack of a single accountable service provider to address health and social needs. Although brief intensive case management interventions have the potential to improve continuity of care for frequent ED users, continuity of care, especially for people with complex health and social needs, may be compromised by program and personal characteristics as well as lack of broader system integration. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Continued Improvements to the PRISM and PIM Ionospheric Models

    National Research Council Canada - National Science Library

    Daniell, Robert

    1998-01-01

    ...) that is operational at the 55th Space Weather Squadron (55 SWXS). It also describes the implications of work carried out under a separate contract for the design and development of a new version of PRISM...

  10. Modeling of Clostridium tyrobutyricum for Butyric Acid Selectivity in Continuous Fermentation

    Directory of Open Access Journals (Sweden)

    Jianjun Du

    2014-04-01

    Full Text Available A mathematical model was developed to describe batch and continuous fermentation of glucose to organic acids with Clostridium tyrobutyricum. A modified Monod equation was used to describe cell growth, and a Luedeking-Piret equation was used to describe the production of butyric and acetic acids. Using the batch fermentation equations, models predicting butyric acid selectivity for continuous fermentation were also developed. The model showed that butyric acid production was a strong function of cell mass, while acetic acid production was a function of cell growth rate. Further, it was found that at high acetic acid concentrations, acetic acid was metabolized to butyric acid and that this conversion could be modeled. In batch fermentation, high butyric acid selectivity occurred at high initial cell or glucose concentrations. In continuous fermentation, decreased dilution rate improved selectivity; at a dilution rate of 0.028 h−1, the selectivity reached 95.8%. The model and experimental data showed that at total cell recycle, the butyric acid selectivity could reach 97.3%. This model could be used to optimize butyric acid production using C. tyrobutyricum in a continuous fermentation scheme. This is the first study that mathematically describes batch, steady state, and dynamic behavior of C. tyrobutyricum for butyric acid production.

  11. Continuous improvement in manufacturing and inspection of fuel; Mejora continua en fabricacion e inspeccion de combustible

    Energy Technology Data Exchange (ETDEWEB)

    Domingon, A.; Ruiz, R.

    2015-07-01

    The manufacturing and inspection process of fuel assemblies in ENUSA is characterized by its robustness acquired over the last thirty years of experience in manufacturing. The reliability of these processes is based on a qualified processes and continuous improvement in the design and upgrading of equipment and optimization of software and manufacturing processes. Additionally, management and quality control systems have been improved in both software and measuring business objectives. this article emphasizes the improvements made over the past five years in management, production and inspection of fuel assemblies. (Author)

  12. Adhesion improvement of fibres by continuous plasma treatment at atmospheric pressure

    DEFF Research Database (Denmark)

    Kusano, Yukihiro; Løgstrup Andersen, Tom; Sørensen, Bent F.

    2013-01-01

    Carbon fibres and ultra-high-molecular-weight polyethylene (UHMWPE) fibres were continuously treated by a dielectric barrier discharge plasma at atmospheric pressure for adhesion improvement with epoxy resins. The plasma treatment improved wettability, increased the oxygen containing polar...... functional groups at the surface, and subsequently improved adhesion to the epoxy and fracture resistance of epoxy composites. Hansen solubility parameters (HSP), quantitatively describing physical interactions among molecules, were measured for the UHMWPE fibre surfaces. The result identifies two distinct...... types of surfaces in both the plasma treated and the untreated fibres. One type is typical of polyethylene polymers while the other is characteristic of the oxygenated surface at much higher values of HSP....

  13. A Continuous Simulation Model of Fluvial Geomorphic and Ecologic Processes

    Science.gov (United States)

    Rodriguez, J. F.; de Almeida, G. A.

    2009-12-01

    We present a physically-based simulation model of unsteady water flow, sediment, morphology and substrate composition that can be used to assess physical habitat conditions in streams on a continuous time basis. The model overcomes one of the most common shortcomings of current morphologically-based habitat assessment practices in which static stream morphology is assumed and only hydrological variability is considered. Furthermore, the model tracks the history of the physical habitat conditions everywhere in the stream, allowing for the analysis of ecological processes that are not only function of magnitude and frequency of flow events but also depend on the actual succession of events, like ecotone recovery or establishment. Depending on the particular process of interest, thresholds in the environmental inputs can be identified (e.g. magnitude of pool and riffle habitat maintenance floods) and used as a basis for the definition of reference conditions for restoration projects. Selective grain size fraction erosion, deposition and transport processes are simulated to provide a realistic description of the substrate distribution, which is particularly important in situations of marked geomorphic non equilibrium that are often present in degraded or recently restored streams. Since the links between geomorphic and ecologic process take place over a wide range of time scales, the model is designed to simulate periods of several years with a time resolution that can be sub hourly. Habitat conditions can be assessed based on flow and geomorphic information via species-specific preference curves or using other indicators of habitat quality like diversity index. To show the capabilities and limitations of our approach we present applications to both real and hypothetical situations.

  14. Independent assessment to continue improvement: Implementing statistical process control at the Hanford Site

    International Nuclear Information System (INIS)

    Hu, T.A.; Lo, J.C.

    1994-11-01

    A Quality Assurance independent assessment has brought about continued improvement in the PUREX Plant surveillance program at the Department of Energy's Hanford Site. After the independent assessment, Quality Assurance personnel were closely involved in improving the surveillance program, specifically regarding storage tank monitoring. The independent assessment activities included reviewing procedures, analyzing surveillance data, conducting personnel interviews, and communicating with management. Process improvement efforts included: (1) designing data collection methods; (2) gaining concurrence between engineering and management, (3) revising procedures; and (4) interfacing with shift surveillance crews. Through this process, Statistical Process Control (SPC) was successfully implemented and surveillance management was improved. The independent assessment identified several deficiencies within the surveillance system. These deficiencies can be grouped into two areas: (1) data recording and analysis and (2) handling off-normal conditions. By using several independent assessment techniques, Quality Assurance was able to point out program weakness to senior management and present suggestions for improvements. SPC charting, as implemented by Quality Assurance, is an excellent tool for diagnosing the process, improving communication between the team members, and providing a scientific database for management decisions. In addition, the surveillance procedure was substantially revised. The goals of this revision were to (1) strengthen the role of surveillance management, engineering and operators and (2) emphasize the importance of teamwork for each individual who performs a task. In this instance we believe that the value independent assessment adds to the system is the continuous improvement activities that follow the independent assessment. Excellence in teamwork between the independent assessment organization and the auditee is the key to continuing improvement

  15. Modeling continuous cultures of microalgae colimited by nitrogen and phosphorus.

    Science.gov (United States)

    Bougaran, Gaël; Bernard, Olivier; Sciandra, Antoine

    2010-08-07

    It is well documented that the combination of low nitrogen and phosphorus resources can lead to situations where colimitation of phytoplankton growth arises, yet the underlying mechanisms are not fully understood. Here, we propose a Droop-based model built on the idea that colimitation by nitrogen and phosphorus arises from the uptake of nitrogen. Indeed, since N-porters are active systems, they require energy that could be related to the phosphorus status of the cell. Therefore, we assumed that N uptake is enhanced by the P quota. Our model also accounts for the biological observations that uptake of a nutrient can be down-regulated by its own internal quota, and succeeds in describing the strong contrast for the non-limiting quotas under N-limited and P-limited conditions that was observed on continuous cultures with Selenastrum minutum and with Isochrysis affinis galbana. Our analysis suggests that, regarding the colimitation concept, N and P would be better considered as biochemically dependent rather than biochemically independent nutrients. Copyright 2010 Elsevier Ltd. All rights reserved.

  16. Continuing research on the classical spiraling photon model

    Science.gov (United States)

    Li, Hongrui

    2014-11-01

    Based no the classical spiraling photon model proposed by Hongrui Li, the laws of reflection, refraction of a single photon can be derived. Moreover, the polarization, total reflection, evanescent wave and Goos-Hanchen shift of a single photon can be elucidated. However, this photon model is still unfinished. Especially, the spiraling diameter of a photon is not definite. In this paper, the continuous research works on this new theory are reported. According to the facts that the diffraction limit of light and the smallest diameter of the focal spot of lenses are all equal to the wavelength λ of the light, we can get that the spiraling diameter of a photon equals to the wavelength λ, so we gain that the angle between the linear velocity of the spiraling photon υ and the component of the linear velocity in the forward direction υb is 45°, and the energy of a classical spiraling photon E = (1/2)mυ2 = (1/2)m2c2 = mc2. This coincides with Einstein's mass-energy relation. While it is obtained that the velocity of the evanescent wave in the vacuum is slower than the velocity of light in glass in straight line. In such a way, the optical fiber can slow the light down. In addition, the force analysis of a single photon in optical tweezers system is discussed. And the reason that the laser beam can capture the particle slightly downstream from the focal point can be explained.

  17. Improved Trailing Edge Noise Model

    DEFF Research Database (Denmark)

    Bertagnolio, Franck

    2012-01-01

    The modeling of the surface pressure spectrum under a turbulent boundary layer is investigated in the presence of an adverse pressure gradient along the flow direction. It is shown that discrepancies between measurements and results from a well-known model increase as the pressure gradient increa...

  18. A simple model to predict soil moisture: Bridging Event and Continuous Hydrological (BEACH) modelling

    NARCIS (Netherlands)

    Sheikh, V.; Visser, S.M.; Stroosnijder, L.

    2009-01-01

    This paper introduces a simple two-layer soil water balance model developed to Bridge Event And Continuous Hydrological (BEACH) modelling. BEACH is a spatially distributed daily basis hydrological model formulated to predict the initial condition of soil moisture for event-based soil erosion and

  19. From Discrete-Time Models to Continuous-Time, Asynchronous Models of Financial Markets

    NARCIS (Netherlands)

    K. Boer-Sorban (Katalin); U. Kaymak (Uzay); J. Spiering (Jaap)

    2006-01-01

    textabstractMost agent-based simulation models of financial markets are discrete-time in nature. In this paper, we investigate to what degree such models are extensible to continuous-time, asynchronous modelling of financial markets. We study the behaviour of a learning market maker in a market with

  20. A quantum relativistic integrable model as the continuous limit of the six-vertex model

    International Nuclear Information System (INIS)

    Zhou, Y.K.

    1992-01-01

    The six-vertex model in two-dimensional statistical mechanics is used to construct the L-matrix of a one-dimensional quantum relativistic integrable model through a continuous limit. This is the first step to extend the method used earlier by the author to construct quantum completely integrable systems from other well-known two-dimensional vertex models. (orig.)

  1. Accelerating quality improvement within your organization: Applying the Model for Improvement.

    Science.gov (United States)

    Crowl, Ashley; Sharma, Anita; Sorge, Lindsay; Sorensen, Todd

    2015-01-01

    To discuss the fundamentals of the Model for Improvement and how the model can be applied to quality improvement activities associated with medication use, including understanding the three essential questions that guide quality improvement, applying a process for actively testing change within an organization, and measuring the success of these changes on care delivery. PubMed from 1990 through April 2014 using the search terms quality improvement, process improvement, hospitals, and primary care. At the authors' discretion, studies were selected based on their relevance in demonstrating the quality improvement process and tests of change within an organization. Organizations are continuously seeking to enhance quality in patient care services, and much of this work focuses on improving care delivery processes. Yet change in these systems is often slow, which can lead to frustration or apathy among frontline practitioners. Adopting and applying the Model for Improvement as a core strategy for quality improvement efforts can accelerate the process. While the model is frequently well known in hospitals and primary care settings, it is not always familiar to pharmacists. In addition, while some organizations may be familiar with the "plan, do, study, act" (PDSA) cycles-one element of the Model for Improvement-many do not apply it effectively. The goal of the model is to combine a continuous process of small tests of change (PDSA cycles) within an overarching aim with a longitudinal measurement process. This process differs from other forms of improvement work that plan and implement large-scale change over an extended period, followed by months of data collection. In this scenario it may take months or years to determine whether an intervention will have a positive impact. By following the Model for Improvement, frontline practitioners and their organizational leaders quickly identify strategies that make a positive difference and result in a greater degree of

  2. Wound Care Center of Excellence: A Process for Continuous Monitoring and Improvement of Wound Care Quality.

    Science.gov (United States)

    Howell, Raelina S; Kohan, Lauren S; Woods, Jon S; Criscitelli, Theresa; Gillette, Brian M; Donovan, Virginia; Gorenstein, Scott

    2018-05-01

    To provide information about a study using a new process for continuous monitoring to improve chronic wound care quality.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After completing this continuing education activity, you should be better able to:1. Recognize problems associated with chronic wound care.2. Identify methods used in this project to improve care.3. Illustrate the findings from this and similar projects and implications for providing improved wound care.Patients with chronic wounds require complex care because of comorbidities that can affect healing. Therefore, the goal of this project was to develop a system of reviewing all hospitalized patients seen by the study authors' wound care service on a weekly basis to decrease readmissions, morbidity, and mortality. Weekly multidisciplinary conferences were conducted to evaluate patient data and systematically assess for adherence to wound care protocols, as well as to create and modify patient care plans. This review of pathology and the performance of root-cause analyses often led to improved patient care.

  3. Ongoing Evaluation of Clinical Ethics Consultations as a Form of Continuous Quality Improvement.

    Science.gov (United States)

    Volpe, Rebecca

    2017-01-01

    Ongoing evaluation of a clinical ethics consultation service (ECS) allows for continuous quality improvement, a process-based, data-driven approach for improving the quality of a service. Evaluations by stakeholders involved in a consultation can provide real-time feedback about what is working well and what might need to be improved. Although numerous authors have previously presented data from research studies on the effectiveness of clinical ethics consultation, few ECSs routinely send evaluations as an ongoing component of their everyday clinical activities. The primary purpose of this article is to equip and encourage others to engage in ongoing evaluation of their own ECS. Toward that end, the following resources are shared: (1) the survey tool used to gather the evaluation data, (2) the procedure used to elicit and collate responses, and (3) how the resulting data are used to support continuous quality improvement and justify the continued financial support of the ECS to hospital administration. Copyright 2017 The Journal of Clinical Ethics. All rights reserved.

  4. How Visual Management for Continuous Improvement Might Guide and Affect Hospital Staff: A Case Study.

    Science.gov (United States)

    Ulhassan, Waqar; von Thiele Schwarz, Ulrica; Westerlund, Hugo; Sandahl, Christer; Thor, Johan

    2015-01-01

    Visual management (VM) tools such as whiteboards, often employed in Lean thinking applications, are intended to be helpful in improving work processes in different industries including health care. It remains unclear, however, how VM is actually applied in health care Lean interventions and how it might influence the clinical staff. We therefore examined how Lean-inspired VM using whiteboards for continuous improvement efforts related to the hospital staff's work and collaboration. Within a case study design, we combined semistructured interviews, nonparticipant observations, and photography on 2 cardiology wards. The fate of VM differed between the 2 wards; in one, it was well received by the staff and enhanced continuous improvement efforts, whereas in the other ward, it was not perceived to fit in the work flow or to make enough sense in order to be sustained. Visual management may enable the staff and managers to allow communication across time and facilitate teamwork by enabling the inclusion of team members who are not present simultaneously; however, its adoption and value seem contingent on finding a good fit with the local context. A combination of continuous improvement and VM may be helpful in keeping the staff engaged in the change process in the long run.

  5. Keeping the "continuous" in continuous quality improvement: exploring perceived outcomes of CQI program use in community pharmacy.

    Science.gov (United States)

    Boyle, Todd A; Bishop, Andrea C; Duggan, Kellie; Reid, Carolyn; Mahaffey, Thomas; MacKinnon, Neil J; Mahaffey, Amelia

    2014-01-01

    Given the significant potential of continuous quality improvement (CQI) programs in enhancing overall levels of patient safety, community pharmacies in North America are under increasing pressure to have a formal and documented CQI program in place. However, while such initiatives may seem great on paper, in practice the outcomes of such programs to community pharmacy practice remain unclear. To explore the perceived outcomes identified by community pharmacies that adopted and actively used a standardized (i.e., common across pharmacies) CQI program for at least 1 year and to develop a framework for how such outcomes were achieved. A multi-site study of SafetyNET-Rx, a standardized and technologically sophisticated (e.g., online reporting of medication errors to a national database) CQI program, involving community pharmacies in Nova Scotia, Canada, was performed. During the summer and fall of 2011, 22 interviews were conducted with the CQI facilitators in 12 Nova Scotia community pharmacies; equally split between independent/banners and corporate chains. Of the CQI facilitators, 14 were pharmacists, while the remaining eight were pharmacy technicians. Thematic analysis following the procedures presented by Braun and Clarke was adopted to identify and explore the major outcomes. Results of the thematic analysis highlighted a number of perceived outcomes from the use of a standardized CQI program in community pharmacies, specifically: (1) perceived reduction in the number of medication errors that were occurring in the pharmacy, (2) increased awareness/confidence of individual actions related to dispensing, (3) increased understanding of the dispensing and related processes/workflow, (4) increased openness to talking about medication errors among pharmacy staff, and (5) quality and safety becoming more entrenched in the workflow (e.g., staff is more aware of their roles and responsibilities in patient safety and confident that the dispensing processes are safe and

  6. Improved model for statistical alignment

    Energy Technology Data Exchange (ETDEWEB)

    Miklos, I.; Toroczkai, Z. (Zoltan)

    2001-01-01

    The statistical approach to molecular sequence evolution involves the stochastic modeling of the substitution, insertion and deletion processes. Substitution has been modeled in a reliable way for more than three decades by using finite Markov-processes. Insertion and deletion, however, seem to be more difficult to model, and thc recent approaches cannot acceptably deal with multiple insertions and deletions. A new method based on a generating function approach is introduced to describe the multiple insertion process. The presented algorithm computes the approximate joint probability of two sequences in 0(13) running time where 1 is the geometric mean of the sequence lengths.

  7. Physical function continues to improve when clinical remission is sustained in rheumatoid arthritis patients.

    Science.gov (United States)

    Radner, Helga; Alasti, Farideh; Smolen, Josef S; Aletaha, Daniel

    2015-08-11

    To investigate the course of functional status assessed by health assessment questionnaire (HAQ) in rheumatoid arthritis (RA) patients with sustained clinical remission (REM). In recent RA clinical trials, we identified patients with subsequent visits of ≥24 weeks in clinical REM according to the disease activity score using 28-joint counts including C-reactive protein (DAS28) (≤2.6), or simplified disease activity index (SDAI) (≤3.3). Area under the curve (AUC) and mean HAQ scores throughout the time in sustained REM were compared using t test, analyses of variance (ANOVA) and adjusted general linear modeling (GLM) with repeated measures. In Cox regression analyses, the time to regain full physical function was modeled. Sensitivity analyses were performed in patients of sustained SDAI low disease activity (LDA; SDAI ≤11). A total of 610 out of 4364 patients achieved sustained DAS28 REM (14%) and 252 SDAI REM (5.8%). ANOVA testing for linear trend showed significant decrease of mean HAQ from week 0 (start of REM) to week 24, regardless of REM criteria used. AUC of HAQ throughout 24 weeks of REM was higher in DAS28 compared to SDAI REM (p ≤0.01). GLM adjusting for covariates showed significant decrease of monthly HAQ scores from week 0 to 24 (DAS28: 0.276, 0.243, 0.229, 0.222, 0.219, 0.209 to 0.199; p = 0.0001; SDAI: 0.147, 0.142, 0.149, 0.129, 0.123, 0.117 to 0.114; p = 0.029). Similarly, a decrease of HAQ over time was found in patients of sustained SDAI LDA. In DAS28 REM, the chance of regaining full physical function was higher for female (hazard ratio HR [95% confidence interval]: 1.41 [1.13-1.76]) and early RA patients (disease duration ≤2 years: HR 1.29 [1.01-1.65]); in SDAI REM no significant differences were found. Physical function continues to improve if the target of REM or LDA is sustained. The stringency of the remission criteria determines achievement of the best possible functional improvement.

  8. A continuous stochastic model for non-equilibrium dense gases

    Science.gov (United States)

    Sadr, M.; Gorji, M. H.

    2017-12-01

    While accurate simulations of dense gas flows far from the equilibrium can be achieved by direct simulation adapted to the Enskog equation, the significant computational demand required for collisions appears as a major constraint. In order to cope with that, an efficient yet accurate solution algorithm based on the Fokker-Planck approximation of the Enskog equation is devised in this paper; the approximation is very much associated with the Fokker-Planck model derived from the Boltzmann equation by Jenny et al. ["A solution algorithm for the fluid dynamic equations based on a stochastic model for molecular motion," J. Comput. Phys. 229, 1077-1098 (2010)] and Gorji et al. ["Fokker-Planck model for computational studies of monatomic rarefied gas flows," J. Fluid Mech. 680, 574-601 (2011)]. The idea behind these Fokker-Planck descriptions is to project the dynamics of discrete collisions implied by the molecular encounters into a set of continuous Markovian processes subject to the drift and diffusion. Thereby, the evolution of particles representing the governing stochastic process becomes independent from each other and thus very efficient numerical schemes can be constructed. By close inspection of the Enskog operator, it is observed that the dense gas effects contribute further to the advection of molecular quantities. That motivates a modelling approach where the dense gas corrections can be cast in the extra advection of particles. Therefore, the corresponding Fokker-Planck approximation is derived such that the evolution in the physical space accounts for the dense effects present in the pressure, stress tensor, and heat fluxes. Hence the consistency between the devised Fokker-Planck approximation and the Enskog operator is shown for the velocity moments up to the heat fluxes. For validation studies, a homogeneous gas inside a box besides Fourier, Couette, and lid-driven cavity flow setups is considered. The results based on the Fokker-Planck model are

  9. Model-based software process improvement

    Science.gov (United States)

    Zettervall, Brenda T.

    1994-01-01

    The activities of a field test site for the Software Engineering Institute's software process definition project are discussed. Products tested included the improvement model itself, descriptive modeling techniques, the CMM level 2 framework document, and the use of process definition guidelines and templates. The software process improvement model represents a five stage cyclic approach for organizational process improvement. The cycles consist of the initiating, diagnosing, establishing, acting, and leveraging phases.

  10. The association between event learning and continuous quality improvement programs and culture of patient safety.

    Science.gov (United States)

    Mazur, Lukasz; Chera, Bhishamjit; Mosaly, Prithima; Taylor, Kinley; Tracton, Gregg; Johnson, Kendra; Comitz, Elizabeth; Adams, Robert; Pooya, Pegah; Ivy, Julie; Rockwell, John; Marks, Lawrence B

    2015-01-01

    To present our approach and results from our quality and safety program and to report their possible impact on our culture of patient safety. We created an event learning system (termed a "good catch" program) and encouraged staff to report any quality or safety concerns in real time. Events were analyzed to assess the utility of safety barriers. A formal continuous quality improvement program was created to address these reported events and make improvements. Data on perceptions of the culture of patient safety were collected using the Agency for Health Care Research and Quality survey administered before, during, and after the initiatives. Of 560 good catches reported, 367 could be ascribed to a specific step on our process map. The calculated utility of safety barriers was highest for those embedded into the pretreatment quality assurance checks performed by physicists and dosimetrists (utility score 0.53; 93 of 174) and routine checks done by therapists on the initial day of therapy. Therapists and physicists reported the highest number of good catches (24% each). Sixty-four percent of events were caused by performance issues (eg, not following standardized processes, including suboptimal communications). Of 31 initiated formal improvement events, 26 were successfully implemented and sustained, 4 were discontinued, and 1 was not implemented. Most of the continuous quality improvement program was conducted by nurses (14) and therapists (7). Percentages of positive responses in the patient safety culture survey appear to have increased on all dimensions (p continuous quality improvement programs can be successfully implemented and that there are contemporaneous improvements in the culture of safety. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  11. Evolution of Technology for Continuous Renal Replacement Therapy: Forty Years of Improvement.

    Science.gov (United States)

    Ronco, Claudio

    2018-01-01

    Continuous arteriovenous hemofiltration (CAVH) was proposed in 1977 as an alternative treatment for acute renal failure in patients in whom peritoneal dialysis or hemodialysis was clinically or technically precluded. In the mid-1980s, this technique was extended to infants and children. CAVH presented important advantages in the areas of hemodynamic stability, control of circulating volume, and nutritional support. However, there were serious shortcomings such as the need for arterial cannulation and limited solute clearance. These problems were solved by the introduction of continuous arteriovenous hemodiafiltration and continuous arteriovenous hemodialysis, where uremic control could be achieved by increasing countercurrent dialysate flow rates to 1.5 or 2 L/h as necessary, or by venovenous techniques utilizing a double-lumen central venous catheter for vascular access. Thus, continuous venovenous hemofiltration replaced CAVH because of its improved performance and safety. From the initial adoptive technology, specific machines have been designed to permit safe and reliable performance of the therapy. These new machines have progressively undergone a series of technological steps that have resulted in the evolution of highly sophisticated equipment utilized today. A significant number of advances have taken place since the time continuous renal replacement therapy was initiated. In particular, there have been successful experiments with high-volume hemofiltration and high-permeability hemofiltration. The additional and combined use of sorbent has also been tested successfully. Progress has been made in the technology as well as the understanding of the pathophysiology of acute kidney injury. Today, new biomaterials and new devices are available and new frontiers are on the horizon. Although improvements have been made, a lot remains to be done. Critical care nephrology is expected to further evolve in the near future, especially in the area of information and

  12. CRUNCH, Dispersion Model for Continuous Dense Vapour Release in Atmosphere

    International Nuclear Information System (INIS)

    Jagger, S.F.

    1987-01-01

    1 - Description of program or function: The situation modelled is as follows. A dense gas emerges from a source such that it can be considered to emerge through a rectangular area, placed in the vertical plane and perpendicular to the plume direction, which assumes that of the ambient wind. The gas flux at the source, and in every plane perpendicular to the plume direction, is constant in time and a stationary flow field has been attained. For this to apply, the characteristic time of release must be much larger than that for dispersal of the contaminant. The plume can be thought to consist of a number of rectangular elements or 'puffs' emerging from the source at regular time intervals. The model follows the development of these puffs at a series of downwind points. These puffs are immediately assumed to advect with the ambient wind at their half-height. The plume also slumps due to the action of gravity and is allowed to entrain air through its sides and top surface. Spreading of a fluid element is caused by pressure differences across this element and since the pressure gradient in the wind direction is small, the resulting pressure differences and slumping velocities are small also, thus permitting this convenient approximation. Initially, as the plume slumps, its vertical dimension decreases and with it the slumping velocity and advection velocity. Thus the plume advection velocity varies as a function of downwind distance. With the present steady state modelling, and to satisfy continuity constraints, there must be consequent adjustment of plume height. Calculation of this parameter from the volume flux ensures this occurs. As the cloud height begins to grow, the advection velocity increases and the plume height decreases accordingly. With advection downwind, the cloud gains buoyancy by entraining air and, if the cloud is cold, by absorbing heat from the ground. Eventually the plume begins to disperse as would a passive pollutant, through the action of

  13. The continuous improvement in quality management for nuclear fuel manufacturing in CNNC

    International Nuclear Information System (INIS)

    Wang Xiaoling

    2004-01-01

    The nuclear fuel plant has been keeping good records in quality. Only one pot failure has been found in the fuels loaded in the reactors at more than ten years. The paper describes quality management in nuclear fuel manufacturing and focuses on the continuous improvement on quality system and process by running the quality management system, process by quality control group, and data analyze, the requirements and the improvements for the quality system, the measurement system and the standardization system, the importance of clearance system. It also describes the future plans in quality management

  14. Improving care transitions through meaningful use stage 2: continuity of care document.

    Science.gov (United States)

    Murphy, Lyn Stankiewicz; Wilson, Marisa L; Newhouse, Robin P

    2013-02-01

    In this department, Drs Murphy, Wilson, and Newhouse highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demon strate innovative approaches to organizational problems. In this article, the authors describe the elements of continuity of care documentation, how sharing information can improve the quality and safety of care transitions and the implications for nurse executives.

  15. Software Process Improvement: Continuous Integration and Testing for Web Application Development

    OpenAIRE

    MUHONEN, MATIAS

    2009-01-01

    Software testing is not the only approach to improve software quality but, perhaps, one of the most important ones. This is because testing gives us the confidence that the software will work as it should in its intended environment. In this thesis the author introduces a Software Process Improvement (SPI) technique for conducting automated web application security testing. The continuous integration process provides rapid and automatic feedback on the security of the web applications under d...

  16. Air quality continued to improve in 2014, but progress are still needed

    International Nuclear Information System (INIS)

    Le Moullec, Aurelie

    2015-09-01

    The improvement in air quality that began some years ago continued. Average concentrations of pollutants decreased and exceedance of thresholds for protection of health was observed in fewer areas. Progress was, notably, the result of efforts made to reduce emissions, something made more difficult by the number and variety of sources of pollution. These improvements were, however, fragile as they were partially dependent on weather conditions. 2014 was, thus, marked by an important episode of particulate pollution. In addition, the progress made was not sufficient to bring France into full compliance with European standards, as was also the case for other European countries. (author)

  17. Development of a team-based framework for conducting self-assessment of Continuous Improvement

    DEFF Research Database (Denmark)

    Jørgensen, Frances; Gertsen, Frank; Boer, Harry

    2004-01-01

    The study presented in this article is based on two basic premises. First, successful continuous improvement (CI) is dependent on shop floor level involvement and participation in improvement efforts. Second, the term "self-assessment" clearly implies that those whose performance is being measured......, and who are involved in conducting the assessment process. Excerpts from longitudinal case studies in a single Danish manufacturing organization demonstrate how teams involved in the process of conducting self-assessment of CI developed a better understanding of the basic principles of CI. Furthermore...

  18. Embracing technology? Using change management strategies to improve the use of continuous lateral rotation therapy.

    Science.gov (United States)

    Cybulski, Pamela; Zantinge, Johanna; Abbott-McNeil, Deanna

    2006-01-01

    The purpose of this quality improvement initiative was to improve the utilization of continuous lateral rotation therapy (CLRT) in a nine-bed community hospital ICU within the context of a nurse-driven protocol. Nursing focus groups, analyzed using a strength, weakness, opportunity, threat (SWOT) approach, resulted in the implementation of four interventions over seven weeks. Change management strategies guided all aspects of the project. Results showed a modest increase in the utilization of CLRT. This initiative demonstrates that change management strategies may assist with the incorporation of technology into nursing practice by increasing empowerment and creating an attachment to and responsibility for outcomes.

  19. Using measures to guide the continuous improvement journey: a partnership between quality assurance and toxicology.

    Science.gov (United States)

    Gentry, P E; Sites, D L

    1994-03-01

    It has been said that you cannot improve what you cannot measure. At Eli Lilly and Company, measurement is one of the five pillars of Total Quality. Quality Assurance and Toxicology have partnered in the use of measures to drive improvements in both areas. Quality Assurance and Toxicology have embarked on a journey in Total Quality to achieve customer satisfaction and drive continuous improvement. Measurement in the research and development world has traditionally not been well received. Contrary to popular belief, we have found that many processes can be measured in the research and development environment. Measurement is critical to the continuous improvement of processes because improvements are made using data. In Quality Assurance and Toxicology, the initial measures were put in place to gather baseline data. As we learned from our measures, we customized them to align with all of our processes. This article describes the journey of measuring Quality Assurance and Toxicology, including highlights of implementation strategies and lessons learned along the way.

  20. WHAT DOESNT GET MEASURED - DOESNT GET DONE: IMPLEMENTING CONTINUOUS PROCESS IMPROVEMENT IN THE AIR FORCE RESERVE

    Science.gov (United States)

    2016-04-01

    AF) is attempting a transformative effort to instill a Continuous Process Improvement (CPI) mindset into its culture. Known by its program name of...required. Given diverse operational requirements, the DoD Components shall have full flexibility to identify CPI/LSS focus areas and training plans...possible. Each of them must decide how CPI best fits into their individual leadership practices. Until such time as a CPI mindset is embedded into the

  1. Modeling of interaction between steel and concrete in continuously reinforced concrete pavements : final report.

    Science.gov (United States)

    2016-01-01

    Continuously reinforced concrete pavement (CRCP) contains continuous longitudinal reinforcement with no transverse : expansion within the early life of the pavement and can continue to develop cracks in the long-term. The : accurate modeling of CRCPs...

  2. Simulation of a Novel Schedule for Intensivist Staffing to Improve Continuity of Patient Care and Reduce Physician Burnout.

    Science.gov (United States)

    Geva, Alon; Landrigan, Christopher P; van der Velden, Meredith G; Randolph, Adrienne G

    2017-07-01

    Despite widespread adoption of in-house call for ICU attendings, there is a paucity of research on optimal scheduling of intensivists to provide continuous on-site coverage. Overnight call duties have traditionally been added onto 7 days of continuous daytime clinical service. We designed an alternative ICU staffing model to increase continuity of attending physician care for patients while also decreasing interruptions to attendings' nonclinical weeks. Computer-based simulation of a 1-year schedule. A simulated ICU divided into two daytime teams each covered by a different attending and both covered by one overnight on-call attending. Simulated patients were randomly admitted on different service days to assess continuity of care. A "shared service schedule" was compared to a standard "7 days on schedule." For the 7 days on schedule, an attending covered a team for 7 consecutive days and off-service attendings cross-covered each night. For the shared schedule, four attendings shared the majority of daytime and nighttime service for two teams over 2 weeks, with recovery periods built into the scheduled service time. Continuity of care as measured by the Continuity of Attending Physician Index increased by 9% with the shared schedule. Annually, the shared service schedule was predicted to increase free weekends by 3.4 full weekends and 1.3 weekends with either Saturday or Sunday off. Full weeks without clinical obligations increased by 4 weeks. Mean time between clinical obligations increased by 5.8 days. A shared service schedule is predicted to improve continuity of care while increasing free weekends and continuity of uninterrupted nonclinical weeks for attendings. Computer-based simulation allows assessment of benefits and tradeoffs of the alternative schedule without disturbing existing clinical systems.

  3. Learning science as a potential new source of understanding and improvement for continuing education and continuing professional development.

    Science.gov (United States)

    Van Hoof, Thomas J; Doyle, Terrence J

    2018-01-15

    Learning science is an emerging interdisciplinary field that offers educators key insights about what happens in the brain when learning occurs. In addition to explanations about the learning process, which includes memory and involves different parts of the brain, learning science offers effective strategies to inform the planning and implementation of activities and programs in continuing education and continuing professional development. This article provides a brief description of learning, including the three key steps of encoding, consolidation and retrieval. The article also introduces four major learning-science strategies, known as distributed learning, retrieval practice, interleaving, and elaboration, which share the importance of considerable practice. Finally, the article describes how learning science aligns with the general findings from the most recent synthesis of systematic reviews about the effectiveness of continuing medical education.

  4. Building a Foundation of Continuous Improvement in a Rapidly Changing Environment: The Dartmouth-Hitchcock Value Institute Experience.

    Science.gov (United States)

    McGrath, Susan P; Blike, George T

    2015-10-01

    A performance improvement competency development program, known as the Value Institute (VI), was established at Dartmouth-Hitchcock (D-H; Lebanon, New Hampshire) in 2011 to develop a performance improvement-focused workforce and systems capable of meeting the challenges of creating a sustainable health system. A tiered competency development program that provides patient safety, health care quality, and improvement science education, and an execution support infrastructure that enables access to performance improvement tools for all employees, comprise the core of the VI. At 20 months after the launch of the first VI classes, more than 10% of all employees were trained to the Yellow Belt level, and approximately 1.5% of all employees became advanced practitioners (Green Belts or Black Belts). Improvement projects have focused on both clinical and business process optimization, as well as regulatory and accreditation compliance and patient safety. Project savings during the two years of operation have exceeded the investment of resources to establish this long-term performance improvement capability by 2.5 times. The D-H VI model promotes multidisciplinary team-based learning, incremental skill development, and access to a common continuous improvement vocabulary and method for all employees-all key to building the teams and momentum needed for successful execution of improvement work and to maintain outcomes. Initial outcomes, represented by organizational spread, project execution status, participants' feedback scores, and return on investment estimates, suggest that robust team-based learning combined with coaching provides sufficient depth and breadth of learning and effective opportunities to gain practical experience in continuous improvement.

  5. Center for Continuing Education and Community Service at Kuwait University: A Model in Leadership for Adult and Continuing Education

    Science.gov (United States)

    Alansari, Eissa M.; Albustan, Suad A.

    2009-01-01

    Education should not be limited only to formal school education but individuals should always find ways and means to increase their knowledge and improve their skills. The rapid flow of knowledge and social change, the discovery of new techniques and innovations, etc call for continuous learning. Individuals who missed formal education looked to…

  6. Expanding Educators' Contributions to Continuous Quality Improvement of American Board of Medical Specialties Maintenance of Certification.

    Science.gov (United States)

    Nora, Lois Margaret; Pouwels, Mellie Villahermosa; Irons, Mira

    2016-01-01

    The American Board of Medical Specialties board certification has transformed into a career-long process of learning, assessment, and performance improvement through its Program for Maintenance of Certification (MOC). Medical educators across many medical professional organizations, specialty societies, and other institutions have played important roles in shaping MOC and tailoring its overarching framework to the needs of different specialties. This Commentary addresses potential barriers to engagement in work related to MOC for medical school (MS) and academic health center (AHC) educators and identifies reasons for, and ways to accomplish, greater involvement in this work. The authors present ways that medical and other health professions educators in these settings can contribute to the continuous improvement of the MOC program including developing educational and assessment activities, engaging in debate about MOC, linking MOC with institutional quality improvement activities, and pursuing MOC-related scholarship. MS- and AHC-based educators have much to offer this still-young and continually improving program, and their engagement is sought, necessary, and welcomed.

  7. Method and apparatus for improved melt flow during continuous strip casting

    Science.gov (United States)

    Follstaedt, Donald W.; King, Edward L.; Schneider, Ken C.

    1991-11-12

    The continuous casting of metal strip using the melt overflow process is improved by controlling the weir conditions in the nozzle to provide a more uniform flow of molten metal across the width of the nozzle and reducing the tendency for freezing of metal along the interface with refractory surfaces. A weir design having a sloped rear wall and tapered sidewalls and critical gap controls beneath the weir has resulted in the drastic reduction in edge tearing and a significant improvement in strip uniformity. The floor of the container vessel is preferably sloped and the gap between the nozzle and the rotating substrate is critically controlled. The resulting flow patterns observed with the improved casting process have reduced thermal gradients in the bath, contained surface slag and eliminated undesirable solidification near the discharge area by increasing the flow rates at those points.

  8. Role of continual environmental performance improvement in achieving sustainability in uranium production

    International Nuclear Information System (INIS)

    Jarrell, J.P.; Chad, G.M.S.

    2002-01-01

    Although the term sustainable development is commonly used today, there is not yet a commonly accepted definition. Various ways of measuring sustainability have been proposed. To show how these issues are being effectively addressed in modern uranium developments, we will review some methods of defining the environmental component of sustainable development in the mining and mineral-processing sector. Environmental impacts associated with uranium extraction and processing in modern facilities are modest. Air and water emissions are well controlled. Waste materials are subject to comprehensive management programmes. The size of the impacted area is smaller than in other energy sectors, providing good opportunity to minimize land impact. Experience over the past three decades facilitated gradual, persistent, but cumulatively significant environmental improvements in the uranium production sector. Cameco's uranium mining and processing facilities exemplify these improvements. These improvements can be expected to continue, supporting our argument of Cameco's environmental sustainability. (author)

  9. Kaizen - continuous improvement of high voltage products; Kaizen - kontinuierliche Verbesserung bei Hochspannungsprodukten

    Energy Technology Data Exchange (ETDEWEB)

    Schwarz, M. [ABB Calor Emag Schaltanlagen AG, Hanau-Grossauheim (Germany); Goessmann, T. [ABB Calor Emag Schaltanlagen AG, Mannheim (Germany)

    1999-07-12

    In the actual global competition only the company can survive who cares for the continuous improvement of all business activities. The ABB Calor Emag Schaltanlagen AG at his production site in Hanau-Grossauheim has installed a specific improvement programm called KVP what is based on the ideas of Kaizen. Aim is the improvement of processes, mainly in production, concerning quality, dates, costs and environment by activating all colleagues. (orig.) [Deutsch] Im heutigen globalen Wettbewerb kann sich nur der behaupten, der sich kontinuierlich in allen Unternehmensbereichen weiterentwickelt. Die ABB Calor Emag Schaltanlagen AG hat in ihrem Werk Hanau-Grossauheim nach den Ideen des Kaizen ein werkspezifisches Programm zur kontinuierlichen Verbesserung der Prozesse in der Fertigung eingefuehrt. Ziel ist die stetige Verbesserung von Fertigungsparametern, wie Qualitaet, Termine, Kosten und Umwelt unter Einbeziehung aller Mitarbeiter. (orig.)

  10. Employees Motivation and Openness for Continuous Improvement: Comparative Study in Polish and Japanese Companies

    Directory of Open Access Journals (Sweden)

    Stadnicka Dorota

    2017-09-01

    Full Text Available Currently, companies must change and evolve to keep pace with the changing environment, customers’ requirements and to be better than their competitors. The changes result from the need to adapt the products to new customers’ requirements as well as to maintain competitive prices of their products. Therefore, companies should be flexible to guarantee short lead time and minimalize their costs to offer a good price for the customers. At the same time, companies should create good work environment for their employees in order to get them involved in improvement processes. In order to survive and develop companies should motivate and involve their employees into a continuous improvement process in different areas of the company. Unfortunately, as based on the companies’ practice and previous research, in many cases employees are not willing to engage in the company development. Continuous improvement is the basis of the philosophy of Quality Management and Lean Manufacturing, which come from Toyota Production System (TPS. The TPS eventually spread throughout the world, and it is held up as an example of the proper management of a production system. The assumptions of TPS system were used to build systems in other companies, but not always with the same success as it was in Toyota. For this reason, the authors of this paper seek to answer the question of whether there are differences in engagement in a continuous improvement process between employees in a Japanese company and a Polish company operating in the same industry and realizing the similar manufacturing. In order to verify this, the research was conducted in two manufacturing companies which operate in the automotive industry. The results of the study and their analysis are presented in the work.

  11. Using Surgeon-Specific Outcome Reports and Positive Deviance for Continuous Quality Improvement.

    Science.gov (United States)

    Ivanovic, Jelena; Anstee, Caitlin; Ramsay, Tim; Gilbert, Sebastien; Maziak, Donna E; Shamji, Farid M; Sundaresan, R Sudhir; Villeneuve, P James; Seely, Andrew J E

    2015-10-01

    Using the thoracic morbidity and mortality classification to document all postoperative adverse events between October 2012 and February 2014, we created surgeon-specific outcome reports (SSORs) to promote self-assessment and to implement a divisional continuous quality improvement (CQI) program, on the construct of positive deviance, to improve individual surgeon's clinical performance. Mixed-methods study within a division of six thoracic surgeons, involving (1) development of real-time, Web-based, risk-adjusted SSORs; (2) implementation of CQI seminars (n = 6; September 2013 to June 2014) for evaluation of results, collegial discussion on quality improvement based on identification of positive outliers, and selection of quality indicators for future discussion; and (3) in-person interviews to identify facilitators and barriers to using SSORs and CQI. Interview transcripts were analyzed using thematic analysis. Interviews revealed enthusiastic support for SSORs as a means to improve patient care through awareness of personal outcomes with blinded divisional comparison for similar operations and diseases, and apply the learning objectives to continuous professional development and maintenance of certification. Perceived limitations of SSORs included difficulty measuring surgeon expertise, limited understanding of risk adjustment, resistance to change, and belief that knowledge of sensitive data could lead to punitive actions. All surgeons believed CQI seminars led to collegial discussions, whereas perceived limitations included quorum participation and failing to circle back on actionable items. Real-time performance feedback using SSORs can motivate surgeons to improve their practice, and CQI seminars offer the opportunity to review and interpret results and address issues in a supportive environment. Whether SSORs and CQI can lead to improvements in rates of postoperative adverse events is a matter of ongoing research. Copyright © 2015 The Society of Thoracic

  12. Promoting Continuous Quality Improvement in the Alabama Child Health Improvement Alliance Through Q-Sort Methodology and Learning Collaboratives.

    Science.gov (United States)

    Fifolt, Matthew; Preskitt, Julie; Rucks, Andrew; Corvey, Kathryn; Benton, Elizabeth Cason

    Q-sort methodology is an underutilized tool for differentiating among multiple priority measures. The authors describe steps to identify, delimit, and sort potential health measures and use selected priority measures to establish an overall agenda for continuous quality improvement (CQI) activities within learning collaboratives. Through an iterative process, the authors vetted a list of potential child and adolescent health measures. Multiple stakeholders, including payers, direct care providers, and organizational representatives sorted and prioritized measures, using Q-methodology. Q-methodology provided the Alabama Child Health Improvement Alliance (ACHIA) an objective and rigorous approach to system improvement. Selected priority measures were used to design learning collaboratives. An open dialogue among stakeholders about state health priorities spurred greater organizational buy-in for ACHIA and increased its credibility as a statewide provider of learning collaboratives. The integrated processes of Q-sort methodology, learning collaboratives, and CQI offer a practical yet innovative way to identify and prioritize state measures for child and adolescent health and establish a learning agenda for targeted quality improvement activities.

  13. Improvement production of bacterial cellulose by semi-continuous process in molasses medium.

    Science.gov (United States)

    Cakar, Fatih; Ozer, Işılay; Aytekin, A Özhan; Sahin, Fikrettin

    2014-06-15

    Bacterial cellulose (BC) has unique properties such as structural, functional, physical and chemical. The mass production of BC for industrial application has recently become attractive to produce more economical and high productive cellulose. In this study, to improve the productivity of bacterial cellulose (BC), BC production by Gluconacetobacter xylinus FC01 was investigated in molasses medium with static semi-continuous operation mode. Cell dry weight, polysaccharide, sugar and cellulose concentrations were monitored and cellulose was characterized by Fourier transform infrared spectroscopy (FT-IR) and scanning electron microscopy (SEM). The highest cellulose yield (1.637 g/L) was obtained in SCP50-7d, which molasses of 1/2 ratio for 7 days by static semi-continuous operation mode. The results show that BC can be highly produced by G. xylinus in molasses with static semi-continuous process than batch process. We claimed that low-cost medium with semi-continuous operation mode in static culture is a good candidate for industrial scale BC productions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. The Sustainable Improvement and Innovation Model

    OpenAIRE

    Clark, Richard A.; Timms, Janice; Parnell, Peter F.; Griffith, Garry R.

    2008-01-01

    The Beef CRC's 'Sustainable Beef Profit Partnerships' (BPP) project is built around the Sustainable Improvement and Innovation (SI&I) Model – a model for the design, leadership and management of projects to achieve rapid and sustained improvement and innovation, and accelerated adoption. The model is implemented through a systemic approach to project design, and the development of a number of integrated strategies to guide the targeting of priority outcomes and work plans. The emphasis is o...

  15. An exploration of the midwifery continuity of care program at one Australian University as a symbiotic clinical education model.

    Science.gov (United States)

    Sweet, Linda P; Glover, Pauline

    2013-03-01

    This discussion paper analyses a midwifery Continuity of Care program at an Australian University with the symbiotic clinical education model, to identify strengths and weakness, and identify ways in which this new pedagogical approach can be improved. In 2002 a major change in Australian midwifery curricula was the introduction of a pedagogical innovation known as the Continuity of Care experience. This innovation contributes a significant portion of clinical experience for midwifery students. It is intended as a way to give midwifery students the opportunity to provide continuity of care in partnership with women, through their pregnancy and childbirth, thus imitating a model of continuity of care and continuity of carer. A qualitative study was conducted in 2008/9 as part of an Australian Learning and Teaching Council Associate Fellowship. Evidence and findings from this project (reported elsewhere) are used in this paper to illustrate the evaluation of midwifery Continuity of Care experience program at an Australian university with the symbiotic clinical education model. Strengths of the current Continuity of Care experience are the strong focus on relationships between midwifery students and women, and early clinical exposure to professional practice. Improved facilitation through the development of stronger relationships with clinicians will improve learning, and result in improved access to authentic supported learning and increased provision of formative feedback. This paper presents a timely review of the Continuity of Care experience for midwifery student learning and highlights the potential of applying the symbiotic clinical education model to enhance learning. Applying the symbiotic clinical education framework to evidence gathered about the Continuity of Care experience in Australian midwifery education highlights strengths and weaknesses which may be used to guide curricula and pedagogical improvements. Copyright © 2011 Elsevier Ltd. All rights

  16. A system for continual quality improvement of normal tissue delineation for radiation therapy treatment planning.

    Science.gov (United States)

    Breunig, Jennifer; Hernandez, Sophy; Lin, Jeffrey; Alsager, Stacy; Dumstorf, Christine; Price, Jennifer; Steber, Jennifer; Garza, Richard; Nagda, Suneel; Melian, Edward; Emami, Bahman; Roeske, John C

    2012-08-01

    To implement the "plan-do-check-act" (PDCA) cycle for the continual quality improvement of normal tissue contours used for radiation therapy treatment planning. The CT scans of patients treated for tumors of the brain, head and neck, thorax, pancreas and prostate were selected for this study. For each scan, a radiation oncologist and a diagnostic radiologist, outlined the normal tissues ("gold" contours) using Radiation Therapy Oncology Group (RTOG) guidelines. A total of 30 organs were delineated. Independently, 5 board-certified dosimetrists and 1 trainee then outlined the same organs. Metrics used to compare the agreement between the dosimetrists' contours and the gold contours included the Dice Similarity Coefficient (DSC), and a penalty function using distance to agreement. Based on these scores, dosimetrists were re-trained on those organs in which they did not receive a passing score, and they were subsequently re-tested. Passing scores were achieved on 19 of 30 organs evaluated. These scores were correlated to organ volume. For organ volumes PDCA cycle to assess competence in the delineation of individual organs, and to identify areas for improvement. With testing, guidance, and re-evaluation, contouring consistency can be obtained across multiple dosimetrists. Our expectation is that continual quality improvement using the PDCA approach will ensure more accurate treatments and dose assessment in radiotherapy treatment planning and delivery. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Improvements of PKU PMECRIS for continuous hundred hours CW proton beam operation

    International Nuclear Information System (INIS)

    Peng, S. X.; Ren, H. T.; Zhang, T.; Zhang, J. F.; Xu, Y.; Guo, Z. Y.; Zhang, A. L.; Chen, J. E.

    2016-01-01

    In order to improve the source stability, a long term continuous wave (CW) proton beam experiment has been carried out with Peking University compact permanent magnet 2.45 GHz ECR ion source (PKU PMECRIS). Before such an experiment a lot of improvements and modifications were completed on the source body, the Faraday cup and the PKU ion source test bench. At the beginning of 2015, a continuous operation of PKU PMECRIS for 306 h with more than 50 mA CW beam was carried out after success of many short term tests. No plasma generator failure or high voltage breakdown was observed during that running period and the proton source reliability is near 100%. Total beam availability, which is defined as 35-keV beam-on time divided by elapsed time, was higher than 99% [S. X. Peng et al., Chin. Phys. B 24(7), 075203 (2015)]. A re-inspection was performed after another additional 100 h operation (counting time) and no obvious sign of component failure was observed. Counting the previous source testing time together, this PMECRs longevity is now demonstrated to be greater than 460 h. This paper is mainly concentrated on the improvements for this long term experiment

  18. Improvements of PKU PMECRIS for continuous hundred hours CW proton beam operation

    Science.gov (United States)

    Peng, S. X.; Zhang, A. L.; Ren, H. T.; Zhang, T.; Zhang, J. F.; Xu, Y.; Guo, Z. Y.; Chen, J. E.

    2016-02-01

    In order to improve the source stability, a long term continuous wave (CW) proton beam experiment has been carried out with Peking University compact permanent magnet 2.45 GHz ECR ion source (PKU PMECRIS). Before such an experiment a lot of improvements and modifications were completed on the source body, the Faraday cup and the PKU ion source test bench. At the beginning of 2015, a continuous operation of PKU PMECRIS for 306 h with more than 50 mA CW beam was carried out after success of many short term tests. No plasma generator failure or high voltage breakdown was observed during that running period and the proton source reliability is near 100%. Total beam availability, which is defined as 35-keV beam-on time divided by elapsed time, was higher than 99% [S. X. Peng et al., Chin. Phys. B 24(7), 075203 (2015)]. A re-inspection was performed after another additional 100 h operation (counting time) and no obvious sign of component failure was observed. Counting the previous source testing time together, this PMECRs longevity is now demonstrated to be greater than 460 h. This paper is mainly concentrated on the improvements for this long term experiment.

  19. Improvements of PKU PMECRIS for continuous hundred hours CW proton beam operation

    Energy Technology Data Exchange (ETDEWEB)

    Peng, S. X., E-mail: sxpeng@pku.edu.cn; Ren, H. T.; Zhang, T.; Zhang, J. F.; Xu, Y.; Guo, Z. Y. [State Key Laboratory of Nuclear Physics and Technology and Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing 100871 (China); Zhang, A. L.; Chen, J. E. [State Key Laboratory of Nuclear Physics and Technology and Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing 100871 (China); University of Chinese Academy of Sciences, Beijing 100049 (China)

    2016-02-15

    In order to improve the source stability, a long term continuous wave (CW) proton beam experiment has been carried out with Peking University compact permanent magnet 2.45 GHz ECR ion source (PKU PMECRIS). Before such an experiment a lot of improvements and modifications were completed on the source body, the Faraday cup and the PKU ion source test bench. At the beginning of 2015, a continuous operation of PKU PMECRIS for 306 h with more than 50 mA CW beam was carried out after success of many short term tests. No plasma generator failure or high voltage breakdown was observed during that running period and the proton source reliability is near 100%. Total beam availability, which is defined as 35-keV beam-on time divided by elapsed time, was higher than 99% [S. X. Peng et al., Chin. Phys. B 24(7), 075203 (2015)]. A re-inspection was performed after another additional 100 h operation (counting time) and no obvious sign of component failure was observed. Counting the previous source testing time together, this PMECRs longevity is now demonstrated to be greater than 460 h. This paper is mainly concentrated on the improvements for this long term experiment.

  20. Assessing the impact of continuous quality improvement/total quality management: concept versus implementation.

    Science.gov (United States)

    Shortell, S M; O'Brien, J L; Carman, J M; Foster, R W; Hughes, E F; Boerstler, H; O'Connor, E J

    1995-01-01

    OBJECTIVE: This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. DATA SOURCES AND STUDY SETTING: Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. STUDY DESIGN: The study involved cross-sectional examination of the named relationships. DATA COLLECTION/EXTRACTION METHODS: Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. PRINCIPAL FINDINGS: A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. CONCLUSIONS: What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult

  1. [Improving the continuous care process in primary care during weekends and holidays: redesigning and FMEA].

    Science.gov (United States)

    Cañada Dorado, A; Cárdenas Valladolid, J; Espejo Matorrales, F; García Ferradal, I; Sastre Páez, S; Vicente Martín, I

    2010-01-01

    To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

  2. A System for Continual Quality Improvement of Normal Tissue Delineation for Radiation Therapy Treatment Planning

    International Nuclear Information System (INIS)

    Breunig, Jennifer; Hernandez, Sophy; Lin, Jeffrey; Alsager, Stacy; Dumstorf, Christine; Price, Jennifer; Steber, Jennifer; Garza, Richard; Nagda, Suneel; Melian, Edward; Emami, Bahman; Roeske, John C.

    2012-01-01

    Purpose: To implement the “plan-do-check-act” (PDCA) cycle for the continual quality improvement of normal tissue contours used for radiation therapy treatment planning. Methods and Materials: The CT scans of patients treated for tumors of the brain, head and neck, thorax, pancreas and prostate were selected for this study. For each scan, a radiation oncologist and a diagnostic radiologist, outlined the normal tissues (“gold” contours) using Radiation Therapy Oncology Group (RTOG) guidelines. A total of 30 organs were delineated. Independently, 5 board-certified dosimetrists and 1 trainee then outlined the same organs. Metrics used to compare the agreement between the dosimetrists' contours and the gold contours included the Dice Similarity Coefficient (DSC), and a penalty function using distance to agreement. Based on these scores, dosimetrists were re-trained on those organs in which they did not receive a passing score, and they were subsequently re-tested. Results: Passing scores were achieved on 19 of 30 organs evaluated. These scores were correlated to organ volume. For organ volumes <8 cc, the average DSC was 0.61 vs organ volumes ≥8 cc, for which the average DSC was 0.91 (P=.005). Normal tissues that had the lowest scores included the lenses, optic nerves, chiasm, cochlea, and esophagus. Of the 11 organs that were considered for re-testing, 10 showed improvement in the average score, and statistically significant improvement was noted in more than half of these organs after education and re-assessment. Conclusions: The results of this study indicate the feasibility of applying the PDCA cycle to assess competence in the delineation of individual organs, and to identify areas for improvement. With testing, guidance, and re-evaluation, contouring consistency can be obtained across multiple dosimetrists. Our expectation is that continual quality improvement using the PDCA approach will ensure more accurate treatments and dose assessment in

  3. A System for Continual Quality Improvement of Normal Tissue Delineation for Radiation Therapy Treatment Planning

    Energy Technology Data Exchange (ETDEWEB)

    Breunig, Jennifer; Hernandez, Sophy; Lin, Jeffrey; Alsager, Stacy; Dumstorf, Christine; Price, Jennifer; Steber, Jennifer; Garza, Richard; Nagda, Suneel; Melian, Edward; Emami, Bahman [Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois (United States); Roeske, John C., E-mail: jroeske@lumc.edu [Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois (United States)

    2012-08-01

    Purpose: To implement the 'plan-do-check-act' (PDCA) cycle for the continual quality improvement of normal tissue contours used for radiation therapy treatment planning. Methods and Materials: The CT scans of patients treated for tumors of the brain, head and neck, thorax, pancreas and prostate were selected for this study. For each scan, a radiation oncologist and a diagnostic radiologist, outlined the normal tissues ('gold' contours) using Radiation Therapy Oncology Group (RTOG) guidelines. A total of 30 organs were delineated. Independently, 5 board-certified dosimetrists and 1 trainee then outlined the same organs. Metrics used to compare the agreement between the dosimetrists' contours and the gold contours included the Dice Similarity Coefficient (DSC), and a penalty function using distance to agreement. Based on these scores, dosimetrists were re-trained on those organs in which they did not receive a passing score, and they were subsequently re-tested. Results: Passing scores were achieved on 19 of 30 organs evaluated. These scores were correlated to organ volume. For organ volumes <8 cc, the average DSC was 0.61 vs organ volumes {>=}8 cc, for which the average DSC was 0.91 (P=.005). Normal tissues that had the lowest scores included the lenses, optic nerves, chiasm, cochlea, and esophagus. Of the 11 organs that were considered for re-testing, 10 showed improvement in the average score, and statistically significant improvement was noted in more than half of these organs after education and re-assessment. Conclusions: The results of this study indicate the feasibility of applying the PDCA cycle to assess competence in the delineation of individual organs, and to identify areas for improvement. With testing, guidance, and re-evaluation, contouring consistency can be obtained across multiple dosimetrists. Our expectation is that continual quality improvement using the PDCA approach will ensure more accurate treatments and dose

  4. Impact of continuous quality improvement initiatives on clinical outcomes in peritoneal dialysis.

    Science.gov (United States)

    Yu, Yusheng; Zhou, Yan; Wang, Han; Zhou, Tingting; Li, Qing; Li, Taoyu; Wu, Yan; Liu, Zhihong

    2014-06-01

    We evaluated the role of a quality improvement initiative in improving clinical outcomes in peritoneal dialysis (PD). In a retrospective analysis of 6 years of data from a hospital registry, the period between 1 July 2005 and 30 June 2008 (control group) provided baseline data from before implementation of systemic outcomes monitoring, and the period between 1 July 2008 and 30 June 2011 [continuous quality improvement (CQI) group] represented the time when a CQI program was in place. Peritonitis incidence, patient and technique survival, cardiovascular status, causes of death, and drop-out were compared between the groups. In the 370 patients of the CQI group and the 249 patients of the control group, the predominant underlying kidney diseases were chronic glomerulonephritis and diabetic nephropathy. After implementation of the CQI initiative, the peritonitis rate declined to 1 episode in 77.25 patient-months from 1 episode in 22.86 patient-months. Ultrasound parameters of cardiac structure were generally unchanged in the CQI group, but significant increases in cardiothoracic ratio and interventricular septal thickness were observed in the control group (both p improve technique survival rates: 95.6%, 92.6%, and 92.6% in the CQI group compared with 89.6%, 79.2%, and 76.8% in the control group (p improve the quality of therapy and its outcomes. Copyright © 2014 International Society for Peritoneal Dialysis.

  5. Continual summing-up, deepening the related researches and improving the interventional nursing

    International Nuclear Information System (INIS)

    Xu Xiufang; Zhang Xiumei; Ding Yue

    2011-01-01

    With the development of the medical technique in the field of clinical interventional radiology, the relevant interventional nursing team has also gradually grown and expanded. At present, there are certain differences in the development situation of interventional nursing between China and foreign countries. The experts in nursing fields in China should learn the matured experience from abroad to open up the features and superiorities of Chinese interventional nursing. Therefore, the nursing workers in China should continually to make summing-up, exert oneself to deepen the related researches and effectively improve the interventional nursing level. (authors)

  6. Environmental assessment, continual improvement and adaptive management within the AREVA sustainable development framework

    International Nuclear Information System (INIS)

    Rosaasen, A.; Frostad, S.

    2006-01-01

    COGEMA Resources Inc. (which is part of the AREVA Group) is a Canadian company with its head office in Saskatoon, Saskatchewan. It owns and operates mining and milling facilities in northern Saskatchewan, which produce uranium concentrate. The McClean Lake Operation commenced production in 1999 and its environmental management system represents an integrated approach to environmental assessment, continual improvement and adaptive management based on operational results. In Canada, sustainable development is promoted through the application of the Canadian Environmental Assessment Act (CEAA). Environmental Assessment (EA) is a planning tool, which incorporates environmental considerations before irrevocable decisions are taken. The basic tenet of the Act is the determination of whether the potential environmental effects of a project are adverse, significant and likely, taking into consideration mitigation measures. Thus, project planning and design entails an iterative process that incorporates mitigation measures to minimize potentially significant adverse effects. As part of the EA process conservative approaches are taken to predict potential effects. Several important elements are generated through the EA process including: a set of environmental effects predictions, a compliance and environmental effects monitoring program, a follow-up program to address uncertainties in the prediction of environmental effects, and the identification of contingency measures that could be implemented should non-conservative assumptions be identified in the original assessment framework. The challenge is to integrate each of these elements into the environmental management framework of the operating facility and develop an iterative mechanism to evaluate operational performance relative to what was originally predicted. In Saskatchewan, a requirement of operational licenses is the periodic evaluation of the 'Status of the Environment' surrounding operational facilities. These

  7. POSSIBILITIES AND LIMITS OF THE CYCLE OF CONTINUOUS IMPROVEMENT -PDCA AS AN ELEMENT OF LEARNING

    Directory of Open Access Journals (Sweden)

    Celso Machado Junior

    2013-08-01

    Full Text Available The aim of this study is to investigate the possibilities and limits of the use of continuous improvement cycle, PDCA, as a tool that contributes to the development of individual learning in the organization. It is a qualitative, descriptive end uses the case study as a method. It was observed that the practice proposed by PDCA, can be used in the process of knowledge creation in line with the authors in the field, constituting a form of knowledge management within the organization, enabling the creation of tacit knowledge and its explicit transformation were not observed limits for their use.

  8. On improving the convergence rate of linear continuous-time systems subject to asymmetrically constrained control

    Directory of Open Access Journals (Sweden)

    A. Baddou

    2006-01-01

    Full Text Available This paper solves the problem of controlling linear continuous-time systems subject to control signals constrained in magnitude (maybe asymmetrically. A controller design methodology is proposed, based on using an asymmetric Lyapunov function, that avoids the discontinuities in the control vector components resulting from the application of a piecewise linear control law previously proposed. The proposed method gives improved speed of convergence without discontinuities of the control vector components, respecting always the imposed asymmetric constraints. An example illustrates the approach.

  9. Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

    Science.gov (United States)

    McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

    2018-01-01

    Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally. PMID:29623271

  10. Improving physiotherapy services to Indigenous children with physical disability: Are client perspectives missed in the continuous quality improvement approach?

    Science.gov (United States)

    Greenstein, Caroline; Lowell, Anne; Thomas, David Piers

    2016-06-01

    To compare the outcomes of two cycles of continuous quality improvement (CQI) at a paediatric physiotherapy service with findings from interviews with clients and their carers using the service. Case study based at one paediatric physiotherapy service Community-based paediatric allied health service in Northern Australia. Forty-nine clinical records and four staff at physiotherapy service, five Indigenous children with physical disability aged 8-21 years, and nine carers of Indigenous children aged 0-21 years (current or previous clients). The CQI process based on the Audit and Best Practice for Chronic Disease involved a clinical audit; a workshop where clinicians assessed their health care systems, identified weaknesses and strengths, and developed goals and strategies for improvement; and reassessment through a second audit and workshop. Twelve open-ended, in-depth interviews were conducted with previous or current clients selected through purposive and theoretical sampling. CQI and interview results were then compared. Comparison of findings from the two studies Both CQI and interview results highlighted service delivery flexibility and therapists' knowledge, support and advocacy as service strengths, and lack of resources and a child-friendly office environment as weaknesses. However, the CQI results reported better communication and client input into the service than the interview results. The CQI process, while demonstrating improvements in clinical and organisational aspects of the service, did not always reflect or address the primary concerns of Indigenous clients and underlined the importance of including clients in the CQI process. © 2015 National Rural Health Alliance Inc.

  11. Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes.

    Science.gov (United States)

    McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

    2018-01-01

    Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

  12. Semi-continuous and multigroup models in extended kinetic theory

    CERN Document Server

    Koller, W

    2000-01-01

    The aim of this thesis is to study energy discretization of the Boltzmann equation in the framework of extended kinetic theory. In case that external fields can be neglected, the semi- continuous Boltzmann equation yields a sound basis for various generalizations. Semi-continuous kinetic equations describing a three component gas mixture interacting with monochromatic photons as well as a four component gas mixture undergoing chemical reactions are established and investigated. These equations reflect all major aspects (conservation laws, equilibria, H-theorem) of the full continuous kinetic description. For the treatment of the spatial dependence, an expansion of the distribution function in terms of Legendre polynomials is carried out. An implicit finite differencing scheme is combined with the operator splitting method. The obtained numerical schemes are applied to the space homogeneous study of binary chemical reactions and to spatially one-dimensional laser-induced acoustic waves. In the presence of exte...

  13. Discrete versus continuous state switching models for portfolio credit risk

    NARCIS (Netherlands)

    Lucas, A.; Klaassen, P.

    2006-01-01

    Dynamic models for credit rating transitions are important ingredients for dynamic credit risk analyses. We compare the properties of two such models that have recently been put forward. The models mainly differ in their treatment of systematic risk, which can be modeled either using discrete states

  14. Shortlist: A Connectionist Model of Continuous Speech Recognition.

    Science.gov (United States)

    Norris, Dennis

    1994-01-01

    The Shortlist model is presented, which incorporates the desirable properties of earlier models of back-propagation networks with recurrent connections that successfully model many aspects of human spoken word recognition. The new model is entirely bottom-up and can readily perform simulations with vocabularies of tens of thousands of words. (DR)

  15. Modular Approach for Continuous Cell-Level Balancing to Improve Performance of Large Battery Packs: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Muneed ur Rehman, M.; Evzelman, M.; Hathaway, K.; Zane, R.; Plett, G. L.; Smith, K.; Wood, E.; Maksimovic, D.

    2014-10-01

    Energy storage systems require battery cell balancing circuits to avoid divergence of cell state of charge (SOC). A modular approach based on distributed continuous cell-level control is presented that extends the balancing function to higher level pack performance objectives such as improving power capability and increasing pack lifetime. This is achieved by adding DC-DC converters in parallel with cells and using state estimation and control to autonomously bias individual cell SOC and SOC range, forcing healthier cells to be cycled deeper than weaker cells. The result is a pack with improved degradation characteristics and extended lifetime. The modular architecture and control concepts are developed and hardware results are demonstrated for a 91.2-Wh battery pack consisting of four series Li-ion battery cells and four dual active bridge (DAB) bypass DC-DC converters.

  16. Improvement of two-way continuous-variable quantum key distribution using optical amplifiers

    International Nuclear Information System (INIS)

    Zhang, Yi-Chen; Yu, Song; Gu, Wanyi; Li, Zhengyu; Sun, Maozhu; Peng, Xiang; Guo, Hong; Weedbrook, Christian

    2014-01-01

    The imperfections of a receiver's detector affect the performance of two-way continuous-variable (CV) quantum key distribution (QKD) protocols and are difficult to adjust in practical situations. We propose a method to improve the performance of two-way CV-QKD by adding a parameter-adjustable optical amplifier at the receiver. A security analysis is derived against a two-mode collective entangling cloner attack. Our simulations show that the proposed method can improve the performance of protocols as long as the inherent noise of the amplifier is lower than a critical value, defined as the tolerable amplifier noise. Furthermore, the optimal performance can approach the scenario where a perfect detector is used. (paper)

  17. Perspectives on continuing education in the health professions: improving health care through lifelong learning.

    Science.gov (United States)

    Leach, David C; Fletcher, Suzanne W

    2008-12-01

    In November 2007, the Josiah Macy, Jr. Foundation convened a conference to address a number of complex issues concerning continuing education (CE) in the health professions. Participants concluded that CE, as currently practiced, does not focus adequately on improving clinician performance and patient care, is too dependent on lectures and too removed from the daily practice of clinicians, does not encourage or emphasize newer technologies and point-of-care learning, is poorly integrated across disciplines, and is inappropriately financed. Recommendations concerning educational methods, metrics, responsibilities, research in CE, financing, and oversight are reviewed. The relationship between the goals of improving clinician performance and patient care, while maintaining high standards of accountability and transparency, are reviewed.

  18. Incorporation of continuous quality improvement in a hospital dietary department's quality management program.

    Science.gov (United States)

    Letort, N R; Boudreaux, J

    1994-12-01

    What techniques or steps are necessary to overcome obstacles and achieve the incorporation of continuous quality improvement (CQI) methods in existing quality management programs? Education of staff, identification of customers' expectations, and implementation of a plan to administer activities are critical to a positive outcome of CQI efforts. Our article outlines one approach to the transition from quality assurance to CQI using the FOCUS-PDCA technique. We use the example of improving the timeliness of late tray deliveries to demonstrate how to implement the conversion to CQI using the FOCUS-PDCA technique. The dietetics practitioners may apply the sequential steps described in the article to successfully incorporate the CQI concept in most hospital dietary departments' quality management activities.

  19. Continuous Auditory Feedback of Eye Movements: An Exploratory Study toward Improving Oculomotor Control

    Directory of Open Access Journals (Sweden)

    Eric O. Boyer

    2017-04-01

    Full Text Available As eye movements are mostly automatic and overtly generated to attain visual goals, individuals have a poor metacognitive knowledge of their own eye movements. We present an exploratory study on the effects of real-time continuous auditory feedback generated by eye movements. We considered both a tracking task and a production task where smooth pursuit eye movements (SPEM can be endogenously generated. In particular, we used a visual paradigm which enables to generate and control SPEM in the absence of a moving visual target. We investigated whether real-time auditory feedback of eye movement dynamics might improve learning in both tasks, through a training protocol over 8 days. The results indicate that real-time sonification of eye movements can actually modify the oculomotor behavior, and reinforce intrinsic oculomotor perception. Nevertheless, large inter-individual differences were observed preventing us from reaching a strong conclusion on sensorimotor learning improvements.

  20. Dissemination of performance information and continuous improvement: A narrative systematic review.

    Science.gov (United States)

    Lemire, Marc; Demers-Payette, Olivier; Jefferson-Falardeau, Justin

    2013-01-01

    Developing a performance measure and reporting the results to support decision making at an individual level has yielded poor results in many health systems. The purpose of this paper is to highlight the factors associated with the dissemination of performance information that generate and support continuous improvement in health organizations. A systematic data collection strategy that includes empirical and theoretical research published from 1980 to 2010, both qualitative and quantitative, was performed on Web of Science, Current Contents, EMBASE and MEDLINE. A narrative synthesis method was used to iteratively detail explicative processes that underlie the intervention. A classification and synthesis framework was developed, drawing on knowledge transfer and exchange (KTE) literature. The sample consisted of 114 articles, including seven systematic or exhaustive reviews. Results showed that dissemination in itself is not enough to produce improvement initiatives. Successful dissemination depends on various factors, which influence the way collective actors react to performance information such as the clarity of objectives, the relationships between stakeholders, the system's governance and the available incentives. This review was limited to the process of knowledge dissemination in health systems and its utilization by users at the health organization level. Issues related to improvement initiatives deserve more attention. Knowledge dissemination goes beyond better communication and should be considered as carefully as the measurement of performance. Choices pertaining to intervention should be continuously prompted by the concern to support organizational action. While considerable attention was paid to the public reporting of performance information, this review sheds some light on a more promising avenue for changes and improvements, notably in public health systems.

  1. Continuing Improvement in the Planetary Ephemeris with VLBA Observations of Cassini

    Science.gov (United States)

    Jones, Dayton L.; Folkner, William M.; Jacobson, Robert A.; Jacobs, Christopher S.; Romney, Jonathan D.; Dhawan, Vivek; Fomalont, Edward B.

    2016-06-01

    During the past decade a continuing series of measurements of the barycentric position of the Saturn system in the inertial International Celestial Reference Frame (ICRF) has led to a significant improvement in our knowledge of Saturn's orbit. This in turn has improved the current accuracy and time range of the solar system ephemeris produced and maintained by the Jet Propulsion Laboratory. Our observing technique involves high-precision astrometry of the radio signal from Cassini with the NRAO Very Long Baseline Array, combined with solutions for the orbital motion of Cassini about the Saturn barycenter from Doppler tracking by the Deep Space Network. Our VLBA astrometry is done in a phase-referencing mode, providing nrad-level relative positions between Cassini and angularly nearby extragalactic radio sources. The positions of those reference radio sources are tied to the ICRF through dedicated VLBI observations by several groups around the world. We will present recent results from our astrometric observations of Cassini through early 2016. This program will continue until the end of the Cassini mission in 2017, although future improvement in Saturn's orbit will be more incremental because we have already covered more that a quarter of Saturn's orbital period. The Juno mission to Jupiter, which will orbit Jupiter for about 1.5 years starting in July 2016, will provide an excellent opportunity for us to apply the same VLBA astrometry technique to improve the orbit of Jupiter by a factor of several. The National Radio Astronomy Observatory is a facility of the National Science Foundation operated under cooperative agreement by Associated Universities, Inc. This work made use of the Swinburne University of Technology software correlator, developed as part of the Australian Major National Research Facilities Program and operated under license. Part of this research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under contract

  2. Ergonomics, quality and continuous improvement--conceptual and empirical relationships in an industrial context.

    Science.gov (United States)

    Eklund, J

    1997-10-01

    This paper reviews the literature comparing the fields of ergonomics and quality, mainly in an industrial context, including mutual influences, similarities and differences. Relationships between ergonomics and the factors: work conditions, product design, ISO 9000, continuous improvements and TQM are reviewed in relation to the consequence, application, and process domains. The definitions of ergonomics and quality overlap substantially. Quality deficiencies, human errors and ergonomics problems often have the same cause, which in many cases can be traced to the design of work, workplace and environment e.g. noise, light, postures, loads, pace and work content. In addition, the possibility of performing to a high standard at work is an important prerequisite for satisfaction and well-being. Contradictions between the two fields have been identified in the view of concepts such as standardization, reduction of variability and copying of best practice, requiring further research. The field of quality would gain by incorporating ergonomics knowledge, especially in the areas of work design and human capability, since these factors are decisive for human performance and also therefore the performance of the systems involved. The field of ergonomics, on the other hand, would benefit from developing a stronger emphasis on methodologies and structures for improvement processes, including a clearer link with leadership and company strategies. Just as important is a further development of practicable participative ergonomics methods and tools for use at workplaces by the workers themselves, in order to integrate the top-down and the bottom-up processes and achieve better impact. Using participative processes for problem-solving and continuous improvement, focusing ergonomics and quality jointly has a great potential for improving working conditions and quality results simultaneously, and satisfying most of the interested parties.

  3. [Study of continuous quality improvement for clinical laboratory processes via the platform of Hospital Group].

    Science.gov (United States)

    Song, Wenqi; Shen, Ying; Peng, Xiaoxia; Tian, Jian; Wang, Hui; Xu, Lili; Nie, Xiaolu; Ni, Xin

    2015-05-26

    The program of continuous quality improvement in clinical laboratory processes for complete blood count (CBC) was launched via the platform of Beijing Children's Hospital Group in order to improve the quality of pediatric clinical laboratories. Fifteen children's hospitals of Beijing Children's Hospital group were investigated using the method of Chinese adapted continuous quality improvement with PDCA (Plan-Do-Check-Action). The questionnaire survey and inter-laboratory comparison was conducted to find the existing problems, to analyze reasons, to set forth quality targets and to put them into practice. Then, targeted training was conducted to 15 children's hospitals and the second questionnaire survey, self examinations by the clinical laboratories was performed. At the same time, the Group's online internal quality control platform was established. Overall effects of the program were evaluated so that lay a foundation for the next stage of PDCA. Both quality of control system documents and CBC internal quality control scheme for all of clinical laboratories were improved through this program. In addition, standardization of performance verification was also improved, especially with the comparable verification rate of precision and internal laboratory results up to 100%. In terms of instrument calibration and mandatory diagnostic rates, only three out of the 15 hospitals (20%) failed to pass muster in 2014 from 46.67% (seven out of the 15 hospitals) in 2013. The abnormal data of intraday precision variance coefficients of the five CBC indicator parameters (WBC, RBC, Hb, Plt and Hct) of all the 15 laboratories accounted for 1.2% (2/165) in 2014, a marked decrease from 9.6% (14/145) in 2013. While the number of the hospitals using only one horizontal quality control object for daily quality control has dropped to three from five. The 15 hospitals organized a total of 263 times of training in 2014 from 101 times in 2013, up 160%. The quality improvement program for

  4. Eigenfunction statistics for Anderson model with Hölder continuous ...

    Indian Academy of Sciences (India)

    We consider random Schrödinger operators on l 2 ( Z d ) with α -Hölder continuous ( 0 < α ≤ 1 ) single site distribution. In localized regime, we study the distribution of eigenfunctions in space and energy simultaneously. In a certain scaling limit, we prove limit points are Poisson.

  5. Cooperation in stochastic inventory models with continuous review

    NARCIS (Netherlands)

    Boucherie, Richardus J.; Chessa, Michela; Timmer, Judith B.

    Consider multiple companies that continuously review their inventories and face Poisson demand. We study cooperation strategies for these companies and analyse if there exist allocations of the joint cost such that any company has lower costs than on its own; such allocations are called stable cost

  6. A model supporting Business Continuity auditing & planning in Information Systems

    NARCIS (Netherlands)

    Zambon, Emmanuele; Bolzoni, D.; Etalle, Sandro; Salvato, Marco

    2007-01-01

    One of the main tasks of IT business continuity planning (BCP) is to guarantee that incidents affecting the IT infrastructure do not affect the availability of IT-dependent business processes beyond a given acceptable extent. Carrying out BCP of information systems is particularly challenging,

  7. A model supporting Business Continuity auditing & planning in Information Systems

    NARCIS (Netherlands)

    Zambon, Emmanuele; Bolzoni, D.; Etalle, Sandro; Salvato, Marco

    2007-01-01

    One of the main tasks of IT business continuity planing (BCP) is guaranteeing that incidents affecting the IT infrastructure do not affect the availability of IT-dependent business processes beyond a given acceptable extent. Carrying out BCP of information systems is particularly challenging because

  8. Model based Control of a Continuous Yeast Fermentation

    DEFF Research Database (Denmark)

    Andersen, Maria Yolanda; Brabrand, Henrik; Jørgensen, Sten Bay

    1991-01-01

    Control of a continuous fermentation with Saccharomyces cerevisiae is performed by manipulation of the feed flow rate using an ethanol measurement in the exit gas The process is controlled at the critical dilution rate with a low ethanol concentration of 40-50 mg/l. A standard PI controller is able...

  9. Strategic planning as a focus for continuous improvement. A case study

    Science.gov (United States)

    Oneill, John W.; Gordon-Winkler, Lyn

    1992-01-01

    What do most of the successful people and organizations in our world have in common? Instead of worrying about the future, they work to create it. They have a plan, or a vision of what they want to accomplish and they focus their efforts on success. Strategic planning has been described as a disciplined, ongoing process to produce fundamental decisions and actions that shape what an organization is, what it does, and how it will respond to a changing environment. This case study discussion will evaluate the relationship between strategic planning and Total Quality Management (TQM), or continuous improvement, through the experience of the NASA Johnson Space Center in developing a strategy for the future. That experience clearly illustrates the value of strategic planning in setting the framework and establishing the overall thrust of continuous improvement initiatives. Equally significant, the fundamentals of a quality culture such as strong customer and supplier partnerships, participative involvement, open communications, and ownership were essential in overcoming the challenges inherent in the planning process. A reinforced management commitment to the quality culture was a clear, long-term benefit.

  10. Strategic planning as a focus for continuous improvement. A case study

    Science.gov (United States)

    Oneill, John W.; Gordon-Winkler, Lyn

    What do most of the successful people and organizations in our world have in common? Instead of worrying about the future, they work to create it. They have a plan, or a vision of what they want to accomplish and they focus their efforts on success. Strategic planning has been described as a disciplined, ongoing process to produce fundamental decisions and actions that shape what an organization is, what it does, and how it will respond to a changing environment. This case study discussion will evaluate the relationship between strategic planning and Total Quality Management (TQM), or continuous improvement, through the experience of the NASA Johnson Space Center in developing a strategy for the future. That experience clearly illustrates the value of strategic planning in setting the framework and establishing the overall thrust of continuous improvement initiatives. Equally significant, the fundamentals of a quality culture such as strong customer and supplier partnerships, participative involvement, open communications, and ownership were essential in overcoming the challenges inherent in the planning process. A reinforced management commitment to the quality culture was a clear, long-term benefit.

  11. Continuous Improvement in Battery Testing at the NASA/JSC Energy System Test Area

    Science.gov (United States)

    Boyd, William; Cook, Joseph

    2003-01-01

    The Energy Systems Test Area (ESTA) at the Lyndon B. Johnson Space Center in Houston, Texas conducts development and qualification tests to fulfill Energy System Division responsibilities relevant to ASA programs and projects. EST A has historically called upon a variety of fluid, mechanical, electrical, environmental, and data system capabilities spread amongst five full-service facilities to test human and human supported spacecraft in the areas of propulsion systems, fluid systems, pyrotechnics, power generation, and power distribution and control systems. Improvements at ESTA are being made in full earnest of offering NASA project offices an option to choose a thorough test regime that is balanced with cost and schedule constraints. In order to continue testing of enabling power-related technologies utilized by the Energy System Division, an especially proactive effort has been made to increase the cost effectiveness and schedule responsiveness for battery testing. This paper describes the continuous improvement in battery testing at the Energy Systems Test Area being made through consolidation, streamlining, and standardization.

  12. X-rays taken by radiologists. Influence on a continuous quality improvement process?

    International Nuclear Information System (INIS)

    Kurtz, C.; Freiburg Univ.; Czapp, W.; Trampe, I.; Leppek, R.; Klose, K.J.

    2000-01-01

    Purpose: To evaluate how the training of radiology residents in taking radiographs influences the work of radiographers and the established quality standards. Methods: A first year radiology resident was trained for 4 weeks in focusing and exposure techniques by radiographers. In a second period the resident took 582 radiograms, which were compared with those taken by technicians for error estimation on a daily basis. During a third period the radiographs were produced in a contest between the resident and a skilled radiographer. Errors were analysed by two independent experts according to established guidelines of the German Medical Association. Results: At the beginning of the second period the average error rate of the resident was 11.9% as compared to 8.9% in the technicians team, in the following month 9.2% versus 15.9%. In the third period no relevant difference in errors could be observed. Finally, unexpected quality improvements were implemented like an improved standardization of focusing and exposure techniques as well as dose reduction. Conclusions: Radiology residents easily learn focusing and exposure techniques and achieve comparable results as radiographers within a short period of time. The additionally achieved knowledge improves the technical process of taking radiographs. We recommend to include a two plane radiography training period in the curriculum of radiology residents. It reinforces the radiologist's role in continuous quality improvements of the diagnostic process. (orig.) [de

  13. Safety implications of standardized continuous quality improvement programs in community pharmacy.

    Science.gov (United States)

    Boyle, Todd A; Ho, Certina; Mackinnon, Neil J; Mahaffey, Thomas; Taylor, Jeffrey M

    2013-06-01

    Standardized continuous quality improvement (CQI) programs combine Web-based technologies and standardized improvement processes, tools, and expectations to enable quality-related events (QREs) occurring in individual pharmacies to be shared with pharmacies in other jurisdictions. Because standardized CQI programs are still new to community pharmacy, little is known about how they impact medication safety. This research identifies key aspects of medication safety that change as a result of implementing a standardized CQI program. Fifty-three community pharmacies in Nova Scotia, Canada, adopted the SafetyNET-Rx standardized CQI program in April 2010. The Institute for Safe Medication Practices (ISMP) Canada's Medication Safety Self-Assessment (MSSA) survey was administered to these pharmacies before and 1 year into their use of the SafetyNET-Rx program. The nonparametric Wilcoxon signed-rank test was used to explore where changes in patient safety occurred as a result of SafetyNETRx use. Significant improvements occurred with quality processes and risk management, staff competence, and education, and communication of drug orders and other information. Patient education, environmental factors, and the use of devices did not show statistically significant changes. As CQI programs are designed to share learning from QREs, it is reassuring to see that the largest improvements are related to quality processes, risk management, staff competence, and education.

  14. Enabling Continuous Quality Improvement in Practice: The Role and Contribution of Facilitation.

    Science.gov (United States)

    Harvey, Gillian; Lynch, Elizabeth

    2017-01-01

    Facilitating the implementation of continuous quality improvement (CQI) is a complex undertaking. Numerous contextual factors at a local, organizational, and health system level can influence the trajectory and ultimate success of an improvement program. Some of these contextual factors are amenable to modification, others less so. As part of planning and implementing healthcare improvement, it is important to assess and build an understanding of contextual factors that might present barriers to or enablers of implementation. On the basis of this initial diagnosis, it should then be possible to design and implement the improvement intervention in a way that is responsive to contextual barriers and enablers, often described as "tailoring" the implementation approach. Having individuals in the active role of facilitators is proposed as an effective way of delivering a context-sensitive, tailored approach to implementing CQI. This paper presents an overview of the facilitator role in implementing CQI. Drawing on empirical evidence from the use of facilitator roles in healthcare, the type of skills and knowledge required will be considered, along with the type of facilitation strategies that can be employed in the implementation process. Evidence from both case studies and systematic reviews of facilitation will be reviewed and key lessons for developing and studying the role in the future identified.

  15. Integrating Essential Components of Quality Improvement into a New Paradigm for Continuing Education.

    Science.gov (United States)

    Van Hoof, Thomas J; Meehan, Thomas P

    2017-01-01

    Continuing education (CE) that strives to improve patient care in a complex health care system requires a different paradigm than CE that seeks to improve clinician knowledge and competence in an educational setting. A new paradigm for CE is necessary in order to change clinician behavior and to improve patient outcomes in an increasingly patient-centered, quality-oriented care context. The authors assert that a new paradigm should focus attention on an expanded and prioritized list of educational outcomes, starting with those that directly affect patients. Other important components of the paradigm should provide educational leaders with guidance about what interventions work, reasons why interventions work, and what contextual factors may influence the impact of interventions. Once fully developed, a new paradigm will be helpful to educators in designing and implementing more effective CE, an essential component of quality improvement efforts, and in supporting policy trends and in promoting CE scholarship. The purpose of this article is to rekindle interest in CE theory and to suggest key components of a new paradigm.

  16. Continuous quality improvement process pin-points delays, speeds STEMI patients to life-saving treatment.

    Science.gov (United States)

    2011-11-01

    Using a multidisciplinary team approach, the University of California, San Diego, Health System has been able to significantly reduce average door-to-balloon angioplasty times for patients with the most severe form of heart attacks, beating national recommendations by more than a third. The multidisciplinary team meets monthly to review all cases involving patients with ST-segment-elevation myocardial infarctions (STEMI) to see where process improvements can be made. Using this continuous quality improvement (CQI) process, the health system has reduced average door-to-balloon times from 120 minutes to less than 60 minutes, and administrators are now aiming for further progress. Among the improvements instituted by the multidisciplinary team are the implementation of a "greeter" with enough clinical expertise to quickly pick up on potential STEMI heart attacks as soon as patients walk into the ED, and the purchase of an electrocardiogram (EKG) machine so that evaluations can be done in the triage area. ED staff have prepared "STEMI" packets, including items such as special IV tubing and disposable leads, so that patients headed for the catheterization laboratory are prepared to undergo the procedure soon after arrival. All the clocks and devices used in the ED are synchronized so that analysts can later review how long it took to complete each step of the care process. Points of delay can then be targeted for improvement.

  17. Continuous improvement in the Netherlands: current practices and experiences in Dutch manufacturing industry (awarded with ANBAR Citation of excellence)

    NARCIS (Netherlands)

    Gieskes, J.F.B.; Baudet, F.C.M.; Baudet, Frank; Schuring, R.W.; Boer, Harm

    1997-01-01

    In order to get insight into the current continuous-improvement practices in European industry, EuroCINet carried out a survey in its member countries. In this article, continuous-improvement activities in a sample of 135 Dutch industrial companies are described. The results show that CI is a

  18. Integrated insulin pump therapy with continuous glucose monitoring for improved adherence: technology update

    Directory of Open Access Journals (Sweden)

    Tumminia A

    2015-09-01

    Full Text Available Andrea Tumminia,1 Laura Sciacca,1 Lucia Frittitta,1 Sebastiano Squatrito,1 Riccardo Vigneri,2 Rosario Le Moli,1 Letizia Tomaselli2 1Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy; 2Endocrinology, Garibaldi-Nesima Hospital, Catania, Italy Abstract: Insulin pump therapy combined with real-time continuous glucose monitoring, known as sensor-augmented pump (SAP therapy, has been shown to improve metabolic control and to reduce the rate of hypoglycemia in adults with type 1 diabetes compared to multiple daily injections or standard continuous subcutaneous insulin infusion. Glycemic variability is also reduced in patients on SAP therapy. This approach allows patients to monitor their glucose levels being informed of glycemic concentration and trend. Trained diabetic patients, therefore, can appropriately modify insulin infusion and/or carbohydrate intake in order to prevent hypo- or hyperglycemia. For these reasons, SAP therapy is now considered the gold standard for type 1 diabetes treatment. To be clinically effective, however, devices and techniques using advanced technology should not only have the potential to theoretically ameliorate metabolic control, but also be well accepted by patients in terms of satisfaction and health-related quality of life, because these factors will improve treatment adherence and consequently overall outcome. SAP therapy is generally well tolerated by patients; however, many clinical trials have identified significant noncompliance in the use of this device, most notably in the pediatric and adolescent populations. In this review we aim to analyze the main reasons for good or poor adherence to SAP therapy and to provide useful tips in order to fully benefit from this kind of novel therapeutic approach. Keywords: sensor-augmented insulin pump therapy, type 1 diabetes, quality of life, patient adherence, continuous subcutaneous insulin

  19. Continuous Flushing of the Bladder in Rodents Reduces Artifacts and Improves Quantification in Molecular Imaging

    Directory of Open Access Journals (Sweden)

    Steven Deleye

    2014-07-01

    Full Text Available In this study, we evaluated the partial volume effect (PVE of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG tracer accumulation in the bladder on the positron emission tomographic (PET image quantification in mice and rats suffering from inflammatory bowel disease. To improve the accuracy, we implemented continuous bladder flushing procedures. Female mice and rats were scanned using microPET/computed tomography (CT at baseline and after induction of acute colitis by injecting 2,4,6-trinitrobenzene sulfonic acid (TNBS intrarectally. During the scans, the bladder was continuously flushed in one group, whereas in the other group, no bladder flushing was performed. As a means of in vivo and ex vivo validation of the inflammation, animals also underwent colonoscopy and were sacrificed for gamma counting (subpopulation and to score the colonic damage both micro- and macroscopically as well as biochemically. At baseline, the microPET signal in the colon of both mice and rats was significantly higher in the nonflushed group compared to the flushed group, caused by the PVE of tracer activity in the bladder. Hence, the colonoscopy and postmortem analyses showed no significant differences at baseline between the flushed and nonflushed animals. TNBS induced significant colonic inflammation, as revealed by colonoscopic and postmortem scores, which was not detected by microPET in the mice without bladder flushing, again because of spillover of bladder activity in the colonic area. MicroPET in bladder-flushed animals did reveal a significant increase in 18F-FDG uptake. Correlations between microPET and colonoscopy, macroscopy, microscopy, and myeloperoxidase yielded higher Spearman rho values in mice with continuously flushed bladders during imaging. Comparable, although somewhat less pronounced, results were shown in the rat. Continuous bladder flushing reduced image artifacts and is mandatory for accurate image quantification in the pelvic region for both mice

  20. Breaking continuous potato cropping with legumes improves soil microbial communities, enzyme activities and tuber yield

    Science.gov (United States)

    Qin, Shuhao; Yeboah, Stephen; Cao, Li; Zhang, Junlian; Shi, Shangli; Liu, Yuhui

    2017-01-01

    This study was conducted to explore the changes in soil microbial populations, enzyme activity, and tuber yield under the rotation sequences of Potato–Common vetch (P–C), Potato–Black medic (P–B) and Potato–Longdong alfalfa (P–L) in a semi–arid area of China. The study also determined the effects of continuous potato cropping (without legumes) on the above mentioned soil properties and yield. The number of bacteria increased significantly (p continuous cropping soils, respectively compared to P–C rotation. The highest fungi/bacteria ratio was found in P–C (0.218), followed by P–L (0.184) and then P–B (0.137) rotation over the different cropping years. In the continuous potato cropping soils, the greatest fungi/bacteria ratio was recorded in the 4–year (0.4067) and 7–year (0.4238) cropping soils and these were significantly higher than 1–year (0.3041), 2–year (0.2545) and 3–year (0.3030) cropping soils. Generally, actinomycetes numbers followed the trend P–L>P–C>P–B. The P–L rotation increased aerobic azotobacters in 2–year (by 26% and 18%) and 4–year (40% and 21%) continuous cropping soils compared to P–C and P–B rotation, respectively. Generally, the highest urease and alkaline phosphate activity, respectively, were observed in P–C (55.77 mg g–1) and (27.71 mg g–1), followed by P–B (50.72 mg mg–1) and (25.64 mg g–1) and then P–L (41.61 mg g–1) and (23.26 mg g–1) rotation. Soil urease, alkaline phosphatase and hydrogen peroxidase activities decreased with increasing years of continuous potato cropping. On average, the P–B rotation significantly increased (p improve soil biology environment, alleviate continuous cropping obstacle and increase potato tuber yield in semi–arid region. PMID:28463981

  1. SWAT2: The improved SWAT code system by incorporating the continuous energy Monte Carlo code MVP

    International Nuclear Information System (INIS)

    Mochizuki, Hiroki; Suyama, Kenya; Okuno, Hiroshi

    2003-01-01

    SWAT is a code system, which performs the burnup calculation by the combination of the neutronics calculation code, SRAC95 and the one group burnup calculation code, ORIGEN2.1. The SWAT code system can deal with the cell geometry in SRAC95. However, a precise treatment of resonance absorptions by the SRAC95 code using the ultra-fine group cross section library is not directly applicable to two- or three-dimensional geometry models, because of restrictions in SRAC95. To overcome this problem, SWAT2 which newly introduced the continuous energy Monte Carlo code, MVP into SWAT was developed. Thereby, the burnup calculation by the continuous energy in any geometry became possible. Moreover, using the 147 group cross section library called SWAT library, the reactions which are not dealt with by SRAC95 and MVP can be treated. OECD/NEA burnup credit criticality safety benchmark problems Phase-IB (PWR, a single pin cell model) and Phase-IIIB (BWR, fuel assembly model) were calculated as a verification of SWAT2, and the results were compared with the average values of calculation results of burnup calculation code of each organization. Through two benchmark problems, it was confirmed that SWAT2 was applicable to the burnup calculation of the complicated geometry. (author)

  2. A continuous media approach to modeling the stress saturation effect in granular silos

    International Nuclear Information System (INIS)

    Rahmoun, Jamila; Millet, Olivier; De Saxcé, Géry

    2008-01-01

    A continuous media approach for the calculation of the stresses in an ensiled granular media which improves on the Janssen theory has been developed. This approach also allows us to represent qualitatively as well as quantitatively the stress saturation phenomenon in granular silos. It is based on three-dimensional equilibrium equations, coupled with a slip condition and a Mohr–Coulomb criterion at the silo walls. Predictions obtained using the proposed model are in close agreement with the classical approaches for non-cohesive materials. The effect of the cohesion and the friction walls on the stored materials was also investigated

  3. A continuous media approach to modeling the stress saturation effect in granular silos

    Science.gov (United States)

    Rahmoun, Jamila; Millet, Olivier; de Saxcé, Géry

    2008-06-01

    A continuous media approach for the calculation of the stresses in an ensiled granular media which improves on the Janssen theory has been developed. This approach also allows us to represent qualitatively as well as quantitatively the stress saturation phenomenon in granular silos. It is based on three-dimensional equilibrium equations, coupled with a slip condition and a Mohr-Coulomb criterion at the silo walls. Predictions obtained using the proposed model are in close agreement with the classical approaches for non-cohesive materials. The effect of the cohesion and the friction walls on the stored materials was also investigated.

  4. Continuous business model innovation in the Danish newspaper industry

    DEFF Research Database (Denmark)

    Holm, Anna B.; Günzel, Franziska

    Business model innovation is undoubtedly of strategic importance in innovation management. However, little is known on how in fact how companies experiment and innovate with regards to their business models. To shed more light on this issue, we have conducted a qualitative study of the newspaper...... industry in Denmark. Business model innovation became imperative for the traditional newspaper publishers after many years of the declining readership and revenues. We collected rich primary and secondary data from various sources during 2010-2012. Our analysis suggests that changing business models in its...... various parts does not guarantee a successful business model change and may even harm the existing well-functioning business model. To innovate a business model successfully, managers need to secure the business logic flow and its feedback loops....

  5. Continuous Energy Improvement in Motor Driven Systems - A Guidebook for Industry

    Energy Technology Data Exchange (ETDEWEB)

    Gilbert A. McCoy and John G. Douglass

    2014-02-01

    This guidebook provides a step-by-step approach to developing a motor system energy-improvement action plan. An action plan includes which motors should be repaired or replaced with higher efficiency models, recommendations on maintaining a spares inventory, and discussion of improvements in maintenance practices. The guidebook is the successor to DOE’s 1997 Energy Management for Motor Driven Systems. It builds on its predecessor publication by including topics such as power transmission systems and matching driven equipment to process requirements in addition to motors.

  6. Modelling and real-time simulation of continuous-discrete systems in mechatronics

    Energy Technology Data Exchange (ETDEWEB)

    Lindow, H. [Rostocker, Magdeburg (Germany)

    1996-12-31

    This work presents a methodology for simulation and modelling of systems with continuous - discrete dynamics. It derives hybrid discrete event models from Lagrange`s equations of motion. This method combines continuous mechanical, electrical and thermodynamical submodels on one hand with discrete event models an the other hand into a hybrid discrete event model. This straight forward software development avoids numeric overhead.

  7. Study of continuous irrigation negative-pressure treatment using an original ulceration model.

    Science.gov (United States)

    Sano, Hitomi; Kajikawa, Akiyoshi; Ueda, Kazuki

    2013-06-01

    A continuous irrigation with intermittent aspiration (CIIA) method has previously been developed in the treatment of infected expander sites. For the purpose of treatment of infected wounds, a new intermittent negative pressure irrigation treatment (INPIT) has been developed that is a combination of CIIA with topical negative-pressure therapy. This study aims to investigate the efficacy of INPIT. The efficacy of irrigation was investigated by changing the conditions including the location and the number of irrigation tubes, flow volume, and the timetable of negative-pressure application using original ulcer models. Although the presence of side holes and increase in the number of tubes or flow volume improved the irrigation efficacy, non-washed-out areas remained. On the other hand, INPIT allowed more uniform and wide area washing even at low flow volume. The results suggest that INPIT is superior to general conventional continuous irrigation treatment in irrigation efficiency.

  8. Improvement of Inventory Control Using Continuous Review Policy in A Local Hospital at Bandung City, Indonesia

    Directory of Open Access Journals (Sweden)

    Fina Hafnika

    2016-12-01

    Full Text Available Abstract. This research was aimed to analyze the excess inventories issue in pharmacy and medical equipment unit at a local hospital in Bandung which affected the service level of the hospital. As one of the busy hospital in Java, proven by the higher amount of the patient/year than in other average Java typical hospital, the hospital needs to concern about the pharmaceutical and medical equipment inventories in order to fulfill patients’ needs and in the same time keeping the inventory level under control. Therefore, an inventory control evaluation was conducted to determine the appropriate number of inventories and time of order to avoid the excessive goods in central warehouse of the hospital. By using probabilistic inventory model and continuous review policy, the pharmaceutical inventory in the hospital was calculated to compare the ideal and actual amount of the average inventory level (AIL. ABC (Always, Better, Control classification also classified in this research to identify the proper item which potentially can be reduced from the inventory. From the analysis, we have discovered that the hospital potentially able to reduce almost Rp 830 million or 57% from the overstock inventory level by using continuous review policy as the basis of inventory control calculation system. Keywords: Continuous review policy, inventory control, EOQ, ROP, AIL

  9. Continuous quality improvement intervention for adolescent and young adult HIV testing services in Kenya improves HIV knowledge.

    Science.gov (United States)

    Wagner, Anjuli D; Mugo, Cyrus; Bluemer-Miroite, Shay; Mutiti, Peter M; Wamalwa, Dalton C; Bukusi, David; Neary, Jillian; Njuguna, Irene N; O'Malley, Gabrielle; John-Stewart, Grace C; Slyker, Jennifer A; Kohler, Pamela K

    2017-07-01

    To determine whether continuous quality improvement (CQI) improves quality of HIV testing services for adolescents and young adults (AYA). CQI was introduced at two HIV testing settings: Youth Centre and Voluntary Counseling and Testing (VCT) Center, at a national referral hospital in Nairobi, Kenya. Primary outcomes were AYA satisfaction with HIV testing services, intent to return, and accurate HIV prevention and transmission knowledge. Healthcare worker (HCW) satisfaction assessed staff morale. T tests and interrupted time series analysis using Prais-Winsten regression and generalized estimating equations accounting for temporal trends and autocorrelation were conducted. There were 172 AYA (Youth Centre = 109, VCT = 63) during 6 baseline weeks and 702 (Youth Centre = 454, VCT = 248) during 24 intervention weeks. CQI was associated with an immediate increase in the proportion of AYA with accurate knowledge of HIV transmission at Youth Centre: 18 vs. 63% [adjusted risk difference (aRD) 0.42,95% confidence interval (CI) 0.21 to 0.63], and a trend at VCT: 38 vs. 72% (aRD 0.30, 95% CI -0.04 to 0.63). CQI was associated with an increase in the proportion of AYA with accurate HIV prevention knowledge in VCT: 46 vs. 61% (aRD 0.39, 95% CI 0.02-0.76), but not Youth Centre (P = 0.759). In VCT, CQI showed a trend towards increased intent to retest (4.0 vs. 4.3; aRD 0.78, 95% CI -0.11 to 1.67), but not at Youth Centre (P = 0.19). CQI was not associated with changes in AYA satisfaction, which was high during baseline and intervention at both clinics (P = 0.384, P = 0.755). HCW satisfaction remained high during intervention and baseline (P = 0.746). CQI improved AYA knowledge and did not negatively impact HCW satisfaction. Quality improvement interventions may be useful to improve adolescent-friendly service delivery.

  10. Continuous quality improvement in a Maltese hospital using logical framework analysis.

    Science.gov (United States)

    Buttigieg, Sandra C; Gauci, Dorothy; Dey, Prasanta

    2016-10-10

    Purpose The purpose of this paper is to present the application of logical framework analysis (LFA) for implementing continuous quality improvement (CQI) across multiple settings in a tertiary care hospital. Design/methodology/approach This study adopts a multiple case study approach. LFA is implemented within three diverse settings, namely, intensive care unit, surgical ward, and acute in-patient psychiatric ward. First, problem trees are developed in order to determine the root causes of quality issues, specific to the three settings. Second, objective trees are formed suggesting solutions to the quality issues. Third, project plan template using logical framework (LOGFRAME) is created for each setting. Findings This study shows substantial improvement in quality across the three settings. LFA proved to be effective to analyse quality issues and suggest improvement measures objectively. Research limitations/implications This paper applies LFA in specific, albeit, diverse settings in one hospital. For validation purposes, it would be ideal to analyse in other settings within the same hospital, as well as in several hospitals. It also adopts a bottom-up approach when this can be triangulated with other sources of data. Practical implications LFA enables top management to obtain an integrated view of performance. It also provides a basis for further quantitative research on quality management through the identification of key performance indicators and facilitates the development of a business case for improvement. Originality/value LFA is a novel approach for the implementation of CQI programs. Although LFA has been used extensively for project development to source funds from development banks, its application in quality improvement within healthcare projects is scant.

  11. Improved ionic model of liquid uranium dioxide

    NARCIS (Netherlands)

    Gryaznov, [No Value; Iosilevski, [No Value; Yakub, E; Fortov, [No Value; Hyland, GJ; Ronchi, C

    The paper presents a model for liquid uranium dioxide, obtained by improving a simplified ionic model, previously adopted to describe the equation of state of this substance [1]. A "chemical picture" is used for liquid UO2 of stoichiometric and non-stoichiometric composition. Several ionic species

  12. Understanding catchment behaviour through model concept improvement

    NARCIS (Netherlands)

    Fenicia, F.

    2008-01-01

    This thesis describes an approach to model development based on the concept of iterative model improvement, which is a process where by trial and error different hypotheses of catchment behaviour are progressively tested, and the understanding of the system proceeds through a combined process of

  13. Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea.

    Science.gov (United States)

    Neikrug, Ariel B; Liu, Lianqi; Avanzino, Julie A; Maglione, Jeanne E; Natarajan, Loki; Bradley, Lenette; Maugeri, Alex; Corey-Bloom, Jody; Palmer, Barton W; Loredo, Jose S; Ancoli-Israel, Sonia

    2014-01-01

    Obstructive sleep apnea (OSA), common in Parkinson disease (PD), contributes to sleep disturbances and daytime sleepiness. We assessed the effect of continuous positive airway pressure (CPAP) on OSA, sleep, and daytime sleepiness in patients with PD. This was a randomized placebo-controlled, crossover design. Patients with PD and OSA were randomized into 6 w of therapeutic treatment or 3 w of placebo followed by 3 w of therapeutic treatment. Patients were evaluated by polysomnography (PSG) and multiple sleep latency test (MSLT) pretreatment (baseline), after 3 w, and after 6 w of CPAP treatment. Analyses included mixed models, paired analysis, and within-group analyses comparing 3 w to 6 w of treatment. Sleep laboratory. Thirty-eight patients with PD (mean age = 67.2 ± 9.2 y; 12 females). Continuous positive airway pressure. PSG OUTCOME MEASURES: sleep efficiency, %sleep stages (N1, N2, N3, R), arousal index, apnea-hypopnea index (AHI), and % time oxygen saturation sleep-onset latency (MSL). There were significant group-by-time interactions for AHI (P sleep. The paired sample analyses revealed that 3 w of therapeutic treatment resulted in significant decreases in arousal index (t = 3.4, P = 0.002). All improvements after 3 w were maintained at 6 w. Finally, 3 w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness (P = 0.011). Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events, improving oxygen saturation, and deepening sleep in patients with Parkinson disease and obstructive sleep apnea. Additionally, arousal index was reduced and effects were maintained at 6 weeks. Finally, 3 weeks of continuous positive airway pressure treatment resulted in reduced daytime sleepiness measured by multiple sleep latency test. These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with Parkinson disease.

  14. Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement.

    Science.gov (United States)

    Ruscic, Katarina J; Grabitz, Stephanie D; Rudolph, Maíra I; Eikermann, Matthias

    2017-06-01

    Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. These outcomes measures have gained prominence as bundled payments have become more common. Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders. Preoperatively, patients should be risk-stratified for PRCs to individualize intraoperative choices and postoperative pathways. Laparoscopic compared with open surgery improves respiratory outcomes. High-risk patients should be treated by experienced providers based on locally developed bundle-interventions to optimize intraoperative treatment and ICU bed utilization. Intraoperatively, lung-protective ventilation (procedure-specific positive end-expiratory pressure utilization, and low driving pressure) and moderately restrictive fluid therapy should be used. To achieve surgical relaxation, high-dose neuromuscular blocking agents (and reversal agents) as well as high-dose opioids should be avoided; inhaled anesthetics improve surgical conditions while protecting the lungs. Patients should be extubated in reverse Trendelenburg position. Postoperatively, continuous positive airway pressure helps prevent airway collapse and protocolized, early mobilization improves cognitive and respiratory function.

  15. Improvement in Physical Activity in Persons With Obstructive Sleep Apnea Treated With Continuous Positive Airway Pressure.

    Science.gov (United States)

    Jean, Raymonde E; Duttuluri, Manideep; Gibson, Charlisa D; Mir, Sadaf; Fuhrmann, Katherine; Eden, Edward; Supariwala, Azhar

    2017-03-01

    Exercise improves sleep quality, yet people with untreated obstructive sleep apnea (OSA) may engage in less physical activity (PA) due to fatigue and daytime sleepiness. We examined changes in PA and sleep quality before and after treatment with continuous positive airway pressure (CPAP) in OSA patients. In this prospective longitudinal study, persons with a primary diagnosis of OSA were enrolled at a community-based hospital in New York City. At 3 time intervals pre- and post-CPAP (3-8 months), we measured sleep quality using validated questionnaires, perceived PA using the International Physical Activity Questionnaire (IPAQ), and actual PA using pedometer steps per day. We sought to investigate how CPAP use and changes in sleep quality impacted the number of steps taken, as recorded in pedometer steps. In total, 62 patients were enrolled in the study from March 2012 to July 2014. In all, patients averaged 53 years of age, and 26 patients (42%) were female. Among all participants, 86% of persons had moderate to severe sleep apnea (AHI ≥15). Approximately 73% of participants were compliant with CPAP use. Poor sleep quality correlated with lower actual PA (P = .004) at baseline. At 3 and 7 months, there was significant improvement in sleep quality (Δ -2.63 ± 3.4 and Δ -3.5 ± 3.8; P improvement in sleep quality and actual PA.

  16. Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units: A 15-year experience.

    Science.gov (United States)

    Chao, Chien-Ming; Lai, Chih-Cheng; Chan, Khee-Siang; Cheng, Kuo-Chen; Ho, Chung-Han; Chen, Chin-Ming; Chou, Willy

    2017-07-01

    We conduct a retrospective study of patients with unplanned extubation (UE) in adult intensive care units (ICU) at a medical center. In 2001, a multidisciplinary team of intensivists, senior residents, nurses, and respiratory therapists was established at Chi Mei Medical Center. The improvement interventions, implemented between 2001 and 2015, were organized around 8 key areas: standardizing procedures, improving communication skills, revising sedation and weaning protocols, changing strategies for restraints, establishing a task force for identifying and managing high-risk patients, using new quality-improvement models as breakthrough series and team resource management, using the strategy of accountability without assigning blame, and changing a new method to secure endotracheal tube. We measured the outcome as the annual event and the rate of UE. During this 15-year period, there were 1404 episodes of UE, with 44,015 episodes of mechanical ventilation (MV) (319,158 ventilator-days). The overall rate of UE was 3.19/100 ventilated patients (4.40/1000 ventilator-days). In 2001, there were 188 episodes of UE and the rate of UE was 6.82/100 ventilated patients or 9.0/1000 ventilator-days. After this continue quality improvement project had been implemented, the annual number of episodes of UE declined to 27, and the rate fell to 0.95/100 ventilated patients or 1.36/1000 ventilator-days in 2015. Overall, the trend analysis showed the change was significant with P continuously and effectively reduced using multidisciplinary and sequential quality improvement interventions.

  17. A combined continuous and interval aerobic training improves metabolic syndrome risk factors in men

    Directory of Open Access Journals (Sweden)

    Sari-Sarraf V

    2015-05-01

    Full Text Available Vahid Sari-Sarraf,1 Akbar Aliasgarzadeh,2 Mohammad-Mahdi Naderali,3 Hamid Esmaeili,1 Ebrahim K Naderali4 1Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tabriz, 2Bone Research Centre, Endocrine Unit, Department of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; 3The School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, 4Faculty of Science, Liverpool Hope University, Liverpool, UK Abstract: Individuals with metabolic syndrome have significantly higher risk of cardiovascular disease and type 2 diabetes leading to premature death mortality. Metabolic syndrome has a complex etiology; thus, it may require a combined and multi-targeted aerobic exercise regimen to improve risk factors associated with it. Therefore, the aim of this study was to evaluate the effect of combined continuous and interval aerobic training on patients with metabolic syndrome. Thirty adult male with metabolic syndrome (54±8 years were randomly divided into two groups: test training group (TTG; n=15 and control group (CG; n=15. Subjects in TTG performed combined continuous and interval aerobic training using a motorized treadmill three times per week for 16 weeks. Subjects in CG were advised to continue with their normal activities of life. Twenty-two men completed the study (eleven men in each group. At the end of the study, in TTG, there were significant (for all, P<0.05 reductions in total body weight (-3.2%, waist circumference (-3.43 cm, blood pressure (up to -12.7 mmHg, and plasma insulin, glucose, and triacylglyceride levels. Moreover, there were significant (for all, P<0.05 increases VO2max (-15.3% and isometric strength of thigh muscle (28.1% and high-density lipoprotein in TTG. None of the above indices were changed in CG at the end of 16-week study period. Our study suggests that adoption of a 16-week combined continuous and interval aerobic training regimen in men

  18. Infinite Continuous Feature Model for Psychiatric Comorbidity Analysis.

    Science.gov (United States)

    Valera, Isabel; Ruiz, Francisco J R; Olmos, Pablo M; Blanco, Carlos; Perez-Cruz, Fernando

    2016-02-01

    We aim at finding the comorbidity patterns of substance abuse, mood and personality disorders using the diagnoses from the National Epidemiologic Survey on Alcohol and Related Conditions database. To this end, we propose a novel Bayesian nonparametric latent feature model for categorical observations, based on the Indian buffet process, in which the latent variables can take values between 0 and 1. The proposed model has several interesting features for modeling psychiatric disorders. First, the latent features might be off, which allows distinguishing between the subjects who suffer a condition and those who do not. Second, the active latent features take positive values, which allows modeling the extent to which the patient has that condition. We also develop a new Markov chain Monte Carlo inference algorithm for our model that makes use of a nested expectation propagation procedure.

  19. [Effect of continuous quality improvement (CQI) on hypertension management in continuous ambulatory peritoneal dialysis(CAPD) patients].

    Science.gov (United States)

    Wang, Xin; Wang, Tao

    2004-04-01

    To improve hypertension management in peritoneal dialysis patients through CQI process. Using the 4-step problem-solving framework called the PDCA cycle-plan, do, check and act, we conducted a CQI program. One hundred and forty-five peritoneal dialysis patients dialyzed for more than 3 months participated in the study. In 49 prevalent patients, the incidence of uncontrolled hypertension (BP>or=140/90 mm Hg 1 mm Hg=0.133 kPa) decreased from 49% to 16.3% although there were no significant changes in antihypertensive medication and total fluid removal. The incidence of uncontrolled hypertension in incident patients decreased from 61.3% to 28%. Height normalized extracellular water decreased significantly. In males it was from (10.8+/-1.4) kg/m to (10.3+/-1.7) kg/m and in females (9.6+/-1.2) kg/m to (8.6+/-1.2) kg/m. CQI is a useful method in the management of hypertension in peritoneal dialysis patients.

  20. Improved Nonequilibrium Algebraic Model Of Turbulence

    Science.gov (United States)

    Johnson, D. A.; Coakley, T. J.

    1993-01-01

    Blend of previous models predicts pressure distributions more accurately. Improved algebraic model represents some of time-averaged effects of turbulence in transonic flow of air over airfoil. Based partly on comparisons among various eddy-viscosity formulations for turbulence and partly on premise that law of wall more universally valid in immediate region of surface in presence of adverse gradient of pressure than mixing-length theory and original Johnson and King model.

  1. Can better modelling improve tokamak control?

    International Nuclear Information System (INIS)

    Lister, J.B.; Vyas, P.; Ward, D.J.; Albanese, R.; Ambrosino, G.; Ariola, M.; Villone, F.; Coutlis, A.; Limebeer, D.J.N.; Wainwright, J.P.

    1997-01-01

    The control of present day tokamaks usually relies upon primitive modelling and TCV is used to illustrate this. A counter example is provided by the successful implementation of high order SISO controllers on COMPASS-D. Suitable models of tokamaks are required to exploit the potential of modern control techniques. A physics based MIMO model of TCV is presented and validated with experimental closed loop responses. A system identified open loop model is also presented. An enhanced controller based on these models is designed and the performance improvements discussed. (author) 5 figs., 9 refs

  2. Primary continuous unilateral headaches: a nosologic model for hemicrania continua.

    Science.gov (United States)

    Pareja, Juan A; Cuadrado, María-Luz; Fernández-de-las-Peñas, César; Montojo, Teresa; Álvarez, Mónica; López-de-Silanes, Carlos

    2012-04-01

    Hemicrania continua was originally described as a strictly unilateral, continuous headache with an absolute response to indomethacin. Recognition of an increasing number of patients with the same clinical features except for a lack of response to indomethacin has generated controversy about whether the responsive/non-responsive phenotypes belong to the same disorder. We suggest that the non-responsive phenotype should be differentiated from the original concept of hemicrania continua, because it probably indicates a separate type of headache of undetermined nature, i.e. hemicrania incerta. However, differentiating hemicrania incerta from hemicrania continua does not imply that the two headaches are unrelated. Both hemicranias may outline a continuum, giving rise to a broader diagnostic field. There seems to be a syndrome of 'primary continuous unilateral headache' with at least two distinctive categories: hemicrania continua and hemicrania incerta, which are differentiated by their respective response to indomethacin. This division means plurality but adds precision, and allows a clear-cut diagnosis of some controversial cases.

  3. Improvement in headaches with continuous positive airway pressure for obstructive sleep apnea: a retrospective analysis.

    Science.gov (United States)

    Johnson, Karin G; Ziemba, Alexis M; Garb, Jane L

    2013-02-01

    We aimed to identify clinical features in patients with severe headaches that predicted obstructive sleep apnea (OSA) and determine clinical and sleep study characteristics that predicted headache improvement with continuous positive airway pressure (CPAP). Many patients with headaches complain of sleep symptoms and have OSA. There is often improvement of headaches with CPAP treatment. We conducted a retrospective chart review of all patients referred to adult neurology clinic for headaches and sent for polysomnography between January 2008 and December 2009. Follow-up ranged from 18 to 42 months. Eighty-two headache patients (70 females, 12 males) were studied. Mean age was 45±13 years (females 45±13, males 43±11) and mean body mass index was 32±9. Headache types included 17% chronic migraine without aura, 22% episodic migraine without aura, 32% migraine with aura, 21% tension-type headache, 6% chronic post-traumatic headache, 11% medication overuse headache, and 7% other types. All patients were receiving standard treatment for their headaches by their neurologist. Fifty-two patients (63%) had OSA. Increasing age, female gender, and chronic migraine without aura were predictive of OSA. Of the patients with OSA, 33 (63%) used CPAP and 27 (82%) were adherent to CPAP. Headache improvement was reported by 40 patients (49%) due to either standard medical therapy or CPAP. Patients with OSA who were CPAP adherent (21/27) were more likely to have improvement in headaches than patients intolerant of CPAP (2/6), those that did not try CPAP (8/19), and those who did not have OSA (16/30) (P=.045). Of the 33 patients who used CPAP, 13 reported improvement in headaches specifically due to CPAP therapy and 10 additional patients noted benefit in sleep symptoms. The presence of witnessed apneas (P=.045) and male gender (P=.021) predicted improvement in headaches due to CPAP. Headache patients should be evaluated for the presence of OSA. Treating OSA improves headaches in some

  4. Modeling and Parameter Identification Involving 3-Hydroxypropionaldehyde Inhibitory Effects in Glycerol Continuous Fermentation

    Directory of Open Access Journals (Sweden)

    Zhaohua Gong

    2012-01-01

    Full Text Available Mathematical modeling and parameter estimation are critical steps in the optimization of biotechnological processes. In the 1,3-propanediol (1,3-PD production by glycerol fermentation process under anaerobic conditions, 3-hydroxypropionaldehyde (3-HPA accumulation would arouse an irreversible cessation of the fermentation process. Considering 3-HPA inhibitions to cells growth and to activities of enzymes, we propose a novel mathematical model to describe glycerol continuous cultures. Some properties of the above model are discussed. On the basis of the concentrations of extracellular substances, a parameter identification model is established to determine the kinetic parameters in the presented system. Through the penalty function technique combined with an extension of the state space method, an improved genetic algorithm is then constructed to solve the parameter identification model. An illustrative numerical example shows the appropriateness of the proposed model and the validity of optimization algorithm. Since it is difficult to measure the concentrations of intracellular substances, a quantitative robustness analysis method is given to infer whether the model is plausible for the intracellular substances. Numerical results show that the proposed model is of good robustness.

  5. Indicators of the management for the continuous improvement of the radiological safety in a radioactive facility

    International Nuclear Information System (INIS)

    Amador B, Z. H.

    2006-01-01

    The use of safety indicators is common in the nuclear industry. In this work the implementation of indicators for the efficiency analysis of the radiological safety management system of a radioactive installation is presented. Through the same ones the occupational exposure, the training Y authorization of the personnel, the control of practices Y radioactive inventory, the results of the radiological surveillance, the occurrence of radiological events, the aptitude of the monitoring equipment, the management of the radioactive waste, the public exposure, the audits Y the costs of safety are evaluated. Its study is included in the periodic training of the workers. Without this interrelation it is not possible to maintain the optimization of the safety neither to achieve a continuous improvement. (Author)

  6. A toolbox for safety instrumented system evaluation based on improved continuous-time Markov chain

    Science.gov (United States)

    Wardana, Awang N. I.; Kurniady, Rahman; Pambudi, Galih; Purnama, Jaka; Suryopratomo, Kutut

    2017-08-01

    Safety instrumented system (SIS) is designed to restore a plant into a safe condition when pre-hazardous event is occur. It has a vital role especially in process industries. A SIS shall be meet with safety requirement specifications. To confirm it, SIS shall be evaluated. Typically, the evaluation is calculated by hand. This paper presents a toolbox for SIS evaluation. It is developed based on improved continuous-time Markov chain. The toolbox supports to detailed approach of evaluation. This paper also illustrates an industrial application of the toolbox to evaluate arch burner safety system of primary reformer. The results of the case study demonstrates that the toolbox can be used to evaluate industrial SIS in detail and to plan the maintenance strategy.

  7. The new health-care quality: value, outcomes, and continuous improvement.

    Science.gov (United States)

    O'Connor, S J; Lanning, J A

    1991-01-01

    No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa.

  8. A Marketing approach on how continuous processes improvement can contribute to hotel business Organic Growth

    Directory of Open Access Journals (Sweden)

    Ioana-Simona IVASCIUC

    2015-12-01

    Full Text Available Generating sustainable growth and profits is like finding a unicorn for most managers. Organic growth should be considered as an alternative for long-term growth in the hotel business. Designing the service process to deliver what customers expect from the hotel offer is a crucial component of encounter marketing. Hotels need to embrace the changes and ensure that their internal processes are aligned not just to current trends, but also to the expected future changes. Keeping up with global changes and trends of any kind, evaluating their impact on your business, continuous improving of the services using PDCA cycle, Six Sigma or Lean principles, are the keys to long-term organic growth.

  9. An Improved Real-Coded Population-Based Extremal Optimization Method for Continuous Unconstrained Optimization Problems

    Directory of Open Access Journals (Sweden)

    Guo-Qiang Zeng

    2014-01-01

    Full Text Available As a novel evolutionary optimization method, extremal optimization (EO has been successfully applied to a variety of combinatorial optimization problems. However, the applications of EO in continuous optimization problems are relatively rare. This paper proposes an improved real-coded population-based EO method (IRPEO for continuous unconstrained optimization problems. The key operations of IRPEO include generation of real-coded random initial population, evaluation of individual and population fitness, selection of bad elements according to power-law probability distribution, generation of new population based on uniform random mutation, and updating the population by accepting the new population unconditionally. The experimental results on 10 benchmark test functions with the dimension N=30 have shown that IRPEO is competitive or even better than the recently reported various genetic algorithm (GA versions with different mutation operations in terms of simplicity, effectiveness, and efficiency. Furthermore, the superiority of IRPEO to other evolutionary algorithms such as original population-based EO, particle swarm optimization (PSO, and the hybrid PSO-EO is also demonstrated by the experimental results on some benchmark functions.

  10. A Hierarchical structure of key performance indicators for operation management and continuous improvement in production systems.

    Science.gov (United States)

    Kang, Ningxuan; Zhao, Cong; Li, Jingshan; Horst, John A

    2016-01-01

    Key performance indicators (KPIs) are critical for manufacturing operation management and continuous improvement (CI). In modern manufacturing systems, KPIs are defined as a set of metrics to reflect operation performance, such as efficiency, throughput, availability, from productivity, quality and maintenance perspectives. Through continuous monitoring and measurement of KPIs, meaningful quantification and identification of different aspects of operation activities can be obtained, which enable and direct CI efforts. A set of 34 KPIs has been introduced in ISO 22400. However, the KPIs in a manufacturing system are not independent, and they may have intrinsic mutual relationships. The goal of this paper is to introduce a multi-level structure for identification and analysis of KPIs and their intrinsic relationships in production systems. Specifically, through such a hierarchical structure, we define and layer KPIs into levels of basic KPIs, comprehensive KPIs and their supporting metrics, and use it to investigate the relationships and dependencies between KPIs. Such a study can provide a useful tool for manufacturing engineers and managers to measure and utilize KPIs for CI.

  11. Methods of mathematical modelling continuous systems and differential equations

    CERN Document Server

    Witelski, Thomas

    2015-01-01

    This book presents mathematical modelling and the integrated process of formulating sets of equations to describe real-world problems. It describes methods for obtaining solutions of challenging differential equations stemming from problems in areas such as chemical reactions, population dynamics, mechanical systems, and fluid mechanics. Chapters 1 to 4 cover essential topics in ordinary differential equations, transport equations and the calculus of variations that are important for formulating models. Chapters 5 to 11 then develop more advanced techniques including similarity solutions, matched asymptotic expansions, multiple scale analysis, long-wave models, and fast/slow dynamical systems. Methods of Mathematical Modelling will be useful for advanced undergraduate or beginning graduate students in applied mathematics, engineering and other applied sciences.

  12. Economic Impact of a Peritoneal Dialysis Continuous Quality Improvement Program in Colombia.

    Science.gov (United States)

    Makhija, Dilip U; Walton, Surrey M; Mora, Juan P; Sanabria, Rafael M

    2017-01-01

    ♦ BACKGROUND: There is little information regarding the financial burden of peritonitis and the economic impact of continuous quality improvement (CQI) programs in peritoneal dialysis (PD) patients. The objectives of this study were to measure the costs of peritonitis, and determine the net savings of a PD CQI program in Colombia. ♦ METHODS: The Renal Therapy Services (RTS) network in Colombia, along with Coomeva EPS, provided healthcare resource utilization data for PD patients with and without peritonitis between January 2012 and December 2013. Propensity score matching and regression analysis were performed to estimate the incremental cost of peritonitis. Patient months at risk, episodes of peritonitis pre- and post-CQI, and costs of CQI were obtained. Annual net savings of the CQI program were estimated based on the number of peritonitis events prevented. ♦ RESULTS: The incremental cost of a peritonitis episode was $250. In an 8-year period, peritonitis decreased from 1,837 episodes per 38,596 patient-months in 2006 to 841 episodes per 50,910 patient-months in 2014. Overall, the CQI program prevented an estimated 10,409 episodes of peritonitis. The cost of implementing the CQI program was $147,000 in the first year and $119,000 annually thereafter. Using a five percent discount rate, the net present value of the program was $1,346,431, with an average annual net savings of $207,027. The return on investment (i.e. total savings-program cost/program cost) of CQI was 169%. ♦ CONCLUSION: Continuous quality improvement initiatives designed to reduce rates of peritonitis have a strong potential to generate cost savings. Copyright © 2017 International Society for Peritoneal Dialysis.

  13. Kaizen Award in Romania: the KAIZEN™ way in obtaining the continuous improvement success

    Directory of Open Access Journals (Sweden)

    Bratu Julien

    2017-07-01

    Full Text Available In the times when the economic performance and sustainable management are representing two of the most challenging characteristics of the business environment, there are some methods and techniques that passed the test of time. The great majority of companies are using in the present the KAIZEN™ Business System, a system of management which has been expanding in all over the world, by having and implying the power of continuous improvement and standardization. Having as “role-model” the well-known Toyota Production System, KAIZEN™ Business System has become the fundamental way of managing a business, which led to the creation of personalized management systems for companies. In Romania, it was also developed the Kaizen by Harmony concept, as an approach of KAIZEN™ Business System, its results being highly appreciated at the international level. In the daily challenging task of changing the paradigms and mentalities, several companies succeeded in understanding the importance of KAIZEN™ Business System and have been applying the Kaizen by Harmony concept ever since. Their results are impressive, few companies reaching to the international benchmark level in their fields of activity and becoming leaders of the Romanian or European markets. Therefore, the Kaizen Award in Romania has become the proper way of acknowledging their results and efforts to strive for excellence in the endless cycle of the continuous improvement. The aim of this paper is to describe the competitive advantage offered by KAIZEN™ Business System and Kaizen by Harmony, in strong correlation with the practical approach of the case-studies representing the amazing stories of the Kaizen Award in Romania winners until the present moment. The use of these best practices will underline once again some important business characteristics that must exist in every company, for it to become and remain competitive.

  14. Drivers of Dashboard Development (3-D): A Curricular Continuous Quality Improvement Approach.

    Science.gov (United States)

    Shroyer, A Laurie; Lu, Wei-Hsin; Chandran, Latha

    2016-04-01

    Undergraduate medical education (UME) programs are seeking systematic ways to monitor and manage their educational performance metrics and document their achievement of external goals (e.g., Liaison Committee on Medical Education [LCME] accreditation requirements) and internal objectives (institution-specific metrics). In other continuous quality improvement (CQI) settings, summary dashboard reports have been used to evaluate and improve performance. The Stony Brook University School of Medicine UME leadership team developed and implemented summary dashboard performance reports in 2009 to document LCME standards/criteria compliance, evaluate medical student performance, and identify progress in attaining institutional curricular goals and objectives. Key performance indicators (KPIs) and benchmarks were established and have been routinely monitored as part of the novel Drivers of Dashboard Development (3-D) approach to curricular CQI. The systematic 3-D approach has had positive CQI impacts. Substantial improvements over time have been documented in KPIs including timeliness of clerkship grades, midclerkship feedback, student mistreatment policy awareness, and student satisfaction. Stakeholder feedback indicates that the dashboards have provided useful information guiding data-driven curricular changes, such as integrating clinician-scientists as lecturers in basic science courses to clarify the clinical relevance of specific topics. Gaining stakeholder acceptance of the 3-D approach required clear communication of preestablished targets and annual meetings with department leaders and course/clerkship directors. The 3-D approach may be considered by UME programs as a template for providing faculty and leadership with a CQI framework to establish shared goals, document compliance, report accomplishments, enrich communications, facilitate decisions, and improve performance.

  15. Improving the physiological realism of experimental models.

    Science.gov (United States)

    Vinnakota, Kalyan C; Cha, Chae Y; Rorsman, Patrik; Balaban, Robert S; La Gerche, Andre; Wade-Martins, Richard; Beard, Daniel A; Jeneson, Jeroen A L

    2016-04-06

    The Virtual Physiological Human (VPH) project aims to develop integrative, explanatory and predictive computational models (C-Models) as numerical investigational tools to study disease, identify and design effective therapies and provide an in silico platform for drug screening. Ultimately, these models rely on the analysis and integration of experimental data. As such, the success of VPH depends on the availability of physiologically realistic experimental models (E-Models) of human organ function that can be parametrized to test the numerical models. Here, the current state of suitable E-models, ranging from in vitro non-human cell organelles to in vivo human organ systems, is discussed. Specifically, challenges and recent progress in improving the physiological realism of E-models that may benefit the VPH project are highlighted and discussed using examples from the field of research on cardiovascular disease, musculoskeletal disorders, diabetes and Parkinson's disease.

  16. Serial recall of colors: Two models of memory for serial order applied to continuous visual stimuli.

    Science.gov (United States)

    Peteranderl, Sonja; Oberauer, Klaus

    2018-01-01

    This study investigated the effects of serial position and temporal distinctiveness on serial recall of simple visual stimuli. Participants observed lists of five colors presented at varying, unpredictably ordered interitem intervals, and their task was to reproduce the colors in their order of presentation by selecting colors on a continuous-response scale. To control for the possibility of verbal labeling, articulatory suppression was required in one of two experimental sessions. The predictions were derived through simulation from two computational models of serial recall: SIMPLE represents the class of temporal-distinctiveness models, whereas SOB-CS represents event-based models. According to temporal-distinctiveness models, items that are temporally isolated within a list are recalled more accurately than items that are temporally crowded. In contrast, event-based models assume that the time intervals between items do not affect recall performance per se, although free time following an item can improve memory for that item because of extended time for the encoding. The experimental and the simulated data were fit to an interference measurement model to measure the tendency to confuse items with other items nearby on the list-the locality constraint-in people as well as in the models. The continuous-reproduction performance showed a pronounced primacy effect with no recency, as well as some evidence for transpositions obeying the locality constraint. Though not entirely conclusive, this evidence favors event-based models over a role for temporal distinctiveness. There was also a strong detrimental effect of articulatory suppression, suggesting that verbal codes can be used to support serial-order memory of simple visual stimuli.

  17. Holomorphic variables in magnetized brane models with continuous Wilson lines

    CERN Document Server

    Camara, Pablo G; Dudas, Emilian

    2010-01-01

    We analyze the action of the target-space modular group in toroidal type IIB orientifold compactifications with magnetized D-branes and continuous Wilson lines. The transformation of matter fields agree with that of twisted fields in heterotic compactifications, constituting a check of type I/heterotic duality. We identify the holomorphic N = 1 variables for these compactifications. Matter fields and closed string moduli are both redefined by open string moduli. The redefinition of matter fields can be read directly from the perturbative Yukawa couplings, whereas closed string moduli redefinitions are obtained from D-brane instanton superpotential couplings. The resulting expressions reproduce and generalize, in the presence of internal magnetic fields, previous results in the literature.

  18. Acupuncture attenuates hyperglycaemia and improves ovarian function in female rats subjected to continuous light exposure.

    Science.gov (United States)

    Kang, Xuezhi; Jia, Lina; Li, Yaming; Zhang, Xu

    2017-10-01

    Exposure to unnatural light cycles is increasingly associated with obesity and the metabolic syndrome. The purpose of this study was to examine the effects of electroacupuncture (EA) on glucose metabolism and ovarian function in female rats subjected to long-term continuous light exposure. Female Sprague-Dawley rats (n=24) were divided into three experimental groups: an LD group that was maintained under a normal light-dark cycle (healthy control); an LL group that was exposed to continuous light for 21 weeks but remained untreated; and an LL+EA group that received EA at ST36 and SP6 during weeks 17 to 21 of continuous light exposure. Oestrous cycles of female rats kept in a continuously lit environment for 21 weeks were disordered and polycystic ovarian syndrome (PCOS)-like changes occurred, accompanied by increased fasting blood glucose (6.23±0.33 vs 5.27±0.40 mmol/L in week 17, p=0.015) and reduced fasting levels of serum testosterone (0.07±0.018 vs 0.12±0.058 ng/L, p=0.043) and insulin (0.89±0.20 vs 1.43±0.46 ng/L, p=0.006). After 5 weeks of EA treatment at ST36 and SP6, ovarian cycle disruption was mitigated and blood glucose levels showed a gradual decline (5.18±0.37 vs 5.80±0.55 mmol/L, p=0.017; and 5.73±0.31 vs 6.62±0.13 mmol/L, p=0.004; in the fourth and fifth weeks of EA treatment, respectively). EA also attenuated the reductions otherwise seen in serum insulin and testosterone levels. Prolonged exposure to light can lead to a decline in ovarian and pancreatic function. EA at ST36 and SP6 may reduce abnormally elevated blood glucose levels and improve ovarian and pancreatic hormone levels. © 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.

  19. Dynamic probabilistic models and social structure essays on socioeconomic continuity

    CERN Document Server

    Gómez M , Guillermo L

    1992-01-01

    Mathematical models have been very successful in the study of the physical world. Galilei and Newton introduced point particles moving without friction under the action of simple forces as the basis for the description of concrete motions like the ones of the planets. This approach was sustained by appro­ priate mathematical methods, namely infinitesimal calculus, which was being developed at that time. In this way classical analytical mechanics was able to establish some general results, gaining insight through explicit solution of some simple cases and developing various methods of approximation for handling more complicated ones. Special relativity theory can be seen as an extension of this kind of modelling. In the study of electromagnetic phenomena and in general relativity another mathematical model is used, in which the concept of classical field plays the fundamental role. The equations of motion here are partial differential equations, and the methods of study used involve further developments of cl...

  20. Employing continuous quality improvement in community-based substance abuse programs.

    Science.gov (United States)

    Chinman, Matthew; Hunter, Sarah B; Ebener, Patricia

    2012-01-01

    This article aims to describe continuous quality improvement (CQI) for substance abuse prevention and treatment programs in a community-based organization setting. CQI (e.g., plan-do-study-act cycles (PDSA)) applied in healthcare and industry was adapted for substance abuse prevention and treatment programs in a community setting. The authors assessed the resources needed, acceptability and CQI feasibility for ten programs by evaluating CQI training workshops with program staff and a series of three qualitative interviews over a nine-month implementation period with program participants. The CQI activities, PDSA cycle progress, effort, enthusiasm, benefits and challenges were examined. Results indicated that CQI was feasible and acceptable for community-based substance abuse prevention and treatment programs; however, some notable resource challenges remain. Future studies should examine CQI impact on service quality and intended program outcomes. The study was conducted on a small number of programs. It did not assess CQI impact on service quality and intended program outcomes. Practical implications- This project shows that it is feasible to adapt CQI techniques and processes for community-based programs substance abuse prevention and treatment programs. These techniques may help community-based program managers to improve service quality and achieve program outcomes. This is one of the first studies to adapt traditional CQI techniques for community-based settings delivering substance abuse prevention and treatment programs.

  1. Continuous Calibration Improvement in Solar Reflective Bands: Landsat 5 Through Landsat 8

    Science.gov (United States)

    Mishra, Nischal; Helder, Dennis; Barsi, Julia; Markham, Brian

    2016-01-01

    Launched in February 2013, the Operational Land Imager (OLI) on-board Landsat 8 continues to perform exceedingly well and provides high science quality data globally. Several design enhancements have been made in the OLI instrument relative to prior Landsat instruments: pushbroom imaging which provides substantially improved Signal-to-Noise Ratio (SNR), spectral bandpasses refinement to avoid atmospheric absorption features, 12 bit data resolution to provide a larger dynamic range that limits the saturation level, a set of well-designed onboard calibrators to monitor the stability of the sensor. Some of these changes such as refinements in spectral bandpasses compared to earlier Landsats and well-designed on-board calibrator have a direct impact on the improved radiometric calibration performance of the instrument from both the stability of the response and the ability to track the changes. The on-board calibrator lamps and diffusers indicate that the instrument drift is generally less than 0.1% per year across the bands. The refined bandpasses of the OLI indicate that temporal uncertainty of better than 0.5% is possible when the instrument is trended over vicarious targets such as Pseudo Invariant Calibration Sites (PICS), a level of precision that was never achieved with the earlier Landsat instruments. The stability measurements indicated by on-board calibrators and PICS agree much better compared to the earlier Landsats, which is very encouraging and bodes well for the future Landsat missions too.

  2. APPLICATION OF QC TOOLS FOR CONTINUOUS IMPROVEMENT IN AN EXPENSIVE SEAT HARDFACING PROCESS USING TIG WELDING

    Directory of Open Access Journals (Sweden)

    Mohammed Yunus

    2016-09-01

    Full Text Available The present study is carried out to improve quality level by identifying the prime reasons of the quality related problems in the seat hardfacing process involving the deposition of cobalt based super alloy in I.C. Engine valves using TIG welding process. During the Process, defects like stellite deposition overflow, head melt, non-uniform stellite merging, etc., are observed and combining all these defects, the rejection level was in top position in Forge shop. We use widely referred QC tools of the manufacturing field to monitor the complete operation and continuous progressive process improvement to ensure ability and efficiency of quality management system of any firm. The work aims to identify the various causes for the rejection by the detailed study of the operation, equipment, materials and the various process parameters that are very important to get defects-free products. Also, to evolve suitable countermeasures for reducing the rejection percentage using seven QC tools. To further understand and validate the obtained results, we need to address other studies related to motivations, advantages, and disadvantages of applying quality control tools.

  3. Organizational learning and continuous quality improvement: examining the impact on nursing home performance.

    Science.gov (United States)

    Rondeau, Kent V; Wagar, Terry H

    2002-01-01

    Interest is growing in learning more about the ability of total quality management and continuous quality improvement (TQM/CQI) initiatives to contribute to the performance of healthcare organizations. A major factor in the successful implementation of TQM/CQI is the seminal contribution of an organization's culture. Many implementation efforts have not succeeded because of a corporate culture that failed to stress broader organizational learning. This may help to explain why some TQM/CQI programs have been unsuccessful in improving healthcare organization performance. Organizational performance variables and organizational learning orientation were assessed in a sample of 181 Canadian long-term care organizations that had implemented a formal TQM/CQI program. Categorical regression analysis shows that, in the absence of a strong corporAte culture that stresses organizational learning and employee development, few performance enhancements are reported. The results of the assessment suggest that a TQM/CQI program without the backing of a strong organizational learning culture may be insufficient to achieve augmented organizational performance.

  4. Improvement for enhancing effectiveness of universal power system (UPS) continuous testing process

    Science.gov (United States)

    Sriratana, Lerdlekha

    2018-01-01

    This experiment aims to enhance the effectiveness of the Universal Power System (UPS) continuous testing process of the Electrical and Electronic Institute by applying work scheduling and time study methods. Initially, the standard time of testing process has not been considered that results of unaccurate testing target and also time wasting has been observed. As monitoring and reducing waste time for improving the efficiency of testing process, Yamazumi chart and job scheduling theory (North West Corner Rule) were applied to develop new work process. After the improvements, the overall efficiency of the process possibly increased from 52.8% to 65.6% or 12.7%. Moreover, the waste time could reduce from 828.3 minutes to 653.6 minutes or 21%, while testing units per batch could increase from 3 to 4 units. Therefore, the number of testing units would increase from 12 units up to 20 units per month that also contribute to increase of net income of UPS testing process by 72%.

  5. Quadriceps strength and weight acceptance strategies continue to improve two years after anterior cruciate ligament reconstruction

    Science.gov (United States)

    Roewer, Ben D.; Di Stasi, Stephanie L.; Snyder-Mackler, Lynn

    2011-01-01

    The anterior cruciate ligament (ACL) is the most commonly-injured knee ligament during sporting activities. After injury, most individuals experience episodes of the knee giving way during daily activities (non-copers). Non-copers demonstrate asymmetrical quadriceps strength and movement patterns which could have long-term deleterious effects on the integrity of the knee joint. The purpose of this study was to determine if non-copers resolve their strength and movement asymmetries within two years after surgery. 26 non-copers were recruited to undergo pre-operative quadriceps strength testing and 3-dimensional gait analysis. Subjects underwent surgery to reconstruct the ligament followed by physical therapy focused on restoring normal range of motion, quadriceps strength, and function. Subjects returned for quadriceps strength testing and gait analysis six months and two years after surgery. Acutely after injury, quadriceps strength was asymmetric between limbs, but resolved six months after surgery. Asymmetric knee angles, knee moments, and knee and hip power profiles were also observed acutely after injury and persisted six months after surgery despite subjects achieving symmetrical quadriceps strength. Two years after surgery, quadriceps strength in the involved limb continued to improve and most kinematic and kinetic asymmetries resolved. These findings suggest that adequate quadriceps strength does not immediately resolve gait asymmetries in non-copers. They also suggest that non-copers have the capacity to improve their quadriceps strength and gait symmetry long after ACL reconstruction. PMID:21592482

  6. Life Improvement of Pot Hardware in Continuous Hot Dipping Processes Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Xingbo Liu

    2006-01-18

    life by a factor of 2. The prototype-scale bearing test apparatus was donated by one of our project partners and was relocated to the WVU airport hanger at Morgantown Municipal Airport. This test apparatus uses full-scale sleeve and bushing dimensions and is designed to more accurately mimic the galvanizing line conditions. Through the combination of corrosion, wear, and dross buildup testing, as well as material modeling and thermodynamic analysis, the research team has been able to show that an order of magnitude improvement in material performance is a realistic goal.

  7. Some Statistics for Assessing Person-Fit Based on Continuous-Response Models

    Science.gov (United States)

    Ferrando, Pere Joan

    2010-01-01

    This article proposes several statistics for assessing individual fit based on two unidimensional models for continuous responses: linear factor analysis and Samejima's continuous response model. Both models are approached using a common framework based on underlying response variables and are formulated at the individual level as fixed regression…

  8. A joint logistic regression and covariate-adjusted continuous-time Markov chain model.

    Science.gov (United States)

    Rubin, Maria Laura; Chan, Wenyaw; Yamal, Jose-Miguel; Robertson, Claudia Sue

    2017-12-10

    The use of longitudinal measurements to predict a categorical outcome is an increasingly common goal in research studies. Joint models are commonly used to describe two or more models simultaneously by considering the correlated nature of their outcomes and the random error present in the longitudinal measurements. However, there is limited research on joint models with longitudinal predictors and categorical cross-sectional outcomes. Perhaps the most challenging task is how to model the longitudinal predictor process such that it represents the true biological mechanism that dictates the association with the categorical response. We propose a joint logistic regression and Markov chain model to describe a binary cross-sectional response, where the unobserved transition rates of a two-state continuous-time Markov chain are included as covariates. We use the method of maximum likelihood to estimate the parameters of our model. In a simulation study, coverage probabilities of about 95%, standard deviations close to standard errors, and low biases for the parameter values show that our estimation method is adequate. We apply the proposed joint model to a dataset of patients with traumatic brain injury to describe and predict a 6-month outcome based on physiological data collected post-injury and admission characteristics. Our analysis indicates that the information provided by physiological changes over time may help improve prediction of long-term functional status of these severely ill subjects. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  9. An Improved Valuation Model for Technology Companies

    Directory of Open Access Journals (Sweden)

    Ako Doffou

    2015-06-01

    Full Text Available This paper estimates some of the parameters of the Schwartz and Moon (2001 model using cross-sectional data. Stochastic costs, future financing, capital expenditures and depreciation are taken into account. Some special conditions are also set: the speed of adjustment parameters are equal; the implied half-life of the sales growth process is linked to analyst forecasts; and the risk-adjustment parameter is inferred from the company’s observed stock price beta. The model is illustrated in the valuation of Google, Amazon, eBay, Facebook and Yahoo. The improved model is far superior to the Schwartz and Moon (2001 model.

  10. Segment-Based Acoustic Models for Continuous Speech Recognition

    Science.gov (United States)

    1993-04-05

    particular realization of the general model expressed in Equation (2). Such a mixture can 7. Kubala , F., Austin, S., Barry, C., Makhoul, J. Place- combine...Through Reevaluation of N-Best Sentence Hypotheses," Proc. DARPA Speech and Natural Language Workshop, pp. 83-87, February 1991. [14] F. Kubala , S. Austin

  11. Modelling of Continual Induction Hardening in Quasi-Coupled Formulation

    Czech Academy of Sciences Publication Activity Database

    Barglik, J.; Doležel, Ivo; Karban, P.; Ulrych, B.

    2005-01-01

    Roč. 24, č. 1 (2005), s. 251-260 ISSN 0332-1649 Grant - others:PSRC(PL) 4T08C 04823 Institutional research plan: CEZ:AV0Z20570509 Keywords : mathematical modelling * electromagnetism * induction Subject RIV: JA - Electronics ; Optoelectronics, Electrical Engineering Impact factor: 0.188, year: 2005

  12. An industry-sponsored, school-focused model for continuing ...

    African Journals Online (AJOL)

    increasingly buying into community development with corporate social investment, especially regarding technology ... HEIs and Departments of Education (DoE), could change the traditional concept that CPTD is the responsibility of DoEs into a new model where the business sector shares some of the responsibility for ...

  13. Constructive Models of Discrete and Continuous Physical Phenomena

    Science.gov (United States)

    2014-02-08

    time. The hardware description language VHDL has a related model of time, where time is a member of N×N, and the second value is used in a manner...behaviors. Tech. Rep. RR 95–52, rev. RR (96–56), I3S, April 1996. 4. ARMSTRONG, J. R., AND GRAY, F. G. VHDL Design Representation and Synthesis, sec- ond

  14. Evaluation of a guided continuous quality improvement program in community pharmacies.

    Science.gov (United States)

    Chinthammit, Chanadda; Rupp, Michael T; Armstrong, Edward P; Modisett, Tara; Snead, Rebecca P; Warholak, Terri L

    2017-01-01

    The importance of creating and sustaining a strong culture of patient safety has been recognized as a critical component of safe medication use. This study aims to assess changes in attitudes toward patient safety culture and frequency of quality-related event (QRE) reporting after guided implementation of a continuous quality improvement (CQI) program in a panel of community pharmacies in the United States (U.S.). Twenty-one community pharmacies volunteered to participate in the project and were randomly assigned to intervention or control groups. Pharmacy staff in the intervention group received guided training to ensure full implementation of a CQI program while those in the control group partially implemented the program. Pharmacy staff in both groups completed retrospective pre-post safety culture questionnaires and reported medication errors and near misses that occurred in their practices. Rasch analysis was applied to assess questionnaire validity and reliability and to confirm if the ordinal level data approximated interval level measures. Paired t-tests and repeated measure analysis of covariance tests were subsequently used to compare observed changes in the attitudes of subjects and frequency of QREs reporting in intervention and control groups. Sixty-nine employees completed the questionnaire, a 43.9% response rate. Improvement in attitudes toward patient safety was statistically significant in the intervention group in six domains: staff, training, and skill ( p  = 0.017); patient counseling ( p  = 0.043); communication about mistakes ( p  continuous improvement ( p  < 0.001); and overall patient safety perceptions ( p  = 0.033). No significant differences were observed in QRE reporting rates between intervention and control groups. However, differences were observed in the types of QREs reported (e.g., incorrect safety cap) and the point in the prescription processing workflow where a QRE was detected (e.g., partner check station, and drug

  15. Improvement of MARS code reflood model

    International Nuclear Information System (INIS)

    Hwang, Moonkyu; Chung, Bub-Dong

    2011-01-01

    A specifically designed heat transfer model for the reflood process which normally occurs at low flow and low pressure was originally incorporated in the MARS code. The model is essentially identical to that of the RELAP5/MOD3.3 code. The model, however, is known to have under-estimated the peak cladding temperature (PCT) with earlier turn-over. In this study, the original MARS code reflood model is improved. Based on the extensive sensitivity studies for both hydraulic and wall heat transfer models, it is found that the dispersed flow film boiling (DFFB) wall heat transfer is the most influential process determining the PCT, whereas the interfacial drag model most affects the quenching time through the liquid carryover phenomenon. The model proposed by Bajorek and Young is incorporated for the DFFB wall heat transfer. Both space grid and droplet enhancement models are incorporated. Inverted annular film boiling (IAFB) is modeled by using the original PSI model of the code. The flow transition between the DFFB and IABF, is modeled using the TRACE code interpolation. A gas velocity threshold is also added to limit the top-down quenching effect. Assessment calculations are performed for the original and modified MARS codes for the Flecht-Seaset test and RBHT test. Improvements are observed in terms of the PCT and quenching time predictions in the Flecht-Seaset assessment. In case of the RBHT assessment, the improvement over the original MARS code is found marginal. A space grid effect, however, is clearly seen from the modified version of the MARS code. (author)

  16. Continuing Medical Education Improves Gastroenterologists' Compliance with Inflammatory Bowel Disease Quality Measures.

    Science.gov (United States)

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

    2016-07-01

    Low rates of compliance with quality measures for inflammatory bowel disease (IBD) have been reported for US gastroenterologists. We assessed the influence of quality improvement (QI) education on compliance with physician quality reporting system (PQRS) measures for IBD and measures related to National Quality Strategy (NQS) priorities. Forty community-based gastroenterologists participated in the QI study; 20 were assigned to educational intervention and control groups, respectively. At baseline, randomly selected charts of patients with moderate-to-severe ulcerative colitis were retrospectively reviewed for the gastroenterologists' performance of 8 PQRS IBD measures and 4 NQS-related measures. The intervention group participated in a series of accredited continuing medical education (CME) activities focusing on QI. Follow-up chart reviews were conducted 6 months after the CME activities. Independent t tests were conducted to compare between-group differences in baseline-to-follow-up rates of documented compliance with each measure. The analysis included 299 baseline charts and 300 follow-up charts. The intervention group had significantly greater magnitudes of improvement than the control group for the following measures: assessment of IBD type, location, and activity (+14 %, p = 0.009); influenza vaccination (+13 %, p = 0.025); pneumococcal vaccination (+20 %, p = 0.003); testing for latent tuberculosis before anti-TNF-α therapy (+10 %, p = 0.028); assessment of hepatitis B virus status before anti-TNF-α therapy (+9 %, p = 0.010); assessment of side effects (+17 %, p = 0.048), and counseling patients about cancer risks (+13 %, p = 0.013). QI-focused CME improves community-based gastroenterologists' compliance with IBD quality measures and measures aligned with NQS priorities.

  17. Bordetella Pertussis virulence factors in the continuing evolution of whooping cough vaccines for improved performance.

    Science.gov (United States)

    Dorji, Dorji; Mooi, Frits; Yantorno, Osvaldo; Deora, Rajendar; Graham, Ross M; Mukkur, Trilochan K

    2018-02-01

    Despite high vaccine coverage, whooping cough caused by Bordetella pertussis remains one of the most common vaccine-preventable diseases worldwide. Introduction of whole-cell pertussis (wP) vaccines in the 1940s and acellular pertussis (aP) vaccines in 1990s reduced the mortality due to pertussis. Despite induction of both antibody and cell-mediated immune (CMI) responses by aP and wP vaccines, there has been resurgence of pertussis in many countries in recent years. Possible reasons hypothesised for resurgence have ranged from incompliance with the recommended vaccination programmes with the currently used aP vaccine to infection with a resurged clinical isolates characterised by mutations in the virulence factors, resulting in antigenic divergence with vaccine strain, and increased production of pertussis toxin, resulting in dampening of immune responses. While use of these vaccines provide varying degrees of protection against whooping cough, protection against infection and transmission appears to be less effective, warranting continuation of efforts in the development of an improved pertussis vaccine formulations capable of achieving this objective. Major approaches currently under evaluation for the development of an improved pertussis vaccine include identification of novel biofilm-associated antigens for incorporation in current aP vaccine formulations, development of live attenuated vaccines and discovery of novel non-toxic adjuvants capable of inducing both antibody and CMI. In this review, the potential roles of different accredited virulence factors, including novel biofilm-associated antigens, of B. pertussis in the evolution, formulation and delivery of improved pertussis vaccines, with potential to block the transmission of whooping cough in the community, are discussed.

  18. Model continuity in discrete event simulation: A framework for model-driven development of simulation models

    NARCIS (Netherlands)

    Cetinkaya, D; Verbraeck, A.; Seck, MD

    2015-01-01

    Most of the well-known modeling and simulation (M&S) methodologies state the importance of conceptual modeling in simulation studies, and they suggest the use of conceptual models during the simulation model development process. However, only a limited number of methodologies refers to how to

  19. MASADA: A MODELING AND SIMULATION AUTOMATED DATA ANALYSIS FRAMEWORK FOR CONTINUOUS DATA-INTENSIVE VALIDATION OF SIMULATION MODELS

    CERN Document Server

    Foguelman, Daniel Jacob; The ATLAS collaboration

    2016-01-01

    Complex networked computer systems are usually subjected to upgrades and enhancements on a continuous basis. Modeling and simulation of such systems helps with guiding their engineering processes, in particular when testing candi- date design alternatives directly on the real system is not an option. Models are built and simulation exercises are run guided by specific research and/or design questions. A vast amount of operational conditions for the real system need to be assumed in order to focus on the relevant questions at hand. A typical boundary condition for computer systems is the exogenously imposed workload. Meanwhile, in typical projects huge amounts of monitoring information are logged and stored with the purpose of studying the system’s performance in search for improvements. Also research questions change as systems’ operational conditions vary throughout its lifetime. This context poses many challenges to determine the validity of simulation models. As the behavioral empirical base of the sys...

  20. MASADA: A Modeling and Simulation Automated Data Analysis framework for continuous data-intensive validation of simulation models

    CERN Document Server

    Foguelman, Daniel Jacob; The ATLAS collaboration

    2016-01-01

    Complex networked computer systems are usually subjected to upgrades and enhancements on a continuous basis. Modeling and simulation of such systems helps with guiding their engineering processes, in particular when testing candi- date design alternatives directly on the real system is not an option. Models are built and simulation exercises are run guided by specific research and/or design questions. A vast amount of operational conditions for the real system need to be assumed in order to focus on the relevant questions at hand. A typical boundary condition for computer systems is the exogenously imposed workload. Meanwhile, in typical projects huge amounts of monitoring information are logged and stored with the purpose of studying the system’s performance in search for improvements. Also research questions change as systems’ operational conditions vary throughout its lifetime. This context poses many challenges to determine the validity of simulation models. As the behavioral empirical base of the sys...

  1. Continuous Modeling of a Multi-Link Flexible Transmission

    Directory of Open Access Journals (Sweden)

    Irit Peled

    2008-01-01

    Full Text Available The problem of dynamic, infinite dimension, modeling of a transmission is considered. An accurate Laplace transfer function matrix of the system that consists of flexible shafts connected by gears that are either rigid or flexible is found. The first step is deriving a set of single input, infinite dimension, transfer functions for a single uniform link. The building blocks of those transfer functions are time delays, representing the wave motion, and low order rational expressions, representing the boundary phenomena. The next step is combining these individual transfer functions into an overall model of the transmission, by means of the link reaction approach that makes use of the geometric relationships and reaction moments between neighboring links. The outcome is a generalized dynamic model with the moments in the gear pairs as the generalized state vector. The explicit and highly structured form of the transfer functions allows physical insight into the system, exact calculation of natural frequencies and the construction of exact simulation schemes built from standard blocks that are available in multi-purpose simulation software.

  2. Improved reference models for middle atmosphere ozone

    Science.gov (United States)

    Keating, G. M.; Pitts, M. C.; Chen, C.

    This paper describes the improvements introduced into the original version of ozone reference model of Keating and Young (1985, 1987) which is to be incorporated in the next COSPAR International Reference Atmosphere (CIRA). The ozone reference model will provide information on the global ozone distribution (including the ozone vertical structure as a function of month and latitude from 25 to 90 km) combining data from five recent satellite experiments: the Nimbus 7 LIMS, Nimbus 7 SBUV, AE-2 Stratospheric Aerosol Gas Experiment (SAGE), Solar Mesosphere Explorer (SME) UV Spectrometer, and SME 1.27 Micron Airglow. The improved version of the reference model uses reprocessed AE-2 SAGE data (sunset) and extends the use of SAGE data from 1981 to the 1981-1983 time period. Comparisons are presented between the results of this ozone model and various nonsatellite measurements at different levels in the middle atmosphere.

  3. A Comparative Case Study Analysis of Administrators Perceptions on the Adaptation of Quality and Continuous Improvement Tools to Community Colleges in the State of Michigan

    Science.gov (United States)

    Mattis, Ted B.

    2011-01-01

    The purpose of this study was to determine whether community college administrators in the state of Michigan believe that commonly known quality and continuous improvement tools, prevalent in a manufacturing environment, can be adapted to a community college model. The tools, specifically Six Sigma, benchmarking and process mapping have played a…

  4. A Model for University-Community Engagement: Continuing Education's Role as Convener

    Science.gov (United States)

    Shannon, Judy; Wang, Tiffany R.

    2010-01-01

    Administrators are continually seeking university-community engagement. Continuing education departments are in a unique position to further these initiatives by connecting academic faculty, staff, and students with emerging community needs. This article provides a model to demonstrate the significant role continuing educators can play in…

  5. Improving appropriate use of echocardiography and single-photon emission computed tomographic myocardial perfusion imaging: a continuous quality improvement initiative.

    Science.gov (United States)

    Johnson, Thomas V; Rose, Geoffrey A; Fenner, Deborah J; Rozario, Nigel L

    2014-07-01

    Appropriate use criteria for cardiovascular imaging have been published, but compliance in practice has been incomplete, with persistent high rates of inappropriate use. The aim of this study was to show the efficacy of a continuous quality improvement (CQI) initiative to favorably influence the appropriate use of outpatient transthoracic echocardiography and single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (MPI) in a large cardiovascular practice. In this prospective study, a multiphase CQI initiative was implemented, and its impact on ordering patterns for outpatient transthoracic echocardiography and SPECT MPI was assessed. Between November and December 2010, a baseline analysis of the application of appropriate use criteria to indications for outpatient transthoracic echocardiographic studies (n = 203) and SPECT MPI studies (n = 205) was performed, with studies categorized as "appropriate," "inappropriate," "uncertain," or "unclassified." The CQI initiative was then begun, with (1) clinician education, including didactic lectures and case-based presentations with audience participation; (2) system changes in ordering processes, with redesigned image ordering forms; and (3) peer review and feedback. A follow-up analysis was then performed between June and August 2012, with categorization of indications for transthoracic echocardiographic studies (n = 206) and SPECT MPI studies (n = 206). At baseline, 73.9% of echocardiographic studies were categorized as appropriate, 16.7% as inappropriate, 5.9% as uncertain, and 3.4% as unclassified. Similarly, for SPECT MPI studies 71.7% were categorized as appropriate, 18.5% as inappropriate, 7.8% as uncertain, and 1.9% as unclassified. Separate analysis of the two most important categories, appropriate and inappropriate, demonstrated a significant improvement after the CQI initiative, with a 63% reduction in inappropriate echocardiographic studies (18.5% vs 6.9%, P = .0010) and a 46% reduction

  6. Improving the provision of pregnancy care for Aboriginal and Torres Strait Islander women: a continuous quality improvement initiative.

    Science.gov (United States)

    Gibson-Helm, Melanie E; Rumbold, Alice R; Teede, Helena J; Ranasinha, Sanjeeva; Bailie, Ross S; Boyle, Jacqueline A

    2016-05-24

    Australian Aboriginal and Torres Strait Islander (Indigenous) women are at greater risk of adverse pregnancy outcomes than non-Indigenous women. Pregnancy care has a key role in identifying and addressing modifiable risk factors that contribute to adverse outcomes. We investigated whether participation in a continuous quality improvement (CQI) initiative was associated with increases in provision of recommended pregnancy care by primary health care centers (PHCs) in predominantly Indigenous communities, and whether provision of care was associated with organizational systems or characteristics. Longitudinal analysis of 2220 pregnancy care records from 50 PHCs involved in up to four cycles of CQI in Australia between 2007 and 2012. Linear and logistic regression analyses investigated associations between documented provision of pregnancy care and each CQI cycle, and self-ratings of organizational systems. Main outcome measures included screening and counselling for lifestyle-related risk factors. Women attending PHCs after ≥1 CQI cycles were more likely to receive each pregnancy care measure than women attending before PHCs had completed one cycle e.g. screening for cigarette use: baseline = 73 % (reference), cycle one = 90 % [odds ratio (OR):3.0, 95 % confidence interval (CI):2.2-4.1], two = 91 % (OR:5.1, 95 % CI:3.3-7.8), three = 93 % (OR:6.3, 95 % CI:3.1-13), four = 95 % (OR:11, 95 % CI:4.3-29). Greater self-ratings of overall organizational systems were significantly associated with greater screening for alcohol use (β = 6.8, 95 % CI:0.25-13), nutrition counselling (β = 8.3, 95 % CI:3.1-13), and folate prescription (β = 7.9, 95 % CI:2.6-13). Participation in a CQI initiative by PHCs in Indigenous communities is associated with greater provision of pregnancy care regarding lifestyle-related risk factors. More broadly, these findings support incorporation of CQI activities addressing systems level issues into primary care

  7. Water activity control: a way to improve the efficiency of continuous lipase esterification.

    Science.gov (United States)

    Colombié, S; Tweddell, R J; Condoret, J S; Marty, A

    1998-11-05

    During continuous lipase-catalyzed oleic acid esterification by ethanol in n-hexane, the oleic acid conversion, initially at 95%, decreases to 20% after 2 h. This decrease is caused by the accumulation of the water produced in the course of the reaction in the packed-bed reactor (PBR). In order to improve the PBR efficiency, it is necessary to evacuate the water produced. In this study, different approaches have been tested to control the water content in the PBR during continuous esterification. The first approach consisted in improving the water solubility by increasing the reaction medium polarity. The addition of polar additives to n-hexane, the use of more polar solvents, and the use of solvent-free reaction medium were tested as a means to favor the water evacuation from the PBR. First of all, the use ofn-hexane supplemented with acetone (3 M) or 2-methyl-2-propanol (1 M) enabled the conversion to be maintained at higher values than those obtained in pure n-hexane. The replacement of n-hexane by a more polar solvent, like the 5-methyl-2-hexanone, resulted in the same effect. In all cases, conversions at steady-state were always less than 95%, as obtained in pure n-hexane. This is explained by a decrease in the enzyme activity due to the increase in the medium polarity. Nevertheless, an increase in enzyme quantity allowed 90% conversion to be maintained during 1 week using 3 M acetone amended n-hexane. Good results (a steady-state conversion of about 80%) were obtained when esterification was carried out in a solvent-free reaction medium containing 2 M 2-methyl-2-propanol as a polar additive. The second approach consisted in the evaporation of the accumulated water by use of an intermittent airflow. Although this process did not enable constant esterification rate to be maintained, it did enable the initial conversion (95%) to be restored intermittently. Copyright 1998 John Wiley & Sons, Inc.

  8. Improved methodologies for continuous-flow analysis of stable water isotopes in ice cores

    Science.gov (United States)

    Jones, Tyler R.; White, James W. C.; Steig, Eric J.; Vaughn, Bruce H.; Morris, Valerie; Gkinis, Vasileios; Markle, Bradley R.; Schoenemann, Spruce W.

    2017-02-01

    Water isotopes in ice cores are used as a climate proxy for local temperature and regional atmospheric circulation as well as evaporative conditions in moisture source regions. Traditional measurements of water isotopes have been achieved using magnetic sector isotope ratio mass spectrometry (IRMS). However, a number of recent studies have shown that laser absorption spectrometry (LAS) performs as well or better than IRMS. The new LAS technology has been combined with continuous-flow analysis (CFA) to improve data density and sample throughput in numerous prior ice coring projects. Here, we present a comparable semi-automated LAS-CFA system for measuring high-resolution water isotopes of ice cores. We outline new methods for partitioning both system precision and mixing length into liquid and vapor components - useful measures for defining and improving the overall performance of the system. Critically, these methods take into account the uncertainty of depth registration that is not present in IRMS nor fully accounted for in other CFA studies. These analyses are achieved using samples from a South Pole firn core, a Greenland ice core, and the West Antarctic Ice Sheet (WAIS) Divide ice core. The measurement system utilizes a 16-position carousel contained in a freezer to consecutively deliver ˜ 1 m × 1.3 cm2 ice sticks to a temperature-controlled melt head, where the ice is converted to a continuous liquid stream and eventually vaporized using a concentric nebulizer for isotopic analysis. An integrated delivery system for water isotope standards is used for calibration to the Vienna Standard Mean Ocean Water (VSMOW) scale, and depth registration is achieved using a precise overhead laser distance device with an uncertainty of ±0.2 mm. As an added check on the system, we perform inter-lab LAS comparisons using WAIS Divide ice samples, a corroboratory step not taken in prior CFA studies. The overall results are important for substantiating data obtained from LAS

  9. The program of continuous improvements in factory in Juzbado; El programa de mejora continua en la Fabrica de Juzbado

    Energy Technology Data Exchange (ETDEWEB)

    Prieto, M.

    2015-07-01

    This articles describes the historical development of the continuous improvement program at Juzbado Factory, since its beginning to nowadays. The evolution throughout the ideas of Total Quality, ISO, EFQM, Six Sigma, and so on, leading to the present situation in which all these tools and methodologies live together is shown. all this has led to a philosophy and business culture focused on safety, quality and continuous improvement. (Author)

  10. School Improvement Model to Foster Student Learning

    Science.gov (United States)

    Rulloda, Rudolfo Barcena

    2011-01-01

    Many classroom teachers are still using the traditional teaching methods. The traditional teaching methods are one-way learning process, where teachers would introduce subject contents such as language arts, English, mathematics, science, and reading separately. However, the school improvement model takes into account that all students have…

  11. Improving Representational Competence with Concrete Models

    Science.gov (United States)

    Stieff, Mike; Scopelitis, Stephanie; Lira, Matthew E.; DeSutter, Dane

    2016-01-01

    Representational competence is a primary contributor to student learning in science, technology, engineering, and math (STEM) disciplines and an optimal target for instruction at all educational levels. We describe the design and implementation of a learning activity that uses concrete models to improve students' representational competence and…

  12. An optimization model for improving highway safety

    Directory of Open Access Journals (Sweden)

    Promothes Saha

    2016-12-01

    Full Text Available This paper developed a traffic safety management system (TSMS for improving safety on county paved roads in Wyoming. TSMS is a strategic and systematic process to improve safety of roadway network. When funding is limited, it is important to identify the best combination of safety improvement projects to provide the most benefits to society in terms of crash reduction. The factors included in the proposed optimization model are annual safety budget, roadway inventory, roadway functional classification, historical crashes, safety improvement countermeasures, cost and crash reduction factors (CRFs associated with safety improvement countermeasures, and average daily traffics (ADTs. This paper demonstrated how the proposed model can identify the best combination of safety improvement projects to maximize the safety benefits in terms of reducing overall crash frequency. Although the proposed methodology was implemented on the county paved road network of Wyoming, it could be easily modified for potential implementation on the Wyoming state highway system. Other states can also benefit by implementing a similar program within their jurisdictions.

  13. Modeling shoreline bioremediation: Continuous flow and seawater exchange columns

    International Nuclear Information System (INIS)

    Ramstad, S.; Sveum, P.; Bech, C.; Faksness, L.G.

    1995-01-01

    This paper describes the design and use of the columns in the study of bioremediation processes, and gives some results from an experiment designed to study the effects of different additives (fish meal, stick water, and Max Bac) on biodegradation of crude oil. There is significant difference in oil degradation(nC 17 /pristane ratio) between the column with additives and those without. Open system models in this type of open column give valuable data o how the chemical and biological parameters, including oil degradation, are affected by the additives, and simultaneously by the dilutive effect of seawater washing through the sediment, and for optimizing formulations. The system is designed with a large number of units and provides a good first approximation for mesocosm studies and field experiments, thus reducing the need for large numbers of such resource-demanding experiments

  14. Prototype of Automated PLC Model Checking Using Continuous Integration Tools

    CERN Document Server

    Lettrich, Michael

    2015-01-01

    To deal with the complexity of operating and supervising large scale industrial installations at CERN, often Programmable Logic Controllers (PLCs) are used. A failure in these control systems can cause a disaster in terms of economic loses, environmental damages or human losses. Therefore the requirements to software quality are very high. To provide PLC developers with a way to verify proper functionality against requirements, a Java tool named PLCverif has been developed which encapsulates and thus simplifies the use of third party model checkers. One of our goals in this project is to integrate PLCverif in development process of PLC programs. When the developer changes the program, all the requirements should be verified again, as a change on the code can produce collateral effects and violate one or more requirements. For that reason, PLCverif has been extended to work with Jenkins CI in order to trigger automatically the verication cases when the developer changes the PLC program. This prototype has been...

  15. Improved double Q2 rescaling model

    International Nuclear Information System (INIS)

    Gao Yonghua

    2001-01-01

    The authors present an improved double Q 2 rescaling model. Based on this condition of the nuclear momentum conservation, the authors have found a Q 2 rescaling parameters' formula of the model, where authors have established the connection between the Q 2 rescaling parameter ζ i (i = v, s, g) and the mean binding energy in nucleus. By using this model, the authors coned explain the experimental data of the EMC effect in the whole x region, the nuclear Drell-Yan process and J/Ψ photoproduction process

  16. Enabling new graduate midwives to work in midwifery continuity of care models: A conceptual model for implementation.

    Science.gov (United States)

    Cummins, Allison M; Catling, Christine; Homer, Caroline S E

    2017-12-04

    High-level evidence demonstrates midwifery continuity of care is beneficial for women and babies. Women have limited access to midwifery continuity of care models in Australia. One of the factors limiting women's access is recruiting enough midwives to work in continuity. Our research found that newly graduated midwives felt well prepared to work in midwifery led continuity of care models, were well supported to work in the models and the main driver to employing them was a need to staff the models. However limited opportunities exist for new graduate midwives to work in midwifery continuity of care. The aim of this paper therefore is to describe a conceptual model developed to enable new graduate midwives to work in midwifery continuity of care models. The findings from a qualitative study were synthesised with the existing literature to develop a conceptual model that enables new graduate midwives to work in midwifery continuity of care. The model contains the essential elements to enable new graduate midwives to work in midwifery continuity of care models. Each of the essential elements discussed are to assist midwifery managers, educators and new graduates to facilitate the organisational changes required to accommodate new graduates. The conceptual model is useful to show maternity services how to enable new graduate midwives to work in midwifery continuity of care models. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  17. [Application of a continual improvement approach to selecting diagnostic markers for acute pancreatitis in an emergency department].

    Science.gov (United States)

    Salinas, María; Flores, Emilio; López-Garrigós, Maite; Díaz, Elena; Esteban, Patricia; Leiva-Salinas, Carlos

    2017-01-01

    To apply a continual improvement model to develop an algorithm for ordering laboratory tests to diagnose acute pancreatitis in a hospital emergency department. Quasi-experimental study using the continual improvement model (plan, do, check, adjust cycles) in 2 consecutive phases in emergency patients: amylase and lipase results were used to diagnose acute pancreatitis in the first phase; in the second, only lipase level was first determined; amylase testing was then ordered only if the lipase level fell within a certain range. We collected demographic data, number amylase and lipase tests ordered and the findings, final diagnosis, and the results of a questionnaire to evaluate satisfaction with emergency care. The first phase included 517 patients, of whom 20 had acute pancreatitis. For amylase testing sensitivity was 0.70; specificity, 0.85; positive predictive value (PPV), 17; and negative predictive value (NPV), 0.31. For lipase testing these values were sensitivity, 0.85; specificity, 0.96; PPV, 21, and NPV, 0.16. When both tests were done, sensitivity was 0.85; specificity 0.99; PPV, 85; and NPV, 0.15. The second phase included data for 4815 patients, 118 of whom had acute pancreatitis. The measures of diagnostic yield for the new algorithm were sensitivity, 0.92; specificity, 0.98; PPV, 46; and NPV, 0.08]. This study demonstrates a process for developing a protocol to guide laboratory testing in acute pancreatitis in the hospital emergency department. The proposed sequence of testing for pancreatic enzyme levels can be effective for diagnosing acute pancreatitis in patients with abdominal pain.

  18. Continuous quality improvement in daily clinical practice: a proof of concept study.

    Directory of Open Access Journals (Sweden)

    Jonathan A Lorch

    Full Text Available Continuous Quality Improvement (CQI is an iterative process of: planning to improve a product or process, plan implementation, analyzing and comparing results against those expected, and corrective action on differences between actual and expected results. It is little used in clinical medicine. Anemia, a complex problem in End Stage Renal Disease patients, served to test the ability of an unique electronic medical record (EMR optimized for daily care to empower CQI in practice. We used data collected during daily care, stored in the EMR, and organized to display temporal relationships between clinical, laboratory, and therapeutic events. Our aims were optimal hemoglobin with minimum epoetin, and maintaining stable hemoglobin and epoetin. The study was done on 250 patients treated by maintenance hemodialysis (HD, receiving epoetin prior to February 1, 2010 and followed to July 31, 2011. Repleting iron, ensuring iron sufficiency, slow epoetin reduction, and decision support tools enabling data display over long periods in patient-centered reports were key elements. Epoetin dose, adjusted 6-8 weekly, was based on current clinical conditions and past responses. Hemoglobin increased by months 1-2; epoetin decreased from month 4. By months 16-18, epoetin had decreased 42% to 9,720 units/week while hemoglobin increased 8% to 123.6 g/L. Hemoglobin and epoetin were stable from month 7 onward. New epoetin orders decreased 83%. Transferrin saturation increased after the study start. Individual patient hemoglobin variation decreased by 23%, range by 27%. Mortality, 11.78 per 100 patient years, was 42% less than United States dialysis patient mortality. Allowable epoetin charges decreased by $15.33 per treatment and were $22.88 less than current Medicare allowance. The study validates the hypothesis that an EMR optimized for daily patient care can empower CQI in clinical medicine and serve to monitor medical care quality and cost.

  19. Quality Improvement of Nasal Continuous Positive Airway Pressure Therapy in Neonatal Intensive Care Unit.

    Science.gov (United States)

    Chen, Chien-Yi; Chou, An-Kuo; Chen, Yu-Lien; Chou, Hung-Chieh; Tsao, Po-Nien; Hsieh, Wu-Shiun

    2017-06-01

    Nasal continuous positive airway pressure (NCPAP) therapy is widely used in neonates, but the clinical practice varies. However, nursing practice differs among individuals, and an inappropriate application method may delay the respiratory therapy, influence the beneficial effect of NCPAP, and increase complications. We introduced a quality improvement project to expedite the application of NCPAP therapy and decrease the incidence of nasal trauma. A new strategy of mobile NCPAP cart with prepacked fixation kits and a written protocol was implemented from April 2006. All medical staff answered a questionnaire to assess their basic knowledge before and after intensive training. The records of the patients who were treated with NCPAP from October 2005 to November 2006 were reviewed. Fifty-nine medical staff were involved in the project, and their mean score for the questionnaire improved from 69.2 points to 98.3 points after training. From October 2005 to November 2006, 113 infants were recruited in total and 82 of them were admitted after the protocol was implemented. The NCPAP cart dramatically shortened the preparation time (from 520 seconds to 72 seconds) and the application time (from 468 seconds to 200 seconds). The use of the nursing protocol significantly decreased the incidence of nasal trauma in the study population (45.2% vs. 19.6%, p = 0.006), but not in infants with a birth weight of < 1000 g. Risk factors for nasal skin trauma included lower gestational age and birth weight, longer duration of NCPAP use, and lack of standardized nursing care. The mobile NCPAP cart with prepacked fixation kits is a practical way of expediting the initiation of NCPAP therapy. The written nursing protocol decreased the incidence of nasal trauma in infants, except for those with an extremely low birth weight. Copyright © 2016. Published by Elsevier B.V.

  20. An improved model of equatorial scintillation

    Science.gov (United States)

    Secan, J. A.; Bussey, R. M.; Fremouw, E. J.; Basu, Sa.

    1995-05-01

    One of the main limitations of the modeling work that went into the equatorial section of the Wideband ionospheric scintillation model (WBMOD) was that the data set used in the modeling was limited to two stations near the dip equator (Ancon, Peru, and Kwajalein Island, in the North Pacific Ocean) at two fixed local times (nominally 1000 and 2200). Over the past year this section of the WBMOD model has been replaced by a model developed using data from three additional stations (Ascension Island, in the South Atlantic Ocean, Huancayo, Peru, and Manila, Phillipines; data collected under the auspices of the USAF Phillips Laboratory Geophysics Directorate) which provide a greater diversity in both latitude and longitude, as well as cover the entire day. The new model includes variations with latitude, local time, longitude, season, solar epoch, and geomagnetic activity levels. The way in which the irregularity strength parameter CkL is modeled has also been changed. The new model provides the variation of the full probability distribution function (PDF) of log (CkL) rather than simply the average of log (CkL). This permits the user to specify a threshold on scintillation level, and the model will calculate the percent of the time that scintillation will exceed that level in the user-specified scenario. It will also permit calculation of scintillation levels at a user-specified percentile. A final improvement to the WBMOD model is the implementation of a new theory for calculating S4 on a two-way channel.

  1. Improving Dairy Organizational Communication from the Veterinarian's Perspective: Results of a Continuing Veterinary Medical Education Pilot Program.

    Science.gov (United States)

    Moore, Dale A; Sischo, William M; Kurtz, Suzanne; Siler, Julie D; Pereira, Richard V; Warnick, Lorin D; Davis, Margaret A

    2016-01-01

    The increasing size and complexity of US dairy farms could make it more difficult for a veterinary practitioner to effectively communicate protocol recommendations for prevention or treatment on the farm. A continuing education workshop was set up based on the results of research on dairy organizational communication on dairy farms, which resulted in a tool to assess dairy communication structure and flow. The workshop specifically focused on communication structure and whom to talk to when implementing health care changes in calf rearing. In addition, modern methods of veterinary-client communication knowledge and skills were provided. Primary outcomes of the workshops were to obtain feedback from participants about research findings and the communication model, to improve awareness about the complexity of communication structures on dairy farms, and to change participants' knowledge and skills associated with on-farm communication by providing communication theory and skills and an approach to evaluate and improve dairy organizational communication. Of the 37 participants completing the pre-program assessment, most recognized a need for themselves or their practice to improve communication with clients and farm employees. After the program, most participants were confident in their new communication skills and would consider using them. They highlighted specific new ideas they could apply in practice, such as conducting a "communication audit." The results from the assessment of this communication workshop, focused on dairy veterinarians, highlighted the need for communication training in this sector of the profession and practitioners' desire to engage in this type of training.

  2. Improving Dairy Organizational Communication from the Veterinarian's Perspective: Results of a Continuing Veterinary Medical Education Pilot Program

    Science.gov (United States)

    Moore, Dale A.; Sischo, William M.; Kurtz, Suzanne; Siler, Julie D.; Pereira, Richard V.; Warnick, Lorin D.; Davis, Margaret A.

    2016-01-01

    The increasing size and complexity of US dairy farms could make it more difficult for a veterinary practitioner to effectively communicate protocol recommendations for prevention or treatment on the farm. A continuing education workshop was set up based on the results of research on dairy organizational communication on dairy farms, which resulted in a tool to assess dairy communication structure and flow. The workshop specifically focused on communication structure and whom to talk to when implementing health care changes in calf rearing. In addition, modern methods of veterinary–client communication knowledge and skills were provided. Primary outcomes of the workshops were to obtain feedback from participants about research findings and the communication model, to improve awareness about the complexity of communication structures on dairy farms, and to change participants' knowledge and skills associated with on-farm communication by providing communication theory and skills and an approach to evaluate and improve dairy organizational communication. Of the 37 participants completing the pre-program assessment, most recognized a need for themselves or their practice to improve communication with clients and farm employees. After the program, most participants were confident in their new communication skills and would consider using them. They highlighted specific new ideas they could apply in practice, such as conducting a “communication audit”. The results from the assessment of this communication workshop, focused on dairy veterinarians, highlighted the need for communication training in this sector of the profession and practitioners' desire to engage in this type of training. PMID:26751909

  3. Language Sensitivity, the RESPECT Model, and Continuing Education.

    Science.gov (United States)

    Aycock, Dawn M; Sims, Traci T; Florman, Terri; Casseus, Karis T; Gordon, Paula M; Spratling, Regena G

    2017-11-01

    Some words and phrases used by health care providers may be perceived as insensitive by patients, which could negatively affect patient outcomes and satisfaction. However, a distinct concept that can be used to describe and synthesize these words and phrases does not exist. The purpose of this article is to propose the concept of language sensitivity, defined as the use of respectful, supportive, and caring words with consideration for a patient's situation and diagnosis. Examples of how language sensitivity may be lacking in nurse-patient interactions are described, and solutions are provided using the RESPECT (Rapport, Environment/Equipment, Safety, Privacy, Encouragement, Caring/Compassion, and Tact) model. RESPECT can be used as a framework to inform and remind nurses about the importance of sensitivity when communicating with patients. Various approaches can be used by nurse educators to promote language sensitivity in health care. Case studies and a lesson plan are included. J Contin Educ Nurs. 2017;48(11):517-524. Copyright 2017, SLACK Incorporated.

  4. The potential of Arachis pintoi biomass to improve quality of soil continuously used for cassava cropping

    Directory of Open Access Journals (Sweden)

    N. Muddarisna

    2014-01-01

    Full Text Available A field experiment that was aimed to elucidate the effects of application of Arachis pintoi biomass and animal dung on quality of soil continuously used for cassava cropping was conducted at Jatikerto Village, Kromengan District of Malang Regency. Eight treatments tested were 100% NPK inorganic fertilizer, 100 kg N Arachis pintoi/ha, (3 100 kg N chicken dung/ ha, 100 kg N cow dung /ha, 100 kg N goat dung /ha, 100 kg N Arachis pintoi + chicken dung /ha, 100 kg N Arachis pintoi + cow dung /ha, and 100 kg N Arachis pintoi + goat dung /ha. Monitoring quality of top soil (0-20 cm was carried out at planting time and 3 months after planting. Soil samples were collected and analyzed for chemical and physical properties. Yield of cassava was measured at 6 months after planting. Results of this study showed that application of organic fertilizer in forms of green manure (Arachis pintoi biomass, and animal dung significantly improved physical and chemical properties of soil. Application of 50% NPK combined with organic manures did not significantly gave different tuber yield with that of 100% NPK.

  5. Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea.

    Science.gov (United States)

    Serrano-Pariente, J; Plaza, V; Soriano, J B; Mayos, M; López-Viña, A; Picado, C; Vigil, L

    2017-05-01

    Continuous positive airway pressure (CPAP) in asthma patients with concomitant obstructive sleep apnea syndrome (OSAS) seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies. Prospective, multicenter study. We examined asthma outcomes after 6 months of CPAP in 99 adult asthma patients (mean age 57 years) with OSAS (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire (ACQ) and the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), respectively. Data were analyzed by intention-to-treat basis. The mean ± SD score of the ACQ decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the mAQLQ increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P obstructive sleep apnea syndrome. © 2016 The Authors. Allergy published by John Wiley & Sons Ltd.

  6. Assessing Continuous Quality Improvement in Public Health: Adapting Lessons from Healthcare

    Science.gov (United States)

    Schwartz, Robert; Cohen, Joanna; Manson, Heather; Scott, Fran

    2017-01-01

    Context: Evidence of the effect of continuous quality improvement (CQI) in public health and valid tools to judge that such effects are not fully formed. Objective: The objective was to adapt and apply Shortell et al.'s (1998) four dimensions of CQI in an examination of a public health accountability and performance management initiative in Ontario, Canada. Methods: In total, 24 semi-structured, in-depth interviews were conducted with informants from public health units and the Ministry of Health and Long-Term Care. A web survey of public health managers in the province was also carried out. Results: A mix of facilitators and barriers was identified. Leadership and organizational cultures, conducive to CQI success were evident. However, limitations in performance measurement and managerial discretion were key barriers. Conclusion: The four dimensions of CQI provided insight into both facilitators and barriers of CQI adoption in public health. Future research should compare the outcomes of public health CQI initiatives to the framework's stated facilitators and barriers. PMID:28277203

  7. Continuous quality improvement in substance abuse treatment facilities: How much does it cost?

    Science.gov (United States)

    Hunt, Priscillia; Hunter, Sarah B; Levan, Deborah

    2017-06-01

    Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI. Copyright © 2017. Published by Elsevier Inc.

  8. High efficient and continuous surface modification of carbon fibers with improved tensile strength and interfacial adhesion

    Science.gov (United States)

    Sun, Jingfeng; Zhao, Feng; Yao, Yue; Jin, Zhen; Liu, Xu; Huang, Yudong

    2017-08-01

    Most of the surface modification technologies for carbon fibers, no matter in laboratory scale or for commercial manufacture, are accompanied by a simultaneous decrease in tensile strength. In this paper, a feasible and high efficient strategy for carbon fiber treatment which could obviously improve both tensile strength and interfacial adhesion was proposed. Continuously moving carbon fibers were treated with atmospheric helium plasma for 1 min, followed by a 5 min pyrolytic carbon deposition using ethanol as precursor at 800 °C. The effects of the new approach were characterized by SEM, AFM, nanoindentation, XPS, Raman, wettability analysis, single fiber tensile strength testing and single fiber pull-out testing. After modification, pyrolytic carbon coating was deposited on the fiber surface uniformly, and the roughness and surface energy increased significantly. The single fiber tensile testing results indicate that the resulting fiber strength increased 15.7%, rising from 3.13 to 3.62 GPa. Meanwhile, the interfacial shear strength of its epoxy composites increased from 65.3 to 83.5 MPa. The comparative studies of carbon fibers modified with commercial anodic oxidation and sizing were also carried out. The results demonstrate that the new method can be utilized in the carbon fiber manufacture process and is more efficient than the traditional approaches.

  9. Esophageal coin removal by emergency physicians: a continuous quality improvement project incorporating rapid sequence intubation.

    Science.gov (United States)

    Bhargava, Rishi; Brown, Lance

    2011-01-01

    The objective of this study was to describe our experience removing esophageal coins from children in a tertiary care pediatric emergency department over a 4-year period. We retrospectively reviewed a continuous quality improvement data set spanning October 1, 2004, through September 30, 2008. In 96 of 101 cases (95%), emergency physicians successfully retrieved the coin. The median age of the children was 19 months (interquartile range [IQR] 13-43 months; range 4 months-12.8 years). The median time to removal of coin from initiation of intubation was 8 minutes (IQR 4-14 minutes; range 1-60 minutes). Coins were extracted using forceps only in 56 cases, whereas forceps and a Foley catheter were used in the remainder. Succinylcholine and etomidate were used in almost all cases for rapid sequence intubation prior to coin removal. Complications were identified in 46 cases: minor bleeding (13), lip laceration (7), multiple attempts (5), hypoxia (3), accidental extubation (3), dental injuries (3), bradycardia (2), coin advanced (1), right main-stem bronchus intubation (1), and other (8). Emergency physicians successfully removed esophageal coins following rapid sequence intubation in most cases. Our approach may be considered for the management of pediatric esophageal coins, particularly in an academic pediatric emergency department.

  10. Assessing Continuous Quality Improvement in Public Health: Adapting Lessons from Healthcare.

    Science.gov (United States)

    Price, Alex; Schwartz, Robert; Cohen, Joanna; Manson, Heather; Scott, Fran

    2017-02-01

    Evidence of the effect of continuous quality improvement (CQI) in public health and valid tools to judge that such effects are not fully formed. The objective was to adapt and apply Shortell et al.'s (1998) four dimensions of CQI in an examination of a public health accountability and performance management initiative in Ontario, Canada. In total, 24 semi-structured, in-depth interviews were conducted with informants from public health units and the Ministry of Health and Long-Term Care. A web survey of public health managers in the province was also carried out. A mix of facilitators and barriers was identified. Leadership and organizational cultures, conducive to CQI success were evident. However, limitations in performance measurement and managerial discretion were key barriers. The four dimensions of CQI provided insight into both facilitators and barriers of CQI adoption in public health. Future research should compare the outcomes of public health CQI initiatives to the framework's stated facilitators and barriers. Copyright © 2017 Longwoods Publishing.

  11. Early haemoperfusion with continuous venovenous haemofiltration improves survival of acute paraquat-poisoned patients.

    Science.gov (United States)

    Gao, Yanxia; Zhang, Xiaofan; Yang, Yanjie; Li, Wenlu

    2015-02-01

    To determine whether haemoperfusion (HP) with continuous venovenous haemofiltration (CVVH) improves the survival of patients with acute paraquat poisoning, compared with those treated using HP alone. Medical records of patients with acute paraquat poisoning were analysed. Patients were randomised to undergo HP or HP + CVVH within 24 h of paraquat ingestion. Mortality rate, survival duration and cause of death were recorded. There were no significant differences in mortality rate between the HP group (n = 458) and the HP + CVVH group (n = 226) (57.4% and 58.4%, respectively). The mean survival duration was significantly longer in the HP + CVVH group than the HP group (8.6 ± 3.1 and 5.1 ± 2.3 days, respectively). Early circulatory collapse was a major cause of death in the HP group. The major cause of death in the HP + CVVH group was late respiratory failure. Combined therapy with HP and CVVH can prevent early death and prolong survival duration following acute paraquat poisoning, providing the opportunity for further treatment. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  12. Developing a framework to model the primary drying step of a continuous freeze-drying process based on infrared radiation

    DEFF Research Database (Denmark)

    Van Bockstal, Pieter-Jan; Corver, Jos; Mortier, Séverine Thérèse F.C.

    2018-01-01

    The continuous freeze-drying concept based on spinning the vials during freezing and on non-contact energy transfer via infrared (IR) radiation during drying, improves process efficiency and product quality (uniformity) compared to conventional batch freeze-drying. Automated control of this process....... These results assist in the selection of proper materials which could serve as IR window in the continuous freeze-drying prototype. The modelling framework presented in this paper fits the model-based design approach used for the development of this prototype and shows the potential benefits of this design...

  13. APPLICATION OF FAILURE MODE & EFFECT ANALYSIS (FMEA FOR CONTINUOUS QUALITY IMPROVEMENT - MULTIPLE CASE STUDIES IN AUTOMOBILE SMES

    Directory of Open Access Journals (Sweden)

    Jigar Doshi

    2017-06-01

    Full Text Available Failure Mode and Effects Analysis (FMEA is a quality tool used to identify potential failures and related effects on processes and products, so continuous improvement in quality can be achieved by reducing them. The purpose of this research paper is to showcase the contribution of FMEA to achieve Continuous Quality Improvement (CQI by multiple case study research. The outcome research conducted by implementing FMEA; one of the Auto Core Tools (ACTs, in the automobile Small and Medium Enterprises (SMEs in Gujarat, India is presented in this paper which depict various means of Continuous Quality Improvements. The case study based research was carried out in four automobile SMEs; all of them are supplied to automotive Original Equipment Manufacturer (OEM. The FMEA was implemented with the help of Cross Functional Team (CFT to identify the potential failure modes and effects, in overall effect on Continuous Quality Improvement. The outcome of FMEA at four companies' reveals the scope of improvement exists in the manufacturing process. Implementation of those improvement points shows the definite signs of continuous improvement of the quality of process and product as well. The FMEA and subsequent implementations had reduced the quality rejections around 3% to 4% in case companies.

  14. Power scaling and experimentally fitted model for broad area quantum cascade lasers in continuous wave operation

    Science.gov (United States)

    Suttinger, Matthew; Go, Rowel; Figueiredo, Pedro; Todi, Ankesh; Shu, Hong; Leshin, Jason; Lyakh, Arkadiy

    2018-01-01

    Experimental and model results for 15-stage broad area quantum cascade lasers (QCLs) are presented. Continuous wave (CW) power scaling from 1.62 to 2.34 W has been experimentally demonstrated for 3.15-mm long, high reflection-coated QCLs for an active region width increased from 10 to 20 μm. A semiempirical model for broad area devices operating in CW mode is presented. The model uses measured pulsed transparency current, injection efficiency, waveguide losses, and differential gain as input parameters. It also takes into account active region self-heating and sublinearity of pulsed power versus current laser characteristic. The model predicts that an 11% improvement in maximum CW power and increased wall-plug efficiency can be achieved from 3.15 mm×25 μm devices with 21 stages of the same design, but half doping in the active region. For a 16-stage design with a reduced stage thickness of 300 Å, pulsed rollover current density of 6 kA/cm2, and InGaAs waveguide layers, an optical power increase of 41% is projected. Finally, the model projects that power level can be increased to ˜4.5 W from 3.15 mm×31 μm devices with the baseline configuration with T0 increased from 140 K for the present design to 250 K.

  15. A Single, Continuously Applied Control Policy for Modeling Reaching Movements with and without Perturbation.

    Science.gov (United States)

    Li, Zhe; Mazzoni, Pietro; Song, Sen; Qian, Ning

    2018-02-01

    It has been debated whether kinematic features, such as the number of peaks or decomposed submovements in a velocity profile, indicate the number of discrete motor impulses or result from a continuous control process. The debate is particularly relevant for tasks involving target perturbation, which can alter movement kinematics. To simulate such tasks, finite-horizon models require two preset movement durations to compute two control policies before and after the perturbation. Another model employs infinite- and finite-horizon formulations to determine, respectively, movement durations and control policies, which are updated every time step. We adopted an infinite-horizon optimal feedback control model that, unlike previous approaches, does not preset movement durations or use multiple control policies. It contains both control-dependent and independent noises in system dynamics, state-dependent and independent noises in sensory feedbacks, and different delays and noise levels for visual and proprioceptive feedbacks. We analytically derived an optimal solution that can be applied continuously to move an effector toward a target regardless of whether, when, or where the target jumps. This single policy produces different numbers of peaks and "submovements" in velocity profiles for different conditions and trials. Movements that are slower or perturbed later appear to have more submovements. The model is also consistent with the observation that subjects can perform the perturbation task even without detecting the target jump or seeing their hands during reaching. Finally, because the model incorporates Weber's law via a state representation relative to the target, it explains why initial and terminal visual feedback are, respectively, less and more effective in improving end-point accuracy. Our work suggests that the number of peaks or submovements in a velocity profile does not necessarily reflect the number of motor impulses and that the difference between

  16. Midwife-led continuity models versus other models of care for childbearing women.

    Science.gov (United States)

    Sandall, Jane; Soltani, Hora; Gates, Simon; Shennan, Andrew; Devane, Declan

    2016-04-28

    Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care. To compare midwife-led continuity models of care with other models of care for childbearing women and their infants. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (25 January 2016) and reference lists of retrieved studies. All published and unpublished trials in which pregnant women are randomly allocated to midwife-led continuity models of care or other models of care during pregnancy and birth. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. We included 15 trials involving 17,674 women. We assessed the quality of the trial evidence for all primary outcomes (i.e. regional analgesia (epidural/spinal), caesarean birth, instrumental vaginal birth (forceps/vacuum), spontaneous vaginal birth, intact perineum, preterm birth (less than 37 weeks) and all fetal loss before and after 24 weeks plus neonatal death using the GRADE methodology: all primary outcomes were graded as of high quality.For the primary outcomes, women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.78 to 0.92; participants = 17,674; studies = 14; high quality), instrumental vaginal birth (average RR 0.90, 95% CI 0.83 to 0.97; participants = 17,501; studies = 13; high quality), preterm birth less than 37 weeks (average RR 0.76, 95% CI 0.64 to 0.91; participants = 13,238; studies = eight; high quality) and less all fetal loss before and after 24 weeks plus neonatal death (average RR 0.84, 95% CI 0.71 to 0.99; participants

  17. Item Parameter Estimation for the Continuous Response Model via an EM Algorithm.

    Science.gov (United States)

    Wang, Tianyou; Zeng, Lingjia

    F. Samejima (1973) proposed a continuous response model in which item response is on a continuous scale rather than some discrete levels. This model has potential because in many psychological and educational assessments, the responses are on a conceptual continuum rather than on some fixed levels. As a first step toward studying the applicability…

  18. Model Identification using Continuous Glucose Monitoring Data for Type 1 Diabetes

    DEFF Research Database (Denmark)

    Boiroux, Dimitri; Hagdrup, Morten; Mahmoudi, Zeinab

    2016-01-01

    This paper addresses model identification of continuous-discrete nonlinear models for people with type 1 diabetes using sampled data from a continuous glucose monitor (CGM). We compare five identification techniques: least squares, weighted least squares, Huber regression, maximum likelihood with...

  19. Improvements in continuum modeling for biomolecular systems

    Science.gov (United States)

    Yu, Qiao; Ben-Zhuo, Lu

    2016-01-01

    Modeling of biomolecular systems plays an essential role in understanding biological processes, such as ionic flow across channels, protein modification or interaction, and cell signaling. The continuum model described by the Poisson- Boltzmann (PB)/Poisson-Nernst-Planck (PNP) equations has made great contributions towards simulation of these processes. However, the model has shortcomings in its commonly used form and cannot capture (or cannot accurately capture) some important physical properties of the biological systems. Considerable efforts have been made to improve the continuum model to account for discrete particle interactions and to make progress in numerical methods to provide accurate and efficient simulations. This review will summarize recent main improvements in continuum modeling for biomolecular systems, with focus on the size-modified models, the coupling of the classical density functional theory and the PNP equations, the coupling of polar and nonpolar interactions, and numerical progress. Project supported by the National Natural Science Foundation of China (Grant No. 91230106) and the Chinese Academy of Sciences Program for Cross & Cooperative Team of the Science & Technology Innovation.

  20. Improved Inference of Heteroscedastic Fixed Effects Models

    Directory of Open Access Journals (Sweden)

    Afshan Saeed

    2016-12-01

    Full Text Available Heteroscedasticity is a stern problem that distorts estimation and testing of panel data model (PDM. Arellano (1987 proposed the White (1980 estimator for PDM with heteroscedastic errors but it provides erroneous inference for the data sets including high leverage points. In this paper, our attempt is to improve heteroscedastic consistent covariance matrix estimator (HCCME for panel dataset with high leverage points. To draw robust inference for the PDM, our focus is to improve kernel bootstrap estimators, proposed by Racine and MacKinnon (2007. The Monte Carlo scheme is used for assertion of the results.